The healing process

The body's healing process has three distinct phases. 

The proliferative phase

Once the inflammatory phase has begun to fade, the clean up job has been almost completed and blood vessels are beginning to grow back into the injured area.

This restores oxygen levels and allows the cells in the damaged areas to get down to .

At three days from the injury the fibroblasts (cells which produce collagen - the stuff scar, ligaments and tendons are made of) begin to multiply (proliferate) and start to produce small fibres of collagen by the fifth day. It is this material which will become scar - the end product of the healed state.

Laying down the scar

How much scar is laid down and how it is constructed makes a difference to how things turn out.

The fibres of collagen align themselves with any force which is being applied through the tissues, ie by movement. This has important consequences for management. When there are sufficient fibres laid down the fibroblasts stop producing and the scar starts to mature, shortening to some extent in the process.

Maturing/remodelling

As the scar matures it shortens, but this is limited by the forces the person is putting through it at the time, maintaining the length of the tissue necessary for normal function.

As we get back to using the part more normally, the scar matures gradually towards the type of tissue which was present before the injury.

However, the scar remains to some extent and the tissue is never exactly the same as before. The process of gradual change over time is called remodelling, and is much more powerful in the under tens and less so in us adults. In large injuries, the maturing and remodelling stages may go on for up to two years.