Practical Application of Physical Rehabilitation

Maggie Lump, BS, RVT, CCRP (Candidate)
Instructional Technologist
Purdue University Veterinary Technology Program

Physical rehabilitation of the canine and feline patient is a team approach.  From the veterinarian’s diagnosis, to the rehabilitation practitioner’s exercise plan, the owner’s observations, as well as input from other professionals such as a groomer or trainer; everyone has something to offer.  The patient itself must also be considered as part of this team, as their behavior gives input to the treatment plan as well.  We must not focus solely on the injury, only to lose sight of the patient’s overall mental and physical status.  Therefore, it cannot be stressed enough that clear communication and involvement of all members plays a crucial role in obtaining the best possible outcome for the patient. 

There are many therapeutic modalities that are used in physical rehabilitation of the dog and cat.  These include manual therapy, thermal agents, electrotherapeutic techniques, mechanical agents, and therapeutic exercise.  Some of these modalities require no more than two hands and a lot of patience, while others require specific facilities and equipment.  For the purpose of this discussion we will focus on the modalities that can be implemented in practice without the need for major equipment purchases.

Manual Therapy
Manual therapy includes massage, stretches, joint and soft tissue mobilization, and chiropractic manipulation.

Massage is beneficial in promoting circulation and lymphatic drainage, mobilization of tissues to break down adhesions, relaxation of muscle and reduction of spasms.  There are many different types of massage strokes, each providing their own unique benefit.  These include efflurage, petrissage, tui-na, TTouch, and myofascial release. The act of grooming alone can be a very beneficial form of massage.

Stretching relieves pain and loosen tight muscles.  It relieves stiffness related to inactivity.  When used before exercise, stretching preemptively protects muscle from strain.  After injury, stretching both restores and maintains normal muscle length. 

Passive Range of Motion (PROM) is the movement of joints through their normal range of movement without stretching or active muscle action.  This is done by the practitioner moving the limb while the pet is in a non-weight bearing position (typically lateral recumbency).  PROM is used to detect restrictions or pain, restore joint motion, and enhance joint lubrication and nutrition.

Acupuncture stimulates specific points on the body with the use of small needles. These needles stimulate the neurological and endocrine systems, prompting pain relief and promoting tissue healing.  Acupressure, however, is where the practitioner uses his/her own body (hand, fingers, elbow) to apply pressure to the same points used in acupuncture.  Acupuncture needles can only be inserted by a veterinarian trained in this modality.  However, a veterinary technician can provide acupressure to patients with appropriate training.

Thermal Agents
Cold threapy is applied as a cold bath or ice pack.  It constricts the capillaries, thereby reducing pain, swelling, and inflammation. For acute injury, the use of cold therapy within the first 24-48 hours after injury can help to slow the inflammatory process.

Heat threapy is applied via moist heat packs or infrared applications. Topical heat application does not penetrate deep through tissue, therefore it is most beneficial for superficial muscles and joints.  Heat increases circulation and speeds up metabolism.  It also aids in the relaxation of muscles and reduction of muscle spasm. Heat also increases the pliability of tendons, ligaments and joint capsules, which allows for an increased ability to stretch. 

Electrical Therapy
Electrical therapy includes low level laser therapy, electro-acupuncture, and pulsed magnetic field therapy.

Electrical muscle stimulation (EMS) is the application of low electrical current through muscle motor points in order to stimulate muscle contraction.  Electrical muscle stimulation retards muscle atrophy, re-educates weak muscle, and encourages delivery of nutrients to the area.

Transcutaneous electrical nerve stimulation (TENS) is the application of low electrical current through tissue to counteract the pain cycle.  TENS relieves muscle spasm and stimulates the release of endorphins.

Mechanical Therapy
Mechanical therapy include therapeutic ultrasound, acupuncture, extracorporeal shock wave therapy (ESWT), and mechanical vibration/massage.

Therapeutic Exercise
Therapeutic exercise is arguably the single most important component of a rehabilitation program.  The exercises performed and the intensity at which they are performed depends upon the initial diagnosis, patient’s pain/discomfort, goals of the client and veterinarian, and the facilities that are available.

Therapeutic exercise includes the use of a treadmill, underwater treadmill, or swimming pool.  These tools may or may not be available in clinical practice.  However, with proper client education and strong owner compliance, pools and treadmills may be considered for use if available in the home environment.

Exercises include: leash walking, dancing/wheelbarrowing, use of exercise balls or physiorolls, isometric exercises, stair climbing/decent and walking over or around obstacles such as weave poles, cavaletti rails or other agility-type equipment.  A change in the substrate or terrain which exercises are performed on can also be incorporated if available to increase difficulty or target specific muscle groups.  For example walking on soft sand, landscape mulch, though tall grass, or even snow may be implemented to provide both mental and physical stimulation.

Other important components of rehabilitation in the dog and cat that bear mentioning include orthotic devices (thermoplastic splints, boots, and custom wraps), carts and wheelchairs, maintaining a high plane of nutrition, and provision of an environment suitable to healing.

The primary goals of any rehabilitation program are to decrease pain, provide a gradual return to normal function, improve strength and coordination and provide mental stimulation.  Every plan must be tailored specifically to the needs of the individual patient.  As time progresses the plan will need to be modified in order to meet the changing needs of the patient.

Rehabilitation Resources
Journals:
Veterinary Clinics - Small Animal  Nov 2005 (35:6) - Rehabilitation Issue
Veterinary Medicine/Veterinary Technician/Compendium articles
International Veterinary Information Service - http://www.ivis.org

Certificate Programs:
University of Tennessee - http://www.utcaninerehab.com
Canine Rehabilitation Institute- http://www.caninerehabinstitute.com
Chi Institute: Traditional Chinese Medicine for Veterinary Technicians - http://www.tcvm.com/Program/outline/vettech_outline.htm

Associations:
American Canine Sports Medicine Association - http://www.acsma.org
International Veterinary Academy of Pain Management - http://www.ivapm.org
International Association of Veterinary Rehabilitation and Physical Therapy - http://www.iavrpt.org
International Association of Animal Massage and Bodywork - http://www.iaamb.org

Books:
Canine Rehabilitation and Physical Therapy – Millis, Levine & Taylor
Animal Physiotherapy – McGowan, Goff & Stubbs
Essential Facts of Physiotherapy in Dogs and Cats – Bockstahler, Levine & Millis
The 5-minute Veterinary Consult Canine and Feline Specialty Handbook Musculoskeletal Disorders
Canine Physical Therapy – Debbie Gross Saunders, Wizard of Paws

Meetings/Workshops:
Many large veterinary CE meetings now offer tracks in rehabilitation, sports medicine, and complementary medicine
IAVRPT International Symposium on Veterinary Rehabilitation
2010 - http://vetrehabsymposium.weebly.com/
2012 - http://www.admicos.com/ISVR2012/