Hey Doc, How Long Is This Going To Take, part 1
One of the most common question I’ve gotten from patients, athletes and fitness enthusiasts is “Doc Mike, how long will it take for this injury to heal?”
Unfortunately, this isn’t a simple question with an easy answer. It’s more like the tip of an iceberg; you know there’s a lot more to it beneath the surface. My initial response is that it depends; you may be disappointed in an answer like that, but hear me out.
Understand that we all have differences such as how we train and what we eat; that’s also true with how we heal. In this post, I’ll explain the phases of healing, the time the body spends in each phase and factors that can affect each phase. I’ll also discuss actions steps you can take to enhance each phase.
Phases of Soft Tissue Healing
There is a predictable response when the body suffers an injury: experts over the years have classified these relations into three phases that always occur. There is some over lap in time and there are multiple factors that have a direct effect on how well and quickly the body heals.
Phase 1: Acute Inflammatory Phase. This phase begins at the onset of an injury. It is characterized by pain, swelling, redness and warmth. It lasts approximately 72 hours. This is the body’s way of protecting and healing itself by laying down scar tissue.
In 1978, Gabe Mirkin, MD (known as the grandfather of sports medicine) released the first book of its kind, “The Sportsmedicine Book”. Incidentally, it was the second book I bought in my quest to educate myself. In it, he wrote about R.I.C.E., or Rest, Ice, Compression and Elevate. This was his protocol for treating acute injuries. Since then P for Protection was added to the acronym, now known as P.R.I.C.E.
Recent research, including work from Dr. Mirkin himself, has questioned whether the use of ice and anti-inflammatory medication actually slows down the healing process. He recently stated in his blog that healing requires inflammation and ice keeps healing cells from entering the injured tissue. It is in his opinion that anything that reduces inflammation, including ice and both non-steroidal medication like Ibuprofen and cortisone type drugs delay healing.
He recommends that while the application of ice does reduce pain, its acceptable to cool the injury for short periods of time, such as leaving ice on for 10 minutes and off for 20 minutes. This process can be performed for up to 6 hours.
It is still SOP (Standard Operating Procedure) to use ice for up to 72 hours. The most effective way to utilize this home remedy is to put crushed ice in a zip-locked baggy wrapped in a moist towel.
Phase 2: Repair Phase. As the inflammation goes down and the bruising starts to fade, the body’s repair mechanism kicks into high gear. The body has stopped its scar formation and begins laying down collagen to replace the damaged tissue. The structure of this early collagen is unorganized and immature at this point making it weak and very tender.
Phase 3: Remodeling Phase. This phase may last 6 weeks to 12 months, depending on the injury. Here, the weaker collagen from Phase 2 is slowly remodeled as the body rebuilds new tissue. This new tissue isn’t as strong as the un-injured area and therefore needs to be strengthened.
For now, it’s important to know that at the onset of an injury you follow the P.R.I.C.E. acronym. Protect the joint, Rest it, use Ice for up to 72 hours, light to mild Compression such as an ACE bandage and keep it Elevated if possible.
In part 2, I’ll discuss a few of the more common reasons why injuries take longer than usual to heal and what treatments are being used to get you back in action.
Move Strong Live Strong