A fitness professional should have a clear understanding of the healing process to help prevent their client or athlete from hindering the healing process, and thus, delaying their return to activity. These phases are not independent or exclusive of one another — they are interdependent on one another, occurring in union along with a healing continuum.
Soft Tissue Healing
Inflammatory-Response Phase (duration: approximately 4-6 days)
Inflammation is the body’s common response to all injuries. The inflammatory response begins immediately after an injury and is often considered the most critical phase because it sets the stage for the remainder of the healing process.
Inflammation attempts to limit the extent of the injury. Cells are releasing chemicals that help to remove necrotic (dead) tissue and initiate tissue repair & regeneration. Although the inflammatory response phase plays a primary and critical role, if inflammation does not subside, normal healing cannot take place.
Signs of acute inflammation are redness, swelling, tenderness and pain, warm to the touch, and loss of function
Fibroblastic-Repair Phase (duration: approximately 3 days to 6 weeks)
In this phase, the body begins to repair and regenerate the damaged tissue. Tissue damage stimulates fibrocytes and the creation of fibroblasts. A fibroblast is a cell that makes up the basic substance of connective tissue and gives rise to other cells, such as bone cells, fat cells, and smooth muscle cells. In this phase, scar tissue forms – a process that begins just hours after the injury and may continue for weeks afterward. Complaints of pain or tenderness at the injury site can help signal the progression of this phase. These complaints tend to diminish as scar formation advances.
Maturation-Remodeling Phase (duration: approximately 5 weeks to 2-3 years)
In this, the longest of the healing phases, collagen density increases. Scar tissue “remodels,” or reorganizes itself, to improve its tensile strength. But scar tissue will rarely be as strong as the original tissue. As the tissue remodels itself to become more like the original tissue it is replacing, “maturation” is taking place and will eventually complete the healing process.
The final stage of maturation varies in duration depending on the individual and the tissue being repaired. For example, soft tissue maturation can continue for a year or more, while bone maturation can continue for many years after a fracture.
Bone healing or fracture healing is the repair of a fractured bone. While immobilization and surgery facilitate this process, a fracture still requires adequate physiological healing.
Depending on the size of the bone, normal periods of immobilization can range from 3 weeks to 3 months. Casting is required for long bones, but not always for the smaller bones. Sometimes a splint or brace is enough. Typically, fracture healing in long bones will require 6 weeks, and 3 weeks for the smaller bones.
Bone healing times are affected by the severity and site of the fracture, as well as the age of the patient. While bone healing essentially follows the same 3-phase path to healing as soft-tissue, there are a few differences.
With fractures, the healing cells originate in the periosteum (the tissue membrane covering the bone). Bone marrow also participates in the healing process. These cells later become osteocytes that produce bone. The structure surrounding the fracture becomes harder — this is a provisional callus. As time goes on, the callus becomes smaller as more and more bone is woven. Over the next few months, as activity resumes, cells called osteoclasts function to reshape the bone (absorb and remove bone until it is reshaped) to complete the remodeling phase.
Obstacles on the Healing Path
While we do not yet have the ability to hasten the course and phases of healing, there are several obstacles to healing that can prolong the process. Some of the obstacles include chronic edema/swelling, poor blood supply to the area, poor immobilization, dehydration of the wound site, atrophy, infection, hemorrhaging, and muscle spasm/contraction (or stretching) causing the torn tissue to separate before it can heal itself.
Cartilage does not heal well because it has little or no blood supply. Those cartilaginous tissues with some blood flow may stand a better chance of healing. Lastly, a person’s age, general health, smoking habits, and diet will either help or hinder healing.
A fitness professional can assist the healing process by ensuring the injured person avoids exercises or activities that might lead to increased swelling, or contraction of the injured tissue before it has sufficiently begun the healing process.
Proper wound care should be exercised for external injuries. Encouraging a continued healthy diet rich in essential vitamins and ample hydration cannot be over-stressed.
The fitness professional can also help prevent muscle atrophy by assisting the injured person with engaging in medically approved movement exercises. The role of movement during healing is key; it helps to increase blood flow to tissues and maintain flexibility, and actually improve the tensile strength of the remodeled tissue.
While a fitness professional can be as knowledgeable as a therapist or medical practitioner about a particular body movement or exercise – the hardest issue is determining when a person is sufficiently far enough along in the healing process to safely begin training again. These decisions are best left to medical professionals.
And finally, as a fitness professional, you must be aware that while returning to activity is the ultimate goal, a premature return to activity can be detrimental for you & your client. Don’t confuse your injured client’s enthusiasm or verbal assurances of “feeling ready” to sway your good judgment and allow a return to activity before medically cleared to do so. None of the possible outcomes are
- beneficial: the injured person could unnecessarily experience increased and prolonged pain interfering with their employment or tasks of daily living
- the coach could lose a star player for an entire season
- the personal trainer could lose a client long-term
- the athlete/client could lose interest or the ability to participate in the activity altogether
Pain Types and Sources
Pain is the body’s warning mechanism and should not be ignored. But pain is essentially an individual and subjective response that differs greatly from person to person. For that reason, assessing and quantifying the severity of pain is tricky.
A conditioned marathoner accustomed to the release of endorphins during prolonged exercise might not rate their pain levels after injury the same as a newcomer to exercise. However, nearly all pain falls into one of three categories and stems from one of four sources.