CANINE REHABILITATION IN THE GENERAL VETERINARY PRACTICE Stacy Reeder, DVM Animal Hospital of Waynesboro Canine physical rehabilitation can be practiced in a general veterinary practice as well as specialty practices. Patients must have a diagnosis from a veterinarian and their treatment must be under the direct or indirect supervision of a veterinarian. Veterinarians, veterinary nurses, physical therapist and physical therapy assistants are those able to practice physical rehabilitation. There are 2 certification programs - The University of Tennessee and The Animal Rehabilitation Institute. There is the American College of Veterinary Sports Medicine and Rehabilitation as well. One must thoroughly understand the anatomy and basic physiology of the dog. In the veterinary profession, our patients vary in size, shape, and function This makes understanding our goals and their anatomy that much more important. It is also very important to understand what is normal. YOU WILL NOT KNOW WHAT IS ABNORMAL UNTIL YOU KNOW WHAT IS NORMAL. Palpate any patient you can. Feel muscles, joints, bones as well as watch their movement (gait, sit, stand). A pug moves and feels much different than a Golden Retriever. There are several modalities used in physical rehabilitation but one does not need big, expensive equipment to have a good physical rehabilitation program. YOUR HANDS AND MIND ARE YOUR BEST TOOLS! Your hands are used for diagnostics, reassessment, joint mobilization, massage, stretching, assistance in exercise, and much more. Other modalities are underwater treadmills. swimming, land treadmills, therapeutic ultrasound, neuromuscular electrical stimulation, microcurrent, pulsed magnets therapy, laser, cold therapy and heat therapy. All of these are wonderful tools but must be used as part of a program and not as a primary treatment. There are other integrative therapies such as acupuncture and chiropractic that will not be discussed in this lecture. Our goal in physical rehabilitation is to return our patient to a functional and pain free life. Because our patients have different life styles, we must first understand the dog s normal routine. There are several canine sports such as agility, obedience, tracking, earth dog, search and rescue and hunting. Many dogs participate in these activities so be sure to understand the sport your patient is involved in. You need an accurate history from the owner on what the dog s daily routine is and what the owner s goals are. Find out the dog s normal environment - hard wood floors, stairs, yard size etc. It is also important to understand the dog s behavior and what motivates the dog. Some dogs are motivated by toys, others food and others nothing at all (these are the most challenging cases). Understand if the dog is used to being crated, if he/she likes other dogs, if he/she is afraid of noise, water, or storms. Some dogs are also better with the owner present, but I have found most dog s work better away form their owner. Owners need to be involved in the plan and will need to do work at home. Understand the owners physical ability as well as their time constraints. Most importantly, develop a relationship with your patient and build trust. Make it fun for the dog and it will be fun for you! Remember your patient is not just a musculoskeletal system. We must know and understand any other medical issues the dog has - heart disease, metabolic disease, endocrine disease, obesity, etc. We must look at the patient as a whole and understand how the medical issues will affect our treatment plan in physical rehabilitation.
Once you understand your patient and the goal of your therapy, it is time to start your treatment plan. Develop the treatment plan with your veterinarian but always be reassessing the dog at every therapy session and throughout each individual sessions. If the veterinarian is not directly involved with the therapy, you must be aware of any changes, good or bad, that develop. We also want to make sure that the dog is progressing. Remember that little things such as being able to sit are BIG positive steps. BE PATIENT. It often takes a lot of repetition to see progress. You may feel you have made progress at the end of one session and then are back to square one at the beginning of the next session. This is normal. Don t get frustrated and look for the small things. Most programs are going to involve manual manipulation and therapeutic exercise. You must be trained to do either of these. Exercises may seem simple but if done wrong, they can be detrimental to progress and train abnormal movements. Remember to vary your routine Don t be afraid to change your treatment based on assessment and willingness of the dog. The following are the different treatment options for the majority of patients. STRETCHING - isolate the muscle and know its origin, insertion and function active or passive TRACTION - tail hanging cervical 2 man JOINT COMPRESSIONS PASSIVE RANGE OF MOTION Passive Range of Motion 1 Toes take each toe and move it back and forth through a full range of motion - 6-8 reps in each direction 2 Hock/ankle the ankle joint will not fully flex without the knee flexing, but take the joint and go in each direction until you get resistance 6-8 reps 3 - Knee and ankle together bend the knee by bringing the ankle up toward the rump and bend the ankle forward push gently up on the bottom of the foot. Hold in position for 3 seconds and move in the opposite direction to straighten out the leg 8 reps in each direction 4 Hip hold the leg at the knee and move the leg backwards for about 20 degrees and then forward to 20 degrees 6-8 reps in each direction THERAPEUTIC EXERCISES Side Bends Have the dog stand straight and lure his nose back to each hip, don t let him have the treat until his nose is back to his hip. Lift his head straight up and down between his front legs as well. Bring the nose back in a downward motion to each toe.
