Treatment Philosophy

Physical therapists use a variety of treatment interventions such as stretching, targeted massage, passive range of motion, and joint mobilization. They also use electrical and thermal modalities and therapeutic exercises to help patients reach their goals. These treatments work synergistically to effectively achieve the therapeutic goals. When designing a treatment plan, the therapist should be aware of the scientific evidence supporting the use of each modality and exercise for the problems being treated. For example, when treating postoperative edema, ice has been proved to be beneficial,¹⁵ whereas certain other therapies are unproven. The therapist should integrate the individual treatment plan with established perioperative and postoperative pain management protocols. Although the clinical signs present in many dogs with orthopedic or neurologic problems may improve over time, such as after fracture repair, a well-designed physical rehabilitation program may accelerate the recovery, may prevent permanent disability, and may help prevent future re-injuries.

Patients with movement disorders, weakness, pain, and limited endurance are candidates for physical rehabilitation. Examples of conditions include dogs recovering from orthopedic or other surgeries, dogs with osteoarthritis, tendonitis, or other soft tissue injuries. After a medical diagnosis is available, the therapist evaluates several aspects of the patient’s health, particularly the health of the cardiopulmonary, neurologic, orthopedic, and integumentary systems. The more specific the medical diagnosis, the more directed will be the care. For example, the medical diagnosis for a patient may be osteoarthritis of the elbow and the physical rehabilitation diagnosis for that patient may be limited flexion and extension with cranial and caudal joint capsule tightness. These factors may limit function in terms of gait; improving elbow range of motion through specific treatment interventions may improve the functional status of the patient. In the practice of physical therapy for humans, the areas evaluated include aerobic capacity, balance, arousal, cognition, environmental barriers, ergonomics, posture, gait, pain, range of motion, prosthetic requirements, and assistive and supportive devices. Most of these parameters may be evaluated in dogs.

Physical rehabilitation in veterinary medicine follows the same principles. The therapist collects functional information by evaluating the dog’s physical fitness, orthopedic, and neurologic health. This may be done in conjunction with or after the veterinarian’s evaluations. There is overlap in these evaluations, but although the veterinarian evaluates the patient to obtain a medical diagnosis and to prescribe medical or surgical treatment plans, the therapist evaluates the patient to create a physical rehabilitation treatment plan. This evaluation includes the assessment of muscle mass, joint motion, joint stability, and pain. For example, loss of range of motion may be present with elbow dysplasia, whereas loss of sensation and muscle atrophy may be observed with radial nerve injuries.

Physical rehabilitation plays an important role in prevention of and recovery from injury. Educating owners in proper warm-up and cool-down techniques, for example, may help prevent orthopedic injuries during training or competition. Owners may have a substantial emotional and financial investment in their dogs and are generally very willing to assist in carrying out rehabilitation programs when properly instructed.

Physical Rehabilitation Evaluation

The physical rehabilitation evaluation involves the evaluation of active motion during various gaits and while performing specific activities, such as stair climbing. The dog should be evaluated at a walk, trot, and gallop if the patient is able and it is safe to do so. The evaluation also includes the assessment of function at rest, including posture, balance, and strength. Balance may be assessed by performing various perturbation maneuvers such as pushing the dog off balance and assessing the dog’s response. Balance is further tested by evaluating overall coordination, gait, and whether or not the patient falls. Proprioception during ambulation is tested by evaluating toe dragging, knuckling, awkward stepping, and limb carriage and placement. Strength is tested by evaluating muscle mass and the ability to perform normal activities. For example, hip extensor strength may be assessed by observing the dog when it rises. The evaluation continues with assessment of pain and motion of joints. The therapist evaluates discomfort and the condition of injured and abnormal tissues, such as excessive laxity or restriction of motion as a result of scar formation (Table 12-1). The therapist collects this information to understand how these limitations affect function and how they may be targeted during therapy.

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