Physiotherapy and functional re-education

© Duhayer/Royal Canin

Physiotherapy is a medical discipline which seeks to maintain and restore normal movement and functional ability using various non-invasive treatments such as thermal treatments (e.g. ultrasound), passive mobilisation of a limb, neuromuscular stimulation or a simple active re-education exercise. The use of scientific physiotherapy techniques to improve the recovery process in the canine athlete, or in a dog which has undergone bone or muscle surgery, has recently become available in veterinary medicine. However, the use of these methods to improve the recovery process in the canine athlete is still under development and more commonly practiced in certain countries (United States, France, Great Britain, Italy, Germany, Argentina, Japan, Korea, etc.).

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The benefits of physiotherapy

The objective of physiotherapy is the restoration of normal function for the affected anatomical element. Very commonly, the surgical treatment of a muscle, tendon or ligament injury, or the stabilisation of a fracture, is only the initial phase of the animal’s rehabilitation. When appropriate rehabilitation is not undertaken, there is invariably a reduction in the animal’s physical capacities and reduced athletic performance or even failure to return to normal locomotor function. In humans, it is difficult to envisage orthopaedic surgery without subsequent functional re-education, and the same applies to dogs. Physiotherapy provides the following benefits for the canine patient:

1. Increased blood and lymphatic flow

2. Early regression of inflammatory processes

3. Increased production of replacement tissues

4. Prevention of periarticular contraction

5. Promotion of the return to normal function of the injured joint

6. Prevention of muscle atrophy

Another highly positive aspect of physiotherapy is it includes the owner in the success of the treatment, making owners feel partially responsible for the dog’s complete recovery. They then feel involved and play an essential role in encouraging the dog to cooperate in the execution of the programmed exercises.

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What is the benefit of physiotherapy?

In human medicine physiotherapy is an integral part of conservative and surgical therapy in orthopaedics, neurology and rehabilitation. For some years these valuable methods have also been used in veterinary medicine. The effectiveness of physiotherapy for dogs and cats has been proven in numerous clinical trials and the worldwide involvement of universities helps investigation of the underlying mechanisms of the various methods used. The work of clinicians and scientist over the last few years has established physiotherapy as a valid treatment, which is important not only in post surgical rehabilitation but also in pain management and conservative therapy.

© Bockstahler

Dr. Barbara Bockstahler, veterinary surgeon
Veterinary University of Vienna
(Austria)

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Examples of physiotherapy protocols

Case number 1:
Greyhound which has undergone reparative orthopaedic surgery on a tarsal fracture.

Weeks 1 and 2

- Immobilisation with a plaster cast.
- Passive mobilisation of the hip and stifle.
- Stimulation of the quadriceps muscle.

Weeks 3 and 4

- Immobilisation with a plaster cast.
- Passive mobilisation of the hip and stifle.

Week 5

- Removal of the plaster cast.
- Radiographic examination of the fracture.
- Passive mobilisation of the hip, stifle, hock joint.
- Stimulation of the gastrocnemius and cranial tibial muscles.
- Daily swimming (for a few minutes).
- Cage rest, with short walks on a short lead to relieve himself.

Week 6

- Very short walks on a short lead.
- Daily swimming.
- Passive mobilisation of the tarsal joints.

Week 7

- Short runs off the lead.
- Daily swimming.
- Long slow walk.

Weeks 8 and 9

- Progressive increase in the time and intensity of the walk, trot, run.

Week 10

- Return to training.

Case number 2:
Australian sheep dog which performs agility, with an anterior cruciate ligament rupture surgically repaired.

Week 1

- Passive mobilisation of the stifle (10 - 15 movements of flexion/extension)
- Massage of the quadriceps with an analgesic balm or Arnica based cream.
- Application of cold compresses on the wound site to prevent inflammation and oedema.
- Walks on a short lead to relieve himself.

