Four Stages Of Soft Tissue Repair and Wound Healing

Posted by on 3/21/2018 to Healing Process
Four Stages Of Soft Tissue Repair and Wound Healing
An understanding of the healing process is needed in order to properly heal any muscle or soft tissue injury. In this day and age, it is actually quite amazing at how many people focus on suppressing symptoms related to their injury versus implementing a plan that focuses on actual healing and rebuilding of those injured tissues.

The following information presents the four major stages that injured muscle, tendons, and ligaments go through on their journey to healing. Focus intently on each stage to ensure a strong and sustainable outcome.

Step 1 - The First 24 Hours after Injury

In step one of the healing process, your body will begin healing your injury within seconds after sustaining a sprain, strain or tissue tear. Your damaged veins will constrict in order to seal themselves to stop bleeding and reduce blood loss. Properties available in your blood will begin to form a mass to seal your damaged tissue to prevent further bleeding – helping to protect the injury site. 

During this stage your body is aware of the injury that has occurred and immediately swings into action to reduce tissue damage.

Step 2 – Inflammatory Response  (24 to 72 Hours after the Injury)

The inflammatory response kicks into gear after a “seal” has formed, preparing the body for tissue re-growth by acting as a “clean up crew”. Inflammation is the body’s natural response to an acute injury and part of the natural healing process. Swelling, pain, heat sensation, and loss of function are the main symptoms of inflammation.

Although these symptoms provide an inconvenience, they are really just a sign that the body is responding to the injury and laying in place the foundation for healing. 

Now at this stage, two amazing things will happen: (1) More essential nutrient-rich blood will flow directly to the site of the injury, and (2) The walls of the veins containing blood will allow fluid to leak into the injured tissue.

Increased heat sensation and redness are signs that blood flow is being increased to the site of your injury. This is also referred to as “vasodilation”. At this point the body, like a hose watering plants, has increased the flow of white blood units to the injured tissue to speed up the healing process.

The combined effort of vasodilation and the leakage of fluid into your damaged tissue helps the body to begin clearing toxins from the injury site. Removing excess waste and neutralizing bacteria must be dealt with before the body can begin re-growth of the damaged tissue.

 Is there Such Thing as Too Much Inflammation?

Even though vasodilation and leakage of fluid are essential functions during the inflammatory process, there is concern for too much or recurring inflammation. Over time, the extra fluid in our damaged tissue will place pressure on the veins carrying blood flow to the injury. This pressure will build until the veins are completely blocked off. When blood flow is blocked, the damaged tissue and surrounding healthy tissue is starved of oxygen, nutrients and qualities needed to get rid of all excess waste and neutralize bacteria.

Inflammation that is not properly controlled will hurt healthy tissue and slows down the healing process. 

This is why it is critical to apply a cold compress in the early stages of an injury and if a re-injury occurs during the healing process. Both the combination of cold and compression is needed to help modulate tissue swelling.

Step 3 – Temporary Tissue Growth - Proliferation (Between 3 to 6 Weeks after the Injury)

At this stage, temporary granulation tissue (new connection tissue) begins to grow on top of and around any seals formed in step one of the healing process. Granulation tissue forms as a band-aid to “cover” and “re-build” the injury because seals do not provide any protection from re-injury. 

In the case of a tissue tear, the granulation tissue will grow from the base of the wound and over a seal to bring both sides of a tear together – temporarily increasing tissue stability. Granulation tissue will ultimately be a part of a network of connective tissue (Type III collagen) laid down, which is known to be a weaker form of normal, healthy tissue. This tissue is like plastering a hole in a wall, without the benefit of sanding, repainting and finishing the plaster used.

As a part of the granulation tissue, new veins are slowly developed in order to increase the availability of blood flow. 

The formation of granulation tissue and new veins will replace the seal that was originally formed to stop the bleeding. Replacing the seal is the first step in strengthening the injured tissue and maintaining the progression of on-going healing.

