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Phases of healing

 

Soft tissue injuries go through 3 phases en route to recovery:

  1. Inflammatory phase
  2. Fibroblastic/Proliferation phase
  3. Remodelling phase.

 

Let’s discuss each phase -
(remember that injuries differ and that the times stated below are guidelines so do overlap with each other)

 

  1. Inflammatory phase

When soft tissue structures (muscles, ligaments etc.) are torn during an injuring event, blood vessels may also be damaged and localized bleeding will occur.
Blood vessels respond to trauma by narrowing their diameter (known as ‘vasoconstriction’), slowing bleeding and allowing the opportunity for a blood clot to form. The blood clot “plugs” the ruptured blood vessels at injury site.

About an hour after the injury, blood vessels start to widen their diameter (known as ‘vasodilation’), to allow the influx of various inflammatory cells, antibodies etc. to the area. These cells are the clean up crew of the injury’s debris and the builders of new muscles cells.
[Phagocytes, for example, are cells that are directed to the injury site and act as antibodies that destroy bacteria and dead cells from the area.]

Even though the inflammatory phase is still very early in the healing process, the laying down of collagen (the protein building blocks of muscles) is initiated here. 
[The type of collagen laid down in the inflammatory phase is not as strong as the type of collagen of the Proliferation phase.]

What to expect:
During the inflammatory phase you will experience more pain than in the other phases. The reason for this is the chemical irritation of the nerve endings by the swelling and bleeding at the site of injury. 

Time line:
The inflammatory phase is set in motion by the injury and can last up to 6 days. In some cases it can last up to two weeks.

 

  1. Fibroblastic/Proliferation Phase 

The proliferation phase is also known as the repair phase. 
It is in this phase that “wound contraction” happens, i.e. the wound starts closing as the margins of muscle fibres are pulled together. 
The most important aspect of this phase is that lots of collagen (protein building blocks) is being laid down, and more collagen means increased tensile strength of the muscle fibers at the injury site. 
[Tensile strength refers to the resistance the muscle fibers have to being torn.]

Time line:
The proliferation phase can start as anywhere from between the fourth day after injury to 2 - 3 weeks after the injury. In some cases this phase can last 2 -1 2 weeks.

 

  1. Remodelling phase 

The remodelling phase is the last of the 3 phases of healing. 
In this phase the collagen that was laid down in the proliferation phase is being matured and the final orientation and alignment of collagen fibres is completed.
At the end of this phase, muscle tissue’s integrity and strength starts to returned to normal but is still vulnerable. Careful loading of the previously injured tissue is advised.

Time line:
The remodeling phase can range from 2 - 4 weeks after injury, and can last up to 6 - 12 months post injury.