Phases of Soft Tissue Healing 12/06/2015

Frequently clients or players have stated that they don’t understand the reason behind swelling & bruising when they sustain an injury. I think it is important to help them understand the processes of injury healing as much as possible, so I briefly explain in Layman’s terms the process & the appropriate rehab.

It is essential as a therapist that I have to fully understand the processes of tissue healing for effective and safe management of soft tissue injuries. Healing is the way the body replaces damaged tissue with living tissue at the site of injury. Every connective tissue in the body has to go through the same processes once it has sustained some damage regardless of severity.

It is widely known that there are 4 distinct but overlapping phases, Bleeding, Inflammation, Proliferation & Remodelling (Figure 1.). There has to be specific rehabilitation and treatment based on the principles of tissue healing.

Figure 1.

Figure 1. Adapted from Watson, (2006). Tissue Repair. The basic response to tissue injury

Inflammation Phase, Acute Stage

Once an injury has been sustained, the damaged blood cells bleed, the site of the injured tissue will consist of dead cells and extravasated blood. A natural inflammatory reaction occurs involving a blood vessel and cellular response with exuded fluid resulting in bruising and cellular activity. The inflammation is triggered by blood vessels opening up and becoming more permeable (the ability to allow liquids to pass through it), this is initiated by chemical responses.

Typically acute inflammation presents itself as swelling, bruising, increased temperature, pain and loss in function at the injury site.


Proliferation Phase – Sub Acute

Repair material is generated at this stage where scar tissue is produced. This starts from 2-3 days after the initial incident and reaches it’s peak at 2-3 weeks. The formation of collagen (the main structural protein of connective tissue) and new local blood vessels occur to aid blood flow to damaged blood vessels from the incident.

It is common practice to immobilise the joint to prevent further damage and the patient to experience pain. The other benefits to immobilising include decreased healing time, increased growth of blood vessels and stronger connective tissue. It is important to get the timing right for immobilisation of the joint. If you remove the immobilisation to early the redevelopment of new tissue and blood vessels can be immature and fragile. On the other hand if you leave the immobilisation for a prolonged period of time, the muscles will waste away and cause functional issues during late stage rehab.

Exercise loading has to be within the tissues limits, a good indicator for this is pain. If this is monitored well, the process of healing can be accelerated. Exercise loading will help with basic movement and strength within the range of movement at the site of injury. This is essential prior to progressing through the rehab/treatment plan towards sports specific rehab.


Remodelling Phase

Around 2-3 weeks post injury (depending on the severity) collagen fibres mature and the remodelling of the tissue occurs. As the collagen matures it aligns with the typical stresses the injury site has to endure. There are different types of collagen, but one in particular is removed from the injury site and replaced with a type which has a greater tensile strength. This type of remodelling can happen for months and even years after the initial incident.

As previously stated, it is essential that in every stage of healing the treatment and rehab is specific and safe. As the injury progresses through the stages of healing, the treatment & rehabilitation has to progress accordingly. If you want to return to participate in sport, it is essential that you progresses through the stages of healing & rehab and adhere to sports specific exercises & rehab to prevent recurrance of the injury.



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