Someone burgles your house; breaks a window, comes in, makes a royal mess and helps themselves to whatever they like. So you do what anyone would do: call the police, and if it’s really bad, some professionals to help you deal with the mess. But what if after a day or two none of them wanted to leave? What if the cops ended up on your couch asking how many cable TV channels you get and if anyone in your neighborhood delivers donuts? What if they started helping themselves to whatever was in the fridge, borrowing your clothes and sleeping in your bed (on your side no less). What if the cleaning crew just kept scrubbing, through the paint on the walls, the finishes on the furniture and the porcelain on the bathroom fixtures? What if they turned out to be obsessive monster’s who seemed to gain super human strength from the inhalation of toxic clearing fumes and wouldn’t ever stop no matter how sweetly you asked?

This scenario is a crazy shut-in’s dramatization of what happens to your body when it sustains an injury, also known as the inflammatory response and what happens when that response goes awry. Shut in because I just had a second knee surgery to try and get the damn cops and cleaners out of my knee for good.

The inflammatory process sets in motion a cascade of chemical reactions. At the site of invasion cops called mast cells get the ball rolling by releasing the chemical histamine. As any allergy suffer knows histamine causes things to leak and on cue plasma seeps out of nearby cells in order to slow down invading bacteria. This is one cause of inflammation’s tell tale swelling. Then ass kicking cops without pot bellies called macrophages begin terrorizing unwelcome germs, parasites and viruses. When macrophages get busy they release a chemical called cytokines, which sends a signal back to headquarters that reinforcements are needed. Soon the site is jammed with cop like immunity cells bent on the destruction of unwanted invaders. The cleaning crew is right behind to dissolve any thugs or unwanted materials in their wake. This well orchestrated immunity response prevents infection and destroys any unwanted bodily invaders.

But sometimes the process doesn’t shut down in order to allow healing to begin. For whatever reason, and there are many, the cops and cleaning crews don’t leave and chronic inflammation sets in. When this happens the processes that were designed to keep the body safe eventually begin to destroy it, as healthy tissue is irritated and destroyed by the ever vigilant immunity cells.

I had chronic inflammation in my right knee and the cops and cleaners took a bunch of my cartilage, the smooth surface on your leg bones that allows your knee to move pain free, before I finally had my swollen knee looked at. There had been a battle going on in my knee for years, ever since I had had my original ACL replacement surgery, and I had chosen to ignore it. The inflammation had caused some stiffness and warmth, but it had never been (too) painful. I had chosen to ignore it because I didn’t want to be told that I couldn’t do all the things that I loved to do. This was a mistake.

Chronic swelling and inflammation in a joint is a sign that something is really wrong. The bodies healing mechanisms are being overwhelmed and may be turning on the healthy tissues as they attempt to heal the perceived (or real) injury. So if you have chronic swelling in any joint, even if it is not painful, get it looked at by a good orthopedic doctor. If it helps to motivate you imagine a crazed housekeeper scrubbing your joint with a piece of iron wool. Call now my swollen friends, call now.