Why is Inflammation Important?
The inflammatory process brings blood flow to the area of injury and cellular debris/waste away. Although the inflammatory process may need to be subdued at times, we do not want to completely halt it because inflammation is an initial and necessary step in the healing process.
The normal healing response begins the moment the tissue is injured. As the blood components spill into the site of injury, the platelets come into contact with exposed collagen and other elements of the extracellular matrix. This contact triggers the platelets to release clotting factors as well as essential growth factors and cytokines such as platelet-derived growth factor (PDGF) and transforming growth factor beta (TGF-ß). Following hemostasis, the neutrophils then enter the wound site and begin the critical task of phagocytosis to remove foreign materials, bacteria and damaged tissue. As part of this inflammatory phase, the macrophages appear and continue the process of phagocytosis as well as releasing more PDGF and TGFß. Once the wound site is cleaned out, fibroblasts migrate in to begin the proliferative phase and deposit a new extracellular matrix. The new collagen matrix then becomes cross-linked and organized during the final remodeling phase.
During this proliferative phase, type I collagen is being laid down by the fibroblasts to increase ligament and tendon strength. After about four weeks, about 60 percent of the tensile strength of the tissue may be restored. This obviously depends on the amount of tissue damage and the ability to mount an inflammatory response after injury. The healthier the immune system, the quicker the ability to heal. Because the proliferative phase lasts about four to six weeks in most individuals, prolotherapy injections are given by most clinicians every four to six weeks.