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Part 3: What to do at each stage of your recovery: The final phase

Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful and uncomfortable process to repair itself. 

We sat down with Nick Marshall from Surf Life Physio in Miami, QLD earlier this month to get a better understanding of the recovery journey. Nick has over 17 years' experience as a physiotherapist, having practised both privately for his own practice Surf Life Physio and as a senior outpatient physio for Tweed Heads Hospital.



This article continues our injury recovery series. Read the first and second article on the first two phases of injury recovery. 

Nick gives his insights on the final recovery stage, known as the remodelling phase, of an injury and provides tips on how best to manage this stage.


What is the remodeling phase?

The remodeling phase is when the less mature Collagen fibres become thicker and stronger.

Depending on the physio rehab, these fibres then align themselves in a position so they are ready to absorb load and stress.

The most important component of the remodeling phase is that it cannot begin until the inflammation phase has come to an end and the area damaged no longer has elevated inflammatory markers.

Builders

In the analogy we are using of the house fire, the remodeling phase are the builders, the people instructed with repairing and re-building the damaged areas, and making sure the quality of the materials and the way they are assembled and constructed will withstand future issues thrown at it.

But as we discussed, in the human body, the remodeling can’t begin with the inflammation present, and neither can a builder start to re-build a house with the area still cordoned off by police and firemen still hosing the flames on the house down (remember the first stage, known as inflammation, is like emergency services).

This is often what happens in the presence of chronic inflammation and so the builders never get to build because the emergency servicers never move out and so the healing fails. 

Like wise the builders can’t start to rebuild the house if the house is still on fire and have people injured inside. This is what quite often happens in the body when a person takes an anti-inflammatory pill (or an anti-emergency services pill) too early in the acute injury model. By denying the area of an inflammatory or emergency services period there’s no possible way to progress and so again the healing of damaged tissues fails

How long does this stage last for?

Like building a house the remodeling phase can be slow and take time. In fact in some injuries especially to tendons and ligaments it can take a year.




How would the injury feel in this stage?

Generally, because this phase can’t start until the area is free of inflammation, this stage is pain free and the person will be almost back doing things without any discomfort. But that can be the danger. Because despite the absence of pain the structures haven’t been completely fixed and healed.


Do I need physio in this stage?

This is the most important period to get physio. It’s at this stage that you are adding exercises and stretches to the program to allow the structures to heal in the right way so to avoid re-injury and restore pre-injury function.


Thanks Nick.

If you missed the last two blog posts, click the links below. They are worth the read. 

Part 1: What to do at each stage of your recovery: The first 3 days
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]
Part 2: What to do at each stage of your recovery: The next 2 weeks
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]

This concludes our injury recovery article series. But be sure to stay tuned for more articles from Nick and the Surf Life Physio team. 

In the meantime, if you have any questions regarding these tips, injury recovery or other health issues please do not hesitate to contact Nick and his team at Surf Life Physio on (07) 5527 7830 or click the button below.

Part 1: What to do at each stage of your recovery: The first 3 days

Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful and uncomfortable process to repair itself. 

We sat down with Nick Marshall from Surf Life Physio in Miami, QLD earlier this month to get a better understanding of the recovery journey. Nick has over 17 years' experience as a physiotherapist, having practised both privately for his own practice Surf Life Physio and as a senior outpatient physio for Tweed Heads Hospital.

This article starts the first of three interviews on injury recovery. Nick gives his insights on the first 72 hours of an injury and provides tips on how best to manage this stage.

Keep an eye out for the next two articles on what happens after this initial phase and for Nick's advice on how to speed up the recovery process. 

So I have hurt myself, what stage am I in?

Immediately following hurting yourself you enter the inflammatory stage.

You've injured yourself and now it's time for your body to fix itself by finding the damage, reducing further risk of injury and laying the first foundations for repair.

This is the period of time when the injury is sore all the time no matter what you do or how you try to carry the injured area. It’s the body's pathological protective response. 

In the first 3 days you are in the first stage of recovery; inflammation.

What is the inflammatory stage?

