Veterinary Rehabilitation

Can your patients benefit?

Laura M. Perez, DVM, CVA, CCRT

Objectives

Basic understanding of veterinary rehabilitation and its associated techniques and modalities

Review the types of cases that would benefit from rehab

Review basic techniques that can be implemented in your practice

Favorite quote

“I believe that in the near future, failing to refer a patient for physical therapy will amount to malpractice”

H.A. Apfelbach, MD 1959

Director of Orthopedics

Rush Presbyterian Medical Center

Chicago, IL

What is Veterinary Rehab?

Human Physical Therapy Treating the soldiers of World War I (1914-1918)

Equine Rehab 1960’s

Equine and Canine Rehab Mainstream in Europe and UK by 1980’s Canine Rehabilitation Institute University of Tennessee

What is Veterinary Rehab?It is NOT just the underwater treadmill or LASER therapy!

What is Veterinary Rehab? Manual therapies Therapeutic exercises Modalities Hydrotherapy

Problem solvingManaging expectationsMeeting owner’s goals

Manual Therapies

Massage

Joint mobilizations

Joint compressions

Stretching

Video

Therapeutic Exercises

Peanut ball, donut, balance disc, etc.

Rocker boards

Cavaletti poles

Hills, variety of surfaces, etc

Video

Therapeutic Exercises

CONTROLLED LEASH WALKS!!!!

Modalities

LASERTherapeutic UltrasoundNMES (E-Stim), TENSMagnetic Field Therapy (PEMF)Thermal Therapies (Heat, Cold)Shockwave

Acupuncture

LASER - Effects

Cartilage stimulation

Fibroblast production

Endorphin release

Increased angiogenesis

Lymphocyte production

Accelerated inflammatory phase

Acceleration of collagen synthesis

Reduce oxidative stress

Help take the body through the stages of healing more quickly

LASER - Indications

Arthritic conditions

Tendonitis, bursitis, fasciitis, capsulitis

Neuralgia

Ligament/tendon injuries

Wound healing

Scar tissue

Improve circulation

Pain relief

Muscle spasm

Superficial skin lesions

Stimulate acupuncture points

LASER - CONTRAindications

Over the eye

Over cancer

Over photosensitive scrubs

Over areas recently treated with cortisone injections

Over the thyroid gland

Over areas of hemorrhage

Over a pregnancy

Over unclosed fontanels

Over the vagus nerve

Over the sympathetic ganglia

Over the heart in cardiac patients

Ultrasound

ContinuousThermal effects

Increased blood flow

Increased soft tissue extensibility

Pain relief

Pulsed

Tissue repair

Bone repair

Reduce swelling

Ultrasound - Indications

Muscle spasm

Trigger points

Tendonitis, capsulitis, bursitis

Soft tissue healing

Chronic synovitis

Contusions

Fracture healing

Joint swelling

Wound healing

Adhesions

Calcifications

Ultrasound - CONTRAindications

Over eyes

Over cancer

Over areas of infection

Over areas of reduced circulation

Over a pregnancy

Over the heart

On the testes

Immediately after exercise

Immediately post-op

Ultrasound - Precautions

Boney prominences

Flared arthritic joints

Implants

Over major nerve or blood vessels

Over intracapsular swelling

Bursitis

Over the growth plate in young animals

Neuromuscular Electrical Stimulation (NMES, Estim) - Indications Disuse atrophy

Neurological atrophy

Improper muscle firing sequences

Joint effusion

Pain

Muscle spasm

Post injury muscle inhibition

Tendon/fracture healing

Neuromuscular Electrical Stimulation (NMES, Estim) - CONTRAindications

Infection

Anytime active movement is contraindicated

24 hours after active inflammation

Over analgesic areas

Animals with seizure disorders

Irritated or broken skin

Magnetic Field Therapy

Theoretic Mechanism of Action Damaged cells have altered rest potentials

(permeability to Na+ and K+). The rest potential of the cell is proportional to the ion exchange occurring at the cell membrane.

Ion exchange is affected by the rhythm of the pulsation introduced by a PEMF

Ion exchange is responsible for oxygen utilization of the cell

Lack of oxygen utilization is a problem with delayed healing and arthritic joints.

