Physical Rehabilitation

This is an often-overlooked but emerging area of veterinary medicine. Physical rehabilitation is like physiotherapy performed by veterinary staff. Physical therapy helps to reduce pain and inflammation and speed healing and recovery.

Injury rehabilitation is also very important in canine athletes. They put greater stresses on their bodies than non-athletes. An injury that allows a house pet to function normally, may prevent an athlete from competing, or a working dog from working. Just like in human athletes, physical therapy such as massage, range of motion exercises, aquatic therapy, electrical muscle stimulation and therapeutic ultrasound help to speed healing and return to athletic form. But whether your pet is an elite athlete or a senior couch potato, conditions can arise that will benefit from physical rehabilitation.

As in humans, physical rehabilitation can be very useful for many conditions such as,

• Arthritis, including hip and elbow dysplasia
• Intervertebral disk disease (back and neck problems)
• Muscle tears
• Degenerative myelopathy (progressive weakening of the back legs)
• Post surgery (fractures and cruciate ligament repairs)
• Any neurologic condition that results in weakness and difficulty walking

Aquatic or Hydro Therapy
The buoyancy of water allows the patient to work on range of motion of the joints and increase muscle strength and endurance without the strain experienced with weight bearing activities. A good illustration of this is the overweight dog with arthritis in the hips. The extra weight puts strain on the hips but the dog is too sore to exercise to lose weight. Putting this dog in a pool removes the weight from its aching hips, allows increase in motion of the joints, strengthening of the weakened muscles and burns calories to lose weight. This likely could not be accomplished with regular land exercise as it would be too painful. Other indications for aquatic therapy are, after any kind of orthopedic surgery such as cranial cruciate (knee ligament) repair, fractures and back surgery. Most dogs that are paralyzed after back surgery or other trauma to the spine will begin to have movement and use their legs much sooner under water then on land. As already mentioned it can be a great help for arthritis and obesity. Muscle injuries, toe injuries and conditioning for canine athletes and just exercise for your water loving pet. The list of uses for aquatic therapy is almost endless.

There are two types of underwater therapy.
1. Underwater Treadmill
2. Deep Water Swimming

Underwater Treadmill

Swimming against jets

Deep water swimming is a complete, non-weight bearing form of exercise in the water. An underwater treadmill reduces weight bearing on the limbs depending on how deep the water is. A treadmill allows the therapist to control the speed of movement of the legs in the water where as dogs free swimming may use their legs too fast, too soon after injury. It has also been demonstrated that dogs with weakness and paralysis in their legs are stimulated to move them by feeling pressure on their feet when walking on an underwater treadmill as compared to being free in the water. The treadmill can control the speed of the legs but it does not allow sideways movement or turning like deep water can.

Free swimming also has some advantages. Swimming in circles strengthens the back muscles and helps to promote more use and strengthening of a specific leg.

Therefore the ideal hydrotherapy combines free swimming and a hydrotreadmill.

Cold (Cryo) and Heat Therapy is the use of cold and /or heat over an injured or healing area of the body.

Ice packs after knee surgery

Hot Packing a sore shoulder.

The Quadruped Biofeedback System (QBS) is a new product based upon sensor technology developed for balance assessment and balance retraining in human physical therapy. The system is laptop based and provides biofeedback from small animals (primarily canines) regarding their "static" weight distribution.

The QBS comprises of four thin (latex free) sensor pads, and a suite of application software. All data is expressed as percentage of body weight. It can be viewed in real time as bar or line graphs, or as data gathered from multiple tests and stored for post processing and analysis.

Applications for the QBS include:

Quantifying static weight distribution
The QBS is used to provide an instance view of the weight distribution on each paw, this can be used to gauge lameness. The weight distribution is expressed as four numbers and can be captured, stored and printed. The prime objective is to make comparisons visit to visit - to gauge improvement or deterioration. Useful for all, but particularly useful in "multi-vet" practices where the same Vet may not see the animal on every visit. It brings objectivity to "slight lameness" observations.

