When a joint or the surrounding muscles are injured or torn, the body will do its best to heal and musculo-skeletal injuries can heal at different rates.
- Inflammation. Almost immediately after the injury, the body floods the injury site with repairing and growth factors to rebuild the damage. This is necessary.
- Protective muscle spasm. The body’s reflex is to tighten the muscles around the injury to prevent further damage.
- Scar tissue is formed to heal the torn fibres in the muscles, ligaments and joints.
- Resumption of movement and activity.
The body’s reaction to torn tissues is to heal by sending in fluid with growth factors to heal the area.
Protective muscle spasm
Muscle spasm serves a purpose to help healing by acting as the body’s own joint splint. Unfortunately the splinting mechanism is often an overreaction and can slow the healing process and perpetuate itself long beyond the time needed to repair the damaged tissue.
In many medical conditions pain is caused by muscle spasm, which can at times be excruciating! Tearing of the muscle or joint ligaments leads to guarding or protective stiffening, the body’s own defense mechanism when it recognises an injury has occurred and tries to prevent further damage. Commonly, the initial pain from the muscle spasm can settle in a few days or weeks.
Muscles in spasm can be so tight that they restrict their own blood supply, producing acidic toxic waste which can trigger nerve endings into sensing pain, inducing a further protective spasm and creating a self-perpetuating vicious cycle, which prevents the injury from healing and causes on-going pain.
Habitual or long term muscle spasm after injury
It is common for the muscles to remain tight around the injury and if these are not helped to relax and return to full movement and strength, they can have a more deep-rooted tightness, which can lead the muscles to becoming more ‘habitually tight’. The movement patterns around the joint are changed probably with reduced mobility; the muscles are shortened but we adapt and get used to the change in function.
Restriction to surrounding joints
If a joint is tight then the neighbouring interacting joints may compensate by moving more and taking more strain, so can become less stable and also run the risk of strain or wear and tear. For example, a knee injury can affect both the hip and the ankles.
Scar tissue healing
Scar tissue forms like a glue to knit the torn tissue back together, but can create inflammation or swelling. Scar tissue will continue to form past six weeks and up to a year in severe back injuries. Whilst scar tissue at the site of injury is important to allow healing, commonly the body creates more scar tissue and muscle spasm than what is necessary for healing to occur. As a consequence, there is a reduction in blood flow and circulation which slows down the healing process; a vicious cycle! Whilst scar tissue is required to heal, it can either lead to excessive haphazard random scar tissue causing long-term loss of movement, or it can heal in a more effective, resilient, functional way.
Healing with tensile and ductile strength
Introducing movement to an injured area has been shown to help the collagen to repair close in structure to the original collagen, rather than a haphazard scar tissue (see Ligament Injury and Healing). This gives tensile and ductile strength to the ligaments, tendons and muscles. Tensile is the ability to stretch without breaking and ductile is an ability to deform without losing strength.
Healing times for muscles, tendons, bone, ligaments, cartilage and nerves
Healing times will obviously depend on whether the injury is mild, moderate or severe. There are so many factors that affect healing time: the ability to rest, seek treatment, care for the injury, and adherence to exercise and advice. However, there are some approximate loose guides with a moderate strain:
|Approx Healing Time
- There is a good flow of blood which helps the healing process with removal of debris, toxins and waste products, and supply of oxygen, growth factors, and platelets to heal.
- There is some movement in the muscle to help break unwanted scar tissue and improve the vascularity and healing process.
- Muscle injuries can lead to imbalance, the stronger whiter outer muscles that move the joints more over-compensating for the weaker inner or postural stabilizing muscles.
Tendons are cords, sinew or bands of fibrous connective tissue and collagen that connect muscle to bone and are capable of withstanding tension. They move the bone or joint when the muscle is contracted, but have some elasticity and give.
- Tendons generally have less blood supply than muscles, so heal slower
- Movement in tension, either contraction or stretching; both increase the blood flow and healing to tendons
- Tendons heal well with eccentric movement, stress while being lengthened. For example the largest tendon in the body, the Achilles, can be eccentrically moved by standing on your toes and slowly lowering your heels back to the ground, under load (the weight of the body). Other examples are lowering a weight during a shoulder press or lowering the body during a pull-up.
- Exercise must be done gently, carefully and gradually, as excessive stress on tendons can slow healing or cause re-injury and give increased pain.
- Initially a fracture should be immobilized to allow the healing process to start. Too much movement too early can delay a fracture repair.
- Initial treatment for a fracture focuses on helping body movement in regions around the fracture site and in other area of the body, to improve blood flow to fracture site.
