Veterinary Physiotherapy and Rehabilitation

importance and witnessed an increasing demand for information, from both veterinarians and pet owners. This book, written by the Spanish specialist Gemma del Pueyo, helps the veterinarian to improve his/her knowledge in the field and discover what this discipline has to offer in the

Gemma del Pueyo Montesinos

The discipline of veterinary physiotherapy and rehabilitation has gained

treatment of the musculoskeletal and nervous diseases of pets.

clinically relevant information about cases seen in daily practice. After a brief introduction, it continues with a description of inflammation and exercise physiology, functional assessment of the patient and a description of active and passive therapeutic methods. One of the chapters is presented as a brief guide to treatment options for the various diseases and is aimed at professionals who wish to start working in this field. Another chapter is dedicated to one of the main diseases requiring rehabilitation: osteoarthritis.

The contents are all described and explained in a clear and practical manner, for quick and easy reference.

This is a practical guide for those looking for an introduction or orientation in the field of functional rehabilitation.

9 788492 569809

Veterinary Physiotherapy and Rehabilitation

The book is divided into twelve chapters, containing practical and

Veterinary Physiotherapy and Rehabilitation Gemma del Pueyo Montesinos

T H E V E T E R I N A RY P U B L I S H I N G C O M PA N Y SMALL ANIMALS

Veterinary Physiotherapy and Rehabilitation TECHNICAL SPECIFICATIONS Author: Gemma del Pueyo Montesinos Format: 17 x 24 cm Number of Pages: 184 Number of Images: 150 Binding: Hardcover ISBN: 978-84-92569-80-9 Year: 2012 RRP: 45 e Written by one of our country’s most eminent specialists Gemma del Pueyo, this book enables veterinary surgeons to further their knowledge in physiotherapy and veterinary rehabilitation, as well as to discover the possibilities offered by this discipline in the treatment of musculoskeletal and nervous pathologies in pets.

In order to make contents as accessible as possible and make them quick and easy to find for the readers, these have been developed in a very simple but precise manner.

Aimed at veterinarians, students, professors and professionals in this field.

Centro Empresarial El Trovador, planta 8, oficina I - Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza - España Tel.: 976 461 480 • Fax: 976 423 000 • pedidos@grupoasis.com • Grupo Asís Biomedia, S.L.

T H E V E T E R I N A RY P U B L I S H I N G C O M PA N Y

Veterinary Physiotherapy and Rehabilitation TABLE OF CONTENTS 1. Introduction Which patients can be treated?

Objectives and practise method Therapeutic techniques and modalities

2. Physiology of inflammation Stages of inflammation Tissue repair

3. Functional assessment of the patient Clinical history Basic general examination Orthopedic and neurological examination Dynamic study/assessment of the gait Pain degree determination Assessment of disability´s degree General palpation Assessment of the articular arch Specific muscle palpation Design of a rehabilitation program

4. Physiology of exercise What does physical condition mean?

Muscles need energy!

Training of the healthy animal

5. Kinesitherapy and stretching Kinesitherapy Stretching

6. Use of superficial cold and heat in rehabilitation Use of superficial cold Termotherapy

7. Therapeutic massage Therapeutic effects of massage Tissue response Types of massage

8. Electrical stimulation Introduction Basic principles of electricity Types of electric current Physiologic responses Pulsating currents. Wave parameters Types of electrodes Physiologic effects Transcutaneous electrical nerve stimulation –TENS– Interferential electrical stimulation Microcurrents

9. Ultrasounds Ultrasounds machine Physiologic response Clinical application

10. Hydrotherapy Properties of water Types of hydrotherapy

11. How to rehabilitate?

Orthopedic rehabilitation Neurological rehabilitation Rehabilitation of fractures Rehabilitation of anterior cruciate ligament (ACL) injury Rehabilitation of hip dysplasia Neurological rehabilitation

12. Rehabilitation and physiotherapy of the osteoarthritic patient Rehabilitation program for the osteoarthritic patient Physical therapies used in the osteoarthritic patient Rehabilitation program model for osteoarthritis

Centro Empresarial El Trovador, planta 8, oficina I - Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza - España Tel.: 976 461 480 • Fax: 976 423 000 • pedidos@grupoasis.com • Grupo Asís Biomedia, S.L.

