Three Phases of Healing- These must occur after any soft
tissue injury.
The body has a predictable response that happens when there is tissue injury. The
reason for the order of response is to promote the best recovery and healing to the
injured area. The phases of healing have been broken down into 3 categories, though
there is some overlap.
1) Acute inflammatory phase – This is what happen immediately after the injury to
about 72 hours after the injury. It is an inflammatory response that is causes pain,
swelling, redness and warmth around the injured area. This is your body’s way of
protecting itself. The swelling causes stabilization in the area, just like when you can’t
move your neck after a car accident. The area gets warmer because blood is being
pooled in the area that actually causes the swelling. There are also chemical signals to
have “search and debris from the injured tissue or bacteria that may have made its way
into the area that might cause an infection. This reaction does not take place in a
chronic type might cause an infection. This reaction does not take place in a chronic
type injury, like the pain in a person’s wrist after typing too much.
2) Repair Phase – this is when the inflammation has gone down and your body
begins to repair the injured area. Your body will begin to lay down collagen to replace
the damaged tissue structure. Oxygen and vitamin C are necessary to aide in the
collagen formation. This process last from 72 hours to six weeks after the injury. The
structure of the collagen is unorganized at this point.
3) Remodeling Phase – once the collagen has been regenerated in the second
phase of healing, it is not is an alignment that will be very capable of withstanding any
stresses placed on it. The collagen is similar to sticky glue at first. It needs to be molded
in certain alignments in order to be able to perform the functional capabilities of the
tissue it is replacing. This phase is largely one of an improvement in the quality,
orientation and tensile strength of the collagen. This phase last from 3 weeks to 12
months (some research is showing up to 2 years).
Problems can occur if proper healing is not promoted in each phase.
1) While the initial inflammatory phase is one that protects us, it can cause problems
as well. If the inflammation gets out of control, it can spread to areas that are not
injured, or last for periods of time longer than what is needed. Since the inflammatory
phase sends out search and destroy chemicals, it may break down some of the healthy
tissue. Also, the swelling causes a splinting of the joint. There is tons of literature
showing early passive motion is one of the best therapeutic interventions that can be
taken early on after the injury.
2) Inadequate levels of nutrients (mainly vitamin C and oxygen) from either
inadequate dietary intake or poor transport through the vascular system can lead to
poor tissue formation, increase in pain and more probable susceptibility to injury later on.
3) The new collagen that is laid down is always irregular. The tissue before the
injury is made up of type I collagen, while the tissue used to repair the injured tissue is
the immature type III collagen, a weaker, stiffer type of tissue. This means that it will
never be as good as the tissue was before it got injured. The type III collagen is also not
formed to fit properly, it must be remodeled. If there is not an appropriate stress placed
on it that causes it to properly realign without re-injuring the tissue, the final result will be
an even weaker, less elastic scar tissue. It really is all about getting the best results with
what you have to work with so that you can have the best quality of life.
Therapeutic strategies
1) Never ice past the first 72 hours. There is some debate over the use of ice at all.
I use it depending on other factors in the person’s presentation.
2) Heat is better used after 72 hours. While there are some benefits to using heat
early, there are still some problems with it a well.
3) The prescription of “bed rest” or “take it easy” is no longer advisable. There is
significant amount of data out there showing that this actually makes the condition
worse. Early intervention through mobilization is absolutely critical to recovery.
4) Brace only in times of fracture or dislocation. Bracing for strains or sprains is not
advisable. As a matter of fact, most people are finding out that casting a broken bone
has many unwanted side effects as well. Some doctors are putting their patients in cast
that can be removed in order to keep motion in areas not primarily involved. This not
only prevents problems in other joints, but also improves healing in the injured area.
Motion is your key to recovery.
5) Therapy is passive (meaning the patient does not perform any of the movements)
for the beginning states of the treatment program. Then light, pain free active (patient
does the work) activities can be implemented.
6) Address nutritional needs. Your body’s biochemistry can mean the difference
between a successful recovery and one that lingers on and never gets the best results.
This aspect of recovery is way under appreciated
7) Pain free does not necessarily mean all is well. The pain will usually begin to
subside in the second phase of healing. The tissue may have not been completely
rehabilitated by that point. Make sure you do not short change your therapy. You only
have a short window of recovery. If you put it off now, you will pay for it later.
tissue injury.
