The tissues that were torn bleed, or leak inflammatory substances into the region for approximately 72 hours. This is why it is common for the patient to feel worse each day for the first three days after a automobile accident. After approximately 72 hours the capillaries have repaired themselves. This will begin the second phase of healing.

This stage will last about 6-8 weeks, during which torn tissue is tied or held down. Fibrous Scar tissue is laid down to bridge the tear that occurred. This new scar tissue is unlike the original tissue. The way that this tissue heals is also different because:

1. Fibrous scar tissue is not aligned in the same direction.
2. Fibrous scar tissue has smaller diameter fibers that are kind of glued and matted together.

Therefore, the resulting healing tissue has three important characteristics different from the original tissue.

1. The tissue is weaker because the strength of any soft tissue is dependent on the cross link. Researchers find that when they look at this tissue under a microscope it has fewer cross-links than the original tissue, also the fiber’s diameter is smaller than the original. Therefore, because it is weaker every time the patient stresses the area it will fail in the exact same place.
2. Healing tissue is stiffer than the original tissue, there are two reasons why:
   • Fibers: The fibers in the resulting scar tissue are lined up differently than a crisscrossed pattern and are weak. The fibers in muscle, tendon, and cartilage line up in a random fashion. Therefore, these tissues are not anatomically the same as before.
   • Glued factor: The glue factor tells us that everywhere these scar tissue fibers touch each other they glue together. In clinical examination we sometimes find this as decreased range of motion.
3. The tissue is more sensitive to territorial invasion. This principle has been well-established in the literature.³ ⁴ This means that the surrounding nerves actually grow into this tissue making it more sensitive and more sore than the original undamaged tissue. Under the microscope they actually find more neurofibrils, which are the little pieces of nerve in this as compared to the original undamaged tissue. As a result, it is common for people to have hypersensitivity where scar tissue has been laid down.

Most of the remodeling takes about 12 months or more. During remodeling if you continually put forces into the tissue as the words in the literature say, “tension within the scar” it makes them lineup any direction of the stress and strain. Thus, the healing tissue can realign itself better.

During the healing of scar tissue, immobilization is bad and mobilization is good because the tissues slowly but surely arrange themselves more like the original undamaged tissue when mobilized.

Therefore, the individual will get a better end product during the healing process. The better the end product heals the smaller the likelihood there will be of a future flare-up or exacerbation of pain and spasms. However, it is impossible to get a perfect heal, because the tissues are weaker, stiffer, and more sore, and they may have periodic flare ups of pain and/or spasm. These are the rules rather than the exception. There is plenty of data to substantiate these types of findings.

Therefore, our chiropractic goal is to get the tissue to more closely resemble the original soft tissue in terms of structure and function.