The Musculotendinous Healing Process

A basic understanding of the soft tissue healing process is helpful – it provides insight into why it is important to address an injury (no matter how small) as soon as possible and gives us general bench marks for how well we are healing.
The process of healing itself is rather complex, but we can look at it in general terms to simplify things a bit. It makes sense that the more serious the lesion is, the more scar forms and the longer it will take to heal. If the lesion is small, or its parts are sutured together soon after the insult, cells from the two separated parts bridge the gap between, binding the ends of the lesion together. This is the fastest type of healing, results in the least scar tissue and is referred to as healing by primary intention. If the lesion is more serious (second degree, where larger amounts of tissue are separated by more space) without surgical intervention, tissue is produced from the bottom and the sides of the wound to fill up the gap. This takes more time, creates more scar tissue and is referred to as healing by secondary intention.

Regardless which type of healing occurs, the process is continuous and will run its course if allowed to so, that is, if we listen to our bodies and do the right thing. Although continuous in nature, we can break the process into three phases, whose signs and symptoms can be read by the therapist and client. This is a quick generalization and should give you a rough idea of what is going on with your lesion, but I urge you to study the process in more detail.


Inflammation

Onset up to day 5
Onset of injury–point tender; red, hot, swollen

Proliferation

Up to day 21
Scar tissue may be larger than normal due to edema

Remodeling

Up to 1 year
Scar tissues loses some of its water content,
scar density increases,
vascularity/redness decrease

(Houglum, 37-43)

During the inflammation stage, the focus needs to be on controlling the inflammation and stabilizing the area to prevent further injury. After that, your therapist will determine what type of therapy is appropriate depending on your injury and using well established guidelines.

There are also general time lines that we can expect for the healing of different types of tissues to regain nearly normal strength:

Ligaments – as long as 40 to 50 weeks
Tendons – as long as 40 to 50 weeks
Muscle – 6 weeks to 6 months
Cartilage – 6 months
Bone – 12 weeks
(Houglum, 48-51)

Keep in mind that these ranges are general and that we are resuming guided activity by the therapist well before the “normal strength” limit has been reached – in fact, the lesion won’t heal properly or fully unless we are active.
There are also general stages of rehabilitation your therapist will take you through that you must be patient with to facilitate the proper healing of the above tissues. You will need to progress from stability of the injured structure, to it’s flexibility, to it’s strengthening, to it’s ability to produce raw athletic power, and finally to full functionality in your sport. These stages will likely overlap each other to some degree. Focusing on preventing other systems and structures from becoming deconditioned in order to facilitate the healing of the lesion and maintaining your readiness to return to full functionality will also be part of your treatment plan.

Treatment will probably include both exercise prescription and modalities (massage therapy, ultrasound, etc). Both are important, but keep in mind, specifically for repetitive stress injuries, it was inefficient movement over a long period of time that caused the condition and that inefficient movement will need to be corrected and will take time to do so. Be patient - the exercises will not only facilitate the healing of the lesion but prevent it from returning. With respect to the modalities, some you won't feel at all and some can be quite painful. Suck it up – you’re an athlete! Learning what’s good pain and what’s bad pain is an important lesson. The realm of ultimate health, inner balance, peace, love, understanding, general feel good, etc. are noble goals, but lie further down the healing spectrum. Your goal is to heal that lesion and get back to kicking ass, not to lie around and feel your inner peace.

So be patient, accept your pain, and work hard, and you’ll back on the field, on the track, on the court, or in the pool, as good as (if not better than!) ever.

References
Houglum, Peggy. “Therapeutic Exercise for Musculoskeletal Injuries, 2nd Edition.” Primary and Secondary Healing. Ed. David H. Perrin. Champaign, IL, Human Kinetics, 2005.