Rehabilitation is a combination of physiotherapy, massage therapy, thermo/cryotherapy, electrotherapy, ultrasound therapy, phototherapy, hydrotherapy and manual therapy to reduce pain and enhance recovery from injury, surgery, degenerative diseases, age-related diseases, and obesity.
You may be thinking "Whoa that's a lot of therapy! What do they all mean?" On simple terms, rehabilitation uses exercises, stretches, massages, different guided movement of the body, some non-invasive electricity, lights/lasers, heat, cold and some swimming, all with the goal of pain relief, building of muscles, improve confidence in mobility and enhance recovery.
Compared to traditional western medical treatment, rehabilitation do not produce fast results. It requires commitment and consistency of the sessions to produce gradual yet long lasting improvement of the condition.
Although most veterinary practices offering physical therapy are geared toward dogs, techniques used in this discipline can also be applied to horses, cats, birds, rabbits, rodents and other small animals.
Rehabilitation is performed by a trained veterinary rehabilitation therapist. The patient first needs to get a referral form from the veterinarian, follow by a full assessment by the rehabilitation therapist where the therapist will run through a series of questions follow by a physical assessment on the patient to gather important information in order to design a program that is catered to the needs of the patient.
The Modalities
1. Physiotherapy
The most commonly known among the modalities. Physiotherapy uses 3 main types of exercises; balance exercises, coordination exercises and dynamic exercises.
Balance exercises uses positions or equipment designed to designed to strengthen weak muscles and build up limbs affected by atrophy. Examples are lifting 1 or 2 limbs off the animal or using equipment such as physio-balls, wobble cushions or balance boards. They are often coupled with manual shifting by the therapist to work on targeted muscle group on the specific limb. The muscles worked in this exercise are mostly anti-gravity muscles and the core muscles, which are very important for the daily movements of the animal.
Coordination exercises helps improve animal's awareness of it's limbs and surroundings. These exercises are often used on animal's with neurodegenerative conditions. These exercises include cavaletti, weaves and figure eights to help build coordination and strength by forcing the animal to shift its weight quickly from one side to the other as it turns.
Dynamic exercises are mostly used on animals with healthy joints. Dynamic exercises often requires treats as a form of motivation for the animal to exercises that require joint movements. Such exercises includes push-ups, slow staircase climb, sit-stand.
Benefits of physiotherapy include pain-relief, strength building on anti-gravity muscles, increase core strength, improved flexibility of the muscle, improved awareness and coordination of limbs, slow down degeneration of muscles and nerves, improve blood flow, improve cardiovascular health and improved energy level.
2. Manual therapy
Manual therapy techniques are skilled hand movements and skilled passive movements of joints and soft tissue and are intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. Techniques may include manual lymphatic drainage, manual traction(stretching of spine), massage, mobilization/manipulation(stretches and manual movements of the body), and passive range of motion(manual rotation of the limb joints).
3. Massage therapy
There is a misconception that rehabilitation is all about massage only. However massage is only one of the modalities used in rehabilitation. Massage therapy is considered a type of manual therapy. It is the systematized manipulation of soft tissues for the purpose of normalising them. Massage can range from strokes, kneads and rhythmic percussion. Coupled with different strength, speed and the different location the massage is performed on the body, these creates a huge range of different types of massages that are used for different purposes and to achieve different results. Different names are massages are effleurage, petrissage, tapotement, acupressure massage, Tui Na, ischemic compression etc.
There are 2 influences of the massage on the body. The mechanic influence is the physical influence of muscles, ligaments and tendons. It improves blood flow, strengthening muscle, reduce muscle tension, slow down muscle degeneration, breakdown toxins, promote good cardiovascular system.
The reflexive influence is the influence of the nervous an endocrine system. Some of the benefits are improving immune system, balancing autonomic nervous system, release natural cortisone and endorphins, improve vital organs function, improve fur and skin quality
4. Thermo/cryotherapy
Thermotherapy is the use of heat to treat symptoms of acute or chronic pain, especially those related to muscle tension or spasm. Thermotherapy widens blood vessels and increases blood flow to the skin. It relaxes superficial muscles, decreases muscle spasm and reduces stiffness of joints. The heat may come from infrared light source or a simple heat pack.
