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Healing timeframes explained


As I often see clients who are recovering from some sort of injury or surgery, the conversation around their rehab can bring us to the subject of healing timeframes. It's not uncommon for clients to be unaware of how long it may take for their soft tissue injury to heal, or to have an expectation that might not match realistic timeframes. Maybe they haven't been told by their healthcare provider or not thought to ask, or perhaps they've been given a "general" timeframe. Often, a client may have seen their GP first and the assessment may be based on the client's account of what happened and what the GP can assess through observation and with some tests - such as range of movement, orthopaedic and/or nerve tests. This is generally before any more detailed assessment is done, e.g. by a Physiotherapist or Specialist. It's worth remembering that GPs only have 10 minutes to assess, diagnose and decide on the best course of treatment, this time pressure in the consult can be a factor. in addition, some injuries may not be so obvious initially, due to the degree of swelling and bruising, how much movement the person is still capable of, and the amount of pain they are experiencing - given that in this instance pain is a normal and protective mechanism to reduce movement and reduce further injury. We've all heard of cases where someone has fractured a bone or damaged a ligament but the initial diagnosis may have been a severe sprain.

The issue here is that clients might receive initial information about the type of injury and the projected healing time that may not reflect the reality of the injury as it unfolds with more investigation. Projected recovery may be under or overestimated, and therein can lie a problem. For the person who thinks their low back strain is just soft tissue and is told it will take 2-4 weeks to recover this can cause a great deal of distress when 3 months later they are still in as much pain as they were at the start, and be quite worried why they aren't better now. Likewise, someone who rolls their ankle and believes that they will be back to their normal physical activities in 3 weeks can get pretty frustrated when they still aren't able to fully weight bear as they could pre-injury 4 or 5 weeks later.

Everyone is different, injuries are not always text-book - some are pretty straightforward and easy to diagnose while others might be more complex, needing further investigation and requiring a range of rehab strategies. Circumstances surrounding recovery can vary too - what the best type of rehab is, whether it can be done at home or needs specific equipment and supervision, and our feeling (worries, fears, sense of hope) about the injury and our recovery, whether we feel confident moving or whether we are worried that movement might cause more damage. What we've compiled below is some general information about healing stages and timeframes and some useful information related to specific types of injuries that is useful to know about.

When you sustain a soft tissue injury (muscle, tendon, ligament), a number of things happen immediately following the injury. There are four phases worth knowing about, these are BLEEDING/HEMOSTASIS, INFLAMMATION, PROLIFERATION and MATURATION/RE-MODELLING.

During the bleeding/hemostasis phase, blood vessels constrict to stem bleeding, the wound (if there is one) is closed via clotting. Hemostasis happens immediately and can last several hours.

In the inflammatory phase blood vessels dilate, there's an inflammatory response with various cells moving into the area to deal with any possible infection or foreign substances in the area. The result of this is the classic 5 signs of inflammation - redness, heat, swelling, pain, loss of function. The purpose of this is to protect the area and promote healing. The inflammatory phase will last from the moment the injury happens to a few days/week or two (depending on severity). It generally tapers off after a week.

The proliferation phase involves more cells moving into the area to aid wound healing by forming a barrier between the wound and the environment, collagen synthesis to provide the structure and strength for the repair of skin, tendons, ligaments, bones, and wound contraction which involves the shrinking of the wound as it heals. This phase may be typified by an increase in mechanical strength to the tissue as the tissue involved in this phase is stronger vs more elastic. This phase begins in the first few hours and can last for several months, with the most active part of this stage taking several weeks.

The last phase, the maturation/re-modelling phase, consists of remodelling of collagen where the collagen fibres align along lines of tension and form crosslinks to increase the wound strength and reduce the thickness of the formed scar. This phase can take anywhere from a few weeks to up to a year or more.

Phases of healing


As a general guide to specific injuries to tendons, muscles, ligaments and bones, the chart below gives a good indication of what to expect. Having an understanding of this might help to allay concerns and give some additional information about how long recovery should take, while being mindful of the fact that if the injury is more complex e.g. the injury grade, if more than one muscle or tendon has been affected, or if there is bone or ligament involvement, that healing will likely take longer.

Tissue healing timeline


If you are unsure, always ask your health professional. Having an understanding of possible timeframes can help you to maintain hope, work with your health professional to set some rehab milestones and take an active role in your recovery.


Additional resources

Wound healing

https://pocketdentistry.com/2-wound-healing/

What are the 5 cardinal signs of inflammation?

https://www.verywellhealth.com/signs-of-inflammation-4580526

How long do injuries take to heal?

https://thriveptpilates.com/wp-content/uploads/2020/01/tissue-healing-with-overlapping-stages.png

How long will this take? Time frames of tissue healing

https://www.lifecare.com.au/blog/how-long-will-this-take-time-frames-of-tissue-healing/

Healing Times

https://www.athletespotential.com/athletes-potential-blog/category/overtraining

Soft tissue injury rehab

https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/

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