Physical Rehabilitation and the Orthopedic Patient

Stephanie Thomovsky, DVM, MS, DACVIM (Neurology), CCRP

Physical Rehabilitation (PR) is a critical part of successful healing from orthopedic disease.  This is true in human medicine and in veterinary medicine.  It is important, when developing a PR program for a patient with an orthopedic injury that the complete scope of the injury is understood.  It is ideal that a complete diagnosis has been made so that the best recommendations for your pet can be made. 

Many orthopedic injuries and diseases benefit from PR.  Post-operative conditions such as those involving the knee, hip, elbow and shoulder and also the bone repair can all benefit from controlled PR during the healing phase.  PR is also recommended for orthopedic conditions that are not surgical these conditions include but are not limited to sporting injuries such as muscle strains or arthritis.  The goal of PR is to make patients who are suffering from lameness functional and pain free.

Our Purdue PT team works regularly with dogs following elbow surgery to treat elbow dysplasia, dogs who have had their knees repaired following a tear in the cranial cruciate ligament or dogs with hip dysplasia who have had a total hip replacement or femoral head and neck osteotomy (FHO).  We also regularly treat patients following fracture repair or those with significant osteoarthritis.  We also rehabilitate patients prior to surgery, helping to improve their fitness or remove some added weight prior to undergoing a surgical procedure.  We also regularly see patients in pain for whom traditional pharmaceutical treatments are not completely effective. 

Therapeutic exercises utilized in veterinary orthopedic patients are of great importance.  Massage is helpful to improve blood supply, improve muscle elasticity and provide some pain relief.  Massage also allows for quiet time; it is a time when a bond is built and trust gained between the patient and the therapist

Passive Range of Motion (PROM) is an effective tool for any PR program.  It is most helpful in patients who have had some degree of joint or limb immobility.  This immobility can be secondary to pain or a physical restriction such as cast or splint.  PROM allows the therapist to maintain or improve the range of movement of a joint or muscle.

Weight-shifting Exercises can be performed on patients with lameness.  Weight shifting allows animals to build postural muscle strength.  Postural musculature are anti-gravity muscles.  These muscles can quickly atrophy in recumbent or lame animals.  As patients stand, their weight is gently shifted back and forth on their limbs to allow for muscle memory and strengthening.  It also allows animals to gain comfort in standing on their affected limbs.  They realize that it is okay to use and walk on their affected limb again!  Standing on a textured surface increases sensory input from the ventral surface of the paw and helps to build the mind/body connection.

Aquatherapy is extremely beneficial to orthopedic patients enrolled in physical therapy.  The buoyancy of the water reduces joint load and reduces the weight a patient has to carry with each step.  Water resistance also helps to build muscle mass. The warmth of the water increases blood flow.  Swimming is a great exercise for core strengthening and improving limb flexion.  Underwater treadmills are ideal for post-operative patients as it allows for a controlled environment wherein patients can be appropriately supported, build muscle memory, core strength and also confidence.  Speed can also be adjusted to allow for patients with varying degrees of paresis to place their limbs with each step.  Each time they successfully place their limb and move their joints, muscle memory and sensory input is increased.

Electrical Equipment is also helpful when performing PR on an orthopedic patient.  Low-level laser therapy, electrical stimulation, therapeutic ultrasound are all useful tools to have in your orthopedic PR tool kit.  Low-level laser can be used to improve blood flow to the musculature and joints. It can also improve joint and muscle healing. 

Electrical stimulation includes TENS (transcutaneous electrical nerve stimulation).  TENS is most commonly used to reduce pain associated with a surgical incision or musculoskeletal injury.  TENS may also reduce edema, increase perfusion and speed tissue healing.  TENS is a wonderful adjunctive or alternative treatment to commonly used pharmaceutical medications.

Therapeutic ultrasound is also an asset to any successful PR program. It is used for deep tissue heating and also to improve collagen elasticity.  It can be used to heat tissue deeper than the traditional warm pack or heating pad.  It is can effectively be used to warm and loosen tight, contracted muscle bellies and in some cases can help with tendon or ligament healing.

Appropriate controlled PR is a critical component to treatment recommendations for many veterinary orthopedic patients.  A Labrador being allowed to run freely after knee surgery is not controlled PR.  A Labrador being allowed to heal in a kennel for 6 weeks and taken out for 3-4 daily controlled PR sessions is necessary for effective healing.

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