Local Inflammation

Pathophysiology

Vascular phase: Brief initial vasoconstriction (seconds) followed by sustained vasodilation, increasing blood flow to the area (causing redness and heat). Increased capillary permeability allows protein-rich exudate and white blood cells to move into the interstitial space, producing edema
Cellular phase: Phagocytic leukocytes (primarily neutrophils in the first 24-48 hours, then monocytes/macrophages) migrate to the site via chemotaxis to engulf debris, pathogens, and damaged cells
Chemical mediators: Histamine, prostaglandins, bradykinin, and cytokines orchestrate the vascular and cellular responses. Prostaglandins sensitize nerve endings (producing pain) and reset the hypothalamic thermostat (producing fever if inflammation becomes systemic)
Resolution vs. chronicity: Acute inflammation typically resolves in days to weeks. If the stimulus persists or healing is disrupted, chronic inflammation develops with macrophage and lymphocyte infiltration, fibrosis, and tissue remodeling
Triggers: Physical trauma (cuts, sprains, fractures), chemical burns, radiation (sunburn), temperature extremes, or pathogen invasion
PRICE protocol: Protect, Rest, Ice, Compression, Elevation — standard acute management that massage therapists should know and reinforce

Redness (rubor) and heat (calor) from increased blood flow via vasodilation
Swelling (tumor) from fluid accumulation in the interstitial space
Pain (dolor) from chemical irritation of nerve endings by prostaglandins and bradykinin
Loss of function (functio laesa) from tissue distension, pain, and protective muscle guarding
Muscle guarding or splinting around the injured area
Pitting edema with spongy or gel-like tissue texture in the acute phase

Spreading redness with red streaks (lymphangitis) indicates infection tracking through the lymphatic system — requires immediate medical referral
Fever, chills, and malaise accompanying local inflammation suggests the process is becoming systemic — see systemic-inflammation
Inflammation with no apparent cause may indicate underlying autoimmune or neoplastic process — refer for investigation
Compartment syndrome: Disproportionate pain with firm swelling in a closed fascial compartment (typically lower leg or forearm) — surgical emergency

Locally contraindicated directly over the site of acute inflammation — massage at the site increases blood flow, can disrupt the clotting cascade, and may spread infection
Vigorous work distal to the site is also contraindicated in the acute phase, as increased systemic circulation may stress the already-congested area
Manual lymphatic drainage can limit edema in the surrounding area without aggravating the injury site — appropriate in the acute and subacute phases
Post-acute/chronic stages: Careful massage improves local circulation, reduces adhesion formation, promotes collagen remodeling along lines of stress, and restores tissue mobility
NSAIDs and corticosteroids: Clients on anti-inflammatory medications may have reduced pain sensitivity, increasing the risk of overtreatment — the tissue is still vulnerable even if the client reports minimal pain
Cold application: Cryotherapy in the acute phase (first 48-72 hours) reduces metabolic rate, limits edema formation, and provides analgesia. Transition to heat in the chronic phase to improve circulation and tissue extensibility
Timing: The transition from acute to subacute inflammation (typically 48-72 hours for minor injuries) determines when direct work can resume — guided by tissue signs (reduction in heat, swelling, and acute tenderness) rather than arbitrary timelines

Know the five cardinal signs of inflammation and their mechanisms (vasodilation, increased permeability, chemical mediators)
Understand the vascular and cellular phases and their timelines
Differentiate local from systemic inflammation (systemic adds fever, CRP elevation, leukocytosis)
Know the PRICE protocol and its rationale
Locally contraindicated during acute phase. MLD is appropriate for edema management

Massage is locally contraindicated directly over acute inflammation. Vigorous work distal to the site is also contraindicated in the acute phase.
The five cardinal signs are redness (rubor), swelling (tumor), heat (calor), pain (dolor), and loss of function (functio laesa).
Manual lymphatic drainage can limit edema during the acute phase without aggravating the injury.
NSAIDs and corticosteroids reduce the client's pain sensitivity, increasing overtreatment risk — the tissue is still vulnerable.
In post-acute and chronic stages, massage improves circulation, reduces adhesions, and promotes collagen remodeling.
Tissue signs (reduction in heat, swelling, acute tenderness) guide the transition from contraindicated to indicated — not arbitrary timelines.