If you look at a forest, all of the trees are parallel with each other. Once in a while you will see a tree that has fallen down and been caught in another tree. Collagen fibers are similar to this. Collagen is supposed to be in parallel lines. After an injury, your body makes a mesh with collagen fibers going in all directions. Another example might be the kids’ game Pick up Sticks. All of the collagen fibers should be parallel, but after an injury they look like the sticks when they are dropped. The fibers are running in all directions. In order to make a strong bond at the site of the injury, these crossing of fibers – or cross-links – are necessary. One problem is that these cross-links limit the range of motion of the structures that have been injured. You may not be able to move your arm or ankle as freely as you once did. In the last stage of healing, remodeling, the crosslinks are slowly reduced and range of motion is increased.

In the regeneration stage, we want to continue to minimize any swelling and inflammation and stimulate protein production of the collagen bonds. Controlled motion helps to unsure that most of the collagen will be laid down in the lines of the normal joint action. Dietary modification to ensure adequate protein intake is very important, as is limiting foods and substances that encourage the inflammatory process. This would include an excess of animal fats, alcohol and partially hydrogenated fats. Increasing Omega3 oils like, EPA, or eating deep-water fish will help to limit any inflammation. To ensure adequate protein intake, small servings of protein should be consumed throughout the day.

“Dietary modification to ensure adequate protein
intake is very important, as is limiting foods and substances
that encourage the inflammatory process.”

In the office, our goal is to make sure that the muscles that have been damaged are treated and made functional. Ligaments that have been damaged may need support both structurally and nutritionally. Keeping the joints aligned properly will allow the damaged structures to heal back at their normal lengths. This stage of the healing goes from 48 hours after the injury in a mild case, to over eight weeks in a more severe injury.

In the remodeling stage, the cross links that were formed in the regeneration stage are slowly reduced and range of motion is increased. In this phase, care is taken to reestablish the motion of the joint. This may require massage type work or stretching. Much of this is done in normal daily living, but the problem is that we tend to protect the injured part by not using it and thereby limit the return to full function. The other major goal in this phase of the healing is to reestablish normal proprioception. This involves muscle coordination.

Muscles react to each other. The contraction of one muscle causes an opposing muscle to relax. When a muscle contracts, it should not cause another muscle to weaken when it should be helping the contracting muscle. When this ballet of muscle coordination is not functioning properly, aches and pains may result, or you may have a decreased range of motion. In the office, we need to test the muscles doing various tasks to determine that the coordination is working propproperly. In simple injuries, this remodeling stage will begin as early as the fourteenth day after the injury. In severe injuries, the stage may last well over a year.

Only when full range of motion and coordinated muscle function has been attained have you recovered from an injury. If these goals are not attained, permanent decreased function and compensations by your body will lead to other problems.

An example is someone who has injured his/her ankle and it doesn’t fully recover. They will walk with a slight limp that will cause knee and hip problems. Years later, arthritis in the ankle, knee and hip joints may result due to the changes that have occurred.

Restoration of normal function depends on successfully completing the three stages of healing. Each one has its own goals and requirements.

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