- Once the bone knits and is sufficiently stable, rehabilitation can shift focus to the fractured area.
- Bones heal best with loads applied. Weight bearing activities stimulate bone growth and strength. Immobilizer boots for ankle and foot fractures allow patients to walk but protects their healing bone and the stress and load on the bone helps the healing to occur faster and, importantly, more effectively than keeping the weight entirely off using a plaster cast.
Ligaments stabilize joints and connect bone to bone. They are rope-like, with tough intertwined cords, and made of collagen. Ligaments also have some elasticity that allows joint movement, but prevents excessive movement. They have less blood supply than either muscle or tendon – increasing the healing time. Common ligament injuries are twisted ankles, knee AC, and anterior cruciate ligament tears.
There are three grades of ligament sprain. Grades are based on the amount of disruption involved to the ligament in an injury, and are defined as follows:
|Minor swelling & bruising
||Moderate -Severe swelling
|Few ligament fibres torn.
||More ligament fibres torn
||Severe fibre tears or rupture
|some ligament stretching
||Joint laxity likely, ligaments overstretched
||Low stability (unstable)
May require surgery to repair
|Mild to moderate pain on stretch
Local muscle spasm likely
|Moderate to severe pain with stretch
more local muscle spasm
|Muscle spasm likely
Pain severe at injury (Pain may be less if ends detached)
Permanent changes in joint stability possible
Ligament injuries need some protection whilst the tissue is healing. Motion in the injured joint is required, to promote circulation and healing. Sometimes bracing is used to allow motion without excessive pain or movement. Ligament healing is usually slow and they often to not heal to the full pre-injured strength and flexibility. Joint laxity from a weakened ligament improves slowly from about six weeks to a year, when patients can still experience joint instability and weakness. In ligament injuries to the ankle, up to 31% who experience positive anterior drawer signs six months after surgery.
Please read Ligament Injury and Healing for further information.
- Cartilage is avascular, meaning it has no blood supply, so it heals slowly.
- Cartilage nutrients are maintained by joint fluids, which lubricates the tissue. Read more in maintaining disc health
- Cartilage has no nerve supply, so pain is often not felt until the cartilage is worn significantly, when the worn cartilage impacts the surrounding bone and ligaments or muscles.
- Inactivity worsens joint cartilage repair and healing, as the fluids are not pumped in and out (see maintaining disc health). It creates thinning of the cartilage, prevents healing and makes it more injury prone.
- Exercises is required, even fairly soon after injury, to increase stress and help heal the cartilage. However, take caution as exercise needs to be increased slowly and gently to avoid re-straining.
- Exercises that incorporate the joints’ full range of motion and that involve some degree of load bearing through the joint surfaces help cartilage to heal.
- Cycling, walking and swimming that have repeated smooth joint movement promote cartilage lubrication with minimal stress on injured cartilage tissue.
- Nerves can be injured by stretching or pressure, and heal very slowly.
- Nerve injury can cause pain, muscle weakness, numbness, tingling, or pins and needles.
- Nerves can be injured in a small local region, at certain points or along the entire nerve.
- An injured nerve needs release of pressure, release of inflammation and mobility to restore the flow of signal to and from the brain.
- An injured nerve is susceptible to stress and pressure which can cause pain and nerve reactivity to recur and slow the healing.
- Stimulating nerve repair is a process that requires patience and persistence. Exercise and rehabilitation need to be incorporated progressively into daily activities so as not to aggravate the injured nerve.
Usually there can be combination of multiple tissue injuries, so treatment needs to help all the injured structures to heal. Treatment needs to be tailored for each individual and monitored or adapted during the healing process, so a one-size-fits-all approach is usually not sensible.
How can Chiropractic treatment aid musculoskeletal injuries
Chiropractic treatment early in the stages of injury helps tremendously with reduction in inflammation, joint mobilization, release of muscle spasm, and reduced pain and nerve pressure which makes movement more comfortable. It also promotes circulation, reduces nerve pressure and helps tissues to begin the healing process faster. It is clear, however, that the treatment required often needs to be tailored to the individual and their capabilities to move, exercise, tolerate the pain, as well as their age and lifestyle. That is why it is important to find a chiropractor who understands the nuances of each injury and tailors their approach according to the client. For a client’s perspective on my work, please see The Jeremy English treatment.
Please read Ligament Injury and Healing if you are interested in a more in-depth understanding of the process.
For the spine: maintaining Intervertebral spinal disc health
I write about Advantages of Seeking early Chiropractic treatment here in how Chiropractic treatment works
Some of the information on this page comes from this article.