Exercise is essential for maximum health and optimal function through the lifespan. Unfortunately, and despite our best intentions, we are occasionally sidelined from our exercise endeavors by an injury. This usually doesn’t mean the end of our fitness or athletic careers, but having an understanding of what’s going on — and what we should do about — an injury, can be extremely beneficial.
Exercise-related injuries come in two major varieties: acute and chronic. An acute injury is a sudden, accidental event, such as an ankle sprain. A chronic injury is often termed an overuse problem, as the body is affected negatively by wear and tear from movement dysfunction that causes overload on a tissue. Examples of this would be conditions such as achilles tendinitis or plantar fasciitis.
The important thing to appreciate is that when injuries happen inside our exercising bodies, they behave almost exactly like injuries which occur on the outside, such as a cut or scrape on our skin. Injuries go through familiar and predictable phases of recovery.
The initial phase of any injury is the acute phase, when tissues (either acutely or in a chronic flareup) are traumatized. This can also be thought of as the “bleeding” phase, as blood vessels are disrupted and the body’s inflammation process is mobilized. This situation is when we experience the predictable response of pain, redness, heat, and swelling. The bleeding phase for most injuries will last from about 3-5 days, depending upon the severity of the damage and the health of the individual. The most important thing to do during this phase is to protect the injured area from further insult, and to allow the body to quickly move through this phase and on to the next one.
The second of the three phases of injury is the subacute, or intermediate phase. You can also consider this to be the “scab” phase, when the acute reactions are calming down and the body is setting up a localized jobsite to carry out all the necessary components of this period. Depending upon the type of tissue(s) involved in the injury, the removal of waste products and the delivery of nutrients is accelerated, and the rebuilding process is emphasized. Again, there will be variances in the length of this phase, but the “scab” process can require about 2-6 weeks to complete. Our focus during this phase is to introduce frequent, safe motion to facilitate circulation and tissue health.
The final phase of injury recovery is generally known as the remodelling, or “scar” phase. The acute and intermediate reactions have mostly completed and the body is fine-tuning the finished product. This is the time when we begin to reintroduce loads to the injured area which allow it to regain the strength and mobility which it had before the injury. This loading actually minimizes the amount of scar tissue our bodies lay down, and this is a good thing. Scar tissue is a strong substance made primarily of collagen, but its exact fiber makeup and orientation isn’t quite as good as the original tissue it replaces. Our bodies do a great job of paring scar tissue down to the minimum amount necessary over time, and this orchestration requires as little as 2-3 weeks to as much as 6-12 months in more extreme cases. Getting some expert guidance from a physical therapist or other rehabilitation professional can be quite valuable in this circumstance, helping you to progress your recovery in the most efficient and safe manner.
It’s important to recognize that these phases of injury recovery tend to overlap in a gradual way as opposed to being very distinct in the timelines. And just as bleed-scab-scar is a flowing process, so is the way in which we manage the injury journey. We progress through recovery with an emphasis on first healing, then rehabilitating, and finally…training. This heal-rehab-train process parallels the bleed-scab-scar undertakings of the body. During the bleed phase we support healing. As the body utilizes scab formation, we rehabilitate with those gentle, controlled motions. And once the injury is in scar phase, we train our bodies back to full capacity with progressive exercise. It is then that we can safely return to our normal, everyday function as well as our fitness and sports pursuits.
Consideration should be given to the specific tissue which was injured, and the primary mechanism it utilizes in recovery. Bones, skin, blood vessels, and peripheral nerves have the capacity to regenerate. This means that they produce new cells of their kind and ultimately use very little scar tissue in their end product. Muscles and connective tissues (like tendons and ligaments), however, are not capable of regeneration and thus depend on the repair process to a greater degree. These areas use scar tissue to fill in the damaged area, then build up the remaining tissue around that “patch.”
The final and critical piece of the injury recovery sequelae is to restore optimal movement capacity in the body. This is the restoration of ideal movement patterns that allow for the greatest ease and efficiency of exercise and daily activity, with the least potential for adverse loading, pain, or reinjury. And it’s during the scab/rehab and scar/train phases that addressing these components is most important. Again, this is where professional assistance, from physical therapists and others, is so beneficial.
Injuries are a reality, but hopefully they don’t occur too often for you. And when injuries do happen…you’ll know what is going on, and what you should do to recover as fully and quickly as possible. And get back to your healthy exercise habits.