Veterinary medicine and surgery are continuously evolving and advancing, along with owner expectations and compliance. I strongly believe that rehabilitation and therapeutic exercise should be considered an important adjunctive to canine medicine, surgery and recovery. Rehabilitation doesn’t have to be expensive with lots of fancy machinery, and therapeutic exercises can be used both in practice and at home. There are many small alterations which can be made that in turn can improve recovery.
Before we consider the types of basic exercises and techniques we can consider using with our patients, it is important to remember some basic anatomy. This allows us to make informed choices, depending on the stage of disease or healing which we have present.
Muscle atrophy and loss of strength can occur as quickly as one week post-immobilisation. Muscle bulk is not directly relational to muscle function, and effective rehabilitation for restoring muscle mass will need to consider altered proprioception and neuromotor function. It is important to ensure adequate range of motion is restored.
Cartilage, found at the end of long bones, acts as a weight bearing surface and transmits the stress applied to the underlying bone. It is avascular and therefore some minimal loading exercises are needed to deliver nutrients and remove toxins from the area. If cartilage becomes dry, it causes pain and, in some cases, can fuse a joint.
We need to think about when rehabilitation may be appro-priate in practice. Here are some examples, but the list is by no means exhaustive:
- Post orthopaedic surgery
- Post spinal injury or surgery
- Debilitating musculoskeletal disease – such as disc protrusion, ﬁbrocartilaginous emboli, vestibular disease
- Genetic disease – hip and elbow dysplasia
- Old age degeneration
From this list you can see there are a lot of conditions and situations in practice where rehabilitation is appropriate. I ﬁnd it easier to think – “if there is something occurring with my canine patient which is going to result in either an abnormal gait or a period (greater than a week) of altered exercise” then some form of rehabilitation plan should be developed. This will speed up recovery, or slow the advancing clinical signs and maintain the patient’s physical and mental status.
There are many different types of rehabilitation available to us, but I ﬁnd it much easier to stick to some regular “go-to” type exercises and actions for day-to-day patient care (Box 1). I ﬁnd these make it easier for other staff members to complete and follow rehabilitation plans. Below are some of my day-to-day go-to choices and reasons for using them.
Cryotherapy, icing using cool packs, is used to encourage heat out of tissues, therefore reducing inﬂammation. The policy in my practice is to use cool packs on all orthopaedic patients when recovering from surgery. They should be used immediately post-operatively, and they should never be used directly over metal implants as they can conduct the cold. It is important to never apply directly to skin – some cool packs come with covers, otherwise I use a pillow case – and to never exceed an application time of 10 minutes. The average penetrative depth is 1cm, and they should be used three times daily for ﬁve minutes, or twice daily for seven minutes.
Manipulation of muscles and associated soft tissues promotes blood and lymph circulation, mobilises tissues, improves tissue elasticity and helps patient relaxation and pain relief. Massages are contraindicated for cases of unstable fractures, neoplasm and infection. There are three main methods:
- Stroking – gentle, sweeping movements across muscles. Generally you should begin with a relaxation and preparatory stage, before more in-depth work
- Efﬂeurage – similar to stroking but with a ﬁrmer pressure, follow contours of musculature and avoid bony prominences
- Tapotement (percussion) and petrissage – more vigorous and stimulating techniques which should only be carried out by somebody trained in their use
Joint range of motion (ROM)
This technique is used to keep joints moving in as nor-mal a way as possible. There are two approaches to this: passive, where we move muscles/limbs manually and the animal does nothing, and active, where the animal does the movement encouraged or assisted by us (eg getting them to sit then stand will result in hip, stiﬂe and tarsus ﬂexion then extension). Whether active or passive, these exercises are essential for normal joint nutrition and cartilage health. It is important to move joints through a full range of motion and hold stretches for 15 seconds. However, if scarring is present start with a maximum of seven seconds.
This is one of my favourites and we do see some great results from this simple exercise, made from household items. Abnormal gaits can be caused by poor nervous messages, as well as habit and pain, so stimulation by various different textures will help stimulate nerves and muscle movements.
All you need to do is get as many different materials as possible, lay them out in a long line and slowly walk the dog over them. My favourites include a shower mat, rafﬁa door mat, rubber matting, corrugated cardboard, foam mat, duvet and bubble wrap.
You should do this twice daily from day three or four after injury.
Figure of eight or serpentine walks
This is another of my favourites and you don’t technically need any equipment for this exercise. However, some own-ers ﬁnd it easier to place markers, such as bean poles or cones, at points to walk and weave around (Figure 1).
This technique is used to improve proprioception, weight shifting and ﬂexibility. You should initially start with a large ﬁgure of eight, and as the patient’s skill improves, you can make the circumference of the ﬁgure of eight smaller.
These are just some of the easy-to-use rehabilitation techniques which could be used in practice – it is important to measure the outcomes of your rehabilitation plan. In the hospital or surgery setting this can be done via the patient’s care plan and monitoring sheets, and at home it is useful to use pain and mobility scoring sheets for owners to complete, charting activities such as getting up, climbing steps, grooming, etc.
Rehabilitation is an area where nurses can excel; it is about spending the time with the patient, building that bond and carrying out techniques to improve their care. If rehabilitation is something you would like to know more about there are lots of CPD options, ranging from basic courses through to formal qualiﬁcations in rehabilitation. Once you have focused on basic rehabilitation for your sick or injured patients, you can also consider preventative rehabilitation. For example, how can we educate owners to perform exercises and tasks with their dogs from a young age to minimise problems in later life? Should we be encouraging owners to perform exercises to improve core strength from a young age? Should we encourage owners to teach alternate lead walk from a young age? But that’s a whole other topic to consider!