EVIDENCE INFORMED PRACTICE

BY HUMPHREY BACCHUS CMT DCN INTRODUCTION

Tissue repair and management of inflammation are key factors in producing positive outcomes in a rehabilitation- and pain-management setting. Damage to the connective tissue and the corresponding cellular and metabolic changes can be modulated and limited by addressing simple dietary requirements and environmental change, which any therapist can employ safely with good patient outcomes. Though the injury response in the body is complex and not simply an inflammatory response we can design treatments that include the limitation of pro-inflammatory oils, encourage good sleep patterns and use specific dietary modifications.

NSAIDS AND P.R.I.C.E The most well practised protocol regarding the management and recovery from sports related injuries is to practise the protect, rest, ice, compress, elevate (P.R.I.C.E) protocol alongside nonsteroidal anti-inflammatories (NSAIDs) in the acute stage. Full assessment of the function, movement, joint integrity and neurological functioning can be used to design appropriate treatment guidelines. In the management of inflammation and tissue repair, the use of NSAIDs needs to be balanced with research showing an associated potential risk of upper GI tract bleeding (1) as well as links to increased intestinal permeability and inflammation in arthritis (2). The P.R.I.C.E. protocol treatment is important in the acute stages of injury as it minimises the possibility of concurrent injury and works to reduce inflammation by contraction of the vascular and fluid supplies.

INFLAMMATION Inflammation is a natural physiological response to injury, pain and trauma as well as infection. There are a myriad of biochemical responses that are key to regulating the process and include eicosanoids, which we will discuss in depth, as well as kinins, proteins and histamines. Inflammation by its nature is a protective response to injury as it tries to move infection and cells from tissue damage away from the area to initiate healing. Inflammatory processes are governed in part by eicosanoids. These

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MANAGING PAIN, INFLAMMATION AND TISSUE REPAIR FOR ATHLETES THROUGH SIMPLE DIETARY AND LIFESTYLE MODIFICATIONS

Simple dietary guidance and environmental changes can have profound effects in supporting positive outcomes in reduction of inflammation and remodelling of connective tissue. Here we look at the research behind it and how to employ the guidance in your practice.

are signalling substances involved in the immune and inflammatory response. Prostaglandins and leukotrienes are two of the eicosanoids that are integral to the inflammation process. While some of the prostaglandins and leukotrienes exhibit anti-inflammatory effects, some exhibit inflammatory effects.

TISSUE REPAIR

When tissue is damaged through injury there is a need of repair and stimulation of connective tissue synthesis. This consists of the remodelling of collagen, elastin and the extracellular matrix. It is widely acknowledged that vitamin and mineral status determines the level of

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