I feel the use of heat and cold is underestimated and not utilised often enough. As part of my own canine rehab from the vet physio for my dog very often my homework will be the use of heat packs or ice packs along with some passive range of movement and myotherapy. For me personally ice or cryotherapy is a real life saver. I use ice packs every time after I’ve been out for a run for me personally and for what I hope to explain for this assignment is the value of ice therapy (turns out I have knee OA so instinctively been using what helps me the most!)

We are all used to the term rest ice compression elevation which gets abbreviated to rice.  The reason why it’s so important to use ice therapy when we immediate onset of any soft tissue injury is due to its obvious ability to constrict and reduce swelling which in itself can help reduce pain.  If ice isn’t available then even just cooling the area with cold water will help. What is interesting it may also reduce the formation of scar issue and therefore less bulk of tissue which may impinge the joints movement (1).

Along with the principles of rice there is also a further acronym of price which has the additional p for protection (2). The protection would be to immobilise the joint and quite obviously protect from further injury (2). As myotherapists may recommend rest and again that is allowing the affected area time to recover, in the case of acute injury which is what we are to discuss here may even have to involve having to put the dog on the lead and take out into the garden and then keeping them entertained through some enrichment activities in order to rest the joint. The ice therapy is so effective because of the very nature of the coldness constricts the blood vessels but also affects the pain signals to the brain and should there be any spasm of the muscles, may also have an effect by reducing this and cell metabolism (2).  The use of compression again constricts the blood vessels and the amount of inflammation to the injured area (2). Finally elevation, it has to be held above the heart and again this is the help reduce swelling (2) but this would be difficult on a dog.

What is interesting are the contraindications of ice therapy and the reason its interesting because I use ice therapy almost daily and yet suffer from one of the top contraindications and that’s Raynaurds, However I still reap the benefits of ice packs as I’m able to apply it to where I suffer from swelling after exercise and that is my knees however should I injure I distal area I wouldn’t be able to apply any ice packs due to Raynaurds affecting the extremities (2). There Is also hypersensitivity to cold which includes but is not limited to :-

Cold Hemoglobinuria – red blood cells cannot bind with blood proteins

Cold Erythema – rash

Cold Urticaria – hives (2)

Never use ice if under anesthetic (2).

Another contraindication aside from those already listed would be for the size of the dog (4). There are some contraindications that whilst they are not absolute should proceed with veterinary advice and these are;-

Cardiac, high blood pressure, nerves (superficial) and wounds that are still healing (2)

The use of ice for muscle injuries is to try a limit the pain caused by the swelling and specifically the ice may lessen the ‘nerve conduction velocity’ and metabolic rate of the affected tissues and by vasoconstriction of the surrounding blood vessels (2). You may also apply cold and then heat repeatedly.  I have only done this my dog for three minute intervals respectively but the advice given on the reference used here is for 10 minutes repeatedly (2).  The reason why it is effective is that it helps to flush the area due to the vasoconstriction (ice) and then vasodilation (heat) but this is only recommended should there be no signs of inflammation and after the first few days of an acute injury. Acute injuries should always be treated with ice first and then consider should the heat/cold type of therapy would be appropriate (2). Chronic injuries are usually treated with heat therapy and certainly, from the vet physio guidelines I was given to home treat my own dog, it is something I have found useful when treating my own dog as it obviously does warm up the muscle and I have found this more pliable to then follow on with his myotherapy treatments.

Should the canine have muscle spasms then ice therapy may be beneficial to help diminish this and with a technique called cryostretching once the muscle spasms diminish would be an opportunity to perform a stretch, but this is not something I would encourage much prefer a passive range of movement (2).

By using cryotherapy even modest application to injured soft tissue has been shown to reduce pain and speed return to function (3)

Cold therapy or cryotherapy initial application affects cutaneous vasoconstriction as the cold pack is applied to the immediate area and affects tissue 2 to 4cm deep.  Vasoconstriction reduces blood flow in the area. Cryotherapy reduces inflammation and edema so it’s use is effective in acute pain but can also be used for muscle spasm, for the reduction of DOMS and even during functional movement may help a stronger muscle contraction.(3)

For the use of ice packs, consideration has to be made for the composition of the area to be applied for instance a dog with a thick coat compared to a dog with a thinner coat in order to overcome this will be to adjust the duration of treatment time also wrapping a wet tea towel around the ice pack maybe able to improve the conduction.  Galen myotherapy protocols are for three minutes over bony areas and an additional four minutes (seven in total) to deep muscle.  In every case allow the tissues to warm and reapply if heat remains.

Obviously even with the benefits of crytotherapy should the dog be returning to exercise will still need to be warmed up. Heat assists muscle activation (3).

Cryotherapy can be used to aid the healing of acute injuries but also after exercise to impact any inflammatory responses. The physiological effects of using ice will be constriction of blood vessels or vasoconstriction.  Due to this decreased blood flow. Due to this decreased swelling and a reduction in tissue damage that is enzyme-mediated as well as numbs the area is known as analgesia (4).

After an injury the body’s response is to form an edema.  The cooling of tissue will impact this reaction and reduce the metabolic rate causing the inhibition of enzymatic effects and histamine release is less. Only takes temperature of 30deg C or lower to inhibit the enzymes protease, hyaluronidase and collagenase which are all degrading to cartilage as well as reduce the flow of inflammatory cells (4).

