This article explains the 2 key factors (from a sports physiotherapy point of view) that you have to understand and apply for your sports injuries to heal in the fastest possible time.
In this article:
- Essential knowledge to speed up your recovery from sports injuries
- Understanding the phases of the healing process
- Treatment of specific sports injuries
Essential knowledge to speed up your recovery from sports injuries
- Understanding the healing process
- Understanding how and when to exercise the injured body part
The body goes through specific phases of healing after an injury. The successful treatment of sports injuries requires you to understand these phases and choose treatment and exercises that are appropriate for the phase you are in.
If you train or load the injury too quickly, you may injure yourself again. If you don’t train or load it enough, you will take longer to recover or may even end up with a weakness in that part, which can also lead to re-injury.
Sports Injuries Treatment: Understanding the phases of healing
There are 3 phases in the healing process of sports injuries. The inflammatory phase, the proliferation phase and the remodelling phase. How long these phases last for, depends on how badly you have injured yourself.
There is always some overlap between when one phase stops and the next one starts.
The inflammatory phase usually lasts between 4 to 6 days and is characterised by hemostasis (stopping blood) and inflammation.
Simply put: when you injure yourself, cells and fibres are torn or disrupted and you get some bleeding. This signals the start of the inflammatory phase.
First a clot forms in the wound to stop the bleeding. The clot also provides scaffolding for other cells to attach to during the healing process.
The injured cells then send out a distress signal which calls all the ‘cleaner’ cells needed for the process of inflammation to take place. Inflammation has been given a bad name over the years and patients are often keen to take anti-inflammatory drugs as quickly as possible after an injury to “stop the inflammation”.
Thing is, inflammation is extremely important for wound healing and research suggests that you can delay or hinder your recovery from muscle and bone injuries by taking non-steroidal anti-inflammatory drugs (NSAIDS), e.g. ibuprofen, within the first few days of sustaining an injury.(2)(3)
SMOKING and CORTICOSTEROIDS (cortisone) also interfere with wound healing and can either cause non-healing or poor healing. Corticosteroids may have a role to play in chronic injuries, but should be avoided during the acute stages of any sports injury.
You should see inflammation as the body’s way of cleaning the wound and preparing it to rebuild strong tissue. During this time certain cells migrate into the wound and destroy bacteria and cell debris. They are preparing the cell for the next phase, the proliferation phase.
The inflammatory phase is characterised by:
- Warm to touch
Treatment during the inflammatory phase should be aimed at protecting the injured area to prevent further injury of the weakened tissue and also to limit how much it bleeds.
- Stop what you are doing. Continuing to run or play your sport when you have torn your hamstring muscle, will for instance cause more injury and bleeding and make your recovery take so much longer.
- Limit the bleeding. Apply ice and gentle compression for 10 minutes after sustaining the injury. It may also help to elevate the body part if possible. This helps to limit the bleeding without decreasing the inflammatory response. Excessive bleeding can cause lots of pressure in the muscle or joint. This increased pressure can cut off the blood circulation and oxygen supply to adjacent cells and you can end up with more damage than what the original injury actually caused. WORD OF CAUTION: applying the ice for longer than 10 minutes or applying very strong compression, may have the opposite effect.
- Limit swelling by applying ice and elevating the body part. Excessive swelling can also cause increased pressure in the surrounding tissue which, as explained above, can lead to a more severe injury. Ice is a better option than using NSAIDS, since it does not cause a decrease in the inflammatory response to the same extent that NSAIDS do. Apply ice (not directly to the skin) for 10 minutes immediately after the injury occurs and with the body part elevated above the heart. You can apply ice every two hours during the first 3 to 5 days of recovery.
- Protect the body part. You may find that using a crutch or sling for a day or two after injury can help speed up your recovery in severe cases. The cells and fibres are very weak immediately after an injury and you will help their recovery if you can decrease the load on them for a few days. Crutches, splints and slings should never be used for more than 2 days without consulting a physiotherapist of medical professional, since prolonged use can also hinder your recovery. NOTE OF CAUTION: Being over-protective of an injury can lead to poor recovery outcomes.
