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The Science Behind How You Heal

How you heal

an orthopedic surgeon's perspective

Hi, Dr. Meredith Warner here –

As an orthopedic surgeon, I not only specialize in surgical procedures – but also have to be an expert in the process of healing. Surgery is simply a means to the end – and the goal of each procedure is healing and the promotion of better form and function. I’d like to share a little bit of what I know about the physical process of healing with you today:

There are four main phases of healing that are universal and generally follow the same pattern and timing no matter what. If there is variation, that is when there are problems. Diabetics, for example, have differences in timing between the four phases of healing, which makes their wounds heal slower or become chronic.

Connective tissue is the stuff that puts a human together and makes the body “stick” together – not just tendons and ligaments. Connective tissue can be bone, ligament, nerves, muscles, tendons and the matrix (surrounding gel/fluid) that holds the cells in place. Its universality throughout the structures of the body serves as a reminder for the interconnectedness of the healing cycle.

When a connective tissue is injured, the collagen must be reformed and the structure of the material (skin, tendon, ligament, etc.) must be re-formed. The human body uses a four-step process that reliably achieves these goals if the environment is right.

The four phases of healing are hemostasis, inflammation, proliferation and remodeling.

Stage One:

Hemostasis

Just after an injury, the body is in a default mode to protect and survive. If, for example, an injury results in bleeding, the body stops the bleeding in an effort to preserve the tissue and save energy for possible fight or flight. The body does this primarily through the process of clotting.

A clot is a clump of platelets and inflammatory cells that are the first to arrive at the site of injury. They are called to the area by a complicated system of signals released into the bloodstream as soon as an injury occurs. At the scene of the wound, be it a cut, laceration, contusion, burn, chemical exposure, tear or anything, the platelets bind the exposed collagen of that tissue within the extracellular matrix. Once bound, the platelets begin to work.

Platelets are magical fragments of cells in the blood stream with awesome healing capacity. These begin to immediately secrete sphingosine-1-phosphate, thrombospondin, fibronectin, von Willebrand factor.

These then stimulate even more platelet action, promoting a release of clotting factors, which stop the bleeding – by causing a matrix of fibrin to develop that acts as a plug. This stable clot/plug then acts as a bed for substances and cells flowing into the wound, because the platelets in a clot also secrete growth factors that are integral to the next steps in healing.

Once these are released by platelets into the wound environment, other cells like neutrophils and macrophages enter the zone. PDGF recruits cells that form fibrin (fibroblasts) and then collagen begins to be deposited – beginning the tissue repair process.

Also read: Why You Should Consider a Multivitamin Before Surgery.

Stage Two:

Inflammation

The hemostasis phase starts immediately after an injury and overlaps with the inflammatory phase of healing. The inflammatory phase should only last a few days. If it persists, then chronic inflammation results and then chronic non-healing or poorly healing tissue is the outcome. For now, we will focus on a normal inflammatory phase of healing.

At the core of the healing process – and any process that occurs in the body – is something called the Endocannabinoid System, or ECS. The ECS governs each “task” your body undergoes – from triggering healing, the sensation of hunger, the sensation of pain, and especially the onset of inflammation.

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An overeager inflammatory response is often the root cause of many conditions. While it has its place in the context of healing, sometimes the ECS can be overloaded and promotes inflammation for longer than it is necessary, causing problems. Here is how inflammation is supposed to work, when the ECS is promoting a proper inflammatory response:


There is a group of signalling molecules in the bloodstream known as the ‘complement’ system. The complement system is activated at the time of the inflammatory phase. The system brings mediators that control the ‘leakiness’ of the surrounding blood vessels and also brings chemotactic factors. These in turn attract white blood cells (leukocytes) withing 24-48 hours after the injury.

The ECS System

and how it impacts inflammation

There is a group of signalling molecules in the bloodstream known as the ‘complement’ system. The complement system is activated at the time of the inflammatory phase. The system brings mediators that control the ‘leakiness’ of the surrounding blood vessels and also brings chemotactic factors. These in turn attract white blood cells (leukocytes) withing 24-48 hours after the injury.

Mast cells ( a type of leukocyte) appear as well and release granules filled with histamine. This is what causes what we think of clinically as inflammation. Mast cells and histamines are directly responsible for the redness, warmth, heat and pain of inflammation. Basically, the “leakiness” of the blood vessels in the region is increased by histamines and that allows for more healing and building cells to reach the zone of injury.

One of these cells is the neutrophil. Neutrophils remove bad things from the wound; they act to remove pathogens, damaged matrix, dead cells and ferign material. Neutrophils do this by phagocytosis; this is literally the ‘eating’ of the bad stuff. These are early and aggressive cells that begin the process of healing.

