• Cellular: neutrophils, platelets, macrophages,
fibroblasts, mast cells, lymphocytes, etc.
• Molecular: molecules and enzymes, modulation of
cellular response.
Each level of inflammation plays an intricate part in
tissue healing and regeneration. Assuming inflammation
is a negative process that needs to be controlled
following an injury to speed up recovery is a gross
oversimplification and a common misunderstanding.
The use of NSAIDS or ice aimed at “reducing
inflammation” may slow or inhibit our body’s ability
to heal by suppressing a normal cascade of events our
bodies were programmed to go through, especially in
acute injuries.
It’s important to understand what happens to our
body when we suffer an injury, in order to determine
whether interventions aimed at reducing inflammation
is the best course of action.
So what happens when our body suffers an injury? A
cascade of events occurs in response to an injury, leading
to vasodilation and vascular permeability that allows
for the infiltration of inflammatory cells into the injury
site from the bloodstream. Our blood vessels contain
the necessary cells that will target injured tissue to start
the healing process. The first type of cells to arrive at the
injury site are called neutrophils, followed by monocytes
(later converted to macrophages). These cells, along
with platelets, fibroblasts, and mast cells, will release
cytokines that will stimulate the recruitment of even
more inflammatory cells. This creates a snowball effect
aimed at addressing the injury and kick-starting the
recovery process.
Once the inflammatory process has begun, it will take
a complex interaction between the cellular level and
molecular level to close out the process and allow the
tissue to return to normal state. The very same cells that
were involved in the inflammatory response will later
switch from a pro-inflammatory (causing inflammation)
to an anti-inflammatory role. This switch is essential in
moving the injured tissue from an injury response state
to a healing and recovery state. This switch in role (from
pro-inflammatory to anti-inflammatory) is mediated
by certain enzymes in our body. One enzyme of note
is called the cyclooxygenase-2 (also known as COX-2).
This enzyme plays a key role in generating both pro-
inflammatory AND anti-inflammatory molecules.
Therefore, our body’s natural response is designed to
have a pro-inflammatory phase followed by an anti-
inflammatory phase in response to injury. When we
introduce medications following an injury, we alter
our natural response, and may delay the healing time
because of the effects of certain medications.
The most common type of over-the-counter drugs
are NSAIDS such as Ibuprofen, Naproxen (Aleve), or
Aspirin. These drugs are a diverse group of compounds
that share the ability to inhibit the various forms of
COX enzymes (COX-1, COX-2, and COX-3). COX-1
plays a big role in the maintenance of gastrointestinal
viability and platelet aggregation. COX-2 plays a huge
role in the inflammatory process (as mentioned earlier).
Finally, COX-3 plays a bigger role with our central
nervous system.
So, when we take over-the-counter medication, we
alter the natural course of recovery by inhibiting the
COX-2 enzyme, and therefore prevent our bodies from
naturally processing the injury—and this may potentially
delay our healing. In addition, the inhibition of the COX-
1 enzyme can lead to GI problems such as bleeds and
ulcers. Another common early-stage intervention is the
use of ice in order to reduce swelling and inflammation.
However, swelling is important as it increases the
blood flow to the area, which brings in the necessary
inflammatory cells described earlier. What we want
to avoid is stagnant fluid, because this prevents new
blood flow from getting to the injury site, and therefore
prevents optimal healing.
So, what should you do? Always consult your
healthcare provider. The information above is
educational, and can be a good discussion to have with
your provider. However, as a general guideline: if the
pain from the injury is tolerable, avoid using over-the-
counter medication and ice, and instead focus on early
motion, elevation, compression heat, resistance bands,
and physical therapy.
If you suffer an injury and don’t know what to do, call
9-1-1 or consult a healthcare provider.
If you have any questions, you can contact The
Pickleball Doctor at [email protected]. •
Noe Sariban is a Doctor of Physical Therapy, Certified
Pickleball Teaching Professional through the IPTPA, an
Engage sponsored athlete, and the Team Engage physical
therapist. Please visit www.thepickleballdoctor.com for more
information on injury prevention and rehabilitation tips. Noe
started his website to provide pickleball players around the
world with a reliable and free source of information. Please like
his Facebook page, www.facebook.com/pickleballdoctor, for
updates and new information!
APRIL/MAY 2020 |
MAGAZINE
67