In our previous posts, we have extensively discussed physical mechanics and how it relates to efficiency, injuries, and performance. While it may be common sense, we thought it may be good to have a discussion: things take time to heal, if it needs and can heal. This post will discuss some factors that affect healing for the general public and they might be important for you to do/not to do when things are healing without too much of the scientific jargon and flamboyant names that some clinicians (admittedly, even us) use.
Healing generally implies that some kind of structure has been damaged in someway, this can be due to chemical (acid burns), physical (sprains, hits), or biological (infections). This first thing to take note of: can it heal? For example a ligament damage that is partial or low grade is likely to heal, but a high grade-tear or a fully ruptured ligament cannot heal. This is probably one of the first things your clinician will do - diagnose: what is damaged? How did it get damaged and how badly? The honest answer is we are never sure 100% of the time, but we can be quite close; sometimes further imaging (e.g. X-ray) is required, but sometimes further imaging does not help either. Feel free to read our previous post on imaging here . But the short version of it is: scans don’t show everything, the “damage” seen on the scan may not be the one you’re having problems with, and the treatment may be the same anyway.
If it can heal, it will heal - given the right conditions. This is where things often get confusing. The first thing to note of: pain is not a good indicator of damage or the absence of healing. We will have an up coming post about pain, but if you want to know more, ask your clinician. There are some structures that simply won’t heal, there are some structures that would normally heal but if it is damaged badly enough it cannot. Otherwise, for a lot of injuries, they do heal. So if it will heal, why don’t things get better sometimes? Let’s look at some possible factors for healing.
Time. By far, time is the most important factor for healing. No matter how healthy and fit you are, no matter how small the damage is; healing takes time. A common misconception with healing times is “I can do whatever I want to it, it’ll still heal.” This is only partially true. During the time of healing, the structure is still damaged. Loading or irritating the structure with activities that would normally be fine, may cause re-irritation and slow down healing or “take a step back”. This is especially true if your injury is traumatic in nature. The initial damage is often followed with a quick pain response as a tissue is damaged, followed by inflammation and pain associated with it (usually worse and stiffer in the morning). After inflammation, healing starts to occur, and structures recover, but may not be as strong or mobile as the original structure was initially -this is where rehab takes place to improve strength and mobility.
External factors are often things that may be overlooked when you are visiting a clinician, instead of having someone visit you at your house/work/sports. When your injury is traumatic, there is always a single traumatic incident that caused the most significant damage, then things should get better from there. If it doesn’t get better, it may mean the damage is big enough it cannot heal, or there are factors that are preventing it from healing. However, if it gets worse that is a sign that something might be re-irritating it. The damage was done at the beginning, the only reason it would sustain more damage is there are external factors that are causing more damage. For example, if we take a simple ankle sprain with minor damage, the ankle joint and ligaments do heal. However, if you put external load through the injured structure, be it via an obvious activity (e.g. jumping and landing) or less obvious (poor footwear or walking pattern), it might prevent recovery or even cause further damage. So yes, time heals most things, but do things within reason, this is usually the reason we “rest” something after an injury, to give it time and not load it. Often, it does not mean complete rest, because the rest of your body may still be healthy, and you should maintain the health and fitness levels of the rest of your body while the injured part heals. This usually involves exercise or activity modification.
Nutrition is also a known factor for recovery. When a structure is damaged, it needs components to build up and heal the structure again, usually biochemically. Most structures that can heal are protein-based structures(protein as a macronutrient) with some extra micronutrients (vitamins, iron, calcium) requiring energy to rebuild it (energy as a macronutrient in calories). This means you don’t need an excess of one thing (e.g. iron), but rather enough of everything: energy, protein, micronutrients. Some evidence suggests that sufficient energy, protein and micronutrients is necessary to have good healing for both prevention and treatment of various types of injuries and depending on the type of injury, there may be some differences, with total energy consumption and protein being the main factors(see references).
General health may also be a contributing factor to healing. General health encompasses many aspects of your wellbeing. Age is often a known factor that might affect the rate of healing, generally speaking, the older you are, the slower things heal. Systemic illnesses, including but not limited to general inflammation issues such as rheumatoid arthritis. Diabetes is also a known factor that slows down healing. Psychological factors and lack of sleep may also cause neurohormonal disturbances and some of these hormones affect inflammation and regulate structures such as bones (e.g. cortisol regulate inflammation and bone health). On the topic of neurohormonal changes, it can also be affected by various factors such as growth spurts, changes in menstrual cycles. There are also hereditary factors that some people may have such as different types of collagen produced which may create a different tensile strength in tendons and ligaments. As you can imagine, general health is quite possibly the largest and muddiest pool of factors that may affect healing. This is usually why healing times serve as a general guideline rather than a hard and fast rule: we are all different. Some of these can be changed, some of them can’t.
All in all, as you can probably tell from the tone of this essay, there are many factors that may affect your healing. Most of them just need enough. Give it enough time, rest, nutrition, sleep, and consider how other factors may affect the rate of healing, some can be modified while others not. This is a brief outlook to how healing is affected by different factors that are known at the time of this writing, but we are likely to find more in the future. Typically, we cannot outrun this healing time-frame. What clinicians do is minimise factors that may slow down the healing, and maintain strength and mobility. Strength and mobility does not occur through the process of healing(e.g. you don’t heal a tight muscle, you’d need to stretch), hence even if you are fully healed, you may not have the full strength and mobility - this is where rehab fits into the picture of recovery; not just healing.
Close, G. L., Sale, C., Baar, K., & Bermon, S. (2019). Nutrition forthe Prevention and Treatment of Injuries in Track and Field Athletes. International Journal of Sport Nutrition and Exercise Metabolism, 29(2), 189–197.doi: 10.1123/ijsnem.2018-0290
Rosen, P. V., Frohm, A., Kottorp, A., Fridén, C., & Heijne, A.(2016). Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scandinavian Journalof Medicine & Science in Sports, 27(11), 1364–1371. doi:10.1111/sms.12735