Lecture 18 2/24/25 Flashcards
Why is physical therapy beneficial?
-increased speed of recovery
-reduce devastating effects of tissue immobilization
-improved performance and quality of movement
-increased strength and endurance
-non-invasive
-positive psychological effects for pet and owner
What are the characteristics of cartilage changes with disuse?
-disuse with the limb in extension creates degenerative changes
-changes are more marked and appear sooner in areas of contact
-see decreased cartilage nutrition with lack of synovial “pumping”
-synovial fluid production is reduced by immobilization
-immobilization in flexion does not lead to OA changes but can cause reversible cartilage atrophy
What is the take home regarding cartilage changes with disuse?
ROM is critical for the health of the cartilage
What are the characteristics of remobilization after casting in flexion?
-normal ambulation for 3 weeks after cast removal leads to cartilage returning to normal
-running/increased movement for 3 weeks after cast removal leads to continued decreases in cartilage thickness and proteoglycan content
-gradual remobilization is best for cartilage health
What are the characteristics of muscles and decreased mechanical stress?
-muscles composed of type 1 fibers are preferentially recruited during normal posture
-postural muscles are more susceptible to atrophy than muscles of mixed or fast fiber composition
-immobilization reduces chronic load on postural muscles and can cause atrophy
What are the characteristics of bed rest?
-prolonged bed rest causes similar muscle changes to immobilization
-10 minutes of standing a day during bed rest reduces muscle atrophy by 25% in humans
-adding resistance exercise attenuates atrophy by 50% in humans
What is the take home regarding ACL stress deprivation and remobilization?
tendon/ligament healing takes a very long time and full strength is never recovered
What are the characteristics of reduced bony stress?
-immobilization and disuse lead to stress shielding
-effects are greater in younger dogs due to rapid bone turnover
-older animals already have somewhat reduced bone mass
-bone needs consistent loading for optimized strength
What are the goals of physical therapy?
-improve biomechanics and flexibility
-reduce pain
-minimize complications
-restore activities of daily living
-prevent future injury through owner/trainer education
Why is the ability to extend the stifle to full range of motion important?
-appropriate stifle ROM is critical for normal walking and activity
-patient is able to experience greater weight bearing on the limb with increased extension
What is passive range of motion?
moving the joint to the end of range slowly
What is stretching?
holding joint at end range
When is passive range of motion and stretching most important?
joint surgery in young dogs, including:
-CCL rupture stabilization
-elbow fractures
-fracture of distal femoral physis
What are the steps to an appropriate PROM/stretching session?
-try to do all joints in the affected limb
-for PROM only, do 10 to 30 reps, 3 to 6 times daily
-for stretching, do 10/10/10 PROM/stretch (10 seconds of flexion and 10 seconds of extension for 10 reps)
-can also do 20 second holds for 5 reps for stretching
-common to do both PROM and stretching in the same session
When is cryotherapy used in dogs?
-post-op swelling/pain
-musculoskeletal trauma
-pain due to muscle spasm
-after exercise to prevent edema/pain
What are the effects of coled?
-vasoconstriction/decreased bleeding
-decreased metabolism and histamine; reduces inflammation
-decreased pain
-decreased muscle spindle firing
-inhibition of cartilage degrading enzymes
What are the characteristics of cryotherapy application?
-typically done for 15 to 25 minutes, 2 to 4 times a day
-post-exercise only needs 10 minutes
-compression increases cold penetration
-effects are more pronounced on skin than in deeper tissues
-incisions and thin tissues should be covered with a pillowcase; take special caution with distal extremities
When is heat therapy used in dogs?
-warm up to exercise +/- massage
-decrease tissue tightness +/- stretching
-decrease muscle spasm or pain
-reduce edema in subacute/chronic phase
What are the methods for superficial heating?
-microwave hot packs
-circulating warm water blankets
Why is it important to wait a 3 to 4 days after injury/surgery to begin heat therapy?
too early of application can increase swelling/edema
What are the characteristics of therapeutic ultrasound?
-increases collagen and tissue extensibility
-reorganizes scar tissue formation and combats contracture
-tendons heat quickly; muscles take longer
-can increase collagen deposition, wound closure, and wound breaking strength
What are the steps TENS therapy?
-electrical signal makes nerve sensation stop
-natural pain relieving substances (endorphins) are released
-no pain messages are sent to the brain; therefore, no pain
What are the characteristics of TENS therapy?
