Let the Healing Begin

Fri, Oct 30, 2009

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I’ve previously talked about soft tissue injuries, more specifically shoulder sprains. In that post, I talked about how ligaments get injured and I brushed on the fact that it takes a long time for soft tissue like ligaments, tendons, and muscles to heal. The process is essentially separated into three stages.

Stage I – The first 72 hours.

Active Phase – This is the first six hours, where hemorrhaging occurs and something called myofibril retraction (when the cells that make up muscles pull apart to open up wounds) occurs. The combination of these promotes bleeding to get out toxins and prevent bacteria from entering the body. If there’s no open wound, vasodilation of blood vessels occurs, which causes redness and swelling of the injured area. During this, cytokines (which cause pain and inflammation) and cellular contents are leaked into the space between cells, causing edema, or swelling. This stops when a clot is formed in the capillaries that are ruptured to stop the bleeding.
Passive Phase -This is when the bleeding stops. Cooling the tissue with ice can limit the inflammation if applied within minutes of the injury. Also, icing can prevent secondary cell death.
Acute Phase – This starts on the tail end of the 24 -72 hours, and finishes in two weeks. During this time the tissue is very fragile from enzymes in the interstitial space, painful from cytokines irritating nerves in the fluid during edema, and also the tissue ends up dying due to the lack of nutrients getting to the cells.

During this stage, it’s important to remember the acronym: PRICES. Protect/immobilize, Rest (or exercise below threshold of pain), Ice (sooner the better), Compression, Elevate, and Support (whether by crutches or braces). It’s important to not re-injure the clot because this prolongs the inflammation and causes collateral damage to other structures in the area. This is actually the number one cause of perpetuating inflammation. You can treat this stage using COX inhibitors (like tumeric) or using therapeutic levels NSAIDs (TALK TO YOUR DOCTOR BEFORE YOU DO THIS). Massage to tolerance, not at the site of injury. Ultrasound and electrical stimulation may also be used.

Stage II – 48 hours to 2 weeks.

This is when tissue is replaced with scar tissue. The only areas that are replaced with normal tissue are areas where mucosa is present. This includes the inside of your mouth and your gastrointestinal system. Elsewhere, granulation/scar tissue is formed that provides protection to the injured areas, and your blood vessels proliferate to allow for healing to begin. This is when rehab begins to become important.

You see, scar tissue is made of cells called fibroblasts that line up according to lines of stress. During this stage, Graston massage is a great way to get these to line up appropriately. It’s important to realize that even at the end of this two week period, the scar tissue only has 15% of its original strength. So even though the pain is gone, it’s not smart to over work yourself because re-injury is still a factor here!

Taking vitamin support like vitamin C (to help build up collagen), iron, zinc, copper, manganese, magnesium, B complex, methionine, and glucosamine sulfate helps this stage progress as smoothly as possible. Also, switching from ice to heat may also help. Cross friction massage as well as Graston massage help to align scar tissue.

Stage III – 3 weeks to 2 YEARS(!!!).

Yep, depending on the injury, this can take up to two years to complete. The more vascularized structures are, the quicker they heal. So skin and muscles can be as quick as 3 weeks. Bones can take around 3 months to heal, while ligaments can take up to 2 years to heal! In all of these cases, the maximum strength that will be achieved will be between 75-90% of the original strength. This is when rehab will be most important. This is to increase range of motion and increase strength as much as you can.

So here’s the recap:

Stage I – Limit pain and inflammation through NSAIDS and “PRICES.”
Stage II – It may start to feel better, but it may ache. You still need to protect it. It’s important to stress nutrition for healing.
Stage III – It could possibly be tender to the touch, and rehabilitation is what is needed.

Image Credit: pointsinthepaint.wordpress.com