Orthopedic Rehabilitation Techniques

 A couple months ago we looked at ways to facilitate your dog’s recovery from a serious orthopedic injury at home. As well as at-home management, there are many different professional physical therapy options that can help to speed up healing and recovery that you can access independently or through your dog’s veterinarian.


From the column "My Dog Is My Homework" by Kate Eldredge. ShowSight – September 2015 issue. CLICK TO SUBSCRIBE.


Meredith White, MA, CCRA of State College, Pennsylvania, is a Certified Canine Rehabilitation Assistant at the Metzger Animal Hospital. She works with the clinic’s licensed veterinarians to form a therapy plan for each dog that comes through the practice and then handles the day-to-day therapy sessions. The most common injury that White sees is the torn cranial cruciate ligament, followed by iliapsoas strains and injuries to supraspinatus and biceps tendons. They also work with a fair amount of disc and spine injuries, and dogs with bad hip dysplasia or arthritis. “HD and arthritis are not ‘injuries’ per se,” says White, “but common conditions that rehab can help manage.”

I asked White what techniques she uses for orthopedic rehabilitation. “We commonly use some combination of underwater treadmill, land treadmill, therapeutic laser, therapeutic ultrasound and e-stimulation with our patients in addition to manual therapies like passive range of motion, stretching and massage and proprioceptive/strengthening exercises,” she says. The treadmills work just like standard human treadmills, with the underwater treadmill being in a sealed tank that can be filled with water to a height appropriate for the dog. Therapeutic laser is a “cold” laser that is used to stimulate the nerves and muscles to help speed up muscle development. Ultrasound and electrical stimulation work similarly, with the former using ultrasound waves and the latter low-level electrical pulses. “Another favorite of mine,” says White, “are just the plain old walking therapies—uphill/downhill walking, sideways walking, backwards walking, walking figure-8s on the side of a hill, etc. These exercises are easily translated to at-home purposeful activity for the animals and can serve to strengthen about every muscle in the body, enhance flexibility in the spine, and improve proprioception.”


For my dog’s recovery from a cruciate tear, I had a list of stretches and exercises from the surgeon to do at home, and then she also went in about once a week for cold laser and e-stim treatments and did weekly underwater treadmill sessions.


The underwater treadmill has become a popular method for both rehabilitation and standard conditioning. White says, “There is some lively discussion in the rehab world about overreliance on the underwater treadmill, but I stand by it as a great tool for rehabbing a lot of animals. We don’t typically use it as our sole method in rehab (unless an owner requests that), but it is a common tool in our rehab programs.”


So what makes underwater treadmills different from land treadmills? White says, “The buoyancy of water reduces the negative effects of gravity—i.e. wear and tear on joints—and allows weakened animals to move without falling. The viscosity adds resistance that enhances muscle strengthening and cardio conditioning. Water also has the power to trigger an animal’s instinct to get moving.” All of these factors combine to provide a great tool for encouraging and enabling sore or injured dogs to use weakened muscles. As well as helping to build muscle strength, underwater treadmill is useful for cardio conditioning.


A brief aside on swimming versus underwater treadmill—swimming has many of the same benefits, but my dog’s rehabilitation team strongly cautioned against adding swimming to our program until her leg had fully healed. The difference is that when using the underwater treadmill, the dog is just walking like she would on dry land, whereas actual swimming requires a stronger kicking motion (this is especially true with enthusiastic swimmers like retrievers). The injured and weakened muscles need to build up gradually, and hard activity can either slow the healing process or cause additional damage. For my dog we approached swimming like full-out running, and have been gradually allowing it now that her leg has healed and the muscles built back up. Consult with your dog’s rehab team to figure out what is best for your dog!

White recommends introducing dogs to the underwater treadmill gradually. “Most dogs are initially apprehensive about the underwater treadmill,” she says. “It’s weird being in a box that is filling with water! Even weirder when the floor starts moving!” Initial sessions are kept very short, with lots of praise, treats and assurance. If a dog is very small or has limited mobility, someone can go in the tank with the dog to help it figure out what is going on and become accustomed to the process. “A lot of owners tell me, ‘My dog won’t do the treadmill—she hates baths,’ but in the six years that I have been doing this I’ve had maybe five dogs absolutely refuse it initially,” says White. Patience during the introductory phase leads to a confident dog that can fully benefit from the underwater treadmill sessions.


Just like when choosing a veterinarian or orthopedic surgeon, it is important to choose your dog’s physical therapist or rehabilitation specialist with care. White advises, “There are two training programs in the US for rehab education—people should be sure that their rehabbers have either the CCRA or CCRT designations from the Canine Rehabilitation Institute or CCRP designation from the University of Tennessee. These are certifications awarded to individuals who complete specific veterinary rehabilitation training.” States may also have individual laws pertaining to animal therapists—for example, in Pennsylvania therapists performing medical rehabilitation must work in conjunction with licensed veterinarians. “Beyond that, I would say be sure that you choose someone who you feel comfortable working and communicating with,” says White. “The more that you can tell us about your animal, the more appropriately we can choose and adapt the course of that animal’s rehab.”


I asked White what her #1 piece of advice is to owners hoping to prevent orthopedic injuries. “Get your animals to a healthy weight and maintain it!” she says. “Simple advice but really, a significant portion of injury and illness prevention and recovery starts right there. It is also a lot easier to rehab an animal with a good level of fitness going into it.” With a little luck none of your dogs will ever have to go through rehabilitation from a serious injury, but it is good to be prepared just in case.  


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