Friday, May 21, 2010

Don’t Forget the Physical Therapy

Guest article by Jennifer Coates, DVM

The medical establishment, at least on the human side of things, has been preaching the gospel about the benefits of physical therapy for a long time.  One of my family members recently had hip replacement surgery.  Her doctor went so far as to say that he could perform a flawless procedure, but if my Aunt didn’t hold up her end of the bargain with physical therapy, the surgery didn’t have a chance of succeeding.  If only we veterinarians could explain that to our patients!  Vets and owners must work together to make sure that dogs get the physical therapy they need. 

Why Physical Therapy?

The benefits of physical therapy shouldn’t be understated.  Some dogs can’t regain normal or even minimal function after surgery, injury or illness without it.  For example, a study published in 2002 reported that dogs receiving physical therapy after surgery to repair a ruptured ACL used their post-op legs as well as their normal legs, while dogs that were rested for six months after surgery still favored their post-op legs.

The goal of physical therapy is to maximize mobility and comfort in the face of whatever condition a dog is dealing with.  

Strength, flexibility, awareness of body position and endurance all come into play.  If your dog suffers from a musculoskeletal or neuromuscular condition like arthritis or intervertebral disk disease or is facing surgery, ask your veterinarian whether he or she is comfortable coming up with a physical therapy plan or whether you should be referred to a canine physiotherapist (that’s a therapist who works with dogs not a dog who is a therapist).  If your veterinary surgeon does not emphasize the importance of physical therapy after musculoskeletal or neurosurgery, consider finding a different surgeon.

Plans vary depending on the condition being treated and where an individual dog is in the recovery process.  In uncomplicated situations, you may be able to provide your dog with everything he needs at home.  In other cases, appointments with a trained physiotherapist will be necessary.  What follows is an overview of common physical therapy techniques, with an emphasis on what might be recommended after repair of a ruptured ACL.

Initial Treatment

Postoperative physical therapy can often start as soon as the last skin suture or staple has been put in place.  The nursing staff may ice the surgical site before your dog has even completely awoken from anesthesia.  This is called cryotherapy and serves to reduce swelling and pain after trauma has occurred.  Cryotherapy usually continues for several days after surgery.  At some point, warm heat may replace the cold packs to help your dog’s body eliminate any persistent swelling.

Passive range of motion exercises (PROM) and massage are also usually started soon after surgery, although the exact timing depends on what type of procedure has been performed.  You may be instructed to flex, extend and/or rotate your dog’s affected joint(s) to the point where you feel mild resistance but your dog is not experiencing pain.  PROM and massage help prevent a patient’s soft tissues from tightening up.  Later on in recovery, stretching may be added to your dog’s regime.  Stretches are similar to PROM exercises except that a little more pressure is applied.  Range of motion and stretching can be passive (i.e., you move your dog’s legs) or active, during which you encourage your dog to move and stretch himself. 

Leash walking is an important and commonly used form of physical therapy.  Use a short leash, keep the pace slow, and to reduce the chances of slips and falls, pick an area that has a relatively level and even surface to begin with.  The goal is to get your dog to start bearing weight on the affected limb.  If your dog is reluctant to do so, and you have checked with your veterinarian to make sure that pain control is adequate and your dog’s recovery is on schedule, you can push him gently from the opposite side as he is about to place his affected leg down.  Sometimes dogs seem to think “hey, I have three good legs.  I’m not even going to bother with this other one,” but this can lead to big problems if it is allowed to go on too long.

Advanced Techniques

Once healing has reached a certain point, more aggressive exercises can be started.  Leash walks are increased in length and trotting, ramps and stairs may be added.  Other activities that force your dog to really bend, stretch and use his muscles can include:
  • Repeatedly asking him to sit and then stand
  • Weaving between poles or cones set in a line
  • Figure eights
  • Dancing – stepping forward, backward and side to side
  • Cavalettis – stepping over poles set on blocks of varying heights and distances apart
  • Feeding from elevated food dishes
  • Physioballs – draping the body over or placing the feet on a large ball and then rolling it to and fro
  • Rocker boards – standing on a platform that can move a small distance in two directions
  • Wobble boards – standing on a platform that can move in all directions
  • Balance blocks – placing the feet on blocks that can be slid in any direction
  • The addition of weights to any exercise
Underwater treadmills are a wonderful addition to most physical therapy programs, but they are expensive and you may have trouble finding a veterinarian or therapist who has one in your area.  See Jana’s “Underwater Treadmill” post for more information on this extremely valuable option for recovery.  Swimming is sometimes referred to as the “poor man’s” underwater treadmill, but the two activities are actually very different.  Some dogs barely use their hind end at all when swimming, which limits its effectiveness for problems affecting the hind legs.  Also, swimming is a very strenuous exercise for dogs that are not used it, and they can easily overexert themselves, which leads to more problems than it solves.

Whatever form of physical therapy your veterinarian or physiotherapist recommends, follow through with it, even if your dog seems to prefer lying on the couch.  

Your canine companion is counting on you to help him make it through his illness or injury and emerge on the other side as much like his old self as possible.

***

Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian. Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Further reading:
Could This Therapy Improve Your Dog’s Mobility?

Related articles:
Underwater Treadmill
Talk To Me About ACL Injuries
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
ACL Injuries in Dogs: Non-Surgical Alternatives?

4 comments

  1. I never thought that a dog would decide that three legs was good enough if he still had four! Pilot, a rescue dog at a place I volunteer at, had surgery on one of her legs... but rather than pretend it wasn't there, she thought she ought to run around instead. The doozy for her wasn't so much the physical therapy as having to slow down, take it easy, and build back up.

    I like this article. =] It's informative and interesting, and has a lot of information that I wouldn't have thought of when it comes to physical therapy. I always just picture stretching muscles and walking a tread mill. While I knew there was more to it, I never really thought about it. But now I have a better idea about it.

    Also, I have quite a few clients whose dogs have had surgery due to tears, hip dysplacia, etc, and it'd be nice to learn more about what they have to go through. Always good when the trainer can help. (Though I always say, "I READ something that said...... but you should ask/confirm with your vet!")

    Anyway, good read!

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  2. Depends on the dog. They will do what they find works best for them. An excitable dog is likely to forget about the problem all together, while others might indeed resort to working around it instead.

    Most importantly, physical therapy isn't just about getting things working, but getting them working properly.

    Before Jasmines first ACL surgery our vet told us right away that how we follow up with the rehab will make or brake the success of the repair.

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  3. It always amazes me that thousands of dollars are being spent on surgical procedures to correct bone and joint problems in dogs yet only a few veterinarians educate their clients (the dog owners) of the importance of post surgery physical rehabilitation.

    One of the problems that I met when my GSD underwent a TPLO was how I could possibly do the post rehab exercises correctly. My vet gave me a long list of discharge instructions but I was literally on my own during the post rehab.

    It's good that I found these videos made by a veterinarian and owner of TopDog Animal Health and Rehabilitation, Dr. James St. Clair. These videos helped me a lot esp. how to execute the physical exercises and other management procedures correctly. This is the link to the videos-- http://topdoghealth.com/video/

    ReplyDelete
  4. I like this article, But I like all the coments here, specially want to thanked @JJ because of sharing such an interesting story....

    ReplyDelete

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