This is a question I get asked ALL the time. How long will this take? How long will I have to modify exercises? How long until things are normal again?
My answer, unfortunately, is typically "it depends". There are SO many factors that go in to tissue healing. That being side, there are some general timelines we can expect tissue to follow, just based on its anatomical ability to heal, and some tips and tricks we can utilize to promote better healing.
To first understand tissue healing time, it helps to understand what tissues are being considered in the first place!
Muscles: we all likely know what a muscle is. Muscle injuries, or strains, occur when there is a partial or complete tear of a muscle. These tears can happen in three places: in the muscle itself, where the muscle and the tendon meet, and in the tendon itself (more on tendons ahead)! Strains have three grades, and the number corresponds to the percentage of muscle fibers affected
Grade 1 strains involve few muscle fibers. Often, there is little to no decrease in strength or change in range of motion with grade I strains.
Grade II strains involve a larger percentage of the muscle fibers. These are larger tears, and typically are accompanied by swelling and a decrease in muscle strength
Grade III strains are severe, complete ruptures of muscle. This is usually accompanied by severe swelling, pain, and complete loss of function.
Tendons: Tendons are the tissue that connect muscle to bone. Tendons can be injured either via a tear in the tendon itself, or can become inflamed in a process called tendinitis (-itis meaning "inflammation of"), or if inflammation is present for a longer period of time, can undergo a change in the makeup of the tendon itself, leading to tendinosis. The key to remember with tendon injuries is that tendinosis-the actual physical change of the collagen in the tendons, takes much longer to recover from than tendinitis-the short term inflammation of a tendon.
Ligaments: Ligaments are the structures that connect bone to bone. They can be intraarticular-meaning they are located INSIDE the joint, or extraarticular, meaning they are located OUTSIDE the joint. Similar to muscle strains, ligament injuries, or sprains, are graded based on the amount of tissue involved.
Grade I sprains: involve very little damage to the tissue itself, and do not result in joint instability. These sprains typically result in localized tenderness.
Grade II sprains: partial tear of the ligament, with swelling, tenderness, and little to no joint instability resulting
Grade III sprains: complete rupture of ligament, with swelling and loss of joint stability
Meniscus & Labrum: these types of tissues, while they are present in different areas, are similar in their make up. The meniscus acts as shock absorbers and a lubricating surface for joint motion at the knee. The labrum in the shoulder and hip create increased stability, as well as act asa cushion for the joint surface. These tissue are made up of cartilage, and varied levels of blood supply. They typically tend to heal slower, as the blood supply is less than tissues like muscles.
Now that we have discussed the different types of tissues and the degrees of injury, let's dive in to timelines for expected healing. These timelines are broad, because healing is multifactorial, but can help serve as minimums for expectations in terms of how long to participate in therapy.
Muscle Strains:
Exercise induced soreness: 0-3 days
Grade I 1-4 weeks
Grade II 2-4 months
Grade III 2-6 months
Ligament Sprains:
Grade I: 2-8 weeks
Grade II: 2-6 months
Grade III: 6-12 months
Grafts/Repairs: 12+ months
Tendon Injuries:
Tendonitis: 3-7 weeks
Tendinosis: 3-6 months
Tear, surgical repair, or rupture: 4-12+ months
Meniscus/Labrum: 3-12 months
Bone: 6-12+ weeks
Cartilage: 9-24 months
Factors that contribute to healing:
Severity of injury- As you can tell from the timelines above, the worse an injury is, the longer it will take to heal
Movement mechanics- moving with altered mechanics, or repetitive patterns, may continue to stress tissues and slow down ability to heal
Hydration: Dehydrated tissues heal slower
Smoking: Smoking nicotine narrows blood vessels, and can contribute to slower healing times
Nutrition: There are increased protein demands during healing
Stress: Increased stress can slow healing time
Sleep: sleeping is a key step in the healing process to allow for tissue repair and inflammation control
Cardiovascular Health: tissues need oxygen to heal, and that oxygen is delivered by blood. Poor cardiovascular health or poor circulation can slow down healing
Loading: tissue healing occurs in response to load- this means the old idea of resting tissue and allowing it to heal is actually counterproductive! Instead, research points towards loading tissue appropriately to promote healing. Loading tissue can be a fine balance between encouraging healing, and getting caught in an inflammatory cycle. This is where seeking out a trained rehab professional can help!
This information can be overwhelming. There are a few key things to remember here. The first is that we can't rush the minimum healing time. Tissues need time to heal, and no amount of anything will make that process go faster than the minimum. That being said, there so many factors of healing that ARE within our control! So while this may be a lot to process, I hope the biggest take away is to give your body the time it needs to do it's thing, trust the process, and see a PT to help you along the way!