{"id":15215,"date":"2019-11-14T10:54:33","date_gmt":"2019-11-14T09:54:33","guid":{"rendered":"https:\/\/lasertherapy.cz\/how-to-manage-inflammation\/"},"modified":"2025-10-21T12:23:52","modified_gmt":"2025-10-21T10:23:52","slug":"how-to-manage-inflammation","status":"publish","type":"post","link":"https:\/\/lasertherapy.cz\/en\/how-to-manage-inflammation\/","title":{"rendered":"How to Manage Inflammation?"},"content":{"rendered":"\n

How Do NSAIDs, Ice, and Laser Compare?<\/strong><\/h2>\n\n
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Mark Callanen, PT, DPT, OCS<\/em><\/h4>\n\n\n\n

Inflammation is a frequently discussed topic in clinical settings. Local inflammation is a crucial part of the healing process and is essential for proper regeneration after soft tissue injuries. Patients often seek pain relief and the best way to manage their injuries. The extent to which a clinician understands the inflammatory process and how various anti-inflammatory modalities affect healing can fundamentally influence the duration and course of regeneration of damaged muscle tissue. <\/p>\n<\/div>\n\n\n\n

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Acute Inflammation<\/strong><\/h3>\n\n

A growing body of evidence indicates that suppressing acute inflammation impairs muscle growth and regeneration in both animals and humans. Nevertheless, non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended as a solution for acute inflammation because they can alleviate pain and inflammation by acting on the cyclooxygenase-2 (COX-2) enzyme. However, it appears that NSAIDs can have a negative impact on tissue repair during swelling \u2013 they reduce the proliferation, differentiation, and fusion of satellite cells in muscles, which can lead to impaired skeletal muscle repair and growth, and increased fibrosis. <\/p>\n\n

It is therefore not surprising that recent studies show many therapists have incomplete knowledge about the effects of NSAIDs or are unaware of current findings. This is a serious problem in the treatment of musculoskeletal injuries, as physiotherapists play a significant role in this area. <\/p>\n\n

Clinicians should understand that COX-2 enzymes are involved in both pro-inflammatory and anti-inflammatory processes at various stages of inflammation. While blocking COX-2 can reduce the pro-inflammatory response, it can also hinder the resolution of inflammation, negatively impacting healing. Inhibition of inflammation can also disrupt the recruitment of macrophages to the injury site, resulting in slower clearance of damaged fibers, increased fat deposition, smaller muscle fiber size, and delayed regeneration. Clinicians should consider these factors before recommending NSAIDs for acute muscle injury. <\/p>\n\n

Chronic Inflammation<\/strong><\/h3>\n\n

For patients with chronic inflammation, it is important to note that NSAIDs have proven ineffective in treating diffuse, systemic inflammation. A better alternative is steroids (SAIDs), such as prednisone, which can more effectively restore the balance of the inflammatory process, especially in cases of repeated microtrauma, such as overuse of the same muscles. Controlling chronic inflammation is important because it can accelerate muscle degradation and reduce the synthesis of contractile proteins. Examples of chronic inflammation include diffuse osteoarthritis, chronic obstructive pulmonary disease, aging, and kidney disease \u2013 all of which are associated with muscle mass loss. <\/p>\n\n

However, the positive effect of steroids is time-limited \u2013 long-term use leads to protein breakdown and muscle atrophy, and reduces the proliferation and differentiation of myoblasts.<\/p>\n\n

Treating Inflammation<\/strong><\/h3>\n\n

Analgesics and other modalities are more suitable for acute muscle injuries than NSAIDs. For chronic conditions, NSAIDs help with pain but do not reduce inflammation. Steroids are used for chronic local inflammation, but long-term use has a negative impact on muscles, thus caution is necessary. <\/p>\n\n

