TREATMENT TYPES

Important

The treatment equipment and many of the treatment techniques described below should only be applied by a qualified physiotherapy practitioner. The use of specialised equipment is especially dangerous in the hands of people who have not been properly trained in assessing conditions and are not aware of the correct levels of current, intensity, treatment frequency, etc that need to be applied. In many cases the use of electrical equipment is contra-indicated and will cause damage if applied.

The use of this specialised equipment and these types of hands-on treatment techniques can be harmful if applied by unqualified people. Do not attempt to perform any of the following techniques or exercise without explicit instruction from your veterinary physiotherapist as you could cause surgical failure or injury to your pet.

Spinal and Limb Joint Mobilisation

Joint assessment and mobilisation techniques are very effective in the treatment of painful arthritic joints (spinal or limb) and any injured joints which would also include damage to cartilage, ligaments, muscles or tendons.

There are many causes for joint dysfunction, the most common having trauma and arthritic/rheumatic origins. Trauma results in an injury which ranges from a simple stretch to a severe ligament tear or even a fracture. Arthritis (“arth” meaning “joint “/ “itis” meaning “inflammation”) can be acute or chronic and even infective. It may be due to a congenital disorder (e.g. hip dysplasia) or a secondary cause (e.g. after trauma to the bone, poor conformation, repetitive joint strains or overuse at young age, poor nutrition etc.).

Physiotherapists use a combination of manual techniques to treat both spinal and limb joints. Joint mobilisation is a technique applied to move a joint within its normal range using graded rhythmical passive movements, i.e. the physiotherapist moves the joint. It is not a voluntary movement performed by the patient, but it is under their control and can be stopped at any time.

A manipulation is defined as an accessory movement beyond the normal physiological joint range of movement and is not under the control of the patient. This treatment requires a sound knowledge of anatomy and pathology of joints.

With these techniques, the physiotherapist would be looking for joint restriction due to muscle spasm; evidence of swelling inside the joint; heat in the joint and normal “feel” at end-of-range movement for that particular type of joint, etc

Passive Range of Movement

Passive range of movement applied aggressively can cause pain, resulting in delayed use of the limb and possible joint fibrosis. The objective of this treatment is to gently flex and extend the individual joint through a comfortable range of movement. The animal should not vocalize pain or attempt to bite. Post-operatively or post-trauma, mid-range passive exercises effectively prevent complications and improve the rate of recovery and ultimate outcome. Stretching techniques move into end-range movements and should only be applied by an experienced physiotherapist.

Stretching Techniques

Stretching is really another topic on its own! It can involve both active involvement of the patient and also passive stretching i.e. stretches performed by the therapist or the owner of the animal. Stretching is performed in conjunction with active exercise to improve the flexibility of joints. There are many factors that can create adaptive shortening of the soft tissues surrounding a joint e.g. after immobilisation in a cast, nerve conditions, disuse due to pain etc. The shortened tissue then needs stretching. Stretching can also be used as part of a warming up and warming down programme for athletic patients and is important in the prevention of injuries.

Therapeutic Exercises

Therapeutic exercise programmes are planned by the physiotherapist as an important part of your treatment. These are not complicated but require expertise and experience to know when and how to apply them. Knowledge of the anatomy and the condition being treated ensures the best outcome.

Balance and coordination are an outcome of proprioception – the awareness of where our limbs are in space without having to look at them – which is dependent on learned movement patterns involving both the nervous and muscular systems. A lesser-known benefit of some exercises is the re-education of proprioception. By improving joint movement and building up strength, exercises also help prevent secondary problems of instability and possible recurrence of injury. This is especially important for competitive sporting animals.

Prescribed Therapy Lead Walks

This walk is different from toileting; it serves the purpose of encouraging limb use, preventing further muscle and range of motion loss and providing mild conditioning. The speed of the walk will be set by your pet. At no time should your pet hop on three legs or change their gait so any lameness worsens. Remember an increase in the speed of the walk will increase the degree of lameness. Lead walks will be increased 10-20% per week. Do not exceed your previous walking duration prior to injury.

General points include

Speed/duration/times per day - will be based on the animal's level of function
Terrain - can include (when prescribed by your physiotherapist ) inclines and declines
Inclines and diagonals - walking straight up an incline will target the front and rear muscles, while walking at a diagonal (i.e. to the right) will increase flexion of the left legs and increase the extension of the right legs
Grass - walking in longer grass will help increase flexion of the joints as they have to pick up their feet
Uneven, soft surfaces (gravel and sand) - walking here can help increase weight shifting, provide sensory feedback, provide mild conditioning, and increase the period of time a leg is touching the ground. Be aware that with certain conditions or at certain stages of recovery soft or deep sand can be damaging.
Shallow water - walking through shallow water will also help encourage limb flexion, extension, and weight shifting. Please keep in mind the terrain under the water i.e. if uneven due to rocks or crevices), the water temperature, and if there are any waves.