Week 2

- Passive mobilisation of the stifle.
- Massage of the quadriceps.
- If necessary, application of cold compresses.
- Removal of the stitches at the end of the week.
- Walks on a short lead to relieve himself.

Week 3

- Passive mobilisation of the stifle.
- Massage of the quadriceps and stifle with ultrasound therapy of the stifle (3 minutes two to three times per week).
- Swimming (5 minutes two to three times per week)
- Walks on a short lead to relieve himself.

Week 4

- Passive mobilisation of the stifle.
- Massage and ultrasound therapy of the stifle (5 minutes two to three times per week).
- Swimming (8 to 10 minutes two to three times per week)
- Walks on a lead.

Weeks 5 and 6

- Massage and ultrasound therapy of the stifle (5 minutes two to three times per week).
- Walks on a lead with hill work.
- Swimming (15 to 20 minutes two to three times per week)

Weeks 7 and 8

- Massages and ultrasound therapy of the stifle if necessary.
- Swimming (20 to 25 minutes two to three times per week)
- Physiotherapy performed by the owner.
- Walks on the lead, hills, ramps or stairs.

Weeks 9 and 10

- Swimming (20 to 25 minutes two to three times per week)
- Progressive return to training with warm-up of the stifle with massages and use of apparatus but no jumping.
- Slopes, ramps, stairs and progressive resumption of walks off the lead.

Thermal treatments

Heat

© Duhayer/Royal Canin

Heat is a very ancient method and often proves to be highly effective. It has beneficial effects on the following:

- reduction in the inflammatory response (heat, pain, swelling, muscle contractions),

- increase in the metabolism of the warmed tissues,

- fibrous scar tissues become easier to stretch,

- increase in blood flow,

- decreased pain.

Thermal treatments can be superficial (self-heating bags, heat lamps, hydrotherapy), in the event of an injury to the toes for example, or can make use of “relative heat dispersion” techniques obtained using ultrasound or microwaves for example (the latter are referred to as diathermal methods). Thermal treatment can also be applied to deep injuries using the ultrasound machines most physiotherapists have. Ultrasounds are waves which are transformed into heat as they pass through the tissues, and can thus penetrate deep down to the surface of the bone. They create micro-massages during their passage, which enables a more precise and targeted action within the affected tissues or joints.

Cryotherapy

© Duhayer/Royal Canin

Cryotherapy uses cold, which when applied locally can successfully stop or at least reduce an inflammatory or oedematous process.

This is achieved through the application of refrigerated cold bags or special instruments that produce a stream of pressurised cold “vapour”, which enables penetration to a short depth into the damaged tissues (this vapour is actually composed of micro-droplets of very cold water).

Passive mobilisation and massages

© Duhayer/Royal Canin

Passive mobilisation is a movement that is imposed by the therapist with the aim of recovering articular amplitude or compensating a loss of suppleness and elasticity of the soft tissues. It is used after traumatic injuries or lengthy immobilisation to prevent tissue adhesions and maintain normal joint motion. It increases the drainage of blood and lymph and prevents muscle contractions and the stiffening of the joints through ankylosis or calcification. Passive mobilisation reproduces flexion and extension movements of the joint, which enables the synovial fluid to nourish the joint cartilages via a “pumping” motion. Such treatment should start on the same day as a surgical intervention and continue for two to three weeks. Massage can be useful, when there are no serious muscle lesions, for reducing pain and improving blood flow, but also to eliminate adhesions of scar tissue and connective tissue between the skin and the underlying soft tissues. Massaging a weakened joint can also help warm and prepare it for exercise. Any session of functional re-education can also be completed by a massage, which promotes muscle relaxation after physical effort, enabling good blood and lymphatic flow as well as the correct elimination of toxins.

Specific physical exercises

© Duhayer/Royal Canin

Functional re-education is a medical science in its own right. The veterinary therapist therefore needs to analyse each case separately and devise a clearly laid out therapeutic plan, which may involve the prescription of a few simple exercises for the dog, aimed at re-educating a specific muscle or joint. Such exercises may involve the use of a staircase, large balls, horizontal ladders placed on the floor, specific obstacle courses, or other "games", which are used in various ways depending on the problem to be resolved in the dog in question.

