• Lisa Corken, PT, DPT

Respect the healing process

There's a term we use in physical therapy called "respect the healing process." I've decided to shed a little more light on what we mean by this. Ultimately, the body is supposed to go through certain processes after an injury. These phases are inflammation, proliferation, and remodeling. Each phase has its frustration with respect to our patients. Contrary to popular belief, physical therapy will not make any of these phases go FASTER.

The inflammation phase is the immediate response to an injury. It is the swelling and the PAIN! Physical therapy works to help manage this phase through soft tissue work, light joint mobilizations, TENS units, exercise for facilitation and activation of surrounding musculature, gradual return of range of motion and more. The goal of getting into physical therapy this early is so that we can be prepared to move into the next phase: proliferation.

The proliferation phase is when most of the scar tissue will form. Scar tissue is a key component to healing. Whatever tissue we injured NEEDS scar tissue to heal. It reinforces the injured tissue. During this phase, physical therapy targets progressive loading of muscle and tendon structures through exercise. These techniques coupled with hands on work will help reduce excessive scar tissue formation. These treatments help prepare us for the last phase: remodeling.

The remodeling phase is when we restructure the scar tissue to align appropriately with the component it is trying to heal as well as increase exercise demand and tolerance for the surrounding areas. For example, if the Achilles tendon was injured or slightly torn, we will emphasize exercise and hands on work to promote the vertical nature of the fiber alignment in the Achilles tendon. This is also achieved with select tissue loading that is usually more weightbearing and functional.

This is the phase where physical therapy transitions to a routine more targeting your goals. If you want to get back to hiking, we will start lunges and squats. If you want to get back to running, we would start light plyometric and speedwork. These exercises are built upon the exercises you've been doing in the proliferation phase. As you can see from the chart above, this is the longest phase of healing. I always like to tell my patients that once you injure a structure or tissue once, you are at a greater risk of injuring it again. Physical therapy will give you all the keys and exercises necessary to reduce this risk as much as possible!

The phases of healing are overlapping in nature but never to be rushed. Physical therapy guides each patient individually through inflammation, proliferation and remodeling to ensure the best recovery and reduce your risk of re injury. A key component during your physical therapy experience at Altitude is that we will identify how you injured yourself in the first place which I have found is the best approach to not letting it happen again! Remember, you can start physical therapy even BEFORE you get injured, too! :-)

For more detailed descriptions of the phases of healing, please see the image above or visit: https://www.physio-pedia.com/Soft_Tissue_Healing

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