Factors that Increase Healing Time in Injuries
By James Beauchamp, D.C.
Why do people with similar injuries sometimes heal at different rates? There are several factors that can lead to prolonged healing times. Medical conditions, physical conditioning, prior injuries and age are all relevant factors in assessing normal recovery time from a musculoskeletal injury. Other factors may include anything from improper post-injury management, premature increases in activity, or re-injury. I will not delve into smoking here, but it is an important consideration for active smokers.
The physical capacity to recover from trauma varies between individuals. For example, people heal slower as they get older compared to when they were younger. So the time frame for healing in an elderly car accident or slip and fall victim is correspondingly greater than that of a sixteen year old. Osteoarthritis is also a factor in extending healing times after injury to a joint. While it is more common to see osteoarthritis in the elderly, it is often first detected incidentally in the 30’s and 40’s after x-rays are obtained because of an unrelated injury. A combination of arthritis, disc deterioration and spinal stenosis in a middle aged person is a common problem that can not only extend healing time but even require interventional pain management.
Physical deconditioning is also a factor that can extend healing times. Relative muscle weakness and atrophy do occur with age, but most people are in relatively poor physical condition because of sedentary lifestyles and a lack of exercise. It is a well known fact that a weak, tight and atrophied muscle is easier to injure than a muscle that is elastic and strong. By accentuating the initial injury, deconditioning can turn a modest accident into a major injury (5).
Obesity and diabetes are associated with excessive pain and slow healing times respectively. While it is true that a clear link between low back pain and weight has never been definitively established (4), it is nevertheless true that obese patients report greater pain levels for similar injuries compared to the non-obese (4). This is not entirely understood, but I suspect it is at least partly due to the well-documented effect of excessive body fat on the inflammatory response. Fat, particularly abdominal fat, secretes chemicals into the body that are pro-inflammatory (6). This can aggravate injury inflammation and lead to greater pain and dysfunction. Of course extra weight also increases mechanical strain on the back and knees in particular (4), making recovery difficult.
It is well known that diabetics can heal from lacerations slowly. Other injuries are no different (2). In addition it is “common knowledge” that diabetes reduces skeletal muscle contractility and induces muscle atrophy. The American Diabetic Association states that diabetics have weaker muscles and higher odds of impaired musculoskeletal function (3). This can compound the effect of general deconditioning, leading to even greater injury than one would expect.
There is only one opportunity to initiate appropriate early injury treatment in order to minimize healing time. While it is well-established that ice and rest are helpful, many times the patient either does not know, or underestimates, their importance and may neglect to follow emergency room recommendations. That is a missed opportunity to speed recovery. Applying heat prematurely will worsen pain and extend disability. Failing to get adequate rest will also increase inflammation because injured muscles and ligaments are weaker after injury and are easily aggravated. Even worse is if the patient continues to work a physically demanding job, tries to exercise or is placed under too aggressive physical therapy and rehab. Strength training can further tear already compromised tissues. Strengthening is appropriate later in the healing process, but it must be remembered that we are treating an injury. Damaged tissues need to be removed and new muscle and connective tissue regrown before aggressive rehabilitation lest the patient’s recovery time be extended unduly.
To acknowledge extenuating factors that complicate, delay or even prevent full recovery after an injury is not a judgement of a person’s lifestyle and in no way absolves the accident or injury from its role as the causative factor. In cases that require lengthy treatment or lead to poor outcomes even to the point of permanent disability, it is important that the physical reality of the injured individual be acknowledged and dealt with in a compassionate and realistic fashion.
Dr. James Beauchamp is a Multi-Specialty HealthCare provider specializing in Chiropractic Care. He is certified in spinal trauma, manipulation under anesthesia, and as an automobile accident reconstructionist. He is also a member of the advisory board for Operation Backbone.
References available by request. Copyright James W. Beauchamp, DC