Stages of Healing for Wounds, Including the Meniscus
Wound Healing Treatment
To properly treat any muscle or soft tissue injury, a basic understanding on the four stages of healing and how the body responds during injury is needed. Proper evaluation of the wound to determine the extent of the damage will be the key factor in managing the healing process.
The condition of a wound is determined by the following factors:
- Type of Activity that let to the injury.
- Amount of Impact to the Knee.
- Wound Contamination (dirt, bacterial, etc)
- General Health of the person afflicted by the injury.
In addition to the effects of the direct trauma, additional micro-trauma will be suffered by tissue surrounding the site of injury. In many cases, the extent of the overall injury is greater than one perceives - which is why it is important to take a comprehensive approach to healing.
The body, in its attempt to achieve a balanced state, results in "stress" being shifted from the site of injury to surrounding muscles and soft tissue (we give this the term "overcompensation"). This causes additional discomfort for the individual. As an example, people who suffer a knee injury that is not properly treated, eventually experience pain and discomfort in the lower back, opposite hip, the piriformis muscle , the other knee, etc. The weight is shifted away from the direct injury to other parts of the body to help protect the injury from more burden.
This makes healing an injury a great challenge for some and can lead to a cycle of injury and re-injury. However, with the right tools and the right information, healing can be accomplished.
Stage 1 - Stop the Bleeding
(also known as "Hemostasis")
Timeline: The First 24 Hours After the Injury
Your body begins to heal itself the very moment you are injured. In Stage 1 of the healing process, your body will begin healing your soft tissue injury within seconds after sustaining a sprain, strain or tissue tear. Your damaged veins will constrict in order to seal themselves to stop bleeding and reduce blood loss.
Cellular processes occurring during Hemostasis (the bleeding stage) or Coagulation:
- Vasoconstriction slows blood flow.
- Fibrin and fibronectin perform clot formation.
- Platelets aggregate.
- Platelets release ECM proteins and cytokines (growth factors).
Platelets available in your blood flow will begin to form a mass to seal your damaged tissue (forming a "clot"), to prevent further bleeding. Platelets initially adhere to the fibers of the wound and then form tiny spikes on their surface. These spikes cause more platelets to stick to the wounded area, strengthening the seal.
During this stage, your body is aware of the injury that has occurred, and your cellular functions immediately swing into action to reduce tissue damage and bacterial infection. Chemical messengers are released, which serve to mobilize the body's natural healing functions to focus on the task at hand - heal the damaged tissue.
Our bodies are smart and they know to seal off blood from leaking because healthy blood flow is essential to tissue healing throughout every stage of the healing process, including the inflammatory response. At this point the body is already preparing the tissue to heal within 24 hours after an injury.
Stage 2 - Inflammation Response
Timeline: 24 to 72 Hours After the Injury
The inflammatory response kicks into gear after a "clot" has formed, preparing the body for tissue re-growth by acting as a "clean up crew" for cellular waste. Inflammation is the body's natural response to an acute injury where soft tissue has been damaged. Swelling, pain, heat sensation (hot to the touch or "calor"), redness (or "rubor"), and loss of function are the main symptoms of inflammation. The easiest indicator for the severity of your inflammation is the degree of swelling - as this is a visible "hard to miss" signal of the body's current condition.
Although these symptoms provide an inconvenience during tissue healing, they are really just a sign that the body is responding perfectly to the injury and giving it everything it needs. Now, two amazing things will happen: (1) More essential nutrient-rich blood will flow directly to the site of the injury, and (2) The walls of the veins containing blood will allow fluid (rich in white blood cells, anti-bodies, etc.) to leak into the injured tissue.
Increased heat sensation and redness are signs that blood flow is being increased to the site of your injury. This is also referred to as "vasodilation". At this point the body, like a hose watering plants, has increased the flow of liquid to the injured tissue to speed up the healing process.
Cellular processes occurring during the Inflammatory Response:
- Platelets release active inflammatory agents and mediators (serotonin, bradykinin, prostaglandins, prostacyclins, thromboxanes and histamines).
- Polymorphonuclear neturophils (PMNs) eliminate cellular debris, kill harmful microogranisms and cleanse the wound by secreting proteases (assimilate proteins).
- Leukocytes (helper T cells) secrete cytokines to increase inflammation and enhance vasodilation and vessel permeability.
