The dual roles of neutrophils and macrophages in inflammation: A critical balance between tissue damage and repair

Timothy A. Butterfield, Thomas M. Best, Mark A. Merrick

Research output: Contribution to journalReview articlepeer-review

262 Scopus citations


Objective: To discuss the acute phase of inflammatory response with a focus on the neutrophilic response and its role in inflammation. We discuss the relative balance between the need for inflammation to stimulate repair and the need to limit inflammation because of the additional damage it causes. Data Sources: We conducted a MEDLINE search from 1966 to 2005 for literature related to acute inflammation, muscle injury, and repair using combinations of the key words inflammation, neutrophil, macrophage, and cytokines. Additional literature was acquired through cross-referencing of bibliographies of articles obtained through the MEDLINE searches. Data Synthesis: We reviewed more than 200 relevant articles. Although neutrophils are an important cell population in acute inflammation, few athletic trainers are familiar with the neutrophil's actions or its dichotomous role as both perpetrator of tissue damage and initiator of repair. Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage by macrophages. These actions are orchestrated by numerous cytokines and the expression of their receptors, which represent a potential means for inhibiting selective aspects of inflammation. Conclusions: Neutrophils infiltrate injured tissues but can also be present after noninjurious exercise. These cells have both specific and nonspecific defensive immune system functions that can cause tissue damage in isolation or as sequelae to other tissue injury. It might seem that limiting the action of neutrophils would be clinically beneficial, but these cells are also responsible for initiating the reparative process that is later managed by macrophages. Although achieving a therapeutic balance between limiting inflammation and stimulating repair is important, the duplicitous roles of neutrophils and macrophages in both the inflammation and healing processes create a physiologic paradox for clinicians whose goals are to limit inflammation and to stimulate healing after acute soft tissue injury.

Original languageEnglish
Pages (from-to)457-465
Number of pages9
JournalJournal of Athletic Training
Issue number4
StatePublished - Oct 2006


  • Acute phase reaction
  • Soft tissue
  • Wound healing

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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