**Please note that individual healing and training specifics are unique to every situation. If you are working with a surgeon, physician, or other health care provider regarding your injury and care, it is very important that you communicate with them regarding your post-operative/post-injury protocol.**
Working with athletes for the past ten years, I have come across a wide variety of injuries and setbacks that have all required time off from training. Everything from osteochondral fractures (fracture of the joint surface) to an ACL
repair will require the patient to step away from certain activities and focus on the rehab process. Depending on the type of injury and location, this may be weeks or months with hours of recovery training and various types of therapy. Progressively, things will start to come together: over time there will be less pain, better range of motion, and improved strength. Inevitably though, the question that always comes up is this: “How do I know when I am ready to return?” The simplicity of this question pales in comparison the complexity of the answer, but by examining several aspects of injury, rate of tissue healing, training, and loading strategies, we will be able develop a more systematic approach to determining when we might be ready to return.
When we find ourselves hurt or injured it is important that we take the time to recognize that the issue is likely not just with that structure, but with a combination of factors that leave us vulnerable at our weakest point.
Type of Injury
Ligaments and tendons don’t have the blood supply that muscles have, so recovery time is typically longer for those structures…
When it comes to real estate we always hear “location, location, location.” We can think of injuries in the same way, but don’t just think of location as where on the body we hurt. Rather, location is more in reference to what structures were involved and to what extent the tissue has been damaged. Muscle, ligament, tendon, bone, and everything in between all have the potential to sideline you or significantly limit performance, and each one will carry a slightly different rate of recovery.
Ligaments, Tendons, and Muscles
When referencing injuries to structures like ligaments (connect bone to bone), tendons (connect muscle to bone), and muscles, a grading system is often used:
- A grade I strain or sprain (FYI: we strain muscles/tendons and we sprain ligaments) indicates that some level of trauma has been experienced with possible minor tearing.
- A grade II is more severe with trauma and tearing to the structure, but the ligament or muscle/tendon is still intact.
- A grade III is the most severe with complete rupture of the ligament or muscle/tendon and, often, significant loss of function.
Surgical repair is a separate type of trauma category for ligaments that is common with the grafting procedure done for ACLs as well as with severe joint instabilities. Ligaments and tendons don’t have the blood supply that muscles have, so recovery time is typically longer for those structures and (in some cases) may require surgical intervention.
Bones don’t carry a grading system like ligaments or muscles, but they can be classified by the type of fracture. Compound, spiral, and stress fractures might all be terms you will hear to describe what is seen on an x-ray. The more traumatized or displaced the bone, the more likely some type of significant intervention will be needed, including surgical repair of the fractured bone.
Phases of Tissue Healing
Oftentimes injuries occur as a result of something that is preventable and avoidable.
For all types of tissue, the initial phases of an injury usually start out the same: an event results in trauma to the tissue; the body initiates a specific series of physical responses to reduce further injury; and the healing process begins. Tissue will go through a cascade of events as it moves from acutely injured to a more stable, healed state.
The bleeding stage is typically short in duration (6-8 hours on average) and is dictated by the level of trauma sustained and the location of the injury. Muscles rich with blood vessels will tend to bleed more, whereas tendons and ligaments have a limited vascular supply and don’t tend to bleed as much. Keep in mind we are referencing internal bleeding here.
The inflammation phase is a necessary component of the healing process and will immediately follow the bleeding phase. Within this phase a series of events takes place that help remove some of the traumatized cells and tissue and allow the body to prepare for the healing process.
The healing phase, or proliferative phase, occurs next and is when the tissue starts the restorative process.
The final phase — the remodeling phase — occurs as scar tissue is formed and becomes a more dynamic part of the tissue again. The tissue will continue to change during this time, becoming progressively more like the original tissue as it matures over time.