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Rehab Science · Chapter 8

How Long Injuries Take to Heal

Healing time depends on severity, tissue type (blood supply), lifestyle and rehab. Tissue moves through inflammation (~72 h), maturation (to ~3 weeks) and remodelling (weeks to two years). The timelines are averages—symptoms and function decide when to progress, and phase 3 often continues well beyond healing.

CompleteSource: Rehab Science · Ch 8 · PDF pp. 147–160
You will learn to
  • ✓ Describe the three healing phases and their typical durations
  • ✓ State typical healing ranges for each tissue and grade
  • ✓ Explain why rehab continues after pain resolves
1.

What changes healing time

📖 Rehab Science

Bigger injuries heal slower. Tissues with good blood flow (muscle, bone) heal faster than poorly supplied ones (cartilage). Rest alone calms tissue but leaves weakness and stiffness, which raises re-injury risk.

Source: Rehab Science · Ch 8 · PDF p. 148show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

2.

Smoking and alcohol

📖 Rehab Science

Tobacco in any form reduces blood flow and slows healing—some surgeons will not operate on smokers. Alcohol slows the protein building that repairs tissue and disturbs sleep.

Source: Rehab Science · Ch 8 · PDF p. 149· 8 original research citationsshow sources ▾
  1. [Ch 8·1] Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069-1079. find original ↗
  2. [Ch 8·2] Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY. The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med. 2015;43(3):745-751. find original ↗
  3. [Ch 8·3] Kanneganti P, Harris JD, Brophy RH, Carey JL, Lattermann C, Flanigan DC. The effect of smoking on ligament and cartilage surgery in the knee: a systematic review. Am J Sports Med. 2012;40(12):2872-2878. find original ↗
  4. [Ch 8·4] Novikov DA, Swensen SJ, Buza JA 3rd, Gidumal RH, Strauss EJ. The effect of smoking on ACL reconstruction: a systematic review. Phys Sportsmed. 2016;44(4):335-341. find original ↗
  5. [Ch 8·5] Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014;96(8):674-681. find original ↗
  6. [Ch 8·6] Steiner JL, Lang CH. Dysregulation of skeletal muscle protein metabolism by alcohol. Am J Physiol Endocrinol Metab. 2015;308(9):E699-E712. find original ↗
  7. [Ch 8·7] Lang CH, Kimball SR, Frost RA, Vary TC. Alcohol myopathy: impairment of protein synthesis and translation initiation. Int J Biochem Cell Biol. 2001;33(5):457-473. find original ↗
Also cited by the book on this page:
  1. [Ch 8·9] Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2004;12(5):465-470. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

3.

The three phases of healing

📖 Rehab Science

1) Inflammation (about 3 days): the body starts repairs, the area is sensitive—use gentle, unloaded movement. 2) Maturation (to about 3 weeks): tissue starts to rebuild—add mobility, strength and stability work, and keep joints from stiffening. 3) Remodelling (4–6 weeks for minor injuries, up to a year or more for ruptures): rebuild capacity with resistance training and a slow return to activity. That is why return to sport after an ACL tear should not be before about nine months.

Diagram · Three phases of tissue healingOriginal illustration
3 days3 weeks6 weeks1 year +Inflammation→ Rehab phase 1Maturation→ Rehab phase 2Remodelling→ Rehab phase 3time since injury (not to scale)
Inflammation (~72 h), maturation/fibroblastic (to ~3 weeks) and remodelling (4–6 weeks for minor injuries, up to 1–2 years for ruptures). These map onto rehab phases 1–3. — Based on concepts in Rehab Science Ch 8 (PDF pp. 149–151).
Source: Rehab Science · Ch 8 · PDF pp. 149, 150, 151· 6 original research citationsshow sources ▾
Also cited by the book on these pages:
  1. [Ch 8·4] Novikov DA, Swensen SJ, Buza JA 3rd, Gidumal RH, Strauss EJ. The effect of smoking on ACL reconstruction: a systematic review. Phys Sportsmed. 2016;44(4):335-341. find original ↗
  2. [Ch 8·9] Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2004;12(5):465-470. find original ↗
  3. [Ch 8·1] Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069-1079. find original ↗
  4. [Ch 8·5] Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014;96(8):674-681. find original ↗
  5. [Ch 8·6] Steiner JL, Lang CH. Dysregulation of skeletal muscle protein metabolism by alcohol. Am J Physiol Endocrinol Metab. 2015;308(9):E699-E712. find original ↗
  6. [Ch 8·7] Lang CH, Kimball SR, Frost RA, Vary TC. Alcohol myopathy: impairment of protein synthesis and translation initiation. Int J Biochem Cell Biol. 2001;33(5):457-473. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

