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Stages of Healing

Welcome to my first blog!


It has always been my opinion that to achieve the best results it is important that my clients have a good understanding of their injury and why they are receiving the treatment offered.


It is for that reason I thought the best place to start would be focusing on acute injuries with the stages of healing for tissue damage.


If you’ve ever wondered what happens at the injury site when you suffer a sudden injury and how that healing continues then you may like to have a read!


First things first..

What are the stages of healing, how long can you expect those stages to last and what’s the best course of action for optimal recovery?



Stage

Time Scale

Treatment

  1. Bleeding

Up to 6-8 hours

​PRICE principle

2. Inflammation

Up to 5 days

​Gentle active range of movement

Pain relief – no anti inflammatory

3. Proliferation

From 72 hour to several weeks

Exercise with caution with small progressions

Electrotherapy

4. Remodelling

From 3 weeks to 1 year +

Massage over scar tissue stretching collagen Strengthen structure Flexibility Proprioception Sports specific



Stage 1: Haemostasis (Bleeding)

Bleeding occurs due to damage to the blood vessels at the injury site. Within minutes of an injury red blood cells and platelets (thrombocytes) which carry growth factors and proteins to trigger the immune system are released from the damaged blood vessels and flow into the wound, aggregating at the site to form a fibrin clot. This clot controls the bleeding by preventing blood flowing out from the site of injury and bacteria flowing in.


Stage 2: Inflammation

The increase of fluid to the site causes swelling also known as oedema. After 48-72 hours white blood cells are attracted to the area to clear the site of any dead tissue, bacteria and pathogens in a process called phagocytosis. Once this dead tissue has been removed, swelling will subside and fibroblasts begin to form new tissue at the injury site. A fibroblast is a type of cell that is responsible for making the extracellular matrix and collagen.


Stage 3. Proliferation

For around one week, fibroblasts continue to migrate in the area to fill the wound with granulation tissue. Granulation tissue consists of newly formed capillaries and connective tissue. They then change to myofibroblasts which contain protein actin with contractile properties. This allows the wound to contract bringing the two ends of the together. Fibroblasts continually deposit new tissue over granulation tissue to form type 3 collagen creating a scar (Velnar, Bailey & Smrkolj, 2009)


Stage 4. Remodeling

The body continually breaks down the old tissue and remodels with new tissue until the final structure reaches around 50 - 80% of its original uninjured strength depending on the severity of the initial injury. The breakdown and synthesis of new tissue takes around 3 weeks. The phase of remodeling may last 1-2 years (Atkins, Kerr & Goodlad, 2010).


The speed of this whole process can be affected by many factors including and not exclusive to lifestyle choices such as smoking, excessive alcohol intake, fitness levels and poor nutrition with other factors beyond our control such as age and disease.


Treatment for injury is possible at each stage of the healing process to reduce pain and improve range of movement in order to maximise strength in the injured site in the later stages.

Atkins E, Kerr J, Goodland E (2010) A Practical Approach to Orthopaedic Medicine. Assessment Diagnosis and Treatment. (3rd Ed) Churchill Livingstone

Velnar, T., Bailey, T., Smrkolj, V. (2009) The wound healing process: An overview of the cellular and molecular mechanisms. The journal of international medical research, 37(5), 1528-1542.


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