A blog by Stephanie from PhysioVerbier on tissue healing
The question we most commonly get asked as physios is- how long until I can get back to normal? How long will my injury take to heal? When ca I start playing sport again? As a junior physiotherapist working in a big city hospital I would get nervous when patients asked me this, as I didn’t want to give them false hope or expectation. Medicine is not an exact science, everyone is different and tissue healing depends on many factors, so answering this question can still be tricky. However, there are some basics of human physiology which can help give us an idea. There are some external factors which can help speed up or slow down our body’s healing process and our ability to heal after a tissue injury. These include but are not limited to:
- Diet
- Smoking and alcohol
- Stress
- Age and sex hormones
- Certain comorbidities such as Diabetes
- Obesity
No big surprises here (at least they shouldn’t be) as these same risk factors crop up time and time again as risk factors for lots and lots of medical problems. If you are going in for an operation speak to your doctor, physio or dietician about ways to maximise your healing potential (hint- giving up smoking is a big one!) As physios, we are mainly concerned with the musculoskeletal system and the tissues which comprise it. Here is a quick run-down of each of these tissues and how long they take to repair:
Bone
Bones have an incredible natural ability to heal. In fact, they heal better than most other tissue in the body. This is due to a very clever response by our immune system which allows us to build new bone tissue around the site of a fracture. Fracture healing times are roughly-
Upper Limb 4-6 weeks
Lower Limb 6-12 weeks
Muscle
Muscles contain lots of blood vessels, allowing oxygenated blood to flow into them to power muscle contractions and deoxygenated blood to flow out. Due to this, if we tear or damage muscle tissue it can cause a significant haematoma or blood clot where blood is released into the surrounding tissue. Muscle tears are graded into three levels depending on the severity of the tear (based on the amount of muscle fibres damaged or broken).
Grade 1: 2-6 weeks
Grade 2: 8-10 weeks
Grade 3: Up to 6 months (may require surgical intervention)
Tendon
Tendons are the connective tissue that join muscles to bone. They are made of collagen and are both highly elastic and very strong. With age, tendons are more prone to degenerative changes caused by a breakdown of collagen tissue. These degenerative changes can cause pain and inflammation and are referred to as tendinosis. Tendinitis refers to and acute inflammatory response of the tendon due to micro tears in the tissue. Tendons can also rupture completely as a result of trauma. Tendons typically have a poor blood supply, which makes healing times longer than other tissues in the musculoskeletal system.
Tendinosis: 3-6 months
Tendinitis: 3-6 weeks
Tendon Rupture: 5 weeks to 6 months
Ligament
Ligaments provide structural support to joints and become damaged when the joint moves beyond its biomechanically ‘normal’ range of motion. The most common ligament injuries occur at the knee (the ACL and MCL) and the ankle (the ATFL). Ligaments are also made of collagen, but do not have the same elastic properties of tendon. They are stabilising structures and therefore a common symptom of ligament damage is joint instability, along with pain and swelling. Ligament healing varies depending on the blood supply. In many cases, a total rupture (Grade 3) will not be able to be repaired by the body and may require surgery to repair the ligament.
Grade 1: 3-6 weeks
Grade 2: 6-12 weeks
Grade 3: Up to 12 months (may require surgical intervention)
References:
Morgan, E. F., De Giacomo, A., & Gerstenfeld, L. C. (2014). Overview of skeletal repair (fracture healing and its assessment). Methods in molecular biology (Clifton, N.J.), 1130, 13–31.
P Sharme and N Maffuli (2006). The Biology of tendon injury: healing, modelling and remodelling. J Musculoskeletal Neuronal Interact; 6(2):181-190
Bray, R. C., Leonard, C. A. and Salo, P. T. (2002), Vascular physiology and long‐term healing of partial ligament tears. J. Orthop. Res., 20: 984-989.