Wound Healing

Irrelevant of where the wound is (i.e. a cut, tendon strain, torn muscle/ligament, etc) the process of healing is the same. In this article we will explore the wonders of how your body repairs itself. Understanding how the body heals will help you manage your injuries better leading to optimal recovery times.

The Event
This could be anything, from a trauma, to a sudden movement. The key point here is that a tissue is damaged. As blood / lymphatic vessels and nerves live very close to all tissues, it is likely that these will be damaged too.

The Plug
When tissues are damaged, they will tear blood vessels (in most cases tiny vessels called capillaries) thus allowing blood to escape. If this is not dealt with quickly we will see unabandanted swelling in the area. Within our blood live some cells called platelets. Normally, these remain dissolved in the blood, however when they come into contact with damaged blood vessels, they become insoluble and sticky. They stick together forming a net which catches all the other substances floating in the blood. In a short space of time, the net has caught enough substances to create a blockage, hence plugging the torn blood vessel and stopping any further blood loss.

Swelling
The plug, creates a blockage and thus a back pressure. This combined with various chemicals released by the damaged tissues, causes the local blood vessels to expand (i.e. dialate). As the vessels expand, their walls become porous to certain cells allowing them to migrate through the vessel walls and onto the damaged site.

How do they know where to go, well the damaged tissue releases various markers which guide them, a bit like a whistle or flare we use when we are stranded in open water. The cells consist of white blood cells (called leukocytes), various growth hormones (called interlukens) and chemicals that promote further inflammation and pain.

Why create pain you may ask? Well, if it does not hurt, how do you know it is damaged? We need pain so we can acknowledge the damage and then change our activities to a) stop it getting worse and b) allow it to heal. The release of these cells comes with the release of water, hence we see swelling.

The scab
We use the word scab as it is familiar to us all, as we have all seen one. However, what we have seen following a skin wound is simply a dried up version of what happens inside us. The correct term is granulation tissue because it looks grainy.

The granulation tissue is a general mixture of pre-mature tissue and temporary blood vessels. Both grow into the area because of the release of those growth hormones mentioned earlier. We need the extra temporary blood vessels to feed the new growing tissue.

The tissue acts as a filler, plugging the gap within the wound. Meanwhile the cells at the peripheriy of the wound, will multiple inwards thereby pulling the two ends together. So now, we have the hole in the middle of the wound being filled as well as the two ends being pulled together, just like when we are pulling the two ends together of a torn piece of clothing prior to stitching.

Unfortunately, the more complex structures (e.g. glands, contractile tissue) are difficult to replicate and are usually lost. This is why repaired tissue is not as strong or as functional as its original. E.g. Repaired skin lesions will rarely have hair and sweat glands.

Re-organising
Once everything is in place, the body can then take its time to reorganise everything into an optimal position. This process is the longest step to recovery, taking anywhere between 1 to 24months. Thus it is important to return to activity gradually.

Ultimately wound healing is a repair process implying that the body is try to fashion a tissue of a similar quality but not an exact replica of the original. Therefore, the replacement tissue will not be 100% as strong as the original, but the body will try and get as close to 100% as it can. Invariably the older we are and the more health problems we face, the further from 100% we will be. However, the vast majority will be above 80%, that is how clever our bodies are.

Factors Affecting Wound Healing

‘Are there any factors that can speed up or slow down the process of wound healing?’

Unfortunately we can not speed the process up but there many ways we can slow it down by creating hurdles to healing. Essentially, doing the wrong things that work against the body. This article will highlight those hurdles and also give you clues on how to reduce their impact.

Hurdles to wound healing

The 1st Hurdle – Sleep and Rest
In today’s modern world we are encouraged to work / play hard and resting little. The downside to this strategy is that the main set of hormones involved in tissue regeneration / repair (termed growth hormones) are most abundant during sleep. These compounds promote healing by encouraging our cells to make new tissue. They work by binding to the outside of the cell and awakening various chemical reactions in the cell that make proteins. Proteins are the building blocks of all our tissues, therefore more protein equals more tissue.

The 2nd Hurdle – Stress
The term stress simply means a challenging situation for body be it physical or mental. Examples include physical stress from injury or illness, fear stress from our perception of pain and/or its consequence and healing stress. Healing stress occurs when we get frustrated because we are not healing at the rate we expected. The question here is, are our expectations realistic? If we expect a 2 year problem to be resolved within a week it is highly likely we will get frustrated even if we see a 50% improvement over 3 weeks! This frustration is not helpful to healing because stress, irrelevant of its form, suppresses healing. Below we outline how.

Cortisol is the main hormone released during stressful situations. It reduces the effectiveness of our immune system, raises our blood pressure by constricting our arteries and reduces the production of growth hormones. We have described [last month] how our immune cells are required for processing the debris produced during tissue damage; how our blood flow is important in bring nutrients into the area as well as removing waste products; and the role of growth hormones in regenerating tissues. If cortisol suppresses these hormones then invariably wound healing will be slower. Hence stress is not conducive to optimum healing.

The 3rd Hurdle – Social interaction
Oxytocin is a hormone that is famous for its production during child birth. It has many other roles, which we are just discovering. Two of its newly discovered roles are:

– it is produced during social interaction,
– it suppresses the release of the stress hormone (cortisol).

Cortisol suppresses wound healing as outlined above. Therefore, if social interaction suppresses cortisol via the release of oxytocin, then social interaction promotes wound healing. When we are in pain, we often lock ourselves away however these new findings tell us to unlock ourselves.

The 4th Hurdle – Adaptation
Injuries range from short term (a few days) to long term (months even years) dependent on the type of injury, what tissue and how bad. Especially with long term injuries, it can be difficult to endure the healing process. It requires adjusting to a new reality, modifying activities and even adjusting your short term goals.

Not accepting this temporarily transition period is a common cause of impeding the healing process.

The 5th Hurdle – Nutrition
Wound healing is a challenging time for the body and thus the body’s demand for energy and particular nutrients (including water) increases. Should we fail to supply our body’s with this energy (or the correct nutrients) can we expect our wounds to heal? We would not expect ourselves to win an athletic event without eating healthy so why do we think differently about wound healing?

To highlight the type of nutrients required and thus the food groups needed would be a long and exhaustive list. We would rather give a few simple guidelines to follow:

1) eat natural healthy food, including all groups. E.g. Carbohydrates, vegetables, fruits, meats, etc),
2) drink plenty of water, as the body consumes a lot of water during healing,
3) avoid process foods or unhealthy foods (as it is difficult for the body to extract the nutrients it needs from them, while most contain very little nutrients!),
4) do not miss a meal

Those are the main hurdles to healing. Reduce or even eliminate these and you can be assured that your body will solve the problem to the best of its ability and in the shortest time.