The 3 Stages of Healing

Have you ever wondered what happens in your body after you have sprained your ankle or torn your hamstring? You might also wonder why your physiotherapist is asking you to rest, stretch or exercise while you are recovering.

Soft tissue structures in the body undergo specific phases of healing and this healing is ongoing for many months. Your physio will take into account how long ago your injury occurred and your treatment and rehabilitation will be specific to the stage of tissue healing you are in.

Here is a quick guide to each stage of the healing process and what physiotherapy can do facilitate your healing process.


Stage 1 Acute/Inflammatory phase

This is from the moment that the injury occurs until about 4 days after injury. There will be bleeding, pain, swelling and inflammation. You will notice that the area of injury could be bruised, hot and swollen. This is a crucial part of the healing process as your body kickstarts the repairing of the soft tissues.

This is why there is some debate as to whether you should take an anti inflammatory in the first 2 days after an injury as you may be delaying the healing process. This is a protective phase and you want to minimise further trauma to the tissues. You can do this by following PRICE.

P=protect R=rest I=ice C=compression E=elevation.

Your physiotherapist can help you to reduce the swelling with electrotherapy or ice as well as strap or brace the injured area.

stages of healing

Stage 2 Subacute/ Repair phase

This phase lasts up to 6 weeks after the injury. During this phase the body begins to lay down new tissue which is made up of fragile soft collagen. You may notice the swelling decreasing but may feel a bit stiffer. You can now start to decrease the amount you protect the injury but remember to still be careful as the new scar tissue is still fragile. Over time the scar tissue matures and strengthens and it does this by being carefully stretched and loaded appropriately.If you are scared to move the injured area you may end up with weaker less mobile scar tissue forming. Your physiotherapist will work the soft tissue to decrease stiffness and muscle tightness and instruct you on ways to strengthen the tissues. They will also work to make sure the scar tissue does not form adhesions and make sure it is extensible. The physio will use techniques like massage, dry needling, electrotherapy and joint mobilisation. Exercise is also important in this phase to stretch, strengthen and correct biomechanical imbalances. Because your physio is familiar with your injury, she will best be able to prescribe the appropriate exercises for you and deal with any niggles you may have doing them.


Stage 3 Late/ Remodelling phase

This phase lasts from 6 weeks to 3 months. As you use the repaired tissue more and more it is strengthened and the soft collagen is replaced with sturdier more supportive collagen. Eventually the injured tissue will be strong enough to meet the demands of strenuous exercise. You should now have regained full movement and should have regained normal strength. The physiotherapist will focus on sports specific exercises, eccentric strengthening, improving endurance and proprioception exercises.

It is worth keeping in mind that healing is an ongoing process and will continue long after 3 months so respect the advice you are given as to how far you should push yourself once the initial injury has healed.


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Noelle Gornall Bsc (Physio) Wits, SPT

Noelle graduated from WITS in 2003 with distinction. After completing her community service in Mpumalanga she then worked in the UK for 3 years at a private hospital in Surrey doing post-operative rehabilitation focusing on lower back and knee patients and has run her own private practice for 6 years. She trained as a Pilates instructor with the Australian Physiotherapy and Pilates Institute doing a course in Clinical Pilates for physiotherapists.

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