A common question that pops up during many of our Physiotherapy assessment and treatment sessions is “how long will it take….?” This can often be a difficult question to answer and there are many factors affecting recovery. The figure below shows the phases and approximate timescale for recovery of certain tissues. As you can see there is a period of overlap through all stages from bleeding, inflammation, proliferation and remodelling and the whole process can take a number of months.
The bleeding phase is often a short phase but depends on the tissue that has been injured. Have you every spotted a bruise in an area that you have injured? This is the bleeding that has occured due to the injury you’ve sustained. We often see extensive bruising in hamstring injuries and ankle sprains.
The inflammatory phase occurs next and can last from days to weeks. It occurs most rapidly from 1-3 days then slows down. Inflammation is normal and an essential part of healing.
Proliferation is the phase where the body begins to repair itself by producing collagen or as you might have heard of ‘scar tissue’. The scar tissue formation begins usually within 48 hours of injury and peaks at around 2-3 weeks. This is where the body lays down tissues that act in a similar way to the surrounding tissue. Unfortunately these tissues are not replaced with ‘like-for-like’ tissues but they develop to tolerate the loads placed upon them.
Muscle injuries can be troublesome to recovery and here is why; our bodies muscle protein turnover is around 1-2% per day. To put this into context this means that in 8 weeks our forearm muscles will have regenerated fully. This doesn’t mean that the muscle is as physically strong as it was pre-injury but gives you an idea of how long it might take for a bigger muscle to repair.
Our nervous system can become injured in many ways but nerves do regenerate albeit very slowly. The rate of regeneration of a nerve is 1-2mm per day in the smaller nerves and up to 5 mm per day in the bigger nerves.
Tendon recovery can also be slow and there is a continuum of injury with regards to the tendon damage. When injured tendons fall into a ‘Reactive’ phase where the tendon has been overloaded and is unable to cope with the demands placed on it. This can result in a short-term thickening of the tendon and a reduction of power produced. This can happen due to a direct trauma such as falling on to the patella tendon resulting in compressive forces on the knee.
This can lead to further damage and the tendon entering the ‘Disrepair’ phase where the tendon fails to heal effectively, this is where the tendon recovery is outweighed by tendon injury.
If the tendon continues along the continuum it can become degenerated which becomes a lot harder to treat. We tend to see this in our older patients.
In terms of time for healing a tendon it’s a question that is difficult to answer – the sooner we offload the surrounding restrictions and load correctly the tendon tissues the better so don’t delay in starting a rehabilitation programme….! Stretching is a ‘no no’ in favour of ‘loading’ which should be directed by a medical practitioner.
We hope this helps to give you some information about healing times and helps to appreciate how long the piece of string might be!