Physical rehabilitation is the treatment of injury or illness to decrease pain and restore function. A rehabilitation veterinarian can treat an acute injury as soon as it has occurred or they can treat chronic injuries or diseases that have been affecting your pet for a long time.
After an injury occurs there is typically inflammation, swelling and spasm in muscles surrounding the area. Rest alone after injury can improve the primary issue but does not address the secondary issues associated with swelling, inflammation and spasm. If the swelling is not addressed the body will adapt to protect these areas and the animal will develop secondary issues from bearing weight in an abnormal way and putting excess strain on other areas of the body. For this reason rehabilitation therapy should start as soon as possible after an injury has occurred. This will make return to full function more likely and will decrease the healing time of your pet.
A rehabilitation-trained veterinarian is a muscle, tendon, ligament, nerve and bone expert who uses physical modalities to restore maximal function and relieve pain. These veterinarians can also perform diagnostics tests, design a treatment plan and prescribe medications and supplements to increase your pets chances at a successful recovery. In some cases rehabilitation trained veterinarians work in a full service general practice and in other cases these veterinarians will work closely with your primary veterinarian to form a team with your pets best interest at heart. A rehabilitation trained veterinarian may also work close with a rehabilitation trained assistant which is a certified veterinary technician that has extensive training in rehabilitation therapy and they may assist you with a home exercise program or they may perform manual therapies in the home or clinic setting.
Your pet's first visit with a rehabilitation veterinarian will be lengthy. The doctor will take an extensive history about your pet's injury by asking you very detailed questions about the injury, your pet's lifestyle and your expectations for your pet. This will help them to set realistic goals in their treatment plan. After this they will perform a very thorough physical and musculoskeletal examination of your pet. They may take measurements of joint angles and muscle mass using specialized equipment and have an assistant (or you) walk your pet in several different ways to assess your pet's gait. After this they will discuss the examination findings with you and then develop a treatment plan to meet both your pets needs as well as your needs. There are many conditions that can be improved with rehabilitation therapy - some of the conditions commonly treated are listed below.
Conditions Treated
Some of these conditions may require surgical treatment in conjunction with rehabilitation.
- Osteoarthritis - increased mobility, range of motion, decreased inflammation and need for medications
- Obesity - weight loss programs can be designed for each individual
- Hip dysplasia - builds supporting muscle mass, increased mobility & comfort
- Muscle injuries - speeds healing, decreases inflammation, prevents scarring, restores normal functional length
- Back injuries - increased muscle support to prevent reinjury, manage pain
- Spinal injury/IVDD - decreased spasticity, pain management, earlier ambulation
- Spondylosis - manage pain, maintain flexibility and strength
- Arthrodesis - faster adaptation, support of surrounding joints
- Joint replacements - faster adaptation, improves coordination & strength
- Fractures - faster recovery, prevents muscle contracture
- Cruciate injury - speeds and improves recovery, restores extension, decreases inflammation
- Amputation - adaptation, builds supporting muscles, management of pain
- Shoulder OCD - increased mobility, strengthening
- Elbow dysplasia - increased mobility, decreased inflammation, strengthening
- Joint dislocation - strengthens supporting muscles & ligaments, prevents reinjury
- Patellar luxation - strengthening of quadriceps, prevents reinjury
- Tendon injury - increased range of motion and strength, decreased inflammation and scar tissue
- Peripheral nerve injury - speeds recovery, functional adaptation, manages pain
- Neuromuscular disease - strengthening, adaptation, pain management
- Fibrocartilagenous embolism (FCE) - can hasten recovery, improve coordination
- Degenerative myelopathy (DM) - helps to maintain muscle function and prolong life
- Cauda Equina Syndrome - manages pain, maintains strength and function
- Vestibular disorders - improves balance and coordination, decreases injuries
There are a number of different modalities that can be used to treat your pet as well. Each rehabilitation therapist will have access to different types of equipment but the general principles are the same - start by decreasing pain, swelling and spasm then progress to strengthening areas of the body which are weaker. The modalities available for rehabilitation therapy through STARS are listed in bold print.
The Underwater Treadmill
The underwater treadmill is designed specifically for veterinary use and uses water to support your pet's weight while walking or running. The treadmill can be used in the very early stages of learning to move well again; the higher the water level, the more of your pet's weight that is supported. As strength and correct movement improves, the water level is lowered each session to further increase strength. Underwater treadmills can decrease recovery time from surgery, improve arthritis through low impact exercise, and improve cardivascular fitness. Swimming where the legs are not touching a surface is considered less specific and does not provide as much joint extension as the underwater treadmill.
Land Treadmill
Treadmills are useful for reprograming your pet's way of walking (gait) and encouraging use of an injured limb following surgery or injury. The action of the treadmill belt makes your pet's strides longer and more exaggerated and also provides some energy so that your pet does not have to do all the work. Later in recover, the land treadmill can be placed on an incline to increase effort and build muscle in the hind limbs.
*Neuromuscular Electrical Stimulation*
Neuromuscular electrical stimulation (NMES) is the administration of a low level electrical current that decreases swelling and allows muscle contraction and recruitment after orthopedic or neurological injury. This is commonly used for patients who are unable to contract muscles on their own or if the muscle is too weak to perform it's full function. Once functional contraction can be used it typically is preferred because strengthening will occur more quickly with this method. Indications for use of NMES are atrophy (muscle wasting), swelling and pain.
*Transcutaneous Electrical Nerve Stimulation*
Transcutaneous Electrical Neuromuscular Stimulation (TENS) is used mostly for pain management. TENS decreases pain and inflammation by providing a low level electrical current which disrupts the normal pain perception pathways. The pulse rate and width can be controlled in order to deliver to desired effect. TENS also can be used to stimulate acupuncture points in order to achieve a body-wide response.