Trying to describe the recovery process is confusing, jargon-filled and to be frank, a little boring. So, I let's look at the process through a real-world example. 

Let's take a house fire and call that our injury. The moment the fire is detected, the emergency services are dispatched. These being Fire, Police and Ambulance.

What does each service do? 

Fire

Like firefighters put out the fire, your body stops any bleeding to limit the extent of the damage caused by the injury. When you injure yourself, it causes blood vessels to break. You will see this when you have a bruise in the area, swelling under the skin or more obviously, when there is blood on your skin. Your body's firefighters, known as platelets, clot your blood and stop any further bleeding.

Police

In a fire, the police will cordon off an area to limit reduce the risk of casualties and further damage. Similarly, our body will relay messages to our brain to tell you the area is painful. In response, your body also floods the area with blood, causing the injures area to swell. This makes the area stiff and uncomfortable. By making an action or activity incredibly painful and uncomfortable it forces you to stop using it and avoids you causing any more damage. The police have successfully kept you safe and out of harm's way. 

Ambulance

The ambulance will bring paramedics to help treat the injured and remove those that need further assistance. Much like the ambulance, the injured tissue will release chemicals to attract the right resources to help begin the process of repairing itself, such as white blood cells. Your body will also begin the process of taking away the damaged cells so new ones can grow. 

How long does this stage last for?

The body’s general response to this inflammatory stage is 72 hours. But largely what you do and how you behave during those initial minutes following the injury will dictate whether it is more or less than 72 hours.

What are the symptoms of this phase?

This phase is generally represented by three symptoms:

  1. Heat and redness: blood is rushed to the injured area to bring resources needed to repair the injury. This pools around the injury causing redness and heat. 
  2. Swelling: this is often a result of fluid seeping through damaged blood vessels into the damaged tissues. These vessels are typically damaged by the initial trauma. In some cases, this will present as bruising. 
  3. Pain: this is the big one. When you first sustain the injury, pain is caused initially by a chemical reaction that interacts with local pain receptors to warn your body you have sustained an injury. This is the pain we were talking about during the 'police' activities in this recovery stage. As you recover, the increased inflammation in the area may place pressure on nerve endings in the area, causing further pain. This pain will inevitably limit function, movement and activity.

What treatment should you be doing? 

There are a number of acronyms that can be used for treatment in this early inflammatory stage. But probably the best message is first and foremost ‘do no harm’.

To achieve this most health practitioners will advise the injured person to commence R.I.C.E.

R

rest

Rest from painful aggravating activities.

I

ice

Ice the injured area, this will reduce the amount of bleeding and swelling and in turn reduce the inflammatory response.

C

cOMPRESS

Compress the injured area to further reduce the localised swelling and accumulation of inflammation.

E

elevate

Elevate the injured area to reduce the effect of swelling pooling in the extremities.

What about anti-inflammatory pills? Should we be taking those?

It might sound strange given we talk about our immediate treatment being to reduce swelling with the R.I.C.E. method but we actually want to avoid anti-inflammatory medication in the first 72 hours.

Despite what so many people think, we actually need the body's inflammatory response and inflammation to start a healing effect. It’s this inflammation that brings all the building blocks of repair and without inflammation, an injury will not heal properly.

We want to reduce the inflammatory response to make it more comfortable but not remove it completely. 

Should you see a physio during this phase?

Absolutely, you see it in elite sport when you are watching TV. The first person to an injured player on the field is the physiotherapist. If for no other reason than determine the level and extent of injury and then to make an educated assessment of the ability of the player to continue to play. It’s no different off the field. 

Quick and early identification, assessment and diagnosis of a person’s injury can better frame the rehab process as well as fast track a rehabilitation plan and return to work.


Thanks Nick. 

Check out the other parts in this series below.

Part 3: What to do at each stage of your recovery: The final phase
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]
Part 2: What to do at each stage of your recovery: The next 2 weeks
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]

Stay tuned next month for Nick's interview on stage 2 of the recovery process.

In the meantime, if you have any questions regarding these tips, injury recovery or other health issues please do not hesitate to contact Nick and his team at Surf Life Physio on (07) 5527 7830 or click the button below.