Thursday, January 24, 2013

Range Of Motion: It’s A Matter Of Degree…

 by Susan E. Davis, PT  

Every joint in a dog’s body is designed for movement and has a “normal” amount of scope it moves through.

This is termed as “Range of Motion”, or ROM, of a joint. There are documented values, measured in “degrees”, which are the standards optimal for each of the joints.


Dogs function best when their ROM is within these normal values.  

However when illness, surgery or injury take place, the dog may be less active and over time their joints become stiff, losing normal range of motion. Other times, due to trauma, the joint might be dislocated and too loose, unstable.

During a Veterinary or PT evaluation, the joints are examined and range of motion is measured with a goniometer.  

Those joints determined to be tight, and not in the “normal” value range, will be identified and may benefit from specific ROM exercises.

Joints move in various ways, such as the shoulder and hip which are “multi-axial”, or the elbow and knee (stifle) which are “hinge” joints.

Multi-axial means that the shoulder (and hip) moves in 3 different planes of movement as well as in 6 directions:
  • Extension: in which the arm moves forward and up toward the head;
  • Flexion: in which the arm moves in a backward direction toward the tail;
  • Abduction: the arm moves away from the body, out to the side;
  • Adduction: the arm moves close to and across the body;
  • Rotation: the shoulder turns inward and outward to achieve Internal and External rotation;
The Stifle and Elbow, being “hinge” joints, move in only 1 plane, with 2 directions:
  • Flexion: or “bending”;
  • Extension: or “straightening;
The Carpus (wrist) joint moves into 4 directions:
  • Flexion: or bending down with the paw tucked in toward the body;
  • Extension: or bending up and back as if the paw is in a “wave” position;
  • Deviation: where the paw moves from side to side
The Hip moves similarly to the shoulder except the terminology changes slightly: Flexion is where the thigh moves forward and toward the stomach and ribs (“knee to chest”); Extension: where the thigh moves in a backward direction toward the rump;

The hock (ankle) joint bends in several directions, but the 2 main are:
  • Cranial Flexion: “toes up” direction, where the paw bends toward the head;
  • Plantar Flexion: “toes pointed” direction, where the paw points away from the body, toward the tail.
When a Veterinarian or Physical Therapist uses a goniometer to measure your dog’s ROM, they will document the result, can advise you of the number and explain how it relates to normal values.

Goniometric measurement on Guinness
For example: if I am evaluating a dog that just had sutures removed after CCL surgery, I will measure the degrees of stifle flexion. A typical result might be 15 degrees.  I will advise the client that normal values for stifle flexion are 42 degrees, and the current measurement is about 35 % of normal.  I would also assure them of what to expect in terms of recovery and how likely the dog is to regain full range, in what time frame, etc.  

Abnormal range of motion is characterized by being either too tight: “Hypo mobile”, or too loose: “Hypermobile”.  

In cases of hypermobility, the joint needs to be rested and restricted from excessive motion by use of splints or wraps. With hypo mobility, joints need exercise in order to gain flexibility and movement. Range of motion exercises will be employed, where the joints and surrounding muscles are moved through their available ranges. This movement may be passive, active or active-assisted. 

Passive range of motion exercises are performed by external force (therapist’s hands, mechanical device) and without any participation by the animal.

This is used when the animal patient is unable to move joints on their own or if self-movement is painful or detrimental. 

Proper technique is very important when Passive ROM is performed.  

The therapist must cradle and support the limb to avoid jarring or twisting stress on joints. The exercise should be smooth, slow and steady, with the dog relaxed and comfortable. A dog owner who is willing to learn can be taught to perform basic PROM at home, but they should be carefully instructed and supervised several times.

Written instructions should be given or video of the exercise recorded for the owner.  Passive ROM exercises are usually performed for 5-10 repetitions, 2-3 times per day.

A dog owner who is uncomfortable doing this type of joint motion should be open and honest about it and never forced to perform PROM on their pet.  

It is better to spend the time and money having a professional provide the service than to have it done incorrectly and risk injury. There is no shame in admitting to feeling “queasy” about this. The only shame is to neglect having passive ROM exercises done when they are needed.

The other 2 types of ROM are Active-Assisted, and Active. 

Active-assisted ROM occurs when the therapist guides the dog’s joint motion and the dog’s muscles assist to a partial degree.

Active ROM is achieved by full muscle contraction by the animal. Placing a treat or toy in a certain position can stimulate the animal to move their limb on their own, through ranges of motion. Also, walking in sand or water, over rails or through a tunnel can achieve active movement through a joint’s range of motion.  

All ROM exercises are performed up to the limit of a joint’s available range, whether done by passive, active-assisted, or active method. Additional pressure applied to the end of this range is called “stretching”.

*** 

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.



Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery

Further reading:
Normal Joint Range of Motion in the Dog and Cat

3 comments

  1. Interesting info there! That poor lil Guinness! I hope he's just panting and not yelping in pain! :)

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    Replies
    1. The general rule of ROM is to work below pain threshold. Though, particularly shortly after a surgery, such as the knee, some pain cannot be avoided, because there is a lot of damaged tissue there. But ROM is working WITH the body, not against it.

      Since Guiness' incision site looks very clean, free of bruising, the stitches seem to be gone, it would have been a while after the surgery and I'd say there is zero pain involved in the photo.

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  2. Spot on, Jana! This photo was taken about 2 days after suture removal, and 12 days post-operation. I believe Guinness is actually in the middle of a good yawn there. He is a lovely guy and tolerated everything real well. The ROM measuring is done slowly and gently without pain or only very slight discomfort.
    S. Davis, PT

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