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Veterinary physiotherapy and rehabilitation

INTRODUCTION

Therapeutic techniques and modalities

Therapy can start immediately after surgery using passive techniques (cold packs, electrostimulation, passive kinesiotherapy) and gradually move to active techniques depending on the speed of recovery (fig. 5).

[

Figure 5. Use of electrostimulation for analgesia.

There are two types of rehabilitation techniques: passive and active.

■■ Passive therapies (performed by the therapist) include the application of hot/cold packs, passive kinesiotherapy (joint movement), stretching, massage, electrostimulation, therapeutic ultrasound, pulsed shortwave therapy, laser, electromagnetism and hydrotherapy (fig. 6).

■■ Active therapies (performed by the patient under guidance) include active kinesiotherapy and exercises aimed at the recovery and improvement of strength, endurance, range of motion, proprioception, coordination and balance (fig. 7).

Passive therapies ■■ Application of hot or cold packs.

■■ Passive kinesiotherapy.

The therapist should have a good knowledge of certain basic concepts of veterinary medicine, such as: ■■ Anatomy.

■■ Biomechanics and exercise physiology.

■■ Pathophysiology of the lesion/inflammation.

■■ Musculoskeletal tissue response to disuse and subsequent mobilisation.

■■ Healing and functional recovery of the various tissues.

■■ Functional neurology.

If the therapist is a veterinary surgeon, he or she will be able to reach a diagnosis, set objectives, draw up a treatment plan and give a prognosis. If the therapist is a veterinary nurse/technician or a qualified human physiotherapist, he or she should always apply the techniques under the supervision of a veterinary surgeon who will be responsible for the case.

■■ Stretching and traction.

■■ Massage.

■■ Electrostimulation.

■■ Ultrasound.

■■ Shortwave therapy.

■■ Laser.

■■ Magnotherapy.

Active therapies ■■ Active assisted kinesiotherapy.

■■ Active resistance kinesiotherapy.

■■ Active kinesiotherapy.

■■ Hydrotherapy.

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Veterinary physiotherapy and rehabilitation

INTRODUCTION

Therapeutic techniques and modalities

Therapy can start immediately after surgery using passive techniques (cold packs, electrostimulation, passive kinesiotherapy) and gradually move to active techniques depending on the speed of recovery (fig. 5).

[

Figure 5. Use of electrostimulation for analgesia.

There are two types of rehabilitation techniques: passive and active.

■■ Passive therapies (performed by the therapist) include the application of hot/cold packs, passive kinesiotherapy (joint movement), stretching, massage, electrostimulation, therapeutic ultrasound, pulsed shortwave therapy, laser, electromagnetism and hydrotherapy (fig. 6).

■■ Active therapies (performed by the patient under guidance) include active kinesiotherapy and exercises aimed at the recovery and improvement of strength, endurance, range of motion, proprioception, coordination and balance (fig. 7).

Passive therapies ■■ Application of hot or cold packs.

■■ Passive kinesiotherapy.

The therapist should have a good knowledge of certain basic concepts of veterinary medicine, such as: ■■ Anatomy.

■■ Biomechanics and exercise physiology.

■■ Pathophysiology of the lesion/inflammation.

■■ Musculoskeletal tissue response to disuse and subsequent mobilisation.

■■ Healing and functional recovery of the various tissues.

■■ Functional neurology.

If the therapist is a veterinary surgeon, he or she will be able to reach a diagnosis, set objectives, draw up a treatment plan and give a prognosis. If the therapist is a veterinary nurse/technician or a qualified human physiotherapist, he or she should always apply the techniques under the supervision of a veterinary surgeon who will be responsible for the case.

■■ Stretching and traction.

■■ Massage.

■■ Electrostimulation.

■■ Ultrasound.

■■ Shortwave therapy.

■■ Laser.

■■ Magnotherapy.

Active therapies ■■ Active assisted kinesiotherapy.

■■ Active resistance kinesiotherapy.

■■ Active kinesiotherapy.

■■ Hydrotherapy.

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Veterinary physiotherapy and rehabilitation

EXERCISE PHYSIOLOGY

Flexibility and mobility Physical fitness is based on four factors:

These can be defined as “the ability to move a joint through its full range of motion”.

