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


PHYSICAL REHABILITATION FOR ARTHRITIC PATIENTS

Osteoarthritis is the most common cause of chronic pain in dogs, affecting about 20% of the canine population, or 10 to 12 million dogs in the United States.56,57 Sadly, more than half of these animals go untreated. Management of osteoarthritis must be viewed as a lifelong commitment. NSAIDs, used consistently, have markedly decreased the degree of discomfort associated with this debilitating disease.6,58-61 Drug therapy is the cornerstone of pain control. Because of the chronic nature of the disease, however, other interventions such as slow-acting disease-modifying agents, weight reduction, modified exercise programs, and physical rehabilitation should be incorporated into the treatment plan.4,62,63 You can think of the pharmaceutical therapy as an adjunct and a means by which a patient can undergo physical rehabilitation to ultimately reduce the amount and frequency of medication needed to maintain a comfortable lifestyle. NSAIDs alone can provide pain relief, but by themselves, they do not directly increase range of motion, muscle mass, or improve synovial fluid production and turnover. Improvements in these factors can be met through exercise and physical rehabilitation.

Keep in mind that older animals are often afflicted with other systemic conditions that may limit the amount or duration of medications they can tolerate.64-68 These patients require a thorough medical workup, including a complete blood count and serum chemistry profile and complete radiographic, physical, neurologic, and orthopedic examinations. Concurrent medical conditions must be treated to ensure the optimal benefits from physical rehabilitation.

Surgical options to treat, prevent, or delay the onset of osteoarthritis include stifle stabilization for cranial cruciate ligament rupture, surgery to correct patellar luxation surgery, triple pelvic osteotomy, joint arthrodesis, femoral head and neck ostectomy, and removal of a fragmented coronoid process, ununited anconeal process, or osteochondritis dissecans lesion. Physical rehabilitation modalities that often benefit arthritic patients include aquatic exercises; ground treadmill exercise; walking on level, incline, and decline surfaces; jogging; neuromuscular electrical stimulation (NMES); and therapeutic ultrasound; as well as massage and other modalities.

CONCLUSION

A wealth of information exists regarding physical rehabilitation in people, and more information is becoming available regarding its application in small-animal patients. It is important to be well-versed in the various modalities, the benefits associated with each and their indications and contraindications. Tailor rehabilitation programs to the individual because the severity of the condition varies in each patient. Many of the major cities in the United States have physical rehabilitation centers for pets. These facilities work closely with referring veterinarians to design and implement programs appropriate for each patient and its condition. It is not difficult to develop a rehabilitation program as a new service within a clinic or hospital. Therapeutic exercises require little financial investment and equipment. Like all disciplines in medicine and surgery, it is important to have proper training before beginning a rehabilitation program.

Greg Arnold, DVM
Darryl L. Millis, MS, DVM, DACVS
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996

REFERENCES

1. Johnson JM, Johnson AL, Pijanowski GJ, et al. Rehabilitation of dogs with surgically treated cranial cruciate ligament-deficient stifles by use of electrical stimulation of muscles. Am J Vet Res 1997;58:1473-1478.

2. Taylor RA. Postsurgical physical therapy: the missing link. Compend Contin Educ Pract Vet 1992;14:1583-1594.

3. Simkin PA, Huang A, Benedict RS. Effects of exercise on blood flow to canine articular tissues. J Orthop Res 1990;8:297-303.

4. Millis DL, Levine D. The role of exercise and physical modalities in the treatment of osteoarthritis. Vet Clin North Am Small Anim Pract 1997;27:913-930.

5. Crandell DE, Mathews KA, Dyson DH. Effect of meloxicam and carprofen on renal function when administered to healthy dogs prior to anesthesia and painful stimulation. Am J Vet Res 2004;65:1384-1390.

6. Millis DL, Weigel JP, Moyers T, et al. Effect of deracoxib, a new COX-2 inhibitor, on the prevention of lameness induced by chemical synovitis in dogs. Vet Ther 2002;3:453-464.


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