Stages of Soft Tissue Healing and Implications for Rehab

Soft tissue injuries are injuries to muscle, tendons and ligaments, often referred to as strains (muscles, tendons) and sprains (ligaments). The appropriate treatment of soft tissue injuries is absolutely dependent on the timing post injury. Healing stages are broken down into three:

Stage 1
a) Early Stage 1 – 24 to 48 hours (known as the hemorrhagic phase)
Goals of treatment are a reduction of pain, swelling and inflammation. Use the principles of RICE – rest, ice, compression and elevation. You can apply ice in a cycle of 10 minutes on, 15 minutes off. If possible, apply compression via a tensor bandage when the ice is on. Do not wrap too tightly which would impair circulation in the dog’s limb. Elevation of the affected limb may not be feasible in a dog but give it your best shot!
b) Late Stage 1 (days 3-5) – also known as the substrate phase
Goal is to facilitate the early stages of healing. Treatment is as above, but with the addition of ultrasound or low dose laser.

Stage 2 (days 5 – 21) – also known as the regeneration phase
Goal of treatment is to help the new collagen fibres in the soft tissue organize and align in the strongest possible way and to prevent adhesions. When collagen fibres run parallel to one another, they are the strongest. Up until approximately day 14 post injury, exercise should be limited to low intensity activities and passive range of motion. Appropriate exercise would be on leash walking, weight shifting exercises and gentle stretching. After day 14, more challenging exercises can be added such as walking backwards or in figure 8’s, walking up or down gentle slopes or balance work using an exercise disc. Use of neuromuscular electrical stimulation might be indicated during this phase. Other modalities such as heat/ice, laser or ultrasound can be used to improve local circulation and enhance healing of the affected structures. By the end of this phase, the dog may be ready for proprioception retraining on a peanut ball, walking over low poles or destination jumping (e.g. jumping onto a pause table).

Stage 3 (3 – 6 weeks, lasting up to one year) – also known as the remodelling phase
As healing continues the tissue at the injury site changes from cellular to fibrous to scar-like tissue. The goals of treatment are to improve muscle strength, maintain ligament or muscle extensibility, improve joint mobility and retrain the proprioceptive sensory system. The rehab program will be dog specific, depending on the severity and location of injury. Progressive time off leash including training on hills, retraining jumping, trotting with incorporation of turns, more difficult balance exercises such as the use of a mini trampoline are some examples. The dog’s practitioner may incorporate more vigorous joint mobilization techniques and soft tissue stretching techniques. Maintenance of range of motion is crucial as the scar tissue is forming.

If your dog has had a soft tissue injury and you are not sure what the appropriate program is, don’t hesitate to consult a canine rehab practitioner with experience in this area.
References:
Animal Physiotherapy, edited by Catherine McGowan, Lesley Goff and Narelle Stubbs, Blackwell Publishing, pages 208-209
Canine Rehabilitation and Physical Therapy, Darryl L. Millis, David Levine, Robert A. Taylor, Saunders Publishing, pages 164-166

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