A muscle strain occurs when the fibres have been overloaded and damaged. The healing phase of the damaged fibres starts immediately after injury and should also be well managed for the tissues to heal properly in the optimal time period for quicker return to normal activities or sport.
The different phases of healing will now be explained and compared to the restoration process of a part of a house that collapsed. The family of the house needs to move back as soon as possible to return to their normal functioning and routine. However, the family wants to leave enough time for the restoration so that it can be done properly. We all know that, similarly to healing, construction needs to be managed well for it to be done neatly and the process to be completed on time. The healing phases happen in typical time periods, but depends on the extent of the injury. The phases can also overlap, as with construction where things are done in parallel. As the workers wait for one part to dry, they carry on with another area. These phases are important to note in order to know what needs to be managed when, for the best possible outcome in the most optimal time period after an injury such as a hamstring strain.
Phase 1 – Inflammatory phase
The first phase of healing can last up to 4 to 6 days. In these few days the inflammatory mediated cells enters the site of injury and acts like a construction crew. Their job is to block off the site with red tape and start cleaning and clearing the destroyed parts of the house. The foundations are now laid in preparation to the new walls to be built. During the first phase, movement of the injured area should be well controlled and sometimes limited, depending on the extent of the injury. The newly laid down foundations must be protected to dry and set first, otherwise the work will have to be done from the start again. Gentle movement, if safe to do so, increases the blood flow which subsequently increases the rate at which the cells move through the site. Therefore, there should be a balance between too much and too little movement.
Phase 2 – Regeneration phase
The next phase might already start in areas where the foundations have set, while other areas of the foundations are still left to dry. Generally, the regeneration phase will start from about day 5 and may last up to 10 or 12 weeks. Now the foundations are laid and the bricks are being carried in for new walls to be built. The bricks are being compared to collagen fibres, which increases the strength of the injured site. Therefore, more movement of the injured area is now allowed to increase the blood flow and to stimulate an increased production of collagen fibres which even further strengthens the site. This can be explained as an increased capacity for more workers on site, as the surface of the foundations are dried and set. However, the manager should still limit the amount of workers entering and exiting the site to prevent the bricks and foundations being damaged which may delay the process or lead to cracks in the bricks or foundations. Movement during this phase is also crucial to smooth out the areas where the new fibres joins the old fibres, just like the joints between the old and new walls should be neatly done by the same type of brick, smoothly plastered and sanded and lastly painted by the same colour code. Gaps between the collapsed ends are ready to be filled with new brick walls.
Phase 3 – Remodelling
The last phase may start from day 21 (week 3) and can take anything up to 6-12months to finish, depending on the amount of fibres damaged during the injury. During this phase the strength of the fibres still increases but at a slower pace than the previous phase. No more new bricks are being carried in. Instead, they are now being organized and strategically packed to form a wall of the same alignment as the existing wall. Therefore, movement becomes the primary aim of this phase to pull the new fibres in the same alignment as the old fibres. The fibres are now able to withstand more forces as the new fibres are being aligned to resist forces together in the same direction. Another factor that allows additional increasing of strength of the fibres, are the cross-bridge formation between the fibres. This can be compared to the cement between the bricks which now dries and becomes strong, holding the fibres together as a unit.
Returning To activity or Sports
After the wall is built, plastered and newly painted, it should now be left to dry. However, the rest of the house can already be cleaned for the family to move in sooner. Similarly, once the scar tissue has formed and gained its strength, the tissue contracts to bring the ends closer together. This, however, can lead to shortening of the muscle. Therefore the scar tissue should now be stretched so that the fibres can be of the same length as the rest of the muscle for returning back to usual activity. Although still vulnerable, strengthening of the muscle should also start in order to protect the wound and to prepare the tissues to withstand the forces during activity or sports. Once the strength, length and alignment of the scar tissue is the same as the rest of the muscle, and the family in the house is unable to notice a difference between old and new walls, everybody can return to their normal routine and activities.