Swimming can also be used as a mode of aquatic therapy. Its uses and benefits are similar to those of an underwater treadmill,
but it has a few key differences.1,4 Swimming dogs use a different pattern than a walking gait, so it may not be ideal for gait retraining in a dog with a neurologic
injury.5 Water in most tanks can be adjusted to a sufficient depth to allow even a large dog to free-swim. Some equipment allows
the use of jets to provide resistance.
Some facilities use a separate pool for swim therapy, allowing more room for a natural swim environment. In some cases, swimming
can be done in lakes or in the ocean, but these are less-controlled and, thus, more risky environments.
CONTRAINDICATIONS AND PRECAUTIONS
Some patients may be fearful of water, but most are willing to exercise on an underwater treadmill if they are slowly introduced
to the equipment and the water. If a patient is fearful of the underwater treadmill, treats placed on the ramp and tread,
or a frozen cup smeared with peanut butter, can often motivate such a patient to get into position to walk.
Patients with cardiac or respiratory disease may experience more difficulty exercising in water than on land. However, most
of these patients can exercise on an underwater treadmill if properly monitored and exercised conservatively.1 Increased resistance in the water causes increased cardiovascular and respiratory demand. Short sessions of exercise followed
by sessions of rest (initially walking one minute, resting two minutes, repeating twice) may be more appropriate for these
patients. The patient is never exercised to the point of fatigue, and its respiratory rate is closely monitored with exercise
ceasing before panting occurs.
As with any active therapy, each patient's general health must be evaluated before initiating therapy to ensure it is capable
of safely and comfortably performing the activity. In addition to general health concerns, the practitioner must determine
if a patient's pain level is too great to initiate active exercise. In most situations, patients in pain derive relief from
aquatic activity.1 Initially, a therapist may choose to perform passive range of motion or standing exercises with the patient in the water
and progress to active walking when the patient is more comfortable.
Certain instabilities (such as spinal instabilities) may need to be resolved before initiating underwater treadmill therapy.
Some patients with instabilities may be safely exercised underwater.3 Many experienced practitioners will initiate underwater treadmill therapy before anterior cruciate ligament surgery and
in some instances when surgical correction is not possible.
It is also best to avoid immersing a newly sutured area, a large wound, incontinent patients, or patients with diarrhea. Hot
spots will heal faster because of the sanitation system in the water as long as the patient is dried thoroughly in the affected
area. As a general rule, any condition that would warrant caution for land exercise would also warrant caution for water therapy.
If a dog is tetraparetic, there should be at least two or three people in the pool with it: one to work with the rear limbs,
one to work with the forelimbs, and if the patient is unable to control neck motion, a third person to prevent head submersion.
Several tanks are too small to accommodate this many people, so this need should be a purchasing consideration if a practice
works with neurologic patients frequently.
Many treadmill parameters, such as water depth and turbulence and walking speed and direction, need to be determined each
session to best achieve the desired outcome for a patient. Water temperature may also vary, but this variation occurs less
frequently in practice than the other parameters.
Changing the water depth can markedly alter a patient's motion and exercise exertion level. A low water level, just above
the carpus (91% weight-bearing), increases carpal and hock flexion more than any other level does and is useful in patients
with reduced flexion of these joints.6 When the water is at elbow level, there is significant resistance with minimal buoyancy (85% weight-bearing)6 since the chest is not displacing water. This level is excellent for dogs you want to increase strength and endurance in,
such as athletes. Water levels at or just above the shoulder have maximum buoyancy for strengthening the limbs with minimal
joint load (38% weight-bearing) and are most beneficial in patients with osteoarthritis or recovering from surgery in which
full weight-bearing is contraindicated or painful.6 Water levels above this level cause dogs to shorten their strides, which can reduce the exercise's benefit.