Injuries: How long to heal? Part I: The Stages of Healing

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Posted on May 20, 2014 by pamofit

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.

 

• Part I:  The Stages of Healing
• Part 2:  The Type of Injury
• Part 3:  Your Impact on Healing

Part I: The Stages of Healing

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.

Acute

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:

• Rest /Mobilise: Rest is prescribed at this point to prevent further damage to tissue and to prevent you creating compensation patters and putting out the rest of your body!  Mobilisation is also suggested during this phase but maybe after 24 hours.  Now this does not mean going for a light job, this means a little passive movement is all at this point and remember – if it causes pain, STOP.
• Ice: Applying ice for about 10 minutes every 3-4 hours will help to manage the swelling.  Avoid heat! I am often asked when to use heat and when to use ice, just remember that heat on inflamed tissues, will inflame them more, so if it is acute stick to the ice.
• Compression:  Applying a compression bandage at this point can also help with managing the inflammation, but as with the ice, less is more.  Don’t cut off the blood supply as it is needed to fuel the new cells that are being created.
• Elevation: Finally elevating the ankle, knee, arm etc. will help the body with draining the dead cells away from the injury site.  Your body is busy so giving it a helping hand in this phase will help it work efficiently.

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.

Sub-Acute

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.

Remodelling/Chronic Stage

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.

 

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