www.advanceweb.com | HEALTHCARE CAREERS | 2018 23 I nflammation is a topic that is discussed in the clinical setting on a daily basis. It is an important part of the healing process and is needed for the proper healing of acute soft tissue injuries.1 Patients often are seek- ing relief from the associated pain and seek advice on how to best manage these injuries. How well a clinician understands the inflam- matory process and how various anti-inflam- matory modalities impact the healing process can have a profound effect on both the recov- ery time and the tissue repair process for dam- aged muscle tissue. ACUTE INFLAMMATION (NSAIDS) There is rising evidence that dampening acute inflammation impairs muscle growth and regeneration in animal and human models.2 Despite this fact, clinicians are often quick to recommend NSAIDs to address acute inflam- mation due to their ability to decrease pain and reduce inflammation via their impact on cyclooxygenase-2 (COX-2) enzymes. While decreasing swelling, NSAIDs have been shown to negatively impact tissue repair by diminishing proliferation, differentiation, and fusion of satellite cells in muscle tissue, which can lead to impaired skeletal muscle repair and growth and increased fibrosis.3,4 Accordingly, it is not surprising that recent studies suggest many therapists have incom- plete or inadequate knowledge on the topic of NSAIDs5,6 or have failed to upgrade their knowledge on the topic.7 This has the poten- tial to be a significant problem in the manage- ment of musculoskeletal injuries as physical therapists are assuming increased roles in the direct access market. It is important for clinicians to understand that COX-2 enzymes are involved with both pro-inflammatory and anti-inflammatory mediators at different stages of the inflamma- tory process.8,9 While blocking COX-2 activ- ity can reduce a pro-inflammatory response it can also inhibit the resolution of inflam- mation, which can negatively impact muscle healing.2 Additionally, there are a variety of inflammatory mediators that play important messenger roles regarding the recruitment of neutrophils and monocytes that are essential for tissue repair. Inhibiting the inflammatory process can impair macrophage collection at the injured site, which negatively impacts tissue repair.2 This can include persistent necrotic myofibers, increased fat accumula- tion10 , decreased myofibril size, and slowed muscle regeneration.11 Consideration should be given to these factors before recommend- ing NSAIDs for acute muscle injuries. CHRONIC INFLAMMATION (NSAIDS) Whenadvisingpatientsonthetopicofchronic inflammation, clinicians should be aware that NSAIDs have been found to be ineffec- tive in reducing diffuse, systemic inflamma- tion.12 Steroids (SAIDs) such as prednisone have been found to be a better alternative in restoring the balance of the inflammatory process for chronic inflammation2 , especially with repeat “asynchronous” injuries to muscle tissue, such as repeated muscle strain to the same tissue.11,13 Controlling chronic inflammation is important as it can increase muscle degrada- tion and reduce the synthesis of muscle fiber contractile proteins.14 Examples of chronic inflammation include diffuse OA, chronic COPD, aging, and kidney disease, all of which are associated with muscle wasting.15,16 It should be noted the positive effects of SAIDs is limited to a window of months to years.17,18 Prolonged use can lead to protein degrada- tion, which leads to muscle atrophy as well as decreased proliferation and differentiation of myoblasts.19 Long-term muscle wasting out- weighs short-term anti-inflammatory benefits in many cases. TAKE HOME FOR ANTI-INFLAMMATORY MEDICATIONS Local inflammation is needed and benefits the healing process. Analgesics and analgesic modalities are a better choice than NSAIDs for acute muscle injuries. HOW DO YOU MANAGE MUSCLE INFLAMMATION? Looking at how NSAIDs, Ice, and Laser stack up by Mark Callanen, PT, DPT, OCS ISTOCK HEALTHCARE CAREERS 2018  |  NSAIDS