Acute Injury Healing Phases

“What typically happens following an injury?”

Freya has injured her ankle whilst out walking Jasper, the dog. They were playing a game of hide and seek and Freya twisted her ankle as she was jumping from a tree. It takes a big force to injure ligaments as they are strong structures. 

Freya’s body is very clever, it knows that the ankle ligaments have been overstretched and a small tear has occurred when she rolled her ankle. It needs to start the healing process straight away.

Freya may feel some pain walking as Jasper helps her home, and when she gets back she notices some swelling and bruising appearing. These symptoms of an injured ankle are all clever protective mechanisms to stop Freya from running or doing any strenuous activity. 

Inside the ankle, the area has already started to bleed, for a short period of time. This is part of the process, removing any injured debris. If Freya has injured any muscles as well as the ligament/s then the bleeding phase may last slightly longer than if she has injured the ligaments alone. 

Next is the inflammation phase, a powerful release of chemicals, which is really important for healing and repair. This phase will peak in about 1-3 days and will largely resolve in 2-3 weeks time. With a ligament injury, Freya may expect this phase to last about 3 weeks. If she had injured a muscle then this phase may complete in about 2 weeks. This is because muscles typically have a bigger supply of blood vessels than ligaments and so will go through the process faster.

After the first two days, the swelling and pain is slightly improved and Freya decides that she’d like to see a physiotherapist to gain extra understanding about what she can be doing to support the healing process. Jasper is keen to get back to playing hide and seek as quickly as possible, so she books an appointment for the next day. 

The physiotherapist does an assessment and provides Freya with advice and an exercise programme to help Freya return to her daily activities as soon as possible. Freya found the session very reassuring and so she decided to book a follow up appointment in order to progress her exercises.

Over the first few days Freya will have to modify her daily activities and walk slower than normal to make sure that she is promoting the healing phases, and not hindering it. To enable her to walk around a bit more comfortably she wraps a tight bandage around the ankle and then when she is resting she takes it off and puts her foot on a cushion, above heart level. She gently moves her ankle and foot in circles, up and down, side to side as much as she is able to, without too much discomfort. She is pleased to see that as she practices this that she can move her ankle in bigger circles after a few days have passed and this continues to improve. Freya practices her rehabilitation exercises every day as the physiotherapist explained to her that it will help her to regain her movement and strength. 

After only a few days the injured ligament fibers are being replaced with new collagen fibers, which will mature over the coming months to end up looking and feeling like the original, non-injured tissue. This phase is called the proliferation phase and may last for 4-6 months. Over this period, Freya is back doing her usual daily activities and sports again without pain. 

Freya is aware of the soft tissue healing process and understands that movement is very important in making sure that her ankle ligaments are given the opportunity to remodel back to full strength and flexibility. Freya continues to complete her rehabilitation programme supported by her physiotherapist, which consists of balance & proprioception, strengthening, flexibility & mobility exercises and when she is ready, plyometric training. She finds that she can gradually do more and more with her movement. 

Freya knows that she is supporting the healing process and also is a lot less likely to sustain another ankle injury by doing these exercises. She wants to be back running, playing with her dog Jasper and doing the things that she enjoys as soon as she can. Freya reads in a blog that the body has the capacity to heal time and time again and so she isn’t feeling worried about re-injury. 

If you would like to see a physiotherapist about an injury or if you are experiencing pain that you’ve had for a while then please contact Natasha at physiotherapy@salopia.club, call 01743 467540 or you can book an appointment directly on the website

Natasha