DVM: What factors generally affect the successful outcome of physical rehabilitation in patients?

Millis: Owner compliance is a big part of it. For patients with chronic conditions that we see a few times a week, we expect owners to do the necessary treatments at home with their dogs. We show exercises to clients to do with their pets. So it's a partnership between the client and veterinarian.

The cooperation of the pet plays a role, too. A small percentage of dogs are not manageable. If they're stressed and miserable, the treatment is ineffective and actually may be injurious to the patient.

DVM: What are some of the rehab techniques you offer at the Small Animal Rehabilitation Clinic?

Millis: We have three underwater treadmills, an exercise area, a pool, a whirlpool, a ground treadmill, wobble boards, balance boards, therapy boards and more. Modalities we offer include neuromuscular electrical stimulation, therapeutic ultrasonography, cryotherapy, heat therapy, low-level laser therapy, extracorporeal shock wave therapy, therapeutic exercises and massage therapy. Our assessment tools include a force plate to measure the amount of weight placed on each limb, motion analysis equipment and a DEXA unit used to measure body composition and bone density.

After an injury or surgery, we control pain with NSAIDs, other analgesics and cryotherapy. Then we do passive range-of-motion exercises. Then during the next 24 to 48 hours, we progress to some weight-bearing and limb-use activities, for example, slow leash walking or having the dog touch the injured leg to the ground. We like to see the return of full range of motion within two weeks after surgery or injury.

The second phase is some proprioceptive work in which we teach the animal joint-position awareness. We try to micromanage the joint's stability by periarticular muscles. So we put them on wobble boards or therapy boards to fine-tune muscle control. We might also use aquatic therapy, treadmills or swimming.

And the third phase to get the animal back to normal entails some speed work, say, jogging or chasing a ball. And to help the animal regain full muscle strength, we have the dog work against a theraband or weights.

DVM: Can you give examples of when surgical intervention is more appropriate than physical rehabilitation?

Millis: Luxating patellas, cranial cruciate ligament ruptures, fractures, hip dysplasia in very young dogs, total hip replacement in skeletally mature patients—these, of course, are just some of the cases in which surgery should come first, and then rehab.

DVM: Would you recommend veterinarians refer patients in need of physical rehabilitation to specialists, or is it better if they bring this expertise into their practices with training and personnel?

Millis: The answer really depends on the interest of the veterinarian. Some may be intimidated and say they've had no training in rehab techniques and are uncomfortable doing physical rehabilitation. So they tend to refer patients. I think, though, a lot of practices can offer some rehab on a limited basis and have some positive results. I always say some rehab is better than no rehab. So practices can do, for example, cryotherapy after surgery with some simple cold packs, and then do a little slow leash walking and passive range-of-motion exercises. It's better than doing nothing. They should use what they have at their disposal. For example, have a dog walk on couch cushions to help improve its joint placement. On the other hand, one might expect even better results with a fully equipped facility.