Canine rehabilitation evolving to aid arthritic, post-op patients
DVM: How has the field of rehabilitation grown in the last few years? Which types of treatments are most common?
Dr. Millis: Our biggest users of rehabilitation are from postoperative care but we are seeing more chronic, geriatric, nagging-injury types of cases, where they have arthritis in multiple joints and they're not candidates for surgery or there's no surgical technique that would be appropriate for them at the present time. They come in primarily for aquatic treatment, both underwater treadmill and swimming. The buoyancy of the water helps take some of the pressure off painful joints plus they receive all of the other benefits of aquatic therapy — cardiovascular, muscle strengthening and joint motion.We still use therapeutic exercises, cryotherapy, heat therapy, passive range-of-motion, stretching; those are all very important parts of rehab. But we're also using things like extracorporeal shock-wave therapy, low-level lasers and neuromuscular electrical stimulation.
DVM: What are the most common conditions you see? Describe the challenges of working with your canine patients.
Dr. Millis: We see a lot of postoperative intervertebral disk patients. They go into and come out of surgery with different degrees of disability. Our goal is to try and keep their musculoskeletal physiology healthy, like providing resistance training, though they may not be able to move their legs, trying to keep some tone in the muscles and normal range of motion in the joints.
As they begin to develop some motor function, the keys are to assist them in a standing position so they can use their forelimb muscles, trunk, abdominal and back muscles to try to keep the body upright, and to begin work on re-patterning their gait.
Swimming is a great way for dogs to use their voluntary motion naturally and begin moving their limbs in somewhat of a rhythmic pattern. The final stage would be normalizing the gait so they don't drag their feet or stand with their feet in an abnormal position, and to work on balancing. We do a lot of proprioceptive activities such a wobble boards, walking on irregular surfaces and other unbalancing exercises. All of those things help dogs learn where their feet are in space and how to respond to perturbations in the position of the body so they don't fall over.
The other common thing we do is postoperative care for tibial plateau leveling osteotomy surgery for cruciate ligament rupture. Initially we work on keeping the swelling down and getting the dog's range of motion back. If we don't get it back by two weeks post-op, some of those patients will have permanent loss of motion. We don't want to have too much force placed on the leg initially because the joint and tissues are remodeling, and if we get too aggressive too early we may actually make things more painful.
So, we do low-level activities for the first three weeks or so. Then we start them on an increasingly challenging program, including limb use, pain control and muscle strengthening. Hopefully by about six to eight weeks after surgery they're pretty much returning to normal.
The biggest challenges of working with dogs are motivation and verbal communication. It's not the type of thing where we can tell them to lift their leg 20 times as in human physical therapy. But there are a lot of things we can use that they like doing and can be trained to do, such as going up and down stairs or sit-to-stand exercises.