Many people are surprised at how long a soft tissue injury (muscle, tendon or ligament) takes to heal and wonder why they’re not fully recovered and back to normal two or three weeks later.
Unfortunately, this is normal as the time it takes for your body to complete tissue healing is actually much longer.
So what actually happens when you sprain your ankle, damage your knee or strain some muscle fibres?
There are four main stages that your body goes through, although in reality these aren’t distinct and they all overlap:
Phase 1: Bleeding
Just like a cut to your skin causes external bleeding, a bruise is a sign of bleeding from your internal soft tissues. Muscles have a very good blood supply and therefore bleed more and for a longer time, often producing a large bruise. Ligaments don’t have a great blood supply so will bleed less.
It’s important to rest during this phase to allow time for the bleeding to stop (approx. 4-6 hours).
Phase 2: Inflammation (swelling)
Inflammation starts within the first hour or two after injury, peaks within 1-3 days but lasts at least a couple of weeks. This phase is when you will experience swelling and some heat around your injury.
This is entirely normal and a natural part of your body’s tissue healing process. It needs to occur and there is nothing you can do (or should do) to prevent it. Follow these treatment principles to improve your recovery time – P.O.L.I.C.E:
Protect – don’t try to push through pain and swelling. You can continue with activities as pain allows but rest when you are able, especially in the first few days, to allow healing.
Optimal Loading – keep the injured area moving within a comfortable range to maintain strength, flexibility and to trigger the next phase of healing.
Ice – this will largely help with pain relief very early on. Try applying an ice pack for up to 15 minutes, 2-3 times per day
Compression – you can apply gentle compression around your icepack using a towel. Compression bandages, like tubigrip, can be used at other times.
Elevation – keep the injured area supported and lifted while resting and especially when you are using an icepack.
Phase 3: Proliferation
Your body has to create scar tissue to repair your injury. This process starts at around 24-48 hours and it can go on for several months, normally stopping at around 4-6 months. So if you’re wondering why you still have some symptoms a couple of weeks after spraining your ankle or knee, it’s because your body is busily laying down scar tissue.
The key to helping your body recover during this phase is to gradually exercise in a pain free way that doesn’t overload the brand new scar but creates a bit of tension within it to build strength and flexibility.
Phase 4: Remodelling phase
Even when you are past the stages of pain and inflammation, your injury isn’t fully recovered. Ligaments, muscles and tendons all have different jobs in your body and your new scar must be taught behave like the structure it was formed to repair. At around 2-3 weeks your body starts to remodel the new scar to get it as close as possible to the original tissue. This process can actually continue for up to 2 years.
Your risk of reinjury is higher during this phase due to loss of strength, flexibility, balance and reaction time, so it’s really important to follow a proper rehab programme. Your programme should also take into account any underlying causative factors to prevent recurrence.
So what’s the take home message?
Firstly, inflammation and swelling is normal after an injury and takes longer to resolve than most people expect. And don’t panic if you’re not 100% back to normal within a few months. If you’ve had a very bad joint sprain, it’s possible that you might still experience some very minor issues up to a year down the line and you can still make a full recovery.
There are things you can do each stage to speed up healing, help your body create a better repair and prevent recurrence.
A physiotherapist will be able to advise you on the right treatment and exercises to carry out at the right time. We’ll also be able to get you back on track if things are taking a bit longer than expected.
