Why Some Injuries Take So Long to Heal
A few weeks ago, I wrote about the natural history of injuries—the idea that recovery follows a predictable timeline of inflammation, repair, and remodeling.
Although, unfortunately, those timelines don't always work out. Here are a few reasons why injuries don’t heal as expected.
1. You're Not Accounting for the Software
We’re still learning how the brain responds to injuries. Even if the hardware (your tissue) heals, the software (your brain’s control systems—motor patterns, pain sensitivity, perception of safety) can lag behind.
Think of it like your body is ready, but your brain doesn’t fully trust it yet.
For example, ACL rehab is often described as a 9–12 month process. But talk to people who’ve been through it, and many will say they didn’t truly feel like themselves until two years later.
So, despite "healed" tissue, something is not being accounted for if we return to performance around 12 months, but things still feel off for another year—that missing factor is likely related to our brain and nervous system.
2. Bad Communication
A mismatch in expectations and reality can impact how a person's rehab goes. Being told, "You'll be better in 6 weeks" or "Back to sport in 3 months" can backfire hard psychologically when your body doesn't follow the same calendar.
There seems to be a standard of care among physicians to prescribe
"physical therapy for 6-8 weeks, 2 x a week," when seeing a patient for an injury.
"physical therapy for 6-8 weeks, 2 x a week," when seeing a patient for an injury.
People then tend to read into this and have some expectation that the doctor wrote that for a particular reason.
The truth is that this recommendation likely isn't based on a scientific process around healing timelines but something much more practical, like a standard checkbox in the medical software, or what's commonly accepted by insurance, or a standard bell curve for what it takes most things to get better.
3. It Was Misdiagnosed, or Something's Compounding It
Sometimes, the initial diagnosis doesn’t tell the whole story, and it's not necessarily a sign of bad care.
Pain and injuries can be complex and diagnoses are often based on patterns, not crystal-clear answers. Also, our bodies don’t always follow the script.
Other times, the injury was diagnosed correctly, but something else is now holding things back. Maybe other things are associated with your injury?. Or, maybe you're overloaded at work, not sleeping well, or skipping key parts of your rehab.
If the answers are murky, it might be time to reassess, ask better questions, or bring in a second set of eyes. Not because someone messed up—just because recovery is rarely a straight line and can be highly variable.
We're Not Machines
The natural progression when something isn't meeting expectations is to panic that something is worse than initially expected or wrong.
But this outlook isn't all that helpful—instead, we need to change our perception.
- Are you 'failing' upwards? Maybe every day isn't better, sometimes there are setbacks, but based on previous weeks or months (depending on the injury severity) are things getting better?
- Are you being honest with yourself about what you are doing that you should or shouldn't be doing? Remember that sleep, nutrition, and stress management are not side notes—they're the foundation.
- Where are you getting your info from? The 6-8 week time frame of healing isn't the gold standard, so ask more questions and look for more info when given expectations.
Remember, your body is constantly adapting, just sometimes a bit slower than we would like it to.
Originally published as Movement #259
