Therapeutic exercise in veterinary rehabilitation
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.