First Stage of Healing

The first stage of healing is the acute or inflammatory stage. This stage is divided into two parts. The active phase and the passive phase. The active phase is the period following trauma where the tissue is shocked, bleeding is occurring, and the mechanisms for the response to injury are not organized. This phase can last from a few minutes to a few hours. This phase can be extended if further bleeding occurs. The passive phase is defined as those events which occur after bleeding has stopped. The passive phase lasts 24 to 72 hours. This phase can also be extended up to 6 weeks by swelling and secondary hypoxia which can create additional damage. The accepted method of treatment is protection, rest, ice, compression, elevation and support. Mobilization such as manipulation and traction is very important in stage I to reposition joint surfaces, balance stress to joint capsules, and stimulate the proprioceptors. Electrical modalities are important in Stage I in order to speed up recovery while reducing pain and swelling.

Second Stage of Healing

The second stage of healing is known as the repair stage. This stage may last anywhere from 24 hours to 12 weeks or 18 weeks from the date of injury depending on the extent of damage and aggravations. This is the stage where collagen is produced and laid down at the site of injury. The object of stage two is to stimulate metabolism and to activate regeneration. It is imperative that the care being rendered does not aggravate or reinjured the damaged area. Mobilization is highly important in this stage of care. Mobilization should include manipulation, traction, and range of motion exercises which can be done at home. This will improve the joint biomechanics, proprioception, and assist in organizing the collagen fibers into a optimum pattern increasing its functional capabilities. Electrical modalities should be used for pain control during this stage.

Third Stage of Healing

The third stage of healing is known as the remodeling or fibrosis of repair phase. This stage may last from 3 weeks to 12 months or more. The goal of stage three is to remodel collagen in order to increase its functional capabilities. It fills in all areas where regeneration did not occur. The collagen at best will be only 70% of the normal tissue it replaced. If proper care is not rendered during this stage the scar tissue will become some value less than 70% of the normal tissue it replaced. This will cause the tissue to be weaker, less elastic, and more sensitive making it prone to reinjury. The objectives of stage III is then to maintain the structural integrity as much as possible, to promote full range of motion, regain full strength and reaction potential, increase proprioception and to limit scarring and adhesions.