Injury and the phases of healing
If you’re a professional athlete or recreation athlete (weekend warrior) injuries will occur and what you do will determine how fast you will be able to return to action. The healing process can be a long and difficult process if injuries not taken care of properly. There are 3 phases of tissue healing: inflammation, repair, and remodeling. The athlete will go through each stage at different rates depending on the type of injury and how they are conditioned.
The inflammation phase is the body’s first reaction to an injury. First the local and systematic inflammatory system response goes in to action. This will decrease function of the damaged tissue. If you have a strained muscle its ability to contract or produce force will be reduced. This is done so that a person cannot continue to cause harm to the injured tissue. The area will be red and swollen due to capillary permeability. Edema can/will occur in the injured tissue which will also limit function. Phagocytosis occurs when there is a release of macrophages which remove dead cells and damaged cells from the injury site. The inflammatory phase may cause the sensory nerve fiber to react which will send a pain signal to the athlete to also decrease function. The inflammation phase will typical last 2-3 days but may last longer depending on the severity of the injury. Treatments during Inflammation phase are usually passive modalities: icing, ultrasound, and electrical stimulation. These treatments are used to help control inflammation in the body. Rest for the injured area is necessary to protect from reinjuring the damaged tissue.
Once the macrophages remove the damaged tissue, the body will begin to place collagen fibers in the wounded area. Scar tissue and new capillaries and blood vessels are formed in the injured area. The best analogy is to think about road construct where they place a large metal board over a pot hole in the street. The large metal cover is not ideal for street repair but it will be temporary fix the hole in the street. This concept is identical to the body placing collagen fibers as a temporary fix to the wounded area. the collagen fibers to strength the wound. The repair phase can start as early as 2 days after the injury but can last up to 2 months depending on the severity of the injury. During repair the new tissue cannot handle a high amount of stress. To assist with repair the NSCA recommend light lifting, and or low impact activities when coming back from injury. It is important to start with low loads and gradually increase intensity of activity. The low loads will increase collagen synthesis and optimum alignment of fibers. Important to note that too little stress may cause a negative effect in which new fibers do not align properly and adhesions may form preventing full range of motion.
The remodeling phase occurs when the body stops producing new collagen fibers and begins aligning current collagen fibers to best deal with stressors. The next step is to improve the structure, strength and function of the new tissue. Using a proper exercise program and progression the new fibers will begin to hypertrophy and align properly to cope with the stress. As the fibers become stronger the athlete will be able to return to function. Though the new tissue will not be as strong as the old tissue initially, it will take another 2-4 months for the new tissue strengthens to cope with the stress.
The exercise rehab and condition progression will go from Light weight Isolation open-chained exercises to Heavier Sport Specific Closed Chained Exercises. I will give to example of rehab progression
Example and Athlete with a shoulder Injury( rotator cuff) may progress through an exercise program like this
- Side Lying Internal/External Rotation
- Standing Lateral Shoulder Raise
- Seated Shoulder Press
- Standing Military Press
Example of progression of knee rehab
- Leg Extension/Leg Curl
- Leg Press
- Bodyweight squat
- Split Squat or single leg variation
- Pistol Squat single leg unsupported squat
Potach, D. (2008). Essentials of strength training and conditioning. (3rd ed., pp. 529-533). Champaign IL: Human Kinetics. DOI: http://www.Humankinetics.com