What Are the Stages of Tissue Healing?

Written by Teo Buzas, PT, DPT

The human body has a process of tissue healing. When tissue is injured, there are three stages of healing: inflammation, proliferation, and maturation.

1. Inflammation – Inflammation often gets viewed as something bad. Inflammation is the body’s reaction to injury and is the necessary first step in healing. It does this to minimize the damage. However, when there is chronic inflammation, other problems can arise. Inflammation begins at the time of injury as the body immediately responds to the trauma (1). There will be some overlap between the three phases, however, inflammation lasts a maximum of one week if treated promptly and correctly. During this phase, you will notice swelling, warmth, pain, and loss of function. Treatment during this phase includes protecting and resting the injured tissue, as well as minimizing further irritation to the area. Positioning and pain-free movements will help to facilitate the inflammation process so that the next phase can begin as soon as possible.

2. Repair and healing (proliferation) – This typically occurs between weeks two through four. The tissues heal and repair during this phase, but they continue to be weak and susceptible to further injury. The healing tissues can tear and bleed easily. During this phase and the injured tissue begins to improve in strength (1). The key in this phase is to apply gentle stresses and loading to the tissues to facilitate repair. A major goal here is the return of flexibility and the full range of motion in all directions as soon as safely possible. This should be done by progressively increasing movement in a controlled way. Exercise during this stage should work on safely pushing into stiffness and pain. There should be full control of the quantity and quality of the movement and exercise. In this stage, it is important to avoid overstressing the area, to not cause a new onset of inflammation, or delay of recovery.

3. Maturation – This typically extends from week four or five to a year or more. The improving strength of the healing tissue is due maturation of collagen. In this stage, it is important to apply graded, regular stress without causing any further damage. As stress is progressively applied, the tissues become more organized, and the strength improves (1). The tissues need to be stretched and strengthened, preventing stiff scar formation. The new tissues continue to go through this process until a strong permanent structure is formed. Major goals here are continued building of strength, endurance, coordination, and agility. Finally, continue with a progressive return to full activity level.

At Bridging the Gap Physical Therapy, we are here for you. We offer full body evaluations and discuss your treatment plan. This includes your diagnosis, your goals, and the plan for getting you there. Find out more by speaking to our team today at 239-676-0546.

1. Houglum P.A. Soft tissue healing and its impact on rehabilitation. Journal of Sport Rehabilitation, 1992, 19-39.