The medical establishment, at least on the human side of things, has been preaching the gospel about the benefits of physical therapy for a long time.
One of my family members recently had hip replacement surgery. Her doctor went so far as to say that he could perform a flawless procedure, but if my Aunt didn’t hold up her end of the bargain with physical therapy, the surgery didn’t have a chance of succeeding. If only we veterinarians could explain that to our patients! Vets and owners must work together to make sure that dogs get the physical therapy they need.
Why physical therapy?
I cannot overstate the benefits of physical therapy.
Some dogs can’t regain normal or even minimal function after surgery, injury or illness without it. Take a look at a study published in 2002. The study reported that dogs receiving physical therapy after surgery to repair a ruptured ACL used their post-op legs as well as their normal legs. On the other hand, dogs that were rested for six months after surgery still favored their post-op legs.
The goal of physical therapy is to maximize mobility and comfort regardless of the condition.
Strength, flexibility, awareness of body position and endurance all come into play. If your dog suffers from a musculoskeletal or neuromuscular condition like arthritis or intervertebral disk disease or is facing surgery, ask your veterinarian whether he or she is comfortable coming up with a physical therapy plan or whether you should be referred to a canine physiotherapist (that’s a therapist who works with dogs, not a dog who is a therapist).
If your veterinary surgeon does not emphasize the importance of physical therapy after musculoskeletal or neurosurgery, consider finding a different surgeon.
Plans vary depending on the condition and where an individual dog is in the recovery process. In uncomplicated situations, you may be able to provide your dog with everything he needs at home. In other cases, appointments with a trained physiotherapist will be necessary.
Following is an overview of common physical therapy techniques, with an emphasis on PT recommendations after repair of a ruptured ACL.
Postoperative physical therapy can often start as soon as the last skin suture or staple has been put in place.
The nursing staff may ice the surgical site before your dog has even completely awoken from anesthesia. This is called cryotherapy and serves to reduce swelling and pain after a trauma has occurred.
Cryotherapy usually continues for several days after surgery. At some point, warm heat may replace the cold packs to help your dog’s body eliminate any persistent swelling.
Passive range of motion (PROM)
Passive range of motion exercises (PROM) and massage start soon after surgery, although the exact timing depends on what type of procedure has been performed. You may be instructed to flex, extend and/or rotate your dog’s affected joint(s) to the point where you feel mild resistance but your dog is not experiencing pain. PROM and massage help prevent a patient’s soft tissues from tightening up.
Later on in recovery, stretching may be added to your dog’s regime. Stretches are similar to PROM exercises except that a little more pressure is applied. A range of motion and stretching can be passive (i.e., you move your dog’s legs) or active, during which you encourage your dog to move and stretch himself.
Leash walking is an important and commonly used form of physical therapy. Use a short leash, keep the pace slow, and to reduce the chances of slips and falls, pick an area that has a relatively level and even surface, to begin with. The goal is to get your dog to start bearing weight on the affected limb. If your dog is reluctant to do so, and you have checked with your veterinarian to make sure that pain control is adequate and your dog’s recovery is on schedule, you can push him gently from the opposite side as he is about to place his affected leg down. Sometimes dogs seem to think “hey, I have three good legs. I’m not even going to bother with this other one,” but this can lead to big problems if it is allowed to go on too long.
Once healing has reached a certain point, more aggressive exercises can be started. Leash walksincrease in length and trotting, ramps and stairs may be added. Other activities that force your dog to really bend, stretch and use his muscles can include:
- Repeatedly asking him to sit and then stand
- Weaving between poles or cones set in a line
- Figure eights
- Dancing – stepping forward, backward and side to side
- Cavalettis – stepping over poles set on blocks of varying heights and distances apart
- Feeding from elevated food dishes
- Physioballs – draping the body over or placing the feet on a large ball and then rolling it to and fro
- Rocker boards – standing on a platform that can move a small distance in two directions
- Wobble boards – standing on a platform that can move in all directions
- Balance blocks – placing the feet on blocks that can be slid in any direction
- The addition of weights to any exercise
Underwater treadmills are a wonderful addition to most physical therapy programs, but they are expensive and you may have trouble finding a veterinarian or therapist who has one in your area.
Swimming is sometimes referred to as the “poor man’s” underwater treadmill, but the two activities are actually very different. Some dogs barely use their hind end at all when swimming. That limits its effectiveness for problems affecting the hind legs. Also, swimming is a strenuous exercise. Dogs that are not used to it can easily overexert themselves, which leads to more problems than it solves.
Whatever form of physical therapy your veterinarian or physiotherapist recommends, follow through with it, even if your dog seems to prefer lying on the couch.
Your canine companion is counting on you to help him make it through his illness or injury and emerge on the other side as much like his old self as possible.