Today I would like to talk about Moist Heat and icing, and when to use both of these. So when we have an acute injury, ice is the first choice. We have lots of swelling and tissue inflammation initially, so we want to use Ice, which will vasoconstrict the blood vessels, and slow down the bleeding/swelling. When we use ice therapy, I prefer to use a gel ice pad that can be left in the freezer. Frozen veggies or popcorn kernels can also work if you need something quick.
Apply the ice pack for about 15 minutes two to three times daily, until swelling is better, or about a week or two after the initial injury. This also helps with pain initially, by taking the pressure and swelling down.
It is important not to do moist heat too quickly after a joint injury, as heat will vasodilate and increase blood flow to the affected area. We don’t want to do this when we have an initial injury with swelling present. After the first 2 weeks, we can start the transition to moist heat.
Now when applying an ice pack, a nice tip is to wrap the ice pack with warm wash cloth. This is a nice gradual cooling, instead of the initial cold shock. Your pup will thank you!
After 2 weeks, we will be switching to moist heat. To make your own moist heat, simply fill a sock with white rice (I double layer mine for washing). This makes a nice moist heat when you warm it in the microwave for 1-2 minutes. Wrap in a towel to make sure we don’t burn our pups.
Moist heat is different that dry heat, like an electric pad. Moist heat gets better penetration into the tissues, and is a very good pain relief. It opens up the area, so that our supplements can penetrate the area. Our knee does not have a great blood supply, so it is good to help with moist heat as much as we can. Do this 2-3 times daily for 15 minute intervals.
I like to do this before we walk, or start physical therapy. It relaxes and makes the knee comfortable. Do this process for up to 12 months, especially with meniscus tears. If you pup is sore after a walk, you can also do icing after the walk as well. Please let us know if you have any questions!
Today let’s go through a few questions regarding scar tissue. I hear a lot of misconceptions regarding this topic, and today would just like to clarify things a bit more. I hear a lot of recommendations of “oh, just wait 8 weeks, and see how it goes.” I just want to clarify that this is not correct, it will take much longer for scar tissue to mature, and 8 weeks is not enough time.
Let’s talk about the mechanics of the knee. The front of the knee is composed of 2 main bumps, the patella and the tibial tuberosity. The tibial tuberosity is on the Tibia bone, and above this sits our menisci. Then we have the femur bone above, with the patella. When we have a CCL tear, the bottom bone, or tibia, will thrust forward, causing abnormal movement in the knee. This is called Tibial Thrust. This is what your veterinarian will check for in the clinic. It may also be called a drawer sign.
So, scar tissue starts forming immediately , once the body has an injury to a ligament, to stop this movement. Basically, with conservative management, we are externally supporting that joint, allowing scar tissue to form, until we get to a point where there is no longer any movement.
Scar tissue takes 6 months to form to the juvenile state, and 9-12 months to fully mature. We suggest using the brace during any active times, to help this scar tissue heal. Any movement without the brace could lead to a re-injury of the scar tissue, and this could set us back a bit.
So, with a tear, we commonly see a lot of re-injury initially, before bracing. This can be a cycle until we get a brace on the knee to stabilize things. A re-injury is easy to do during the juvenile state. If this happens, just keep rested for 1 week, and resume our Physical Therapy schedule along with bracing. Too much too soon is not a good thing, this is not a race.
This is why it is so important to include Physical Therapy with our bracing, so that this scar tissue forms in the pattern we want it to. Range of motion allows the scar tissue to form in a healthy manor, and be more flexible. We do not want hard/stiff scar tissue to form, as this will decrease our mobility down the road. Please let me know if you have any questions!