Physical Therapy
There are many physically therapeutic modalities and procedures available to the small animal patient. Post surgical management is a critical determinant of the success rate of many surgeries. Prior to the initiation of a physical therapy program, a thorough evaluation should be performed. The overall goal of physical therapy is to facilitate and expedite successful recovery following an orthopedic or neurological injury or surgery.
Patient Assessment:
Your pet's physical therapy evaluation includes: previous medical history, current surgical or medical therapy, limb range of motion, muscle mass and strength, gait analysis, palpation, neurological and spinal examinations. Although basic physical therapy protocols have been established for routine procedures, it is frequently necessary to make adaptations for the individual patient.
Modalities and Procedures:
Cold Therapy (Hypothermia):
Local hypothermia decreases the messages sent through the nerves, thereby creating mild pain reduction. It produces blood vessel constriction in localized tissues to decrease swelling and relax skeletal muscles.
Heat Therapy (Hyperthermia):
Local hyperthermia increases tissue temperature, thereby producing pain relief, sedation, and an increase in local metabolism. Heat therapy facilitates the healing process by producing blood vessel dilation, thereby enhancing local blood flow and decreasing edema. In addition, localized heat may enhance subsequent soft tissue massage and exercise therapy, and thus should precede these supplemental therapies.
Soft Tissue Massage:
The objective of massage is to increase blood and lymph flow through the massaged tissues. This will increase the delivery of nutrients to the area and hasten the removal of waste products and edema fluid. Specific soft tissue mobilization myofacial release techniques may be used to decrease soft tissue contracture of affected musculature if present. Massage can also stretch tendons and decrease the potential for fibrosis.
H-Wave:
Electrical stimulation in the form of milliamperage, facilitates the reduction of postoperative swelling & edema. H-Wave produces a series of repeated muscle contractions, which allows the blood and lymphatic vessels to constrict and relax rhythmically, in an effort to remove localized edema from the surgical site. H-Wave can also be used at high frequencies, to produce a "TENS" effect or pain relief.
Acuscope:
Electrical stimulation in the form of microcurrent promotes and facilitates the healing of neurological and musculoskeletal tissues. This is accomplished by producing normal electrical activity to affected tissue sites, thus creating "homeostasis", or an ideal environment for healing to occur. Studies have also demonstrated that acuscope treatments have a cumulative effect.
Ultrasound:
In ultrasound therapy, electrical energy is converted into high frequency sound waves by means of a piezoelectric crystal, Thermal effects, probably the most useful, are beneficial for musculoskeletal problems, such as muscle spasms, adhesions, tendon and ligament injuries. Ultrasound is particularly useful in helping to decrease soft tissue contracture of musculature that has been affected during the surgical process, and assisting in breaking down scar tissue.
Neuromuscular Stimulation:
In an effort to prevent disuse atrophy of affected muscle tone during the healing process, the use of an electrical stimulation device creates an artificial contraction of weakened or paralyzed muscles. Neuro-muscular stimulation has also proven to be effective in promoting muscle reeducation.
Hydrotherapy:
Hydrotherapy is an ideal form of active and active assisted exercise. The buoyancy effect of the water provides a gravity eliminated environment which improves movement of affected limbs. Hydrotherapy sessions should begin slowly to accustom the animal to the water and the procedure. Current sources advocate beginning with wading the patient with the water at mid chest level, in an effort to allow the patient to move their limbs without having to support the entire body weight.
The physical therapy regime is enhanced when the water is heated to stimulate vasodilation and improve the rate of healing.
Passive Exercise (Passive Range of Motion):
Passive exercise maintains the normal range of motion and prevents soft tissue and joint contracture. It also improves blood flow and sensory awareness of affected joints and limbs. Paralyzed or weakened pets may be supported by a sling or cart during passive exercise. Treatment should involve flexing and extending the limbs through a normal painfree range of motion.
Active Exercise:
Active exercise helps to improve muscle strength, coordination, and cardiovascular function. Depending on the level of function of each individual patient, active exercise may include the following:
assisted standing
prolonged standing activities
repeated sit to stand activities
weight shifting in standing
tail, towel or sling walking
Active exercise should be performed 1-2 times daily working within the patient's tolerance.
Client Education:
It is important that you encourage and support your pet during their physical therapy. Home care programs may include passive and active exercise, neuromuscular stimulation, hot and cold packs as appropriate and hydrotherapy if available.
Goals of Physical Therapy:
1. Decrease pain and facilitate healing of inflamed and injured neurological and musculoskeletal tissues.
2. Maintain normal range of motion in affected joints, i.e.; hindlimb, forelimb
3. Prevent soft tissue contracture and fibrosis in weak or paralyzed limbs.
4. Prevent further disuse atrophy of affected musculature of hindlimb/forelimb during the healing process of neurological and musculoskeletal tissues.
5. Improve strength and function of weak or paralyzed limbs.
6. Maximize postsurgical recovery and function of the patient.
7. Provide positive psychological effects for the patient and owner.
Physical therapy is particularly helpful in expediting and maximizing recovery of the following patients:
1. Elbow/ Shoulder
2. Spinal
3. Stifle / Hip
4. Brain Disorders
