HOW THE BODY HEALS

Part 2 – Repairing the damage

As the initial inflammatory response starts to subside within the first few days, and clean-up has occurred, we  have to start laying down new tissue. This is what I call framing the house.  It takes organization.

Cells in our bodies that are able to divide will regenerate. Some tissues are better at rebuilding than others.

The skin, for example, is great at repair, while some of our organs are not so great.

Before we start to rebuild we need to make sure the plumbing is intact. We need to repair and re-establish any torn blood vessels.

You don’t heal well without blood flow to the area.  That’s why smokers have a more difficult time with healing.  The blood flow is compromised.

THE FIRST TWO-FIVE DAYS

The repair or rebuilding stage starts within the first two to five days post injury (overlapping with the inflammation stage). By the end of one week, rebuilding should be the primary thing happening at the work site.

The debris should be all cleared away.  The rebuilding takes up to two to four weeks on average.

The repair stage requires fibroblasts which are cells that re-frame the tissue.  Basically we start to lay stronger material over that initial chicken wire we put over the hole in our fence, except our fencing material is called connective tissues which comes in the form of collagen.

At the start of the repair stage, collagen is weaker (typically type III collagen) and more vulnerable to re-injury during this stage of healing.  This is for up to three weeks post injury.  There is research that suggests anti-inflammatories of the corticosteroid type (which are most other than aspirin, ibuprofen or Tylenol) interfere with collagen formation resulting in a weaker collagen structure. Typically our soft tissues, including mature scar tissue are made up of type I collagen. We want the connective tissue to be aligned properly so it’s once again strong and supportive.

STRETCHING WITHOUT RE BREAKING TISSUE

Care is needed not to re-injure the tissue during these initial stages (typically one to three weeks depending on the injury and the tissue). Some movement is required however to help with re-organization and strengthening of new tissue (material) as it gets laid down. If the injured area is not moved (because of fear, pain or casting) new tissue remains disorganized and has adhesions that prevent movement.  What I think of here is a mass of spaghetti that hasn’t been rinsed. It’s stuck together and breaks easily if you try to pull it apart.

SCAR TISSUE FORMATION – WE NEED IT

Scar tissue formation (fibrosis) occurs when there’s extensive tissue damage or the structure of the tissue was damaged and is complicated and difficult to reconstruct. While scar tissue can be up to 90 per cent as strong as normal healthy tissue, it generally is less in terms of the volume of the tissue that it has replaced. Scar tissue is meant to contract to pull the edges of the wound together.

Basically, trying to heal without this happening would be like trying to mend a tear in your shirt without pulling the two edges together. This leads to contractures and constriction of the structure that was injured (it’s tighter and harder to stretch resulting in loss of mobility or movement).

During the repair stage you still need to protect the injured area but avoiding the aggravating activities (those that increase pain and swelling). You also need to start using the injured area to the edge of pain. It’s not a no pain no gain mentality. We need movement to help re-align and strengthen the tissue, but pain should still be the guide.

Gentle is key.

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