Ice<\/strong><\/h3>\n\n

People have used it for decades to alleviate inflammation, so it should be a good option \u2013 or not? In 1978, orthopedic surgeon Gabe Mirkin, M.D., introduced the well-known acronym “R.I.C.E.” (rest, ice, compression, elevation) as a guide for managing inflammation. Its simplicity and widespread acceptance made it the gold standard in the medical community for nearly 40 years. However, this appears to be changing. Dr. Mirkin himself was recently quoted in an article published on the Spartan website (www.life.spartan.com), where he now openly rejects at least half of the R.I.C.E. concept. <\/p>\n\n

“I no longer believe in icing,” he explained via email. He also no longer believes in the “R” (rest) component of his famous recommendation. In the foreword to the second edition of the book Iced!<\/em>, Dr. Mirkin states that most athletes are more interested in long-term recovery than short-term pain relief. “And research,” he writes, “now shows that both icing and prolonged rest actually delay recovery.” <\/p>\n\n

The research he refers to includes a study in the British Journal of Sports Medicine<\/em>, where 22 separate studies were retrospectively reviewed. The conclusion? Ice is commonly used after acute muscle tears, but there are no clinical studies confirming its effectiveness. A report in the Journal of Strength and Conditioning Research<\/em> even states that ice not only does not aid in injury healing but also delays recovery. <\/p>\n\n

Ice plays a greater role as an analgesic than as a means of reducing inflammation. A 2013 study published in the Journal of Applied Physiology<\/em> showed that cryotherapy had zero or only a mild effect on pro-inflammatory markers in exercise-damaged muscles. Research from the Cleveland Clinic went even further \u2013 icing an injury delays the release of IGF-1 (insulin-like growth factor-1), a hormone involved in the inflammatory cascade that helps repair damaged tissues. These findings should at least raise questions about the effectiveness of cryotherapy. <\/p>\n\n

Laser<\/h3>\n\n

So, if R.I.C.E. is no longer the answer, and NSAIDs are detrimental to the tissue healing process in acute injuries and ineffective in chronic inflammation, what is a better strategy for managing inflammation and accelerating healing? Promoting active recovery is becoming a more common alternative to previously preferred approaches. Gary Reinl, an experienced athletic trainer and author of the book Iced! The Illusionary Treatment Option<\/em>, believes the answer lies in a new acronym, A.R.I.T.A. (Active Recovery Is the Answer). Instead of immobility and restricted blood circulation, movement and circulation should be restored as soon as possible. <\/p>\n\n

In line with this concept, laser therapy is finding increasing application in modern training and rehabilitation centers equipped with new technologies. Laser triggers photobiomodulation (PBM) \u2013 a mechanism in which photons induce photophysical and photochemical processes in tissues, leading to physiological changes and therapeutic effects. This process accelerates the inflammatory response and, consequently, tissue healing. <\/p>\n\n

Unlike NSAIDs, which block the inflammatory cascade at the COX-2 level, and ice, which slows inflammation by restricting blood flow for a certain period, laser acts at a metabolic level directly in the damaged tissue \u2013 specifically on mitochondria \u2013 thus accelerating the healing process. Photobiomodulation has both a direct photochemical effect on mitochondria via cytochrome C oxidase and an indirect effect by modulating the inflammatory cascade through enzymatic changes. Both of these effects shorten the time required for tissue repair. <\/p>\n\n

Research on laser therapy, which focuses on mechanisms associated with inflammation healing, at first glance appears similar to pharmacological studies because it affects the inflammatory cascade at comparable sites. This includes a reduction in COX-2 levels, a decrease in bradykinin quantity, and reduced levels of IL-128 and PGE-2. However, the fundamental difference with photobiomodulation is that anti-inflammatory signaling is triggered by improved cellular metabolism and microcirculation. <\/p>\n\n

Two recent studies compared ice, ice combined with laser, and standalone laser therapy in treating the quadriceps after maximal voluntary contraction (MVC). The conclusion was that laser led to significantly higher MVC values in repeated tests and lower oxidative stress compared to the placebo group. It was also found that combining cryotherapy with laser reduces the effect of the laser treatment alone. <\/p>\n\n

