One of the most frequently asked questions I get in the clinic is how long will this injury take to heal? Injuries are frustrating and can be complex and multifactorial. As you can imagine, this is an exceedingly difficult question to answer. But there is increasing amounts of data on injury in different tissues. To give you a rough guide on healing times for injuries lets look a little closer at my simplified guide to tissue healing.
Lets break things down into three phases; Inflammatory, Repair and Regeneration, and Remodelling
This is the early onset of injury, a tear in the muscle, a sprained ankle, a broken bone or a torn cartilage. The inflammatory phase is typically the first few days of the injury lasting up to around 14 days in most cases. In this phase there is usually swelling and pain, and the body goes into its protective mode making it more painful to use this area as it can cause further injury. Damaged nerve endings and an influx of special proteins are responsible for the extra sensitivity and perception of pain from things not normally painful. An influx of blood to the injury usually sets in motion the clean-up of the injury site by specialised cells, the commencement of tissue repair and callus formation.
Repair and Regeneration phase.
Acute injuries set off a cascade of events leading to the repair and regeneration of tissue. Certain growth factors play a part in signalling specialised cells to start the building process of more of that type of injured tissue. This process can take weeks. Muscles are thought to take around five weeks, bone can take 6-12 weeks, and cartilage, tendons and ligaments are in a very grey area somewhere in between or beyond. Spinal discs are also increasingly difficult to measure. There are many complex reasons for why one soft tissue injury repairs at a different rate another. I will touch on this further below.
Once the tissue is robust enough to return to normal function the body learns to fortify the new tissue with more tissue in the same place and in the same direction. Think of a buildings scaffold holding up the roof. There are directions of force being placed in this new scaffold and therefore require beams in the same direction as the lines of force. If there are too little then the structural integrity is compromised and the roof will fall, or tissue will fail again. If there is an abundance some of the excess fibres are removed. The body is aiming for the sweet spot of not too little and not too much. This process can be ongoing for years!
When it does not go to plan!
Most injuries do not result in a like for like replacement of the tissue. For example, if we tear our hamstring we do not get a direct replacement of the same amount of muscle tissue in the same place pulling in exactly the same way. Scarring is involved and we can have a build up of other fibres in the injury site that add little to no structural value.
Pain, or more importantly our perception of our injury, can play a large role in the rehabilitation process. During the repair process it is common to have an influx of nerve and vascular tissue, these can make things more sensitive when the tissue is placed under normal stress causing increased pain and therefore limiting function.
In some cases the pain process can be ongoing because of changes in the central nervous system, or the peripheral nervous system. This can form maladaptive pain experiences long after the tissue has healed. For example in patients with chronic pain. In other cases there can be minimal pain experienced but tissue integrity is suboptimal. Like an ACL surgical repair after a few months.
We know that comorbidities affect how fast we heal, as too do diet and unhealthy habits. What we also don’t realise is these lifestyle choices can also put you at greater risk of injury.
How long will my injury take to heal?
The short answer is we don’t know exactly how long it will take for an injury to heal but we can give an estimate. On one hand there is the time it takes for the structure to mend, and the other involves our pain experience.
If you need good concise advice on your injury management and pain relief come in and see one of our highly skilled and friendly Physiotherapists. We have four convenient Sydney city locations, and also offer Telehealth consults online.