How Inflammation Affects Your Workout
When Meghan Rabbitt, 32, was living in Boulder, Colorado, she couldn't get enough of the great outdoors — biking, hiking, swimming, you name it. But so much opportunity for activity left her with regular aches and pains. "I was feeling so sore one day that I went to yoga to try to stretch myself out," she says. "And my instructor, ironically, started talking about how muscle inflammation is actually a gift; that achy feeling is our body's way of telling us to back off and let it heal so it can make us stronger. That one little gem has really changed the way I think about exercise soreness and inflammation. I now look at it as an important part of the process rather than something I can't wait to have end so I can get back to the gym."
Most of us hear the word inflammation and images of swollen ankles, puffy knees, and ice packs quickly come to mind, followed by fears of being sidelined with strains, sprains, and other annoying injuries. But inflammation is also part of a vital balancing act going on in your body every time you work out. "I call it the Goldilocks effect," says Shawn Talbott, PhD, a fellow of the American College of Sports Medicine and author of Natural Solutions for Pain-Free Living. "You need enough inflammation to trigger a physiological response that makes your body fitter and stronger and helps it recover after a workout, but not so much inflammation that it slows the body's natural repair process."
To appreciate inflammation's impact on your workout, it's important to first understand how it affects the body in general. Part of the immune system's protective mechanism against injury, foreign substances, and infection, inflammation can be acute and short-term, like when you sprain a ligament, or low-grade and chronic, like when it's related to such ongoing conditions as sinus infections or Lyme disease. Here's how inflammation works: When the immune system senses something is amiss — you twist an ankle or sprain your wrist, for example — it expands the blood vessels leading to the injured area and seals off those leading away from it. The body then sends in a double dose of inflammatory cytokines and white blood cells (think of them as your internal repair crew). With the "enter" door open and the "exit" door shut, the cytokines and white blood cells pile up, working overtime to repair and rebuild injured muscles and ligaments. Once the trauma has been reduced and any infections in the area have been eliminated, the body automatically reopens the "exit" blood vessels for the cytokines, and the swelling goes down.
The immune system produces some degree of inflammation to heal any kind of injury or illness. Levels that are too high, however, can damage healthy muscle and tissue cells while trying to repair the unhealthy ones, leading to additional aches and pains. In the case of exercise the problem may become chronic: You take a tough kickboxing class; afterward, your knees are slightly swollen as the healing process begins to repair and rebuild your tendons and ligaments. But if you take another class before you're fully recovered, you add more swelling to the already inflamed area. Eventually your body can't keep up. "Too much joint inflammation can lead to arthritis," cautions Steven Lamm, MD, professor of internal medicine at NYU School of Medicine in New York City. "It's unhealthy in other areas of the body as well: Excessive inflammation in the lungs can cause asthma, and in the intestines it can lead to colitis."
But how much inflammation is too much? What are the signs that you're hurting instead of helping your body? Discover the secret to mastering this fine balancing act.
What Causes Inflammation and Why You Need It
It's not always the obvious injury or muscle overuse that causes inflammation. Every week some of your workouts are likely to set off the response, and that's a good thing. Vigorous sweat sessions or bouts of increased-intensity exercise can cause varying degrees of small injuries, called microtraumas, to muscles, connective tissue, bones, or joints, especially if you're not used to a workout's duration or difficulty, says Laura Goldberg, MD, a sports medicine physician at the Cleveland Clinic. You may not even notice any aches. These microtraumas trigger the body to release an increased number of cytokines, which rebuild the soft tissue cells in muscles, ligaments, and tendons to be tougher and more durable so they'll withstand a similar workout in the future. "Given appropriate rest and time to repair, the tissues adapt to the increased load and lead to improved strength and fitness," Dr. Goldberg says.
And there's a side benefit: Just as your muscles adjust and get stronger with each workout, your body's ability to modulate inflammation within appropriate levels also gets better. That means you can work out harder longer while breaking down your muscles less and recovering faster. A 2007 study in Medicine and Science in Sports and Exercise found that only 12 weeks of aerobic exercise and strength training significantly decreased inflammatory markers in both younger and older people. "Women who exercise regularly tend to have lower stress levels and less body fat, both of which keep inflammation at a healthy point in the body," Dr. Lamm notes.
Why Inflammation Is Good for You
Big picture: You need inflammation to fight infections and speed recovery. And small doses of inflammation will stimulate tissue to be more resilient to damage later; the more you work out, the more your cells can handle oxidation and inflammation.
On the other hand, too much can do a lot of damage, and inflammation is sneaky. One of the biggest problems for active women is that they don't realize it's time to ease up until it's too late. Alia Malley, 38, of Los Angeles, learned this the hard way when she dove headfirst into yoga after finding a class and instructor she adored. She thought only good things could come from diligently working on perfecting her poses. But after months of pushing herself through almost daily vinyasa classes, the yoga devotee found herself dealing with extreme pain in her knees. Her doctor's verdict? Partially torn ACLs in both knees, which would require surgery and physical therapy to repair. "I was ignoring the warning signs — soreness and swelling," she says. "I kept pushing myself until I got hurt, because I thought I could handle it." Her physical therapist suggested post-exercise icing to reduce inflammation and nightly foam-roller exercises to release tension in her muscles and IT bands, the fibers running along the sides of the thighs. She also recommended that Alia diversify her workouts to allow for a faster recovery and not overuse the same parts of her body. "I'm using different muscles and ligaments this way," says Alia, who has added surfing and core-conditioning classes to her fitness repertoire.
