A Runner’s Guide to Inflammation



Kyle has written 164 posts on Salty Running.


Did someone say INFLAMMATION!?

English: "Stripe" Gremlin figure, le...

INFLAMMATION is coming after you! (img via Wikipedia)


Wait…why are we hurrying?

Relax, dear runner.  Inflammation doesn’t have to be a gremlin in your body.  In fact, if you take care of it well and don’t feed it after midnight, Inflammation can be a protective little guy who helps keep you running right.


Inflammation isn’t so bad for you after all.

Okay, so maybe inflammation isn’t coming to get you. Maybe it’s just trying to tell you something.

You’ve all had some kind of inflammation; it’s your body’s natural response to any kind of trauma, and a hard workout is just that. You know you need to tear your muscles down so you can build them up again, right?  That’s why we get sore after a hard workout – we’ve torn our muscles down.  Enter inflammation: it makes those muscles sore, tender, hot and maybe even swollen, which is a big yellow sign telling you to take it easy so your body can catch up with that fast brain of yours.

But that’s not all! Inflammation is so much more than just a “Go Slow sign – it’s also a messenger, sending signals to your blood to get to work cleaning out the damaged tissue so proteins can come in and rebuild stronger muscle.

As described here here and here, inflammation’s role in your training goes like this:

  1. You train hard, which makes little teeny-tiny tears in your muscles.
  2. Your muscles become inflamed, which releases white blood cells called neutrophils, macrophages and monocytes to eat away all the torn, broken bits of tissue. We’ll come back to that.
  3. You ingest protein (like these pancakes), which helps you build new, happier, stronger muscle
Release the Mogwai

This is what inflammation does when it sees broken muscle tissue. img via fbcoverlover.com (doctored by me)

So back to those white blood cells…the neutrophils, macrophages and monocytes. Gizmo will help me demonstrate how they react when your body has an inflammatory response.

For the other science nerds out there, neutrophils are granulocytes (one of the types of white blood cells) that swim around in your blood stream waiting for problems to happen.  At the fist sign of inflammation they speed in first, like a superhero dashing in to fight the bad guys.  In fact, that’s their whole job, to be the first responders who spring into action with an arsenal of weaponry to either eat or kill bacteria!

Man, check out that arsenal of weaponry! This guy’s ready to fight some infection!

Unfortunately though, it’s a suicide mission.  When neutrophils are done with their job they die where they are, turning into pus.  But luckily the monocytes are going to help with that.

Monocytes (which are phagocytes, a different kind of white blood cell) swim around in your blood stream too, but they’re more like the heavy artillery. When inflammation begins, these guys hurry over and start some serious cell division to create an army of macrophages (which are for our purposes a subcategory of monocytes).  What’s extra badass about monocytes is that about half of them live in your spleen, so if there’s something seriously wrong they can always call in the reserves!

Monocytes + Inflammatory Response = LOTS of Macrophages!

The army of macrophages begins the real clean-up.  Their job is to find a foreign substance and ATTACK! In this case, foreign substance is the broken muscle tissue from our hard workouts, any remaining bacteria and pus from the dead neutrophils.  Macrophages come in guns-a-blazing, ready to gobble up foreign substances and clean the whole place out!

Macrophages are gonna kick some foreign substance A$$!

It’s all-natural, baby, and what’s good about your hard workouts causing minor inflammation is that these little guys get lots of practice.  And practice, as we all know, is how they get better, stronger, and faster at what they do….

Taking post-workout NSAIDs is like trapping your body’s good responses to inflammation in a cage! Don’t do it!

Which is why you should not interrupt this process with anti-inflammatory drugs (like ibuprofen or other NSAIDs). The latest studies show that NSAIDs like ibuprofen actually impede your bodies adaptation to your training. We want your body to get stronger and faster from training, so quit the post-workout Advil, stat!

Now that we understand what happens when inflammation begins, we can start to reconcile with it a little.  The next step, after we ensure we get enough rest in to let the neutrophils, monocytes and macrophages do their work, is that we go run some more so they can get more practice!


But wait, what about ICE?

I know, I know. This bugs me too!  If inflammation is causing good things to happen in my blood, what about the I-C-E in R-I-C-E?  Ice, compression and elevation all slow down the blood flow.  Does that mean they’re not good for me post-run?

Well, no, not under normal circumstances.  The science indeed suggests slowing down blood flow will reduce the effectiveness of your body’s natural healing through this process (meaning you can quit the regular post-workout ice baths!) Which in short means you’re going to need more rest time for your macrophages to do their thing.

So here comes the hard part: knowing when to suffer through the pain and when to treat it.


When Good Inflammation Goes Bad

So now that we know why we get inflammation, how it works and thus why it can be beneficial it’s time to discuss when you need to treat it with ice, drugs or other methods.  To this end, I have created the Salty Running Inflammo-meter:

How does your pain rank?

So you’re a little sore.  Okay, it hurts but it’s tolerable.  You’re not gonna like this, but provided the pain is minor (think yellow zone), it’s better for you to just suffer through the pain. You can try massage, like the Stik or Foam Rolling to help work through it; separating your muscle fibers helps your blood get in there and clean out all the yucky stuff.  This is where M-E-A-T is Good For You!

