Companion Animal Rehabilitation
Rehabilitation is rapidly becoming recognized for the prevention and treatment of many conditions. When humans have soft tissue injuries, fractures, trauma or surgery, physiotherapy is used to accelerate the healing process and restore function. This therapy is now available to aid in the recovery of these conditions in animals as well.
Dr. Elizabeth Jobe DVM, CCRP, CVMA
Dr. Elizabeth Jobe was born and raised in the South, near Atlanta, Georgia, though she doesn’t have a southern accent to prove it! Her family knew she would become a veterinarian upon the discovery of her sleeping outside in the doghouse with the family pets as a child. Dr. Jobe grew up playing soccer and competed for the USA National team and Clemson University, graduating with a Bachelor of Science degree in Animal and Veterinary Sciences in 2007. Upon graduation, Dr. Jobe attended The University of Georgia College of Veterinary Medicine and graduated Summa Cum Laude in 2012.
Diana, CVT, CCRP
Certified Veterinary Technician & Certified Canine Rehabilitation Practitioner
Who is a candidate for physical rehabilitation?
Dogs and cats with conditions such as arthritis, degenerative neurologic conditions, herniated discs, gait abnormalities, post-surgical orthopedic or neurological problems (such as cranial cruciate ligament or spinal surgery), fracture repair, patellar luxation, muscle injuries or strains, senior pets to improve function or quality of life, obesity or weight loss programs, conditioning for performance competitors, and conformational abnormalities.
What Can I Expect When I Bring My Pet in For An Initial Rehabilitation Evaluation?
We assess your dog or cat’s entire body for changes such as pain, limping, swelling, reduced range of motion, reduced muscle mass or trigger points, and balance and proprioceptive abilities. After our orthopedic and neurologic evaluation, we will make a plan with you for diagnostics, pain management, and the next steps that may include physical therapy (either at home or here at PAWS) and/or referral to a specialist such as a surgeon or a neurologist, depending on the diagnosis.
Here at PAWS, we use a variety of specific therapeutic exercises and modalities to improve function and promote healing, including: assisted hydrotherapy in our heated underwater treadmill, land therapeutic exercises, massage, thermotherapy, cryotherapy, acupuncture, Class 4 Laser, electrical stimulation, traditional and alternative medications and supplements, proper weight management and nutritional plans to accomplish our goals. We also assess athletes, such as agility and hunting dogs, to create individualized programs to help them perform at their peak.
On the first visit, our team will assess your pet and develop a rehabilitation plan specific to your pet’s needs. Many factors are considered when designing a rehabilitation program and deciding which particular therapies will be suitable for each animal.
What are the goals of rehabilitation?
- Reduce pain.
- Improve balance, proprioception, and muscular strength.
- Increase joint flexibility, function, and range of motion.
- Restore mobility and function through gait retraining.
- Improve cardiovascular and respiratory endurance.
- Improve muscle memory to reduce muscle atrophy and/or nerve damage.
- Accelerate healing and expedite recovery after surgery or illness.
- Maximize core-conditioning for athletes.
- Enhance weight loss.
- Encourage positive behavior.
- Improve the overall health and quality of life for your dog or cat.
In addition to evaluations and programs in our hospital, we encourage you to follow through with a home exercise program developed specifically for your pet. We welcome you to be with your pet during their session; we also have the ability to board your dog for the day or week for your convenience.
At PAWS, our goals are:
- To provide hope for owners after patient injury or surgery.
- To provide alternatives to traditional care or surgery for many reasons (age, cost, exhausted options, contraindicated or insufficient treatments, and as a last resort).
- To complete the picture for patients instead of focusing on one specific problem.
- To be available and present for owner motivation, empowerment, and support.
- To provide a plan for recovery, progressive improvement, short and long term goals, and for the unexpected.
- To provide a haven that is associated with post-operative compassion, positive rewards, and encouragement.
- TO HAVE FUN!
What We Offer
Our patients here at PAWS Veterinary Center enjoy having three doctors on staff offering acupuncture as a treatment modality for various conditions and not just for our rehabilitation patients! This complementary modality is a safe, non-invasive, and successful way to treat pain as well as many other illnesses and conditions such as those listed below.
Veterinary medical acupuncture is science-based and is the application of very slender, sterile needles to specific points on the body near nerves and vessels leading to improved comfort and function of specific muscles, organs and nerves through neuromodulation and enhancing blood flow.
