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Acute Inflammation and Healing

In the earliest stage of an acute injury, such as an ankle sprain, platelets and neutrophils appear at the injured site within a few hours. Whilst the platelets plug together to form an effective repair mesh, the neutrophils (and to a certain extent incoming macrophages) attack and kill harmful bacteria. This accounts for the majority of cells present within 24 hours of the injury.

However the neutrophils cannot distinguish between friendly cells and harmful cells and so in addition to killing bacteria they also destroy surrounding injured or healthy cells. Consequently as neutrophils are not actually required for the successful repair of an injury, finding a way to limit their non-discriminatory killing of injured tissue would be most beneficial. The primary way you can achieve this is to reduce the blood flow to the injured area. And the best way to do this is to apply ice and compression regularly to the painful site. It is for this reason, and for minimising secondary cell death by hypoxia, that physiotherapists will always advise you to apply ice and compression to your painful site for the first 2 days of the injury.

From the 2nd-6th days after an injury there is a vulnerable “lag phase” where there is little tissue regeneration and where the injured tissue is fragile, characterised by a weak fibrin bond. Therefore it is during this first 6-day period, after the injury, that your physiotherapist will advise you to rest the injured area and limit any strain to it. Strain applied to this area during this period may disrupt the fibrin and exacerbate the inflammatory response. It is also important to note that the use of anti-inflammatories (eg ibuprofen, diclofenac, nurofen), during this first 6-day period, may inhibit tissue regeneration and so is not recommended during this time.

After this first week there is a rapid regeneration and increase in collagen production, the vital building blocks for regenerated tissue. As a result this greatly increases the tensile strength of the injured tissue. It is during this phase that gentle mobilisation of the injured site is beneficial. Additionally, as there is now a substantial need for more oxygen by your busy cells, it would now be beneficial to use heat (rather than ice) in order to increase the blood flow to the recovering area.

After this regeneration phase, there is a remodelling phase. This is characterised by further increases in tensile strength due to the formation of collagen cross linkages. Further physiotherapy can help maximise recovery during this phase.

More Information

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