Soft Tissue Healing
There are many factors that can cause injury which then leads to an intelligent healing process. The body is required to go through the full phase of each stage, keeping in mind that stages overlap and each individual will go through the phases in a unique way.
We don’t want to stop or inhibit any of the phases, we want to give our bodies the right environment to accelerate them. These phases range from hours-to-weeks-to-months and even year/s. Each phase will peak at different times, for which the timescales will vary based largely on health status and lifestyle choices of that individual.
Please see below table for more information on these phases. Please bear in mind that this is general information based upon the average person with an average injury with the average medical history:
Healing process example:
Healing phase: Bleeding in the tissue
Timeframe: 4-6 hours
Role: Protection phase
Healing Phase: Inflammation, which when acute, is completely normal and necessary
Peak reaction after 1-3 days and may last for 2-3 weeks
Role: Repair phase
Healing Phase: Proliferation, where the damaged tissue is building scar tissue
Rapid onset 24-48 hours and reaches a peak after 2-3 weeks, lasting 4-6 months
Role: Repair phase
Healing Phase: Remodelling, where the scar tissue closely resembles the parent tissue and requires movement to be functional
Starts after week one, peaking after 2-3 weeks
Role: Repair phase
The above Information was reviewed from Soft Tissue Repair and Healing Review by Tim Watson (2017).
Inflammation is a hot topic amongst doctors and physical therapists in 2019 and we have already suggested that inflammation is a natural and important part of healing. That implies that it is part of an acute injury and it will disappear, given the right environment. Inflammation isn’t beneficial when it becomes a persistent (on going), daily occurrence. Also, be aware that stimulating an inflammatory reaction doesn’t always require injury.
Other factors that can cause tissue damage and swelling may include:
– Repeated micro trauma (for example, shoulder injury in the gym and then the same workout/weights/load is continued causing the pain to worsen)
– Autoimmune disease (for example, rheumatoid arthritis may lead to joint problems due to the nature of the disease)
– Excessive heating and cooling of an area
– An infection (for example following a severe fracture)
– Persistent stress (lifestyle/nutrition/psychological/emotional)
If tissue experiences delayed healing for any number of reasons (physical, nutritional, psychological/emotional) then it may increase the time required to successfully move through the healing process. This may result in delayed return to sport activities or movement goals may take longer to achieve.
In our clinical experience, it is the delay in return to sports or restricted movements or pain that motivate individuals to seek the support of a physical therapist for a rehabilitation plan.
Here is an Proactive Being overview to help you better understand the process of injury.
1. Physiotherapists and Osteopaths (collectively known as physical therapists) are known for being good at assessing and diagnosing injury. After the assessment process, which is typically a face-to-face process, or sometimes over the phone, you will often be provided with a set of exercises plus other self-management strategies that you can do as part of your daily routine. Advice provided and the plan given should help to stimulate the healing process, so it is important to listen carefully and ask questions where appropriate.
2. A rehabilitation goal is usually always around supporting an individual to get back to the activities and sports that they enjoy; return the affected area to full movement, without pain.
3. More likely than not, individuals will be advised to keep active but to modify or change the activities or sports that they do in order to speed up the healing process. An open minded approach is extremely beneficial.
4. Depending on how long the individual has had an injury and the injury type, advice may be given to exercise in a pain-free range of movement, which will provide the necessary environment for the body to go through the phases of healing.
5. It is important to understand the healing phases and remember that you can’t skip straight to the final phase (everything in life is a process after all!) but you can facilitate getting there efficiently and effectively using self-management strategies.
6. Following injury scar tissue will be built. To build quality scar tissue, that mirrors the parent tissue as closely as possible, requires quality movement. This means putting weight through your joints and soft tissues, even if this means using walking aids for a short period of time to reduce the weight-bearing/load through a joint and soft tissues.
7. There is growing evidence that suggests that non-steroidal anti-inflammatory drugs (NSAIDs) have a negative effect on the initial healing process following an acute injury (Wheeler, P. and M. E. Batt (2005). *Please note that the majority of these studies have been carried out on animal subjects.
Using the current evidence, it has been suggested to avoid using NSAIDs for the first 2-3 weeks following acute injury, to allow the inflammatory process to move undisturbed through the phase.
Most importantly, please seek specific advice for your circumstances.
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