30/08/2024
Unlocking the secrets of healing timelines! From initial inflammation to full recovery, understanding these phases is key to a strong comeback. Trust the process with expert guidance from our team. 💪🦴
Healing Time Frames – When we have an issue in the tissue
Our bodies do a fantastic job at healing injured tissue. This timeline of healing does depend on the severity of the injury, and the type of tissue injured. Having an understanding of this timeline is extremely helpful in predicting overall recovery time and setting realistic expectations. We are often impatient when it comes to returning to the activities we love, but not respecting this essential healing time can lead to ongoing pain and potential re-injury.
Ligament healing
Regardless of how severe the injury is, your body will undergo an inflammatory response to the injury in the first 2-3 days. During this phase, your body will utilise platelet cells to form a clot, which stops the localised bleeding into the injured area. If the injury is mild, the clot will be small and will form quicker, however more serve injuries may take a little longer than 2-3 days for this process to occur.
Next, the proliferation/repair phase begins and your body will start to lay down cells that will rebuild the ligament tissue. These cells will bridge the gap between the ends of the injured fibres, essentially forming a scar. This process starts around day 5 post-injury, but can last up to several weeks.
Lastly, once the scar tissue is formed, it must mature so that the fibres are well-organised, which gives the scar strength and resilience. It is important to appreciate that this process can take up to several months depending on how severe the injury is.
To put this in to context, ankle sprains are the most common ligament injury. Following those 3 phases of healing, a mild ankle sprain will take about 2-4 weeks to be healed and for the person to be returned to sport. A moderate ankle sprain is about 6-12 weeks, and severe sprain may take anywhere from 3 – 12 months to be feeling back to normal.
Having some knowledge about the healing time frames can also assist us in making good decisions around how to manage an injury. During the inflammation phase – it makes sense to allow our body to have this inflammatory response. We can then choose to avoid taking anti-inflammatory medications in those first few days post-injury, and this is in line with the PEACE & LOVE acrimony that is now considered the bets evidence based approached to acute injury management. During the proliferation/repair phase – we want to add controlled mechanical stress through the injured ligament in the form of appropriate exercise, to help stimulate the production of the ligament fibres. We also do not want to expose the ligament to high forces and unpredictable loads during this phase when we know the scar is not yet strong or mature. This means delaying a return to sport until we are well into the maturation phase of the healing process, which may be a little longer than you expect.
Muscle healing
Muscle healing is very similar to ligament healing. The injured muscle will undergo the same 3 step phases: inflammation, proliferation/repair and maturation. As muscles are our force-producing tissue, we must understand the impact an injury has on our strength, as well as flexibility.
The research tells us that by 4 weeks post-injury, a moderately injured muscle will have regained about 90% of the non-injured side. For some people, this may be sufficient for a return to usual activity, however maximal tensile strength may take up to 4 months to achieve in certain muscles, such as the hamstring.
Muscle tissue needs to be strong, but also flexible. If muscles heal in an inflexible manner, the muscle will be ‘stiffer’, and not absorb and distribute load as readily. Incorporating some eccentric type exercises into the rehab program, will help to ensure that muscle length and flexibility is maintained during the proliferation/repair phase, as eccentric exercise uses the muscle in a lengthening manner, as it contracts. There is a significant amount of research which demonstrates the importance of including eccentric exercise in the rehab protocol, particularly for hamstring and calf strains.
With this information in mind, we can expect that a mild muscle strain may take 2-3 weeks to heal, a moderate muscle strain anywhere from 4-16 weeks, and a severe muscle strain may take up to 6 months.
Bone healing
Bone healing is often more predictable than that of soft tissue. There is still a similar healing process that occurs. The bony callous/scar which starts forming after the inflammation phase winds down, can be seen on an x-ray at around 7-10 days post injury. Bone is typically considered ‘radiographically’ healed at the 6 week mark, where the fracture is no longer able to be identified on x-ray.
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