Canine physical therapy

Physical therapy for canines, or canine rehabilitation, adapts human physical therapy techniques to increase function and mobility of joints and muscles in animals. Animal rehabilitation can reduce pain and enhance recovery from injury, surgery, degenerative diseases, age-related diseases, and obesity.^[1]

The goal of physical therapy for animals is to improve quality of life and decrease pain. Although most veterinary practices offering physical therapy are geared toward canines, techniques used in this discipline can also be applied to horses, cats, birds, rabbits, rodents and other small animals.^[2]

History[edit]

The benefits of physical therapy for animals have been widely accepted in the veterinary community for many years. However, clinical practice of physical therapy for animals is a relatively new field in the U.S. In Europe, equine and canine physical therapy have been widely recommended and used for at least the last fifteen years. In the last three to five years, the veterinary community in the U.S. has seen a large growth in physical therapy practices for animals, making it a more available resource for practicing veterinarians. This growth in the availability of canine physical therapy is forcing a change in focus in many veterinary practices from curative and palliative care to preventive care. An example of this is the push for the use of animal physical therapy for weight reduction in obese animals. Weight reduction can reduce the risk of developing many degenerative diseases such as osteoarthritis and DJD.^[3][4]

Education[edit]

An animal generally must have a diagnosis and referral by a veterinarian to start a physical therapy regime. A certified canine rehabilitation practitioner (CCRP) performs physical therapy. A certified veterinary technician (CVT) may also perform physical therapy techniques if they have been trained and are supervised by a CCRP.

Several programs exist to obtain a CCRP certification. These programs focus on training individuals to apply physical therapy techniques to animals while minimizing discomfort. CCRP certification courses can last from 6 months to one year depending on the program chosen and offer a certification exam at the end of the program

The University of Tennessee[edit]

The University of Tennessee currently offers post-graduate courses and certification for CCRPs through their canine rehabilitation program. This program is directed by David F. Levine and Darryl Mills, and is taught by a combination of veterinarians and canine physical therapists. Educational topics offered include orthopedics, pain management, joint mobilization, and many others. These courses are offered to qualified veterinarians, veterinary technicians, physical therapists, physical therapy assistants, and occupational therapists. Course work is blended between on-site seminars and online courses.^[5]

Techniques[edit]

In an animal physical therapy practice, a CCRP usually confers with the diagnosing veterinarian on the cause and severity of an animal's condition to develop a specialized therapy plan on a client by client basis. Each technique used in animal physical therapy has different benefits and not all techniques are useful for each condition. Physical therapy for orthopedic conditions can include any combination of the following techniques: thermotherapy, cryotherapy, hydrotherapy, muscle building exercises electrical stimulation and coordination exercises. Neurological conditions generally benefit the most from balance and coordination building exercises, muscle building exercises, electrical stimulation and hydrotherapy. Surgical repairs and traumatic injuries are generally treated with heat therapy, cryotherapy, massage, electrical stimulation, and hydrotherapy.^[6]

Massage[edit]

Massage is used in animal physical therapy to relieve tension in muscles and stimulate muscle development. Massage helps speed up recovery from injuries and surgery by increasing blood flow to the area and relieving muscle spasms. Massage is used widely in canine physical therapy and can be helpful in improving the comfort of animals affected by nearly all medical conditions.^[7]

Thermo and cryotherapy[edit]

Thermotherapy is generally used in animal physical therapy before strength building exercises and hydrotherapy. Heat packs are applied to the affected area to increase range of motion, decrease stiffness in joints and increase blood flow. This helps to make the animal more comfortable in the application of other physical therapy techniques. Deep heating of the muscle by laser therapy is often used to stimulate healing of surface wounds and relieve pain and discomfort of constricted and sore muscles. Cryotherapy is often used after an intensive physical therapy session to decrease discomfort caused by inflammation of the muscle.^[8]

Passive range of motion[edit]

Passive range of motion (PROM) is accomplished through flexion and extension of the joint to its limits. It is important for the physical therapist not to stretch the joint past its normal limits. PROM is used to encourage animals to use the full range of motion of the joints. This therapy technique can significantly increase an animal's range of motion and decrease joint pain, improving its quality of life.^[9][10]

Balance Exercises[edit]

Balance exercises make use of equipment designed to strengthen weak muscles and build up limbs affected by atrophy. These exercises include balancing on physio-balls, wobble boards and balance boards. Balance exercises can be useful in animals recovering from surgery. The animal is forced to place weight on the surgical repair, building muscle in the affected area. These exercises can also be helpful for animals with neurological conditions. For example, an animal recovering from a stroke has decreased coordination and balance which can be improved through a physical therapy regime that includes balance exercises.^[11]

