There are general musculoskeletal tissue types we work with in Physical Therapy: Bone, ligament, muscle and tendon. They all have their own varying fabric, blood supply, action, strength and healing time. Injuries to these tissues look and behave differently. People’s biological healing process and timeline can also vary based on prior health, inflammatory response sufficiency, body mass, rest-time, etc. The list goes on. We want to provide you with a basic, barebones (pun intended) and text-book breakdown of generic terminology and expected healing times for these tissue types. Understand this is not black and white; there are so many integrated circumstances that make you and your healing process different from the next person.
*Articular cartilage has been excluded from this blog, but is a tissue type which can incur injury and has its own variables.
These injuries are described as direct (contact), indirect (non-contact) and over-use. These tissue strains are broken into degrees of severity
· Mild or first degree strain (Grade I): Minor fibrous tear, minimal swelling and local tenderness. Usually there is no resultant loss of function in the muscle. Healing time is within 0 to 3 days.
· Moderate or second degree strain (Grade II): Pain, strength loss, and possible joint instability. Associated tissue damage is more excessive and typically participation in activity is discontinued due to the above symptoms. Rehabilitation time can be anywhere from 3 to 28 days.
· Severe or third degree (Grade III): This consists of a tear through the entire muscle belly. In cases of a complete tear, loss of muscle activation occurs and pain may not be directly associated. Surgical repair is often indicated. Rehabilitation time can take upwards of 3 months.
You’ll often hear of tendonitis (acute) and tendinosis (chronic) with regards to musculotendinous injuries. This refers to the acuity of inflammation within the tendinous fibers. These are generally over-use associated injuries to tendons. Physical Therapy intervention can reduce signs and symptoms and improve function, restore tissue length and health of tendon.
These are joint related injuries, most often occurring from excessive lengthening of the tissue when stress is placed on the joint (like hyperextension, subluxation or dislocation).
· Grade I (mild): Stretching of fibers, but no tearing or significant damage, minor integrity loss. There is no abnormal motion involved, however localized tenderness and minor bruising may occur. Here we’ll apply a healing time frame using ankle sprains – expect 6 to 12 days before resuming full pain-free function.
· Grade II (moderate): Stretching and some tearing of the ligament fibers, structural weakening and some integrity loss. There can be abnormal motion, bruising and swelling associated with this level of injury. Ankle sprain example - expect 2 to 6 weeks for healing time and resume full activity.
· Grade III (complete): Involves almost complete ligament fiber tearing or structural disorder. Integrity loss, significant abnormal motion, and severe bruising and swelling due to excess bleeding/fluid into structure are associated with the severity of this injury. Ankle sprain example – healing times can range from 4 to 26 weeks, with some patients requiring up to 2 years to be symptom free and resume full function.
Normal healing of ligament injuries can take from 6 days to 2 years depending on severity, area of the body, blood supply and efficiency of inflammatory response.
There are several different categories of bone fractures with accompanying severities: Complete (bone fragment separate completely), incomplete (bone fragments are still partially joined), linear, transverse, spiral, compacted, compression, avulsion (part of a bone is pulled away by its attached tendon or ligament), stress etc. Healing varies on type of injury, age, body mass, health, vascularity (blood supply), location, and so on. A normal healing timeline is 3 weeks (for a simple fracture) to 12 weeks.
The suggested intervention for when these injuries occur in non-emergency situation: PRICEM
Manual Therapy – See your Physical Therapist
Early Motion - See your Physical Therapist
Contact us at Northwest Wellness for manual therapy intervention, return to sport training and if you have a question and/or concern about an acute or chronic injury.
34740 Pacific Hwy. S
Federal Way, WA 98003