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CHAPTER

83

Physical Therapy and


Rehabilitation
| Robert A. Taylor

GENERAL CONSIDERATIONS
Initial Assessment
I. Both the initial and subsequent physical assessments of
the injured or affected body part are vital for developing
physical therapy and rehabilitation plans and for providing
an objective parameter to assess recovery and response.
II. Such parameters include weight-bearing status, limb circumference measurements, and determination of joint
range of motion, in addition to a complete history and
physical examination.

History
I. The nature of the injury, when it occurred, positive identication of the affected limb or body part, preexisting
medical conditions
II. Methods of treatment already administered, including any
surgical treatments
III. Response to previous conservative or surgical treatment
IV. Frequency of recurrence, any current supplements or nonprescription drug therapy

Physical Examination
I. A full orthopedic evaluation and a baseline neurological
examination are conducted.
A. Physical ndings should match the diagnosis.
B. For example, a dog with a 6-week-old, cranial cruciate
ligament (CCL) injury typically has partial weightbearing lameness, evidence of synovial effusion, medial
buttressing, and instability.
C. If the dog has nonweight-bearing lameness for 2
weeks, then other diagnostic considerations must be
entertained.
II. The degree of muscle atrophy and decreased range of
motion can help determine the chronicity of the injury and
the length of time necessary for physical therapy and rehabilitation.
A. In general, if an injury has been untreated with physical
therapy for 6 weeks, then at least 12 weeks of therapy
will be necessary.
B. With an acute CCL injury, synovial and cartilage
changes are evident by 3 to 4 weeks; muscle atrophy
continues for at least 6 weeks.

III. Long-standing muscle atrophy, joint atrophy, and diminished weight bearing and range of motion result in the need
for prolonged physical and rehabilitation therapy.
IV. Neurological and/or oncologic issues may mimic orthopedic problems, and they must be excluded during the
diagnostic efforts.
V. See Table 83-1 for a list of common conditions to be ruled
out by the clinician.

Monitoring of Progress
I. Response or lack of response to therapy is important.
II. Before beginning therapy, the clinician must have clearly
delineated goals and measurable parameters of success.
A. For example, goals that might be achievable when
treating a postoperative case of CCL stabilization would
include full range of motion, normal gait, full restoration of muscle mass, and return to function by 12 to
14 weeks.
B. Achievable goals after physical therapy and rehabilitation for bilateral femoral head and neck osteotomy
include pain-free range of motion and restoration of
gluteal muscle strength.
III. If the animals response to physical therapy and rehabilitation is inconsistent with expected results, then the clinician
should reconsider the diagnosis.
A. For example, a dog recovering from CCL stabilization
should be ambulatory at a walking gait 4 weeks after
surgery.
B. By the sixth week of therapy, a persistent nonweightbearing lameness and lack of progress regarding muscle
mass restoration indicate the need for conrmation of
diagnosis and evaluation of the lack of response to the
physical therapy.

TYPES OF PHYSICAL THERAPY


Heat Therapy

Denition
I. Heat therapy is the application of a heat source to a body
part.
II. Heat may be applied via direct transfer from a hot-water
bottle, warmed uid packs, ultrasound techniques, and
diathermy.
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818

