Here is an interesting exceprt regarding tissue healing that I found while trying to find tissue healing times
Biological Facts of Soft Tissue Healing
All mesodermal tissues are in a constant state of equilibrium. “The milieu interieur” —Claude Bernard
All tissues of the musculoskeletal system have a threshold above which they fail. ACL - 2000 Newtons, Achilles tendon - 4000 Newtons, Hyaline Cartilage - 25 mPa/m2. (Ref: Noyes FR. Functional Properties of Knee Ligaments and Alterations Induced by Immobilizations. Clinical Orthopaedics; 123:210, 1977. Komi PV. In Vivo Registration of Achilles Tendon Forces in Man. International Journal of Sports Medicine, 8:3-8, 1987.)
After injury, musculoskeletal tissues never return to normal, either mechanically or architecturally. (Ref: Ng YF, et al. Long Term Study of the Biochemistry and Biomechanics of ACL - Patellar Tendon Autografts in Goats. J. of Orthopaedic Reseach, 1996; 14:851-856.)
All techniques of rehabilitation have limitation. Such strategies can only “normalize” injured tissues. (Ref. Stanish WD, Curwin S. Special Techniques and Rehabilitation; Crucial Ligaments 2nd Edition, Eds. John A. Feagin, pgs. 773-785, 1993.)
Factors Which Impede Healing (Systemic)
Age
Mal-nourishment
Corticosteroids/NSAIDs
Diabetes
Anti-coagulants
Factors Which Maximize Healing (Systemic)
Adequate nutrition
Calcitonin
Vitamin A
Glucosamine
Anabolic Steroids
Factors Which Impede Healing (Local)
Prolonged immobilization
Rigid fixation
Excessive soft tissue gap
Excessive motion or stress/repeat injury
Factors Which Maximize Healing (Local)
Electrical stimulation
Injectable growth factors
Surgical gap closure/surgical
Controlled motion
(Ref: Stanish WD, Rubinovich M, Kozey J, MacGillvary G. The Use of Electricity in Ligament and Tendon Repair. The Physician and Sports Medicine; Vol. 13:8, August 1985. Buckwalter JA, Cruess RL. Healing of Musculoskeletal Tissues. Fractures In Adults. Eds. Charles Rockwood, David Green, Robert Bucholz; 3rd Ed. pgs. 181-222, 1991.)
Injuries To Tendon/Ligaments
Introduction
When injured, tendon ligaments go through virtually identical phases of healing.
Phase I - Inflammatory
Phase II - Proliferative
Phase III - Remodelling
(Ref: Woo SLY, Buckwalter JA. Injury and Repair of Musculoskeletal Soft Tissues. Am. Academy of Orthopaedic Surgeons Symposium, Illinois 1988.)
Example No. 1: Forty-year-old squash player/rupture of the Achilles tendon.
Clinical Experience
A complete rupture of the Achilles tendon requires surgical repair of reconstruction. This offers the most favorable result and thwarts the very high re-rupture rate seen with a non surgical approach.
The rehabilitation for partial tears of the Achilles tendon requires:
short-term immobilization to control the inflammatory phase.
progressive stretching and strengthening.
eventually task-specific rehabilitation which must include eccentric training to optimize tendon repair.
(Ref: Stanish WD, Rubinovich M, Curwin S. Eccentric Exercise in Chronic Tendinitis. Clinical Orthopaedics and Related Research, pgs. 65-68, 1985. Stanish WD, Lamb H, Curwin S. The Biomechanical Analysis of Chronic Patellar Tendinitis and Treatment with Eccentric Loading. Surgical and Arthroscopy of the Knee, 2nd Congress of the European Soceity; Eds. Muller/Hackenburch; Springer-Verlag Berlin Heidelberg 1988. Curwin S, Stanish WD. Tendinitis: Its Etiology and Treatment. The Collamore Press, D.C. health and Company, Lexington, MA.)
The Histochemistry of Tendon Repair
The healing Achilles tendon demonstrates both intrinsic and extrinsic mechanisms of repair with initially disorganized immature collagen. The “healed” Achilles tendon demonstrates realignment of collagen fibres which are similar in caliber, but do realign according to the lines of stress.
The Biomechanical Response of Tendon Repair
With a tendon injury - complete or partial - early control of inflammation followed by progressive stress to the tendon, is in order. Task specific challenges, emphasizing eccentric training, must follow