Dr David McGrath

Spine Physician

MB BS (Hons) FAFOM, RACP, FAFMM
Master of Pain Medicine

Time is often called the fourth dimension.
In the context of healing and structural change,we need to give this dimension its due respect.

When we break a bone, the time taken to recover,depends on multiple factors.
1.Age (younger heal faster)
2.Other diseases
3.The specific bone (lower limb bones take longer than upper )
4.Previous trauma

In this case, because of the nature and purpose of bone,splinting in anatomical position,is normally all that is required. The bone will either mend or not over an expected time period.(bone healing induction is another subject )
The situation is more complicated, for those structures, which are designed to move.
Joints and muscles, respond negatively, to long periods of rest or immobilisation. This creates, a clinical judgement issue. We need to balance the time needed for healing and rest, against the intrinsic requirement to move. This has given rise to the concept of "relative rest". This implies, that there is an ideal input, and also, that is depends on the stage of healing.
Clinical experience, indicates, that in the early phases of an injury or with severe symptoms, more rest is needed,relative to movement input. With progress, the movement component can increase.
If this balance is incorrect, the optimal healing rate,is compromised. The dynamic profile,of the input also,needs to be optimised,but that is another subject.

The issue,under consideration,is the frequency of suitable inputs,as a function of the healing stage. Movement and exercise, as inputs into the healing response, need to be woven into the fabric of time. Too much of an optimal input (dynamic profile) may be superfluous to healing, as the structure may be unready to receive another input within the period. Too little input, and there is insufficient stimulus for tissue remodelling.
In the technique of recursive neuromodulation, the inputs are designed to have no negative effects,but the optimal frequency of inputs, is largely unknown. Generally it is better to err on the side of excess, given there are no negatives. In this case, the optimal rate of progress is achieved,but its rate is determined by the tissue and injury response.
For sructures, that are not injured, but simply dormant or inactive, we have the same time constraints. There is maximum,rate of recovery, given an optimal dynamic input. Changes, can run deep, involving the acivation of chromosomes,and the expression of proteins need for remodelling. This takes time.
At this point in our technology,we can only do and wait. Waiting, can be the hard part.