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Remodeling Tissues with Exercise

Chapter

5

Phases of Remodeling Soft Tissues

Using Exercise to Remodel Injured Tissue

Exercise is an integral component of all Active Release Techniques treatment protocols. It is the critical element required to ensure both proper tissue remodeling and to restore full neurological function.

Phases of Remodeling Soft Tissues

To better understand why exercise is so essential, let us consider the process of tissue repair after injury. This repair typically occurs over three distinct phases¹:

1 - Reaction or Acute Inflammatory phase: This 72hour phase is characterized by swelling and pain. During this phase, use ice to reduce inflammation, and if required, take an over-the-counter anti-inflammatory medication. Avoid using these medications after the first 72 hours since they can have a negative effect on tissue regeneration. Even during this initial stage, it is important to get some motion into the affected area in order to speed the healing process.

2 - Regenerative or Repair phase: During this 48-hour-to-six-week phase, new collagen is formed and laid down to repair the injured area. If the injured person is performing the correct exercises, the majority of the collagen will be laid down in the same direction as the tissue being repaired, making the repaired tissue stronger and more capable of performing its function. If the individual is not exercising, the tissue will be laid down in more random patterns, leading to the development of weaker tissue that is easily re-injured.

3 - Remodeling Phase: The remodeling phase can last up to 12 months. During this phase the collagen fibres increase in size, diameter, and strength. The amount of remodeling that takes place is dependant upon the forces that are applied to the tissue as the collagen remodels to withstand the stresses that are placed upon it. If the injured person is performing appropriate strengthening exercises, the collagen will remodel to withstand the stresses placed upon it. With exercise, this remodeling will lead to a complete recovery of the injured tissue, along with a decreased chance of re-injury. Without appropriate strength training, the possibility of re-injury is very high.

It is very important to exercise throughout all stages of tissue repair. Lack of exercise results in decreased oxygen delivery to soft tissues, increased scar tissue formation, and increased muscle atrophy, and can prevent full recovery from the injury.

Using Exercise to Remodel Injured Tissue

It is important to use a combination of stretching and strengthening exercises to properly remodel injured tissues and ensure proper recovery of these structures.

Remodeling Tissue with Stretching Exercises

Stretching (in which you increase the length of your muscles and tendons) is critical for increasing range of motion and flexibility, improving performance, decreasing the risk of injury, and preventing soreness – in addition to making you feel much better. (Just look at the pleasure your pets get when they stretch!)

Stretching is particularly important if you have been training too hard or if you have not been exercising on a regular basis. In such cases, your muscles will tend to contract, shorten, and become more prone to injury.

During the Regenerative or Repair Phase of an injury, your body creates and lays down collagen to repair the injured area. By performing the correct stretching exercises, the majority of new tissue will be laid down in the same direction as the tissue that is being repaired, thereby allowing this tissue to properly perform its function (once the healing phase is complete).

Remodeling Tissue with Strengthening Exercises

Strength training is a critical component of any exercise program. Unfortunately, strength training is also an area that is often misunderstood and misapplied in many exercise routines. True strength integrates neuromuscular control, good body mechanics, correct posture, and excellent core stability.

Problems arise when you focus on developing strength without first establishing these preliminary components. Starting strength training too soon can set you up for an injury or result in a decrease in your overall physical performance.

This is why we do not emphasize strength training during the early phases of our rehabilitative exercise routines. Strength training is only introduced after you have mastered the key aspects of our Beginner Routines which integrate and introduce neuromuscular development, postural changes, and core stability.

On the other hand, once you have established these basics, the benefits of strength training are considerable. Not only will strength training allow your muscles to work harder and longer without injury, it will increase your lean tissue mass, decrease your fat levels, increase your bone density, increase your metabolism, and promote some very positive biochemical changes.

Biochemical Benefits of Strength Training

Biochemically, strength training is one of the key factors that will naturally increase your levels of Human Growth Hormone (HGH). This increase is known as the EIGR Response, or Exercise Induced Growth Hormone Response.² As we age, the levels of HGH naturally decrease. This is unfortunate since decreased secretion of growth hormone is (in part) responsible for decreases in lean body mass, increases of adipose-tissue mass (fat), and the thinning of the skin that occurs with old age. Obviously, it would be a great thing if we can stop these negative effects from occurring in our bodies.

The sad truth is that as most people age, they do not focus upon strength training. This is unfortunate since strength training is one of the key tools for turning back your biological clock.

Strength Training and Remodeling Tissue

Strength training is a key component of effective tissue remodeling. Every time you injure yourself, your body lays down new tissue to repair itself. The new tissue is initially very fragile, thin, and easily torn or re-injured.

Strength or weight-training places stress upon these new tissues, causing them to go through a process of remodeling. During this process, the new tissue literally converts from one type of collagen to a different type which is up to 10x thicker and 10x stronger. But, this collagen conversion only occurs when you apply continued stress upon the tissue... as you would with weight and strength training exercises.

The amazing thing is that this remodeling of your tissues can – with the right stimulus – occur at any age, even for those in their 80’s or 90’s. Increased age is not an excuse for avoiding strength training. In fact, increasing age often means you need to focus even more on this often neglected area.

So, no matter what your age or physical condition, you need to make strength training an integral part of your exercise routines, both for recovery from an injury, and for performance care.

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^1. Acute soft tissue injuries-A review of the Literature, Medicine and Science in Sports and Exercise. Oct. 1986; 18(5):489-500. John Kellett

^2. Effects of Human Growth Hormone in Men Over 60, New England Journal of Medicine 1990; (323:1-6.)