Types of Injuries, Healing Phases and Treatment Goals

In the fitness industry, injuries can mainly be broken down into two categories; macrotraumas and microtraumas. Macrotrauma is a specific, sudden injury to a bodily tissue. Macrotrauma injuries to bones can result in fractures or contusions. When they occur to joints, they can be classified as either a complete dislocation (complete displacement of the joint surfaces) or a subluxation (partial displacement of the joint surfaces). Microtraumas occurring to ligaments are sprains classified in degree stages (1, 2, 3) where first degree is a partial tear without joint instability, second degree is also a partial tear but with minor joint instability, and third degree is a complete tear with full joint instability. Injuries affecting tendons are classified similar to bones as contusions or strains based on where the injury takes place.

When looking at muscle strains, they are also classified by degrees. A first degree muscle strain is a partial tear of the muscle fibers where the individual can make a strong contraction, but pain is present. Second degree strains also involve partial tears, but the individual can only complete weak, painful contractions. Third degree strains involve a complete tear of the muscle fibers with a very weak and very painful muscle contraction.

Microtraumas, on the other hand, result from overuse injuries caused by abnormal stress repeated to bodily tissues over extended periods of time. Microtraumas can happen due to a number of reasons including poor program design, bad training surfaces, incorrect form, insufficient motor control, decreased flexibility, predisposition, etc.

Inflammation Phase

This is the initial phase experienced during an injury. Inflammatory responses cause the injured area to become red and swollen, and cause a hypoxic environment which leads to cell death and increased blood flow to the injured area. Edema occurs which is an escape of fluid into surrounding tissues. The point of this is to inhibit range of motion to the body part to help prevent further injury. Inflammation phase usually lasts 2-3 days.

Treatment Goals - The main focus here, since the inflammation phase occurs immediately after an injury, should be to prevent further injury. This should involve immediately ceasing any movement to the injured body part and removing any external hazards that could cause further injury. Once this has been completed, new tissue needs to begin to form to repair the damaged area which can be achieved by resting, icing the area, compression and elevation.

Repair Phase

As the inflammatory phase ends, tissue repair begins. New and identical tissue is produced to replace the tissues that were damaged, as well as scar tissue forms. This phase may begin as soon as 2 days after an injury but could last up to 2 months!

Treatment Goals - Collagen fibers form at the injury site to provide framework and therefore support to the injured area. By avoiding any movement or resistance to the area can cause further atrophy (decay) to the injury and surrounding tissues. On the other hand, you obviously do not want to stress the injury to the point where further injury can happen or the recovery process is slowed. There should be a happy medium where light activity to the body part or joint occurs to promote strength and stability but to also increase blood flow to the area to warrant proper recovery.

Remodeling Phase

This is where the tissues that formed during the repair phase strengthen and prepare to return to pre-injury state. Collagen fibers decrease in production so that the proper tissues can grow and replace the injured ones.

Treatment Goals - Optimizing tissue function and full range of motion should be the primary goal of this final stage. Individuals at this stage can often be tempted to do "too much, too soon", but they should be constantly reminded to not push themselves too far and to increase resistance gradually.

-Tyler Robbins
B.Sc. PTS