The Three Stages of Sinew Injury in Chinese Medicine

A Different Way to Understand Healing After Strains, Sprains, and Overuse

When most people think about injury, they think in Western terms: inflammation, tissue damage, rehab, strengthening.

Chinese medicine views trauma a little differently.

In Traditional Chinese Medicine (TCM), strains, sprains, tendon irritation, and ligament injuries fall under what’s called “sinew damage.” The sinews include muscles, tendons, ligaments, and connective tissue — essentially the structures that allow us to move.

Rather than labeling injuries strictly by tissue type, TCM focuses on how the injury is behaving in the body — heat, swelling, stagnation, cold, weakness — and treats accordingly.

Healing isn’t one phase. It progresses through three distinct stages, and treatment changes at each stage.

Understanding these stages helps explain why early icing, later heat, acupuncture timing, and movement strategies all matter.

Stage One: Acute Injury

Heat, Swelling, Redness, and Sharp Pain

This is the immediate stage — usually the first few hours to days after injury.

You may notice:

• Visible swelling
• Warmth or heat in the area
• Redness
• Sharp or throbbing pain
• Limited range of motion

In Chinese medicine, this stage is characterized by heat and blood stasis. Blood and fluids are not moving properly, and inflammation is prominent.

Treatment Principle: Cool & Move Gently

At this stage, the goal is to:

• Clear heat
• Reduce swelling
• Move stagnant blood without over-aggravating the area

Acupuncture is used carefully to:

• Reduce inflammation
• Improve local circulation
• Decrease pain
• Prevent excessive scar tissue formation

Points may be chosen both locally and distally to help regulate circulation without irritating the injured tissue.

External therapies at this stage are generally cooling and aimed at calming the acute inflammatory response.

The biggest mistake in Stage One?
Applying aggressive heat or deep tissue work too soon.

Stage Two: Subacute Injury

Swelling Reduces, Stiffness and Aching Increase

This stage typically begins several days to a couple of weeks after injury.

Heat and redness begin to fade, but the area may feel:

• Stiff
• Achy
• Bruised
• Tight
• Weak

There may still be some swelling, but it’s no longer hot and inflamed.

In TCM terms, this is when blood stasis remains, but cold and dampness may begin to settle into the tissues if circulation isn’t restored.

Treatment Principle: Warm & Move Blood

The goal becomes:

• Increase circulation
• Break up lingering stagnation
• Restore mobility
• Reduce stiffness

Acupuncture at this stage:

• Moves blood more actively
• Encourages tissue repair
• Improves range of motion
• Reduces residual pain

This is often when patients notice the biggest improvement because circulation is finally restored to tissues that were stuck in the inflammatory phase.

Heat therapy, warming treatments, and appropriate manual work may now be introduced safely.

Stage Three: Chronic or Lingering Injury

Cold, Weakness, and Persistent Ache

If an injury is not fully resolved, it may enter a chronic stage.

You might notice:

• Dull, lingering ache
• Pain that worsens in cold or damp weather
• Stiffness after inactivity
• Recurrent flare-ups
• A sense of weakness in the joint

In Chinese medicine, this stage often involves cold, wind, and deficiency in the sinews.

Treatment Principle: Warm & Strengthen

Treatment may include:

• Warming acupuncture techniques
• Moxibustion (gentle therapeutic heat)
• Strengthening the underlying tissues
• Supporting joint stability

Why Stage-Based Treatment Matters

For example:

• A hot, swollen ankle sprain should not be treated the same way as a stiff, 6-week-old sprain.
• Chronic knee pain that worsens in cold weather requires a different strategy than acute post-run inflammation.

How Acupuncture Supports Each Stage

Across all three stages, acupuncture helps by:

• Improving local circulation
• Reducing inflammation
• Relieving pain
• Supporting tissue repair
• Preventing excessive scar formation
• Restoring normal joint mechanics

The Takeaway

Injury recovery isn’t one-size-fits-all.

Your treatment in the first 48 hours should look very different from your treatment three weeks later.

Healing isn’t just about time — it’s about matching the right therapy to the right phase.