What Does Swelling Mean?

May 11

Most people are familiar with swelling and basic management, but what exactly is happening underneath the skin? Why is it important to follow soft tissue injury guidelines like RICE, SPRICEM, or the more modern PEACE & LOVE protocol? Let’s break it down.

The Scenario

Imagine this:

You’ve spent the weekend tidying the garden. Lifting, bending, twisting, carrying, pushing—you feel strong and accomplished.

Then, as you finish packing the shed… “Crunch!” “Ouch!”

Suddenly, you’re on the ground, clutching a sprained ankle. After hobbling inside and taking off your shoe and sock, you notice the swelling starting to form and rapidly increase.

What’s happening inside your ankle?

Phase 1: Bleeding (Immediate Response)

This occurs right after the injury.

Blood vessels transport white blood cells to the injured area to prevent infection.
Pain-inducing chemicals flood the tissue, discouraging movement and weight-bearing.
Swelling begins as fluid accumulates.

Management: Support, protect, and rest the ankle.

Phase 2: Inflammation (1–4 Weeks Depending on Severity)

The body’s goal here is to stop bleeding and start repairing tissue.

Clotting occurs to protect the wound.
A clear fluid (containing proteins and white blood cells) enters the surrounding tissue.
Pain, swelling, redness, and warmth often increase—the ankle may feel stiffer and more painful the morning after injury.

Management Tips:

Ice hourly for the first 24 hours
Elevate the ankle with compression above heart level until swelling reduces

Phase 3: Proliferation (24–48 Hours to 2–3 Weeks)

During this phase, the body produces collagen to form scar tissue. This tissue is initially weak and prone to re-injury.

Management Tips:

Relative rest—avoid running, jumping, or high-load activities
Start gentle, pain-free joint movements
Gradually resume normal function as tolerated

Phase 4: Remodelling (1–6 Weeks, Overlaps With Proliferation)

The scar tissue strengthens as weaker type 3 collagen reorganises into strong type 1 collagen.

Management Tips:

Movement and muscle activation are essential to reduce swelling
Encourages optimal collagen alignment
Gradually increase activity guided by pain, swelling, range of motion, and confidence

Key Takeaways

The healing phases overlap, and each injury is unique.
Early assessment and management by a physiotherapist can help ensure efficient healing, reduce complications, and safely guide your return to activity.
Follow evidence-based strategies like PEACE & LOVE to manage swelling and recovery effectively.

With the right approach, you’ll be back in the garden—or on the sports field—in no time!

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