Chronic Low-Grade Inflammation: The Silent Spark Behind Pain and Disease

By Dr. John Mishock, PT, DPT, DC 

 

We often think of inflammation as something visible, like the swelling after an ankle sprain or the redness around a cut. But there’s another, quieter form of inflammation that may be the true villain behind chronic pain, fatigue, and even life-threatening diseases: chronic low-grade inflammation.

This hidden form of inflammation doesn’t cause immediate pain or swelling. Instead, it slowly simmers beneath the surface, damaging tissues, disrupting organ function, and accelerating aging. Mounting research links chronic inflammation to nearly every modern chronic disease, from heart disease and diabetes to arthritis, depression, and even cancer.

What Is Chronic Low-Grade Inflammation?

Unlike acute inflammation (which helps heal injury), chronic low-grade inflammation is a persistent, body-wide immune response to subtle threats: processed food, stress, poor sleep, sedentary lifestyle, pollution, or even hidden infections. Over time, it becomes self-sustaining. According to researchers at Harvard Medical School, “chronic inflammation is a common denominator in many diseases,” including neurodegenerative, cardiovascular, metabolic, and musculoskeletal disorders (Furman et al., Nature Medicine, 2019).

How does inflammation affect our organs?

Visceral inflammation – that is, inflammation affecting the internal organs, has profound systemic effects:

• Heart Disease: Inflammation accelerates the formation and rupture of arterial plaques. High-sensitivity C-reactive protein (hs-CRP) is a strong predictor of heart attack risk (Ridker et al., New England Journal of Medicine, 2002).
• Diabetes: Inflammatory cytokines interfere with insulin signaling, promoting insulin resistance and fat accumulation (Hotamisligil et al., Nature, 2006).
• Gut Disorders: Chronic inflammation alters the intestinal barrier, leading to conditions like irritable bowel syndrome (IBS), Crohn’s, and “leaky gut” (Turner, Current Opinion in Gastroenterology, 2009).
• Brain Health: Systemic inflammation crosses the blood-brain barrier, contributing to depression, Alzheimer’s, and cognitive decline (Holmes et al., Neurology, 2009).

How does chronic inflammation affect our muscles and joints?

In my clinical practice, I regularly see patients whose joint or muscle pain persists long after an injury heals. Often, this is driven not by structural damage, but by low-grade inflammation that keeps pain receptors overactive.

• Osteoarthritis: Once thought to be only “wear and tear,” OA is now known to have a strong inflammatory component. Synovial inflammation predicts joint damage and pain severity (Sokolove & Lepus, Nature Reviews Rheumatology, 2013).
• Tendinopathy: Chronic tendon pain, from the Achilles to the rotator cuff, often involves low-grade, non-resolving inflammation disrupting tendon healing (Dean et al., British Journal of Sports Medicine, 2016).
• Back Pain: Studies using MRI and inflammatory markers show that systemic inflammation contributes to nonspecific low back pain (Bautmans et al., Clinical Rheumatology, 2009).

Why does this matter for chronic pain?

When inflammation is chronic, even small triggers such as prolonged sitting, stress, or mild overuse can flare up pain. Inflammatory mediators like IL-6, TNF-α, and prostaglandins activate and sensitize nociceptors (pain-sensing nerves), amplifying discomfort and disrupting tissue repair (Marchand et al., Physiology Reviews, 2005).

What are the hidden triggers that keep this fire burning?

1. Ultra-Processed Foods: Diets high in refined sugar, seed oils, and preservatives activate our immune system, releasing cytokines (inflammatory mediators), sustaining inflammation (Monteiro et al., Public Health Nutrition, 2018).
2. Sleep Deprivation: Poor sleep increases inflammatory markers like IL-6 and TNF-α (Irwin, Archives of Internal Medicine, 2006).
3. Stress: Chronic stress activates areas of the brain (HPA axis), leading to stress hormone (cortisol dysregulation) and immune system dysfunction (Black & Slavich, Neuroscience & Biobehavioral Reviews, 2016).
4. Sedentary Behavior: Lack of movement leads to visceral fat accumulation, a known pro-inflammatory depot (Fantuzzi, Immunologic Research, 2005).

What are evidence-based solutions to combat inflammation?

As a physical therapist and chiropractor, I help patients reverse this invisible inflammation through a multi-pronged lifestyle approach:

1. Anti-Inflammatory Diet: Emphasize leafy greens, omega-3s, wild fish, nuts, turmeric, ginger, and polyphenol-rich berries. Avoid processed sugars and refined carbs.
2. Exercise: Moderate aerobic and resistance training reduces systemic inflammation and boosts anti-inflammatory cytokines like IL-10 (Petersen & Pedersen, Journal of Applied Physiology, 2005).
3. Therapeutic Movement & Manual Therapy: Controlled physical therapy restores joint mechanics, reduces local inflammation, and improves circulation.
4. Mind-Body Practices: Deep breathing, mindfulness, and stress resilience training lower cortisol and inflammatory response.
5. Sleep Optimization: 7-9 hours of restorative sleep improves immune regulation and lowers inflammatory markers (Irwin, 2015).

Final Thoughts

Inflammation doesn’t always roar. Sometimes it whispers; silently damaging organs, sensitizing nerves, and setting the stage for chronic illness and pain. The good news is that chronic low-grade inflammation is not inevitable. It’s reversible.

By addressing lifestyle, nutrition, movement, and stress, we can turn off the internal fire, reclaim our health, and prevent future disease.

Don’t treat the smoke, extinguish the fire.

We can help!

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call: locations in Gilbertsville (610-327-2600), Skippack (610-584-1400) , Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800)  at www.mishockpt.com or request your appointment by clicking here.

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.