Thursday, February 5, 2015

The Pet PT Pit Stop: Physical Therapy is Great, Except When It Isn’t

by Susan E. Davis, PT “pull in for a helpful refuel!”  

It’s all about guiding and empowering you to help your pet avoid injury, provide practical solutions and achieve rapid restoration of health and function!   
 

Physical Therapy has been my beloved profession for the past 37 years. I think it’s pretty great, except when it isn’t…! Does that make sense? You’ve seen me tout the benefits of PT in many blog articles and book pages, so I think it’s time I highlight the other side of the coin and discuss areas of caution, when PT should be avoided or stopped.

1. Growth Plates

Located near the ends of long bone shafts in the limbs, they remain open during a puppy’s first months of life and tend to close at 9 to11 months of age. The texture and quality of bone is softer at the growth plates than other regions. Growth plates are susceptible to physical stress and cellular disruption at this stage, brought on my trauma, improper nutrition, environmental factors, etc. 

Physical therapy contraindications to growth plates include Laser, Ultrasound, high impact exercise, and thrust manipulation of the spine, hips, stifles, elbows, carpus and hock joints.

2.  Infection

PT is dangerous if a fever is present or during active infection, especially if modalities such as laser, ultrasound, shock wave, electromagnetic field and even some types of electrical stimulation are used. 

These treatments typically increase cellular function and therefore could potentially spread or exacerbate the infection. 

If your dog is on antibiotics, you must notify the therapist as some cause photosensitivity and laser light would be harmful. Any canine infection must be under control and responsive to medication before PT is administered.  Here is a recently example: I received a call from a woman whose dog had surgery to repair damage from disco spondylitis, a disease of the spinal discs and vertebral bodies caused by inflammation and infection.  The dog initially improved with surgery and antibiotics, and then started to regress after the procedure.  The surgeon recommended PT, specifically laser and water therapy.  I did not accept the case until it was determined why the dog deteriorated after 5 weeks: was it due to re-infection, bone softening, cord compression, surgical failure? If any of these were the cause, laser and water therapy would be dangerous! But if it was simply due to inflammation or small bone spurs formed after the procedure, PT would be of great help! How important to have the right information before proceeding!

3. Instability

Areas of laxity (typically at the spine, hips, hocks, and carpus joints), which are unstable from trauma, disease or birth defect,  become worse with certain therapy treatments.

Wobbler syndrome is a type of instability in the neck.

Hip dysplasia is a form of laxity in the coxa femoral (hip) joint.

Hocks (ankles) can hyperextend after ligament damage and carpus (wrist) joints drop from injury as well as congenital anomalies.

Although PT is helpful in general for all of these conditions, specific precautions and modifications must be made.  Stability of the affected joints must be maintained at all times by the therapist and pet owner through bracing, splints or wraps. Stretching and manipulation should be avoided. A dog with Wobbler syndrome should not be given neck traction, spinal manipulation or passive stretching. Hip dysplasia should be treated with manual joint compression rather than pulling, or distraction techniques. 

Strength of surrounding muscle is critical for support of the body area that is lax, but the exercise method must be carefully adapted.  When strengthening muscles around an unstable joint, therapists restrict excess motion with their hands or by use of weight bearing “closed chain” isometric exercises. Muscles can be coaxed to contract by the therapist or pet owner using their fingers to tickle, tap and vibrate the skin, while the limb is held still.

4. Neoplasm and Malignancy

I need to be careful here because PT is definitely beneficial for cancer patients via exercise, conditioning and pain relief. The danger lies in the use of modalities such as laser, ultrasound and some forms of electrical stimulation over areas of neoplasm (new growth which is abnormal), especially if determined to be invasive and malignant.

These treatments have never been proven to cause cancer, but their application directly over existing tumors may spread cancer cells.  Most manufacturers of laser and therapeutic ultrasound continue to list cancer as a contraindication.  From a practical point of view, I feel that laser, ultrasound and all forms of electrical stimulation should be avoided over areas of prolific cancers such as skin cancer and lymphoma. In other cancers that are more lytic in nature (causing tissue breakdown and destruction) such as bone cancer, the following may be safe to apply for pain relief: massage, TENS, targeted pulsed electromagnetic field.

5. Poor response  

While this may seem obvious, some pet owners continue to pursue PT in the hopes that it will “eventually” help their dog. Many view PT as holistic and non-harmful. PT is not holistic but part of traditional western medicine.

If there is no improvement in 2-3 visits, the treatment plan should be reassessed and modified to obtain better a better response. 

Often, a change in treatment will yield the desired result. If it doesn’t, don’t waste valuable time and resources. Dogs generally respond quickly to PT if it is beneficial. If your dog gets worse after 1-2 visits, stop treatment and discuss a different path of care with your veterinarian.

In the vast majority of cases, physical therapy is safe and provides an important role in veterinary health care. 

Your therapist ultimately desires the best outcome for your dog and this is enhanced when you are informed and aware!

*** 

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 
Physical Therapy Tip Of The Month: Ideas to Chew on - Can Physical Therapy Help with my Dog’s Digestive Problems?
Wrap It Up: Using Soft Supports For Your Dog
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part I) 
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part II) 
Physical Therapy Tip Of The Month: Safe Summer Boating Tips for your Dog 
Physical Therapy Tip Of The Month: Hip Dysplasia - What’s a Dawg Mama to Do?
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part I)
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part II)
Staying in the Loop with Targeted Pulsed Electromagnetic Field Therapy
Addressing Frailty Syndrome in Geriatric Dogs 
The Pet PT Pit Stop: "Where's The Evidence?"

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