-mild electrical stimulation is delivered to painful area via electrodes on skin
-can be used for edema reduction and muscle spasm control
-typically used for 2 to 3 days post-op but can be used indefinitely for chronic pain
What are the characteristics of neuromuscular electrical stim./NMES?
-targets muscle activation by recruiting more contracting fibers and increasing contractile force of fibers
-may reduce disuse atrophy
-increases blood flow and metabolism
-increases joint ROM
-decreases pain and edema
-promotes wound healing
What are the characteristics of extracorporeal shockwave?
-shockwaves are high energy sound waves occurring in nature or via man-made devices
-created by high amplitude acoustic pressure with short build-up time followed by rapid drop in negative pressure
-creates cavitation; gas bubbles burst and release energy into the tissues
What are the uses for shockwave therapy?
-analgesia
-fracture/osteotomy/bone healing
-tendon and ligament healing
-osteoarthritis
What are the biologic effects of laser?
-activation of resp. chain enzymes, especially cytochrome C oxidase
-oxygen production
-ATP production
-DNA production
-cell proliferation
-reduced production of cyclooxygenase and prostaglandin E2
-potential anti-inflammatory effects
What are the suggested uses for laser?
-wound healing
-bone and cartilage healing
-arthritis
-ligament and tendon conditions
-analgesia and pain
-peripheral nerves and spinal cord
What are the characteristics of laser evidence/efficacy?
-only evidence in support of laser is when used for wound healing and nerve regeneration
-fur/hair reduces laser penetration by 70 to 90%
What are the characteristics of standing exercises?
-good for bilateral pelvic and neurologic injuries
-often the only voluntary applicable exercise in early post-surgery/injury period
How are standing exercises done?
-dog is placed with feet squarely underneath itself and with a sling used supportively
-animal is allowed to support their weight; when they slowly collapse, they are pulled back up via sling
-typically start with 10 to 15 reps, 2 to 3 times a day and slowly increase to 5 minutes per session
What are the goals of balancing activities?
enhance proprioceptive feedback
-encourage weight shifting and muscle contraction
-facilitate balance and function
What are the characteristics of slow walks?
-THE most important therapeutic exercise in early post-op
-must go at a speed that encourages pet to bear weight
-slings and harnesses are helpful tools for encouraging appropriate speed and weight bearing
-up and down inclines and hills can increase challenge
-owner/vet staff ergonomics is very important; must go at pet’s speed
What are the characteristics of the ground treadmill?
-often works well for leash-trained dogs
-harness and sides prove useful
-can vary the speed, time, and incline easily
-useful for patterning gait and encouraging early use of limb
What are the characteristics of stair climbing?
-useful to improve power in hind limbs, especially quad muscles
-increases stifle extension with less strain on hips
-go slow to prevent hopping
-start with 5 to 7 steps and gradually increase to 2 to 4 flights 1 to 3 times a day
What are the characteristics of dancing exercises?
-good for strengthening, ROM, and encouraging use of hind limbs
-forelimbs are lifted off ground
-dogs with normal proprioception will naturally move rear limbs and “dance” backwards
-can dance up and down inclines for more challenge
What are the characteristics of sit-to-stand exercises?
-strengthen hip and stifle extensors
-combine with training for good results
-may be easier to back into a corner
-concentrate on appropriate sitting and standing motions
-start with 5 to 10 reps one or twice a day and work up to 15 to 20 reps two to three times a day
What are the characteristics of cavaletti rails?
-rails or poles spaced apart on the ground
-improve joint ROM
-lengthen stride
-encourage limb use
-challenge balance
-begin walking and progress to trotting
-can raise height of the rails to encourage greater active flexion and extension of joints
What are the characteristics of aquatic therapy?
-allows active muscle contraction with minimal weight bearing on joints and bones
-cannot be done until incisions are sealed
-always supervise activity
-can use whirlpools, pools, bathtubs, lakes, streams, and underwater treadmills
How does the height of the water impact buoyancy?
higher water levels will increase the reduction in hind limb weight bearing
What are the “pearls” of physical rehab?
-daily exercises are needed
-follow up is critical
-combine with weight control
-vary the routine
-in pain or lameness increase during step ups in routine, step activity down by 50% for 2 or 3 days before trying the step up again
-progress is slower during chronic phases