Minor pain does not include pain that:

  • makes you cry
  • keeps you awake at night
  • prevents you from normal daily activity (this includes swelling)
  • hurts like a m*****f***** so bad you want to tear the affected body part off

Those things, friend, are major pain (think orange zone), and measures like M-E-A-T and R-I-C-E should definitely be used to help alleviate the pain, but not to stop the inflammatory response.  Don’t pop an Advil just yet though – NSAIDs are still off-limits.  Instead, try a non anti-inflammatory drug if you need chemical help with pain management.  Think acetaminophen (Tylenol).

Think about most of the inflammatory pain runners discuss: Plantar fasciitis, heel bursitis, chafing, shin splints, runner’s knee… All of these are great examples of pain, heat and swelling that occur acutely in a localized area of the body. With I-C-E you can manage the pain and swelling.  And if you rest enough* your white blood cells will have ample opportunity to clean out the damage. The inflammation should disappear on its own!

*This isn’t to say you can’t run through minor pain – just that you should listen to your body and try not to jump the shark.


When to seek medical attention and further treatment

Okay, let’s change the model a little to talk about when you should seek medical help:

Inflammation Gremlins

This infographic explains my theory that if you give inflammation NSAIDs, give it ice baths or feed it after midnight, it will turn on you and become a horrible pestilence upon your town! Er…body!

In short, seek help whenever your inflammation is no longer acute or local.

For example, in my recent case, when my acute pain from my injury in January became chronic, when it didn’t go away after weeks and weeks and weeks, I should have sought medical attention. When localized inflammation became systemic, like when the pain that started in my knee began spreading down my calf and throughout the back of my hamstrings, causing me to nearly collapse at a race, I should have sought medical attention.

Ignoring inflammation that becomes chronic or systemic is tantamount to feeding your Mogwai after midnight – it turns it into a gremlin, an angry beast that will stop at nothing until you pull out all the stops to rid your body of its pestilence!

Make no mistake – inside every inflammatory response is the potential for evil.

And THAT, my dear friend, is when you get to unleash the big guns:


Non-Steroidal Anti-Inflammatory Medication (NSAIDs)

A bottle of 50 200mg Advil caplets

If your inflammation is minor enough to warrant steroid treatment, this is what you’re gonna get.  img via Wikipedia

If you’re lucky you won’t need steroid treatment, which is usually injected (*shudder*).  My doctor told me that as an anti-inflammatory, OTC ibuprofen actually does not do a whole lot unless you take it very regularly and at multiple times a day, the same time each day for at least a month.  I have an alarm set to ring four different times of day to remind me to take it.  Both Mayoclinic.com and the National Library of Medicine recommend that dosage is often prescribed on a case-by-case basis, so you should not take more than the recommended dose on the package without supervision by a physician.

It’s also a good idea for a doctor to know you’re using it so you can call someone if you exhibit any of the insane amount of side effects, including heart attacks, strokes, and GI bleeding!  So far I’m one week into my treatment and I feel fine, so I’m not too worried about side effects, but I’ll still be more at-ease when I’m done with the medicine.

My doctor also prescribed heat to help induce blood flow to my torn and inflamed ligament.  At first I was surprised by that prescription, but now that I understand the science of it, I know it will help keep the neutrophils and monocytes flowing.


Are you ready to give up your post-workout NSAIDs and ice baths? Have you ever dealt with severe inflammation? When do you run through the pain and when do you use R-I-C-E methods to manage it?

10 Responses to “A Runner’s Guide to Inflammation”

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  1. misszippy says:

    I gave up NSAIDs a long time ago b/c I just don’t tolerate them well. I only use if I’m desperate and feel on the verge of injury. I have given up ice baths, too, b/c of all the re-thinking. I will, however, still go to ice immediately post run if something is a little off, but that’s actually pretty rare too. I think it will take a loooong time for runners to get out of these old habits!

  2. Mint says:

    I never do post-workout NSAIDS, but I do indulge in the occasional ice bath after a hard long run in the heat.

    I also do not take NSAIDS before I run – but I know some people who do. After seeing the Grey’s Anatomy episode where Callie had to slit open a marathon runner’s calves after taking aspirin before the run – I guarantee I never will either!! (BTW I don’t think aspirin CAUSED the issue on that show, but still – NEVER.) :)

  3. Sassafras says:

    Great post, Cinn. I am confused, though. How does compression gear fit into this picture? If I wear it while running, does it prevent those muscle tears?

    • Cinnamon Cinnamon says:

      That’s something I need to research more. Since I don’t use compression stuff (It’s so expensive and I’m skeptical that something so unnatural would work) I haven’t really looked into it much. It’s a post for another day, I suppose.

  4. This is a well-researched post, and I love the Gremlin analogies (haven’t seen that movie in years). I’m not a big NSAID user and welcome the dull aches and pains that come from hard training as part of the reward. Once one comes to accept that these are the signs of progress, one can stop trying to alleviate any minor symptoms that come along. Thanks for your efforts on this post.

  5. Rosemary says:

    I love the infographic! It captures the “threshold” of good vs bad inflammation perfectly!

  6. Ginger Ginger says:

    The pictures make this article. I wish you were my science teacher in high school! In fact, this post can so be used for a high school biology class, anatomy 101.

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