Stages of Healing
Physiotherapists assess numerous patients with a variety of injuries and at different stages of healing. Taking a good history of the mechanism of injury and when it occurred in conjunction with assessment findings will help determine the diagnosis and the stage of healing.
Generally there are three stages of healing. The first stage is the substrate phase, which starts from the moment of injury and lasts about five days. In this inflammatory phase, the body responds to cell damage by increased cell permeability, increased blood flow in the area, and consequently swelling. Moreover, specific cells which produce collagen (part of the scar tissue) are mobilized to the damaged tissue. In this inflammatory stage the RICE protocol is best: R = rest, I = Ice, C = Compression, E = Elevation. Note: the injured part should be placed one foot above the heart to aid in drainage. Splinting and/or braces can help protect and rest the injured part while compression, ice and elevation help reduce swelling. A physiotherapist can tape or wrap the injured part and provide guidance on the use of ambulatory aides.
The second stage of healing, the fibroblastic phase, starts about a week after injury and lasts anywhere from four to ten weeks. In this phase, scar tissue is produced and laid down to heal the injured tissue. During this process, the goal of treatment is to restore mobility and tensile strength of the tissue and prevent adhesions. A strong yet extensible scar is the goal. Physiotherapists will provide the appropriate exercises to achieve this goal and return the patient to optimal function.
The final phase of healing is the maturation phase. This phase begins at 4 weeks after injury and can last six months or more. Remodeling of the scar tissue occurs to make it as strong as possible.
Often patients come in for physiotherapy three to four weeks after injury when they are still experiencing pain and stiffness. The lack of mobility is usually due to adhesions.
The outcome is often better when patients start physiotherapy in the first stage.
Written by Susan Reive, Owner of Kilborn Physiotherapy Clinic