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In
the fields of orthopaedics and sports medicine much time is
spent combating the effects of the inflammatory process.
For decades, practitioners have struggled with different
methods of preventing, reducing, and eliminating the
inflammatory cascade.
Inflammation
is the body’s response to injury.
Its an ancient protective mechanism that ideally protects
the body against further injury.
Unfortunately, with the advent of modern medicine, the
inflammatory response has become more of a hindrance than
anything else.
Whenever
there is a musculoskeletal injury you can bet that inflammation
is involved. Everything
from ankle sprains to rotator cuff tears to tennis elbow involve
inflammation in one for or another.
Some
inflammation, like what would be seen in a sprained ankle, is
acute. Conversely,
chronic processes involve a more chronic inflammatory condition.
Although the time frame and precipitating factors are
different, the effect is the same.
One
of the oldest effective strategies for reducing inflammation is
cold therapy. Cold
is a very effective way to reduce swelling and interrupt the
inflammatory cascade. Because
of its effectiveness and the marketability of potent
anti-inflammatory remedies, new and different ways to use cold
therapies are constantly being designed. There are ice machines, cold pacs, cooling gel compresses
coming onto the market all of the time.
But they all have in common that they make use of the
anti-inflammatory effects of cold.
Most
people are familiar with a class of drugs known as anti-inflammatories.
The acronym NSAID is commonly used to describe the common
drugs used to treat inflammation. NSAID stands for non-steroidal anti-inflammatory drugs.
These are a mainstay of pharmacological treatment in many
medical practices, especially sports medicine.
Aspirin
was one of the earlier NSAIDs available.
It effectively reduces inflammation but can have
undesired side-effects on the blood and GI tract.
Yet, for most healthy people, aspirin is still a
reasonable choice for treating inflammation.
Other
NSAIDS have come along since aspirin such as ibuprofen,
ketoprofen, naproxen sodium and others.
Until recently all NSAIDs available had the potential to
cause relatively severe gastrointestinal side-effects in
susceptible people. Recently
however, a new class of NSAID has made it onto the market that
is much less likely to cause GI side-effects.
The
newer NSAIDs are called COX-2 inhibitors and break the
inflammatory cascade primarily in certain parts of the body
rather than the “shotgun” approach of the older NSAIDs.
This results in fewer side-effects, especially
gastrointestinal ones.
The
choice of oral anti-inflammatory medicine is influenced by
several factors including:
physician experience; patient experience, medical
conditions; type of injury; duration of treatment; cost of drug;
availability of drug; etc.
For
certain localized inflammatory processes, doctors have another
tool at their disposal. In
some cases it is possible to inject steroidal anti-inflammatory
medication directly into the effected tissue.
This has the potential to be a very potent method of
reducing inflammation. The
caveat is that this therapy can’t be repeated with unlimited
frequency. While
one to three or four injections of steroid a year can be
beneficial, more frequent injections can actually be harmful.
It
is also possible to localize steroidal medication into inflamed
tissues through physical therapy modalities.
By using mild electrical stimulation or ultrasound,
therapists and doctors can drive cortisone through the skin into
certain inflamed tissues. This
often produces a marked anti-inflammatory response.
As you can see, there are many different and
often complex ways of fighting inflammation, and this is only an
introduction. If
you have an acute or chronic inflammatory process it is
important to allow your doctor to guide your selection of
anti-inflammatory therapy.
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