I recently did a short blog about Sprains and Strains but whether it is a mild, moderate or severe injury to a muscle, tendon or ligament the healing process will follow a similar path.

1st or 4th Stage?

The reason for asking if there is a 4th stage of healing is that in some text books there is an initial stage of healing called ‘hemostasis’ – this is normally when there is an open wound involving blood loss.

This stage happens extremely quickly, blood vessels constrict to reduce the blood flow and the blood forms a clot to cover the injury site and prevent any further blood loss. We can help this stage usually by compressing the site to help stem the flow and allow the clot to take place, hopefully this will help control the injury before needing to seek medical advice.

However, for the purpose of this blog we are interested in the injuries that don’t involve lots of blood and therefore the initial stage of hemostasis can be disregarded for the time being.

Stage 1 – Acute / Inflammatory Stage

• There are often said to be 5 signs of injury – heat, redness, swelling, pain and reduced range of motion – all of which are normally seen at this acute stage.
• Inflammation is a natural part of the healing process and tends to last up to 3 days (72 hours) from the time of injury.
• When an injury first occurs the injured blood vessels leak and cause swelling in the area, this fluid contains water, salts and protein and allows healing and repair at the site of the wound.
• The area becomes red and warm due to the increase of blood reaching the injured tissue, the white blood cells that are within the blood help control infection.
• The increase of blood flow and the increase in fluid in the area are bringing vital nutrients and removing bacteria from the area which is all important in this first stage of healing.
• The main aim at this point is to prevent any further damage to the area and also to try and reduce pain – this is where RICE/POLICE come into play but that is for another blog.

Stage 2 – Post Acute / Proliferation Stage

• This stage normally lasts from 3 days up to 3 weeks (21 days) and during this stage it is good to try and exercise the injured area (within your pain tolerance) to increase the range of motion and flexibility as well as the strength.
• There will very likely still be swelling, bruising and a limited range of motion but hopefully the initial inflammation and pain will have subsided somewhat.
• New tissue, which is made up primarily of collagen (a protein that supports soft tissue growth and repair) is being laid down at the site of the wound, so as the new tissue starts to grow the wound contracts and new blood vessels are constructed to ensure nutrients and oxygen get to the new tissue. 
• (With skin damage, new skin cells are generated – these grow quicker when the wounds are kept moist and hydrated – hence the popularity of Compeed plasters for things like blisters).
• The new tissue will lay down haphazardly to repair the wound so a gentle hands on treatment at this time may help reduce the build up of any scar tissue adhesion and allow for stronger long term healing.

Stage 3 – Chronic / Remodelling Stage

• This stage normally starts around Day 21 and can continue for weeks, months and potentially even longer depending on the severity of the injury and other factors.
• Bruising, swelling and pain should have reduced considerably by now but it is still important to follow medical advice to try and reduce the risk of any recurrence – too many people rush back to the activity too soon and often end up back injured.
• Increasing strength, increasing stretching, increasing flexibility and range of motion of the injured area is important and exercises are normally recommended to help with this.
• Soft Tissue Manipulation is also a good idea at this stage as it helps align the new tissue (reducing scar tissue build up), increase circulation and therefore speed up the healing process.
• It’s a very difficult time for sports people especially as they feel like the injury is getting there and they are good to go but it is very important to be patient.

Summary

So as you can see there are 3 stages of healing when it comes to soft tissue injuries and the timings of these injuries are going to follow a similar pattern but there will be overlapping and as I have said in previous blogs – everybody is different.

There are numerous factors that can affect the speed and ability of an injury to repair, such as age, current fitness levels, gender, weight (both over and under), underlying conditions, medications, smoking, drinking and plenty of other factors.

Ideally, we don’t get injured in the first place but if we do then we need to be patient, follow the instructions of any medical personnel or our sports therapist and try to do things that help the healing process.

Thanks for reading and if you want to talk more about this or any of my other blogs then please don’t hesitate to ask and don’t forget to book in for a treatment whether it’s for prevention, maintenance or recovery – be good to yourself and see you soon.

Paul