The body has a predictable response that happens when there is tissue injury. The
reason for the order of response is to promote the best recovery and healing to the
injured area. The phases of healing have been broken down into 3 categories, though
there is some overlap.
1) Acute inflammatory phase – This is what happen immediately after the injury to
about 72 hours after the injury. It is an inflammatory response that is causes pain,
swelling, redness and warmth around the injured area. This is your body’s way of
protecting itself. The swelling causes stabilization in the area, just like when you can’t
move your neck after a car accident. The area gets warmer because blood is being
pooled in the area that actually causes the swelling. There are also chemical signals to
have “search and debris from the injured tissue or bacteria that may have made its way
into the area that might cause an infection. This reaction does not take place in a
chronic type might cause an infection. This reaction does not take place in a chronic
type injury, like the pain in a person’s wrist after typing too much.
2) Repair Phase – this is when the inflammation has gone down and your body
begins to repair the injured area. Your body will begin to lay down collagen to replace
the damaged tissue structure. Oxygen and vitamin C are necessary to aide in the
collagen formation. This process last from 72 hours to six weeks after the injury. The
structure of the collagen is unorganized at this point.
3) Remodeling Phase – once the collagen has been regenerated in the second
phase of healing, it is not is an alignment that will be very capable of withstanding any
stresses placed on it. The collagen is similar to sticky glue at first. It needs to be molded
in certain alignments in order to be able to perform the functional capabilities of the
tissue it is replacing. This phase is largely one of an improvement in the quality,
orientation and tensile strength of the collagen. This phase last from 3 weeks to 12
months (some research is showing up to 2 years).
Problems can occur if proper healing is not promoted in each phase.
1) While the initial inflammatory phase is one that protects us, it can cause problems
as well. If the inflammation gets out of control, it can spread to areas that are not
injured, or last for periods of time longer than what is needed. Since the inflammatory
phase sends out search and destroy chemicals, it may break down some of the healthy
tissue. Also, the swelling causes a splinting of the joint. There is tons of literature
showing early passive motion is one of the best therapeutic interventions that can be
taken early on after the injury.
2) Inadequate levels of nutrients (mainly vitamin C and oxygen) from either
inadequate dietary intake or poor transport through the vascular system can lead to
poor tissue formation, increase in pain and more probable susceptibility to injury later on.
3) The new collagen that is laid down is always irregular. The tissue before the
injury is made up of type I collagen, while the tissue used to repair the injured tissue is
the immature type III collagen, a weaker, stiffer type of tissue. This means that it will
never be as good as the tissue was before it got injured. The type III collagen is also not
formed to fit properly, it must be remodeled. If there is not an appropriate stress placed
on it that causes it to properly realign without re-injuring the tissue, the final result will be
an even weaker, less elastic scar tissue. It really is all about getting the best results with
what you have to work with so that you can have the best quality of life.
Therapeutic strategies
1) Never ice past the first 72 hours. There is some debate over the use of ice at all.
I use it depending on other factors in the person’s presentation.
2) Heat is better used after 72 hours. While there are some benefits to using heat
early, there are still some problems with it a well.
3) The prescription of “bed rest” or “take it easy” is no longer advisable. There is
significant amount of data out there showing that this actually makes the condition
worse. Early intervention through mobilization is absolutely critical to recovery.
4) Brace only in times of fracture or dislocation. Bracing for strains or sprains is not
advisable. As a matter of fact, most people are finding out that casting a broken bone
has many unwanted side effects as well. Some doctors are putting their patients in cast
that can be removed in order to keep motion in areas not primarily involved. This not
only prevents problems in other joints, but also improves healing in the injured area.
Motion is your key to recovery.
5) Therapy is passive (meaning the patient does not perform any of the movements)
for the beginning states of the treatment program. Then light, pain free active (patient
does the work) activities can be implemented.
6) Address nutritional needs. Your body’s biochemistry can mean the difference
between a successful recovery and one that lingers on and never gets the best results.
This aspect of recovery is way under appreciated
7) Pain free does not necessarily mean all is well. The pain will usually begin to
subside in the second phase of healing. The tissue may have not been completely
rehabilitated by that point. Make sure you do not short change your therapy. You only
have a short window of recovery. If you put it off now, you will pay for it later.
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