The overall structure of the Type III collagen at this point is unorganized and much weaker than healthy tissue. Over time, Type III collagen will morph into stronger, healthier tissue – but this is completely dependent upon getting a healthy supply of blood flow the injured tissues. The more consistent the blood flow treatments, the more consistent and sustainable the healing process will be.

At this stage, the pain and inflammation will have subsided to a great degree for most. It is at this point that people contemplate jumping back into their favourite sport or activity at levels like they did pre-injury. 

In addition, many individuals tend to believe they are fully healed because they are not experiencing the same discomfort levels as previously – so they stop actively treating the injury. 

These false premises are what leads to a constant cycle on injury and re-injury. The more an injury is aggravated, the more scar tissue will ultimately build – leading to a greatly delayed recovery.

While it is fine to begin more active physical movement, too much too quickly will not bode well for the healing process. This is why it is important to be aware of what is happening in your body and pay attention to your limitations.

Instead of focusing only on physical movement, you should be making sure that your body is getting the immediate benefits of physical movement – the increased blood flow and enhanced extensibility. Ideally, this should be done in the most non-invasive ways that greatly reduce the chances of suffering.

How can You Increase Blood Flow When You Can’t Physically Move due to Risk of Re-Injury?

Increasing physical activity too soon even though you may be feeling “back to normal” can send you back to step one of the healing process. It is true that once temporary (granulation) tissue and Type III collagen are formed, you will feel much better than you have since your body was injured. This can easily lull you into a false sense of security with your injury.

Just remember - even if you might “feel” like your injury is better, this doesn’t actually mean that it really is. All this means is that your body has done a stellar job in healing itself so far. However, your injury still has a long way to go before it can handle your normal level of activity.

The reason why movement makes you feel good is because local blood flow is mildly increased when tissue moves. Blood flow is like the life force of your body; it provides and maintains a healthy level of oxygen and nutrients in your tissue. When you are injured, this blood flow is essential to replenish your tissue with everything it needs to heal.

But how can you increase blood flow when moving will only re-injure your already weakened tissue?

This is where the consideration should be made to utilize treatments based on an enhancing circulation. 

Step 4 – Healthy Tissue Growth (Wound Remodeling)

The final step of the healing process is tissue remodeling, which can take months to complete depending on severity of the injury. 

During this step the scar tissue or type III collagen placed over the injured tissue will be converted in stronger, healthier tissue ( Type I collagen). This process is like taking that plaster that has been used to fill a hole in the wall (in step 3), and sanding it, repainting it and finishing it over time. The tissue throughout this step will strengthen and become more flexible over time.

Scar tissue serves its’ purpose as another temporary solution that will strengthen the damaged tissue, and serve as the foundation for the formation new tissue. Unfortunately, scar tissue will also fuse to surrounding healthy tissue and stiffen the entire area restricting movement for rehabilitation efforts. In addition, if one constantly re-injures themselves, excess scar tissue will build and this will provide a roadblock in the healing process as your chances of re-injury are greatly increased. 

The body will naturally convert brittle scar tissue to more healthy and flexible tissue (Type I collagen) over time – but this is dependent on getting a healthy supply of blood flow to the injury site. As mentioned above, it is through the blood the body carries the nutrients, oxygen, and anti-bodies injured tissue needed to repair and rebuild. 

As the body ages, the inherent ability to convert scar tissue to normal healthy tissues becomes more and more difficult. This is why children seem to “easily” bounce back from tissue injuries. Their bodies are young, with tissue still constantly growing, and they have the energy and blood flow ready to handle an injury a little bit more easily. 

For the rest of us, healing takes time, patience, dedication and effort. 

But with the right tool and the correct approach – you can dramatically speed the recovery from most muscle and soft tissue injuries.

This article is not meant to be used to diagnose or treat any medical condition. For diagnosis or treatment of any medical problem, consult your physician.

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