The Stages of Healing and The Role of Physio

April 20, 2019

 

A soft tissue injury is when there is damage to the muscles, tendons, and/or ligaments in the body. It commonly occurs after a sprain or strain, after a blow or a contusion, or after repetitive overuse. It can lead to swelling, bruising, pain, and loss of function. The recovery time for these injuries can vary depending on the time frame since injury, the severity of the damage, the location of the injury, and the healing processes that are occurring at the time (see my previous post here about factors that affect healing). But what exactly is happening during the healing process?

 

After a physical trauma, the balance of normal cellular function gets disrupted, and this triggers a cascade of physiological processes that ultimately leads to healing and repair. Understanding the stages of healing gives you more control over the pain and allows you to manage or accelerate the healing process to increase the likelihood of a complete recovery. These phases include the following:  inflammation (reaction), proliferation (repair), and maturation (remodel).

 

STAGE 1 (ACUTE) - INFLAMMATION


During the first 24 to 72 hours after an injury, an inflammatory response naturally begins at the injured site. An injury is termed “acute” from the initial time of injury and during the time that the pain, bleeding, swelling, and guarding are at the worst. It is during this stage that the PRICE (protect, rest, ice, compress, elevate) principle comes into effect in order to prevent further damage. Physiotherapy helps get through this phase by increasing blood flow to help bring healing nutrients and oxygen to the injured area while taking waste products away. Treatment is targeted at reducing pain, swelling, bruising, and spasms. This stage can last from several days to around a week.

 

STAGE 2 (SUB-ACUTE) - PROLIFERATION


An injury progresses to “sub-acute” when the tissues become less inflamed and begin to repair. This stage typically lasts between 6 to 8 weeks as your body starts to lay down new soft tissue. The need to protect your body during this phase is reduced as new tissue matures. However, this is also the stage at which undesirable scar tissue may begin to form. Physiotherapy is beneficial at this time to prevent excess scar tissue formation, to increase range of motion, to build strength in the damaged tissues, as well as to continue with relieving pain and promoting healing.

 

STAGE 3 (LATE) - MATURATION


The body does not just stop healing after 6 to 8 weeks post-injury. During the final phase of healing, normal function is gradually restored, and this process may take up to 3 to 12 months. Don’t be fooled into thinking that you are completely healed just because you no longer have pain. The healing tissues are reasonably mature, but as you continue to stretch, strengthen, and stress the newly formed tissues, you might find that it is not strong enough to cope with your increased physical demand. Physiotherapy is targeted at improving the flexibility, mobility, strength, and function of the soft tissues. In addition, it is important to assess the true cause of the injury and correct faulty mechanics or fix muscle imbalances in order to prevent future injuries from occurring. Work- or sport-retraining might be recommended at this stage to ensure safe return. 

 

It is important to realize that during the stages of healing, the tissues are vulnerable and more prone to re-injury. They are not as strong as they originally were, and unfortunately, they may never be. If chronic pain and/or dysfunction develops, different interventions are used to re-stimulate the injured area to begin the healing process again. 

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