SECTION

11 | Musculoskeletal System

TA BL E

83-1

Common Conditions of the Pelvic Limbs That


May Benefit from Physical Therapy
BODY LOCATION

COMMON CONDITIONS

Digits, pads,
feet

Paronychia
Lacerations of the interdigital skin or foot pads
Luxations of the interphalangeal joints
Luxations of the tarsometatarsal joint
Fractures of the metatarsal bones
Fractures of the phalanges
Fractures of the sesamoid bones
Osteochondritis dissecans of the talus
Fracture of the calcaneus
Fracture of the central tarsal bone
Fracture of the third or fourth tarsal bones
Luxations of the tarsus with damage to the
short or long tarsocrural ligaments
Osteoarthritis
Disruption of the common calcaneal tendon
Rupture of the plantar ligaments
Fractures of the tibia and bula
Panosteitis
Traumatic periostitis
Osteosarcoma
Cranial cruciate ligament rupture
Osteochondritis dissecans of the femoral
condyles
Injuries to the medial/lateral collateral
ligaments
Medial/lateral patellar luxation
Medial/lateral meniscal damage
Fractures
Congenital absence of the patella
Caudal cruciate ligament disruption
Osteoarthritis
Fracture of the femur
Panosteitis
Osteosarcoma
Hip dysplasia
Fracture of the acetabulum
Fractures of the femoral head or neck
Fracture/separation of the proximal capital
femoral physis
Legg-Calv-Perthes disease
Traumatic luxation of the coxofemoral joint
Osteoarthritis

Tarsus

Tibia and
bula

Stie

Femur

Coxofemoral
joint

Reprinted with permission from Taylor RA: Orthopedic and neurologic


evaluation. p. 185. In Millis DL, Levine D, Taylor RA (eds): Canine
Rehabilitation and Physical Therapy. Elsevier Saunders, St. Louis, 2004.

Effects
I.
II.
III.
IV.

Increases regional blood ow


Elevates pain threshold
Accelerates resolution of inammation
Causes vasodilation from stimulation of cutaneous thermoreceptors and the release of vasoactive peptides
V. Accelerates the rate of biochemical reactions
VI. Increases extensibility of collagenous tissues

Indications
I. Heat therapy is recommended after resolution of acute
inammation.
A. In most orthopedic cases, heat therapy is used 2 weeks
after surgery (after suture removal).
B. Heat application is used after femoral head and neck
excision, beginning the third postoperative week.
II. Application of heat to a body part or limb can enhance
vasodilation as well as venous and lymphatic drainage.
III. Heat can be used after joint surgery to increase the extensibility of collagenous tissues and help regain joint range
of motion.

Application Recommendations
I. Heat is usually applied during the second or third week
after surgery or trauma.
II. Periincisional heat may be applied QID for 10 minutes.
III. When using heated water, care must be taken to avoid excessive temperatures (>42.2 C [108 F]).
IV. To avoid burns, do not use heat that is uncomfortable when
placed on a human forearm.

Cautions and Contraindications


I. Supercial (or deeper) burns are easy to create with overaggressive use of heat.
II. Hot packs must be checked for leaks or thermal hot spots
to avoid burning the animal, especially if heat is used while
the animal is anesthetized, sedated, or has diminished
nociception.
III. Avoid heat in the early phases of inammation, because it
may exacerbate edema and increase periincisional pain.
IV. Contraindications include use of heat on limbs or body
parts with decreased sensation, during the rst postoperative
week, and when the animal does not tolerate the heat.
Cryotherapy

Denition
I. Cryotherapy is the application of cooling agents to regional
areas of the body.
II. Cooling of tissues can be achieved by the local use of ice or
ice packs, certain types of cryogens, or circulation of a
coolant agent in a blanket or booty placed on the extremity.

Effects
I. Decreases blood ow via vasoconstriction
II. Decreases nerve conduction velocity of nociception bers
and can provide analgesia
III. Decreases pain and inammation

CHAPTER

IV. Increases tissue viscosity and stiffness


V. Effects mediated through decreased metabolism and local
vasoconstriction

Indications
I. It may be used within the rst 10 to 14 days of an injury
or surgery to combat acute inammation.
A. Periincisional cooling for 7 to 10 days after surgery
B. Regional cooling after joint manipulation
C. Regional application over tendons and ligaments during
physical therapy and rehabilitation
II. It can be used in emergency care for burns (see Chapter 134).
III. Cryotherapy provides postoperative analgesia and is used
to reduce pain after joint mobilization procedures.

