Is there scientific evidence to back up using canine physical therapy?
Quite a few years ago, a funny commercial appeared on television for Wendy’s, the famous American hamburger fast-food chain. It featured a little elderly lady picking up the top hamburger bun and peering down at the sandwich. She frowns, raises her chin, and yells, “WHERE’S the BEEF?!!!” Remember it? What good is a burger without a hefty amount of beef?
In today’s human and non-human animal medicine, the ‘beef’ is evidence!
The question of ‘Where’s the Evidence’ is an essential part of providing care and receiving third-party reimbursement. Evidence-based medicine is “the effort to place all medical decisions on the strongest scientific proof available”.
The pressure of evidence-based medicine
Health care professionals are under pressure to practice evidence-based medicine.
Is this a good thing?
I’m not the ‘cookbook’ type in terms of being a therapist or in the kitchen! I tend toward creativity and intuition when planning treatment and also when cooking. But, I recognize the importance of considering valid research studies (and tested kitchen recipes) as guidance in clinical decision-making. It shouldn’t be the sole basis, but it should always be a factor.
Using evidence helps assess the effectiveness of therapy and critically document reproducible results.
Yes, it’s a good thing.
Absence of evidence isn’t evidence of absence
Physical therapy and rehabilitation for animals is a relatively new field. As a result, there are few veterinary studies in the literature on which to base decisions.
There are some excellent studies. However, therapists must often go to the human field to find evidence to apply when making therapy recommendations.
Example studies supporting effectiveness of physical therapy
Here are examples of studies and findings which support the effectiveness of various therapeutic interventions in animal rehabilitation:
Cranial cruciate ligament injury and surgery in dogs
Darryl Millis and David Levine (U Tennessee Veterinary School)
The effectiveness of early PT following ligament repair surgery 9both TPLO and non-TPLO):
VetSurg 26:254, 1997.
A similar study on the effects of post-op rehab on limb function after CCL repair
Journal of Am Vet Med 220: 2002,
by Marolais, Dvorak and Conzemius.
These and other studies document significant improvement post-operatively in dogs receiving PT compared to those cage-rested only.
Millis et al. also conducted trials comparing dogs who received electrical stimulation (NMES) to those who received exercise only. Increased muscle mass with greater thigh circumference was present in the dogs having NMES.
Degenerative Myelopathy (DM) and PT treatment
Kathmann and Cizinauskas compared survival time in dogs with suspected and confirmed DM: Journal Vet Med, 2006.
Dogs having daily structured PT consisting of the following remained ambulatory longer than the control group.
- assisted gait activity
- range of motion exercises to the limbs
- swimming exercises and
- underwater treadmill walking
The variety of canines studied included German Shepherd Dogs, Bernese Mountain Dogs, and mixed breeds.
PT for dogs diagnosed with Fibrocartilaginous Embolic Myelopathy (FCEM)
Gandini, G et al, Journal of Small Animal Practice, 2003: 75
Comparison between dogs with FCEM receiving PT and control group. Dogs having the following PT treatments following immediately after diagnostic workup demonstrated improvement. PT treatment had a significant influence on the recovery rate of paralysis.
- water exercise and standing in hydrotherapy pools
- neuromuscular electrical stimulation (NMES)
- stretching and functional strength exercises
Use of laser on wounds
Meta-analysis performed by Woodruff, LD, and Bounkeo, JM; Photomed Laser Surgery Journal 1997, showed a significant positive result in wound repair for human beings receiving laser treatment.
Lucroy and Edwards posted a similar study involving dogs,
Vet Surg Journal, 1998,
Demonstrating rapid wound closure in canines receiving daily laser.
Carpal Ligament injury and bracing
Tomlinson, J E posted a study in Journal American Vet Med Assoc, 2014,
Evaluating the application of a carpal brace plus range of motion exercises and isometric strengthening in athletic performance dogs having unilateral (one limb only) carpal ligament injury (similar to the wrist joint in humans) with instability. Eleven out of fourteen dogs receiving PT and bracing returned to agility activity. In addition, all of the dogs had increased joint stability and decreased lameness.
More studies will shed light on the effects of PT and rehabilitation for dogs in the future. Personally, (wishing I were 25 years younger), I would love to see studies in the following areas:
- The effect of PT treatment on partial cruciate ligament tears (non-surgical) consisting of Laser, NMES electrical stimulation and therapeutic exercise.
- Comparison of rapid onset of PT after injury (within 1 week) v. delayed onset (6 weeks post injury)
The effect of limb patterning, brushing and other sensory stimulation on the recovery of paralysis in spinal cord injury, FCEM, trauma to nerves, etc.
- Any studies on PT for species beyond canine and equine. I hope to see Physical Therapy expand further into feline, avian, caprine and many other species. If you are curious to know some of the most unusual ones, tweet me @animalPTsue and I’ll tell you!
In the meantime, keep your veterinarians and therapists on their toes. When they make treatment recommendations, ask, “Hey, where’s the (beef) EVIDENCE?”
Physical Therapy: Is the Treatment Necessary? Is It Working?
Evidence for Canine Rehabilitation and Physical Therapy