Soft tissue structures encompass the muscles, ligaments and tendons. These structures are responsible for generating torque and subsequently movement in the body. The degree in which the tissues experience damage is on a spectrum and varies dependent on the type of injury, the characteristics of the individual, their health status and the extent of damage.
Following injury there is a physiological cascade to repair and replace the affected tissue. The constant evolution and crossover between the transitions of healing means the actuality of the stages are quite poorly defined. The following article aims to provide information regarding these timeframes and what to expect during each phase.
Immediately following damage to the tissue bleeding occurs for up to 6-8 hours. In response a process of coagulation occurs to ‘plug’ the wound site. This inflammatory phase of healing results in a cellular cascade over a 6-8-hour window whereby the rapid influx of blood flow to the area causes some swelling and redness.
The proliferative phase of healing commences during this 24-hour window and is sustained up to 3 weeks post-injury. Think of this is the foundational stage of healing. Granulation tissue which structurally is both loose and oedematous. Over time collagen and new vessels are laid down enforcing the granulation tissue and forming scar tissue. As the scar tissue nears completion, the remodelling phase overlaps to ensure the scar is functional and organised in a similar fashion to the surrounding tissue.
As discussed, the degree and tissue impacted during injury also significantly impacts on the duration of recovery. Muscle soreness following exercise for example usually lasts 0-3 days however a grade 3 muscle strain can last from 3 weeks to 6 months. Whether the impacted tissue is muscle, ligament, tendon, bone or cartilage also increases the timeframes respectively.
So, where does this leave you in the acute phase of injury?
With the age-old RICER permeating acute injury management, the literature has evaluated the efficacy of this management procedure. The acronym PEACE & LOVE; protection, elevation, avoid anti-inflammatories, compression, education AND load, optimism, vascularisation and exercise provide an interesting evolution to the acute injury management narrative.
This method encourages restricting movement or unloading the affected area within the first 3 days versus complete rest. Despite limited evidence surrounding the efficacy of elevation, encouraging the dispersal of fluid is of no risk to healing. Your therapist will discuss the appropriateness of oral anti-inflammatories in a case by case fashion. Re-loading early through active range of motion and graded strengthening exercises is highly recommended for tissue tolerance and strengthening. Rehabilitation should also incorporate pain-free aerobic exercise to promote early return to sport/life.
Your therapist will work to create an individualised rehabilitation program that is specific to your day to day activities or goals with return to sport or work. There is strong evidential support for the inclusion of an exercise-based program to optimise long term outcomes.
Quick guide to acute injury management
Dubois B, Esculier J-F. Br J Sports Med 2020;54:72–73.
Electrotherapy on the web. Soft Tissue Repair and Healing Review. The International Society for Electrophysical Agents in Physical Therapy (ISEAPT)
Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain. or By Mikael Häggström, used with permission. [Public domain]