Acupuncture is an important component of many of our rehabilitation patients’ treatment plans for injuries such as:
- Orthopedic injury including arthritis in joints, hip dysplasia, elbow dysplasia, knee injury, shoulder pain, tendonitis and much more.
- Neurologic disease including neck and/or back pain, unsteady walking, and limb weakness.
- Soft tissue injury including muscular spasm, knots or pain.
- Fecal and/or urinary incontinence.
- Post-operative recovery for pain management (decrease oral medications needed).
- Limb swelling or edema.
- Local pain and anti-inflammation.
We can also target many other disease processes through acupuncture and improve comfort and recovery such as:
- Gastrointestinal disease-causing nausea, decreased appetite, diarrhea, and constipation.
- Emotional anxiety/stress.
- Reproductive problems.
- Eye illnesses including glaucoma, dry eye, and others.
- Kidney and/or liver disease.
- Auto-immune diseases.
Acupuncture is well tolerated by nearly all patients, and once they realize that they are more relaxed and comfortable afterward patients begin to get excited to come in for more treatments!
Hydrotherapy, or aquatic therapy, is physical therapy and exercise in warm water including walking in the underwater treadmill, swimming, and pool exercises. By utilizing our heated underwater treadmill we are able to provide an extended level of care for our patients whether for exercise with minimal weight bearing on painful and arthritic joints, endurance conditioning for athletes, post-operative muscle strengthening and gait retraining, and even weight loss.
Benefits of Warm Water:
- Increases blood flow to muscles.
- Increases joint flexibility and thus range of motion.
- Decreases pain while encouraging circulation.
In the underwater treadmill, we can adjust the water level for changes in buoyancy and therefore the amount of weight bearing on different joints. The higher the water level, the less weight the body is bearing on the joints when walking. This reduces pain on joints while enhancing their range of motion. Animals that will not bear much weight on a limb or walk very stiff with less flexion and extension can gait more normally and use the joint in the intended range of motion with hydrotherapy. With the body surrounded by water, animals have increased confidence while standing and balancing to try to walk again and use limbs after injury and surgery. The water pressure also helps to reduce swelling in limbs, and the water resistance and surface tension are important for muscle strengthening.
- Allows gait retraining with proper mechanics (using assistance if needed).
- Encourages weight bearing on affected limbs.
- Increases overall range of motion by increasing flexion (less than swimming) while increasing extension (more than swimming).
- More controlled environment than swimming as referred to body mechanics
Many dogs are so passionate about swimming and playing fetch in water that they will go beyond their limits increasing the risk for injury and overexertion. This is a concern for pets that are out of shape, overweight, injured, or have arthritis. Instead of having your pet swim in a river or lake, we recommend a training program managed by our rehabilitation doctor to achieve your goals and reduce the risk for injury.
Massage is the systematic, therapeutic, and functional stroking and kneading of the soft tissues of the body. There are numerous techniques ranging from lighter, softer strokes to deeper tissue massage. The technique chosen depends on the size of the area, the desired pressure, the rate and rhythm, and the duration of the massage. This tool is utilized at various times during rehabilitation, and we often perform massage prior to a session to loosen trigger points as well as during physical therapy sessions when the tissues are warm.
- Relieves muscle spasm and tension.
- Pain reduction by stimulating lots of free sensory nerve endings.
- Encourages physical and mental relaxation.
- Allows examination of deeper tissues when superficial tissues relax.
- Encourages blood flow to tissues to deliver oxygen and nutrients.
- Decreases swelling and edema.
- Minimizes scar and tissue adhesions after tissue trauma or surgery.
- Decreases delayed-onset muscle soreness after exercise.
- Reduces inflammation and promotes cell metabolism in muscles for healing.
- Improves human-animal bond.
Massage is an important key in physical rehabilitation for animals. Often when animals have an injury, the body compensates and uses the soft tissues and muscles differently than how they normally function. This creates compensatory muscle soreness and trigger points (knots) that need attention. We often teach owners how to perform massage themselves on their pets so it can be performed regularly at home.
Therapeutic exercise is a physical therapy intervention encompassing a broad range of activities designed to restore or improve musculoskeletal, cardiopulmonary and/or neurologic function. Some form of therapeutic exercise is indicated in every physical therapy case.
The goals of therapeutic exercises are to improve active pain-free range of motion and limb use, improve muscle strength and muscle mass, improve daily function and quality of life, and to help prevent further injury. With these goals in mind, the rehabilitation professional must use specialized knowledge to determine exercises that are appropriate for a patient’s level of ability, age, endurance, the severity of the injury, and stage of recovery.
