The number one question we hear most often from patients is "how long will it take for this to heal?" Living in a fast-paced world like ours where everything happens quickly it can be difficult to be patient with our bodies after an injury. And while there may be things we can do to optimize the healing process, our bodies still go through specific phases of healing. The length of time in each phase is dependent upon the severity of the injury and the tissues affected.
The healing process consists of 3 phases, the inflammatory phase, the fibroblastic repair/proliferation phase, and the maturation remodeling phase. These phases do not have clear start and end points but are instead on a continuum with phases overlapping during the healing process.
Once an injury occurs the healing process begins immediately with hemostasis. Bleeding begins immediately and generally resolves in 6-8 hours, but highly vascular tissues can bleed for 1-2 days. The damaged cells/tissues initiate the inflammatory response which is critical to the healing process as it increases the local circulation sending various healing cells and mediators to the injured area. Swelling, redness, tenderness, and increased temperature are typical symptoms seen during this phase which can last for several days.
The fibroblastic repair or proliferation phase usually begins within 24-48 hours after injury and tends to peak at 2-3 weeks, but continues for several months. During this phase, scar formation begins and the signs and symptoms of the inflammatory response begin to subside. Usually, there is still some tenderness to touch and pain occurs when movements or activities stress the injured area. As this phase progresses those complaints start to decrease and gradually disappear.
Maturation remodeling is the final phase of healing and is a long-term process. During this phase, the collagen fibers that were created during the scar formation process are remodeled and realigned by the forces to which they are subjected. This is where the expertise and knowledge of a skilled physical therapist can help guide the healing process. Gradually the tissues attain a more normal appearance and function. This phase can take several years to be fully complete.
So what are the typical tissue healing timeframes?
Delayed Onset Muscle Soreness (DOMS) / Exercise-Induced Muscle Soreness
0-3 days
Muscle Strain
Grade 1: 1 – 3 weeks
Grade 2: 1 week – 3 months
Grade 3: 4 weeks – 6 months
Tendon Injury
4 – 6 weeks
Ligament Sprain
Grade 1: 4 – 10 days
Grade 2: 3 weeks – 6 months
Grade 3: 5 weeks – 8 months
Ligament Graft
2 months – 2 years
Bone
5 weeks – 3 months
Cartilage (articular)
2 months – 2 years
Nerve
1 – 3 mm/day
What can I do to optimize healing?
Stay hydrated – tissues that are dehydrated tend to heal slower
Get proper nutrition – healing tissues need nutrients such as protein and poor nutrition can increase systemic inflammation which can delay healing
Prioritize sleep – sleep is essential for tissue and cellular repair and keeps inflammation under control
Seek help from a physical therapist – during the initial phases of healing, physical therapy can help manage your pain through manual therapy and other modalities. As you progress through the healing process your therapist can prescribe graded exercises to load the tissue appropriately for healing while you return to activity, and correcting any movement abnormalities.
Remember injured tissues are at risk of reinjury until the remodeling process is complete. Healing takes time. Let our team of skilled physical therapists help you recover from your injury so that you can get back to doing all the activities you enjoy!
Jennifer Buono, PT, DPT
Resources: https://physicaltherapyweb.com/tissue-healing-timelines/