COMPONENTS OF PHYSICAL FITNESS

Flexibility and mobility can be restricted by any of the following factors: ■■ Muscle contractures, scars, shortened ligaments.

■■ Joint incongruence or altered biomechanics.

■■ Inflammation, oedema, effusion, adhesions or fibrosis.

■■ Cardiovascular endurance.

■■ Flexibility.

■■ Muscle strength.

■■ Muscular endurance.

Passive kinesiotherapy and stretching are used to help soft tissues recover their normal length and function and to prevent contractures and subsequent lesions (fig. 2) (see chapter on Kinesiotherapy and stretching).

Cardiovascular endurance Cardiovascular endurance is defined as “the capacity of the heart, lungs and blood vessels to carry oxygen to the muscles during activity”.

To build up endurance, an exercise plan should include low-intensity, longduration exercises with little static muscle contraction (e.g. jogging rather than sprinting). This implies aerobic and endurance exercises (fig. 1).

[

Figure 2.

Stretching of the gastrocnemius muscle to increase flexibility.

[

Figure 1. Walking or running in the field are good examples of cardiovascular exercises.

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Veterinary physiotherapy and rehabilitation

EXERCISE PHYSIOLOGY

Flexibility and mobility Physical fitness is based on four factors:

These can be defined as “the ability to move a joint through its full range of motion”.

COMPONENTS OF PHYSICAL FITNESS

Flexibility and mobility can be restricted by any of the following factors: ■■ Muscle contractures, scars, shortened ligaments.

■■ Joint incongruence or altered biomechanics.

■■ Inflammation, oedema, effusion, adhesions or fibrosis.

■■ Cardiovascular endurance.

■■ Flexibility.

■■ Muscle strength.

■■ Muscular endurance.

Passive kinesiotherapy and stretching are used to help soft tissues recover their normal length and function and to prevent contractures and subsequent lesions (fig. 2) (see chapter on Kinesiotherapy and stretching).

Cardiovascular endurance Cardiovascular endurance is defined as “the capacity of the heart, lungs and blood vessels to carry oxygen to the muscles during activity”.

To build up endurance, an exercise plan should include low-intensity, longduration exercises with little static muscle contraction (e.g. jogging rather than sprinting). This implies aerobic and endurance exercises (fig. 1).

[

Figure 2.

Stretching of the gastrocnemius muscle to increase flexibility.

[

Figure 1. Walking or running in the field are good examples of cardiovascular exercises.

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Veterinary physiotherapy and rehabilitation

KINESIOTHERAPY AND STRETCHING

[

[

[

[

Figure 26.

‘Dancing’ on the hind legs.

Figure 27.

Wheelbarrow walking.

Figure 28. Kneebend exercises.

Figure 29. The cavaletti exercise improves joint mobility and aids in gait reeducation.

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KINESIOTHERAPY AND STRETCHING

[

[

[

[

Figure 26.

‘Dancing’ on the hind legs.

Figure 27.

Wheelbarrow walking.

Figure 28. Kneebend exercises.

Figure 29. The cavaletti exercise improves joint mobility and aids in gait reeducation.

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Veterinary physiotherapy and rehabilitation

THERAPEUTIC MASSAGE

Types of massage

Effleurage Although there are several kinds of effleurage, including stroking, this section will only describe lymphatic drainage massage (fig. 4). This massage consists of moderate-pressure strokes in a centripetal direction (towards the heart), using the palm of the hand and keeping the fingers together. It is usually applied from the most distal part of the extremities towards the trunk.

A wide range of massage techniques is available, each with its advantages and disadvantages, its indications and contraindications. There is no best technique: the therapist should make a coherent choice based on the lesion, the patient and his/her own skills. In the next section, some of the most commonly used techniques in veterinary rehabilitation are described.

The effect of the drainage technique is an increase in blood and lymph flow, which makes it particularly suitable for the treatment of, for instance, distal oedema.

Stroking This is a gentle massage that consists of rhythmic continuous strokes in a centrifugal direction (in the direction of the hair growth) using the palm of the hand with the fingers held together; contact with the patient is never lost (fig. 3). It is a superficial massage that produces a relaxing effect in the patient, thus preparing it for further manipulation. It also increases blood flow and stimulates lymph flow. This massage is commonly used to start and end a session, although it can also be used during a session. Stroking is useful to calm a patient after a massage of the deeper tissues.

