Tissue Healing Stages
A PTA must have a solid understanding of tissue healing stages in order to select the most appropriate intervention from the plan of care. Although pain is the main reason people seek physical therapy, the underlying cause of pain is an injury or repetitive strain which results in inflammation and tissue strain.
Stage 1: Inflammation
- Typically from onset of injury/event up through 10-14 days; acute injury is typically the first 48 hours
- Includes "cardinal signs": reactive tissue healing
- Cellular repair and clean up is initiated
Stage 2: Proliferation
- Typically from 3 days post injury to 3 weeks post injury
- Blood vessels grow into the tissue healing area (vessels are fragile and at risk for reinjury if strained); immature scar tissue is now well-vascularized and will change in appearance in response to heat
- Skin and soft tissue fill in the wound area and knit it back together
- Healing tissue can withstand controlled mechanical stresses (such as movements)
Stage 3: Remodeling
- Collagen from newly healed wound is remodeled in response to tensile (stretching) forces along the wound area
- May take place over an extended period of time (years) depending on the nature and depth of tissue injury and tissue function
- Scar tissue is typically 70-80% as strong as the original tissue 60 days post injury
- Benefits from continued movement to increase tissue extensibility and strength
