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How do soft tissue injuries heal and when should we seek additional help from a Sports Therapist?







How do soft tissue injuries heal and when should we seek additional help from a Sports Therapist?

When injury resulting in damage to the soft tissue is imminent (acute) or whether injury occurs over time a series of physiological responses occur as the immune system responds to the injury. Special proteins flood the blood stream. Known as acute phase proteins, they indicate that the body is in response mode to control the injury.




There are 4 phases to return soft tissue back to health:

1. Acute Inflammatory phase

2. Repair phase (subacute)

3. Maturation and remodelling phase

4. Rehabilitation phase

The following outlines the stages of healing of soft tissue (acute injuries)


The acute phase occurs as soon as the soft tissue injury is sustained and while the pain, bleeding and swelling is at its worst. The body's aim at this point is to protect the injury from further damage.


1. Acute Inflammatory phase (protection phase)

• Lasts 2-4 days during which there is generally an increase of swelling, redness, heat, increase of blood flow.


• Immune response - white blood cells flood to the damaged site(s) - ‘the cleaners’; to help the body heal and/or fight off harmful substances (such as bacteria or viruses). Acute phase proteins help the body respond to soft tissue injury. For instance, some proteins may help cells destroy harmful substances, such as bacteria, while others may help the blood clot and prevent blood loss. This increase in immune cells leads to inflammation in the body.


• Body has its own inflammatory process for up to 48hrs. Inflammation is caused by a rush of blood to the injured site(s) to protect the damage tissue and commence the healing. However, if inflammation is still prominent several weeks later seek advice from your doctor.


• At this stage treatment therapy will be minimal and mostly involve icing and gentle massage away from the injury site to increase drainage of wastes and swelling. About a week post injury is the time to seek sports massage treatment in most cases.


• During healing with ice/heat, flexion and extension exercises (non-weight bearing) are important but must be pain free (to prevent further injury).


2. Repair phase (subacute)

• This phase starts when signs of inflammation begin to reduce and much of the pain has begun to subside, the wound decreases in size and scar tissue formed.


• New blood vessels form and fibroblasts (cells responsible for making collagen) migrate to the area known as the ‘the builders’ to create new tissue. This new tissue is commonly called the scar tissue.


• The scar tissue starts forming within a few hours of the injury, and most of it is usually created in 4 to 6 weeks post the injury. The body over produces scar tissue to ensure injury sites are completely covered.


• However, it is important to be aware that the produced scar tissue in this period is not fully functional, and it does not possess the qualities of the healthy tissue. In other words, the structure of the collagen is weak and unorganised, and is subject to re-injury.




The more cross linking of collagen the stronger the fibres become. Sports massage helps to realign the fibres and restore healthy muscle function. (see photo 'healthy/injured tissue)


• Often post healing phases it is the scar tissue to blame for inhibiting full muscle function and is why sports massage becomes an essential part of rehabilitation. The scar tissue needs help to be broken down if muscle is to be restored back to full functional capacity. Scar tissue hardens over time which can lengthen the therapy time.


• Resuming normal level of activity too soon can cause weakness within the muscle causing other muscles to take the strain. Over time this will be too much for the compensating muscles to handle eventually leading to a chronic injury several months later.


• Some muscle action is important at this stage to prevent muscle atrophy. When a full range of motion can be achieved without any pain during this movement, concentric strength exercises can be introduced. When there is pain, the intensity must be immediately decreased. Your therapist will be able to guide you through the stages of healing.


3. Maturation & Remodelling phase

When the bulk of scar tissue is created in the repair stage, it needs to be remodelled to function similar to healthy tissue. During the remodelling stage, the tissue becomes organised, stronger and more flexible.


• An appropriate stimulus (stress) to the injured tissue at the right time during the healing process accomplishes this stage. It helps the scar tissue to become stronger. With suitable remodelling conditions, the scar tissue can meet the demands of the individual’s normal physical activities.


• The remodelling stage usually starts by week 3 or 4 after injury when the scar tissue is reasonably mature. But it can continue for three months or more. In some cases, the remodelling may take years to make the scar tissue function normally.


• If the remodelling process is not accomplished fully and is incomplete, there could be consequences. The individual may be bothered by pain, limited function, and reduced mobility and flexibility even long after the injury.


4. Rehabilitation

• The key focus of a rehab program is to achieve an improvement in the client's ROM through introducing a progressive range of exercises. Restoring mobility to the ankle joint will provide a solid base from which to progress to more complex, intense and challenging exercises, designed to restore the joint back to full health.


• This healing paradigm happens with all types of injury such as ankle sprain, fracture, muscle tear, pinched nerve and even after surgery. It just happens at a different level.


• Soft tissue injuries are quite common and physical therapists treat many people with this type of injury.


• However, people often overlook the importance of remodelling stage. With physical therapy, they can make sure the remodelling phase is completed correctly.


• Research has shown that providing regular stress to an injured tissue under the level of damage can cause the tissue to undergo a chemical and structural change. Seek advice by your therapist to manage this carefully.


• Such a change promotes elongation, organisation, and strengthening of the tissue. By employing this method, Soft tissue therapy contributes to the remodelling and healing process.


How to stimulate the body's ability to heal...


• Sports massage stimulates healing particularly after the body has done all it can. Regular manipulation to the injury sites will stimulate/restart the body’s healing processes helping return you back to full fitness.


Please note, this would not be a one-time visit to your therapist but a series of 6-10 sessions in more extreme cases. Each session you have with your therapist will stimulate healing and lasts for 3-4 days post massage with self-management tips help promote healing in between treatment sessions.


Weekly sessions are advised to start with to get the injury healing going. Be mindful that lingering/older injuries are often painful to touch (as the fibres are impaired) during the initial treatment sessions. Going too deep too soon can be very painful and must be managed carefully by your therapist.


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