[

Figure 4.

Drainage technique.

[

Figure 3. Stroking technique.

The hands are gently moved in a centrifugal direction.

Kneading or petrissage Kneading is a type of deep massage that should be applied to a relaxed animal, which means that it should be preceded by both aforementioned massage types. It consists of grasping a fold of skin, subcutaneous tissue or muscle (depending on the depth), then releasing it, and moving on to the next area (fig. 5). The movement of the hands is similar to kneading dough. It may be started in the most distal areas of the body and advance in a proximal direction. This massage is applied both parallel and perpendicular to the fibres.

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Veterinary physiotherapy and rehabilitation

THERAPEUTIC MASSAGE

Types of massage

Effleurage Although there are several kinds of effleurage, including stroking, this section will only describe lymphatic drainage massage (fig. 4). This massage consists of moderate-pressure strokes in a centripetal direction (towards the heart), using the palm of the hand and keeping the fingers together. It is usually applied from the most distal part of the extremities towards the trunk.

A wide range of massage techniques is available, each with its advantages and disadvantages, its indications and contraindications. There is no best technique: the therapist should make a coherent choice based on the lesion, the patient and his/her own skills. In the next section, some of the most commonly used techniques in veterinary rehabilitation are described.

The effect of the drainage technique is an increase in blood and lymph flow, which makes it particularly suitable for the treatment of, for instance, distal oedema.

Stroking This is a gentle massage that consists of rhythmic continuous strokes in a centrifugal direction (in the direction of the hair growth) using the palm of the hand with the fingers held together; contact with the patient is never lost (fig. 3). It is a superficial massage that produces a relaxing effect in the patient, thus preparing it for further manipulation. It also increases blood flow and stimulates lymph flow. This massage is commonly used to start and end a session, although it can also be used during a session. Stroking is useful to calm a patient after a massage of the deeper tissues.

[

Figure 4.

Drainage technique.

[

Figure 3. Stroking technique.

The hands are gently moved in a centrifugal direction.

Kneading or petrissage Kneading is a type of deep massage that should be applied to a relaxed animal, which means that it should be preceded by both aforementioned massage types. It consists of grasping a fold of skin, subcutaneous tissue or muscle (depending on the depth), then releasing it, and moving on to the next area (fig. 5). The movement of the hands is similar to kneading dough. It may be started in the most distal areas of the body and advance in a proximal direction. This massage is applied both parallel and perpendicular to the fibres.

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Classification of electrical therapies According to the type of current

Direct current: galvanic and faradic.

ELECTRICAL STIMULATION

[

Figure 4. Device for the application of electric currents with variable parameters.

Alternating current: low frequency, interferential (medium frequency), shortwave and microwave (high frequency).

Electrochemical (ionic changes): galvanic.

According to the physiological effect

Electrokinetic (muscle contraction): low-frequency alternating, galvanic and interferential current.

Thermal: short wave and microwave (high frequency).

Physiological effects Sensory or motor nerve fibres can be stimulated, depending on the type of therapy and the parameters used (fig. 4).

1] Motor stimulation (muscle contraction without joint movement) will help to obtain (fig. 5): ■■ Muscle strengthening.

■■ Increased muscle tone.

■■ Decreased muscle spasms.

■■ Increased venous circulation.

■■ Increased lymphatic and arterial flow.

■■ Prevention of adhesions.

■■ Stretching of fibrotic tissue.

■■ Improved quality of the connective tissue (collagen alignment).

[

Figure 5. EMS. Application of electrodes over the origin and insertion of the gluteal muscle.

2] Sensory stimulation (analgesia): ■■ Via the spinal gating mechanism (stimulates the production of enkephalins in the dorsal spinal horn).

■■ Through the production of endorphins.

■■ By stimulation of the descending inhibitory pathways (serotonin pathway).

General indications and objectives for electrical stimulation ■■ Muscle contraction: both innervated and denervated muscles.

■■ Analgesia.

■■ Myofascial pain syndrome (trigger points).

■■ Passive congestion.

