Healing is a complex process without which the body would be unable to survive.
A Sports Massage Therapist (SMT) needs to appreciate the processes involved in soft tissue repair since all treatment and post-care advice must be appropriate to the phase of injury and competence level of the professional.
The healing process is common to all tissue types and can be divided into three stages.
The process of soft tissue repair:
Stage 1 – Acute stage/The inflammatory phase (The first 3-7 days post-injury).
Stage 2 – Sub-acute stage/The repair stage (3-7 days to 3-6 weeks post injury).
Stage 3 – Chronic stage/ The remodeling phase (3-6 weeks to up to 2 years post injury).
The timescales detailed for each stage of repair are guides only. In reality there are a number of factors which may influence these processes, including:
– The severity of the injury – The more tissue damage there is, the longer it will take to heal (particularly in stage 1 as there is likely to be increased swelling and inflammation.)
– The location of the injury – Lower back and lower limb injuries have a tendency to remain acute for a longer period due to the reduced ability to completely rest the area.
Stage 1 – The acute stage
Inflammation is the body’s most basic attempt to protect itself. It is caused by any stimulus the body deems to be harmful or potentially harmful.
In some instances, the inflammatory response can be over exaggerated and may in itself be harmful (anaphylactic shock). However, in most instances, inflammation is therapeutic in nature because the ultimate aim is to protect the threatened tissue from further harm or injury whilst setting in motion the repair process.
The body can perceive any irritant, infection or damage to be potentially harmful and initiate the inflammatory response. This section focusses on the inflammatory response initiated by damaged tissues (injury). Small micro tears caused by dysfunction may also cause some inflammation. The process will be the same, although the individual may not be aware of any signs or symptoms.
Stage 2 – The sub-acute stage
New blood vessels used to be formed at the injury site in order to supply oxygen and nutrients to the cells of the damaged tissues, with lymphatic vessels providing drainage.
Fibroblasts (collagen producing cells) migrate into the sticky matrix and begin to lay down in accordance with the multidirectional tensile stresses the tissue is subject to.
If there are insufficient tensile stresses applied to the tissues, collagen will form in a haphazard manner, resulting in an excess of unfavorable scar tissue or adhesions. This may limit the functionality of the repaired tissue and continue the dysfunction and injury cycle.
The collagen will begin to contract, drawing the wound together and providing a permanent solution to the tissue damage.
Stage 3 – The chronic stage
The majority of the collagen fibers are laid down to the sub-acute stage of the healing process. Approximately 20% of the tissues original strength is regained by the start of the chronic (remodeling) stage.
In the chronic stage, the body continues to lay down collagen fibres which act as reinforcements to the already formed scar tissue. The fibres continue to contract and align themselves with the tensile stresses, and remodeling occurs to cope with any increased stresses placed upon the area as normal function returns.
The strength of the permanent scar tissue can be improved through suitable treatment, but even with the appropriate balance of stress and support, scar tissue will only ever reach a maximum of 80% of its pre-injury strength. This is because scar tissue has a higher proportion of strong collagen fibres compared with non-injured tissue, so it will lack some of its previous elasticity.