Soft Tissue Healing

Soft tissue healing process or phases of remodeling - what happens as we heal? When aware of this information one is less apt to become frustrated when not healing as fast as expected. The following information should help give some realistic expectations of how long it takes us to heal, the processes that take place and things we can do to improve our chances of the best possible outcome.   

Once soft tissues (fascia, tendons or muscles) are injured the pain and inflammation may eventually resolve, but the healing process continues long after that. The function of those repaired tissues may not completely return. When scar tissue lays down over an injury the tissues lose elasticity, become weakened and function is reduced. Tissues are prone to reinjury. Depending on the severity, a person may not notice any weakness and re-injury never occur. But, re-injury is possible without adequate rehabilitation to strengthen both the injured area and also those structures adjacent or associated with the original injury.

Ideally, we want to engage in activities that promote tissues becoming both stronger and more flexible. Massage techniques such as cross fiber friction at the appropriate time can help restore some of that function but not all of it. Treating an injury correctly, right away, putting your rehab time in - doing your part, and allowing the body time to heal itself is essential. This being equally important in both the short and long termed stages of healing.  The healthier we are prior to an injury or disease the better off we are. 

The stages of soft tissue healing are:

1) Acute – 0-72 hours, Inflammation will occur along with pain, swelling, warmth to the area, and redness. The key here is to keep swelling down. You're not going to eliminate all of it and some is actually necessary for proper soft tissue healing to take place. In other words the damage has already been done so what we're doing is trying to keep the body from over reacting to the trauma that has occurred. We use the concept RICE rest, ice, compression and elevation. Rest helps the body stabilize thus preventing further damage to the injured area as the body sets up for the 2nd phase of soft tissue healing. Ice helps to constrict excessive swelling and also helps decrease pain through it's analgesic nature. Compression helps to keep swelling down. Elevation is about keeping swelling down. So, the key during this stage, yep, you guessed it … keep swelling down and reduce pain as much as possible. The role of massage for the injury itself, at this stage, isn't a good idea concentrate more on the RICE and your body's own natural ability to heal.

For those interested in a more in depth look at the processes involved with healing take a look at Dr. Campbell's video and if you like buy one of his books at where funds from selling books helps to finance distribution of resources to students in foreign countries.

2) Sub acute – Depending on your age, health, extent of the injury etc. The starting of the sub acute phase can start a bit earlier, but generally 48 hours and lasting to around the three week mark.  Again, this can all depend on the general health of the injured person. Age, those with vascular problems, re-aggravating the injury etc. can also all play a factor in how long this phase of soft tissue healing will last. It's at this stage that significant gains in soft tissue healing or repair work is done. Dead cells are being removed and reparitive tissue is laid down over the injury. This reparitive tissue needs time to set up properly, sort of like jello, without it being re aggravated by further tearing or swelling. This is where a vascular flush can help. The vascular flush helps in creating a pump like action that facilitates the removal of dead cells and bringing in the reparitive cells. During this stage massage can be done, if done carefully and with some of the following considerations -- professionals or those with appropriate training certainly would have additional options. The primary goal for massage is to reduce the amount of pain in the surrounding areas and reduce any excessive muscle guarding. So with an ankle injury, work the back of the knee on up to the hip with a fair amount of deep effleurage. Stay away from the injury itself unless you have experience in judging injuries. What I will generally do, is some very light massage around day ten or so to the site, but my intentions are calculated and deliberate. Health of the person, their age, severity of injury etc. also factors into any decisions. Generally, all other overall health considerations of the individual, you're on the safe side going to the next joint up and massaging without aggravating the injury. Just keep in mind if it hurts don't do it. This is simplistic, but, that's why we have pain receptors to let us know.  Ask a seasoned massage professional about all of this from a clinical perspective and most would say there's a certain amount of art to all it. Sequence of care, modalities, knowing what kind of person you're dealing with, intuition, palpation skills, the tools (techniques) in the war chest -- experience. What can we do to put the body in the best position to do more for itself -- as it was designed? 

3) Chronic – Your chronic stage can last up to a year or more as the repairs that are done in the sub acute stage become stronger. It may very well be that you'll never regain the full function that you once had as the repaired tissue will not be as strong or flexible as they once were. This can leave you more prone to additional injuries. Massage in this phase is about helping to to restore as much flexibility as possible to the injured areas and it's surroundings. One of the big keys is reducing the amount of adhesions that are formed. What we want is the collagen (repair tissue) to line up properly (this allows for you to have more function) – this comes by way of massage, stretching, movement and strengthening exercises. When collagen (repair tissue necessary for soft tissue healing) lays down over an injury, it's very indiscriminate thereby making for some overlapping (gluing so to speak) to adjacent structures that cause binding and shortening of those structures such as other muscles and tendons.


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