Patience In Healing: The Parallels of Physical and Emotional Trauma

It never ceases to amaze me how parallel physical and emotional healing can be. In this season of healing and re-organizing my outer and inner world, I am constantly being given reminders of the importance of doing both thoroughly. My healing from some significant injuries and surgeries and my healing from betrayal trauma have gone hand in hand. Both processes have frustrated me at times with their slowness, but both show promise to help me become someone better and stronger than I’ve known before.

I am a PT who guides patients through injury healing by educating them on the normal biological timelines and prescribing exercises and interventions that fit with each healing phase. I educate people on the differences between the acute phase, the proliferative phase, and the chronic phases of injury or surgery recovery and how to move through each one for optimal recovery. I frequently remind my patients that there is a normal process that happens in healing that can only be facilitated but not rushed – even when following the rules to a T. When it comes to myself, I am mostly a rule follower by nature. But I have always secretly wished that my knowledge of the human body and what it takes to heal would help me duck the system a bit. I know this is not the case and I don’t push the boundaries unreasonably, but I do get impatient.

I am currently recovering from a knee replacement five months ago, and a quadriceps repair just over three weeks ago. After the first surgery I pushed, even past sharp pain, when I was told to push. Because I know from clinical experience that recovery from a knee replacement by nature is not meant to be comfortable or easy, and I was determined to build strength so I could return to some of the activities that I have missed doing the past couple years. But my intuition and clinical experience also told me early on that something was not right. These two realities wrestled with each other. As my symptoms worsened and my leg became weaker and more painful, I began listening to that inner guidance more while continuing to speak out and advocate for myself to the surgeon – while still alternating with pushing through. Until I couldn’t.

By the time my pain worsened to the point where turning over in bed was becoming uncomfortable, I sought a second opinion and was found to have several large tears of up to 5 cm in my quadriceps, and a full tear of the retinaculum. (For those non-medical types, the retinaculum is a thick, fibrous band of connective tissue that acts like a stabilizing strap, holding the patella and nearby tendons in place). When both structures are torn, the patella / kneecap becomes unstable and painful with use. Imagine the sensation of a knife in the kneecap every time you flex the muscle above the knee, attempt to strengthen or go up a stair, and you have my knee. On a particularly bad day, the pain felt more like the sensation of pouring alcohol on a stab wound. Ultimately, the severity of the tears required an additional surgery to repair and stabilize.

The surgery went well, and I now have a repaired quadriceps and retinaculum. This is a much different healing process from that of a knee replacement. I am in a locked brace, with limited range of motion allowed, and using crutches for a few more weeks while my own biological processes reinforce the tears that were surgically repaired. I haven’t completed stairs normally now in over 5 months, and it might be another couple months until I do. And, after months of enduring horrific pain while trying to function with multiple tears, I now have virtually no pain. But I still have precautions. It makes going through this process of taking it slowly somewhat boring, but with this recovery I know that slow and steady wins the race - so that is exactly what I am doing.

I make a parallel to recovering from emotional trauma as so many aspects have felt similar. Looking back at the people I trusted who betrayed me, I also now see that something was not right that I would not clearly see until I was looking back. And for a long time, I pushed past those signs even when I was being injured. After betrayal upended my world, I endured months of what felt like bone-crushing internal pain (and many external physical symptoms), with the pain gradually subsiding after removing the bad players from my life. But the time to get from “tear” to “healing” has felt very long and convoluted. The main difference has been that, with this pain, I did not have a protocol to guide me.

With physical healing, I have years of clinical training and evidence-based timelines to lean on. I knww that a quadriceps repair requires six to twelve weeks of protected weight-bearing because the biology of tendon healing simply demands it. Collagen fibers need time to mature, align, and strengthen. There is no shortcut. But with emotional healing after betrayal trauma, no one hands you a protocol. No one tells you that week three will feel like the acute inflammatory phase, or that the fog and exhaustion of month four is actually your nervous system doing the hard work of rewiring. You are largely left to interpret your own symptoms and healing path without a framework. The entire time, you hope that you don’t make a mistake that will re-tear old wounds or pull you backwards. And yet, the phases exist whether we name them or not. I only vaguely recognized the similarities of where I was at to a physical injury, and did the best I could to move forward and not backward. I flailed at times, but tried to learn from each setback and take care of myself the best I could in this new territory.

