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Healing Processes After Injury: Part 3 – Tendons and Ligaments

We are back for part 3 of our small series on the healing and recovery of tendons and ligaments. As discussed previously there are some common themes in the healing of both tendons and ligaments. Both are:

  1. Made up of collagen fibres
  2. Poorly vascularised aka have a poor blood supply
  3. Metabolically very slow

This all results in poor healing times, which anybody who has had Achilles problems, tennis or golfers elbow can attest to. The healing when it occurs is also by scar formation. As mentioned in the last post, scar formation results in a weaker structure and the tendon/ligament will not be as strong as it was pre-injury.

After injury, inflammation peaks at around 3 to five days. One of the most fascinating responses by the body is a huge surge in neovascularisation (new blood vessel formation). This is a very smart response from the body as we know that tendons and ligaments have a poor blood supply and therefore a slow healing time. The new blood vessels grow into the injured area to allow the healing process to speed up and bring vital nutrients into the area. Research shows that this increased blood supply to the area lasts until about 4 months after injury, which shows just how long the healing goes on for.

The ever present collagen III (weak collagen) initially forms in the injured area and needs an early and constant, progressive load through the area in order to realign the fibres in the right direction – hence the advocacy of keeping yourself moving and as active as possible as early as one can after injury. The constant load is needed through tendons and ligaments to eventually turn the collagen III into the much stronger collagen I. Studies show that tendons that are repaired by surgery and treated with early mobilisation have TWICE THE STRENGTH of tendons that are immobilised after 3 weeks. The moving and loading of the tendon speeds up the tendon recovery. The remodelling continues from 2 weeks until up to a year after, maybe more.

The key to recovery with these injuries is PATIENCE. It is vital to understand that with tendons and ligament it takes time. Here is a summary below of the main take home points:

  1. Tendons and Ligaments are SLOW to heal, with remodelling lasting over a year mostly due to the poor blood supply. 
  2. When injured, inflammation peaks between 3-5 days afterwards.
  3. New blood vessels grow into the area to allow the healing process to speed up.
  4. Healing is by scar formation – it will always be weaker than it was post injury
  5. Healing is much faster with early mobilisation and regular, progressive loading to realign the fibres and lay down the stronger collagen I fibres. 
  6. Patience is key to understanding the recovery process can take well over half a year and continue until after a year afterwards.

This is the last post on the Healing Processes After Injury series. We hope you have enjoyed the information provided. Be sure to look out for more posts soon.

West 12 Health Centre

 

 

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Healing Processes After Injury: Part 2 – Muscles

Hello all, we are back with part 2. There has barely been enough time to digest part 1 but we wanted to keep the storyline sailing smoothly so here it is. In this post, wet will be addressing muscle injury, recovery and repair.

Muscle tissue is a very active tissue – that it has a high level of energy because of the ample blood supply and nutrients it receives. In practical terms it means 2 important things: muscles GROW and HEAL QUICKLY, in comparison to other tissues. That is why when people start exercising and weight training, they note rapid growth in muscle mass and muscle conditioning. Muscle requires a lot of energy to be maintained, which is why you see all those muscle bound guys in the gym eating constantly! That is also why weight training should be incorporated into weight loss regimes, as at rest, muscle needs more energy to maintain itself than fat.

On the other hand, if muscles are not used constantly and/or fed adequately, they waste away, and waste away at an alarming rate. An example is immobilisation after surgery – A leg in a cast for six weeks results in a decrease of around 20% of the quadriceps muscle. Within hours, the metabolism of the muscles decreases, they begin to shorten and stiffen, so you can imagine how after just 6 weeks there is a significant decreases in muscles size, strength and length.

Those who go to the gym or exercise regularly will know that strength training (low reps, high weight) leads to an increase in muscle mass and size and that endurance training (high reps, low weight) increases the ability for sustained effort. However, an interesting bit of research we first came across in Louis Gifford’s Aches and Pains:

  1. Young people were asked to do 10 reps, twice a day, three times a week for 8 weeks of bicep contractions. They pushed with only 2 thirds of their force. After 8 weeks their ‘trained’ arm increased strength by 25%. Interestingly however, their ‘UNTRAINED’ ARM also INCREASED in strength by 15%. Suggesting there was a change in the nervous system that was contributing to this change in the ‘untrained’ arm.
  2. After repeating the training, they found that in the first 2 weeks,80% of the strength change in the trained arm was achieved by changes in the nervous system and muscle activation (this basically means that your muscle is not getting bigger, but is getting better at using more of the muscle – essentially becoming more efficient). The remaining 20% was due to changes in the muscle itself. However, after 8 weeks, 95% strength of the strength was due to changes in the muscle and only 5% due to changes in the nervous system.
  3. The above studies are very useful for those who are immobilised as it shows that if you keep the other muscles of the body strong and active, you may be able to slow down the wasting and increase the recovery times of the immobilised area.
  4. Finally, in another study, and a little off topic, groups of people who did exercises to strengthen the muscles of their little finger. The group that did the strengthening exercises increased in strength by 40% over 4 weeks but another group IMAGINED doing the exercises and increased their strength by 22%! Maybe we shouldn’t have mentioned that, otherwise people will never take advice to get up and moving!

Muscle Repair

Inital repair in muscle injury is done by weak disorganised fibres called collagen III, which are gradually replaced by collagen I, which is much stronger. It is therefore important to NOT stretch the injury or wound initially and slowly incorporate gentle stretches.

Research shows that taking it easy at the very beginning (a few days max) with muscle injuries is a good thing (it is important though that it is only for a very short period), as moving after a few days rest leads to:

  1. Better aligning of the new muscle fibres
  2. A faster decrease in surrounding blood and inflammation
  3. Better organised regeneration of the muscle
  4. Faster increase in strength of the muscle.

Small Tears – Also known as strains lose power initially after injury, which is rather obvious. Inflammation lasts up to 4 days (Remember to ICE). Recovery begins 24-48 hours after injury and by day 7 power has returned to over 75% of the original. Muscle fibre regeneration is complete by 10- 14 days.

Large/Complete Tears – 50% muscle strength returns by 12 weeks and the ability to contract the muscle is about 80% of the original.

It is vitally important to have an idea of the recovery process as the times of recovery vary from weeks to months, which results in different treatment and management plans. However, one factor they all have in common is the old adage: USE IT, OR LOSE IT. Muscles, Ligaments and Tendons need to have loads put through them constantly to remain healthy. They weaken and waste away relatively quickly when unused for long periods. The common message to take away from all our blog posts is: KEEP ACTIVE AS MUCH AS POSSIBLE.

The importance of activity, any activity is better than no activity at all. Inactivity is the scourge of western lifestyle and ill health. Muscle is remarkable in its ability to adapt, as illustrated above and gives us all hope, no matter where we are in terms of our health, that we can always change our circumstances even if we begin by just doing 5 minutes more than we did yesterday.

Have a good week from all of us here at West 12 Health. Hasta luego!

 

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