Determine suitability of drug therapy
By viewing the animals static balance, and weight distribution during weight shifting, one can establish if pain killers or anti inflammatory drugs are working effectively. This can contribute to a more effective treatment for the animal, and be more cost effective for the owner.

View effectiveness of physical therapy
Similar to reviewing the effect of drug treatment, the QBS can help evaluate the effects of physical therapy or alternate treatments such as acupuncture, or nutraceuticals.

Monitor weight-shifting exercises
The ability of the QBS to provide an instant view of the animals weight distribution, enables the Vet to see how the animal redistributes his weight with each movement.

Training Owners to administer therapeutic exercises
Again using the ability of the QBS to provide an instant view of the animals weight distribution, the Vet can demonstrate the exercise to the Owner and the effect on the dog's posture.

Therapeutic Exercises are an important part of the rehabilitation services we provide. An exercise may be as simple as doing passive-range-of-motion (PROM) to improve or maintain a joint's flexibility, to ambulation exercises to retrain an animal to walk. Exercises are often devised specifically for each individual patient, so it is difficult to explain all the exercises we may prescribe for a patient.

• Passive range of motion (PROM) exercises increases blood flow to the joint cartilage, stimulate new cartilage production, and are used to increase range of motion at the joint.
• Stretching exercises increase circulation and muscle flexibility.
• Proprioceptive exercises are exercises used to help the animal know where their feet are in space.
• Strengthening exercises (stairs, sit/stands, etc.) are used to strengthen individual muscles or muscle groups.
• Weight shifting exercises are exercises used to help the animal shift their weight to the affected limb or side to make the animal walk more balanced.
• Ambulation exercises are exercises used to re-educate a paretic animal (severe loss of function of their limbs) how to walk.

Neuromuscular electrical stimulation (NMES) is the application of a low level electrical current which results in a muscle contraction. This is achieved by placing electrodes at the beginning and end of the muscle. These muscle contractions can be used to mimic strength training for animals that are non-weight bearing or have limited use of a muscle or muscle group. NMES is used to prevent atrophy post surgery or injury, or to increase strength for muscles that have been chronically underutilized. NMES is commonly used in weak dogs or dogs post surgically before they are weight bearing and during reeducation of ambulation. Electrical stimulation can also be used to decrease pain and swelling.

K Laser Therapy

Laser therapy has been used in humans for many years. The K Laser is a class 4 laser which s the most powerful therapy laser available. Previous classes of lasers were effective for superficial problems but class 4 lasers can penetrate deep in to tissue to allow treatment of large joints like hips, backs and shoulders. Laser therapy works by applying light energy at the cellular level to stimulate the cells and promote healing, increased blood flow and reduced pain. It is non painful and is applied 6 times over a 3 weeks period. Many patients show almost immediate results. Monthly maintenance treatments can often reduce the need for medication. This is especially useful in arthritic cats that do not want to swim or do exercises and are sensitive to many medications.

Known biological effects of the K laser Class IV laser therapy

Clinical studies and trials of laser therapy technology indicate the following beneficial effects of laser light therapy on tissues and cells:

