To Your Health
June, 2010 (Vol. 04, Issue 06)
Phase Two: The Repair Phase. After the initial 48-72 hours, the repair phase begins and lasts six or more weeks. During this period of time, care is predominately passive and the tissues begin to repair and regain tensile (functional) strength.
Increases in exercise, stretching, and aerobic and resistance activity are all gradually employed (see below). Once the tissues have achieved the strength needed to stabilize the area and resist further tearing, the remodeling phase begins. Activity usually increases significantly during the phase. Care is a mixture of passive and active activities during the repair stage.
Phase Three: The Remodeling Phase.Remodeling occurs as the body redirects the healing fibers attempting to increase the strength and orient the tissue fibers along the lines of greatest stress. This is the longest of the three phases. Beginning at six weeks, the process can continue for up to two years. This may seem like a very long time, but it is a necessary process.
To provide an example of this time frame, think about a surgical scar you or someone you know had or currently has. The scar remains red for a considerable period of time after surgery. It eventually fades from red to skin color. The red color seen after surgery is the result of capillary vessels in the scar that are supplying the nutrients for healing and remodeling the scar. Once remodeling is complete, the capillaries are absorbed and the red color (blood) will disappear.
Care is predominately active during the remodeling phase. It is obvious the soft-tissue healing is not a quick process. Additionally, the process is not perfect. The scars formed during soft-tissue healing are not as functional as the injured tissues. Scars are fibrous, inflexible and weaker than the original tissue. This leaves the area of the injury vulnerable to future injury. Appropriate rehabilitation helps reduce the factors, but it is not a complete or perfect cure. The key is to start treatment early and receive proper care during each phase in order to achieve the best results.
Grading the Severity of a Soft-Tissue Injury
The soft-tissue-injury grading system based on numbers (I-IV) has been in use for a few decades. Prior to its use, the terms mild, moderate and severe were used. Mild equaled a grade I sprain or strain. Moderate equaled a grade II sprain or strain. Severe equaled a grade III sprain or strain. However, this original system fell into disfavor as it was often confused with the system uses for rating a patient's degree of pain as mild, moderate or severe. If the doctor found physical evidence of a moderate sprain and/or strain, and the patient rated their pain a severe, an immediate conflict occurred. Third parties often choose to interpret the patient's "severe" as a complete rupture. To avoid this situation, grades I through IV are used to assess tissue damage and a 0-10 pain scale is used to rate pain.
- Grade I: Consistent with tearing of less than 50 percent of the tissue fibers. This is the same for ligaments and/or tendons/muscles.
- Grade II: Consistent with tearing of more than 50 percent of the ligament, tendon and muscle tissue fibers.
- Grade III: A complete tear; the muscle or ligament has been separated into two sections.
- Grade IV: Also a complete tear, but with the separation occurring at the muscle's or ligament's attachment to the bone. This results in the tissue detaching a small fragment or chip of bone.
While the grades for sprains and strains are usually described as individual entities, they can occur in combination. More than one grade can be present in a joint or series of joints. For example, varying degrees of sprain and strain can occur in the cervical spine (neck) following cervical acceleration-deceleration (whiplash) injuries.
K. Jeffrey Miller, DC, MBA,is an assistant professor of chiropractic at the University of Missouri Orthopedic Institute, a branch of the University of Missouri Health System. He is a graduate of Palmer College of Chiropractic and the author of several practitioner and patient texts.