Application Recommendations
I. Ice packs are applied to periincisional tissues for 10 minutes
QID for the rst postoperative week.
II. A neoprene booty that cools via a refrigerant pumped
through a network of tubes can reduce the need for postoperative analgesia after stie surgery.

Cautions and Contraindications


I. Avoid excessive cryotherapy in regions of decreased sensation
II. Limit duration of cryotherapy to 20 minutes; thermal
washout and reex vasodilation will rewarm peripheral
tissue within 20 minutes.
Passive Range-of-Motion Exercise

Denition
I. Exercise is often the mainstay of physical therapy.
A. Exercise may involve active or passive activities.
B. In most instances, the application of active openchain activities, such as cycling, to animals is difcult,
so most active therapeutic exercise involves closedchain activities.
C. Closed-chain activities usually revolve around normal
canine activities such as sitting, standing, walking,
trotting, or swimming.
II. Passive range of motion is an exercise activity that passively
moves a joint through its normal arc of motion.
A. In many acute or chronic problems, the range of motion
is limited.
B. After surgery of the extremities, passive range-of-motion
exercises are a vital part of the immediate postoperative
care.
C. Such exercises are performed without active muscle
contractions and are done to the limit of the animals
tolerance for motion.

Effects
I. Helps reduce loss of range of motion after extremity surgery
II. Helps mobilize tissue edema
III. Stretches ligaments, tendons, and joint capsules at the
beginning and end of the available range of motion
IV. Decreases postoperative pain

83 | Physical Therapy and Rehabilitation

819

Indications
I. Dogs recovering from CCL surgery receive 10 to 15 minutes
of passive range-of-motion exercises three to four times
daily.
II. Dogs recovering from cubital joint arthroscopy for fragmented coronoid removal receive passive range-of-motion
exercises 10 to 15 minutes four to six times daily.
III. Early attention to passive range of motion minimizes the
risk of joint contracture.

Application Recommendations
I. Passive range-of-motion exercises are done for 10 minutes
QID, beginning the rst day after joint or extremity surgery.
II. The affected limb is gently grasped while the dog is in a
comfortable position.
A. The joint is either exed or extended, unless the joint is
resistant or painful.
B. The extremity is held in this position for 30 seconds
and then moved in the opposite direction.
C. At no time are vigorous manipulations done that create
pain or discomfort for the dog.

Cautions and Contraindications


I. Passive range-of-motion exercises are contraindicated after
unstable xation of fractures, immediately after total joint
replacement surgery, and after certain skin-grafting procedures.
II. Avoid overzealous motion after total elbow replacement,
extensive skin-grafting procedures, or when extensive
tension-relieving sutures are used for wound closure.
Therapeutic Exercise

Denition
I. Therapeutic exercise is active, participatory exercise done
to improve muscle health and redevelopment, extend the
range of motion of joints, and improve tissue atrophy.
II. The method and application of therapeutic exercise is
customized based on the animals needs and the resources
of the hospital and staff members.
III. Treadmill walking involves the use of conventional
treadmills for rehabilitation and physical therapy.
IV. Aquatic therapy involves the use of water as a medium for
physical therapy.
A. Its physical nature provides buoyancy of the animals
body, resistance to movement, and compression to
body soft tissues.
B. These properties can be exploited to provide earlier
therapeutic exercise.
C. Its resistance and viscosity provide resistance to motion
and can be used to stimulate muscle contractions.

Effects
I. Treadmills are useful for patterning gait and to encourage
early, postoperative weight bearing.
A. The movement of the belt encourages the dog to walk.
B. Activity may be awkward at rst, but most dogs quickly
acclimatize to its motion.