• Accelerated Tissue Repair And Cell Growth. Photons of light from lasers penetrate deeply into tissue and accelerate cellular reproduction and growth. The laser light increases the energy available to the cell so that the cell can take on nutrients faster and get rid of waste products. As a result of exposure to laser light, the cells of tendons, ligaments and muscles are repaired faster.
• Faster Wound Healing. Laser light stimulates fibroblast development [fibroblasts are the building blocks of collagen, which is predominant in wound healing] in damaged tissue. Collagen is the essential protein required to replace old tissue or to repair tissue injuries. As a result, LT is effective on open wounds and burns.
• Reduced Fibrous Tissue Formation. LT reduces the formation of scar tissue following tissue damage from cuts, scratches, burns or surgery.
• Anti-Inflammation. Laser light therapy has an anti-edemic effect as it causes vasodilation, but also because it activates the lymphatic drainage system [drains swollen areas]. As a result, there is a reduction in swelling caused by bruising or inflammation.
• Anti-Pain [Analgesic]. Laser therapy has a high beneficial effect on nerve cells which block pain transmitted by these cells to the brain and which decreases nerve sensitivity. Also, due to less inflammation, there is less edema and less pain. Another pain blocking mechanism involves the production of high levels of pain killing chemicals such as endorphins and enkephlins from the brain and adrenal gland.
• Improved Vascular Activity. Laser light will significantly increase the formation of new capillaries in damaged tissue that speeds up the healing process, closes wounds quickly and reduces scar tissue. Additional benefits include acceleration of angiogenesis, which causes temporary vasodilatation, an increase in the diameter of blood vessels.
• Increased Metabolic Activity. Laser therapy creates higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells.
• Improved Nerve Function. Slow recovery of nerve functions in damaged tissue can result in numbness and impaired limbs. Laser light will speed up the process of nerve cell reconnection and increase the amplitude of action potentials to optimize muscle action.
• Immunoregulation. Laser light has a direct effect on immunity status by stimulation of immunoglobines and lymphocytes. LT is absorbed by chromophones [molecule enzymes] that react to laser light. The enzyme flavomono-nucleotide is activated and starts the production of ATP [adenosine-tri-phosphate], which is the major carrier of cell energy and the energy source for all chemical reactions in the cells.
• Trigger Points and Acupuncture Points. Laser therapy stimulates muscle trigger points and acupuncture points on a non-invasive basis providing musculoskeletal pain relief.

Applications

Musculoskeletal disorders

• Pain
• Mobility
• Old Age

Post-surgical treatment

• Orthopedic
• Soft-Tissue

Trauma

Wound healing

For more information: www.spot-check.com

Land Treadmill
The use of a land treadmill is the next step after water therapy in strengthening a dog recovering from injury or conditioning an athelete. Because the belt runs under the dog there is less strain then actually regualr ambulation as the moving belt does some of the work. This is also helpful to retrain normal gait in recovering dogs or just for exercise on a rainy day.

One of the unique treatment options we provide at the Spaw is Pulsed Signal Therapy (PST).  Pulsed Signal therapy is a new therapy that has been used extensively in Europe for the treatment of osteoarthritis, rheumatoid arthritis, tendon and ligament injuries, etc.  This treatment has been used in Europe for over 20 years with over 100,000 patients.  PST is approved for use in Canada on humans.

For background on the principles of PST, it is believed that there is an electrical field around each joint that plays an important part in the continual regeneration of cartilage and connective tissue. If osteoarthritis or inflammatory joint disorders are present, there is a disturbance in this electrical field.  PST allows reconstruction of the disturbed electrical field, which returns the natural regeneration capabilities and reactivates the cartilage and connective tissue to increase production of proteoglycans and collagen (the building blocks of cartilage) to aid in repairing the cartilage defects.  PST does this by pulsing an electro magnetic field to the treatment area.  In human clinical trials there was a significant improvement of pain and "performing" activities of daily living" in greater than 85% of treated patients.  

Some of the conditions that may benefit from PST include hip and elbow dysplasia, arthritis of any joint, intervertebral disk disease, tendonitis, wound healing, fracture healing, chronic cruciate ligament injury. This is a completely non-invasive non-painful procedure. It can replace the need for chronic medication and can last up to several years.

For more information go to www.pstvet.com.

Therapeutic Ultrasound is the use of ultrasound waves to increase the temperature of muscles, ligaments and tendons to reduce pain and increase mobility. It also helps to increase healing of injuries.

Land Treadmill
The use of a land treadmill is the next step after water therapy in strengthening a dog recovering from injury or conditioning an athelete.

Because the belt runs under the dog there is less strain then actually regular ambulation as the moving belt does some of the work. This is also helpful to retrain normal gait in recovering dogs or just for exercise on a rainy day.