Therapeutic Ultrasound
Ultrasound is commonly used on tendon and muscle injuries, and certain conditions resulting in decreased range of motion. Therapeutic Ultrasound breaks down scar tissue, increases the elasticity of the muscles, aids healing, increases circulation, and reduces pain and spasm.
*Laser Therapy*
Laser therapy uses L.A.S.E.R (Light Amplification by Stimulated Emission of Radiation) to repair tissues through photobiostimulation. Put simply, the cells in the injured areas use the energy of the laser to aid their healing. The intensity of the laser is less than that of lasers used in surgery. Laser therapy has been shown to relieve pain from muscle and joint soreness, relieve symptoms of arthritis, relax muscle spasms and increase blood flow to an area, helping wounds to heal.
*Thermotherapy*
Thermotherapy is the therapeutic use of physical agents or means to heat or cool the body. Superficial heating of an area increases blood flow, reduces pain, increases extensibility of fibrous tissues, and aids in muscle relaxation. Special hot packs or infrared heat lamps are often used. Cold (cryo) therapy decreases cellular metabolism, leads to constriction of blood vessels, reduces pain, and reduces muscle spasms.
*Therapeutic Massage*
Therapeutic massage increases circulation to improve healing, decreases pain and reduces swelling. Therapeutic massage can be used for acute or chronic problems, but the pressure and intensity of the massage will vary with the pain level of the patient. Therapeutic massage increases blood flow - which improves oxygen delivery to tissues; and breaks down scar tissue. Therapeutic massage also promotes mental and physical relaxation.
*Joint Mobilization*
Mobilization can be of great benefit to joints and allows for greater movement. Mobilization of the spinal column can provide relief from spasms and pain. The use of mobilization is important to restore function to many patients. There are grades (degrees) of mobilizations that a rehabilitation practitioner can apply to a joint depending on variables of the joint itself. This includes veterinary chiropractic (see below). Compression and distraction is used with stretching to achieve the desired non-painful result.
Pulsed Magnetic Therapy
Pulsed magnetic field therapy was used primarily in treating horses for resolution of back and leg injuries. This was followed by widespread use with greyhounds, since these incur frequent sprains, ligament injuries and fractures, all of which respond well to pulsed magnetic field therapy. It is now used with other animals for similar injuries and has also been used to improve metabolism.
Pulsed Signal Therapy
PST, or Pulsed Signal Therapy is a new medical treatment now being offered to treat pain and injuries in small animals. PST consists of pulsed electromagnetic signals. Pulsed Signal Therapy can relieve the severity of joint pain and swelling and can improve mobility. PST signals mimic the normal healthy physiological signals, transmitted into the joint to promote the repair of damaged cells and to stimulate the repair and maintenance processes.
Extracorporeal Shock Wave Therapy (ESWT)
Extracorporeal Shockwave Therapy (ESWT) is used for the treatment of musculoskeletal pain caused by arthritis, ligament injuries, scar tissue or other injuries. Therapy sessions provide successful relief of acute and chronic pain to restore painless mobility and stimulate bone growth and tissue regeneration.
*Passive Therapeutic Exercise*
Passive exercises consists of passive range of motion (PROM) and stretching exercises. Theses exercises are performed to help maintain or improve flexion and extension of joints, help the body's awareness of neuromuscular structure and function, and improve flexibility of muscles, tendons and ligaments. Passive exercise means movement not initiated by the patient. Passive range of motion exercises (PROM) are very important if the patient is not using a body part or has limited movement of a body part.
*Active Therapeutic Exercises*
Active exercise involves your pet moving himself (with guidance from a human). While active exercise is in many ways the foundation of physical rehabilitation, the exercises must never cause overuse or strain. A rehabilitation practitioner should devise an individualized plan for your pet with specific goals and frequent re-evaluations. Examples of Active exercises and modalities used to perform active exercises: Active exercise involves your pet moving himself (with guidance from a human). While active exercise is in many ways the foundation of physical rehabilitation, the exercises must never cause overuse or strain. A rehabilitation practitioner should devise an individualized plan for your pet with specific goals and frequent re-evaluations.
Acupuncture
Acupuncture is the insertion of very fine needles into specific areas on a dog to treat a diagnosed condition. These specific points are called acupuncture points and are mapped and diagramed for each species body. In veterinary practice, acupuncture may be used alone to treat musculoskeletal pain, or in conjunction with other therapies. Traditional Chinese medicine has used acupuncture for over 4000 years. It became accepted officially by the American Veterinary Medical Association in 1998. Many veterinarians currently embrace both traditional and western medicine in an effort to provide the best care for their patients.
Veterinary Chiropractic
Chiropractic manipulation gently realigns the spine, corrects subluxations, relaxes the surrounding muscles and allows the gradual restoration of neurologic and biomechanical function. Chiropractic will help keep the musculoskeletal system functioning normally and prevent compenstatory injuries. Chiropractic is an integral part of the holistic trend in animal health care. The foundations of chiropractic philosophy are based on the intimate relationship of the spinal column to the nervous system, as well as the role of the spinal column in biomechanics and movement.
Bioelectric Whirlpool
Bioelectric Whirlpool Therapy is a form of treatment combining the benefits of hydrotherapy with the pain management benefits of electromedical therapy similar to TENS. This represents an avenue for providing pain relief for a variety of conditions.
*Orthotics and Prosthetics*
Custom fitted splints, braces, carts and even prosthetics limbs are available from many rehabilitation veterinarians. These devices are used to support an injured limb while it heals, to correct a deformity or to encourage correct limb use. Carts are fitted to patients that are paralyzed or unable to walk without support.
For more information on rehabilitation therapy please visit the American Association of Rehab Vets website at www.rehabvets.org
