Rehabilitation of patients with acute, chronic, neurologic, or orthopedic conditions involves the application of controlled challenges to tissues to improve strength, condition, and function.
Intervertebral disk disease is one of the most common disorders that produces paresis/paralysis in the dog. Degenerative changes within the disk can cause protrusion into the vertebral canal, causing compression of the spinal chord. This can cause severe pain with loss of movement and feeling of the legs.
Physical rehabilitation uses the same techniques that physical therapists use on patients with stroke and cerebral palsy. It does help to decrease spasticity of the muscles, with pain management and earlier ambulation.
Arthrodesis is the surgical fusion of a joint. It a procedure that is done on many situations trying to avoid amputation (e.g. irreparable fracture of a joint, unstable joint, severe osteoarthritis, and neurological injuries).
Rehabilitation does help the animal to adapt faster, and to support the surrounding joints. The other joints on the leg having the arthrodesis can suffer from compensation, rehabilitation does also help the other joints to move and function better.
Limb amputation may be performed as a treatment for cancer or for severe soft tissue, orthopedic, or neurologic disorders.
Therapeutic exercises are developed to help the animal adapt to the new center of gravity. In older dogs that may have neurologic conditions on top of the amputation, teaching them transitions (from lying down to sitting to standing) is an important role of rehabilitation.
Acute complications occur as a direct result of the trauma sustained and can include damage to the blood vessels, nerves, or soft tissues.
Rehabilitation uses different modalities that help decrease the inflammation and swelling right after the injury or the surgery to correct the fracture.
Normal bone formation is influenced by mechanical stress. Delayed union or non-union of a fracture is the failure to heal within the expected time. Malunion refers to union of the fracture in unsastifactory position.
Delayed union and non-union may be managed conservatively by putting load on the bone by controlled weight bearing and pulsed electromagnetic field therapy during rehabilitation.
Total Hip Replacement eliminates the joint, thus eliminating joint-associated pain. The hip joint is replaced by a prosthesis.
One of the most common postoperative complications is hip luxation, so muscle strengthening after a period of healing is an important part of rehabilitation.
FHO is the removal of the head of the femur to let it heal with fibrous tissue (scar tissue). Pain is relieved by elimination of bony contact between the femur and the pelvis as scar tissue interposes.
After FHO the femur tends to be located more dorsally than normal so there is a functional shortening of the leg, which can cause gait abnormalities.
There is an emphasis on regaining hip extension during rehabilitation after FHO, as well as strengthening of the hindlimb muscles.
Hip luxation is common and usually due to severe trauma. However, the presence of hip dysplasia may diminish joint stability and predispose to luxation with less severe trauma.
After surgical reduction of the luxation, immobilization with a sling may be needed for 1-3 weeks.
After removing the sling, rehabilitation goals are to help with hip extension and muscle strengthening.
Legg-Calvé-Perthes Disease involves spontaneous degeneration of the head on the femur bone, located in the dog’s hind leg. This results in disintegration of the hip joint (coxofemoral) and bone and joint inflammation (osteoarthritis).
The etiology is unknown, although a genetic component has been identified in some breeds.
Dogs usually are limping between 6 and 10 months of age.When is chronic, there is muscle atrophy of the hip and thigh muscles.
The treatment of choice is FHO. Prognosis is good after surgery, provided appropriate rehabilitation is performed beginning immediately after surgery.
Cranial Cruciate Ligament (CCL) Rupture is one of the most common orthopedic conditions in dogs.
Trauma-induced acute rupture of the CCL results in gross instability of the knee, and the dog will show limping and not want to put his leg down. However, most cases of CCL rupture in dogs occurs as degeneration of the ligament. In these cases the limping may be intermittent, as they can have partial rupture of the ligament. In either scenario osteoarthritis changes occur with time and result in less use of the leg.
For more information on the CCL rupture and Surgical treatment, please see this video:https://www.youtube.com/watch?v=CNymdzyRavs
With or without surgery, rehabilitation is important for the dog to regain full use of the leg. CCL rupture causes important muscle atrophy, and part of the physical rehabilitation is dedicated to build up muscles on the back legs.
Medial Shoulder Instability is thought to result from chronic repetitive activity or overuse, such as jumping.
