Physical rehabilitation: Improving the outcome in dogs with orthopedic problems - Veterinary Medicine
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Physical rehabilitation: Improving the outcome in dogs with orthopedic problems
Difficult, painful ambulation, whether resulting from orthopedic surgery or chronic pain, must be treated for an animal's optimal health. Explore the options and benefits of establishing a physical rehabilitation program.


VETERINARY MEDICINE


Controlled leash walks

The main exercise for most patients in the early rehabilitation period is slow, short, controlled leash walks in which the patient is encouraged to achieve the most normal gait possible and use the affected limb to the best of its ability. Unfortunately, this exercise is often performed incorrectly; if a patient is led too quickly, the pet tends to skip with the affected limb or not use the limb at all. Slow walks increase stance time, flexibility, strength, and weightbearing. When an animal has mastered the slow walk, faster walks can further develop endurance, strength, balance, coordination, and proprioception.32

Walking inclines provides a low-impact method to strengthen the gluteal muscles as well as the cranial and caudal thigh muscles. The handler should be able to control the patient's head and may want to have it slightly raised to transfer additional weight to the hindlimbs or slightly lowered to transfer weight to the forelimbs, depending on the desired effect. It is best to start with small inclines and progress as the patient is able. Declines are also beneficial for forelimb muscle strengthening and limb use. Walking downhill may also result in increased hock, stifle, and hip flexion during the stance phase of gait because the limbs are advanced further cranially under the body as the dog walks downhill.32 Although walking results in some joint motion, the joints do not undergo their maximum range of motion.33

Treadmill walking


Figure 4. Walking on a treadmill encourages early limb use after surgery and challenges proprioception. A harness can be used for support if needed.
Most dogs that are accustomed to walking on a leash readily take to treadmill walking with minimal training (Figure 4). The front of the treadmill should face toward the center of the room or a hallway. A person standing in front of the treadmill with treats or words of encouragement often helps with patient compliance. Start the patient on a stationary treadmill, and slowly increase the velocity to the desired setting. Treadmills for dogs are available, but many of the models used by people can be modified for dogs by adding an overhead bar with a support system that can attach to a harness. Harnesses help support the dog in case it stumbles or falls. Variable incline and speed controls are also useful. Joint range of motion is similar in dogs walking on a treadmill or over ground. Normal dogs tend to have an increased stance time and shorter stride length while walking on a treadmill compared with walking on ground.34 Further studies are needed to determine whether patients, particularly those with osteoarthritis, benefit from these alterations in gait. Walking on a ground or underwater treadmill is an unnatural experience for dogs and challenges their balance, proprioception, and coordination. Most animals are more likely to use an affected limb on a treadmill. Inclined treadmill activity may offer additional strength training.

Dancing

Dancing exercises allow additional weight transfer to the patient's hindlimbs. This activity increases weightbearing and challenges balance, coordination, and proprioception. Hip extension is greater with dancing backward as compared with dancing forward, and stance time is slightly increased with dancing. Assess a patient's range of motion before dancing so that a comfortable range of motion is not exceeded. The patient should be consistently using the affected limb at a walk before graduating to dancing. Muzzle the patient during initial sessions for handler safety.35

Wheelbarrowing

Another form of therapeutic exercise, wheelbarrowing, focuses on using the forelimbs. Place your hands under the dog's caudal abdomen and gently lift the dog's hindquarters off the ground a few inches while the dog walks forward. Lifting the animal higher does not seem to increase the peak force placed on the forelimbs. This is likely because of the decreased stride length when wheelbarrowing and the partial hindquarter support. While shoulder extension is increased with wheelbarrowing, the extension and flexion of the other joints are less than achieved with walking.35


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Source: VETERINARY MEDICINE,
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