Uncovering the physiology behind how long healing times take for common diagnoses from joint replacements to strains and sprains
It has crossed our minds more than once. The big question after we have injured ourselves with a scrape or cut, or even after we have major surgery is "How long will this take to heal?" This blog post will help to give you background on the physiology of healing as well as give an insight into how different tissue types heal.
The 4 stages of Healing:
It's important to understand the "how" we heal before diving into "what" is healing in our bodies.
The process of healing can be broken down into 4 main stages, each with its own unique timelines and processes. The four stages are hemostasis, inflammation, proliferation, and remodeling/maturation.
Hemostasis
Hemostasis is the first step in the healing process of our tissues, often initiated by the injury itself. Our bodies will immediately respond by vasoconstriction, or shrinking, the blood vessels that have been damaged to prevent blood loss.
After this process, platelets are released, which causes our blood to clot and stop bleeding. This process can take up to 4-6 hours depending on the size and depth of the wound, as well as if the tissue damaged has a lot of blood vessels in it (vascularization)
This is why using a band-aid or gauze to cover a wound is often helpful to stop bleeding
Inflammation
Most of your therapists will refer to this phase when discussing your healing after injury. This second phase is characterized by the blood vessels' vasodilation, or enlarging, to allow our white blood cells to enter the wound site to prevent infection and remove damaged tissue. After the threat of infection is gone, the site prepares for remodeling.
Often patients will feel increased heat, see redness, and have increased tenderness in the injured area which are all normal during this phase
Inflammation peaks after 1-3 days post injury, and then will gradually reduce over the next few weeks. If the damaged tissue isn't appropriately cleared during this time, it can lead to chronic inflammation and pain.
Proliferation
In this third phase of healing, specialized cells will come into the wound site to create granulation tissue, otherwise known as scar tissue. This tissue is often called an "extracellular matrix" which will replace the damaged tissues, and is often red due to the inflammatory agents--which indicates a healthy healing process. Collagen is the primary cell makeup of the new tissue and this phase takes 2 or more weeks to fully lay out the new structure.
Remodeling/Maturation
During this final phase, the tissue that has been regenerated is often weaker than its predecessor by about 20%. During this time, the collagen fibers are disoriented and randomized and need to be stressed and challenged for durability and elasticity to develop. Doing mobility work and resistance training helps align the fibers in line with the direction of force to reduce the occurrence of scar tissue and re-injury.
This phase takes the longest, with this process taking up to 12+ months to complete
These four stages are the framework that drives the healing process and can be applied to all the tissue types in our bodies.
Healing times of different tissues in our bodies
Healing in itself takes time but it is also dependent on "what " is injured. Healing time and severity of an injury have a positive relationship, so the more trauma a tissue suffers, the longer it will take to heal. There are also other factors involved, such as age, gender comorbidities, diet, and amount of activity you are currently involved in both before and after injury.
The table below outlines each tissue that's involved with healing and the average time it takes for healing. It is important to note that each of the times are approximations, and Grades 1-3 indicate the severity of a sprain, with grade 3 being the most severe.
A common question that we get from our joint-replacement patients is how long the rehab process takes. In general, it takes up to one year for full recovery to occur from joint replacement. However, the infographic below is a great visual on the typical timeline of recovery:
Tissues in our bodies all have unique timelines of healing, but the foundation for healing remains consistent. It is important to acknowledge that our bodies weren't made in a day, and repairing them takes time. Most of us will often feel ready to get back into our daily routines and activities before our bodies are, so it is best to approach any activity on a gradual scale or with a doctor's protocol to prevent the risk of re-injury.
If you or someone you know recently received surgery, or have a chronic musculoskeletal issue and or general joint-related pain, see a physical therapist at Restorative Therapy Co and get relief from your symptoms! For more information about our services or to schedule an appointment, please contact us at 757-578-2958, visit www.restorativetherapyco.com or email us at info@restorativetherapyco.com. We are participating providers with a variety of insurance plans and no physician referral is needed for your initial physical therapy evaluation! We want to help you feel well and be well.
Contributed by Frances Rogers, PT, DPT
Franny has been practicing as a Doctor of Physical Therapy since 2023 and has been part of the RTC team since January! She sees a wide range of patients from post-surgical to balance disorders and enjoys helping everyone live a pain-free, confident, and active lifestyle!
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