Updated: Feb 11
When we injure a soft tissue during sport or daily activity a process is initiated to promote repair of these tissues. The stages of a repair guide us to what treatment is available to us to help facilitate this process. These stages are; Injury, Inflammation, Repair and Remodelling and are typically overlapping with one initiating the other to provide a continuum. The initial injury initiates a reactive phase and promotes changes leading to cell death. This cell death brings on chemical release promoting bleeding for a number of hours afterwards. A blood clot will form and initiate inflammation with a cascade of chemicals to promote a vascular and cellular response cleaning and stimulating the next phase. Signs of inflammation are heat, redness, swelling and pain plus a reduction or loss of function. Many people think we can somehow control or alter this reaction with medication or ice. These have been shown to hinder this response and delay muscle repair, analgesics may be taken to reduce pain. Inflammation would tend to last up to 3 days, during this time we need to provide protection as this is an acute response we do not want to interfere with this process. At this stage, we can provide some immobilisation and promote rest and unloading of tissues.
The next phase begins the sub-acute tissue repair, this can last a number of weeks and we can now begin with the gradual return of movement and mechanical loading. We must monitor this load to first return ROM and not re-damage tissue from excessive loading. This may begin with passive movements followed by active, then active with resistance. We may see repeats of inflammation during this period as tissues are healing, it is important to subject tissue to mild stress and there may be mild discomfort which is indicating tissue is being stimulated to remodel.
The next stage is remodelling which overlaps repair and can continue for weeks and even months depending on tissue damage. During this period we are rebuilding the strength and function of the tissue. Individual tissue type and individual persons will respond differently to remodelling and loading. During this stage we are heading towards a return to normal activities, this is also a time to be very careful not to try too hard too soon. We need to keep promoting load and stimulation for tissue to grow and strengthen. There is a high risk of re-injury as some people feel no further need for rehab or monitoring, our aim here is to promote self-management of load and recovery.
Tissue Healing Times.
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