Basic concepts of canine rehabilitation (Proceedings)
Veterinary physical therapy is the process of reconditioning body tissues that have been injured or diseased to their previous state or to a manageable state. Potential applications include recovery from medical cases, injuries, or post-surgical cases. There are three factors to consider in a designing rehabilitation regimen. These three areas of influence are the dog's structural, physiology and psychology. The concepts of rehabilitation can be applied to all species that are seen by the Veterinarian. It can be compared to taking a journey and just like any journey our goal is to get from point "A" to point "B". Point "A" is the current state of condition and point "B" is the state we want to achieve. The journey's path is based on common sense with regard to the tissues we want to rehabilitate, rehabilitative tools available and the mindset of the patient.
The first step is to identify the primary problem and the associated secondary and tertiary problems. The primary problem is defined as the tissue structure that is initially injured or affected. The primary problem affects how the body moves and functions. This altered movement places altered forces on the rest of the structure. These altered forces can create secondary and in some cases tertiary problems elsewhere in the body. For example, if the dog has a ruptured anterior cruciate ligament (ACL) of the stifle, the ruptured ACL is the primary problem. The secondary issues associated with this are stifle arthritis, muscle atrophy and hip pain in the injured leg. These secondary issues can create further issues in the other rear leg, the front legs and the vertebral column. The primary problem is a structural issue that leads to other structural issue and associated physiological. The psychological affect is that the dog develops the mental concept that there is pain in the stifle. The mind learns that certain movements or activities result in a pain response. The rehabilitation process then involves repairing the primary problem and correcting the associated secondary and tertiary problems. It should also address the psychological issues associated with the injury and how the patient accepts the rehabilitative regimen.
The most important component of Veterinary rehabilitation is to correctly diagnose the primary problem. The success and recovery speed of the patient is dependent on understanding the primary cause. If the regimen is designed for the wrong problem it will fail to reach the desired outcome.The progression of focus begins with 1) the injured tissue, then 2) the injured limb and lastly 3) the condition of the overall body. Rehabilitation begins by focusing on the disrupted tissue and the surrounding tissue. As that tissue begins to heal and strengthen, the focus widens to the limb. As the limb strengthens rehabilitation should be on rebalancing the body as a whole.
The first phase of the regimen will focus on rehabilitating the injured or diseased tissues. The first priority should be to allow healing to take place. If the techniques disrupt the healing process the rehabilitation program will either be delayed, cause other problems or result in failure. The healing process will be dependent upon which tissues are affected, how bad they are affected and how they have been affected. Structural stability is also very important to healing process. Instability delays the tissue's ability to repair. Activities or modalities that enhance healing can be applied along with activities that act to maintain or recondition the other parts of the body. Phase one of rehabilitation should allow tissue healing, minimize to tissue instability and finally help to minimize body deconditioning.
The second phase of rehabilitation will focus on limb reconditioning. This stage begins when the damaged tissue has healed. It can be phased in with the initial rehabilitation regimen. This phase not only addresses muscle conditioning but also bone, cartilage, muscle and ligament. When musculoskeletal tissue is underused it looses its strength. The nervous communication may need to be re-educated if the structural feedback has been altered. Some examples of aids for this phase would include: adding weight straps to strengthen muscles, uphill stair-work or electrical muscle stimulation. The second phase of rehabilitation should provide for increasing muscle and tissue strength and re-educating the neuronal control of the limb.
The third phase of rehabilitation should focus on reconditioning as well as rebalancing the whole body. Any injury or problem that causes a musculoskeletal fault will create an imbalance of how the physical forces act upon the body. As the affected limb becomes stronger the body as a whole should be reconditioned to handle the changing forces. Activities utilized for this phase are swimming, walking, jogging, jumping, running or other numerous activities. The third phase should act to balance and recondition the body to its new rehabilitated structure or design.
The proper rehabilitative program provides a balance between exercise and recovery. There is a fine line between an aggressive regimen and a conservative regimen. Veterinarians usually error on the conservative side. A common prescription is to let the dog rest for a couple of weeks and see how it is at that time. This usually results in prolonging the rehabilitation time. This can predispose the tissue to re-injury because of weakened scar tissue. On the other hand, an aggressive regimen will re-injure healing tissue thus elongating rehab time. Initially it is better for the practitioner to error on the conservative side and then as they become more acclimated and comfortable with the concepts of rehabilitation they can get more aggressive in their rehabilitation programs.