820

SECTION

11 | Musculoskeletal System

Fill to level of lateral malleolus

91% of weight on land

A
Fill to level of femoral condyles

85%

B
Fill to level of greater trochanter

38%

FIGURE 83-1 Dogs in water to the level of the lateral malleolus (A), lateral epicondyle (B), and greater trochanter (C), illustrating the amount
(percent) of weight displacement that occurs with different levels of water. Reprinted with permission from Taylor RA: Aquatic therapy. p. 265. In
Millis DL, Levine D, Taylor RA (eds): Canine Rehabilitation and Physical Therapy. Elsevier Saunders, St. Louis, 2004.

CHAPTER

II. Aquatic therapy involves the use of water as a medium for


physical therapy.
A. Its physical nature provides buoyancy of the animals
body, resistance to movement, and compression to
body soft tissues (Figure 83-1).
B. These properties can be exploited to provide earlier
therapeutic exercise.
C. Water provides resistance to motion and can be used
to stimulate muscle contractions.

Indications
I. Indications for treadmill exercise
A. Treadmill exercise is used to restore muscle mass and
full range of motion after most types of orthopedic
procedures.
B. It can be more effective than leash walking because the
grade and speed of the treadmill can be adjusted to the
animal.
C. Specic indications include the following:
1. Extremity surgery: cruciate surgery, total joint replacement
2. Neurological and orthopedic surgery: intervertebral
disc disease
3. Fitness and agility training
4. To provide strengthening in certain types of neuromuscular or orthopedic diseases
II. Indications for aquatic exercise
A. Aquatic therapy increases strength and endurance,
improves range of motion of joints, enhances the wellbeing of the animal, improves agility, and can reduce
pain.
B. Using the natural buoyancy of water allows for earlier
weight bearing after trauma or surgery.
C. Specic indications include the following:
1. Certain orthopedic conditions: fracture repair, repair of CCL rupture, total hip replacement, treatment
of tendonitis
2. Certain neurological conditions: brocartilaginous
emboli, intervertebral disc disease, polymyopathy,

83 | Physical Therapy and Rehabilitation

821

polyneuropathy, after repair of vertebral fractures


or luxation

Application Recommendations
I. Beginning 3 to 6 weeks after CCL stabilization, level-grade
treadmill walking is started at a speed of 1.5 miles per hour
for 15 minutes and is gradually increased over the next
4 to 6 weeks.
II. Free swimming may be started after shoulder surgery for
osteochondrosis.
III. Underwater treadmill therapy is useful after total hip
replacement and CCL stabilization surgery.

Cautions and Contraindications


I. Treadmill exercise: unstable extremity fractures, fractious
or unruly animals
II. Aquatic exercise: fear of water, open wounds, presence of
external xators, concurrent cardiovascular diseases, unstable diabetes mellitus
Bibliography
Dunning D: Rehabilitation of postoperative patients. Proc West Vet
Conf, Las Vegas, 2004
Levine D, Millis D, Marcellin-Little DJ (eds): Introduction to veterinary
physical rehabilitation. Vet Clin North Am Small Anim Pract 35:1248,
2005
Marsolais G, Dvorak G, Conzemius MG: Effects of postoperative
rehabilitation on limb function after cranial cruciate ligament repair
in dogs. J Am Vet Med Assoc 220:1325, 2002
Marsolais G, McLean S, Derrick T et al: Kinematic analysis of the hind
limb during swimming and walking in healthy dogs and dogs with
surgically corrected cranial cruciate ligament rupture. J Am Vet Med
Assoc 222:739, 2003
Millis DL, Levine D, Taylor RA: Canine Rehabilitation Physical Therapy.
Elsevier Saunders, St. Louis, 2004
Taylor RA: Aquatic therapy. p. 265. In Millis DL, Levine D, Taylor
RA (eds): Canine Rehabilitation and Physical Therapy. Elsevier
Saunders, St. Louis, 2004a
Taylor RA: Orthopedic and neurologic evaluation. p. 185. In Millis DL,
Levine D, Taylor RA (eds): Canine Rehabilitation and Physical
Therapy. Elsevier Saunders, St. Louis, 2004b