4.

Typical healing time frames by tissue

📖 Rehab Science

Muscle strain — grade I 1–3 weeks, grade II 4–12 weeks, grade III 3–6 months (often surgery). Tendon — tendinopathy 2–12 weeks, tendinosis 3–6 months, rupture 3 months to a year. Ligament — grade I 1–3 weeks, grade II 4–6 weeks, grade III 8 weeks to a year. Cartilage — 3 months to 2 years (and some never fully heal, yet symptoms can still resolve). Nerve — irritation 4–6 weeks, severe injury 3–12 months, regrowing about 1 mm a day. Bone — simple or stress fractures 6–8 weeks, complex rarely beyond 6 months.

  • Timelines are averages — symptoms and function decide progression
  • Keep doing phase 3 after pain resolves
Diagram · Typical healing time frames by tissueOriginal illustration
1 wk2 wk4 wk8 wk12 wk26 wk1 yr2 yrMuscle — grade IMuscle — grade IIMuscle — grade IIITendinopathyTendinosisTendon ruptureLigament — grade ILigament — grade IILigament — grade IIICartilageNerve irritation (e.g. sciatica)Severe nerve injuryBone — simple / stress fractureBone — complex fracture
Averages only—symptoms and function decide progression. Log scale. Rehab (especially phase 3) usually continues beyond these ranges. — Based on concepts in Rehab Science Ch 8 (PDF pp. 152–160).
Source: Rehab Science · Ch 8 · PDF pp. 152–160· 7 original research citationsshow sources ▾
  1. [Ch 8·8] Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. find original ↗
  2. [Ch 8·9] Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2004;12(5):465-470. find original ↗
  3. [Ch 8·10] Shalabi A, Kristoffersen-Wilberg M, Svensson L, Aspelin P, Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32(5):1286-1296. find original ↗
  4. [Ch 8·11] Bahr R, Fossan B, Løken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee). A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(8):1689-1698. find original ↗
  5. [Ch 8·12] Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416. find original ↗
  6. [Ch 8·13] Grafstein B. Role of slow axonal transport in nerve regeneration. Acta Neuropathol. 1971;5:144-152. find original ↗
  7. [Ch 8·14] Hoffman PN, Lasek RJ. Axonal transport of the cytoskeleton in regenerating motor neurons: constancy and change. Brain Res. 1980;202(2):317-333. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

5.

Why rehab outlasts the pain

📖 Rehab Science

Pain often fades before tissue is fully rebuilt. Continuing phase 3 strengthens the area so it is less likely to be hurt again—especially when returning to the activity that caused the problem, like running after Achilles tendinopathy.

Source: Rehab Science · Ch 8 · PDF pp. 152, 154, 157· 3 original research citationsshow sources ▾
Also cited by the book on these pages:
  1. [Ch 8·8] Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. find original ↗
  2. [Ch 8·11] Bahr R, Fossan B, Løken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee). A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(8):1689-1698. find original ↗
  3. [Ch 8·12] Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Check your understanding

1. How long does the inflammatory phase typically last?
2. Typical healing range for a grade II ligament sprain?
3. Approximate peripheral nerve regeneration rate?