- Macrophages (monocytes) also eliminate cellular debris and kill bacteria (pathogens), while secreting growth factors and cytokines to attract cells involved in proliferation.
Swelling is a sign that the veins holding the increased blood flow have leaked healing cells into the damaged tissue. Think of this stage as a high-tech sprinkler system. The body allows for the leakage of this fluid in order to bring white blood cells to every part of the damaged tissue within the injury site.
The combined effort of vasodilation and the leakage of fluid into your damaged tissue encourage the body to begin cleaning toxins from the injury site. This will also get rid of cellular waste and neutralize bacteria in the area. This is why this entire process is like a "clean up crew". Cellular waste and bacteria must be dealt with before the body can begin re-growth of healthy tissue.
Is there Such Thing as Too Much Inflammation?
Even though vasodilation and leakage of fluid are essential functions during the inflammatory process, there is a danger for too much or recurring inflammation. Over time, the extra fluid in our damaged tissue will place pressure on the veins carrying blood flow to the injury. This pressure will build until the veins are completely blocked off. When blood flow is blocked, the damaged tissue and surrounding healthy tissue is starved of oxygen, nutrients and antibodies needed to get rid of all cellular waste and neutralize bacteria.
Inflammation that goes on too long will hurt healthy tissue and slows down the healing process. So how do we control the amount of inflammation that we have and unblock our veins to allow blood flow to reach our injury for tissue re-growth?
There is an easy and natural way of controlling inflammation. This solution will get the pain, swelling and leakage of fluid under control to protect soft tissue. This is where cold temperature therapy comes in. The use of a Cold Compress or Ice Pack is intended to reduce pain and swelling, helping control the inflammatory response to a manageable level.
Stage 3 - Tissue Growth and Repair (Cellular Proliferation)
Timeline: Between 3 and 6 Weeks after the Injury
At this stage, temporary tissue (granulation) begins to grow on top of and around any clots formed in Stage 1. Granulation tissue forms as a band-aid to "cover" and "re-build" the injury because clots do not provide any protection from re-injury. In the case of a tissue tear, the granulation tissue will grow from the base of the wound and over a clot to bring both sides of a tear together - temporarily increasing tissue stability. Granulation tissue will ultimately be a part of a network of connective tissue (Type III collagen) laid down, which is known to be a weaker form of normal, healthy tissue. The growth of type III tissue is like plastering a hole in a wall, without the benefit of sanding, repainting and finishing the plaster used.
As a part of the granulation tissue, new veins are slowly developed in order to increase the availability of blood flow. It is important to keep in mind that the injured tissue would have also included ruptured veins. This is why blood flow has been decreased down to a trickle after the inflammatory process - the damaged veins have yet to be sealed in the early stages of injury.
Cellular processes occurring during Proliferation:
- Fibroblasts enter wound from adjacent healthy tissue to begin proliferation, create granulation tissue, and secrete growth factors to begin angiogenesis.
- Angiogenesis (neovascularization) occurs - endothelial cells from uninjured vessels create new blood vessels.
- Growth factors and fibronectin encourage proliferation.
- Fibroblasts start to convert granulation tissue to Type III collagen
- Collagenases and other factors degrade new collagen growth
The formation of granulation tissue and new veins will replace the clot that was originally formed to stop the bleeding. Replacing the clot is the first step in strengthening the injured tissue and maintaining the progression of on-going healing. The overall structure of the Type III collagen at this point is unorganized and much weaker than healthy tissue, but know that over time, Type III collagen will morph into stronger, healthier tissue. This occurs during Stage 4 of the healing process.
The weaker nature of this tissue increases the risk of re-injury and regression to earlier stages of the healing cycle. If, for example, your injury starts to feel better during Stage 3 (cellular proliferation) of the healing process, you will probably think you can start being active like you used to be. Physical movement is important during Stage 4 (wound remodeling), but moving too much too quickly will cause re-injury. Beginning movement and activity levels at this point (when the tissue is already weak) will result in re-injury, bringing you back to Stage 1 where you need to stop the bleeding again. This is why it is important to be aware of what is happening in your body and pay attention to your limitations.
Traditional methods require your body to move to promote blood flow, but that same motion that promotes blood flow can also lead to making your pain and condition worse. Instead of focusing on movement, you should be focusing on increasing blood flow in a safe, controlled and non-invasive manner.
How can I Increase Blood Flow Without Risk of Further Injury?
