Soft tissue healing

Posted by physionewbies20 on

“Soft tissue healing is defined as the replacement of destroyed tissue by living tissue in the body. This process consists of two parts – regeneration and repair” ~ Physiopedia

  • Regeneration = specialised tissues are replaced by the proliferation of the surrounding undamaged specialised cells
  • Repair = lost tissue is replaced by granulation tissue which matures to form scar tissue

Soft tissue healing involves 4 stages:

  1. Bleeding
  2. Inflammation
  3. Proliferation
  4. Remodelling

These stages overlap – one stage acts as a stimulant to the following stage.

(We will go into further details about some of these stages in future blogs – this is just a brief overview)

Stage 1: Bleeding

Short lived phase varies depending on nature of the injury and tissue.

  • More vascular (muscle) tissue will bleed for longer
  • Tissue like ligament will bleed for less
  • Injury –> end of bleeding = 4-6 hours

Stage 2: Inflammation/inflammatory response

Rapid onset (a few hours) and swiftly increases in magnitude to its maximum reaction (1-3 days) before gradually resolving (over 2 weeks). Involves the movement of immune defense cells to the area of injury, characterised by heat, oedema, pain and redness.

  • Onset + resolution is quicker in more vascular tissues

Stage 3: Proliferation

Proliferation = ‘noun. the growth or production of cells by multiplication of parts. a rapid and often excessive spread or increase’

Involves the generation of the repair material, which for MSK injuries involves the production of scar tissue (collagen). At this stage early activity needs to start to help align scar tissue.

  • Rapid onset (24-48 hours) but takes 2-3 weeks to reach its peak activity

Proliferation starts (first 2 days) –> peak proliferation (2-3 weeks) –> activity decreases (4-6 months)

Stage 4: Remodelling

Starts at the peak phase of proliferation and lasts up to 3 months – helping to improve the quality and function of scar tissue. At this stage stretching and mobilisation will help align the tissues.

Remodelling = orientation of collagen fibres and reabsorption of early collagen –> replacement with type 1 collagen –> scar tissue

  • Scar tissue is dense and less elastic than healthy tissue which increases the risk of re-injury and decreases the range of motion – this is why rehab and movement is so necessary at this stage

Wound healing:

This is a very similar process to soft tissue healing:

  1. Hemostasis (Stops bleeding and clots area)
  2. Inflammation (cleans up wound)
  3. Proliferation (granularion tissue forms)
  4. Maturation and wound contraction (repairs area and makes it stronger)

Key points:

  • The timeline for healing depends on: the individual; extent of the injury; age; overall health status.
  • Physiotherapy helps facilitate better healing – resulting in a smaller risk of re-injury, chronic pain and dysfunction.
  • One of the main risks of future injury is how the soft tissue is rehabbed, or recovered, from previous injury / surgery
  • Think about healing times and the best point to begin rehabbing a patient – Acute phase (1-7 days) = RICE or POLICE principle, sub-acute phase (day 3 – < 3 weeks) = pain free ROM exercises, remodelling phase (1-6 weeks) = stretching and strengthening, functional phase (2 weeks – 6 months) = return to hobbies and sports – this is very dependent on the individual, timelines will differ.

Keep your eyes peeled for more blogs in the next few days!

Physio love x

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