Tissue Healing Times, and What It Means For You

Injuries suck. It's not fun to be in pain, to modify your activities, or take time off from doing what you love. But, they're to some extent a part of life. Everyone tweaks something at some point, and people who are active have a higher risk of many minor injuries simply because they are active. 

The main questions that most people have when they get injured are,

"How long with this take to go away? When can I go back to running/climbing/biking/skiing/paragliding/swimming/etc.?"

A key part of our injury rehabilitation approach is helping patients to understand their diagnosis and prognosis, and to work with them to get them back to their activity, without symptoms, as soon as possible.

While the proper treatment can often rapidly eliminate pain and allow a resumption of activity, we can only speed human biology so much. When an injury occurs, there is often real irritation or damage to a structure, and this takes time to repair and remodel. Different tissues have different structures and varying degrees of blood flow, and therefore heal at different rates. Likewise, the severity of an injury will definitely affect healing time as well. 

So, we find it helpful to discuss average healing times with many of our patients. This can give an expectation for how long an injury will take to truly heal. We created an infographic for many of the most common types of orthopedic injuries. Sources are listed below for the research geeks out there.

A few notes and caveats:

But what about pain?

In the first several visits with new physical therapy patients, we often place a focus on getting symptoms under control. Usually, this means reducing pain. In many cases, we can resolve or drastically reduce pain in just several focused sessions. However, the absence of pain does not mean that the injury is healed! We're unfortunately not miracle workers, and cannot change human biology. We can only optimize. Until the tissue is fully remodeled, it will still be at risk of reinjury, even if pain is generally low.

A good example is a flexor digitorum brevis tendinopathy. This is a common injury that we see in runners who have pain in the bottom of their foot. After a correct diagnosis, we can usually eliminate 80-100% of pain in one visit using hands-on manual therapy, a specific type of taping to offload the injured muscle, and perhaps a small gait change. That's right, a problem that may have plagued a patient for months will be pain free. But, in no way did we cause the tendon to remodel, repair, get stronger, or heal in 60 minutes. We simply desensitized it with manual therapy, and then took stress off it with tape or a gait change. The tissue is still injured, but we've decreased or eliminated inputs that create the sensation of pain. In chronic cases, it may take 2-12 months for complete resolution of the injury. This does not mean 2-12 months of constant pain. It does mean 2-12 months of careful attention to symptoms, targeted exercise, a gradual re-exposure to loading, and dealing with possible recurrences of symptoms quickly.

Until the tissue is fulled remodeled, it will be at increased risk of re-injury. Because we don't have an MRI machine or way to tell when this has occurred, our general rule is that you're not truly "out of the woods" until symptoms have been relatively quiet for multiple months with full activity.

Likewise, the presence of pain does not necessarily indicate significant tissue damage. (A quick example is a paper cut: It briefly hurts like crazy, but there's not really much tissue damage.) After an injury, the nervous system remains sensitive to inputs in and round that area of the body. It becomes "protective" of the injured area, and pain is the nervous system's alarm system. This especially true of areas that have been injured repeatedly, such as the bottom of the foot, the knees, or the lower back. When this happens, an introduction of a new stimulus, or a minor strain or tweak, can feel incredibly painful or sensitive. These occurrences are also common, indeed expected to some extent, as patients return to activity after an injury. In the absence of some new trauma, it's important to not panic, calm symptoms down, and then proceed on with the rehabilitation process.

Struggling with aches, pains, or an injury? We'd love to help. Click the button below to schedule to a FREE 15 minute consult with a Doctor of Physical Therapy. We'll develop a strategy together to help you get out of pain, and exceed your goals.

What is the role of physical therapy in the process? If you can't speed up healing, what do you do?

