Most people are aware of swelling and how to manage it, but what is exactly happening underneath? Why is it important to follow guidelines for soft tissue injury management like RICE, SPRICEM, or the newest acronym, PEACE & LOVE? Has a nice ring to it…

Let me set the scene for you.

You have been tidying up the backyard looking after the garden all weekend. It’s looking very good now and you’re feeling very proud of yourself

Lifting, bending, twisting, carrying, and pushing. No problem!

You feel good……strong!

You just finish packing everything back in the shed and head back to the house because it’s getting late. 

‘Crunch!’ “Ouch!” 

All of a sudden, you’re sprawled on the ground, clutching a sprained ankle. Where did that step come from!?

After painfully pulling yourself up and hobbling inside you take your shoe and sock off. It doesn’t look good. The swelling has started on the outside of your ankle and getting bigger by the minute!

Phase 1: Bleeding

The short phase immediately after injury; the vascular system transports the body’s main defence (white blood cells) to the damaged area. This prevents the spread of toxins and bacteria. During this phase, fluid and pain producing chemicals flood the area and can continue for between 6 and 8 hours. By producing pain, the body won’t want to move or put weight on the ankle.

• Support, Protection and Rest.

Phase 2: Inflammation

The inflammation phase occurs to stop the bleeding phase and can last for between 1-4 weeks depending on severity. Here, the body is trying to prevent blood loss from the wound and will cause clotting while a clear fluid (protein and white blood cells) will come out of the injured tissue and into the surrounding space.

More pain mediating cells are released to stimulate nerve endings. This phase explains the increasing swelling and redness, warmth and a very stiff/painful ankle the morning after injury. It’s normal for it to feel worse.

• Ice hourly for no longer than 24 hours

• Elevate with compression regularly above the level of the heart until swelling reduces.

Phase 3: Proliferation

At the same time as inflammation, collagen is produced to form a scar tissue on the injury site of the connective tissue. This tissue is very weak and can re-injure easily if loaded too early. Proliferation of scar tissue cells starts between 24-48 hours after injury and can last up to 2-3 weeks as the inflammation and swelling reduces.

• Relative rest and no running, jumping or landing activities

• Commence pain-free movement of the joint and gentle function

Phase 4: Remodelling 

Remodelling starts during the peak of the proliferation phase.  Weaker type 3 collagen tissue fibres mature and re-organise into strong and robust type 1 collagen. This phase lasts from 1-6 weeks and activity is guided by pain, swelling, range of motion, and confidence depending on injury severity.

• Movement and muscle activation reduces swelling and optimises collagen fibre alignment 

Because the phases overlap, and injury type and severity are so varied, early assessment, diagnosis and management by a physiotherapist is important to ensure a more efficient healing process with less issues. 

You’ll be back in the garden in no time!