Before we start, let's clarify some basic terminologies.
Tendons are the parts of muscle that connect muscles to bones, while ligaments are tissues that connect bones to each other (e.g., the ACL).
Mechanical stimulation: the movement of these connectors. For instance, when you sprain your ankle, simply walking can stimulate the ligaments and tendons there.
Stem cells: are special cells that help your body create new tissue along "scaffolding" that is put in place by inflammation.
These explanations are not medical jargon, but rather an easy way to understand what's happening.
This is not a scientific paper, but a simplified explanation of the processes that occur with injuries to these connectors.
People suffer injuries every day, and this number is increasing among individuals in their 30's and older as weekend sports become more intertwined in their lives. Consequently, the U.S. healthcare system was burdened with an estimated $40 billion medical expense in 2014 related to ligamentous injuries. While I don't have specific figures, it wouldn't be unreasonable to assume that other Western countries, in general, face a similar problem in terms of injury rates, if not necessarily financial implications. Non-Western countries also experience such injuries, although I would question the reliability of available data.
BREAD AND BUTTER:
As time goes on, more people will face this issue, particularly as the population ages. Although there have been significant advancements in the field since the 1970's, there is still much more that can be accomplished. New practices are emerging as we gain a better understanding of how the body functions in relation to both acute and chronic injuries. By studying these injuries and comprehending the genetic factors involved, we can develop new protocols that increase successful repairs while reducing the risk of re-injury. While it would be ideal to introduce a method that allows for complete repair without any negative effects, such technology is not yet available. Therefore, for now, let's focus on understanding what is happening, discovering the best ways to facilitate recovery, and preventing further injuries.
repair timeline
In simple terms, when you sprain/strain your tendon/ligament, a few things occur in a specific order. First, the area becomes flooded with blood cells, which causes inflammation. This inflammation is actually beneficial because it contains the healing properties your body needs. Second, about a week later, a framework(reparative) is established to guide your body on how to heal, this is when "stem cells" are released. This is like a scaffolding that provides instructions for the healing process. Finally, the body begins the healing process(remodeling) and gradually repairs the injured tendon/ligament.
It's important to note a couple of things about this final stage. First, the time it takes for complete healing is not fixed and can vary. It could take anywhere from 3 - 6 weeks or even 3 - 6 months. Second, studies have shown that the tendon/ligament doesn't fully repair in the sense that it continues to undergo repair over time. One study mentioned a repair process lasting 12 years.
rough times for healing
However, if the tendon/ligament is completely torn or ruptured, the first two stages still occur biochemically, but the third stage won't happen naturally because the human body cannot repair this type of injury on its own. In such cases, surgery is required. The same stages will still occur after surgery, but the third stage, the healing process(remodeling), is a guaranteed period of 5 to 9 months(21-39 weeks), depending on the extent of the tear and your determination to actively part take in physical therapy.
After gaining a basic understanding of the injury, here are steps you can take to achieve optimal results in your recovery:
Immobilize the joint for one week following the injury. This allows the for critical nutrition's to be introduced to the wound. Avoid Icing, the Dr. who created Icing has retracted his statement. New research shows that ICING is detrimental to the healing process.
Depending on the severity of the injury, gradually introduce light exercises, after immobilization. Avoid stretching during this phase, as it can hinder the overall healing process and compromise the quality of repair. Adequate stress absorption is crucial to prevent re-injury.
Once you have completed the phase of light exercises, begin incorporating heavier weights and sport/activity specific exercises.
Lastly, perform tests to assess the strength of the surrounding muscles. It is important to ensure that the injured tendons/ligaments are sufficiently strong enough to withstand the forces generated by the movements involved in your chosen activity. This involves, usually checking stability, time to activate surrounding muscles, and force generation. Quick internet searches like: "fibular brevious tendinosis return to sport test" will pull up enough info to get a general idea of what you need to accomplish before returning to your sport.
Return to sport or activity, but also participate in a daily routine to strength muscles. The best way to prevent injuries is to develop a workout schedule that suits your needs while developing strength and flexibility.
By following these steps, you can enhance your chances of achieving the best possible outcomes and minimizing the risk of re-injury.
TL;DR:
Current technology doesn't allow for 100% recovery from injuries; you can expect around 98% recovery, which may decrease with age or re-injury. To maximize your body's recovery potential, follow these steps after an injury:
Immobilize the joint as soon as possible.
Once the immobilization period is over(1-3 weeks), gradually introduce mechanical strain to the injured area (e.g., 1-mile walks for ankle injuries).
In the final stages of healing, incorporate heavier weights and sport-specific exercises(after 5-6 weeks min).
Perform tests to ensure your body can handle the forces associated with the activity that caused the injury(after 6-8 weeks).
A note on the time periods used here. These are low numbers, your immobilization period could be 4-6 weeks. Mechanical stress period could be around the 7th-9th week mark. Lastly, the final stage could be after 4 months.
Following this protocol will give you the best possible outcome.
Closing Thought:
Recovering from an injury can be challenging and sometimes demoralizing, but it's crucial to stay focused and committed to the plan. Avoid rushing or getting ahead of yourself. Set a specific goal that you want to achieve and use it as your guiding light throughout the healing process. Remember to stay grounded and patient as your body has the ability to heal itself given enough time. It's always advisable to conduct your own research. With the accessibility of modern search engines and reputable journal institutions, you can find valuable information to supplement your understanding and aid in your recovery journey.
Resources used for this article:
Tendon Healing: Repair and Regeneration, 09/2012, (Annual Reviews)
Tendon and Ligament Regeneration and Repair: Clinical Relevance and Developmental Paradigm, 11/2013, (National Library of Medicine)
Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration, 11/2019, (Wiley Online Library)
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