The second study focused on similar combinations but monitored delayed onset muscle soreness (DOMS), MVC, and oxidative damage. The results showed that using laser as the sole treatment (without combining it with ice) led to the “best post-exercise recovery, resulting in a complete return to baseline within 24 hours after high-intensity eccentric contraction.” <\/p>\n\n

These results generally support the concept of active recovery and specifically the use of photobiomodulation in muscle regeneration after exertion. In conjunction with further research, a clear question arises as to whether the use of cryotherapy and NSAIDs is truly the ideal choice for treating injured muscle tissue. <\/p>\n\n

Changing long-established practices is never easy, but research suggests that the ideal approach to managing pain and inflammation will require a departure from traditional methods. Avoiding ice and NSAIDs in the early stages of the inflammatory process and introducing pro-metabolic modalities, such as laser therapy, could become the new standard of evidence-based practice. Clinicians should therefore begin to explore the A.R.I.T.A. philosophy and put R.I.C.E. “to rest.” <\/p>\n\n

REFERENCES:<\/p>\n\n

  1. Smith C, Kruger MJ, Smith RM, Myburgh KH. The inflammatory response to skeletal muscle injury: illuminating complexities. Sports Med . 2008;38:947\u2013969. <\/li>
  2. Duchesne E, Dufresne S, Dumont N. Impact of Inflamma- tion and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical Therapy [serial online]. August 2017;97(8):807-817. <\/li>
  3. Bondesen BA, Mills ST, Pavlath GK. The COX-2 pathway regulates growth of atrophied muscle via multiple mechanisms. Am J Physiol Cell Physiol . 2006;290:C1651C1659. <\/li>
  4. Bondesen BA, Mills ST, Kegley KM, Pavlath GK. The COX-2 pathway is essential during early stages of skeletal muscle regeneration. Am J Physiol Cell Physiol . 2004;287:C475\u2013C483. <\/li>
  5. Braund R, Abbott JH. Recommending NSAIDs and paracetamol: a survey of New Zealand physiotherapists\u2019 knowledge and behaviours. Physiother Res Int . 2011;16:43\u201349. <\/li>
  6. Green M, Norman KE. Knowledge and use of, and attitudes toward, non-steroidal anti-inflammatory drugs (NSAIDs) in practice: a survey of Ontario physiotherapists. Physiother Can . 2016;68:230\u2013241. <\/li>
  7. Grimmer K, Kumar S, Gilbert A, Milanese S. Non-steroidal anti-inflammatory drugs (NSAIDs): physiother- apists\u2019 use, knowledge and attitudes. Aust J Physiother . 2002;48:82\u201392. <\/li>
  8. Duchesne E, Tremblay MH, C\u00f4t\u00e9 CH. Mast cell tryptase stimulates myoblast proliferation; a mechanism relying on protease-activated receptor-2 and cyclooxygenase-2. BMC Musculoskelet Disord . 2011;12:235. <\/li>
  9. Gilroy DW, Colville-Nash PR, Willis D et al Inducible cyclo- oxygenase may have anti-inflammatory properties. Nat Med . 1999;5:698\u2013701. <\/li>
  10. SummanM,WarrenGL,MercerRRetalMacrophages and skeletal muscle regeneration: a clodronate-containing liposome depletion study. Am J Physiol Regul Integr Comp Physiol . 2006;290:R1488\u2013R1495. <\/li>
  11. ArnoldL,HenryA,PoronFetalInflammatorymonocytes recruited after skeletal muscle injury switch into antiinflammatory macrophages to support myogenesis. J Exp Med . 2007;204:1057\u20131069. <\/li>
  12. SinDD,ReidWD.Isinflammationgood,badorirrelevant for skeletal muscles in COPD? Thorax . 2007;63:95\u201396. <\/li>
  13. DadgarS,WangZ,JohnstonHetalAsynchronousremod- eling is a driver of failed regeneration in Duchenne muscular dystrophy. J Cell Biol . 2014;207:139\u2013158. <\/li>
