How the Body Heals Itself Part 3: Remodeling, Case 1: Remodeling Gone Right

Remodeling gone right is all about progressive loads. A repairing tissue has to be exposed to a certain force or load so that it can adapt to that stimulus. This is accomplished by cells undergoing hypertrophy, aligning collagen fibers along lines of stress and depositing minerals in bone.  For example, a repaired Achilles tendon needs to be able to handle the load of standing and then walking before running and then sprinting and then maybe eventually landing a back flip on hard ground. Along the way muscles get bigger and stronger, the tendon itself gets tougher, and the bones achieve appropriate shape and density as they are “taught” to do so by progressively more difficult activity.

 

The art in remodeling gone right is considering every nuance of the forces applied to the healing tissue. When progressing an activity, one needs to consider how frequently it will be performed, with how much volume (duration, distance), at what intensity, and with what variability. All of these factors clearly contributing to the overall load. Typically, you make loads progressively more difficult in the same order the variables were listed above. In the case of the Achilles tendon, I generally would recommend that someone return to running three days per week (or whatever their goal is) before increasing the distance of the run. After said person has returned to their desired distances, now he can play with intensity in the form of hills and speed work. When this is sufficiently toyed with, we can consider other variables such as running on different surfaces such as increasingly difficult trails or shale. Or he can consider running with a pack or a more minimalist shoe. Et cetera.

 

The other part of the art in remodeling is achieving specificity. If you want to be able to do pull ups, you will not get there by pulling on cute little therapy bands below shoulder height all day. Sure, that could be where you start just to achieve a pulling motion but then that pulling needs to increase in angle and intensity until you can pull your body weight directly from an overhead position.

 

The most important piece of remodeling is those bolded words in the second sentence. A repairing tissue has to be exposed to a certain force or load for remodeling to occur. When a force is experienced, cells are stimulated to change. No force, no change. Progressive forces must be applied for the tissues to truly adapt. No exceptions.

 

So, the individual who has done remodeling right has gradually increased loads on the injured tissue in a logical fashion. He has waited until his body feels good, with no lingering soreness or pain before progressing a force. He has made the loads specific to his goals. He also saw the process all the way through to the end, achieving his desired outcome even if it took years to do. He may have plateaued a number of times, potentially for weeks or even months but he never once resigned himself to “good enough.”