The dreaded question we face as therapists – ‘How long to heal?’. It is not because we don’t want to commit to a timeline but it is because there are so many variables to healing time that it truly is like asking
‘How long is a piece of string?’. To go some way to helping you understand the process and what you can do help the body along I have written a three piece blog on Injuries.
Healing is generally split into three stages – the Acute, Sub Acute and Remodelling stages. What you do in each of these stages can dictate not only the time for your injury to heal but the quality of the tissues post healing so it is important that from the very offset you take the correct actions to ensure a swift recovery.
Typically this is the first 1-3 days after the injury has occurred but can last longer depending on other factors. Once the injury has occurred the tissues have been damaged, blood vessels have been broken leading to cells dying around the injury site. Your body responds with an inflammatory response bringing the fluid and cells needed to kick start the healing process. Inflammation although necessary, needs to be managed. Too little and you can hinder the healing process, too much and suddenly it is affecting the development of the new tissues. In terms of protocol RICE and MICE are what you need to focus on:
In addition to the above, the only hands on work I would be looking at as a therapist is light strokes away from the actual injury to help reduce the inflammation and to help speed up the removal of the dead cells via your lymphatic system. Certainly no deep tissue action at this point.
This phase is the one I see as the ‘make or break’ in terms of healing quickly. This stage can last from 3 -21 days but can be even longer depending on the grade of the injury. At this point the body is turning the cells established in the acute phase in muscle fibers. Old damaged tissue is continually being replaced by new tissues. This is where we need to take heed to not re-damage the new tissue causing to heal poorly or to turn into stiff scar tissue.
At this point we need to mobilise the tissues gently. We want the scar tissue to be mobile, pliable and strong, not hard and sticky causing restriction. In the early stages the focus is again on passive mobilisation, light flushing techniques and being conscious of pain level. As this stage progresses we move toward slightly deeper strokes but steering clear of the deep techniques like friction. Heat can start to become useful in helping to relax the tissues if stiff. Proprioception work is also key, we need to ensure that the damaged tissues can function, helping them to remember how to contract, relax and move.
In terms of what you can do, this is where we start gentle stretching and rehabilitation. Your therapist will work out what is right for you so that you can start working on getting you back to your best. Too much too soon and you are back to square one so heed any advise given.
The damaged tissue has been replaced but now it needs to become stronger. This phase lasts from 3 weeks to many many weeks or months. Some research even suggests it can take years for collagen to be fully healed. Here we see the collagen fibers remodelled and reshaped to become strong and agile. What you do at this stage can still impact the quality of the fibers as stresses and strains lead to strengthening and thickening of the tissue.
As a therapist I am concerned with aiding this process, ensuring fibers are aligned in the right directions, breaking down adhesion’s and scars as they form to ensure plasticity in the tissue. In addition, we are working together to eradicate any compensation patterns that may have appeared from the earlier phases of healing.
You are progressively increasing the stretching, exercise and load to the tissues to get you back to your previous levels. As a rule of thumb increasing only by 10% per week to ensure a gradual return to form and helping to ensure you don’t cause re-injury.
I hope this helps you understand the phases you need to go through in healing and the work that is involved or to be avoided in each phase. Advise is key, don’t tough it out, see an expert and be confident that you are doing the right things.
Stay posted for the next installment which will look at what you have injured and to what degree and how that impacts the healing timeline.