Physical therapy has been my beloved profession for the past 37 years. I think it’s pretty great, except when it isn’t…!
Does that make sense? You’ve seen me tout the benefits of PT in many blog articles and book pages. It’s time I discuss areas of caution when PT should be avoided or stopped.
Growth plates
Growth plates are located near the ends of long bone shafts in the limbs, They remain open during a puppy’s first months. They tend to close at 9 to 11 months of age.
The texture and quality of bone is softer at the growth plates than other regions.
During this stage, growth plates are susceptible to physical stress and cellular disruption. Growth plates can be stressed by
- trauma
- improper nutrition
- environmental factors, etc.
Physical therapy contraindications to growth plates include
- laser
- ultrasound
- high impact exercise
- thrust manipulation of the spine, hips, stifles, elbows, carpus and hock joints
Infections
PT is dangerous if a fever is present or during an active infection.
The counterindicated modalities include
- laser
- ultrasound
- shock wave therapy
- electromagnetic field,
- some types of electrical stimulation
These treatments typically increase cellular function and therefore could potentially spread or exacerbate the infection.
If your dog is on antibiotics, you must notify the therapist. Some antibiotics cause photosensitivity and laser light would be harmful. Before administering PT, the infection must be under control and responsive to medication.
A recent example
I received a call from a woman whose dog had surgery to repair damage from disco spondylitis. Disco spondylitis is a disease of the spinal discs and vertebral bodies caused by inflammation and infection.
The dog initially improved with surgery and antibiotics and then started to regress after the procedure. The surgeon recommended PT, specifically laser and water therapy.
I did not accept the case until I found out why the dog deteriorated after 5 weeks. Was it due to re-infection, bone softening, cord compression, surgical failure?
If any of these were the cause, laser and water therapy would be dangerous! But if it was simply due to inflammation or small bone spurs formed after the procedure, PT would be of great help! How important to have the right information before proceeding!
Instability
Areas of laxity (typically at the spine, hips, hocks, and carpus joints), which are unstable from trauma, disease or birth defect, become worse with certain therapy treatments.
Wobbler syndrome is a type of instability in the neck.
Hip dysplasia is a form of laxity in the coxa femoral (hip) joint.
Hocks (ankles) can hyperextend after ligament damage and carpus (wrist) joints drop from injury as well as congenital anomalies.
Although PT is helpful in general for all of these conditions, specific precautions and modifications must be made. Maintaining the stability of the affected joints at all times is crucial. This can be facilitated by bracing, splints or wraps.
Stretching and manipulation should be avoided.
A dog with Wobbler syndrome should not be given
- neck traction
- spinal manipulation or
- passive stretching
The treatment of choice for hip dysplasia is manual joint compression rather than pulling or distraction techniques.
Strength of the surrounding muscle is critical for the support of the body area that is lax. However, the exercise method must be carefully adapted.
When strengthening muscles around an unstable joint, therapists restrict excess motion with their hands or by use of weight-bearing “closed chain” isometric exercises.
Muscles can be coaxed to contract by tickling,, tapping and vibrating the skin, while the limb is held still.
Neoplasm and malignancy
I need to be careful here because PT is definitely beneficial for cancer patients via exercise, conditioning and pain relief.
The danger lies in the use of modalities such as
- laser
- ultrasound
- and some forms of electrical stimulation
They should be avoided over areas of neoplasm especially if determined to be invasive and malignant.
These treatments have never been proven to cause cancer, but their application directly over existing tumors may spread cancer cells. Most manufacturers of laser and therapeutic ultrasound continue to list cancer as a contraindication.
From a practical point of view, I feel that laser, ultrasound and all forms of electrical stimulation should be avoided over areas of prolific cancers such as skin cancer and lymphoma.
In other cancers that are more lytic in nature (causing tissue breakdown and destruction) such as bone cancer, the following may be safe to apply for pain relief:
- massage
- TENS
- targeted pulsed electromagnetic field.
Poor response
While this may seem obvious, some pet owners continue to pursue PT in the hopes that it will “eventually” help their dog. Many view PT as holistic and non-harmful. PT is not holistic but part of traditional western medicine.
If there is no improvement in 2-3 visits, the treatment plan should be reassessed and modified to obtain better a better response.
Often, a change in treatment will yield the desired result. If it doesn’t, don’t waste valuable time and resources. Dogs generally respond quickly to PT if it is beneficial. If your dog gets worse after 1-2 visits, stop treatment and discuss a different path of care with your veterinarian.
In the vast majority of cases, physical therapy is safe and provides an important role in veterinary health care.
Your therapist ultimately desires the best outcome for your dog and this is enhanced when you are informed and aware!
Related articles:
Physical Therapy for Dogs: Evidence
Further reading:
Contraindications and Cautions of Animal Rehabilitation, Physiotherapy, and Hydrotherapy