Inflammation and Recovery

Two different things share a name

"Inflammation" has become a villain in health writing, and that framing causes real problems in a clinic.

Acute inflammation is the repair response. When tissue is injured, blood flow increases, immune cells arrive, damaged material is cleared, and the signals that direct rebuilding are released. This is not damage. It is the mechanism by which you heal, and interfering with it has consequences.

Chronic low-grade systemic inflammation is a different phenomenon entirely — a persistent, low-level elevation in inflammatory signaling that does not resolve and is associated with insulin resistance, cardiovascular disease, and impaired tissue repair.

Conflating the two leads people to suppress the response they need in pursuit of avoiding the one they should actually address.

The case against reflexively taking an anti-inflammatory

This surprises people, so let me be specific.

For chronic tendinopathy, NSAIDs are largely the wrong tool. Chronic tendon pain is primarily degenerative rather than inflammatory, so there is limited inflammation to suppress — and there is evidence that NSAIDs interfere with the tendon remodeling process you are trying to encourage.

After exercise, regularly blunting the inflammatory response appears to attenuate the training adaptation. Some work suggests high-dose anti-inflammatories reduce muscle protein synthesis and blunt strength and hypertrophy gains. The soreness after a hard session is part of the signal.

For fracture healing, there is ongoing concern about NSAID effects on bone healing, and many surgeons avoid them in this setting.

With PRP, we specifically ask you to avoid anti-inflammatories, because the entire mechanism depends on provoking a healing response.

None of this means never take an NSAID. Acute injury with genuine inflammatory pain, an inflamed bursa, an acute flare that is preventing sleep — reasonable uses. The point is that "reduce inflammation" is not automatically the goal, and reaching for it by reflex can work against you.

Ice deserves a similar caveat. It is useful for acute pain control, and the older assumption that it improves healing has not held up well. Comfort is a legitimate reason to use it. Accelerated repair is not a claim I would make.

What chronic systemic inflammation actually is

This is the version worth taking seriously, and it is driven by a fairly consistent set of contributors:

Visceral fat, which is metabolically active tissue that secretes inflammatory cytokines directly.

Poor sleep, which raises inflammatory markers after even modest restriction.

Physical inactivity, independent of body composition.

Chronic psychological stress, through sustained cortisol and sympathetic activation.

Diet patterns high in ultra-processed foods and refined carbohydrate, particularly in the context of insulin resistance.

Smoking, periodontal disease, and chronic infections.

The pattern is that these are largely structural features of how someone lives, not deficiencies of a particular supplement.

Why this matters for a musculoskeletal problem

A tendon trying to remodel, a joint trying to tolerate load, a surgical repair trying to consolidate — each of these happens in a systemic environment.

When that environment is characterized by insulin resistance, poor sleep, and chronic inflammatory signaling, repair is slower and less complete. This is one reason two patients with identical injuries and identical rehabilitation programs have different outcomes, and it is one reason I ask about sleep, stress, and metabolic health when you came in about your foot.

It is also why I am cautious about promising results from any procedure to someone whose recovery environment is working against them. The injection is not the variable that will decide it.

What actually reduces chronic inflammation

The interventions with genuine evidence are unglamorous:

Regular exercise, including resistance training. Exercise produces an acute inflammatory response and a chronic anti-inflammatory adaptation. This is among the most reliably supported interventions there is.

Adequate sleep, consistently.

Reducing visceral fat, principally through the combination of resistance training, adequate protein, and an overall dietary pattern you can sustain.

A dietary pattern emphasizing whole foods, adequate protein, fiber, and unsaturated fats. Mediterranean-style patterns have the most supporting evidence. This is about the pattern, not any individual food.

Stress management that you will actually do.

Treating sleep apnea, if present.

On supplements

Omega-3 fatty acids have reasonable evidence for modest effects on inflammatory markers. Curcumin and a few others have some supporting data, generally with bioavailability problems and effect sizes far smaller than the marketing implies.

None of them substitute for sleep, exercise, and body composition. If you want to take fish oil, that is a defensible choice. If you are taking fish oil instead of addressing five hours of sleep a night, the arithmetic does not work.

I would rather you spend the money on something that changes the inputs.

What I do with this in the room

I am not going to hand you a lifestyle lecture in place of treating your problem. You came in with a specific complaint and it deserves specific treatment.

But when a case is not progressing the way it should, this is where I look. Frequently the manual treatment was appropriate, the exercise program was appropriate, and the thing standing in the way was that the body doing the healing was not in a position to heal well. That is a fixable problem, and it is worth naming rather than escalating to a more aggressive procedure.