All patients want to know how long it will take to recover from their injury and this can be a very tricky question to answer as you will find out here!
How DO We Heal?
You injure yourself. It hurts. How long will it take to recover? Do you know what best to do when part of you hurts or do you just limp around for a few days and ‘hope for the best’?
The important thing to remember when trying to answer this question is that if you don’t know what tissues you have actually injured, then you can only guess how long it is going to be before you feel better again and what to do for the best to help the healing process.
Other factors influence healing times though such as the severity of the injury, your age and your general health, your diet and the care you take following the injury.
How do you damage tissue?
Bones can fracture, muscles, and tendons can be strained.
Ligaments can be sprained.
Cartilage can degenerate or tear.
Nerves can tear or be pinched.
Injury to any of these tissues can result from either one high magnitude stress for a brief duration or a low force stress for a shot duration or a moderate stress applied to the same tissue many times.
When you look at your back, it is made up of all of these tissues and you can injure one or all of them at the same time.
What happens when you injure tissue?
It doesn’t matter which joint or tissue you injure or how, inflammation follows immediately. This also means that the tissue is less tolerant of any further stresses – so if you feel you have hurt one of your joints, but you choose to ignore it and continue to ‘work through the pain’ by still doing what caused the injury, the inflammation produced makes you more likely to do greater damage – and will take longer to heal, hence the need to listen to your body!
Generally, inflammation lasts up to 6 days following injury.
Between day 4 and day 24, the tissues enter proliferation phase when collagen protein collects around the injury site in a random way. It is important not to overuse the area within this period as this random collagen does not provide the same amount of strength as normal tissue. It explains why you will continue to experience symptoms a couple of weeks after your injury. While the body not yet creating scar tissue, you need to remain active and positive but not overdo it.
You are at risk of feeling less pain in this phase and so you may be tempted to believe that you are, in fact, closer to full recovery than you actually ARE – therefore understanding this and taking care will help you to be more patient and not start moving ‘normally’ or resuming sports until you have allowed your body to go through all of the healing cycle!
Between day 21 and 2 years the remodelling phase occurs when the collagen is changed into more structured tissue that does provide better support in the form of scar tissue. It is important to apply more stress to the tissues now in order to realign the fibres along the proper lines of stress so that increased loads will be supported by the new tissues.
However, healing times are influenced by blood supply to the tissue damaged and the biological make up of the tissue and you need to understand the importance of rest immediately after doing damage to any tissue and then mobilise the area and increased levels of exercise.
How long WILL I take to heal?
If you stop doing what has caused the injury immediately and do everything to help heal the area then the following times apply. If you keep playing the sport that hurts, or keep sitting awkwardly at your desk despite the fact that you hurt then you will potentially cause the injury to gradually worsen and that will mean the healing times are much longer and the injury will probably become chronic.
If you do injure yourself, you need to follow a targeted approach rehabilitation programme so that you don’t overdo things.
The length of time for different types of tissue to fully recover from injury is very variable –
Connective tissue is found in bone, disc material and tendons. An acute injury can take 3 – 7 weeks to heal fully.
A chronic injury, which means one that has been coming and going for many years or one that just will not heal up, can take between 2 months and a year to heal fully.
Muscle tissue is responsible for movement. An acute, mild injury can take a few days to 5 weeks to heal.
A grade 2 or 3 muscle strain can take between three weeks to a year to heal.
Ligaments surrounding joints can take between a few days and a year to recover depending on the grade of sprain.
Nervous tissue helps communication between parts of our body and grows between 3 -4 mm per day if cut. If bruised or traumatised it should recover over a 6 – 12 week period.
Cartilage coats joints and takes anything up to 12 weeks to heal.
How can YOU help improve your rate of recovery according to the best research?
Whatever the tissue injury, In the initial phase of injury you need to pay the PRICE! Protect the area; Rest it; Ice the region; Compress the area and Elevate the involved area. PRICE! If you are worried that you may have broken a bone then you will need an x-ray to establish this if it is not immediately obvious, of course.
The Healing Process
A lot of chemicals are involved in the healing process!
Cells need to be stimulated to start to proliferate to replace the injured tissues. Tissue Repair involves stimulating cell division and regeneration of blood vessels to restore the blood supply and regeneration of the substance surrounding the tissues to hold the tissues together. It is a complex process, which is governed by age, nutrition and whether there exist other diseases in the body. Blood vessels are important as regeneration requires oxygen and nutrients.
Therefore you need to eat healthy foods, remain active and optimistic in order to help your body to heal quickly. Also research has shown the following to be most consistenly helpful over the years –
ICE – Research shows that the optimal use of ice is to apply 10 – 15 degrees C locally for 10 – 15 minutes every hour for 3 – 5 days.
COMPRESSION – Research shows less soreness after exercise and a positive effect on recovery and muscle function.
INCREASE ACTIVITY – INCLUDING MOBILISATION – Results in increased blood flow to the area and quicker recovery of the injury.