  14. BonaldoP,SandriM.Cellularandmolecularmechanisms of muscle atrophy. Dis Model Mech . 2013;6:25\u201339. <\/li>
  15. W\u00e5hlin-LarssonB,CarnacG,KadiF.Theinfluenceofsys- temic inflammation on skeletal muscle in physically active elderly women. Age (Dordr) . 2014;36:9718. <\/li>
  16. Batsis JA, Mackenzie TA, Jones JD et al Sarcopenia, sarcopenic obesity and inflammation: results from the 1999\u20132004 National Health and Nutrition Examination Survey. Clin Nutr. 2016;35:1472\u20131483. <\/li>
  17. SaliA,GuerronAD,Gordish-DressmanHetalGlucocor- ticoid-treated mice are an inappropriate positive control for long-term preclinical studies in the mdx mouse. PLoS One . 2012;7:e34204. <\/li>
  18. Manzur AY, Kuntzer T, Pike M, Swan A. Glucocorti- coid corticosteroids for Duchenne muscular dystrophy. Cochrane Database Syst Rev . 2008;(1):CD003725. <\/li>
  19. tePasMF,deJongPR,VerburgFJ.Glucocorticoidinhibi- tion of C2C12 proliferation rate and differentiation capac- ity in relation to mRNA levels of the MRF gene family. Mol Biol Rep . 2000;27:87\u201398. <\/li>
  20. Reinl G. ICED! The Illusionary Treatment Option. Oct 15, 2013: 9-11. <\/li>
  21. Crystal NJ, Townson DH, Cook SB, LaRoche DP. Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise. Eur J Appl Physiol . 2013;113:2577\u20132586. <\/li>
  22. H. Lu, D. Huang, N. Saederup, I. F. Charo, R. M. Ran- sohoff, L. Zhou. Macrophages recruited via CCR2 pro- duce insulin-like growth factor-1 to repair acute skeletal muscle injury. The FASEB Journal, 2010; DOI: 10.1096\/ fj. 10-171579<\/li>
  23. Chow R. et al. Inhibitory Effects of Laser Irradiation on Peripheral Mammalian Nerves and Relevance to Analgesic Effects: A Systematic Review. Photomedicine and Laser Surgery Volume X, Number X, 2011. Mary Ann Liebert, Inc. Pp. 1\u201317. <\/li>
  24. Karu T et al. (1997) He-Ne laser radiation influences sin- gle-channel inonic currents through cell membranes: a patch-clamp study. Proc. SPIE. 3198:57-66.<\/li>
  25. Liebert, A.D. et al. (2014) Protein conformational modu- lation by photons: a mechanism for laser treatment effects. Med Hypothesis. 82(3):275-281.<\/li>
  26. Prianti, A.C.G. et al. (2014) Low-level PBMT (LLLT) reduces the COX-2 mRNA expression in both subplantar and total brain tissues in the model of peripheral inflam- mation induced by administration of carrageenan. Lasers Med Sci. 29(4):1397-1403.<\/li>
  27. Jimbo, K. et al. (1998) Suppressive effects of low-power laser irradiation on bradykinin evoked action potentials in cultured murine dorsal root ganglion cells. Neurosci Lett. 240(2):93-96.<\/li>
  28. Lopes-Martins, R.A. et al. (2005)Spontaneious effects of low-level PBMT (650 nm) in acute inflammatory mouse pleurisy induced by carrageenan. Photomed Laser Surg. 23(4):377-381. <\/li>
  29. Mizutani, K. et al. (2004) A clinical study on serum pros- taglandin E2 with low-level PBMT. Photomed Laser Surg. 22(6)537-539. <\/li>
  30. DeMarchi,T.etal.(2017)Doesphotobiomodulationther- apy is better than cryotherapy in muscle recovery after a high-intensity exercise? A randomized, double-blind, placebo-controlled clinical trial. Lasers Med Sci. DOI 10.1007\/s10103-016-2139-9.<\/li>
  31. De Paiva, P. et al. Photobiomodulation therapy (PBMT) and\/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial. Lasers Med Sci (2016) 31:1925\u20131933. <\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    How Do NSAIDs, Ice, and Laser Compare? Mark Callanen, PT,…<\/p>\n

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