By using cryotherapy cellular metabolism is decreased and the peripheral nervous system creates an analgesic effect. Muscle spasm can also be helped by using cryotherapy. The best way to decrease inflammation will be the use of cryotherapy which will also decrease pain.

During the inflammatory response cyotines are released causing muscle membranes pressure to rise and may increase pain to that area. Should cryotherapy be applied this can cause a constriction of the blood vessels and numbing effect by reducing pressure on nociceptors and reduction in the conductivity of the nerve.  Inflammation is decreased and the healing process maybe sped up by reduction in blood flow to the affected area (19).

Cryotherapy also helps reduce the formation of scar tissue as can provide some parity between the work of the fibroblast and the myoblast.  Where the fibroblasts work to provide the necessary collagen framework for the myoblasts to work in. Too much collagen impedes the myoblasts creating lower contractile strength by ineffective myotubule.  Cryotherapy maybe able to inhibit this over assembly of fibroblast and under of myoblasts making a typical myofiber instead and not one with a lesser function and therefore likely for a secondary injury

Cryotherapy may provide relief from the injury but can also help reduce healing time and the reduction of scar tissue and adhesions as the application ice will lead to less scar tissue build up.  Scar tissue is where the collagen fibres no longer have their original elasticity and become rigid. Scar tissue is also present from a muscle tear or strain that the body tries to heal. Inflammation is important as it cleans, protects and restricts the area however it is important that inflammation does not last too long as excessive tissue damage can occur which may lead to scar tissue.  Cryotherapy helps with reducing the amount of blood lost from the area and reduced blood flow which will result in reduced swelling as less plasma to accumulate which will reduce the pain transmitted by nociceptors.

Working at your dogs pace for their best movement health  – Amanda Perriman

References

1)        Quay Street Physio – Sports Physio Bundaberg  –  https://www.quaystreetphysio.com.au/fact_sheet/heat_or_ice_which_to_do_fact_she accessed 28 March 2022

2)        Sports Injury clinic – Cold Therapy (Cryotherapy) In Sport https://www.sportsinjuryclinic.net/treatments-therapies/cryotherapy-cold-therapy  accessed 28 March 2022

3) Chris Zink and Janet B. Van Dyke, Canine Sports Medicine and Rehabilitation, Second Ediction, p492, Wiley Blackwell

4) Chris Zink and Janet B. Van Dyke, Canine Sports Medicine and Rehabilitation, Second Ediction, p137, p314, Wiley Blackwell

5) Online pet health – tissue healing times, https://membership.onlinepethealth.com/courses/try-content-free/small-animal-free-content-here/tissue-healing-timelines-free/ accessed 29 March 2022

6) Chris Zink and Janet B. Van Dyke, Canine Sports Medicine and Rehabilitation, Second Ediction, p114, p115  Wiley Blackwell

7) Merriam Webster fibroplasia https://www.merriam-webster.com/medical/fibroplasia#:~:text=Medical%20Definition%20of%20fibroplasia,tissue%20(as%20in%20wound%20healing) accessed 29 March 2022

8) National library of medicine – Epithelialization in Wound Healing: A Comprehensive Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086220/#:~:text=Epithelialization%20is%20defined%20as%20a,essential%20for%20successful%20wound%20closure. accessed 29 March 2022

9) National Cancer institute – Angiogenesis Inhibitors https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet#:~:text=Angiogenesis%20is%20the%20formation%20of,chemical%20signals%20in%20the%20body. accessed 29 March 2022

10) The other end of the leash – Dogs and Psychological Trauma https://www.patriciamcconnell.com/theotherendoftheleash/dogs-and-psychological-trauma#:~:text=Here%20are%20some%20symptoms%20we,pattern%2C%20and%20refusal%20to%20play. accessed 29 March 2022

11) Sympathetic nervous system – https://www.kenhub.com/en/library/anatomy/sympathetic-nervous-system accessed 23 February 2022

12) Hemostasis: Lesson 1 – An Introduction https://www.youtube.com/watch?v=5GPPt0kftfE accessed 31 March 2022

13) Medscape – Wound Healing and Repair https://emedicine.medscape.com/article/1298129-overview#a5 accessed 31 March 2022

14) Electrotherapy – Soft Tissue Repair and Healing Review http://www.electrotherapy.org/modality/soft-tissue-repair-and-healing-review

accessed 8 April 2022

15) Science Direct – Granulation Tissue https://www.sciencedirect.com/topics/immunology-and-microbiology/granulation-tissue#:~:text=Granulation%20tissue%20is%20vascularized%20tissue,proliferating%20fibroblasts%20within%20granulation%20tissue. Accessed 8 April 2022

16) Science Direct – Oxygen and the Basic Mechanisms of Wound Healing  https://www.sciencedirect.com/topics/medicine-and-dentistry/epithelization Accessed 8 April 2022

17) Science Direct – Tumor Biology and Tumor Markers  https://www.sciencedirect.com/topics/medicine-and-dentistry/angiogenesis accessed 8 April 2022

18) Galen Myotherapy – Student Task Guide Unit Five Task 4 p3 accessed 8 April 2022

19) Study.com – Ice packs are used for all manner of things, including sports injuries and post-surgical healing… https://study.com/academy/answer/ice-packs-are-used-for-all-manner-of-things-including-sports-injuries-and-post-surgical-healing-for-procedures-such-as-knee-and-hip-replacements-why-does-the-intermittent-use-of-ice-reduce-swelling-and-speed-up-healing.html accessed 7 May 2022