Tissue Healing Phases

This is a summary of a video seminar that I watched on tissue healing. The reason it’s relevant is that most of the major injuries to tendons or ligaments don’t have a single cause. The structures in the body are designed to take loads from the body over the entire lifetime, so very few people experience the type of force that could immediately destroy them. The most common reason for major injuries is a breakdown caused by light injury complicated by constant re-injury over an extended period of time. This means major injuries are generally preventable by the treatment of moderate and light injuries, when athletes complain of pain but aren’t impaired.

New models for injury treatment are available and often fly in the face of traditional treatment. Ice packs for 20 minutes twice a day is now the bare minimum of treatment for a sprain, the equivalent to attending class in college but not taking notes, studying, or doing homework. Athletes often leave their pains untreated, especially if there aren’t easy answers, which is an indication for a more serious injury later on and a disgrace for the trainers and coaches of the injured athlete.

Tissue healing goes in three phases:

The first phase is the inflammatory phase, which is the body’s natural reaction to an injury and lasts 2-3 days. The body encapsulates and swells the muscle into a specific position because it opens the blood vessels to their maximum, which also stiffens the injured area into a rough splint. The problem is that the body is designed for maximum emergency measures, to try and heal the body as quickly as possible so that it can get back on the primordial trail. As with most things in life, the quickest solution is usually not optimal, because it’s not designed for permanent healing but to get the body up and running so the person won’t die in the next week.

The treatment is ice, which reduces the inflammation (i.e. the pain) and slows down the body’s response into a more measured and permanent healing. Folk sports medicine says that the best ice is frozen peas or blueberries, but those are actually the crappiest because they’ll thaw too quickly from the body’s heat. The best ice is actually frozen beef, if we’re specific, Trader Joe’s frozen bulgogi. The marinated Korean beef will stay frozen for hours at room temperature and won’t thaw or drip, better than any fancy chemical pack. A little dixie cup of frozen water is also pretty good, if you’re okay with wiping away water. Also, 5 minutes of ice massage is the equivalent to 20 minutes of laying ice on your body. Ice treatment should be an alternation of ice for 20 minutes and letting the body warm for about an hour. It should also be done before (ice massage half an hour before) and after workouts. DO NOT FALL ASLEEP ON THE BULGOGI OR IT WILL FUSE TO YOUR BODY. It’s kind of funny but you won’t laugh at how difficult it will be to thaw the meat and get it off of your skin and clean out ice sores if it happens.

The second phase is the proliferative phase, which lasts from 2 days to 2 weeks after injury. During this period, the body is starting to heal by remodeling the structures by either rebuilding it or replacing it with scar tissue.

The final phase is the remodeling phase, which generally lasts 2 to 6 weeks. The body is beginning to be pain-free and starting to restore function. The challenge is to avoid a cycle of inflammation, where the injuries are healed and then immediately re-injured. The cocktail of inflammatory treatments is not good for the long-term health of ligaments and tendons because it increases the necessity of scar tissue, which is both rougher (hence, more painful) and weaker than the original tissues. This is obviously dependent on the will and decision of the athlete – a professional athlete getting paid $15 million might have to suffer through the pain for a few months until the end of the season and hope that it doesn’t break down into a major injury. But the amateur athlete should come back slowly and treat injuries gingerly, adapting to the strength of their newly healed tissues and trying to gradually build it back up to normal.