Introduction to Therapeutic Exercise
World Small Animal Veterinary Association Congress Proceedings, 2018
Janet B. Van Dyke, DVM, DACVSMR
Canine Rehabilitation Institute, Inc., Wellington, FL, USA

The rehabilitation therapist assesses the patient by gathering subjective data from the client, medical history from the referring veterinarian, and objective data from an in-depth physical examination that includes assessment of posture, gait, strength, flexibility, AROM, PROM, and neurologic function. From this data, a problem list is created and an assessment narrative is written. The treatment plan addresses each of the items on the problem list and includes manual therapies, physical modalities, and therapeutic exercises.

Therapeutic exercise plans are based upon the weight-bearing status of the patient. Weight bearing is classified as: non-weight bearing (NWB), partial weight bearing (PWB), and full weight bearing (FWB). Animals that are FWB are then classified by strength: minimal (Less than 3 on a scale of 5, shown here as <3/5), moderate (3 out of 5, shown here as 3/5), and good (greater than 3 out of 5, shown here as >3/5). Exercise plans for each of these weight-bearing statuses will include work on proprioception, strength, flexibility, and endurance.

The therapist must then focus upon the structures being treated: the muscles. There are two basic muscle types: joint stabilizer muscles and mobilizer muscles. Stabilizers tend to be short bellies with short excursion length. They tend is sit deep to the mobilizers and insert close to the joint. These muscles tend to have more Type 1 muscle fibers. Mobilizers have longer bellies and tendons, sit more superficially in the limb, have more Type 2 muscle fibers, and are more frequently diagnosed with strain injuries. Patient evaluation requires a thorough examination to assess for areas of pain and/or weakness. The patient’s emotional and intellectual abilities must be assessed as well, as this will determine the types and intensities of treatment plans that will be optimal. With all information gathered, the therapist will create both short-term and long-term goals for the patient, based upon age, injury acuity, weight bearing status, and client’s goals. When designing a therapeutic exercise plan, many variables must be controlled. These include: frequency, intensity, duration, environment, and degree of impact. These variables are then applied to each type of exercise (proprioception, strength, flexibility, and endurance). At the start of each exercise session, the patient is first trained how to complete the desired movement. The correct movement is then demonstrated to the client, who is then asked to complete the movement with the patient. The therapist must be aware of possible avenues for the patient to avoid doing the correct movement and be prepared to prevent or correct each while instructing the client how to observe these actions.

There are some basic rules that should be observed when carrying out an exercise program:

1.  Always start within the patient’s comfort zone. Any exercise that causes pain will no longer be a viable option for the anxious patient. Intensity of the exercise is gradually increased until the short-term goals are met. Once the patient is able to easily complete the prescribed exercise, the frequency, intensity, duration, environment or degree of impact can be increased.

2.  Strength work should be done 3 to 5 days per week with days off alternating with work days. For the client that insists on training daily, the plan will work on thoracic limbs one day, core the next, and pelvic limbs the next.

3.  All patients have a daily stretching routine after working out.

Therapeutic exercise equipment for dogs includes physio balls, therapy bands, rocker/wobble boards, inflatable discs, cavaletti poles, and treadmills.

Cavalettis were introduced from equine training and are used to enhance proprioception, strengthen flexor muscles, and increase stride length. Land treadmills are popular today. The concern when working canine patients on human treadmills is that the treads are relatively short (1.5 m). For breeds larger than border collies, the tread needs to be at least 2 m long. A short tread can lead to a shortened/altered gait that persists when off of the tread. This can have very detrimental effects on working dogs. There are several companies manufacturing canine-specific treadmills. Inflatable discs are very valuable tools. They are used as low unstable surfaces when working on proprioception and balance. Rocker/wobble boards come with interchangeable devices on the underside that allow the therapist to convert from uni-directional rocking to multi-directional wobbling. As stated above, exercises are developed to address proprioception, speed, strength, and endurance. Proprioception can be addressed using cavaletti poles in patterns on the ground, weave poles, inflatable discs, and rocker/wobble boards. Once the patient is proficient in one activity, the exercises can be combined into a circuit. The goal for speed work is to increase stride length, efficiency and burst speed. Cavaletti poles are used to increase stride length and efficiency, while interval training is used to increase burst speed.

The goal for endurance work is to increase the duration and intensity of exercise as fitness improves. Here, the therapist must introduce cross training to prevent overuse injury or patient boredom. Unilateral or focal strengthening exercises are beneficial for patients who have gait asymmetry, focal atrophy, or a regional issue such as poor core tone. Two of our favorite exercises for this category include the Sit>Beg>Stand>Beg>Sit exercise and the “Commando Crawl”. The first is a great core strengthener. The patient is taught to sit squarely, then is trained to sit up (‘beg’). Once the patient is capable of holding this posture, even with mild to moderate perturbations by the therapist, the next step is added: The patient is encouraged to transition from the beg posture to standing upright on the pelvic limbs. The therapist must be ready to keep the patient’s focus sufficiently up and toward the back to prevent him from dropping down into a stand position. From this posture, the patient is trained to return to the beg position without allowing the front paws to return to the ground. From the beg, the dog is trained to slowly return to the sit position. This is a challenging but very rewarding exercise, especially for our geriatric patients. Commando crawl involves the patient crawling under a set of obstacles or through a tunnel. This requires great eccentric control of the triceps, quadriceps, supraspinatus, and hamstring muscles.

In conclusion, therapeutic exercise programs are designed based upon the patient’s weight bearing status. There are no ‘cookbook’ protocols, each patient requires strategic problem solving each day that they are treated. The therapist must remain focused upon both the patient’s and the client’s motivation, skill, and long-term goals. Most importantly, the therapist must keep it fun for the patient, always being prepared to make changes quickly as dogs can become bored or frustrated.


Speaker Information
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Janet B. Van Dyke, DVM, DACVSMR
Canine Rehabilitation Institute, Inc.
Wellington, FL, USA

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