Increasing physical activity too soon (even though you may be feeling "back to normal") can send you back to Stage 1 of the healing process. It is true that once temporary (granulation) tissue and Type III collagen are formed, you will feel much better than you have since your body was injured. This can easily lull you into a false sense of security with your injury. Just remember - even if you might "feel" like your injury is better, this doesn't actually mean that it really is. All this means is that your body has done an excellent job in healing itself so far... But your injury still has a long way to go before it can handle your normal level of activity.
The reason why movement makes you feel good is because local blood flow is increased when tissue moves. Blood flow is like the life force of your body - it provides and maintains a healthy level of oxygen, nutrients and antibodies in your tissue. When you are injured, this blood flow is essential to replenish your tissue with everything it needs to heal. But how can you increase blood flow when moving will only re-injure your already weakened tissue?
This is how a T•Shellz Wrap® can truly help your body heal itself through a process we call Deep Tissue Therapy. Deep Tissue Therapy is a soothing therapy that boosts the body's natural capability of increasing blood flow. This therapy provides your body with something essential that is needed for on-going healing and protection against re-injury. A T•Shellz Wrap® provides soothing warmth to injured deep tissue via electromagnetic energy waves. Heat generated in deep soft tissue invokes an increase in blood flow, as the body use blood flow to maintain a stable body temperature. As blood flow is increased directly to the site of your injury you gain the benefit of an increased delivery of oxygen, nutrients and anti-bodies to the injured soft tissue - the essentials that it needs to heal quickly and completely.
Stage 4 - Healthy Tissue Growth (Wound Remodeling)
Timeline: Months to Years After the Injury
The final stage of the healing process is wound remodeling, which can take months or even years to complete. During this step the granulation tissue or type III collagen placed over the wound will be converted in stronger, healthier tissue (Type I or Type II collagen depending upon the are affected by injury). This process is like taking that plaster that has been used to fill a hole in the wall (in step 3), and sanding it, repainting it and finishing it over time.
First, Type III collagen (scar tissue) - which is weak and unorganized - must be converted to Type I or Type II. Scar tissue is known to be brittle and provides more long term fusing together of damaged tissue. Scar tissue serves its' purpose as another temporary solution that will strengthen the damaged tissue, and serve as the foundation for the formation new tissue. Unfortunately, scar tissue will also fuse to surrounding healthy tissue and stiffen the entire area restricting movement for rehabilitation efforts.
Cellular processes occurring during Maturation and Remodeling:
- Equilibrium is reached between collagen production and degradation forcing remodeling to begin (Type III collagen is converted to Type I or Type II collagen).
- Reorganization of collagen fibers form a more organized lattice structure.
- Activity at wound site is reduced.
- Apoptosis occurs - blood vessels no longer needed are removed.
The body will naturally convert brittle scar tissue to more healthy and flexible tissue (Type I or Type II collagen) over time. However, as the body ages, the inherent ability to convert scar tissue to normal healthy tissues becomes more and more difficult. This is why children seem to "easily" bounce back from tissue injuries. Their bodies are young, with tissue still constantly growing, and they have the energy and blood flow ready to handle a tough injury. For the rest of us, healing takes a lot of time, patience, dedication and effort.
Although scar tissue will lend additional stability to your injury, you will have to afford some time to heal completely. Even after months, if not years, your injury will not get back to 100% of the functionality it once had. Once tissue is injured, it will never really be the same. There are ways to support your body while healing naturally, and ways to speed the entire process. Maintaining healthy blood flow to tissue combined with consistent, controlled movement can give your injured tissue exactly what it needs to soften, break-down and convert scar tissue into healthier and stronger Type I or Type II collagen (healthy tissue).
How to Stop the Cycle of Re-Injury
Consistent deep heat treatments will reduce your risk of re-injury. Throughout the 4 stages of wound healing, your body is in a fragile state. Sure, it can perform powerful cellular processes to heal itself, but it is not immune to additional injury. Recovering soft tissue will hold together to allow you to heal over time, but it is not nearly strong enough to perform to the muscular or tissue capacity which you are used to. Increasing blood flow in and around the area of your injury consistently over time will augment your recovery; further to this, the introduction of deep heat is known to temporarily increase both elasticity and length of soft tissue, which is why we recommend deep heat treatments via the T•Shellz Wrap® before activity and stretching.