Magnetic Field Therapy

Effects of PEMF Enhanced cartilage repair

Stimulation of chondrocytes

Increase in collagen synthesis

Increase in osteogenesis

+/- nerve repair??

Magnetic Field Therapy -

Indications Bone healing

Inflammation

Muscle spasm

Pain

Disorders of the neuro system

Tendon healing

Degenerative diseases of the musculoskeletal system

Infection

Poor circulation

MS, Parkinsons

Burns and wounds

Magnetic Field Therapy -

CONTRAindications Hemorrhage

Electrical implants

Cancer

Thermal Therapies - Heat

Indications Pain relief

Increase circulation

Muscle spasm

Facilitate tissue healing

Prepare a stiff joint or muscle for exercise

Chronic swelling

Tissue scarring

Thermal Therapies - Heat

CONTRAindications Circulatory problems

Cancer

Areas prone to hemorrhage

Areas with poor/no sensation

Thermal Therapies - Heat

Application Best AFTER the acute inflammatory stage (24-

48-72 hours)

Superficial heat penetrates 1cm

Deeper tissues need 15-30 minutes to warm up

Use water as hot as the hand can tolerate

101-105 F

Thermal Therapies - Cold

Indications Pain relief

Reduce inflammation

Hemorrhage

Fever

Muscle spasm

Thermal Therapies - Cold

Precautions Poor/no sensation

Impaired circulation

Hypertension

Cold sensitivity

Over wounds

Thermal Therapies - Cold

Application First 48-72 hours following acute

musculoskeletal injuries OR any time there is heat and swelling

Apply for 10-20 minutes every 2-4 hours

New units use circulating cold for longer time (combined with compression)

Effects occur when tissue temp gets between 59-66 F

Do NOT allow for an airspace between the skin and cold medium

Air gets colder and can damage the skin

Shockwave

How it Works High energy waves (pulses or shockwaves)

Energy is released at tissue interfaces

Energy released causes a cellular reaction that results in the release of cytokines that accelerate healing

Shockwave

Effects Neovascularization = increased blood supply to

the treated tissue = regeneration in tendons, joints and bone.

Reduce inflammation and swelling

Improve tendon/ligament/muscle fiber alignment

Fracture healing

Wound healing

Shockwave

Applications Osteoarthritis

Joint injuries

Chronic back pain/LS Disease

Non-union or delayed healing fractures

Tendon/ligament injuries

Chronic wounds (lick granuloma)

Acupuncture Stimulatory for neuro patients

Local points around a specific joint or limb

Hydrotherapy

Underwater treadmillWarm water

Buoyancy

Compression

Swimming

Who can benefit?

Orthopedic cases“Pre” hab

Post op

Surgery is not an option

Anesthetic risk, financial reasons, etc.

Neurologic casesChronic, degenerative diseases

Medically managed IVDD, Post-op surgery

FCEM

Who can benefit?

GeriatricsArthritic, overweight, subtle neuro deficits

Overweight

Athletic, working dogsConditioning

Sports related injuries

Evaluation

Symmetry Stance, movement, muscle girth, etc.

Current Abilities What are they still able to do?

Current Problems – owner’s opinion Painful?

Weak?

Poor balance?

Lack of endurance?

Stiff? ROM? Flexibility?

Orthopedic

Rory bilateral biceps and supraspinatus tendinosis

MistyOlder dog with extracapsular repair for

rCCL

Misty’s Daily PT

6/30 7/01 7/02 7/03 7/04 7/05 7/06

Square

sitting

Feet up+

S.Stepping

Balance

Challenge

Stepping

Over-2-3”

2 Leg

Standing

Walk, O’s

& 8’s

Neurologic

Banner – T3-L3 myelopathy

Jude - DM

Pepper – FCE

Geriatrics

Spinner

Overweight

Lacey

Conditioning

Beans – Schutzhund

Sable – agility

Basic Techniques

PROM, stretchingCookie stretchesSit to StandPush ups

Encourage leash walking!!!

Videos/pics

Fun stuff

Ball work

Wobble board

Front feet up

Beg

Diagonals – Dog yoga