31 May Rest or not to rest? – Initial Muscle Healing
Written By Megan Hunter
Initial muscle healing – stop giving inflammation a bad name!
When considering whether to rest, one factor that may be taken into account may be tissue healing times. Inflammation is a normal and essential process needed to start a good healing process. If short term relative rest is recommended by your health professional following muscle injury, then it is usually with the purpose of making sure this part of the healing process is protected.
When a true muscle strain occurs and results in injury to the muscle fibres, either end of the injured muscle fibre contracts away from each other creating a “gap” which is known as the regeneration zone. This regeneration zone is exactly as it sounds, where the body does all the good work to heal the injured muscle tissue.
For most people, the inflammatory phase intensifies within 24 hours and peaks at 48 hours post-injury. Disruption of the muscle fibre and associated blood vessels results in a “flooding” of substances into the injured fibres – otherwise known as swelling or oedema. This flooding acts as a form of communication to the body to send more inflammatory cells to the area to help. Inflammatory cells called neutrophils and macrophages are especially important – I like to think about these cells like a little pac man clean up crew within the injured area, but they are also important in letting the body know that it needs to start the regeneration process.
After the first 48 hours this inflammatory process gradually decreases until day 5-7 post injury. At this stage there is usually evidence of initial scar tissue formation.
The protection of this phase is important to ensure that healing has started off well. You may be aware of some recommendations that suggest the avoidance of anti-inflammatories and ice following acute muscle injuries, including the previously mentioned PEACE & LOVE guidelines. While there is still some debate, it is thought that these may reduce the bodies’ ability to recruit the neutrophils and the macrophages to the injured area and slow the start of the regeneration process. HOWEVER, a balance must be struck as in certain circumstances inflammation may be “excessive”. The overriding advice is to allow the initial inflammatory process to do its thing, but to intervene in these cases where inflammation is thought to have gone overboard.
Stretching during this period is also not recommended, to avoid any mechanical deformation of the injured area so that the body can bridge the “gap” in the regeneration zone.
While some time frames have been discussed in this blog, it is important to aware that individual factors may influence the rate of healing such as the type of injury, location, severity, age and overall tissue health which is further influenced by genetics, diet, physical activity levels and the presence of other health conditions such as diabetes. This may result in recommendations by your physiotherapist to be more protective or conversely less protective depending on these factors and your presenting symptoms.
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