Sports Massage – The Process Of Soft Tissue Repair: The Chronic Stage And Factors

In the first of our two blogs on soft tissue dysfunction, we discussed the acute and sub-acute stages of soft tissue repair. In our second blog, we are going to cover the chronic stage and factors.

Sports massage therapists should tailor their treatment and advice to the severity of the injury and the phase of recovery.

To recap, there are three phases of recovery for soft tissue:

1. Acute phase, inflammatory: 3-7 days post-injury
2. Sub-Acute phase, repair: 3-7 days to 3-6 weeks post-injury
3. Chronic phase, remodelling: 3-6 weeks to up to 2 years post-injury

As previously outlined, these are approximate timings, which can fluctuate depending on the severity of the injury and its location, for example, injuries to the legs or back can take longer to heal as it’s not as easy to rest these parts of the body.

The chronic stage of soft tissue repair

After the initial injury, there will be inflammation, swelling and pain, as the body repairs itself. Around three to six weeks later, the soft tissue repair process will move into the chronic stage. This can last weeks, months or even years, depending on the injury.

By the time the chronic stage begins, the soft tissue will have regained around 20% of its original strength. This is because the fibroblasts – cells that produce collagen – have been hard at work laying down collagen fibres.

This process continues during the course of the chronic stage.

What do the collagen fibres do?

These reinforce the scar tissue that has been formed in the earlier stages of the repair process.

As the fibres contract, they will align themselves with the tensile stresses. Gradually, the injured person will find that their usual range of movement returns, with the collagen fibres and scar tissue now able to deal with any stress they are put under.

How strong is scar tissue?

Scar tissue differs from ordinary tissue in that it has more strong collagen fibres. This means that it isn’t as elastic as tissue that hasn’t been damaged and repaired.

The best that scar tissue can therefore reach is around 80% of its strength before the injury took place.

Most of us will have some scar tissue, whether from minor or major injuries, and will have seen our scars fade over time, although they won’t disappear altogether. There are, however, various ways of reducing the prominence of scars, for example by smoothing the skin or reducing redness using topical gels, steroids, laser treatment or surgery.

What key factors affect soft tissue repair?

There are many factors that can affect how quickly soft tissue repairs itself, the most prominent ones being:

• Activity v rest
• Age
• Medication
• Nutrition
• Treatment

Taking each in turn:

Activity v rest – working out how much to move around and how much to rest can be a tricky balancing act. Too much activity can slow recovery or cause further injury. Too little can lead to tightness and adhesions, and limit blood flow, depriving the injury site of much needed nutrients.

Age – a crucial factor. While the final outcome can be the same for older people as the young, it’s probable that the repair will take longer as connective tissues generally have more collagen and less elastin as we age.

Medication – apart from possible side effects, medication can sometimes dull or remove the pain, leading the injured person to be more active, placing more stress on the site of the injury.

Nutrition – a poor diet can adversely affect the healing process, while a healthy diet with plenty of protein and a good balance of macronutrients and micronutrients can speed it up.

Treatment – the body’s ability to repair the damaged soft tissue can be aided by the right treatment plan, with targeted activity for each stage of the repair process.