In physical rehabilitation, the acute phase is characterized by inflammation, pain, and protective guarding. The body swells around an injury and increases blood flow to it in order to contain the damage and signal that something needs attention. We don’t fight this phase – we respect it. To push too hard in the acute phase is to risk making the injury worse, much like what happened before I knew my quadriceps was torn. I did not give my emotional healing that same respect in the beginning either. I tried to return to full function while still in the acute phase of betrayal trauma. I tried to maintain my routine, keep up appearances, look normal, and hid my injury – while internally, the damage was far from contained. I didn’t speak up for myself (other than the occasional breakdown or rant when I couldn’t hide it), nor did I tend to myself fully. The inconvenient exhaustion I felt was my system doing exactly what it was supposed to do, but I saw it as something to push through. Looking back, I realize now realize I was better at listening to a banged up body than to a banged up soul.

The proliferative phase of physical healing is where new tissue begins to form. In tendon repairs especially, the newly repaired tissue must be introduced to gentle, progressive load in order to organize properly. Too much stress too soon, and it fails to mature. Too little stimulus, and it becomes rigid. I believe emotional healing has its own version of this phase – the point where something new begins to form - new narrative, clarity of meaning and values, and a clearer sense of self. It’s a time of forming new limits that previously felt impossible to set. Like immature tendon tissue, this is real and growing stronger, but challenge needs to happen gradually and without being overwhelmed before it has the chance to mature. This is also where I tell patients healing physically not to be surprised if they are more tired than they expected. The body is working hard to lay down this new and improved framework, and it takes a lot of energy. It is the same with emotional healing. The building up is there, but so is the need to move through it in a meaningful way.

The chronic phase of healing — whether physical or emotional — is the phase of learning to live in the new normal. The acute crisis has passed. The new tissue has formed. Life begins to look functional again, and from the outside, recovery may appear complete. But those of us who have been through significant injury or trauma know that the tissue is permanently changed. In physical recovery, scar tissue is stronger in some ways than what it replaced, but it is also less elastic, more reactive to certain stressors, and capable of being aggravated long after the original injury has healed. I am not yet in the chronic phase of my quadriceps repair — I am still teetering between acute and proliferative, still in the brace, and still letting the new tissue find its footing. But emotionally, I deeply recognize this terrain. The bone-crushing pain of the acute phase is largely behind me. Something new has formed — a clearer sense of purpose, a deeper understanding of my own resilience, and bonds that feel, in many ways, stronger than what existed before. And yet I am also aware that what has healed looks permanently different than it did before. A song, a photograph, or a conversation can still find the scar and reopen it unexpectedly, putting me right back in the grief for a moment. These moments are fewer now, and I have learned to move through them rather than be consumed by them. But I do not expect them to disappear entirely, and I no longer need them to. I’m becoming better at looking at the information my body (and soul) is giving me and learning from it. That is simply what it means to have healed from something real.

The locked brace I now wear is a reinforcing container until my quadriceps muscle is fully healed. It says, “We know what you are capable of, and we are asking you not to do it yet, because the tissue is not ready”. I have had to build my own emotional equivalent of that – structures, boundaries, and intentional limitations on what I expose myself to and allow in while the deeper healing work continues. I’ve also learned that help and support from others, and honesty about your own needs throughout the process, is essential for both kinds of healing. What I tell my patients – and what I am still learning to tell myself – is that the goal in all of the healing phases is not always to see progress that is exciting or flashy. Progress usually happens beneath the surface, and can seem invisible and slow at times —but is absolutely essential. Even when you can’t see it working, there’s an underlying process that is predictable and restorative. When tended to and nurtured, the body is much more resilient than we give it credit for. And so, it turns out, is the human spirit.