Dogs typically develop a chronic, intermittent weight-bearing lameness that is not responsive to treatment with NSAIDs.
Medial shoulder instability can be confirmed by goniometric measurements of shoulder abduction. The normal abducion angle in a large breed dog is approximately 30 degrees. The affected shoulder will have a much larger abduction angle as compared with the normal shoulder.
The degree of instability may be characterized as mild, moderate or severe. Mild instability is associated with minimal pathologic changes and abduction angles of 35 to 45 degrees. Dogs with moderate instability have abduction angles of 45 to 65 degrees and more advanced pathology is seen arthroscopically. Dogs with severe instability typically have shoulder abduction angles greater than 65 degrees.
Rehabilitation is crucial to give support to the joint by strengthening the medial supporting muscles.
Shoulder Luxation is usually a result of trauma, but may also be seen with congenital joint malformation.
Once the shoulder is reduced, need to be immobilized in a sling or splint for 1-3 weeks.
After removing the sling, the range of motion of the shoulder must be restored. Exercise is initially restricted, with gradual progression of weight-bearing exercises. Full recovery may require 1 to 3 months.
Hip dysplasia is an abnormal development of the hip joint, usually bilateral, that occurs primarily in medium and large breed dogs. The causes are multifactorial and include genetic predisposition, rapid growth rate, and diet. Puppies with a genetic predisposition for hip dysplasia develop clinical disease much later in life and to a much lesser extent when fed a restricted calorie diet, as compared with littermates that are fed more.
The hips are normal at birth but develop instability in the early stages of the disease, between 4 and 12 months of age. At this stage the dog may exhibit difficulty rising, decreased activity level, “bunny hopping” gait, and loss of muscle mass in the hindquarters.
As the disease progresses periarticular fibrosis provides some joint stability and the pain may be significantly decreased. However, with further progression of the disease, osteoarthritis results in pain, crepitus, decreased range of motion, waddling gait, and reluctance to exercise.
The focus of rehabilitation is to promote muscular development of the hindlimb with low-impact exercise.
Elbow Dysplasia includes fragmented medial coronoid process (FCP), osteochondritis dissecans (OCD), and ununited anconeal process (UAP). Dogs with elbow dysplasia usually have only one of the three conditions.
Factors that have been implicated include genetics, improper nutrition, and trauma.
Elbow dysplasia usually occurs in large or giant breeds of dogs. Affected dogs typically have bilateral problems, although one elbow may be more severely affected.
Fragmented Medial Coronoid Process
Dogs with FCP are presented with a mild to moderate weight-bearing lameness, which is usually noted between 4 and 7 months of age.
Treatment is removal of the abnormal process via arthroscopy. Postoperatively activity is limited for 2 to 4 weeks.
Osteoarthritis will progress regardless of treatment, but changes are more severe in untreated cases.
In all cases rehabilitation is directed toward preventing, slowing, or treating OA to maintain an acceptable quality of life.
Osteochondritis Dissecans of the Elbow
Dogs with elbow OCD are typically presented with mild to moderate lameness between 4 and 9 months of age. Many dogs have bilateral lesions.
Surgery is the treatment of choice in dogs with clinical signs. It is performed via arthrotomy or arthroscopy ro remove the defective cartilage.
Long-term management of OCD is focused on limiting or treating osteoarthritis.
Ununited Anconeal Process
Ununited anconeal process (UAP) is a failure of the anconeal process to fuse with the olecranon by 5 months of age, and is apparent on radiographs.
Instability of the anconeal process causes inflammation and eventual osteoarthritis.
Regardless of the treatment, osteoarthritis progresses, therefore ongoing treatment is directed at managing OA.
OCD is a relatively common condition that affects young large breeds of dogs. It is characterized by the development of a cartilaginous flap on the articular surface of various bones. In dogs the most frequently diagnosed site of involvement is the shoulder joint.Â
OCD lesions are often bilateral.
Risk factors in dogs include young age, large and giant breeds, rapid growth (high calorie diet), and excess calcium consumption.
Dogs are typically presented with mild to moderate weight-bearing lameness between 4 and 8 months of age.
Rehabilitation is focused on exercises to help maintain joint range of motion and provide joint nutrition and stress along normal lines of movement.
