The Healing Process

How soon will I recover? That is the probably the #1 question asked to physical therapists’. The time of healing depends on the many factors with the primary factor being the site of injury. Trauma can occur to brain tissue, organ tissue, bone, cartilage, and skin. In this article we will explore the healing process and discover the necessary time to heal specific tissues. Understanding how tissues heal is the basis of determining the appropriate course of treatment. This plan of care will determine how soon you will fully recover.

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Phases of tissue healing:

  • Homeostasis:

This phase occurs immediately after trauma. It is the physiologic response to warn your body that an area of your anatomy has been compromised. During this phase, the blood vessels constrict to minimize blood flow and blood clots form to minimize blood loss. If the skin is compromised, the blood clot is useful to reduce the influx of bacteria. However if heart vessels are damaged and blood clots are formed, this could cause something life threatening like a heart attack or stroke. This stage may last for about 3 hours.

  • stop-wrist-painInflammatory stage: 

Inflammation is the natural response to trauma. Capillaries dilate which allows for a large volume of blood that contains immune cells and fibroblasts to fight possible infection and begin repair. The influx of blood causes the redness seen in the skin and swelling seen at the site of injury. This stage usually takes 24-72 hours.

  • Proliferation:

During this stage of healing the injury site is rebuilt with new tissue. Collagen and extracellular matrix begin a process know as angiogenesis. this process develops a new network of blood vessels, bringing oxygen and nutrients to the site of injury for further regeneration and healing. Fibroblasts also produce healthy new connective tissues and vessels on the superficial surface of an injury during the healing. This new tissue is called granulation and is irregular in texture without bleeding easily. This helps to prevent re-injury during the healing process. This stage can vary between 4 days – 3 weeks.

  • Remodeling:

May begin close to the 3rd or 4th week of healing. Collagen fibers are still developing and the strength of scar tissue is slowly adapts in relation to the demands placed on the tissue. This is the reason why placing weight or tension on tissues in this stage is important. Conservatively stressing the muscles and connective tissues stimulates growth and improves range of motion and mobility. This is necessary to prevent muscle weakness, re- injury, and contractures. This stage may last up to 12 months

Healing Rate:

There are average rates for tissues, but healing time can differ between individuals based on a number of factors. These factors are comorbidities, age, medications, and activity level. However there is an average length of time each type of tissue heals. Healing generally goes from 50% in the first 2 weeks to 100% in 3 months. healing of tissues is also based on blood supply to the affected area. blood brings oxygen, nutrition, and repair agents to the site of injury allowing faster healing. Therefore tissues with less blood supply will take more time to heal.

  • Muscles =      2-4 weeks
  • Tendons =     4-6 weeks
  • Bones =          6-8 weeks
  • ligaments =  10-12 weeks
  • Cartilage =    12 weeks
  • Nerve injuries regenerates at about 3-4 mm per day

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R I C E:

The RICE method is the most popular way to aid the healing process after injury. R=rest I=ice C=compression E= elevate.

Though popular, the research is mixed on supporting up the claims of ice and in some cases excessive rest. To have a better understanding on why the research may be mixed we first need to understand what does ice does and how it aids the healing process if at all. Ice slows down blood flow and metabolic rate which reduced the oxygen needed at the site of injury. This is main idea behind using ice because the reduction in blood flow and metabolic rate reduces the sensation of throbbing pain.

  • The Problem

However, slowing down blood flow may not be the best thing. Remember from above that inflammation is one of the the 1st stages of healing and is a major component of the natural response to injury. When ice is used during inflammation, it impairs the natural healing response to injury. Another factor is rest, rest is necessary in moderation but too much rest can impair the healing process as well. the blood vessels takes contents to the site of injury but another system called the lymphatic system helps take the debris away. The lymph system and blood vessels needs the help of muscles to help pump the debris away from the injury site to reduce swelling, pain and clear the way for further repair to take place.

  • Traffic Jam

7457906740_9046c65fdd_bThink of an ambulance trying to get to the site of an accident but there is traffic blocking the roads. Now imagine that there are no tow trucks at the site to help clear the accident and help traffic flow through. The ice is acting as traffic slowing the ambulance from reaching the accident, and excessive rest is the road block with no assistance with clearing the accident and letting traffic through.

The inventor of the RICE method, Dr. Gabe Mirkin M.D, actually took back his statement and said, “anything that reduces inflammation also reduces healing.”

Remember research is still mixed on this topic so if the pain is absolutely too overwhelming, ice can be used to reduce pain and discomfort. Contrast baths are a great way to use ice and mobility at the same time to promote healing, see video here.

What To Do:

  • Protection: from further injury
  • Moderate rest: to allow healing
  • Mobility: to aid in swelling reduction and optimal tissue recovery
  • Compression: to reduce swelling
  • Elevation: to reduce swelling

Check out this video for a short visual of the healing process.

Thank you for your attention.

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Edited: Ffrancesca Famorcan

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References:
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261
Bleakley, CM and Davidson, GW. Cryotherapy and inflammation: evidence beyond the cardinal signs. Physical Therapy Reviews. Volume 15, Number 6, December 2010 , pp. 430-435(6).
Hubbard, TJ, Denegar, CR. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? J Athl Train. 2004 Jan-Mar; 39(1): 88–94.
Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med. 1986 Nov-Dec;3(6):398-414.
Mirkin, G. (2014, September 16). Why Ice Delays Recovery. Retrieved September 04, 2016, from http://www.drmirkin.com/fitness/why-i…
van den Bekerom MP1, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy Train. 2012 Jul-Aug;47(4):435-4
Broughton, G., 2nd, J. E. Janis, et al. (2006). “The basic science of wound healing.” Plast Reconstr Surg 117(7 Suppl): 12S-34S.
Cyr, L. M. and R. G. Ross (1998). “How controlled stress affects healing tissues.” Journal of Hand Therapy 11(2): 125-130.
Garrett, W. E., Jr. Muscle strain injuries: clinical and basic sciences. Med. Sci. Sports Exerc. 22:436-443, 1990.
Herring, S. A. Rehabilitation of muscle injuries. Med. Sci. Sports Exerc. 22:453-456, 1990.
Huard J., Y. Li , and F. H. Fu. Muscle injuries and repair. Current trends in reseach. J. Bone Joint Surg. Am. 84(5):822-832, 2002.
Kannus P. Immobilization or early mobilization after an acute soft-tissue injury?. Phys Sportsmed. 2000;28(3):55-63.
Chapter 9: Soft Tissue Damage and Healing
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