Next, monocytes and lymphocytes enter. These become macrophages. Macrophages are the workhorses of the demolition process, because they remove remaining dead and damaged tissues. The macrophages are more selective and powerful than the neutrophils and they do a more ordered and detailed “clean-up” of the damaged tissues.

Macrophages are also important because these cells also produce more healing factors. All of these growth factors and cytokines from macrophages act to cause the fibroblasts (fiber forming cells) to grow along with smooth muscle and endothelial cells. Endothelial cells are lining cells for vessels and skin.

Once the macrophages have finished cleaning up the injury site and started the healing and rebuilding process by providing the building blocks, they actually then remove the neutrophils – the cells that clean up debris and are one of the first cells that reach the injury. As these cells are removed, the proliferation phase begins.

Stage Three:

Proliferation

The proliferation phase is the actual construction phase of the tissue. Here is where the connective tissue is made whole again.

The fibrin and fibrin matrix that was produced at the inflammatory phase is merely a scaffold for the actual tissue. It is ‘granulation’ tissue and must be converted to the actual tissue needed; this may be smooth skin, strong tendons and ligaments, muscle or bone. The fibrin is replaced by collagen. This process usually starts on day 2 or 3 after the injury or surgery.

Proliferation involves angiogenesis (forming of new blood vessels), tissue granulation, re-epithelialization (formation of skin) and wound contraction (making a wound small).

The formation of new blood vessels is important because without blood nothing can heal. Blood brings oxygen and nutrition. Blood also allows for the efficient removal of waste. Different growth factors are released that signal for this process to happen.

The growth factors that are released also stimulate fibroblasts, which start the process of skin production. Skin building cells called keratinocytes flow to the injury site through the bloodstream and enter from the edges of the wound. Fibroblasts come from bone marrow when they respond to the chemical signals released during the inflammatory phase. These produce a matrix that allows for tissue to build. The matrix is made of proteins like collagen, fibronectin and hyaluronan. The fibroblasts are stimulated to produce by the PDGF and EGF that the macrophages make.

Some fibroblasts will turn into ‘myofibroblasts’. These have a muscular component and will literally pull the edges of the wound together to make it smaller as it heals.

Stage Four:

Remodeling

Wound remodeling is the last phase of healing. It usually starts at week 2 or 3 and can last up to a year in some cases. In this phase the tissue matures and becomes its true self. 

Weaker collagen is replaced by stronger collagen. Disorganized tissue becomes organized. The organization process is regulated by the fibroblasts that secrete an enzyme that degrades the collagen matrix of the wound bed and allows for the realignment of that collagen into organized networks. That organization is modified by stress, load, pressure, gravity and other mechanical and chemical forces. 

The key to good wound repair is the remodeling and re-organization of the extracellular matrix of the damaged tissue – how well it was constructed during the earlier phases of healing. This is why it is so important to make sure that you allow your body plenty of rest during this time, only undergoing physical therapy if advised to do so by your physician. Good nutrition is also key to making sure your body advances through the four phases of healing properly.

 

Prevent Chronic Inflammation

for proper healing

If the injury or condition goes without proper treatment, or if you have some underlying condition that makes you more prone to inflammation, you can experience chronic inflammation – which does more harm than good. chronic inflammation results and then chronic non-healing or poorly healing tissue is the outcome.

This is why ensuring you have a foundation of good nutrition and overall wellness is essential for your recovery process – from surgery or any other procedure. I recommend starting a supplement regimen to all my patients before their treatments, especially those that require surgery. Nutrition provides the building blocks for all functions of the body – and is especially important for recovery after an injury or surgery.

I developed my multivitamin with all the essential nutrients we commonly miss out on in our diets – and included Full Spectrum CBD powder in my formulation. CBD has been making waves in the medical and scientific communities for its powerful anti-inflammatory properties, making it a game changer for achieving full-body wellness.

 
ABOUT THE AUTHOR

Dr. Meredith Warner is the creator of Well Theory and The Healing Sole. She is a board-certified Orthopedic Surgeon and Air Force Veteran.

She is on a mission to disrupt traditional medicine practices and promote betterment physically, spiritually and mentally to many more people. She advocates for wellness and functional health over big pharma so more people can age vibrantly with more function and less pain.

At Well Theory, Our surgeon-designed products are FDA Registered and formulated to help people:

  • Manage the symptoms of musculoskeletal pain
  • Recover vibrantly from orthopedic related surgeries
  • Fill the gaps in our daily diets
  • Manage pain associated with inflammation

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