There are numerous benefits of incorporating therapeutic exercises into a rehabilitation program. They are a non-invasive form of therapy, facilitate an increased rate of recovery from injury, improve quality of movement of limbs, and have a positive psychological effect for both the owner and pet. Not only do therapeutic exercises enhance performance and endurance in our pets needing physical therapy, but this benefit is also important for sporting and agility dogs that need core-conditioning and want to enhance their performance level.
Similar to people that go to the gym regularly for these benefits, it is important to vary the routine for our patients as well. Animals get bored doing the same exercises repeatedly, so creativity is an important aspect of rehabilitation for animals. At PAWS Veterinary Center, we try a number of different activities to determine what works best for an individual in order to modify the treatment plan. It is also important to allow the patient to guide the increase in activity. While many of these exercises can be performed at home, they are best guided by the rehabilitation practitioner so that the progression of therapy is carefully monitored and assessed.
The intensity and difficulty of the exercises vary greatly depending on the individual’s condition and injury. With patients that have recently had spinal surgery, for example, our initial exercises are simply targeted at getting them standing on their own. We facilitate this utilizing a number of our physioballs, the land treadmill with sling assistance, and nerve-stimulating balancing exercises. For patients that are in the final stages of recovery from knee surgery or limb injury, they will perform exercises such as carrying weighted vests, perform dancing and wheelbarrowing exercises, and climb stairs with resistance bands between their feet. Different exercises target specific muscle groups and range of motion in certain joints, so the exercise plan is continually evolving based on the patient’s needs. Come visit us for a free tour of our rehabilitation area!
Therapeutic Floor Exercise
Therapeutic exercise is a physical therapy intervention encompassing a broad range of activities designed to restore or improve musculoskeletal, cardiopulmonary and/or neurologic function. Some form of therapeutic exercise is indicated in every physical therapy case. The rehabilitation professional must use specialized knowledge to determine exercises that are appropriate for a patient’s level of ability, age, endurance, the severity of the injury, and stage of recovery. The intensity and difficulty of the exercises vary greatly depending on the individual’s condition and injury.
- Improve active pain-free range of motion.
- Improve muscle strength and muscle mass.
- Encourage limb use after surgery or injury and increase weight bearing.
- Improve daily function and quality of life.
- Prevent further injury.
- A non-invasive form of therapy.
- Facilitates an increased rate of recovery from injury.
- Improves the quality of movement of limbs.
- It has a positive psychological effect on both the owner and pet.
- Enhances core-conditioning for sporting and competition dogs.
IMPORTANT FOR ANIMAL REHABILITATION:
- Vary the routine.
- We try a number of different activities to determine what works best for an individual in order to modify the treatment plan.
- Allow the patient to guide the increase in activity.
- While many of these exercises can be performed at home, they are best guided by the rehabilitation practitioner so that the progression of therapy is carefully monitored and assessed.
EXAMPLES OF EQUIPMENT:
- Land treadmill
- Swiss balls
- Fit discs and donuts
- Balance boards
- Leg weights
- Weighted vests
- Cavaletti rails
- Agility equipment
Limping and Lameness
When your pet is limping that indicates pain, weakness, and/or a structural problem affecting the leg’s range of motion. Limping is a common sign of bone and joint disease, but it also occurs with muscle and nerve injuries making it a nonspecific sign for orthopedic and neurologic conditions.
DETERMINIMING IF THERE IS LAMENESS
- History is important: When did it begin? Is it getting worse or better? Did the lameness appear suddenly or was there an event that caused injury?
- Which leg is involved? A dog often holds up the paw or places less weight on a painful leg, especially one that has recently been injured.
- The dog’s head bobs up on the painful side and down on the side with the good leg.
- A dog usually takes shorter steps on a painful or weak leg.
- With chronic lameness, the dog may take very short strides with no noticeable limp. This is also true if more than one leg hurts with arthritis for example.
- With neurologic conditions, patients often take short, choppy steps or long and lopey strides that can appear as if their legs are drunk.
DETERMINING THE CAUSE
If you think you know which leg is involved, try to identify the specific site.
- Start by examining the nails, between toes, and footpads for cuts, punctures, torn nails, or red and swollen areas.
- Carefully feel the leg from the toes up. Locate areas of tenderness, heat, and swelling by applying gentle pressure.
- Flex and extend all joints from the toes to the shoulder or hip for pain or resistance. Lack of easy movement or resistance is a sign of joint pain, which will be evident when the dog attempts to pull the leg free.
