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 they think they should. 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. It can take as long as up to six weeks. Most often it's around three weeks. Again, this can all depend on the general health of the injured person. Their age, those with vascular problems, whether they've re- aggravated the injury etc can 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 situation that facilitates the removal of dead cells and bringing in the reparitive cells. During this stage massage can be done, if done carefully. The primary goal for massage is to reduce the amount of pain in the surrounding areas and reduce further and probably unnecessary muscle guarding. So, what I'd do as at home user of massage is this. Say you have 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 do is some very light massage around day ten or so to the site, but my intentions are calculated and deliberate. Additionally, chances are I'll know the health of the person, their age, etc. that factors into my decisions.  I'd think you're safe going to the next joint up and massaging without aggravating the injury. Just keep in mind if it hurts don't do it. I know this is simplistic, but, that's why we have pain receptors to let us know.

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.

Can we heal without professional help? 

One thing I have noticed on occasion is wall posters showing the basic stages of soft tissue healing that we will all go through if an injury occurs regardless of receiving any treatment or not. The twist on these "patient education" posters lead you to believe that these natural stages of soft tissue healing occurs because of the treatment that you're receiving, or will receive. What you'll see is something along the lines of increased number of treatments at the beginning of care that fades over time in correlation with the stages of healing that we all go through anyway, again, treated or not. Often you'll find these kinds of posters where exams are done and the exact same treatment plan is employed for every person that comes through the door. I might point out that part of the reason for any exam is to gather information about the person so a rough idea as to what treatment plan might be best for the individual. Some of that information might include medical history, assessing the extent of symptoms presented, how long the symptoms have been present, identifying specific factors that might impede treatment, their age, lifestyle etc. These kinds of things are different from person to person and will and should alter the specific treatment plan for each individual, but obviously this isn't always the case. Am I alone in my views? No! Dr. Bill Kinsinger in this video (at about the 5:18 mark of the video) here says, “70% of the patients suffering from acute low back pain will get better in three weeks no matter what they do, no matter who they go see, or if they go see nobody. If we did a better job of spending more time with the patient and giving them better explanations, they'd probably be more happy with our care. But, the chiropractors they're very good at that and I give them credit.” Dr. Kinsinger's views are his own and the inclusion of his video is not included on this page to be disparaging to the chiropractic profession. But, he brings up a good point relevant to the topic of soft tissue healing. Aside from the more serious cases where professional treatment is necessary to facilitate adequate soft tissue healing, healing will indeed take place on it's own - how well depends on the general health of the individual. In a lot of cases at home instructions are adequate. In other cases, professional consultation might be helpful to identify possible structural influences (skeletal) and which exercises and stretches to do - and vital for ensuring healing is done in a way that restores maximum function. Please don't discount the benefits of chiropractic that are numerous.

The key is to gather as much information as you can. Often people want cradle to grave health care provided to them with absolutely no effort put forth on their part. And, there's plenty of health providers out there happy to accommodate, so long as you have the insurance benefits or cash to pay for it.  But, if maximum results are what's desired, one has to take an active role in their own health care. 

Additional information on soft tissue healing time constraints.


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