The Healing Process – Simplified
When determining the next step you should take when you are rehabilitating an injury it is important to understand what your body is doing to heal. The basic healing process follows these four steps:
- Hemostasis
- Inflammation
- Proliferation
- Remodeling
Since this is a simplified explanation of the healing process we’ll redefine the steps as:
- Transportation
- Clean up
- Building
- Remodeling
Transportation
At the very beginning the body has to stop any bleeding and then get all its nutrients to the area. Other than nutrients the body also sends white blood cells to clean up the area and guard against any infections. This part of the healing is usually done within 10 minutes of the injury.
What you can do during transportation
If there is any bleeding then compression is recommend to stop the bleeding. Putting ice on the injury is also recommended within this time period. Slowing the metabolism can prevent secondary metabolic injury. Injured cell can hurt healthy cells and they call this secondary metabolic injury. You can put ice directly on the skin (not recommended if it is an open wound) for 30 minutes. Only put it directly on the skin if you are actually using ice at 32 degree Fahrenheit. Most freezable gel packs get colder than 32 degree, so you should put a cloth between the pack and your skin.
Clean up – Inflammation
Inflammation is needed during the healing process. It is when the body is cleaning up the injury and getting it ready for new tissue to be grown to heal the injury. During this time we want to manage inflammation, not get rid of it.
We can manage inflammation through the principle of POLICE:
Protect – Avoid making the injury worse. Wear a brace, use crutches, or avoid activities that would make it worse.
Optimal Loading – Rest does not mean we completely stop, we want to figure out how much you can still do without making the injury worse. If you have a sprained ankle and you can still walk, then continue walking. Figure out a slow and steady way to adapt you injury back to normalcy.
Ice – Only useful within the first 2-3 days of the injury. You can use ice for 30 minutes every 90 minutes. You can put it directly on the skin if it is true ice at 32 degrees Fahrenheit. Gel packs tend to be colder so don’t put them directly on the skin.
Compression – Most useful at night. Use a compression sleep or ace wrap bandage to move swelling away from the injury. Only useful if there is swelling.
Elevation – If you are very swollen, getting your injury up above the heart can help get rid of swelling. Do this whenever you are stationary like at night.
How do I know if I have inflammation?
There are five signs of inflammation:
- Redness or purpling/graying (for darker skin tones) of the skin
- Loss of function
- Pain
- Heat
- Swelling
Building
At this stage inflammation should be close to done and the body is ready to lay down new tissue and heal the injury. When the body does this it lays down tissue haphazardly forming tissue that is rigid and a little fragile. During this time you can do light massage and movements to encourage correct healing.
Also during this time you can use modalities that will help with healing. You can use things like heat, photobiomodulation, light exercises, muscle stimulation, or anything else that will promote blood flow.
Remodeling
Remodeling is just that, remodeling. After the body has put tissue haphazardly all over the injury, it now needs to remodel it to function properly. Building creates scar tissues, remodeling cleans it up and makes it look good.
During this stage you can continue to do any heating modalities to help with the removal of scar tissue. You can also begin to do more aggressive modalities like massage, muscle scraping, and stretching.
As you can see there is something you can always do to support your body as it is healing. If you need any more help or want more ideas feel free to contact us! Every injury is different so it is very beneficial to have a professional guide you through the process.
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