Analgesics should be continued through the postoperative period and should include opioids and NSAIDs along with physical
therapy for pain relief. Physical rehabilitation is an effective adjunct to traditional anti-inflammatory and analgesic medications.
In fact, physical rehabilitation can lower the dose or frequency of medication needed to control pain.2,4,13
Superficial thermal modalities
Ice compresses provide an excellent method to help control pain and inflammation in the immediate postoperative period. Not
only is cryotherapy beneficial in the acute phase of tissue injury and inflammation, it is also advantageous after exercise
and throughout rehabilitation when inflammation occurs. The effects of cryotherapy include vasoconstriction, decreased blood
flow, reduced cellular metabolism and permeability, attenuation of traumatic or exercise-induced edema, and decreased muscle
spasm.17,18 Another primary effect of cryotherapy is analgesia, which is thought to be a result of decreased sensory and motor nerve
conduction velocity that occurs when nerve fibers are cooled.19,20
Cryotherapy can be accomplished with a variety of methods. The simplest way is by placing crushed ice in a sealed plastic
bag and then wrapping the bag in a thin cloth, such as a pillowcase or towel. Alternatively, you can prepare a mixture consisting
of two parts water and one part alcohol in a double-sealed plastic bag and place it in a freezer. The resulting pack is a
frozen slush that conforms to any surface. Apply the cold pack for 15 to 20 minutes immediately after surgery while the patient
is still recovering from anesthesia. Be careful when applying cold packs to patients that are already hypothermic postoperatively.
Use cryotherapy for the first three or four days after surgery to help minimize inflammation, swelling, and pain from surgery.
Apply the cold compress for 15 to 30 minutes three or four times a day.21,22 Monitor the patient for discomfort, and assess the tissues periodically for signs of adverse effects such as white or pale
areas. Do not use cryotherapy in patients with poor or absent pain sensation.
Cryotherapy results in significant reductions in intra-articular temperatures of peripheral joints. After 15 minutes of ice
application to the canine stifle, the temperature inside the joint can drop 7.4 F (4.1 C). Immersion in ice water can produce
a more marked decrease in stifle joint temperatures (36.4 F [20.2 C]) but may produce decreases in rectal temperatures.22 Temperature changes vary depending on the type and depth of tissues cooled.21,23 In one study, ice packs applied to dogs' thighs for 20 minutes resulted in a precipitous drop in temperature of tissues up
to a depth of 1 cm, but minimal cooling occurred at tissue depths of 3 cm. However, the tissue temperature remained below
normal for 100 minutes.24
Apply heat to tissues only after the acute phase of inflammation is complete, generally three to five days after surgery or
injury. Commercially available hot packs are generally used for heat therapy and may be heated in a microwave until they are
warm to the touch. Alternatively, you can make a microwavable hot pack by placing rice in a sock and knotting it closed. Test
that the pack is not too hot by placing it on the back of your neck. Use a blanket or towel as an insulating layer between
the patient's skin and the heat source to prevent burns. Therapeutic ultrasound also effectively heats tissues up to 5 cm
Superficial heat causes vasodilation, which improves circulation to the superficial tissues, increases tissue oxygenation
and transportation of metabolites, and increases the rate of enzymatic and biochemical reactions to facilitate tissue healing.23,25,26 Heating soft tissues before stretching allows for greater extensibility of collagenous tissues. Maximum deformation occurs
when tissue temperatures are maintained at 104 to 113 F (40 to 45 C) for a maximum of five to 10 minutes while applying a
stretch force.26 Joint stiffness can be reduced and range of motion can be improved immediately after heat is applied.27 Do not apply heat in the early inflammatory phase of healing because swelling and edema may increase and result in further
Range of motion and stretching exercises
Range of motion and stretching exercises are vital activities to help improve joint motion and flexibility in pets after surgery
or in patients with chronic orthopedic conditions. These exercises help prevent adhesions between soft tissues and bone, improve
muscle extensibility, and prevent further injury to joints, ligaments, tendons, and muscles. True passive range of motion
exercise is performed without muscle contraction and is facilitated by a therapist. Complete relaxation is rare in veterinary
patients, so most range of motion exercises are active-assisted.