Hydrotherapy

© Duhayer/Royal Canin

Swimming is an ideal exercise for post-traumatic, post-surgical and post-nerve damage locomotor recovery, as it’s the least traumatic form of exercise for the injured structures. More than 60 percent of the bodyweight is carried by the water, which enables the animal to move its limbs through their full amplitude with more ease, without the trauma induced by ground impact. It is a complete technique that gets the entire body working: cardiorespiratory apparatus, all of the muscles (limbs, dorsolumbar muscles) and all of the joints. The massaging and draining effects of the water on the blood and lymphatic circulation are also a positive factor. The use of hot water (between 25 and 30°C) helps to relax the muscles, which loosens the animal up and relieves pain. Hydrotherapy (or water therapy) can be implemented very soon after a surgical procedure, as soon as the surgical wound has healed, or following any other injury without an open wound.

The association of walking and water is increasingly popular in functional re-education centres for dogs; the dog is placed on a treadmill which is in the bottom of a pool that can be filled to varying depths, thus enabling less weight to be taken off the joints as the dog progresses. These machines are undoubtedly the most effective means of simple motor function re-education; however they are very expensive.

Electrostimulation

© Duhayer/Royal Canin

Small portable neuromuscular electrostimulation machines are used to rhythmically contract the main muscle groups via the skin. They prevent the muscle atrophy that is associated with enforced rest or prolonged partial immobilisation. Depending on their intensity, the low frequency electrical impulses can also help to reduce pain and stimulate blood flow and nerve sensitivity.

Low energy laser

© Duhayer/Royal Canin

Various types of lasers can be used in the dog to help resolve muscle problems or tendonitis. Their efficacy is based on their technical characteristics. In general “soft” lasers are used for acupuncture in the dog, “moderate” lasers for muscle or joint problems, and “hard” lasers in surgery. This classification reflects the intensity and power of the laser beam. The therapeutic effects of lasers help prevent inflammation and oedema and decrease pain (analgesic effect); and they accelerate the healing process in the event of a lesion or rupture. Low energy lasers represent the non-invasive treatment of the future in athletic dogs, so specialist vets are now often equipped with such lasers despite their high cost.

We should also mention the application of pulsed electromagnetic fields, which is sometimes used in physiotherapy with apparently good results in the resolution of muscle and tendon injuries.

Shock waves

A new technique widely used in equine medicine has appeared in canine treatment over the last few years: this is the use of shock waves. These waves are produced by a generator under a discontinuous pulsed mode and the frequency is adapted to the pathology being treated. The session is usually coupled with cryotherapy (application of cold) for its anti-inflammatory and analgesic effects. The technique is principally used for tendon injuries and inflammation of the bone (periostitis). Improvements of 60 to 70 percent are seen after three sessions, even for refractory tendonitis. This technique is becoming increasingly popular in sports dogs.

A well-planned physiotherapy programme is an essential element in the dog’s recovery. Using the above methods, a functional re-education schedule very similar to those devised for humans can be implemented with the owner over several weeks.

Whenever physiotherapy techniques are used during re-education, it is very important to ensure that the animal’s progress is recorded on a weekly basis and to adapt the techniques depending on the animal’s capabilities and the evolution of the clinical signs.

In a plan spread over several weeks, moving to the next step should not be done until the objectives of the previous week have been attained and only if the animal is capable of this. It is important not to generate any new pain in the application of the techniques and exercises.

The owner should only be allowed to continue the treatment themselves once the animal is weight-bearing normally once again. Regular maintenance is needed, as well as performing correct warm-ups and regular training, combined with an appropriate high-quality diet. Sporting dogs are considered in the same way as a human athlete, for whom all these elements are essential in the prevention of injuries, the maintenance of acquired performance and its improvement.

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