INFLAMMATION & ANTI-INFLAMMATORIES in Skeletal Muscle Healing

15 Aug 2020

The following information comes from this paper:

Duchesne E, Dufresne SS, Dumont NA. Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Phys Ther. 2017;97(8):807-817.

Some snippets from the abstract:

• Although inflammation was originally believed to interfere with skeletal muscle regeneration, several recent studies have highlighted the beneficial effects of inflammatory cells on muscle healing. 
• To better appreciate the paradoxical roles of inflammation, clinicians must have a better comprehension of the fundamental mechanisms regulating the inflammatory response. 
• In this perspective article, cellular, animal, and human studies were analyzed to summarize recent knowledge regarding the impact of inflammation on muscle regeneration in acute or chronic conditions.

https://www.instagram.com/p/CCLXCU1HGoP/

Here are the take away points:

• Inflammation is a Normal Process with Acute Injuries - Inflammation and muscle regeneration are closely interconnected through complex cellular, physical, and chemical interactions which is beneficial during acute injuries, but can be detrimental in chronic conditions
• Anti-inflammatories are NOT recommended during acute injuries - Anti-inflammatory drugs target an enzyme known as COX-2, which when it is inhibited, it will have a direct effect on the proliferation of satellite cells thus impairing muscle healing
• NSAIDS are inefficient for chronic systemic inflammation - When inflammation becomes more systemic vs local (such as prolonged osteoarthritis); NSAIDS will become inefficient in management with more potential for harm than benefits
• Systemic anti-inflammatory medications (SAIDS) have been known to promote muscle wasting - Prolonged use of systemic anti-inflammatory modalities such as SAIDs might have detrimental side effects on skeletal muscle by promoting muscle wasting.
• Not all painful conditions are associated with an inflammatory response - Certain tendinopathies have shown very little inflammatory markers associated with them in which case anti-inflammatory modalities would have no efficacy for treatment.

This is not only important for human rehab, but animal rehab as well.  I think that too often animals are prescribed anti-inflammatories for lamenesses that aren’t properly diagnosed or addressed.   “Likely a soft tissue injury” isn’t a diagnosis, and subsequently, nor should it warrant the prescription of an NSAID.  Then, even if a true diagnosis of a soft tissue injury has been made (i.e. a tendinopathy of the supraspinatus), then research says, not to prescribe a NSAID anyways!

We need all of these cases to be referred to rehab! 

How can we make that happen?

1. Educate the GP veterinarians
2. Educate the public
3. Communicate your findings

On that note… Now you know more!  Now you have some goals for spreading the message!  Now we get on with making our patients better!