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.  

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