Repair Phase of Healing

Dr. Wallace Wade

Chiropractor in Citrus Park FL 33625

What Happens to the Tissue

Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase

  1. “Repair/Regeneration or Fibroblastic phase”
  2. Phase will extend from 48 hours to 3-6 weeks
  3. Phase removes debris & temporary repair – SCAR FORMATION (fibroplasia)
  4. Adenosine triphosphate (ATP) is a critical factor that regulates the rate & quality of healing- cell’s primary source of energy- provides metabolism needed to restore cell’s membrane properties by moving Na2+ & K+ into & out of cell, to build new proteins & synthesize proteins
  5. 4 processes of soft tissue repair
    1. Fibroblast formation
    2. Tissue remodeling
    3. Synthesis of collagen
    4. Tissue alignment

Soft Tissue Repair Dependent on Levels of:

  1. Debris removal
  2. Endothelial production
  3. Production of fibroblasts

Repaired through 3 phases:

  1. Resolution – (little tissue damage and normal restoration) dead cells & cellular debris are removed by phagocytosis (tissue left with original structure & function in tact)
  2. Regeneration – (replacement of tissue by same tissue) damaged tissue is replaced by cells of the same type (structure retains some or all of its original structure & function)
    1. Related to
      1. i. Health,
      2. ii. Nutrition
      3. iii. Tissue type
    2. Dependent on levels of:
      1. i. Debris (phagocytosis)
      2. ii. Endothelial production (hypoxia and macrophages stimulate capillary buds)
      3. iii. Production of fibroblasts (revascularization allows for enhanced fibroblast activity and collagen production which is tied to Vitamin C, lactic acid, and oxygen

      Repair – (if resolution is delayed) original tissue is replaced with scar tissue (original structure & function is lost)
      Phase will extent from 48 hours to 6 weeks following cleaning of fibrin clot, erythrocytes, and debris

        1. Results in Scar formation
          i. Less viable than normal tissue, may compromise healing
          ii. Firm, inelastic mass devoid of capillary circulation
          iii. Develops from exudates with high protein and debris levels resulting in granulation tissue
          iv. Invaded by fibroblasts and collagen forming a dense scar and while normally requiring 3-14 weeks may require 6 months to contract
  1. Primary healing (healing by first intention-Resolution)
    1. Closely approximated edges with little granulation tissue production
  2. Secondary healing (heal by secondary intention-Repair)
    1. Gapping, tissue loss, and development of extensive granulation tissue
    2. Common in external lacerations and internal musculoskeletal injuries


  1. Continue Pain Relief
  2. Increase Joint Motion
  3. Restore Ligament Elasticity
  4. Reduce Tension on the Injured Connective Tissues
  5. Restore Ligament Integrity
  6. Improve Ligament Laxity
  7. Prevent Muscular Atrophy and Weakness


Phase II: Fibroblastic Phase:

  1. As inflammatory phase begins to subside & pain decreases, add
    1. Active Motion
    2. Restore full ROM
    3. Restore or increase strength
    4. Re-establish neuromuscular control
  2. Continued use of modalities for:
    1. Pain Control
    2. Decrease Muscle Spasm or Tension
    3. Increase Joint Range of Motion
    4. Increase Muscle Strength
    5. Restore Sensory or Motor Loss

If you have any further questions about the repair phase of healing please call me at 813-265-4135

Dr. Wallace Wade Chiropractor in Citrus Park FL 33625