By Don Williams
B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA
One of the most common questions that we get asked every day in practice is, “How long will it take to get better?” Unfortunately there is no short answer to this question, however, in this article I will try to outline some of the contributing factors and delineate some guidelines and ideas which may help answer this question for you.
Everyone is an individual, and in that sense, how different people respond and heal from different injuries does vary somewhat, some injuries are particularly unpredictable, shoulders are particularly problematic in identifying how well or how quickly they will respond to treatment. However with most injuries, there are general time frames in which most healing will occur.
Most people who have ever had an injury and minor procedure which required stitches will remember that the stitches generally come out in around 7 days and this time frame is a good indication of how long a cut or trauma takes to “bond” back together, however, the general healing process generally takes around 21 days. This is the timeframe for the body to lay down a “callus” or matrix of fibres around the injury and develop new connections and bridges to stabilise the injury and repair. But this timeframe is dependent on good blood flow and environment for repair, additionally, just because the injury is stabilised, does not mean that it is fully healed and fully function. This healing process and time frame is specifically relevant for muscle and skin.
Areas of the body that receive poorer blood supply take longer to recover. Tendons and particularly joint cartilage and ligaments receive a lower direct blood supply and take longer to heal. We normally expect that tendon and ligament injuries will take 6 weeks to start to repair well and 3 months to be stable.
Bones fractures also take longer to heal. Interestingly, the ratio of cortical bone (the dense outer “shell”) to cancellous bone (the “spongey” inner core) also affects the healing rate. So when we look at bones like the tibia (the larger of the two lower leg bones) they take a particularly long time to heal (up to 4 months).
The other interesting thing to note is that an injury is not always something that is readily assessable via an x-ray or scan and often, the severity of the pathology on the scan can be very unrelated to the amount of pain. For example, someone with severe degenerative changes noted on an x-ray may not have any pain, and in contrast, someone with very severe pain may have really good looking x-rays.
It is also important to note that many people use pain as a guide to where they have a problem or not. This is a situation which has been reinforced with dodgy advertising commercials by big pharmaceutical companies suggesting that all of our aches and pains can be targeted and resolved with a little tablet. At times pain killers can be helpful, but it is important to realise that, contrary to the advertising campaigns, and the statements of the celebrities fronting these commercials, these drugs do not “target” the source of pain. They work globally in the system to mask the pain. In fact anti-inflammatories drugs can actually slow the healing process and all of these drugs have potential for complications and side effects, some of these can be severe.
But pain is only the tip of the iceberg. Pain exists as an indicator that something is going wrong in our system. We have an area that is under duress or load which is unhappy or injured. Sometimes there are weaknesses or imbalances or inappropriate actions which have caused this problem to develop. Getting rid of the pain is a good start, but addressing the underlying dysfunction or causative factors is also important to reach a good long term outcome.
Part of our goal in assessment at Institute of Sports and Spines is to try to assess the contributing factors which caused your problem to develop in the first place and help you to eliminate or address these issues.
Another complicating factor as eluded to, early in the article is the individual nature of response.
Sometimes we will see muscle spasm problems which are very severe and painful, which is not related to severe pathology. At times these issues will respond very quickly to treatment and at other times they will be a little stubborn and take a little longer. Generally, the response to treatment gives a more accurate prediction of how quickly the issue will settle. Further to this, if you have had previous episodes of the same problem, the previous response rate is generally a reasonable indicator of the response rate for future episodes.
So as a general time line for healing rates:
Early tissue healing occurs in around 7 days
The majority of soft tissue healing takes around 21 days.
Early bone healing takes 6 weeks (up to 4 months so large, long bones)
Cartilage and Ligament issues take around 6 weeks to 3 months
Re-education and retraining takes a minimum of 3 months
Remodelling can take up to 1 year.
In a perfect world things can progress more quickly. The addition of complicating factors can drag these times frames out. The better that problems are managed and treated increases the probability of a good resolution and good long term outcome.
Later in this newsletter and over the next few additions we will outline more specifically injuries of the neck, back, knee, hip, shoulder and tendonopathies.
If you have any further questions then talk to the team and we will help you out with more specific advice.
Fracture Healing -
Wound Healing -