Last month, registered massage therapist and Integrated Peak Performance Consultant, Tamara Vaughan, talked about the first stage in the healing process - the inflammatory stage. This month, Tamara tackles the second stage of healing - the proliferation stage.
The proliferation stage begins around day 7 and continues until day 14 after the initial injury. Pain is no longer continuous at this point, but movement can be painful and the injured area may be stiff and inflexible. Swelling should be decreasing, and bruising may be more diffuse.
The proliferation stage is the time when the body begins to produce new cells and tissue. Special cells called fibroblasts begin to replace platelets within the blood clot. These fibroblasts create a framework of collagen - the universal building material for most tissues in the body - for new cells to develop, essentially sewing the two bits of damaged tissue back together. In soft tissue injuries, this new collagen is what we call scar tissue.This framework or scar tissue will ultimately become new tissue, but the type of tissue it will become is dependent upon its location. Following muscle injuries, fibroblasts lay down collagen that will become new muscle fibres; in bone injuries, collagen will become new bone.
In normal muscle and soft tissue, collagen is organized in nice straight lines, which means that stress is dissipated evenly through the tissue when it is stretched. Collagen formed after an injury during the proliferation stage is not laid down in nice straight lines, instead, it is constructed in a random, disorganized fashion. This happens because the body is trying to repair the area quickly and, as a result, the repair site is left weak and susceptible to further injury.
Over the coming days, the scar tissue begins to contract and pull the two damaged bits of tissue back together. In addition to collagen and scar tissue formation, the body starts to bring fresh blood and nutrition to the area via new blood vessels.
Treatment during this stage is aimed at managing inflammation, so the principals of PRICE (protection, rest, ice, compression, elevation) and the use of anti-inflammatories (if approved by your doctor) should be continued. Manual therapy at this stage can also be beneficial. Soft tissue techniques can help ensure that collagen is laid down in a more organized fashion from the outset. Depending on the severity of your injury, your body will eventually re-organize this scar tissue for you, however, it can often take a lot longer to do so. In addition to aiding the reorganization of scar tissue and collagen, manual therapy helps to remove unwanted debris from around the injury site. This could be dried blood, dead muscle cells, old swelling, etc. Therapy helps to decrease congestion to the area and allows fresh blood and nutrients into the injury site.Acupuncture may also be beneficial during this stage as it helps to promote blood flow whilst reducing muscle spasm and pain.
Rehabilitation should be aimed at targeting any newly formed scar tissue in a controlled way. There are particular exercises that can target scar tissue and help strengthen the surrounding musculature. Because collagen is laid down along lines of stress, mobilization and strengthening exercises are aimed at helping the body lay down tissue in the most effective manner.