What is rehab and why is it important?
You may be more familiar with the term physical therapy in people or human medicine. In veterinary medicine we use the term rehabilitation and conditioning or “rehab”. Same principals just different number of feet on the ground in which we are treating.
Did you realize immobilization, either from not weight bearing on a joint or a joint placed in a cast for greater than six weeks causes irreversible osteoarthritis? This amongst many other reasons are why we promote early return to function either through medical or surgical intervention which many times are combined with a concurrent rehabilitation and conditioning program.
Gone are the days, for example, of six weeks in the kennel post cruciate or fracture repair or a femoral head and neck osteotomy and ‘poof’ you’re healed mentality.
Why?
We also know that dogs can lose 30 to 40% of their muscle mass following cruciate ligament surgery within the first 4 to 6 weeks if not allowed to weight bear early and build muscle. Rehab starting day one will help return these patients to pre surgical performance in a fraction of the time.
“For every day of muscle atrophy, it takes on average three to four days to regain lost muscle. This is why surgical timing is important!”
Another example, if you ever were to have a total knee replacement yourself, the night of surgery you would be placed in a passive assist machine that takes your knee through a gentle range of motion. Day one! We should be equally proactive at regaining range of motion as soon as possible with regards to our individual four legged patients.
Also, dogs lose muscle three to four times faster as compared to humans! And to make things more challenging, dogs develop osteoarthritis within the first few weeks after tearing their cruciate ligament as compared to the human knee which takes years to develop. The biomechanics of the canine knee are complex to say the least.
Another positive correlation is in Dachshunds that experience an intervertebral disk extrusion that have under gone surgical decompression, those receiving aggressive and early post op rehab recovered in half the time as compared with those patients that did not receive early rehab intervention.
Another example in cases involving the knee joint, with rehab performed within two weeks, these patients were able to achieve return to full range of motion while those patient not receiving rehab have some degree of permanent loss of full extension. When a patient is not able to fully extend through the stifle, poor weight bearing was seen on a force plate and as little as a five degree loss of extension can have an appreciably negative effect on ones gait.
These are just a few examples
Overall benefits of rehab
- Increased speed of recovery
- Injury prevention
- Positive psychologic effect for some patients and owner through time and positive engagement
- Increase performance and quality of life
- Increased strength and endurance
- Reduced pain
- Improved biomechanics and flexibility
- Non invasive
- Minimal complications
- Improved cardiovascular performance
- Improved aerobic metabolism
- Increased weight loss
Rehab is not a one size fits all.
Rehab is often considered a part of a multimodal treatment plan meaning there are several different treatment methods all occurring at the same time to improve the end results.
Combination therapies included through rehab:
- Non steroidal anti inflammatory medications
- Various levels of pain medications specific to the individual patient
- Supplements
- Laser therapy
- Nutritional support and weight reduction
- Under water treadmill
- Cold/ heat therapies
- Pulsed electromagnetic field therapies
Manual therapies to include:
- massage
- Passive range of motion
- Active range of motions
- Stretch
- Heat/cold therapies
- Core engagement
- Proprioceptive training
- Weight shifting
- Side bends
- Belly tickles
- Acupuncture and other traditional Chinese medicines and herbal support
- Massage therapy-relaxation, increased circulation, improved range of motion, positive physiological response
(With any exercise or rehab program, vary the exercises/ activities and make it fun. If your pet is anxious or uncomfortable with the task at hand stop/ back off/ don’t make it unpleasant and ask for other options. We want this to be fun! We want everyone in the family unit engaged and ultimately your pet recovers quicker.)
The basic goals of rehab
- Reduce pain
- Retain movement
- Restore function
- Accelerate healing
- Increased quality of life
Common conditions
- Osteoarthritis
- Post fracture stabilization
- Post TPLO, MPL repair
- Post IVDD hemilaminectomy and other neurological conditions
- Soft tissue injuries
- Post Trauma
- Weight loss
- Conditioning
the list goes on….
“Frequent, mild, weight-bearing exercise over an extended period has been shown to help patients reduce body weight, increase joint mobility, and reduce joint pain while strengthening supporting muscles and boosting metabolism”
When to start rehab?
As soon as possible, after injury to prevent unwanted scarring and hardening of what is naturally strong but flexible tissue like muscle, tendons and ligaments. And for the record, a CCL tear is considered a traumatic injury and likewise a surgical scalpel is also traumatic.
How do I start?
Eighty percent of therapeutic exercises are with your hands, expensive equipment is not needed in the beginning and for a large percentage of the protocol. Every surgery or condition is sent home with a home based written exercise program which has been demonstrated and reviewed at each subsequent session or recheck appointments. As your pet progresses, we will assess each individual and discuss next steps to include underwater treadmill, laser therapy, to be determined, as well as, additional and more advanced at home, next level exercises to be performed; again, not your one size fits all plan.
Dr. Murphy completed his CCRP (Canine Certified Rehabilitation Practitioner) certificate at the University of Tennessee, which many consider to be the founding group of veterinary rehabilitation and conditioning. Likewise, the staff at Liberty Hill Veterinary Wellness has benefited from Dr. Murphy’s advanced training and eagerness to train the next generation of veterinarians and technical staff. LHVW has a great staff who loves to get involved in their patients’ recovery from start to finish. Communication is key, and we are always a phone call or email away.