"The challenge is finding your limits," acknowledges Tom Hackett, MD, an orthopedic surgeon at the Steadman Clinic in Vail, Colorado, and head team physician for the men's and women's U.S. snowboarding and raft teams. "It's obvious when your gums are inflamed, for example, but you can't see inside the inflamed fascia or muscle tissues that can cause tendinitis, arthritis, or even fibromyalgia. What you can do is know your body." In the same way that volleyball and tennis players realize they're more likely to injure a shoulder or an elbow and runners and skiers know they're more apt to injure a knee or ankle, be aware of your most vulnerable spots. "Swollen and painful joints, muscles, or tendons that repeatedly cause problems are signs that you need to rest," Dr. Hackett says. "If it's a chronic situation, you should see a doctor, trainer, or physical therapist who can help you establish a healthy cycle of exercise, rest, and recovery." Your doctor can also check the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) in your blood; this is a reliable marker of levels of cellular inflammation in the body. If you're experiencing exercise soreness that keeps recurring in the same muscle or area of your body, it's probably an indication that your anti-inflammatory response is compromised. The risk: Inflammation can spread from that area to other organs in your body. "Studies of people who are overexercising show that they have excessive amounts of inflammation and stress hormones in their bodies," Talbott says. "This combination causes such things as a loss of muscle mass, an increase in belly fat, a higher risk for upper-respiratory tract infections, and significant mood changes with more fatigue and depression."
How to Recover Properly
What's best for your body is a careful balance between exercise and recovery. "Your goal is to train hard enough to stimulate gains in your fitness level and to then back off and let your body adapt to the gains," Talbott says. If you tend to focus on one activity — cycling, say — consider swapping in one or two alternate workouts — swimming, perhaps — each week to give your quads a break while you're still exercising. Strength-training? Allow 48 hours of rest to help your muscles recover before another session. (Note: Rest does not necessarily mean hitting the sofa for some Seinfeld reruns. It does mean finding alternate activities that use different muscle groups, Dr. Hackett says.) Exercising in the early morning will also have less of an inflammatory impact, as this is when certain hormones, such as testosterone and cortisol, are at their highest levels and will make for a faster recovery, says Barry Sears, PhD, president of the Inflammation Research Foundation in Marblehead, Massachusetts.
In addition, what you eat can contribute to your post-exercise recovery, but you need to tailor your choices to your workout's intensity. After a four-mile run at a moderate pace, you might just drink water and refuel with a healthy dinner; after a 60-minute interval routine on the treadmill, you'll recover faster if you consume a 200-calorie snack of carbs and protein, like a glass of low-fat chocolate milk, within 20 minutes of your sweat session, Talbott recommends. Getting a minimum of eight hours of sleep a night and soaking your legs in ice baths after a tough workout can also accelerate repair and speed the inflammation process along. Also, a growing number of studies point to massage as a key to faster recovery.
That's what helped Anne Delp, 35, of Kensington, Maryland, stick with her summertime training for 5Ks and occasional half-marathons. "Every year I look forward to the better weather, when I can enjoy running outdoors," she says. What Anne doesn't look forward to are sore hamstrings, quads, and feet. A few years ago she found a sports massage therapist certified in myofascial release, a type of massage aimed at manipulating connective tissue and reducing tension and inflammation. It's made a huge difference, she says: "I'm able to recover faster for my next run and reduce overall soreness." Self-massage with a foam roller may offer similar recovery benefits. Meanwhile, nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen, are good options for reducing immediate swelling from a strain or fall, but active women should use them judiciously for chronic aches because overuse of NSAIDs has been linked to kidney failure and stomach disturbances. NSAIDs may also slow and inhibit bone growth and decrease the ability of a tendon, bone, or ligament to heal itself, Dr. Hackett says. Drinking a lot of water with ibuprofen may help minimize the impact the drug has on your organs, Talbott advises.
What about the growing number of anti-inflammatory supplements on the market? "On a scale of one to 10, I give vitamins, minerals, and herbs about a one; polyphenols a five; and fish oils a 12 in terms of their performance," Sears says. "If a product is labeled 'anti-inflammatory' but doesn't contain adequate levels of the ingredient demonstrated to reduce inflammation in humans, it obviously won't work," he explains. Sears suggests using supplements that contain fish oil with combined amounts of EPA and docosahexaenoic acid greater than 600 milligrams a capsule. Other effective inflammatory ingredients include proteolytic enzymes, like papain in papayas and bromelain in pineapples, and specialized flavonoids, such as xanthones in mangosteens, Talbott says. Before you buy any of these items, though, experts recommend that you look for clinical studies in humans that support the claims. Also, check with your doctor to be sure they're right for you.
Lifestyle choices also matter. More sleep and less stress are simple tweaks proven to reduce inflammation, as is meditation. A 2010 Ohio State University College of Medicine study found that after a stressful event, participants who did hatha yoga regularly had lower blood levels of compounds that are markers for inflammation.
Certain foods have also been found to fight inflammation. Tuna, salmon, and herring contain oils rich in EPA, a powerful anti-inflammatory agent. Colorful fruits and vegetables, like carrots and dark leafy greens, contain antioxidants that also combat inflammation. "Foods and supplements high in antioxidants, including vitamin D, prevent the production of free radicals, which can help avoid damage to other cells and excessive inflammation," says Ray Strand, MD, a sports medicine specialist and author of Healthy for Life.
"The more vigorous your workouts or training, the more inflammation you'll produce. A good diet can help you lower inflammation so you can do more high-intensity training with faster recovery," Sears notes.
In the end, dealing with inflammation requires a balancing act. Workout, rest, recover, repeat. The more you respect your body and its limits, the faster — and better — you'll reach your fitness goals.
Originally published in FITNESS magazine, September 2011.