Neurological Rehabilitation

Physiotherapy aims to facilitate functional return by taking advantage of any spontaneous recovery; stimulating the reorganisation and adaptation of neural tissue function via new experiences; preventing or minimising complications; developing mobility aids/resources that offer a better quality of life. There are various approaches and methodologies used in rehabilitating human neurological patients and a combination of the same variety of principles are useful in treating the canine patient. As verbal communication is limited and where key components of movement need to be performed, sensory stimulation techniques can bridge that gap.

Postural Rehabilitation

This technique influences postural mechanisms and contributes to postural control in the musculo-skeletal apparatus, through vertical righting reactions, rotational righting reactions, equilibrium reactions and protective extension reactions.

Proprioceptive Neuromuscular Facilitation (PNF)

This technique uses specific proprioceptive stimulation to re-educate the neuromuscular system. Mature movement patterns are reproduced as in the movement pattern we would use to bring food from the plate to our mouths or in dogs, the mass movement characteristically used to scratch an ear or hold a bone between the front limbs. Specific techniques include slow reversal techniques and rhythmic stabilisations

Massage

There are many types of massage. However, the choice of technique is based on the effect that is required. Massage can be used for relaxation and general well-being, to increase circulation, lymphatic drainage, to relieve muscle spasm, improve body awareness, tissue lengthening and to build a bond with the animal. Physiotherapists use various massage techniques aimed to mobilise soft tissues in areas where there is restriction and lack of mobility. Assessment and treatment occur at the same time. Massage can be superficial or deep and again the medical condition of the patient must be known to the therapist to ensure the correct treatment is given.

Although massage can be very relaxing, there are situations which massage could be contra-indicated, for example in patients presenting with fever, tumours, infections or hypersensitive areas.

Photon (Light) and Laser Therapy

This treatment produces the emission of a beam of radiation and different wavelengths penetrate to different depths of tissue. Laser therapy and light therapy are particularly effective in the treatment of wounds as they stimulate at an intra-cellular level therefore promoting healing. These techniques are non-invasive and have been shown to be very effective for treating soft tissue injuries, wounds and has been shown to be very effective in pain relief in chronic conditions like arthritis.

Electrical Muscle Stimulation (EMS)

Electricity has been used therapeutically since the 18th century and the faradic current generator invented by Faraday in the early 1800’s is the basis for most modern muscle stimulators. Electrotherapy is used for the restoration of muscle function after injury. These stimulators deliver an electrical signal which causes the muscle to twitch. Varying currents are used: to relieve pain; for muscle re-education even when the nerve has been damaged; for prevention of muscle atrophy; to maintain or improve circulation and to improve joint movement. The electrical frequencies vary, and it is important that they are applied correctly under professional supervision.

Therapeutic Ultrasound

Ultrasound is a very effective treatment used in musculo-skeletal conditions where there is injury to muscles, tendons or ligaments and in conditions where there is restricted joint movement, pain, muscle spasm and wound healing.

The sound waves create a mechanical vibration generated by an acoustic source. The mechanical energy in the tissues is converted to heat, thereby improving circulation which provides pain relief, reduces muscle spasm and promotes healing.

Superficial heating treatments penetrate to about 1cm, but ultrasound can produce deep heat, increasing temperatures in the tissues to a depth of 3cm or more. There are many benefits to this modality but used without the correct training and knowledge it can cause damage instead of healing. It should therefore only be used by a trained practitioner. The mechanical effect is created by ultrasound waves exerting pressure and tensile forces at molecular level in the tissues, i.e. a micro-massage effect.

Thermotherapy – Cold and Hot (superficial vs deep)

Recent injuries benefit from cooling, to reduce the amount of bleeding, swelling and pain. After 48 hours the same injury may benefit from heating, to increase the metabolism and therefore healing. Overcooling has been shown to diminish healing. Generally, swelling is reduced by cold therapies and heat has an analgesic (pain-relieving) effect, reduces muscle spasm and decreases joint stiffness. Heat is usually applied with hot-packs or infrared. Cold is applied with ice-packs, immersion in ice water or cold hosing.

Warning – animals cannot verbalise discomfort easily, they may also have sensation changes and therefore care should be taken when applying hot or cold therapies, to avoid ice or heat burns which can be very painful.

Orthotic Devices

After an accident, illness or surgery it is important to encourage movement as soon as possible. As most pets will drag themselves around if given the opportunity, it is important that they are properly confined. But the question is: how can you get your pet moving without risk of further injury? If your dog has a mobility problem, then splints, braces, walking harnesses and custom-made wheels and carts can assist.

Physiotherapists are trained to assess patients and take measurements for the correct orthotic appliance or walking aid and can provide the appropriate device.

Chest treatments – percussion & postural drainage

These treatments are routine in human care but are not well documented or established in veterinary medicine. Postural drainage is the use of changes in body position to drain specific lung segments by gravity. Percussion is a rhythmical cupping action of the hands on the chest over a specific lung segment that produces a mechanical loosening of secretions.

Performance enhancement - Working and competitive sporting dogs

Physiotherapy checks are also advised for competitive and working dogs. Regular check-ups can detect and treat early signs of muscle tension and asymmetry before they go on to cause an injury. It is also advisable to include land-based exercises to their training programmes to help with muscle strength and tone.

A variety of techniques, exercises and owner advice are available to improve performance in sport horses and competing or working dogs.