■■ Consolidation and fibrosis (healing).

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Veterinary physiotherapy and rehabilitation

ELECTRICAL STIMULATION

[

Figure 4. Device for the application of electric currents with variable parameters.

Classification of electrical therapies According to the type of current

Direct current: galvanic and faradic.

Alternating current: low frequency, interferential (medium frequency), shortwave and microwave (high frequency).

Electrochemical (ionic changes): galvanic.

According to the physiological effect

Electrokinetic (muscle contraction): low-frequency alternating, galvanic and interferential current.

Thermal: short wave and microwave (high frequency).

Physiological effects

[

Figure 5. EMS. Application of electrodes over the origin and insertion of the gluteal muscle.

Sensory or motor nerve fibres can be stimulated, depending on the type of therapy and the parameters used (fig. 4).

1] Motor stimulation (muscle contraction without joint movement) will help to obtain (fig. 5): ■■ Muscle strengthening.

■■ Increased muscle tone.

■■ Decreased muscle spasms.

■■ Increased venous circulation.

■■ Increased lymphatic and arterial flow.

■■ Prevention of adhesions.

■■ Stretching of fibrotic tissue.

■■ Improved quality of the connective tissue (collagen alignment).

2] Sensory stimulation (analgesia): ■■ Via the spinal gating mechanism (stimulates the production of enkephalins in the dorsal spinal horn).

■■ Through the production of endorphins.

■■ By stimulation of the descending inhibitory pathways (serotonin pathway).

General indications and objectives for electrical stimulation ■■ Muscle contraction: both innervated and denervated muscles.

■■ Analgesia.

■■ Myofascial pain syndrome (trigger points).

■■ Passive congestion.

■■ Consolidation and fibrosis (healing).

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OSTEOARTHRITIS

OWNERS OFTEN NOTE THAT THEIR PET:

Radiography is the most common diagnostic tool in veterinary practice.

Radiographic signs that can be found in a joint with any degree of OA include (figs. 4, 5 and 6): ■■ Degeneration of the joint cartilage.

■■ Formation of osteophytes.

■■ Bone remodelling.

■■ Periarticular changes.

■■ Synovial effusion.

■■ Has difficulty getting up.

■■ Shows increased lameness when it is cold.

■■ Has difficulty climbing up and/or down stairs and ramps.

■■ Has a slower and stiffer gait than before.

■■ Is less active (plays less, sleeps more).

For the diagnosis of OA, in addition to the history, a complete physical and orthopaedic examination is required (fig. 2 and 3); further investigations may be carried out, such as radiography, synovial fluid analysis, ultrasonography, MRIs or CT scans.

[

Figure 2.

Measuring the range of motion of the elbow.

[

Figure 3.

Measuring the range of motion in the elbow of a Labrador with OA.

[

Figure 4.

Radiograph showing OA in the hip of a 9-year-old Pug.

[

Figure 5.

Radiograph showing OA in the elbow of a 12-yearold Labrador.

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Veterinary physiotherapy and rehabilitation

OSTEOARTHRITIS

OWNERS OFTEN NOTE THAT THEIR PET:

Radiography is the most common diagnostic tool in veterinary practice.

Radiographic signs that can be found in a joint with any degree of OA include (figs. 4, 5 and 6): ■■ Degeneration of the joint cartilage.

■■ Formation of osteophytes.

■■ Bone remodelling.

■■ Periarticular changes.

■■ Synovial effusion.

■■ Has difficulty getting up.

■■ Shows increased lameness when it is cold.

■■ Has difficulty climbing up and/or down stairs and ramps.

■■ Has a slower and stiffer gait than before.

■■ Is less active (plays less, sleeps more).

For the diagnosis of OA, in addition to the history, a complete physical and orthopaedic examination is required (fig. 2 and 3); further investigations may be carried out, such as radiography, synovial fluid analysis, ultrasonography, MRIs or CT scans.

[

Figure 2.

Measuring the range of motion of the elbow.

[

Figure 3.

Measuring the range of motion in the elbow of a Labrador with OA.

[

Figure 4.

Radiograph showing OA in the hip of a 9-year-old Pug.

[

Figure 5.

Radiograph showing OA in the elbow of a 12-yearold Labrador.

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