Massage and The Three Phases of Healing:

Inflammation is the First Phase of Healing:

Right after the injury occurs, the body begins to heal itself through inflammation. The signs of inflammation are heat, redness, swelling, pain and loss of function. Heat and redness occur because the blood vessels dilate to increase blood flow to the injured area. Swelling occurs when the blood brings white blood cells, clotting proteins, blood plasma and other nutrients into the injured tissue. The pain sensation is stimulated by the damaged and surrounding tissues. The pain is typically described as constant and general. Loss of function occurs from the swelling and pain in the affected area. Protection of the injured area by changing or restricting normal patterns of movement is common because it helps to minimize pain and further injure the area. However, the different patterns of movement may also cause pain or discomfort in other areas that may not normally be felt. Rest, ice, compression, and elevation of the injured area is encouraged.

Massage during this phase will assist the healing process through relaxation. The relaxed state from the massage will decrease pain in all areas of the body and will help promote more restful sleep. Massage during the inflammation phase will not be completed on the injured tissue.

Repair is the Second Phase of Healing:

New blood vessels come into the area and produces a delicate scar tissue. Pain in this phase is described as being located in a specific area. Returning to normal activities should be done slowly and in moderation.

Massage during the repair phase still cannot be done on the injured area but the surrounding area can be done gently. Massage techniques that promote increased circulation will benefit the healing process.

Efforts shift to maintaining function, minimizing compensation, and increasing circulation. Direct techniques continue to focus primarily on associated structures, but you may now begin addressing injured areas more specifically as inflammation subsides.

Remodeling is the Thrid Phase of Healing:

The third and final phase of the healing process requires construction of permanent tissue, typically strong scar tissue made from a dense network of collagen fibers. As function returns and various demands are placed on the new tissue, the structure must be reconfigured to adapt. It does so by deconstructing and reconstructing the collagen fibers according to specifically applied forces for maximum strength and flexibility. This process of aligning collagen fibers along the lines of stress is called remodeling and is the primary purpose of the final phase of healing.

Initially, the collagen fibers that form the substance of mature scar tissue are arranged randomly, spreading in all directions. As forces are placed through the tissue, some collagen fibers are destroyed, allowing greater flexibility, while others are reinforced, providing increased strength. The collagen network continues destroying fibers that limit necessary motion and reinforcing fibers that resist tension as greater and more varied stresses are applied to the tissue. Ideally, the new tissue will offer maximal flexibility and strength, according to the demands placed on it during the remodeling phase.

The pain associated with inflammation gives way to that of ischemia during the remodeling phase. Blood flow to the injured area decreases as capillaries are deconstructed and mature scar tissue forms. Clients overwhelmingly report decreased mobility as dense networks of collagen replace granulation tissue, making soft tissue less pliable. Pliability may be further diminished if adhesions form between fascial layers in affected and associated areas. Trigger points often develop during this phase due to increasing ischemia.

If compensation has been necessary throughout the healing process, chronic dysfunction may occur in associated structures. This includes hypertonic muscles, abnormal movement patterns, and referred pain from trigger points. Many of my clients become frustrated as pain moves to new areas (associated structures from compensation) and mobility decreases. Again, this is quite normal and indicates progress through the healing process.

Remodeling may take months or years, depending on the severity of injury and demands placed on the tissue. Success in this phase requires gradual progression of functional activities followed by appropriate tissue adaptation. Encourage clients to return to activities previously modified or avoided with the intention of retraining the injured tissue (with physician permission, of course). Help them recognize compensatory patterns, improve body awareness, and return to more functional movements. Supervised activity may be necessary to restore full function, requiring assistance from physical or occupational therapists or fitness professionals.

Supporting the Healing Process:

Once the remodeling phase begins, treatment becomes much more aggressive. Focus on breaking up scar tissue and adhesions, increasing range of motion and circulation, and eliminating compensatory movement patterns. Clients embark on a systematic return to normal activities as you work together to achieve optimal tissue alignment and coordinated movement. This may require professional oversight from therapists who specialize in therapeutic exercise and neuromuscular reeducation.