“When will it heal?” – Matt Jeffs, PT

Being asked this question all the time, I thought this would be a good opportunity to describe how our body’s cellular healing system performs after an injury. For this purpose, we’ll discuss four healing stages that normally follow common musculoskeletal strains and sprains.

Stage I: The Inflammatory Stage – The first 24 hours

Immediately after a soft tissue injury, fluid from damaged vessels leak into the area. Within minutes a clot made of ‘fibrin’ is formed to stabilize the wound site. White cells then migrate to the injury to clean up so infection won’t set in. Rest and immobilization is vital at this stage. Ice is also very helpful to mediate inflammation and control pain.

Stage II: The Granulation Stage – The second 24 hours

By the next day, capillary ‘budding’ is taking place. The body immediately repairs damaged vessels so that cellular transport can expand and accelerate. This granulation stage was named in olden times when ‘granules’ of growing capillaries could be observed in open wounds with the naked eye. Rest, ice and immobilization are still warranted.

Stage III: The Remodeling Stage – or ‘Fibroplastic’ Stage

Some of the cells that migrate to the area produce and lay down connective tissue. They’re called ‘fibroblasts’, and they fabricate the collagen that will replace the fibrin, just like filling in a dent in a car body. These cells need constant nutrition, so the vessel re-growth started in the previous stage is a key to progress. If a muscle is torn (strained), its highly vascular structure will allow secure scar formation in as little as one week. If a tendon or ligament is torn (sprained), it could take around a month to form secure scar because they’re far less vascular. These first few days or weeks are often a safe time to initiate gentle range-of-motion exercises in a sequence that begins with mild heating, followed by gentle exercise, finishing with ice to control inflammation.

Stage IV: The Maturation Stage

Chemical bonding between connective tissue strengthens during this stage. A steady retreat of those vessels rebuilt for the healing process occurs, too. The tougher tissue allows for more aggressive stretching and strengthening, usually within the second month. The connective tissue begins to draw closer to itself, becoming more compact and stronger. Resuming and maintaining activity at this stage is crucial so that no setbacks or complications can set in.

“So…When WILL it heal?”

Our understanding these basic steps and timeframes in simple soft-tissue healing can calm the anxiety associated with injury. We realize that we have to be patient and allow ‘Nature to take its course’. Proper nutrition, hydration and NOT smoking are keys to keeping this process moving forward on its expected schedule. If we eat properly, don’t become dehydrated (from too much alcohol or caffeine), and don’t smoke (which greatly impedes the healing process), the progression through a soft-tissue injury won’t be a life-altering event. We can be back in the game and up to full speed in a reasonable, predictable amount of time.