The ABCs of Running and Inflammation
Inflammation has been a hot topic recently among endurance athletes, especially the effect that chronic inflammation has on risk of injury, overtraining, and decreased performance. There are many variables that runners should be aware of, such as the difference between good and bad inflammation and how to treat and prevent its occurrence.
What is Inflammation?
The most common type of inflammation, acute inflammation, occurs after a hard race, workout, or as the result of a sudden injury, such as a sprained ankle. It leads to swelling, stiffness, pain, and possibly redness around the sore area, especially near the joints. This type of inflammation is due to micro-tears or minor injury within the muscles, ligaments, tendons, or joint that occurs as a result of strain. The body produces an inflammatory response via release of healing inflammatory cells, like neutrophils and macrophages1, to repair and restore the site of the injury.
Inflammation Explained. © Dreamstime
The Benefits of Acute Inflammation
Acute inflammation2 is important and necessary for the building of strength and fitness. When athletes train, they are teaching their bodies to adapt to stress. As they experience more and more stress, their bodies will temporarily break down, leading to the inflammatory response which allows for muscle repair.
As swelling occurs, vascular pathways increase allowing mediators to flood towards the affected area. When the inflammation drains from the area, typically after 1 – 3 days, the lymph nodes may stimulate an additional immune response, which is beneficial for healing.
Without inflammation as a result of training trauma, muscles would be chronically overworked and the body would never be able to adapt to the training load. You may be asking: If inflammation is so good, why does it have to be painful? Some researchers speculate that painful inflammation may be due to evolution; those who were forced to rest were able to repair their bodies, while those who pushed forward ultimately succumbed to injury or disease.
Can Inflammation be Bad?
More recently, inflammation has only been discussed in a negative light. Indeed, too much inflammation can be a bad thing. Factors such as overtraining, getting inadequate rest, eating an inadequate diet, and having poor recovery habits can all lead to chronic inflammation3, which occurs when the body cannot effectively control the normal inflammatory mechanism. For instance, inflammatory cells may continually flood to an area without any drainage, leading to an habitually inflamed region of the body that persists for weeks or months.
The Effects of Chronic Inflammation
A growing number of researchers are looking at the effects of chronic inflammation on the endurance athlete’s body. When the cellular response is no longer in the acute phase, the anti-inflammatory cells can become pro-inflammatory, and attack the tissues they should be repairing. Chronic inflammation is associated with leaky gut syndrome, fatigue, allergy-like symptoms, heart disease, asthma, overtraining syndrome, and even Alzheimer’s disease4 due to the imbalance between inflammatory and anti-inflammatory proteins in the body.
Is there a Test for Inflammation?
If you are concerned about the amount of inflammation you may be experiencing and the effects of these biomarkers on your quality of life and athletic performance, there are a number of tests your doctor can perform. The most common is to look for elevated levels of C-Reactive Protein, which is a hallmark of inflammation within the body. Sedimentation rate is another test that can be performed. It looks at the amount of red blood cells that sediment in a tube over a given period of time. Other levels of elevation that can be looked at include homocysteine, HDL, monocytes, and blood glucose.
Ways to Reduce Inflammation
Reducing inflammation through a number of lifestyle changes is recommended. The following are common ways to reduce inflammation within the body.
Getting a good night’s rest is one of the most important factors in reducing and preventing acute or chronic inflammation. In fact, even one night of inadequate sleep can dramatically increase inflammation levels in most people. Receiving 8+ hours of sleep can help your body naturally reduce cortisol levels, a known pro-inflammation hormone. Sleep also improves immune function, which helps remove waste products from muscles more efficiently.
Athletes that struggle with chronic inflammation often have difficulty balancing easy and hard efforts. When an endurance athlete approaches every day of training as a hard day, muscles are never given adequate chance to repair for the next speed workout or long run. It is important to include 1 – 2 days of truly easy running (i.e. conversational pace) in order to prevent chronic breakdown of muscles.
Perhaps the most popular way to fight inflammation is by changing your diet. Table sugar is especially inflammatory, as are grains, gluten, alcohol, and night shade vegetables (i.e. tomatoes, eggplant, etc.). On the other hand, a number of foods are anti-inflammatory, such as ginger, zucchini, green tea, probiotics5 (i.e. yogurt, kombucha, kimchi), tart cherries, turmeric, blueberries, kale, and beets, to name a few. These foods contain antioxidants, certain acids, and polyphenols, which protect against the release of inflammatory cells.
The first step in reducing inflammation is to cut processed foods and those with added sugars out of your diet. From there, experiment with different food groups to determine their effects on your body. Keep track of symptoms such as fatigue, mood, and daily weight in order to get an idea of how foods affect your inflammation levels.
