Rehabilitation of the small dog following surgery (Proceedings)

Aquatic therapy

Aquatic therapy is the use of the therapeutic properties of water to provide appropriate exercises for strength, range of motion and endurance while reducing the risk of injury.

The therapeutic thermal effects of water are the same as for superficial heat only more systemic. Passive range of motion and stretches can be performed in warm water to increase stretch and range of motion due to increase in tissue extensibility. The soothing effects of warm water reduce pain and may increase the dog's ability to exert more effort.

Buoyancy property of water is used to increase or decrease the amount of weight bearing on joints and bones.[1]

Reduce Body Weight by 9%-Reduce Body Weight by 15%-Reduce Body Weight by 62% -36% -64% -37% -63% -29% -71%

The actual effect of buoyancy can be very dramatic. Reducing the body weight of the dog by approximately 60% can reduce the amount of stress on a weak joint to

allow the dog to exercise in more natural gait pattern and move more comfortably.

Swimming and use of the underwater treadmill are exceptional therapeutic exercises for the canine. The unique effects of the underwater treadmill include the ability to vary the water depth to increase or decrease the amount of weight bearing the dog has while exercising, vary the speed of exercise, and to control the water temperature closely due to small body of water. Increasing the water temperature can stimulate metabolism, relax tight muscles, help reduce pain, and increase soft tissue extensibility.

Swimming is an excellent cardiovascular exercise and is indicated when zero weight bearing is desired. The swimming dog may not extend the stifle or hip joints. Walking and trotting in the underwater treadmill provides normal flexion and extension of joints with reduced impact and provided more benefit in the majority of rehabilitation regimes.                                                                                                 

Exercise therapy

Canine exercise therapy is an active rehabilitation technique using the dog's natural ability to perform activities. This form of therapy is designed to return the dog to function sooner and to lessen the risk of future injuries. The level of each exercise will vary with the post operative stage of the dog.

An exercise therapy program begins with short duration, low impact activities and progresses to longer time periods with more strenuous activities. The exercise session should include at least one exercise from each of the following sections: strength, endurance, range of motion, and balance.

Strength activities increase the number of muscle fibers and cross sectional area of the muscle unit.

Endurance activities increase the oxidative capacity of the muscles. This reduces the fatigue of the animal.

Range of motion exercises provide:

• Maintenance of physiologic elasticity and contractility of muscles

• Sensory feedback from the contracting muscles

• Development of coordination and motor skills required for functional activities

Balance or proprioception exercises are important to increase the dog's physiologic protective mechanisms.

Post exercise therapy includes icing the affected muscles to reduce any inflammation or micro-trauma that may have been caused during the exercise session.

Proprioception exercises

Physioroll

The ball should be at the wither height of the dog when he is standing. Air can be added or removed to help make the ball the right size.  While many dogs may resist being placed on the ball initially, most dogs relax after to rhythmic movement or bouncing begins.

Place the dog on the ball so that the trunk is supported. Gently roll the ball until the front legs come in contact with the ground. 

Hold and bounce gently for 10 to 20 seconds. Then gently roll the ball so the front feet come off the ground and the back feet touch the ground. Gently bounce for 10 to 20 seconds. The weight is gradually shifted from front to hind limbs and then back again. The amount of weight can be increased or decreased depending on the amount of roll and pressure on the ball. The dog will use trunk muscles to stabilize himself.

Balance board

Place front feet or back feet on balance board. Rock side to side for 20 repetitions. Then turn board and rock front to back for 20 repetitions. Dog will contract muscles and shift weight to stay on balance board.

One leg standing

Lift the leg contra lateral leg. Hold for 10 – 15 seconds. Repeat 2-3 times. Increase time and repetitions as dog's strength is increased.

Cross leg standing

Lift the leg contra lateral leg. Once the dog is balanced, lift the diagonal rear leg. Hold for 10 – 15 seconds. Repeat 2-3 times. Increase time and repetitions as dog's strength is increased.

Cavaletti exercises

Cavaletti Poles can be used to increase range of motion, stride length and stance time in the dog.

Start with poles approximately the same distance apart as the height of the dogs elbow. Trot dog through the poles. Raise, lower or spread apart to reach desired gait.

Sit to stand

Place the dog in a sit position by command or with assistance. Hold a treat at the level the dogs head will be when he stands. Ask the dog to stand.

Down to stand

Place the dog in a sphinx down position by command or with assistance. Hold a treat where the dog's head will be when he stands. Ask the dog to stand.

Gait training

Chronic pain or traumatic injury can cause a dog to alter his movement. This alteration in gait may cause pain or injury to unaffected limbs. Gait training techniques and exercise focus on returning the dog to as near normal movement as possible.

Theraband is an elastic resistance material that can be tied at different locations on limbs to apply resistance or stabilization through the dogs gait pattern. Be careful not to tie the bands so tight that circulation to the limb is compromised.  One example is placing the theraband distal to the tarsal joint as medial and lateral stabilizer of rear limb.

Irritate contra lateral limb – tape a syringe cap on the paw of the contra lateral limb to cause just enough discomfort in the weight bearing limb to encourage weight bearing on the affected limb.

References

[1] TragauerV, Levine D, PT, PhD, OCS, Millis, DL, MS, DVM, Percentage of Normal Weight Bearing During Partial Immersion at Various Depths in Dogs, University of  TN College of Veterinary Medicine, Knoxville, TN, USA, Presented at the 2nd International Symposium On Rehabilitation and Physical Therapy in Veterinary Medicine. Knoxville, Tennessee, USA, 2002.