When we injure ourselves, whether it’s a broken bone, a sprained ankle or a simple skin cut, all of our tissues follow the same stages of healing; inflammation, repair and remodeling. The stages overlap, one stage flowing into another, with elements of different stages happening at the same time. How well the tissue heals depends on many factors including which tissue has been injured, how you manage pain and inflammation and how and when you start to use the tissues again.
Stages of Healing:
Inflammation seems to be the new buzzword in medicine and has been linked to all kinds of health issues. And it’s true that inflammation in the intestines from food sensitivities and in the joints from arthritis is destructive and should be managed. This is not the kind of inflammation we are talking about here. What we are referring to here is the inflammation that begins with injury and lasts anywhere from four days to three weeks. Immediately after an injury, the damaged tissue is bleeding and without oxygen. This activates your immune system, causing an inflammatory response in the injured tissue. A clot quickly forms and many different kinds of inflammatory cells are attracted to the injured tissue. Over the next several days, debris is removed and cells that are more anti-inflammatory in nature are attracted to the area. These cells will transform into the blood vessels and tissues of the healed injury. It is during this phase that many of the cells that you will need in the next two phases are attracted to the area, called in by the injury and inflammation.
This phase begins as early as day four and lasts until about day 28. In this phase you begin to make the basic structure of tissue. Basic blood vessels form. You form a matrix, which is sort of like a gel. Into this gel you lay collagen, the fibers that provide structure. The gel gradually firms, trapping the collagen and beginning the healing of the tissue, closing the gap and reconnecting the edges of the injured tissue.
Remodeling is the longest phase and can last as long as two years, depending on the tissue. During remodeling, the basic tissue formation that began in the repair phase is refined. The tissues gradually transform further into the tissue they are meant to be. The ratios of cells and vessels normalize. The collagen fibers become the type that normally occurs in that tissue, the fibers line up along the lines of the forces applied to the tissue and the structural strength of the tissue gradually improves.
Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) After an Injury
Non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen and aspirin (e.g. Tylenol, Advil, etc.), are often used after an injury to manage pain and inflammation. But many studies indicate that the use of NSAIDs in the inflammation phase impairs healing in the repair and remodeling phases. NSAIDs interrupt the inflammation phase by inhibiting certain enzymes. This interruption limits how many and which cells you have for use in the repair and remodeling phases. (Remember that many of the cells you will use during repair and remodeling are attracted to the area during the inflammation phase.) So you might want to minimize the use of or avoid using them altogether during the first one to two weeks after an injury. On the other hand, studies of NSAID use during the repair and remodeling phases indicate that use during these later phases is not detrimental to healing. In fact, NSAID use during repair and remodeling of ligaments and tendons may in fact improve the quality of the tissue and decrease formation of abnormal scars.
Using ice for inflammation and pain does not interrupt the inflammation phase in the way that NSAIDs do. Cold numbs sensation on the skin and constricts the vessels, decreasing the amount of fluid in the area temporarily, thus providing some relief of pain and inflammation.
Tension and Forces through the Healing Tissue
Providing the correct tension to the repairing tissue can assist healing and improve the final quality of the repair. How and when to apply tension through the healing tissue will depend on which tissue is involved and which phase of healing it is in. During the inflammation phase, correct movement will help reduce swelling and prevent abnormal scaring and loss of muscle mass. During the repair and remodeling phase, tissue specific tension will assist with proper bone formation and healing of muscle, ligament and tendon. It does this by providing the stimulus for reorientation of the collagen fibers in the proper direction and encouraging thicker, stronger collagen fibrils that can withstand greater forces. Knowing just how to do this properly is complicated, so get some help. Have your doctor and physical therapist guide you through the phases and tell you how and when to use the tissues, so you can recover from your injury strong and well healed.
Interested in learning more? Join us for our upcoming Healing 101 lecture on Thursday, September 21st at 6PM. Click here for more details.