Deep Tissue Therapy also optimizes all of the good things that naturally occur in our bodies. Regular treatment with a will send oxygen, nutrients, antibodies and energy directly to the treatment area - boosting the body's natural power to heal itself. Increasing natural blood flow is the answer you are looking for to speed the healing process without having to rely on NSAIDs, cortisone injections, or surgery with the hope of repairing an injury. Many of those alternatives mask pain and inflammation - symptoms that occur in your body for a reason. They do not truly heal the injured tissue. In some cases, they may prolong overall recovery and not allow the body to get what it truly needs.
Many individuals believe this type of technology is only available in a clinical setting. While many clinics and hospitals do utilize the concept, the T•Shellz Wrap® devices are available for home use. While this form of treatment is slowly catching on in North America, the truth is, it is a therapy that has been utilized in other societies for decades.
Scar Tissue & Stretches
There are other ways to help your scar tissue convert into stronger, more flexible Type I or Type II collagen. Regular, consistent movement through rehabilitative exercise will enhance extensibility of tissue. This can be achieved through regular physical therapy sessions or advice from your doctor, physician, surgeon, orthopedic specialist or physical therapist. Unfortunately, many people cannot afford the time and cost needed to attend physical therapy sessions 3 times a week for several weeks. Rehabilitative efforts can be made at home when it is difficult to dedicate time and money to regular PT sessions. Inquire with your doctor or physical therapist about getting a stretching regimen that you can perform by yourself at home.
A Good Stretching Plan Is Crucial As It Will Help:
- Build Muscle Strength.
- Increase Mobility and Range of Motion.
- Speed Overall Healing.
- Prevent Muscle Loss.
- Improve Muscular Function and Capability
- Refine Tissue Alignment and Physical Balance
- Encourage Joint and Tissue Flexibility
- Facilitate Proper Warm Up for Regular Exercise
- Promote Healthy Circulation of Injured Tissues
Traditional Options to Heal Wounds May Not Always Be the Best Option
Muscle and soft tissue injuries are very common problems that everyone eventually suffers from. The pain and discomfort from these injuries directly impacts one's lifestyle as work and activity must be modified. In many cases, traditional healing advice is sometimes more geared towards providing short-term relief without a strong focus on the long-term healing essentials.
Resting has a role to play, but it is only one small factor in a recovery plan. The truth is, direct injuries lead to many other issues which include overcompensation issues that result in other muscle and soft tissue ailments. This can easily lead to a vicious cycle of injury and re-injury which can quickly become debilitating.
It may take weeks or months for these factors to surface, but when they do, merely resting will not solve the underlying issues. You need to utilize options that treat the source of the pain and help reverse the damage that has been done.Certainly one wants to rest in the earliest stages of injury, but too much rest will lead to weakness in muscle, less flexibility of the soft tissue (tendons and ligaments) and overall reduced range-of-motion. With this reduced flexibility and increased weakness, it is almost a certainty that re-injury will occur. This will ultimately delay any sustained recovery.
For many, cortisone (steroid) injections is one of the first recommendations they were given following an injury. Cortisone can be a very helpful and powerful tool, but in some cases, a cortisone shot gives people a false sense that they are healing because they are not experiencing the pain they once did. Some individuals even engage in activities they should not be doing because they "no longer feel pain". When the effects of the cortisone wear off in mere days or a few weeks, people find they have done more damage to the body. This of course, results in a prolonged recovery. What we are saying is this - if you get a cortisone shot, take it easy and do not make the mistake of assuming that your injury is healed.
Merely masking the pain with an anti-inflammatory (NSAID) is not a solution; it is just a temporary fix. Cortisone and antinflammatories does not provide a permanent contribution to any stage of healing.
The third traditional recommendation is physical therapy. We certainly tout the benefits of physical therapy; however, most people lead busy lives and can only attend therapy a few times a week. In addition to the cost of physical therapy, this option is out of reach for many.
The best way to minimize the risk of re-injury is to work with your body and properly manage each stage of healing. The body is complex and does have the ability to heal, it just needs the proper tools and the right balance between rest, controlled exercise and consistent treatment to get on the road to recovery. To truly provide a long term solution for your injury, you should be receiving treatment on a daily basis. Generally speaking, treatments one should be receiving for injuries are cumulative in nature...meaning the more the consistent the treatments are, the faster one will heal.
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