Inflammation 911

November 23, 2009

When Washington Ballet apprentice Corey Landolt felt a pinch in his lower back while rehearsing a pas de deux from Coppélia last season, he didn’t waste any time dealing with what could have become a painful inflammation. “Just as I was lowering my partner from a simple arabesque press, I knew something was wrong,” remembers Landolt, 21. “I hit the ice immediately, popped some ibuprofen and made an appointment with the physical therapist before I left the building.” As the son of a pediatrician, Landolt knew to be proactive rather than wait until the pain in his back became a persistent problem.

Inflammation is the body’s way of getting our attention. Landolt heard the message, and according to Rebecca Clearman, MD, who’s affiliated with The Methodist Hospital System’s Center for Performing Arts Medicine in Houston, he did all the right things in the right order.

Inflammation occurs when blood loaded with white blood cells rushes into the area of injury to remove unhealthy material such as torn muscle and ligament fragments from the area. “Think of those white cells as first responders. When the body senses something is damaged, white cells act like a clean-up crew trying to rid the body of debris,” says Clearman, who runs a free, once-a-month clinic for performing artists.

Signs of inflammation include pain, a sensation of heat, redness and swelling. “Depending on what is inflamed, visible swelling may or may not be present,” says Clearman. “But the important thing is that the area will feel swollen. The heat sensation comes from the presence of the white blood cells. You may also notice a slight redness.”

BalletMet Columbus dancer Jamie Brianne Dee’s experience with inflammation was dramatic after she sprained her ankle last October landing from a lift while dancing the role of Mina Harker in David Nixon’s Dracula. “I was in extreme pain right away. My ankle swelled to the size of my knee almost immediately,” says Dee, 26, now in her seventh season with the Ohio-based company. She also turned to ibuprofen (a drug that reduces hormones that cause inflammation and pain in the body), then iced, wrapped and elevated her ankle. Next, she picked up the phone to get an appointment with the company’s physical therapist. Dee was using the RICE protocol (rest, ice, compression, elevation), which has been proven to be a dancer’s best weapon to fight inflammation.

The “rest” part is not always possible for dancers in the midst of a busy season. “I try to keep dancers dancing when I can,” says Clearman. “I will use artificial means to manage the inflammation, such as prescription strength ibuprofen (Motrin).”

Concerned about the harm to the digestive system with long-term anti-inflammatory use, she prefers a larger dose—always with a meal—for a shorter time period. “The ‘Take enough to really help and then stop’ approach works best for dancers,” she says. Clearman warns against taking the once-popular anti-inflammatory drug Voltaren, which has the potential for causing cardiac complications.

Physical therapists and physicians have an array of techniques to address inflammation, among them electrical stimulation, tape for compression and massage to help with mobilization. While these techniques may seem simple enough, they are best administered by a professional who knows when and how to use them.

Other, more accessible ways to move the healing process along include BenGay and Icy Hot, which work by creating an irritant, which in turn increases blood flow to the injured area. “They can’t hurt you,” advises Clearman, “but I prefer an anti-inflammatory topical cream. Several are available over the counter, including the old standard Aspercreme.” Landolt has found that Traumeel, a topical homeopathic inflammation remedy, works for him. Arnica gel is also popular with athletes, and the magnesium sulfate in an Epsom salt soak also draws off inflammation, but Clearman suggests soaking only the injured part of your body.

Eating well also aids in clearing inflammation because a healthy body heals more quickly. A low-glycemic diet, staying away from the empty-calorie refined sugars and white flour, can make a big difference. “Eat colorful food, but I don’t mean Cheetos,” says Clearman. “Protein is also essential for the body to repair itself. And it’s great that dancers are including berries to reduce inflammation in their diet, but we need more research there.” Adequate fluid intake and a good night’s sleep also support the healing process. She recommends taking a good quality multi-vitamin and between 1200 and 1600 milligrams a day of calcium with vitamin D.

Because inflammation is the body’s reaction to trauma, it can be useful, but if it appears frequently, it can indicate a problem. When Dee sprained her ankle a second time, she had to find the root cause of the injury and get down to business about prevention. “I considered my first sprain a fluke because I slipped on a hard floor. But the second time made me wonder why my ankles are weak and what I can do to prevent a third sprain,” says Dee. “I know now that the problem is not just about my ankles. I need to attend to how my whole body is working.”

Nancy Wozny writes about the arts and health in Houston.

Relief in a Pill

The anti-inflammatory drugs mentioned in this story are non-steroidal. The class of drugs called steroids or corticosteroids would rarely be used for this kind of inflammation. Steroids can be highly effective for chronic diseases but they have serious side effects, such as bone loss, swelling and weight gain, and can compromise the immune system.

Here’s an FYI on some of your choices. Although, when it comes to inflammation, it’s always good to work with a medical professional to determine the best course of action.

These non-steroidal anti-inflammatory drugs are available without a prescription:

    • aspirin (Bayer, Bufferin)
    • ibuprofen (Advil, Motrin)
    • naproxen (Aleve, Naprosyn)

The following non-steroidal anti-inflammatory drugs are easier on the digestive system and appropriate for dancers:

    • Prescription Motrin
    • Celebrex
    • Mobic
    • Voltaren

Because they are stronger and have potential negative side effects—such as heart damage—you need a prescription to purchase them.