After inflammation comes proliferation. During this time, the foundation of the tissue repair is laid. Cells surround the area of damage and make new, immature cells that become the repair. The collagen that is laid down at this time is an immature, weaker type called type III collagen. The body is not too worried about organization and perfection at this time. Rather, the new cells and fibers are produced quickly and distributed randomly. One could even say that the cells are proliferating (get it?).
The proliferation phase is most likely to occur between days 4 and 24 following tissue injury but could take longer than this depending on the extent of the injury and whether or not the individual takes appropriate care. We will know that we have entered the proliferation stage if pain is no longer constant and the cardinal signs of inflammation such as redness, edema, and heat have greatly or completely dissipated. The hallmark of the proliferation stage is pain that is not constant but will be produced if the site of injury is subjected to any mechanical force or load that the infant tissues are not ready for yet. When the disorganized, novice tissues are loaded beyond their capacity, they will revert back to an inflammatory state in order to repair the damage that was caused. This will result in pain or soreness and possibly swelling.
I believe that the proliferation stage is the most difficult to navigate. Setbacks are common as it is easy to accidentally overload the delicate tissue repair. Leaving the healing tissues alone is no longer an option as they require mechanical loading to organize and strengthen cells and collagen fibers. We now have to walk a narrow path finding the just right amount of movement. Not too little, not too much, but just right. A target that I like to call “The Goldilocks Zone”. A series of blogs to follow will explore how we find this zone, what can go wrong along the way, and how we eventually get to the other side of the proliferation phase.