What is your body doing after an injury?
- Nazan Garcia
- Sep 28
- 5 min read
Updated: Oct 14
Step-by-Step: The Healing Journey of Acute Sports Injuries Explained
The healing process of tissues following trauma follows a predictable sequence and timeframe. It consists of three phases: the inflammatory response phase, the fibroblastic-repair phase, and the maturation-remodeling phase. Although these phases are presented as distinct entities, it is important to note that the healing process is a continuum.
The phases overlap and do not have definitive beginning or end points (Prentice, 2011). Both bone and soft tissue respond to the physical demands placed on them, leading to a process of remodelling or realignment along lines of tensile force. Consequently, it is essential that injured structures are exposed to progressively increasing loads throughout the rehabilitation process (Prentice, 2011).
The Inflammatory Phase (Phase 1)
The inflammatory phase lasts a few days and involves a characteristic sequence of vascular, chemical, and cellular events aimed at repair, regeneration, or the formation of scar tissue (Bahr and International Olympic Committee, 2012). The five cardinal signs of inflammation are rubor (redness), tumor (swelling), calor (heat or increased temperature), dolor (pain), and functio laesa (loss of function). During this phase, the inflammatory response is focused on “cleaning up” the damaged area, creating an environment conducive to the subsequent fibroblastic phase.
A brief period of immobilisation (24 to 48 hours) is recommended to facilitate healing by controlling inflammation and reducing clinical symptoms (Prentice, 2011). By days two or three, swelling begins to subside, and the injured area may feel warm to the touch, with some discoloration usually apparent. While the injury remains painful to the touch and movement, patients should initiate active mobility exercises within a pain-free range of motion. In this phase, regaining range of motion is more critical than strengthening, though strengthening should not be completely neglected (Prentice, 2011).
A Note on Chronic Inflammation
Chronic inflammation is characterised by the production of granulation tissue and fibrous connective tissue. In this scenario, cells accumulate in a highly vascularised and innervated loose connective tissue matrix at the injury site (Prentice, 2011). The precise mechanisms behind an insufficient acute inflammatory response remain unclear, but they appear to relate to situations involving overuse or overload, leading to cumulative microtrauma in a particular structure.
The Proliferative/Repair Phase (Phase 2)
The proliferative or repair phase follows the inflammatory phase and lasts several weeks. During this period, the production of type I collagen significantly increases, while the initial clot and injured extracellular matrix undergo continuous breakdown and remodelling to form a stronger matrix (Bahr and International Olympic Committee, 2012). As healing progresses, controlled activity aimed at restoring normal flexibility and strength should be combined with protective support or bracing.
Generally, clinical signs and symptoms disappear by the end of this phase (Prentice, 2011). By this point, swelling should have completely resolved, and while tenderness may still be present, pain levels should decrease during both active and passive motion. Once inflammation is controlled, rehabilitation programmes should incorporate activities that maintain cardiorespiratory fitness, restore full range of motion, increase strength, and re-establish neuromuscular control (Prentice, 2011).
A Note on Collagen
Collagen plays a crucial role in this process as a major structural protein that forms strong, flexible, and inelastic structures, holding connective tissues together. Collagen fibrils are the load-bearing elements of connective tissue, with the orientation of collagen fibres aligning along lines of tensile stress (Prentice, 2011).
There are at least 16 types of collagen, but 80-90% of the collagen in the body consists of types I, II, and III. Type I collagen is found in skin, fascia, tendon, bone, ligaments, cartilage, and interstitial tissues; type II is present in hyaline cartilage and vertebral discs; and type III is found in skin, smooth muscle, nerves, and blood vessels. Type III collagen has less tensile strength than type I and is more prevalent during the fibroblastic-repair phase (Prentice, 2011).
The Maturation/Remodeling Phase (Phase 3)
The maturation or remodeling phase is the final stage of healing and may last several months, depending on the injury's severity (Bahr and International Olympic Committee, 2012). This phase focuses on the realignment or remodeling of collagen fibres that comprise scar tissue, according to the tensile forces exerted upon it. As stress and strain increase, collagen fibres realign for maximum efficiency, parallel to the lines of tension. Although the tissue gradually regains its normal appearance and function, a scar is rarely as strong as the original tissue. By approximately three weeks post-injury, a firm, strong, contracted, and non-vascular scar should be present, although complete maturation may require several years (Prentice, 2011).
As the remodeling phase commences, it is vital to incorporate aggressive active range-of-motion and strengthening exercises to facilitate tissue remodelling and realignment (Prentice, 2011). Pain levels will largely dictate the rate of progression. Additionally, massage and gentle mobilisation techniques may be employed to reduce muscle guarding, increase circulation, and alleviate pain. Enhanced blood flow delivers essential nutrients to the injured area to promote healing, while increased lymphatic flow aids in the breakdown and removal of waste products (Prentice, 2011).
Conclusion
Understanding the healing process of acute sports injuries is essential for effective recovery. The body moves through three key phases—inflammatory, proliferative and remodelling—each playing a vital role in restoring tissue and function. While the process can vary depending on injury severity, a well-paced rehabilitation plan aligned with these stages helps minimise re-injury and optimise recovery.
By respecting these phases, athletes can return to their sport stronger and more resilient, with improved understanding of their body’s natural healing timeline. Patience, knowledge, and a gradual approach are key to successful recovery.
References:
-Bahr, R. and International Olympic Committee eds., 2012. The IOC manual of sports injuries: an illustrated guide to the management of injuries in physical activity. Chichester, West Sussex, UK ; Hoboken, NJ: Wiley-Blackwell.
-Peterson, L. and Renström, P., 2017. Sports injuries: prevention, treatment and rehabilitation. Fourth edition ed. Boca Raton London New York: CRC Press.
-Prentice, W.E., 2011. Rehabilitation techniques for sports medicine and athletic training. 5th ed ed. New York: McGraw-Hill.
Acupuncture and Osteopathy Clinic in North West London (Queen's park and Kensal Rise)
Ready to Heal and Perform at Your Best? Book Your Acupuncture or Osteopathic Consultation Today!
If you’re struggling with a sports injury or want to optimise your training while reducing the risk of injury, an osteopathy consultation can provide the personalised support you need. Whether you’re dealing with persistent pain or looking to return to sport after an injury, I can help you regain strength, balance, and confidence through a tailored approach to care.
Living in London? Book your Acupuncture and Osteopathic appointment today!
Comments