Two and Three leg standing Lift any leg off of the ground and hold for 3-4 seconds. Randomly pick different legs and eventually pick up 2 legs at a time. Gradually extend each leg that is being held either forward or backwards. Eventually work to holding out one front leg and the opposite rear leg. Dancing Hold both of dog s front legs and have him stand for several seconds. Once he is comfortable standing, have him take small steps forward and backwards. High five/ scrunchie on nose place a hair scrunchie on dog s nose so he has to paw it off using his front feet. This promotes extension of shoulders. You can also place a ball of tape on his head and when he paws it off, reward him. Gradually decrease the size of the ball until he does a high five on command Happy Butt Dance Scratch the top of the dog s rear most dogs will start to dance in a side to side motion Sit to Stands Ask the dog to sit and make sure he sits square with both hips under him. Ask him then to stand and repeat several times Beg Have dog sit square and ask him to raise up while sitting. It will look like he is sitting up like a groundhog. Sphinx lying to a stand Have dog lay on his chest as a sphinx and ask him to stand and repeat several times Bow From a standing position ask dog to lower his front and stretch backwards while keeping his rear in the air Hill Walking and Zig Zags Walk straight up hills and alternate by walking at different angles up the hill so inner and outer leg muscles are used Weaving Use cones/bottles/flower pots and set them as far apart as the dog is tall at the shoulders. Always use an even number of cones. Lure the dog through the cones 6-8 laps. Gradually tighten his turns Poles Place poles approx 14-16 inches apart. Use 6-10 poles and make sure they are at least 24 inches long. Start with the poles on the ground and have the dog walk slowly over them. Do 6-8 laps and once he is comfortable ask him to walk backwards through the poles. The height of the poles can be gradually increased to the level of mid-forearm. Tug of War Teach dog to tug in a straight motion backwards. Limit side to side motion Zeus get up Have the dog lay in lateral recumbency then hold onto the lowermost front limb and coax the dog to stand. Do both sides equally.
Tail Traction This can be done standing, sitting, or lying down. Hold the base of the tail and pull straight back, hold for 3-5 seconds and repeat slowly. Repeat 20-30 times Ball Start with the dog s front feet on the ball and gently rock or bounce the ball several times. Eventually work the dog over the ball so all 4 feet are off the ground if possible. Then move the dog forward so his front feet are on the ground and his rear legs on the ball. Gently rock or bounce the ball in each position. Keep him on the ball for 5-10 minutes/session Circles Keep the front feet in one position and ask dog to move its rear legs in a circle around the front feet. Switch and do the same with the rear legs staying stationary. You can then add blocks to the stationary feet. Pillow walks Walk dog over pillow or soft surface such as a mattress. Balance Board Place board over small pillow or ball and have dog stand on the board with either front or rear legs. Gently rock the board in various directions. The feet off of the board are doing the most work. Crawl Have the dog in a down position and ask dog to crawl forward. Walking under poles place pole at level of shoulder and ask dog to walk under the pole. THERAPEUTIC ULTRASOUND HEAT AND COLD THERAPY NMES LASER SWIMMING/ UNDERWATER TREADMILL LAND TREADMILL