Inflammation, recovery and persistent symptoms. Much of this has an ordinary explanation. Some of it is the early sign of an inflammatory or autoimmune condition, and those are far easier to manage when they are recognised early.
of 80-year-olds with no back pain at all show disc degeneration on a scan.
of people aged twelve and over have a positive ANA test, and most have no autoimmune disease.
lower odds of a raised CRP in people who ate the most fibre, compared with those who ate the least.
There is often a point in midlife when the body stops bouncing back. A hard session leaves you sore for days instead of hours, a minor niggle turns into months of pain, or you collect symptoms, such as tiredness, aching joints, a rash or an unsettled gut, that nobody has tied together. Much of this has an ordinary explanation, such as too little sleep, too much load or not enough fuel.
Think of inflammation as the body’s fire brigade. When there is an injury, an infection or a threat, it arrives, puts the fire out and goes home. The trouble starts when it doesn’t leave, and the signs can be as vague as waking tired, brain fog, bloating or weight that won’t shift.
CRP rises within hours of an infection, injury or flare and falls quickly once the cause settles, so it shows what is happening now. ESR changes more slowly and is also raised by age and anaemia. Both tell you that inflammation is present somewhere, but not where or why. A raised CRP after a cold or a hard training block usually settles, so the right step is often to repeat it once you are well. Normal markers do not rule everything out either, because lupus and early arthritis can both be active with a normal CRP. Inflammation also raises ferritin, which can hide true iron deficiency.
Before anyone reaches for a special test or a supplement, the rule is to get the base right first, then we can get fancy. Cut back on alcohol and stop smoking. Eat deep-sea fish about four times a week, or take fish oil; in a pooled analysis of 68 trials, marine omega-3 supplements lowered CRP. Eat the fibre in vegetables, legumes and wholegrains that feeds the gut; in a year-long study of 524 adults, those who ate the most fibre were 63 per cent less likely to have a raised CRP. Pick up a heavy weight, because working muscle releases myokines that have anti-inflammatory effects. And sleep: in more than 50,000 people, disturbed sleep was linked with higher CRP. Going to bed at eleven with the alarm at half past five cannot give you eight hours.
Soreness for a day or two after hard training is repair, much of it done in deep sleep. Recovery that has slowed over months usually means the balance between load and recovery has tipped, through short sleep, a training load that has crept up, life stress or not eating enough to fuel the work. Tendons are often managed the wrong way. They get stronger with load, not rest: in a trial of 58 people with long-standing Achilles pain, twelve weeks of heavy slow resistance training, slow and heavy calf raises three times a week with the weight increased as the tendon allowed, improved pain and function, and the gains held at one year. A flare along the way is normal, and recovery takes three to six months.
Scans can mislead as easily as blood tests. Disc degeneration shows up on the scans of most people with no back pain at all, and the proportion rises steadily with age. Imaging is most useful when its result will change the plan.
Disc degeneration on scans of people with no back pain at all, by age.
Some patterns point to inflammation rather than wear and tear: visibly swollen joints, morning stiffness lasting more than an hour, and pain where tendons attach to bone, such as the heel. For back pain, five features stand out.
Many people see a different practitioner for each problem: a physiotherapist for the knee, a dermatologist for the rash, a gastroenterologist for the gut and a GP for the tiredness. It is like calling a different tradesperson for every room when the fault is in the wiring. Our approach is to cluster the findings rather than chase each one, because three small clues pointing the same way say far more than any one alone. Antibody tests need the same care. A positive ANA is found in about one in seven people aged twelve and over, and most of them have no autoimmune disease.
Recognised patterns that link symptoms across different systems, and the condition each pattern can suggest.
Some symptoms need same-day attention: a hot, swollen joint with a fever, or, in people over 50, a new headache with scalp tenderness, jaw pain on chewing or a change in vision.
A 38-year-old runner has had pain in both Achilles tendons for a year, despite rest, physiotherapy and an injection. He also has back stiffness that lasts more than an hour each morning and eases once he starts running, he had a red, painful eye eighteen months ago, and his bowels have been unsettled. His CRP is normal. Each problem has been treated as a separate overuse injury. Read together, they describe axial spondyloarthritis, and the normal CRP does not exclude it. The next steps are a blood test for HLA-B27, a genetic marker carried by most people with this condition, an MRI of the pelvic joints and referral to a rheumatologist, because effective treatment exists and his tendon programme will work far better once the inflammation is controlled.
At My Performance Doctor, one doctor looks at your symptoms, results, training and history together, starts with the base, and looks harder when the pattern says the base is not the whole story. If you have a collection of symptoms that nobody has connected, a call with Robyn is a good place to start.
This article is general information and is not a substitute for individual medical advice. From the doctors at My Performance Doctor.