Coordination exercises[edit]

Coordination exercises help improve an animal's awareness of its surroundings. Such exercises include cavalettis, weaves, and figure eights. Cavaletti is an exercise that gives an animal obstacles to walk over. This exercise makes the animal focus on where each foot is being placed and builds coordination. Weaves and figure eights help to build coordination and strength by forcing the animal to shift its weight quickly from one side to the other as it turns. These exercises are very useful in dogs suffering from neurological conditions and spinal cord injuries.^[12]

Strengthening exercises[edit]

These exercises include uphill and downhill walking, stairs, standing on 2 or 3 legs, ramps, and sit-to-stands. Uphill and downhill walking are effective physical therapy techniques for increasing flexion of the hip joint. This is a good technique for stretching the hip joint and increasing range of motion in dogs with hip dysplasia and degenerative joint disease. Walking up and down stairs forces an animal's weight to shift fully onto its front or hind legs and builds muscle in the shoulders and thighs, respectively. A simple but effective strengthening exercise for animals with surgical repairs is to force an animal to place more weight than they would normally on the affected limb by lifting the opposite leg. If the physical therapist is attempting to build muscle in the right hind leg, they lift the left hind leg to shift weight onto the right hind leg. To increase the difficulty of this exercise they lift both the right front and left hind legs. Ramps work similarly to uphill and downhill walking. The angle of the ramp can be altered to increase or decrease difficulty. Sit-to-stands work similarly to squats in humans. The animal is asked to sit square on its haunches and is then encouraged to push off its hind legs to stand up. This exercise increases strength in the thigh and stifle joint of an animal.^[13][14]

Hydrotherapy[edit]

Hydrotherapy techniques use water as a tool to improve muscle and joint function in animals. These techniques include but are not limited to swimming and underwater treadmill. Swimming allows an animal to work several muscles at once while stretching further than walking on land would allow. This helps to build muscle and endurance and is a technique that minimizes stress on the joints. Underwater treadmill is used commonly in animal physical therapy. It provides the benefits of land exercises while decreasing the weight placed on the animal’s limbs. Underwater treadmill and swimming can be very useful in dogs recovering from surgery, such as anterior cruciate ligament and cranial cruciate ligamentrepairs and break repairs.^[15][16]

Electrical Stimulation[edit]

Electrical stimulation techniques uses electrical currents to either stimulate muscles or to combat pain. Neuromuscular electrical stimulation (NMES) is often used to help improve muscle strength, and/or motor recruitment. Trans-cutaneous electrical nerve stimulation (TENS) can be used to help relieve the pain that the animal may be experiencing. These techniques are used along with the other techniques listed above.^[17]

References[edit]

1. Jump up^ Hellyer P, Rodan I, Brunt J, Downing R, Hagedorn J, Robertson S. 2007. AAHA/AAFP Pain Management guidelines for dogs and cats. J Am Anim Hosp Assoc. 43:235-248.
2. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
3. Jump up^ Mlacnik E, Bockstahler B, Muller M, Tetrick M, Nap R, Zentek J. 2006. Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc. 229(11):1756-1760.
4. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
5. Jump up^ http://www.utcaninerehab.com/
6. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
7. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
8. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
9. Jump up^ Crook T, McGowan C, Pead M. 2007. Effect of passive stretching on the range of motion of osteoarthritic joints in 10 Labrador retrievers. Vet Rec. 160(16):545-547.
10. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
11. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
12. Jump up^ Holler P, Brazda V, Dal-Bianco B, Lewy E, Mueller M, Peham C, Bockstahler B. 2010. Kinematic motion analysis of the joints of the forelimbs and hind limbs of dogs during walking exercise regimens. Am J Vet Res. 71(7):734-740.
13. Jump up^ Holler P, Brazda V, Dal-Bianco B, Lewy E, Mueller M, Peham C, Bockstahler B. 2010. Kinematic motion analysis of the joints of the forelimbs and hind limbs of dogs during walking exercise regimens. Am J Vet Res. 71(7):734-740.
14. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
15. Jump up^ Jurek C, McCauley L. [Updated 2010]. Underwater treadmill therapy in veterinary practice: Benefits and considerations. DVM 360. Available from:http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/591380.
16. Jump up^ Rivera PL. 2007. Canine Rehabilitation Therapies I and II. Proceedings of the 79th Annual Western Veterinary Conference; 2007 Feb 18-22; Las Vegas. 11p.
17. Jump up^ Mills D, Levine D. Canine Rehabilitation and Physical Therapy, 2e 2013. p342-53