Cryotherapy, also known as ice application, is the simplest and oldest way to treat injuries. it is a popular and well known because of its effectiveness, convenience, low cost and ease of transportation. Cryotherapy is good for pain relief and can be used in both acute and chronic pain. It also decreases oedema, nerve conduction velocities, reduce muscle spasm, improve muscle fatigue, increase cellular metabolism and local blood flow. The effect of the cryotherapy depends on the method, the duration, temperature of the ice and the depth of the subcutaneous fat. They can come from ice packs, gels or cryotherapy machines.
5. Electrotherapy
It is a treatment that directs mild electrical pulses to the problem area. These electrical pulses are often generated from a battery operated machines. Here are some of the commonly used electrotherapy for animals:
Transcutaneous electrical nerve stimulation(TENS)
TENS therapy typically uses electrodes on small, sticky pads attached via wires to a battery-operated device. The electrodes are placed over the area in pain, and current is sent through the electrodes, stimulating the sensory nerves and creating a tingling sensation that reduces the feeling of pain.
A hand-held controller allows the individual to select from a range of options, such as high frequency or low frequency current as well as complex patterns of stimulation.
Electrical muscle stimulator(EMS)
An EMS appears similar to a typical TENS unit, with electrodes attached by wires to the small, battery-powered stimulator. In EMS, the current is directed at weakened muscles, rather than nerves, prompting the muscles to contract and gradually regain their strength.
EMS can be helpful for rehabilitation after muscles have been weakened substantially or for less serious conditions, such as a pulled muscle.
Pulsed Electromagnetic Field Therapy
PEMF involves generating and directing powerful, pulsed energy waves toward damaged or injured areas of the patient’s body. These waves quickly pass through the cells in the damaged region, increasing the spin of the electrons contained within them as a result. relieves edema, inflammation and pain by stabilizing leaking cell membranes. The device is easily applied over the wound dressing, and has no known side effects for either the mother or the infant.
6. Ultrasound therapy
Ultrasound (US) is a form of mechanical energy (not electrical). Ultrasound is the usage of high sound energy, which causes molecules to vibrate on the spot when in contact with the sound energy. The molecular vibration generates heat. While most modalities are used to reduce inflammation, ultrasound therapy actually promotes inflammation or rather, it optimises inflammation. Inflammatory process is essential to the effective repair of tissue, and the more efficiently the process can complete, the more effectively the tissue can progress to the next phases of healing. This is how ultrasound can enhance healing. Other benefits of US is the softening of scar tissue and pain relief.
7. Phototherapy
While there are many different types of phototherapy, the one we'll be talking about is the most commonly used in animal rehabilitation, the Cold laser therapy. It is low-intensity laser therapy that stimulates healing while using low levels of light. The technique is called “cold” laser therapy because the low levels of light aren't enough to heat your body's tissue. They are commonly used for pain relief, anti-inflammation, skin rejuvenation, would healing and also stimulating of acupuncture points.
You may start to wonder, what about hot laser therapy? Well there are no such thing as the hot laser therapy as of now as hot lasers are used to cut through tissues!
8. Hydrotherapy
Hydrotherapy can be done in a good sized pool or hydro treadmill machine. The main difference is the hydro treadmill is a more controlled environment to work on the animal but the pool is more enjoyable for most dogs! Water can be used efficiently for trauma treatment, as well as to maintain good health and injury prevention. Variation in temperature can aid in healing process in injuries and stimulate the body's inherent healing ability. Hydrotherapy provides a weightless environment for the animal to exercise, this aids in building muscle mass, joint range of motion without causing pressure on the joints. Some of the benefits of hydrotherapy includes increasing blood circulation, improve energy level and one of the most effective way to improve cardiovascular. Because the animals are exercising in a weightless environment, the muscle built are mostly propulsion muscles, muscles that helps the animal to move forward. Hence it is still important for animals to have a combination of land exercises to build the anti-gravity muscles.
“Rehabilitation is the use of non-invasive modalities that supports the body's natural healing ability to heal.”
Its never too early to start on rehabilitation!
If you have read all of the above, you will notice that the modalities are additional aids and support, the healing is still largely dependent on the animal's body. So starting the introduction to rehabilitation while their healing ability is at their optimum, which is when the animal is young, is very important. This facilitates a smoother rehabilitation when they are much older. Never wait for problems to become obvious before starting rehabilitation because the results are often not as ideal as compared to those that start young. Prevention is the best cure!
If you're unsure if its time for your animal to start the rehabilitation or not, it is always good to bring in for a "servicing" of the dog's body to have an ease of mind!
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