Therapeutic exercise can provide a wide range of benefits for veterinary rehabilitation patients. It can be used to increase
range of motion, flexibility, endurance, strength and proprioception. Exercise can help dogs recover more quickly from surgical
procedures or injuries, promote functional independence, and keep canine athletes at peak performance levels. Creating and
evaluating a therapeutic exercise program requires training and experience. In fact, honing these skills is an integral part
of the education of a certified canine rehabilitation professional.
A helping hand: To help Bowser recover after a femoral head ostectomy, Nicole DeFelice, LVT, goes through strength training
and weight lifting exercises with him at Advanced Veterinary Care Group in Canton, Mich. (PHOTO: COURTESY OF DR. ANDREW ROLLO)
Range of motion
There are a number of factors to consider before using exercise to increase range of motion. Do you want to improve active
or passive range of motion? What joint is being treated? Which tissues around the joint are affecting range of motion? In
what condition are the joint surfaces, articular cartilage, joint capsule and ligaments? Keep in mind that it may or may not
be possible to restore a "normal" range of motion depending on the lesions affecting the joint. When you are working to increase
range of motion in a canine patient, the goal is to gain function.
Range-of-motion exercises can be applied actively or passively. In an active range-of-motion exercise, the patient is encouraged
to perform exercises that cause the joint to assume the desired range. An example is using a physioball to get a postoperative
elbow-fracture patient to extend the elbow. The dog is lifted onto the ball with its forelimbs draped over the front. As the
ball is gently rocked forward, it will reflexively extend its forelimbs to protect itself from falling on its nose. In a passive
range-of-motion exercise, the therapist creates the motion. An example is using gentle flexion and extension of the stifle
in a postoperative anterior cruciate ligament repair patient. The success of both active and passive range-of-motion exercises
is determined by using a goniometer to measure joint range of motion before and after therapy.
There is an important distinction between range of motion and flexibility. Range of motion is associated with joint osteokinematics.
Flexibility relates to muscle and tendon elasticity. It is interesting to note that issues related to flexibility commonly
appear in two muscles surrounding the same joint rather than in just one. Therapeutic exercises that focus on stretching can
be initiated once these muscles have been identified.
Not unlike their owners, dogs should always warm up before beginning any stretching work. (In the case of non-ambulatory patients,
E-stim or therapeutic ultrasound can be used for this purpose.) Therapeutic stretches can be active or passive. An active
stretch is initiated by the patient. In a common stretching technique, cookies are used to encourage the dog to reach into
positions that will stretch the affected muscle. Active stretching also can be accomplished with exercises such as walking
through weave poles or around cones set in a tight pattern. Passive stretches are done by the therapist. An example is advancing
the forelimb to stretch the latissimus dorsi and teres major muscles. The patient needs to be comfortable with the therapist
and relaxed and cooperative in order to benefit from passive stretching exercises.
Building endurance is equally important in debilitated patients and canine athletes. Dogs recovering from an extended period
of recumbency have very low endurance. This is because the first fibers lost when a muscle is immobilized are the slow-twitch
fibers, most common in muscles of posture or gravity-resistance. Early endurance work for these patients may involve little
more than assisted standing, with a focus on postural muscles rather than on the cardiovascular system.
On the other hand, building endurance in a canine athlete is focused on the cardiovascular system. Land routines, treadmills
and water can all be utilized to increase strength, speed and duration of effort in these dogs. Heart rate, respiratory rate
and how fast each recovers after a maximum effort are monitored on an on-going basis. Resistance can be used to augment the
effects of any exercise program, which can be done using weighted vests, sleds, resistance bands, hill work and water.