Soft Tissue Recovery
The recovery of soft tissue (muscles, tendons or ligaments) injuries involves inflammation, regeneration, and remodelling. The healing times of different injury types are mainly dependent on the blood supply of the specific injured tissue. Delay in healing times of soft tissue injuries can be due to age, location of injury, delayed treatment, incorrect diagnosis, incorrect treatment, failure by patient to follow treatment plan, and poor communication.
The initial inflammatory phase (0-72 hours) is necessary for tissue repair but is usually excessive compared to the extent of the injury and results in increased pain, spasm, swelling, and eventually, prolonged healing.
The regeneration phase (48 hours-6 weeks) involves the production of collagen (connective/scar tissue) to repair the tear in the muscle, tendon, or ligament. Different healing times are reflected by how much oxygen and other nutrients reach the injured tissues by the circulatory system.
The final remodelling phase (3 weeks-12 months) has the collagen shortening and maturing resulting in increased stiffness and strength. Stretching during this period is beneficial in aligning the stresses and scar tissue in the desired direction for optimal healing. Any immobilization or lack of activity would lead to muscle atrophy, weakening of ligament attachments, cartilage changes in the joint surfaces, and bone loss. Proprioceptive (joint position) training is beneficial during this time to retrain and activate the mechanoreceptors in the ligaments that were deactivated in the injury.
Muscle injuries range from delayed-onset muscle soreness, strains (3 degrees), contusions, and avulsions. Since muscle has a rich blood supply, 85-95% of its original strength can be regained after 7-10 days. A mild 1st degree muscle strain can heal in 2-21 days.
Tendon injuries can be inflammatory, degenerative, or ruptured. Since tendons have less blood supply than muscle, they tend to take longer to heal. Therefore, a tear in the belly of a muscle heals faster than an injury to the musculotendinous junction.
Ligaments, which have a poor blood supply, take the longest to heal. Ligaments regain 60-70% of their strength after 6 weeks and only 80% after 3 months. Sprains to a ligament may take up to 2 weeks for a mild 1st degree injury and 3 months for a moderate 2nd degree problem.
In order to optimize the time for healing, control of the initial inflammatory phase with ice is required. Excessive inflammation leads to increased scarring/adhesions, continued pain, loss of function (flexibility, strength) and a tendency to be re-injured. An accurate diagnosis and an early appropriate treatment plan are necessary for a prompt recovery. Finally, progressive activities resembling your sport or activity along with balance (proprioceptive) training will impart the required stresses to the injured tissue to allow you to return to full function.
All soft tissue injuries have a time period required for recovery. If there is pain past that point, one can be comforted that the tissue has been repaired and pain is more likely due to the nervous system and how our brain interprets and processes the pain and the injury. When evaluating an injury, functional testing and how the body moves are more important than pain in determining the level of recovery. If you take the right actions, injury recovery can be shortened and chronic pain does not have to be an issue.