- If you aren’t sure if something you feel is normal, compare it to the dog’s other leg.
Once you have isolated the injury site to the best of your ability, give us a call. We are happy to help you assess whether your pet needs to be seen by a veterinarian. Please keep in mind that a pet in pain can react by lashing out so please take precautions when examining any pet in discomfort or pain.
Weight Loss and Conditioning Programs
A 2014 study found that an estimated 52.7% of US dogs are overweight or obese, and an estimated 57.9% of US cats are overweight or obese. These pets are at risk for joint pain and arthritis as well as other medical conditions such as diabetes.
For pets struggling with losing weight, the Rehabilitation Department at PAWS can create a weight loss program including appropriate nutrition while dieting, underwater treadmill exercise, and a home exercise program to help achieve weight loss goals.
The underwater treadmill is instrumental in facilitating weight loss through cardio while simultaneously alleviating pressure on the joints and spine thus allowing exercise safely and confidently for our companions. Additionally, the dedicated physical therapy staff at PAWS excels at challenging our canine athletes through individualized strengthening and core conditioning programs to help athletes perform at their peak.
Electrical stimulation (E-stim) is a commonly used modality in human physical therapy practice as well as being utilized in the veterinary world. The main two types utilized in veterinary medicine are neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS). When this modality is chosen the doctor will determine which type will give us the best outcome. Small adhesive pads (electrodes) are placed on the skin and an electrical current is passed through the tissue between the pads to stimulate nerves.
NMES is important for muscle re-education, prevention and slowing of muscle atrophy, and to enhance joint movement. It targets specific muscle groups to create a muscle contraction by depolarizing motor nerves causing a contraction. NMES is most commonly chosen for patients immediately following musculoskeletal or neurologic injury or surgery to encourage muscle use and discourage atrophy. It is also beneficial to prevent contracture of joints by contracting muscles that cause joint flexion and extension.
TENS is important for pain control as an alternative therapy. It works by depolarizing sensory nerves to alter pain and creates a tingling sensation in the skin. It also stimulates the release of endorphins, which are the feel-good hormones.
OVERALL BENEFITS OF E-STIM:
- Swelling/edema reduction.
- Pain control.
- Muscle re-education, strengthening, conditioning.
- Reducing muscle disuse atrophy.
- Reducing joint contracture/tightening.
- Selective strengthening of a muscle group.
- Reducing muscle spasm.
Our Class IV Therapeutic Cutting Edge MLS and Class IIIb Chatanooga Group lasers are very versatile tools and are not only utilized in the rehabilitation department but also by our general practitioners for a variety of conditions and post-surgery care. The Class IV laser differs from ‘low-level lasers’ or ‘cold lasers’ (Class III b lasers) in that it penetrates deeper into the affected tissue because it has a longer wavelength of light and has broader tissue coverage. Therapeutic lasers do not achieve energy ranges such as surgical cutting lasers. Class IV therapeutic lasers treat tissue through photo biostimulation, which is a process that uses light to stimulate components in cells to create chemical energy increasing the production of ATP, DNA, and oxygen for enhanced cell metabolism.
- Increases endorphin release, the feel-good hormone.
- Improves blood flow and new vessel formation in tissues.
- Blocks pain nerve fibers.
- Enhances nerve regeneration.
- Increases metabolic activity for healing.
- Breaks down the damaging free radicals in the tissue.
- Speeds all phases of wound healing.
- Reduces swelling and edema in tissue.
- Reduces bacterial growth.
The treatments are quick (5-15 minutes) and painless. Most dogs really enjoy these sessions, completely relax, and love coming back for more because it makes them feel better. We use our laser quite often for geriatric dogs with chronic arthritis to reduce their amount of oral pain medications.
SOME COMMON USES:
- Acupuncture point stimulation.
- Skin and ear infections.
- Arthritic joints.
- Post-operative incision healing and swelling/edema reduction.
- Pain management.
Therapeutic ultrasound achieves deep heating of tissues, such as joints and muscles, through the creation of vibrations by a tiny crystal in the transducer head that touches the skin. These vibrations from undetectable sound waves or pressure waves in the tissue creating heat. Superficial heating (heating pads) penetrate only approximately 1 cm deep, and for many injuries such as hip joint disease, the tissue is 3 cm or deeper, which can be best targeted through therapeutic ultrasound. For patients that will benefit from this modality, we may need to clip a small area of hair in order to perform the treatment because it works best in direct contact with the skin. Ultrasound can also be combined with other physical therapy treatments and performed at the same time such as massage, E-stim, acupuncture, or laser therapy for example.