Patella (knee cap) luxation are most commonly associated with malformation of the bones in the back leg, that predisposes the knee cap to come outside the joint area.
They are classified from grade I to grade IV, with grade IV being the most severe.
Surgery is only recommended when the patella luxation causes limping.
With or without surgery, physical rehabilitation does focus on muscle strengthening to prevent the knee cap to come outside the joint space.Â
Osteoarthritis may also termed degenerative joint disease (DJD), or spondylosis if in the spine.
It is a deterioration of joint health that occurs secondary to joint instability, or some other disruption of the joint cartilage.
Mechanical and biochemical changes that occur within the joint result in decreased cartilage strength, cartilage thinning, increased bone density (subchondral sclerosis), inflammation of the joint membranes (synovitis), and formation of bony projections (osteophytes, bone spurs).
Clinical signs include joint pain and stiffness, that lead to lameness or decreased activity, with a resultant loss of muscle mass and strength.
The goals of treating osteoarthritis are to manage pain, maintain function and range of motion, and mintain or regain normal activity.
These goals are accomplished by weight management, therapeutic exercises, physical modalities, and supplements.
For geriatric patients with kidney or liver problems that prevent them to take medication, physical rehabilitation is important to maintain function and manage pain.
Spondylosis is a condition not caused by inflammation or infection, where there are bone spurs and bridges between the vertebrae on the spine.
Spondylosis rarely causes neurologic signs; however, occasionally causes spinal pain, especially after exercise.
Rehabilitation helps by managing pain, maintain flexibility and strength.
Carpal hyperextension injuries occur after jumping of falling from a height, spraining the carpal ligaments. It may also be caused by immune-mediated joint disease, or endocrinopathy such as hyperadreocorticism.
In severe cases the carpus may touch the ground.
Carpal laxity syndrome has been described in puppies, which walk with the carpus in a hyperextended position. The cause in unknown but it is speculated to be caused by abnormal growth between the skeleton and the muscles. Treatment generally include a balanced diet and controlled exercise on surfaces that provide good traction.
Carpal flexural contractures have also been recognized in puppies. Poor nutrition has been implicated as a factor, so altering the diet may be beneficial.
Muscle/ Tendon Injuries
Muscle or tendon injuries may be caused by acute trauma or repetitive loading.
Rehabilitation does speed healing, decreases inflammation, prevents scarring, restores normal functional length.
A strain is a tear or rupture of some part of the muscle-tendon unit, which is caused by excessive stress on the tissues.
The treatment varies depending o=if it is a mild (grade 1), moderate (grade 2) or severe (grade 3) rupture.
Inadequate warm-up, fatigue, or overtraining may also be factors involved in muscle strains.
Rehabilitation after a muscle injury speeds healing, decreases inflammation, prevents scarring, and restores normal function length.
Due to its length and diameter, the ilipsoas is an important flexor and stabilizer of the hip joint and the vertebral column.
Iliopsoas strain can be caused by an explosive motion such as turning or twisting during a jump, fall or slip.
Manual therapy, including range of motion exercises, stretching and massage, forms the mainstay of rehabilitation.
Bicipital tenosynovitis is a degeneration or failed healing response of the biceps tendon.
Tendon injuries may be caused by acute trauma or repetitive loading.
It is commonly seen in middle- to older-age large-breed dogs. Affected dogs usually have a weight bearing limping that is insidious in onset, progressive or intermittent, and exacerbated by exercise. Atrophy of the muscles around the shoulder area is seen in chronic cases.
Rehabilitation can reduce inflammation and pain, joint mobilizations are used to improve range of motion, and exercises are designed for biceps muscle strengthening.
Supraspinatus tendinopathy may cause mild to moderate lameness in medium and large breed dogs. The etiology is unknown but it is speculated to be caused by overuse and repetitive trauma.
Affected dogs typically have chronic, intermittent, unilateral lameness.
Mineralization of the supraspinatus tendon can be seen on radiographs.
Rehabilitation does help with inflammation and pain. Extracorporeal shock wave therapy may decrease the size of the mineralized region in dogs.
Contracture is a shortening of the tendon-muscle unit that is not caused by active muscle contraction. Most or all of the muscle and/or associated tendon is replaced by fibrous tissue.
