Wound healing phases

An overview of the phases of wound healing

Typical symptoms of the wound healing phases

• Inflammatory phase: redness, swelling, warmth, restricted movement and pain
• Proliferation phase: decreasing pain, new tissue, noticeable hardening
• Modelling phase: increasing resilience, occasional scar tension

Phase 1: The inflammation phase (3-5 days)

If an injury, such as a Muscle tear or a muscle fiber tear injury occurs, the body starts the inflammatory phase almost immediately. In this phase, the tissue repairs the damage caused by the internal bleeding. Signs of inflammation are redness, swelling, warmth, restricted movement, and pain. These reactions are completely normal and a sign that the body is working on the healing process. Lymphocytes and granulocytes migrate to the injury site and begin clearing away dead tissue and pathogens.

In this phase, it is important to protect the injured tissue. Complete rest is usually only advisable for a few days; after that, early, controlled exercise supports healing (see below). Excessive exercise and careless handling of anti-inflammatory medications can disrupt the natural inflammatory process and delay healing. If used incorrectly, medications can suppress inflammation and thus impair wound healing. Their pain is a signal from the body that should be taken into account to promote optimal healing. Edema and tension in the connective tissue can also occur and require special attention.

Phase 2: The proliferation phase (up to 28 days)

After the inflammation phase, the body produces new tissue elements in the proliferation phase, which are necessary for healing. This is crucial for injuries such as muscle tears, torn muscle fibers and muscle strains. Fibroblasts migrate to the injury site and start producing type III collagen, which is later converted into more robust type I collagen.

During this phase, specific stimuli and early functional treatments are crucial. Especially in the first four weeks, appropriate treatments such as targeted, gradually increased loading should be continued so that the new fibers align along the load. The duration of this phase varies for different tissue types: ligaments take about three weeks, muscles about four weeks, bones up to six weeks, and tendons between one and three months for significant healing.

Phase 3: The Remodeling Phase (up to 500 days)

The final phase, the remodeling phase, can take up to 500 days. During this stage, the previously produced collagen is further restructured and aligned to restore the normal function and strength of the tissues. When subjected to functional loading during the proliferation phase, the collagen fibers align correctly along the plane of function. However, if loading stimuli are absent, adequate collagen formation does not occur, and the tissue remains more susceptible to re-injury.

Full tissue resilience can only be expected after the completion of this phase. Premature loading can lead to a prolongation of the inflammatory phase, increased collagen deposition, and ultimately to crystallization and ossification. Stress and hormonal dysregulations such as adrenaline/noradrenaline releases can also impair the healing process.

It is important to respect these phases, especially in the case of muscle tears, muscle fiber tears, muscle strains, or Bursitis to recognize that the healing process often takes longer than that of a bone fracture. Mobility and functionality are promoted not only by the right timing, but also by targeted intervention in every phase of wound healing.

Patience and thoughtfulness are the key to healing

Injuries such as muscle strains, muscle fiber tears, or muscle tears are often associated with a prolonged healing process. While it can be difficult to maintain patience, it is essential to accompany the body through the various phases of wound healing and to give it the necessary space for regeneration. Edema, tension in the connective tissue, and other complications are normal; however, they can be efficiently managed through protection in the first few days, appropriate therapeutic measures, and a cautious return to physical activities.

Wound healing phases: What the studies show

• Defending, then loading: The recommendation «PEACE and LOVE» (Dubois and Esculier 2020, British Journal of Sports Medicine) summarizes the current state of knowledge regarding soft tissue injuries: in the first few days, protect the area, store it in a high-altitude location, and avoid using anti-inflammatory agents as much as possible; thereafter, gradually increase the load and remain active.
• Earlier start speeds up the return: In cases of severe muscle tears in the thigh or calf, leisure athletes who started their rehabilitation two days after the injury instead of nine days returned to sports about three weeks earlier, without any further injuries (Bayer et al. 2017, New England Journal of Medicine).
• Exercises already in the first week: After a sprained ankle, targeted exercises improved function more effectively in the first week than simple rest (Bleakley et al. 2010, BMJ).

For the wound healing phases, this means that the phases provide a rough timeframe. However, how quickly you can load depends on your progress and not just on the calendar.

Self-help: This is how you can support wound healing yourself

• Keep the wound clean and follow the dressing change instructions exactly.

• Feed yourself with a balanced diet rich in protein – the tissue needs building materials for repair.

• Move adjacent joints within the allowed limits to prevent adhesions.

• Avoid nicotine, which slows down blood circulation and thus healing.

When should you get it checked by a doctor?

Seek medical attention promptly if there is increasing redness, swelling, or overheating of the wound, if there is fever, if there is foul-smelling or pus-like discharge, or if the wound does not heal after the expected timeframes.

For the post-operative care after operations, we also support you with our Manual lymphatic drainage, To specifically reduce swelling.

We hope that this overview has provided you with more clarity about the healing process after an injury. If you have any further questions or specific concerns, please do not hesitate to contact us at Physiotherapy Waidfuss to contact in Höngg. Your health and recovery are our priority, especially when you have had surgery, our Physical therapy after surgery in Zurich.

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Sources

• Dubois B, Esculier JF (2020): Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. PubMed
• Bayer ML et al. (2017): Early versus delayed rehabilitation after acute muscle injury. N Engl J Med. PubMed
• Bleakley CM et al. (2010): Effect of accelerated rehabilitation on function after ankle sprain: randomized controlled trial. BMJ. PubMed