Understanding a bit about how our bodies heal can help us support this process so we can recover faster and more effectively. I’m going to talk about traumatic injury–an injury due to physical damage–what our bodies do about it, and the important ways we can help or hinder them.
1. Acute Stage
(injury just occurred — a few days later)
The first thing that happens after an injury is that you bleed. Even if you don’t have blood visibly leaking out of you, cells that are damaged are losing their fluid to the outside space, causing stuff to go where it shouldn’t. The body’s first action is to stop this bleeding, which it accomplishes with inflammation.
Inflammation is a process that the body uses to stabilize the area of the injury and start repairing the damage. The only reason inflammation is bad is that it is a sign damage has occurred, but it is also a sign that the body is doing something about the damage. Sometimes there can be too much inflammation due to other problems in the body or if the damage keeps reoccurring. However, normally inflammation is a good and necessary event.
During inflammation, important chemicals, such as histamine, bring in phagocytes that eat up damaged cells, platelets to create clots to stop the bleeding, and fibroblasts that start producing new cells. There is usually pain, a signal indicating tissue damage with the intent of inducing you to protect the injured body part and not cause further harm. There will also be edema (swelling) due to the bleeding and extra cells drawn to the area by inflammation. Some swelling is good because it is just part of the essential inflammation process. There is generally some extra swelling, however, and by assisting the lymphatic system to decrease it (see my post on Moving Your Fluids Around), we can support the body in this stage.
What you can do:
–Avoid doing anything that increases the pain, such as putting weight on an injured leg or moving the injured area.
–Rest, drink lots of water, eat lots of healthy food, and try to put yourself in a stress-free environment.
–Apply ice if it feels helpful
–Receive massage therapy: not directly to the injured part, but to help decrease excess swelling and prevent your non-injured parts from becoming tight, sore, or achy due to the pain and stress of the injury.
2. Subacute Stage
(a few days after injury—a few weeks later)
The first stage of healing is all about stopping the bleeding and damage from happening. Now that the area has been stabilized, the body is focused on re-growing tissue, which it does in the form of disorganized granulation fibers. They run this way and that, simply focusing on patching up the hole. Imagine if you were in a ship that suddenly got a leak in it. Your first priority would be to block the hole to keep the water where it is supposed to be. You wouldn’t take the time to make the patch look nice or be as strong and functional as the rest of the ship’s wall until you got the ship back to shore. The body works in a similar fashion. It makes a messy patch first, simply focusing on keeping fluids in the right place and being able to use that body part again. Later on, it will work on making the patch more functional.
As you are able to start using your healing body part again, the movement of muscles, tendons, and ligaments in the area will direct the formation of the new scar tissue so it forms in line with the rest of the tissue. The disorganized fibers will slowly become more organized as fibers going in the same direction of muscles and connective tissue are strengthened, and fibers going in different directions are dissolved.
What you can do:
At this stage, your injured part should no longer feel pain without being used. There may still be pain and swelling with movement or activity, but it really depends on how much movement and activity. It is crucial that you respect the signals your body gives you:
–If you feel pain with a certain movement, or a certain amount of movement, don’t do it!
–If you don’t feel any pain with a movement or activity, do it!
This seems pretty straightforward, but a lot of things end up complicating this stage, preventing people from healing past this point. For example, if you are taking pain medication, you can’t necessarily trust the signals your body gives you. It may feel alright to do something that it actually is not ready for. Another common instance is that you feel that you absolutely need to return to work or to playing sports or whatever you normally do, and therefore you do so too quickly. It’s difficult for those cells trying to build new tissue if you keep tearing it up again.
However, another complication is when people are too afraid of re-injuring themselves, or they wear a cast or brace overly long, and therefore don’t challenge the new tissue at all. It is necessary to begin using your healing body part before it is completely healed because the movement will encourage the new tissue to re-grow in the correct manner to allow such movement. If you keep a healing body part immobilized, all the disorganized new fibers will mature and strengthen so instead of having new tissue that runs along with the muscle fibers around it, you will have stiff and immobile scar tissue.
–You may want to apply ice in instances where you challenged the tissue a bit much. However, be mindful how often you are using ice. At this point, you should feel the need to ice much less, and consistent use of ice could be a sign that your tissue is stuck in this stage of healing and not able to progress. Pay attention to whether you may have been using that injured part more than it is ready for.
–You can start receiving massage directly to the injured area, but make sure your therapist has experience working with injuries. Massage can also be helpful in preventing compensatory mechanisms from becoming permanent.
3. Maturation Stage
(a few weeks/ months after injury— a few weeks/ months/ years later)
This is the stage when scar tissue really becomes functional—as long as you continue to slowly introduce your injured body part back to doing things. The new fibers continue to become stronger and more organized. The body is focused first on improving mobility, meaning that you can move your joints through their normal range and don’t have to stop short because it feels painful or stuck. Then the tissues work on regaining their original strength.
What you can do:
–Stay in your pain free zone and keep gradually increasing the amount of work you give your injured part. Once you have full range of motion back (for example, you can fully bend and straighten your healing knee), you can start loading it. This might mean that you transition to allowing your injured leg to bear your weight normally again. Or that you allow your injured arm to start carrying, pushing, and pulling things again.
–You might still apply ice to the injured part after heavier bouts of activity. You might alternatively start applying heat before activity or treatment if the scar tissue has become stiff and immobile.
–Massage therapy will be focused on facilitating the remodeling of fibers so the scar tissue is properly aligned and you can regain full mobility of the injured part.
On the Uses of Ice and Heat:
Ice is used to decrease pain, muscle spasm, and to slow excess inflammation. Sometimes people think ice helps decrease swelling, but that is not the case since it can inhibit the function of the lymphatic system.
If you are wondering whether or not to apply ice to your injury, ask yourself if it feels helpful to you. Does the ice feel like it calms the tissue and eases the pain? Or do you use ice simply because you think you ought to? If you find you agree with the latter, know that ice is not necessary, and you can still heal without it. Find something that does feel helpful to you, like elevating the injured limb or massaging the surrounding area, and do that. If you enjoy using ice, beware of overdosing. If the tissue trying to heal itself is kept too cold too often, this may inhibit the healing process. There is no exact frequency or duration of icing that everyone agrees is the correct amount, but by listening to your body you can often tell when it has had enough.
Two guidelines I use are: if the tissue starts to ache deeply, or if I’ve applied the ice longer than 10 minutes, it’s time to stop.
The purpose of applying heat is to mobilize stiff tissue. For the intent of aiding a healing injury, heat is only ever useful by the maturation stage or when an injury is considered chronic, meaning that it has developed over time and lasted a long while.
For example, you might apply a hot pack to thick, rigid scar tissue before a massage so that the therapist can start treating deeper tissue more quickly and effectively. It may also be beneficial before lightly stretching and exercising a nearly healed body part. Additionally, heat, in the form of a hot shower, a nap in the sun, or a heated blanket, might be a balm to long term back pain or achy joints. Just like ice, applying heat is not necessary for an injury to be able to heal, but if it provides comfort and ease it can help you in your effort to allow healing to happen.
Of course, any time you have questions regarding proper treatment of an injury, it’s a good idea to ask a trusted health care provider. Every person is unique, and so one person’s injury will not necessarily require the same treatment as another.