Our understanding of tissue repair and healing has greatly changed over the last few years. Knowledge of the healing and repair process is continuously advancing and changing. Tissue healing and repair refers to the body’s ability to replace the destroyed, damaged, or injured tissue.
There are four main stages of healing and repair into four phases. It is important to understand that these phases are not independent of each other but instead work together to simultaneously produce a favourable end result. The four phases of healing and repair can be simplified into Bleeding, Inflammation, Proliferation, and Remodelling.
Following an injury, to your calf, there is likely to be a degree of bleeding. The calf muscle being highly vascular has the potential to bleed for longer with the possibility of blood escaping to the tissue. The bleeding phase occurs immediately following injury and is considered to be relatively short-lived. Research suggests that from point of injury to the end of bleeding is often quoted as being between four to six hours though this is an average and bleeding can be significantly longer.
The inflammatory phase is thought to occur within a few hours and is thought to peak at approximately days one to three before gradually easing and resolving over the next few weeks. This inflammatory phase is normal and should be considered essential to overall recovery. The calf muscle being a relatively vascular tissue, resolution of the inflammatory phase is often swifter than in other areas of injury which are poorly supplied by blood.
The proliferation phase is thought now to occur much earlier than previously thought. This phase occurs within the first twenty-four to forty-eight hours of injury. It does however take considerably longer for this phase to reach its maximum activity. This is usually considered to be between two to three weeks post-injury. The purpose of the proliferation phase is to generate repair material commonly known as the production of scar tissue.
The majority of the scar tissue is formed at two to three weeks but the final end product which is of higher quality and much more functional is not achieved until much later in the tissue and healing process. Post-injury the proliferation phase is thought to continue for several months and may last up to four to six months post-injury.
This is an extremely important phase of tissue repair especially in the consideration of therapy and rehabilitation. The emphasis of the remodeling phase is to produce scar tissue that is organised and of significant quality to be both functional and as similar to the initial tissue prior to injury. It was previously thought that this phase began at approximately two to three weeks post-injury, but it is now more considered that this process begins very early post-injury and possibly within the first week.
The remodeling phase is thought to continue for months, sometimes years. The tissue healing and repair process is a complex body function that should be considered normal and essential to healing and recovering. It is possible to influence this process in a positive way to facilitate recovery back to sport, reduce the risk of further injury or delayed healing.