In addition, food sensitivities have been estimated to affect nearly 30% of the population and are also a strong contributor to systemic, chronic inflammation. The immune system releases inflammation-fighting mediators to “fight” certain foods that are mistakenly deemed foreign. When the offending foods are highly prevalent in a person’s diet (such as corn, soy, or wheat) inflammation levels can become chronic, affecting both a person’s quality of life and athletic performance. There are numerous food sensitivity tests available that can be prescribed by a physician or dietician.
Acute inflammation can be stubborn to leave extremities that are far from the heart, such as ankles and feet, because of the long way it has to travel – against gravity – back to the heart. Compression gear can reduce inflammation by improving dilation within veins and arteries and gently promoting blood flow upwards thanks to the graduated design of compression socks and sleeves. This allows deoxygenated blood and waste products to flow back to the heart, while healing oxygenated blood returns to the affected area.
There are many types of massage that can promote healing within an athlete’s body. Immediately following a race, a runner may receive a quick “flush” as part of the post race amenities in order to promote lymphatic drainage to reduce post-race acute inflammation. A deep tissue sports massage can help heal inflammation – at least in the short term – by inflicting acute muscle damage to trigger an immune system response for muscle repair. For chronic inflammation sufferers, nearly any type of massage that promotes the immune system is beneficial for helping rid the body of persistent inflammatory cells.
A study performed by the Ohio State University found that yoga can reduce the body’s inflammatory responses, resulting in better health, less stress, and a greater sense of calm. Yoga has been shown to have important implications for the parasympathetic system, which is linked to the immune system. When athletes engage in yoga, their hormonal balances can change, with a greater adiponectin (anti-inflammatory) ratio in comparison to leptin (pro-inflammatory). The longer and more regularly athletes practice yoga, the greater the response of the anti-inflammatory hormone.
Especially when acute inflammation is present, elevating your legs above your heart (or practicing inversion yoga poses, such as the shoulder stand) is a powerful recovery tool to reduce inflammation while producing important calming benefits for the body. If yoga is not a part of your regular practice, simple poses such as “legs up the wall” are accessible to any athlete, yogi or not.
Simply sit as close to a wall as possible and stretch out your legs with calves and heels supported. This pose is beneficial for chronic inflammation sufferers, as well as those with acute soreness. In fact, inversion (particularly with the use of an inversion table) may have strong implications for treating disorders that may be rooted in chronic inflammation as well, such as anxiety and depression.
What Not to Do
When fighting inflammation, there are a few treatment options that inflammation sufferers should avoid.
Although once prescribed as a necessary component of every athlete’s medicine cabinet, anti-inflammatories are no longer considered healthy6 for athletes. For one, they suppress the body’s natural healing tendencies, resulting in inefficient adaptation to the normal stresses of training. In a recent study, scientists found that endurance athletes who regularly consumed NSAID anti-inflammatories experienced worse recovery than athletes who abstained. Beyond impaired response, NSAIDs can also disrupt an athlete’s stomach lining, particularly if taken before strenuous exercise. The result is gastrointestinal distress which further complicates the problem of both acute and chronic inflammation.
Ice is one of the most common treatments for inflammation, but is it necessary? While it will lessen visible swelling and numb the pain of muscle soreness, it will hinder the body’s own healing process, potentially increasing the amount of time it takes to recover, while giving athletes a false sense of security that muscles have healed, due to decreased pain and soreness.
Preventing chronic inflammation is key for optimal endurance training. While acute inflammation is necessary and beneficial for success, chronic inflammation can decrease a runner’s ability to adapt to training and can ultimately hinder performance. The following long term lifestyle changes help prevent inflammation from becoming an ongoing issue:
The foods we eat are among the largest contributors to chronic inflammation. Making small changes, such as cutting out refined sugars, can make a big difference for athletes. Certain supplements have also been shown to improve the body’s response to chronic inflammation levels, such as probiotics, Vitamin D, and Omega 3 and 6 fatty acids. As the saying goes, an ounce of prevention is worth a pound of cure, and having a healthy diet to begin with is better for the body than using food as treatment for inflammation.
Simply being more aware of your personal thoughts, feelings, and emotions can prevent inflammation levels from rising in the body. Emotional and psychological stress is a major contributor to the production of stress hormones which can trigger inflammation. Taking a few moments to meditate, breathe, and regroup when life becomes overwhelming is important for keeping inflammation at bay.
Even one night of less-than-adequate sleep can result in an immune system response that contributes to chronic inflammation. While sleep cannot be perfectly controlled at all times, it is necessary to get 8+ hours of sleep per night most of the time so that one bad night of sleep doesn’t do too much damage to a body already experiencing high levels of inflammation.
Finally, taking time to engage in proper preventative self care techniques, such as preventative massage or yoga, can go a long way in keeping the body healthy. While many athletes cite the cost of self care as prohibitive, the cost of losing precious training time or having to sit out due to injury from chronic fatigue is a far greater burden to bear.
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