While we cannot speed up or change human biology, we do feel that physical therapy plays an important role in the rehab process for most injuries. We generally have several goals:

  1. Determine an accurate diagnosis and prognosis. This helps us have a conversation with the patient about their symptoms and develop a plan. Without a diagnosis, we're just grasping in the dark.
  2. Avoid or modify aggravating factors. Once we've established a diagnosis, we can help patients understand what factors may be aggravating or worsening their injury. Rarely do we tell patients to stop doing what they love. Instead, we usually recommend small changes to movement patterns or technique, and help patients to avoid repeated activities that will prolong healing.
  3. Reduce symptoms, normalize joint motion, minimize swelling. While eliminating pain isn't the same thing as tissue remodeling or healing, we do place a focus on reducing symptoms, especially early in the rehab process. This is how we know that we're on the right track. Additionally, normalizing joint range of motion and minimizing swelling are usually key factors in promoting a proper healing response. We often use hands-on manual techniques to help achieve these goals.
  4. Addressing factors that led to or are perpetuating the injury. This could include muscle imbalances, mobility deficits, impaired motor control or balance, or one of a number of other factors.
  5. Monitor progress and help with exacerbation or recurrences. Because we encourage our patients to stay active, it's fairly normal to have minor setbacks or exacerbation of symptoms at some point during the recovery process. As long as these instances are monitored and addressed quickly, we think that this is a good tradeoff: The benefits of regular exercise are too great for us to tell our patients to stop being active. We might recommend an adjustment in volume or technique, but almost never do we advise a cessation of activity. During this process, it's normal to occasionally bump into the injured tissue's upper limit and have a recurrence or return of symptoms. We want to manage these flare ups quickly, and then use the information learned (e.g., How or why did it occur? At what volume? How long did it take to calm down? etc.) to further tweak and guide the recovery process.
  6. Develop a long term place to reduce risk of recurrence. As we get towards the later stages of these healing times, our focus shifts towards preventing recurrence. We see ourselves as partners in the long term health of our patients, and so we think that closing the loop on this step is among the most important in the process. Often this involves a regular warm up routine or strength training program, but it looks different for each patient.

These healing times are average estimates. Your experience may differ significantly.

Everyone is different, and therefore how long it takes a certain musculoskeletal tissue to remodel will be different as well. These times are the best that we could find in the research, but the research isn't black and white (links below). Some of the research is based on animal models, and other pieces on observation or expert consensus. We've also injected our own clinical experience into the mix. Additionally, your healing rate will be influenced by countless factors, including (but not limited to) genetics, nutrition, stress, sleep, posture, hydration, activity, prior injury, and other illnesses or diseases.

But, even if you think you are a "fast healer," it's unlikely that you can heal more quickly than the lower estimate presented in the chart. 

What role does nutrition play in the process?

Our thought process is that proper nutrition is essential to injury and wound healing. Eating a diet that controls inflammation, has adequate protein and healthy fatty acids, and is rich in micronutrients, will help to optimize the process. 

How do I know the type and severity of my injury?

This is the main focus of our initial physical therapy evaluations. We seek to determine a diagnosis and develop a prognosis and plan of care. Here's some info on the grading of muscle strains and ligament sprains.

How do injuries heal?

The process of tissue healing is fascinating, and involves several steps. Every injury must pass through three phases: 1) Inflammatory phase; 2) Proliferation phase; and 3) Maturation and remodeling. Pain or injuries that have persisted for a long period of time are usually "stuck" in the inflammatory or proliferation phases. This can happen with repetitive aggravating activities (e.g., running 10 miles on a swollen ankle will keep it inflamed). Our job with physical therapy is to help nudge this healing process along. You can read more about it here. (Clinical side note: There is some debate about the etiology of chronic tendon injuries, called tendonoses. Some suggest that these injuries are related to a stalling of healing in the proliferation phase, and a failure of proper maturation. This study discusses it in more depth).

Struggling with aches, pains, or an injury? We'd love to help. Click the button below to schedule to a FREE 15 minute consult with a Doctor of Physical Therapy. We'll develop a strategy together to help you get out of pain, and exceed your goals.

Brian Kinslow