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:
- Made up of collagen fibres
- Poorly vascularised aka have a poor blood supply
- 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:
- Tendons and Ligaments are SLOW to heal, with remodelling lasting over a year mostly due to the poor blood supply.
- When injured, inflammation peaks between 3-5 days afterwards.
- New blood vessels grow into the area to allow the healing process to speed up.
- Healing is by scar formation – it will always be weaker than it was post injury
- Healing is much faster with early mobilisation and regular, progressive loading to realign the fibres and lay down the stronger collagen I fibres.
- 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