If you haven't read Part one of this blog series, click here to check it…
So you went over on your ankle. Now, a black and blue softball currently resides where your ankle used to live. It’s painful, swollen, hot and difficult to walk on. When is this going to get better?!
This is probably the most frequently asked question I get as a physiotherapist. Generally speaking, a moderate sprain/strain can take upwards of 8+ weeks to resolve. HOLY CRAP! 8 WEEKS?! Yes, 8 weeks, give or take. I cannot expedite the body’s ability to heal tissue (I wish I could just place my hands on someone and heal them, I would make a lot of money!). I can merely help create an environment in your tissues conducive to healing. So if you have a swollen, black and blue body part, chances are it’s going to take 8+ weeks to heal itself (And compared to the 20 odd years it took you to become an adult, 8 weeks is pretty fantastic!). Understanding what happens during these 8 weeks, however, can really help prevent re-injury and decrease your risk of things becoming chronic.
1. Inflammatory phase (3-5 days)
There is not much we can do during this initial phase short of resting, elevating and compressing the affected area. Trauma to your tissues (also known as collagen) cause bleeding. Fluid and other cells (your body’s knights in shining armor) travel to the area to help assess the damage that has been done. The pressure from the fluid, in addition to the chemical soup now residing in the injured area, stimulates nerve endings causing more pain.
Pain limits function. And from an evolutionary standpoint this makes sense. The brain needs to assess the area to figure out what it needs to do to heal itself. It doesn’t want you walking on that sprained ankle, you might hurt it some more! So get those crutches ready and take it easy for those 3-5 days, you have my permission!
2. Repair Phase (3-21 days)
Remember those knights and shining armor I talked about in the inflammatory phase? Well these cells initiate a chemical response which causes blood clotting to stop the bleeding. Fibroblasts also make their presence known in this blood clot. Fibroblasts are cells in your body which essentially act like little carpenters. They come in and help build new tissue. Unfortunately in this stage, Type 3 collagen is laid down. This type of collagen is very weak and has little tensile strength. Its goal is to essentially help plug up the injury!
It’s important to recognize that this new tissue is really weak. Your injury may start feeling a lot better in the next 2-3 weeks. It doesn’t take much to tear this new tissue. Tearing this plug will only bring you back to the inflammatory phase, starting the 8 week process all over again! Re-tearing the tissue over and over again can cause disrepair, which can leave you with an ugly chronic issue.
3. Re-modeling phase (21+ days)
This phase can last up to a year if the injury was severe enough. In this phase, the weak Type 3 collagen is replaced by much stronger Type 1 collagen. Type 1 collage has a lot more tensile strength and makes the tissue more resilient. Type 1 collagen is still not as strong as the surrounding tissue, however, due to its plug-like nature. Most of our tissues are composed of parallel fibers which oppose the forces we put through them. The new tissue is literally a shredded-wheat of fibers, all criss-crossed in a haphazard formation.
In this phase, we can start aligning the fibers in the optimal parallel formation using controlled stretching and strengthening. We also need to work on other important things, but I can’t give it all away in one post! Haha!
Originally written by Bailey Gresham, RPT.