- Gentle movement. Moving the body part within its pain free range can help to decrease your pain and help recovery. I usually tell people to start doing this on the second day after injury depending on how bad it is. So, if you injure it today, start moving it from tomorrow.
The body has used the inflammatory phase to clean the injury site and it now uses the proliferation phase to rebuild the tissue. During this phase new blood vessels and cells are formed and collagen fibres are laid down. This phase usually starts around day 4 post injury and can last up to 14 days depending on the severity of the injury.
During this phase the injury is busy healing but the ligament, muscle etc. is still very weak. The new cells and collagen fibres do not yet look like they will in healthy, uninjured tissue. They are randomly laid down and not yet organised to form a strong, functional scar.
For a scar to be strong all fibres has to be aligned in the direction that it has to withstand force in. The scar is thus getting stronger during this period of time but is still very vulnerable. If you load it too quickly, e.g. strong exercise or returning to sport too quickly, you can easily tear it again.
Think of the cells as being a mess of spaghetti in your plate during this phase. For the scar to be strong, all of the spaghetti strands have to align next to each other. This will happen in the remodelling phase.
Treatment during the proliferation phase of healing should include:
- Movement but within the limits of pain. This means that movements should be done PAIN FREE. Movement is important since it tells the body to form new cells and also in what direction it should align the new cells and collagen fibres.
- You may still have to protect the body part to some degree by limiting how much force you put through it. If for instance your ankle sprain is severe enough to require you to use crutches, you should usually progress from using 2 crutches, to using 1 crutch, to using no crutches within 2 weeks. Again, this is heavily dependent on the extent of your injury and is best discussed with your physiotherapist. You can read more about the treatment of ankle sprains in this blog post.
This post about the treatment of Osgood-Schlatters (knee pain in children) will give you an idea of how you can implement relative rest to help a sports injury heal quickly.
Maturation and remodelling phase
This phase can start at 8 days after injury and last up to 1 year depending on the severity of your injury. Doing the correct rehabilitation exercises during the remodelling phase is extremely important – I’ll explain why.
The first collagen fibres and cells that are laid down are very thin and not aligned in the same way as normal, healthy tissue. (Think of your spaghetti bowl again.)
By moving the body part and doing stretches and exercises, you tug on the scar tissue. This tugging acts as mechanical stimulation to tell the body in what direction it should align the fibres. It also acts as a signal for it to form stronger cells and collagen fibres.
This allows the scar to become stronger over time. Progressively loading the scar tissue is thus key to creating a strong functional scar.
It is important to understand that it can take a very long time for an injured muscle, ligament etc. to get back to full strength. Research has shown that “at 1 week, the wound has only 3% of its final strength; at 3 weeks, 30%; and at 3 months (and beyond), approximately 80%.”
That is why it is so important to go through a carefully graded strengthening programme before returning to your sport. There is unfortunately no one size fits all recipe for rehabilitation and it is best to seek guidance from an experienced physiotherapist. You may also be able to play sport before you have gained full strength if you use appropriate braces or taping techniques.
You can find an example of a graded exercise programme as treatment for lower back pain in this post.
Treatment of specific sports injuries
You can find out more about the treatment of specific sports injuries in these blog posts:
- Overtraining syndrome
- Plantar fasciitis treatment
- Sprained ankle treatment
- Muscle cramps
- Exercises for lower back pain
- Neck pain while running
- Exercises for torn ACL
- Osgood-Schlatters treatment
You can make sure that you do not delay your recovery from sports injuries through understanding the phases of healing and doing the correct exercises in each phase.
Please let me know if you have any questions
Maryke is an experienced sports physiotherapist who can diagnose your injury online and provide you with a tailored treatment plan, online over Skype.
- Broughton, G., 2nd, Janis, J. E., & Attinger, C. E. (2006). Wound healing: an overview. Plast Reconstr Surg, 117(7 Suppl), 32e-S.
- Paoloni, J. A., Milne, C., Orchard, J., & Hamilton, B. (2009). Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. British Journal of Sports Medicine, 43(11), 863-865.
- Wheeler, P., & Batt, M. E. (2005). Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. British Journal of Sports Medicine, 39(2), 65-69.