- Decrease pain.
- Decrease muscle spasm.
- Increase blood flow/tissue metabolic rate, therefore, enhancing healing.
- Increase range of motion/decrease stiffness in tissue.
- Reduce swelling/edema.
- Fibrotic myopathy/joint contracture.
- Wound and fracture healing.
- Calcific tendonitis.
Superficial Thermal Modalities
The use of heating and cooling of tissues has various purposes in physical therapy. There are different methods of cooling and heating, and the method can affect the amount of time needed to achieve the change in temperature in the tissue and the size of the area that can be treated.
Cryotherapy is the use of cold as a therapeutic agent. It is a key component for rehabilitation immediately after injury or surgery as well as after an exercise session to decrease muscle soreness.
- Decreases blood flow, edema, and inflammation at the injury site.
- Decreases cell metabolism and the release of inflammatory mediators.
- Decreases muscle spasm.
- Inhibits enzymes that degrade cartilage and healthy tissue.
- Decreases pain by slowing nerve signal transmission and raising the threshold for nerve stimulation.
EXAMPLES OF METHODS TO COOL TISSUES:
- Ice packs or cool gel packs
- Ice massage
- Cool compression units
- Ice baths
Thermotherapy is the use of heat as a therapeutic agent. After the acute inflammatory period has resolved approximately 72 hours after injury, then heat becomes an important component of healing. This is the ideal modality for patients that have chronic injuries such as arthritis.
- Increases cell metabolism for healing.
- Increases blood flow to bring oxygen and nutrients to tissue.
- Increases resorption of old inflammatory debris.
- Decreases force needed for stretching tissues.
- Decreases pain by sedating sensory nerve endings.
EXAMPLES OF METHODS TO HEAT TISSUES:
- Hot packs
- Hydrotherapy (ex. Underwater Treadmill)
- Warm compresses
Carts, Slings, and Assistive Devices
Patients with severe injuries or debilitating conditions, whether short or long-term, benefit from assistive devices. Depending on the location of the injury and amount of time that the assistance is needed, we choose from pelvic and chest harnesses (Help-em-up brand), padded abdominal slings, and a variety of mobility carts specially measured to the patient and designed to allow ambulation in animals that cannot walk on their own. We can order harnesses, 2-wheel and 4-wheel carts from a variety of companies after measuring your dog.
Less severely affected animals, such as dogs that can walk but are weak, are candidates for ToeGrips or booties, these products help by providing traction thus eliminating or decreasing the amount of sliding and splaying. For injuries affecting only one limb that needs corrective support, we order and modify orthotics, splints, and braces as needed for fittings.
Our goal in physical rehabilitation is to limit the need for assistive devices if possible, but for many of our patients’ conditions, they have a dramatically enhanced quality of life through necessary long-term assistance. We want to keep your pet in motion!
Pain management is one of the most important aspects of veterinary medicine to improve our patient’s quality of life. Whether dealing with acute pain related to trauma or surgery versus more chronic pain associated with arthritis, animals experience pain and need appropriate intervention. We provide an integrative approach to managing pain that includes varying modalities as well as pharmaceuticals and nutraceuticals to provide a plan that is specific to our patient as well as our client.
- Diagnose and treat the source of pain.
- Offer multimodal interventional treatment options.
- Improve function and sustain the quality of life.
- Promote healthy activities and preventative care.
- Return patients to the most functional and productive lifestyle possible.
- Treat noninvasively as much as possible.
We utilize a combination of multimodal medical management in addition to the modalities listed below to achieve our pain management goals. Prescription medications may be necessary such as non-steroidal anti-inflammatories (NSAIDs), steroidal anti-inflammatories, opioids, and neuromodulators. There are also numerous beneficial nutraceuticals such as diet/nutrition, omega-3 fatty acids (fish oils), glucosamine/chondroitin joint supplements, and antioxidants such as vitamin E to name a few. A specific cartilage protectant that improves joint fluid health, called Adequan, is instrumental in many of our cases.
PHYSICAL REHABILITATION MODALITIES:
- Class IV Laser Therapy
- Therapeutic Ultrasound
- Transcutaneous E-Stim. (TENS)
- Controlled exercises including land, hydrotherapy, and weight loss programs
- Stretching and passive range of motion
- Cryotherapy and Thermotherapy
Rehab Program Brochure
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