Inflammation: Why do we care about it?

The past few fall semesters, I had the privilege of teaching a class on Wellness to the third year Doctor of Physical Therapy students at the University of Dayton. One of my lectures was titled “Modulating Inflammation”. It was the middle of the semester, student attitudes were surely waning, and even I was not positive that this was going to be the most interesting lecture of the course. To my surprise, as I began gathering content for the lecture, I realized something: This was likely the most important lecture of the course, and this was information that I felt was necessary for them to take into their careers as physical therapists.

Why? Because the stark reality of physical therapy is that not everyone is going to get better with physical therapy. In theory, physical therapy is a science: It is muscle, joint, nerve, and other tissues that are either injured or healthy, and we must figure how to make the injured become healthy and make the entire system work together. This is what we talk about in school, and this is also what I primarily educate patients on at each appointment. While this is good in theory, there is a human with emotions, responses, experiences, and a whole heap of other factors that lives in those tissues. That is why physical therapy is a science and art.

What is inflammation? Think about when you get a simple cut on your skin. It may bleed. It will certainly become red and swollen.  Then over time it scabs over and finally heals. The red and swollen phase is the inflammatory phase, and it absolutely must occur in order to give way to healing. While this is a small example, this is what happens every time there is an injury in the body. Beyond joints and muscles, I would argue that in physical therapy, all we are really doing is just modulating the inflammatory phase in order to reach the healing phase faster.

Sometimes, however, the body gets stuck circling, for whatever reason, in the inflammatory phase and struggles to reach the healing phase. This is what I mean by “not everyone gets better with physical therapy”. No matter how many inputs we give it or no matter how hard we attempt to regulate the inflammatory phase, the body just will not reach healing. Sometimes this is a result of an underlying inflammatory condition. For example, if someone has an autoimmune disease, their body constantly lives in a heightened state of inflammation, and this can impede physical healing. Other times, this is a result of a person giving their body inputs that lead to a heightened inflammatory state. Little sleep, poor eating, and high stress are just a few example of inputs that can all lead to increased bodily inflammation. Fear of movement and pain can also lead the body to a high-inflammatory environment. That is not to say that pain is “all in the head”, but a fixation on pain can put the body on high-alert, which is not an optimal atmosphere for healing.

At Physical Therapy 212, we hold ourselves to higher standards than treating only a patient’s joints and muscles. We search hard to pinpoint the exact inflammatory factors that impede a patient from healing as fast as they should.  We educate patients on how to better self-manage their inflammatory environment, and when it is necessary, we recruit other professionals to help modulate that specific factor while we continue to do our work here. So before you resign yourself to the statement physical therapy really didn’t work for me, I ask you: Have you been to Physical Therapy 212?