Muscle Contracture leads to permanent shortening of the affected muscle and can limit ROM of the associated joint. Muscle contracture can occur in any muscle, but has been reported in the infraspinatus, supraspinatus, teres minor, brachialis, quadriceps, semitendinosus, gracilis, and sartorious.
Fibrotic Contracture of the Infraspinatus Muscle
Infraspinatus contracture causes a mild weight -bearing lameness mainly in hunting or working dogs. The cause is hypothesized to be acute muscle trauma, which results in incomplete rupture of the infraspinatus muscle. Replacement of muscle fibers by fibrous tissue occurs over days to weeks.
Physical rehabilitation is beneficial if the condition is diagnosed and referred early. Range of motion exercises to the joints on the front leg maintain joint flexion/extension and promote normal alignment of the healing tissues. Â In cases in which there is significant disuse atrophy of the forelimb muscles, general conditioning exercises for the limb are used to gradually return the muscle to normal size and strength.
Quadriceps contracture, also called quadriceps tie-down is due to scarring of the quadriceps muscle group, so the stifle is unable to fully flex and the leg is always in extension.
It can be secondary to muscle trauma, but it is most commonly associated with femoral fractures in young dogs.. It does occur more often when the leg is immobilized with a splint in extension.
Treatment may need surgery and intensive rehabilitation.
Fibrotic Myopathy is a condition in which the muscle fibers are replaced with scar tissue, resulting in a hard band inside the muscle.
It has been reported in German Shepherds, but also seen in Doberman pinschers, Rottweilers, and other breeds.
Intensive rehabilitation is needed for the dogs regain an acceptable use of the leg.
IVDD is one of the most common disorders that produces weakness and lack of movement in the legs in the dog. In addition to these signs, there is irritation of the nerve roots causing severe pain.
Physical rehabilitation is key in managing pain, and promoting earlier ambulation. We do use similar techniques that physical therapists use on people with stroke, to reeducate the nervous system andÂ muscles. The approach to patients’ care include interventions to remediate impairments and to compensate for functional limitations. We frequently use motor control and motor learning approaches to facilitate daily activities.
With or without surgery, rehabilitation give patients the opportunity to be able to walk again.
In cases not able to regain control of the legs, we offer education and training on the use of wheelchairs.
Traumatic nerve injuries cause weakness or loss of movement of a specific limb, depending on which nerve is affected.
Conservative management includes protecting the foot from injury by using a boot and physical rehabilitation to maintain muscle mass and range of motion.
Diseases that affect one or more components of the neuromuscular junction. The neuromuscular junction is the area where the nerves connect with the muscles to produce a contraction.
Diseases that affect this area can cause paralysis.
Rehabilitation speeds recovery, functional adaptation, and pain control.
Degenerative Myelopathy is a slowly progressive disease that involves the spinal cord.
It appears to be more prevalent in German Shepherds, but it can also affect other breeds.
Early signs include mild weakness with loss of control of the back legs. The back legs may cross when the dog walks, and swaying movements of the rear end are apparent. The disease can slowly progress to complete paralysis.
Rehabilitation does improve the quality of life and can extend the life of the dog see article: http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2006.tb01807.x/epdf
A fibrocartilaginous embolism (FCE) is a blockage in a blood vessel in the spinal cord. When such a blockage occurs, an area of the spinal cord dies.
The clinical signs are acute and progress rapidly from initial pain to paralysis.
Rehabilitation can speed up recovery and improve coordination.
Cauda Equina Syndrome or Degenerative Lumbosacral Stenosis is a compression of the spine at the lumbosacral joint.
Early clinical signs include pain in the area. Dogs may have difficulty rising, they may limp on one or both legs, and they refuse to jump. Exercise exacerbates the signs.
Rehabilitation helps to manage pain, and maintains strength and function.
The vestibular system, in most animals, is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance. The structures inside the inner ear send signals to the area of the brain that affects the muscles involved in posture and that keep an animal upright.
Vestibular syndromes are characterized for loss of balance and head tilt.
Rehabilitation improves balance and coordination.
Constrictive Myelopathy is a new disease diagnosed in Pugs, causing loss of coordination on the back legs, and paralysis.
Rehabilitation may help to delay the progression of decline in function and improve the quality of life of the pet.