Now that we have established that your injury needs to go through a number of stages and processes to heal the next step is to establish is the type of injury. There are two aspects that I will consider here ‘What tissue is damaged?’ and ‘How badly is it damaged?’.
‘What’ you have damaged makes a significant difference to healing time whether it is muscle, tendon or ligament can be the difference in weeks and months when it comes to healing:
Muscle: Muscle is a collection of cells, fibres, nerves and blood vessels that work together to allow movement within the body. These fibres have contractile properties which allow the muscle to change in length and tone which in turn impacts on the other connective tissues within the body to move our joints , they create movement. Due to this high level of movement and contraction they are susceptible to injury when they are overloaded, overstretched and overworked. On the up side, due to the high vascular element of the tissue they heal well and heal relatively quickly compared with Tendon Strains and Ligament Sprains.
Tendon: Tendons are made up of densely packed collagen fibres which allow them greater tensile strength needed to connect muscles to bones to allow movement. The tendon fibres consist of ‘crimps’ which allow a level of flexibility or elasticity allowing a little ‘spring’ action. Given their whiter appearance you have probably guessed that they are less well serviced by blood vessels so although stronger and less at risk of injury than muscle, healing times are longer as a result and require specific care and attention if they are to heal well.
Ligament: The poorest healer of the bunch! Although similar to tendon in that they are made up of dense collagen fibres, they are arranged in a more ‘criss –cross’ pattern than parallel rendering them tougher than tendons, but as a result there is very little elastiscity. Their function is to connect bone to bone, not to facilitate movement but to prevent ‘over’ movement. Serviced poorly by blood vessels they tend to rely largely on the vascular supply to the synovial joint. It is no wonder that when sprained, torn or over stretched they struggle to return to their original length or to heal.
It is possible you may have damaged more than one of these types of tissue, so early assessment is important to establish the extent of your injury and to advise on what you need to do to look after your injury appropriately.
Next up is the degree of injury. Some ankle sprains take days to heal while others take weeks, the difference can simply be how ‘damaged’ the area was to start with.
Grade 1 – A mild injury with pain and swelling local to the injury site. There may be some weakness in the muscle or reduction in strength but function remains. Post swelling there may be tenderness in and around the injury site. These types of injuries tend to fall into the 14-21 day healing time frame.
Grade 2 – A moderate injury or partial tear to the tissues involved. Although similar in symptoms to a Grade 1 injury the symptoms are more pronounced, pain levels are higher, bruising may be deeper and muscle function impacted to a greater degree. The stages of healing take longer as more fibres have been damaged. Healing time starts to increase and can double the healing time of a grade 1 injury.
Grade 3 – A severe injury that sometimes means a complete sever to the tissue e.g. ligament has completely severed and is no longer attached to the bone. Often this type of injury is not painful as the nerve may have been completely severed. What is clear is that there will be a complete loss in function of the muscle. Surgical intervention may be required so it is vital that you go to A&E for assessment immediately if this is the case. Healing time as you may expect can almost double again leading to months instead of weeks before you are back on your feet.
In writing this down it reminds me how important it is that you look after your injury correctly. My own experience (if only I knew then what I know now!!) a grade 2 ankle sprain that I rested for 3 months, returned to squash and ‘pushed through’ the instability and sometimes pain only to have to stop playing a month later. 18 months and surgery later I was back on a squash court finally ready to play. What should have been a simple rehab became a two year nightmare as I did not listen to my body and seek further advice after the initial rehabilitation phase! Every person and every injury is different so get assessed, heed advice and most importantly LISTEN to your body, if it hurts – stop!
In the final installment ‘You’ I will discuss how you play the biggest part in your own healing and what you can do to maximise your bodies healing power.
Part 1 – The Stages of Healing: http://www.pamofit.co.uk/2014/05/injuries-how-long-to-heal-part-i-stages.html