In addition to the three stages described above, recent attention has been directed at the fourth stage, the remodeling stage. As described, following an injury the body goes quickly through the acute and subacute stages. If the injury is not too severe and the treat-ment is appropriate, the problem heals and the condition never reaches the chronic stage. Under less than ideal circumstances, however, tissue healing may be inadequate and chronic problems may develop.
During the remodeling stage, the body attempts to return to normal structure and function. The body responds to the demand placed on it, and if the demand is sufficient, the injury heals with no residual defects or problems. If the demand is not appropriate, if the injury is too severe, or if the treatment is inadequate there may be residual (chronic) deficits. There is some evidence that this stage may last as long as 1-2 years post trauma in some patients.