The thing to bear in mind is that you may have injured several different tissues at the same time. For example, the back has bony vertebrae held together with discs and behind the disc is the spinal cord with nerves exiting to supply your legs and arms and behind this you have two joints either side which have joint capsule, ligaments and muscles around them. Your mid back has ribs attached to the vertebrae on either side; the low back has huge muscles linking to the hips and the neck has muscles and ligaments linking to the shoulders and head.
Depending on what you have done to cause the injury, you can have issues with any or all of these tissues with their differing healing times! Some tissues heal quicker than others – you will only fully recover when the slowest tissue to heal has done so!
How can you reduce the likelihood of tissue damage?
If you understand how the tissues function you can realise when you may be failing to use some tissues optimally without realising and thus making yourself more open to injury. It is better to take a small amount of time to prevent injury than to wait for an injury to recover!
The muscles that move or support your body – in your abdomen, arms and legs are often the strongest, whilst the deeper, more postural muscles are weaker.
These postural muscles should be firing all the time to maintain our body position.
However, if we adopt faulty postures for too long the firing may become imbalanced and overworked one side or the other and then the muscles that do the moving will try to help out the suffering postural muscles. Thus the moving muscles can become overworked without us realising and start to hurt when we don’t think we have done anything.
Tendons attach muscles to bones and generally do not have a prolific blood supply and therefore if you do injure them, they take much longer to heal. Injuries are often caused by sudden, continuous repetitive forces on the same joint. You need to keep changing your workout and not overloading the same joint. Make sure that you focus on your general posture while you exercise, not just the joint you are exercising but more importantly perform warm ups before you play sport.
Five minutes of warm up for every 30 minutes of exercise is a good rule to apply. Warm up the joints you will be using in particular. Gradually build up the intensity of the workout and only slowly increase the exercise load.
At work, position your computer at the correct height and observe how you are sitting and how often you are actually quite uncomfortable but you choose to ignore it as you are busy and ‘it will be OK’.
If you feel pain when doing something – STOP – it is your brain telling you that you need to take a break – so LISTEN to yourself!
Performing eccentric exercises helps to stimulate blood supply to tendons – for example stand; press up on your toes then slowly lower your heels to the ground – a good eccentric exercise for the achilles tendon.
If you develop chronic inflammation of a tendon, it will get in the way of tendon healing. It is better to prevent injury to a tendon than to try to heal it afterwards.
If you do exercise, to help tendon health, always STRETCH afterwards in addition to having done your pre-exercise warm up.
Ligaments attach bone to bone and have an even less efficient blood supply than do tendons. Hence they take even longer to heal.
They are tougher and have less stretch than tendons. They tend to be damaged with sudden large forces being applied.
A sudden stretch is called a sprain and a bad sprain can lead to a complete tear.
Ligaments are responsible for the stability of a joint – for example the anterior cruciate ligament in the knee (ACL) keeps the knee stable when you rotate it.
The best way to avoid ligament damage is to maintain stability by wearing proper footwear; maintaining a healthy weight as the more weight you put on your joints, ligaments and tendons daily, the more likely you are to have issues with them as they spend all their time under stress.
Mix your activities up, as for the tendons i.e. don’t spend too much time overloading the same joint with the same exercise.
Lines the joint surfaces of the bone. Cartilage has no blood supply. Nutrition to cartilage is via fluid within the joints. To aid healing you need to move the joints without putting them under strain such as static cycling.
You often do not feel pain in cartilage until it wears away when joints undergo degeneration because they do not have nerve supply either. To reduce problems you need to make sure your joints move throughout their range of movement evenly so they are not overloaded for years without you realising.
Nerves conduct signals from brain to muscle and muscle to brain and inform us of temperature, pressure, pain, body position and body movement via muscles, skin and joints.
Nerves can become trapped or pinched particularly as they exit the spine by a disc bulge pressing on the nerve in the limited space in their bony canals or overstretched and any of these injuries can cause numbness, tingling or muscle weakness. Nerves heal very slowly and rehabilitation requires careful monitoring.
Between every two vertebrae in your neck and back there is a disc. It is composed of connective tissue and there are three main components – a thick outer ring of fibrous cartilage called the annulus fibrosus then a more gelatinous core called the nucleus pulposus and the cartilage end plates of each vertebral body. Discs allow the vertebral column to move and you to bend. A problem with the discs is that they are positioned just beside the canals through which the nerves pass from your spinal cord out to your body and limbs. If you tear a disc or it bulges, it can put pressure on the nerve as it exits and cause pain in your arms or legs.
Factors affecting the time you will take to heal.
Collagen, as we said already, is important for healing but collagen production slows down from our mid 20’s dropping by 1-2% each year. By the age of 60 your ability to produce collagen has probably reduced by 50%.
Puts greater pressure onto discs. If you also smoke and have diabetes these three problems are significantly associated with increased diagnosis of disc disease and increased recovery times from injury.
When you reduce activity you reduce the collagen in your body. This then increases your injury risk yet again.
TAKING NON STEROIDAL ANTI INFLAMMATORY MEDICATION
NSAIDs usage reduces collagen mass at the site of injuries, increasing the likelihood of further injury rates by up to 25%.
This reduces the collagen within joints.