Janet B. Van Dyke, DVM, DACVSMR
∼Canine rehabilitation is the application of physiotherapeutic techniques to evaluate and treat musculoskeletal impairments in our canine patients. It incorporates the use of objective outcome measures (goniometers, girthometers, etc.), manual assessments (including palpation, joint glides, and neurological assessment), gait analysis, and special tests brought from the field of human physiotherapy. This allows the therapist to tease out the specific structure and tissue type causing the impairments.
The therapist evaluates the presenting complaint, subjective information from the owner, and objective assessment carried out during the examination to create a problem list. Each item on the problem list is addressed in the plan of care.
Therapeutic plans generally involve a combination of manual therapies (joint mobilizations and soft tissue mobilizations), physical modalities (laser, therapeutic ultrasound, e-stim, shockwave), and therapeutic exercises. The modalities are generally used to prepare the tissues for the manual therapies and therapeutic exercises. Physical modalities should never be the sole therapeutic method applied to any patient.
Therapeutic exercise plans are based upon the weight bearing status of the patient, with early interventions focusing upon functional weight bearing exercises, later progressing to functional strengthening exercises. All exercise plans incorporate proprioception, balance, strength, flexibility, and endurance. Exercise equipment includes physioballs (shaped as rolls, peanuts, eggs, donuts, and balls), cavaletti poles, therapy band, rocker/wobble boards, and treadmills.
Physical modality parameters are chosen based upon the acuity of the injury. They are used to prepare the tissues for additional therapy and can generally be applied by trained veterinary nurses. The most commonly used physical modalities include neuromuscular electrical stimulation, laser, therapeutic ultrasound, extracorporeal shock wave therapy, and ice/compression units. Physiotherapy became ‘mainstream’ globally after WWI when tens of thousands of troops returned home needing assistance in regaining functional independence. At the same time, there was a polio epidemic. Equine rehabilitation became commonplace in the 1960s as horses transitioned from ‘beasts of burden’ to multimillion-dollar sport horses. Canine rehabilitation has been common throughout Europe and the UK since the 80s and in the USA since the 90s.
Veterinarians wishing to offer rehabilitation in their practices must pay attention to the legal issues involved. The terms physical therapy and physiotherapy are both protected terms globally. This means that only those people who are licensed to practice human physiotherapy may use these terms. Similarly, no one can use the term veterinary to describe their practice unless they are a licensed veterinary professional. There is a list serve for those interested in this field: Vetrehab@yahoo.com. This list is managed by Dr. Julie Mayer: firstname.lastname@example.org. Veterinarians are encouraged to join the American Association of Rehabilitation Veterinarians (AARV: www.rehabvets.com), a global organization that maintains an archive of current publications related to the field of veterinary rehabilitation. The American College of Veterinary Sports Medicine and Rehabilitation, a specialty college providing board certification to qualified veterinarians was approved by the AVMA in 2010 and received full accreditation from the American Board of Veterinary Specialists earlier this year. There are currently ~240 diplomates in this college. The field of veterinary rehabilitation is being driven, in large part, by client demand. This is not unlike the growth of veterinary acupuncture in the 1980s. One of the largest drivers is the global phenomenon of canine agility competition. Enthusiasts are spending millions of dollars annually on training, equipment, travel, and competition, and they are seeking out those veterinarians who understand their sport and offer rehabilitation services. There are many other organized canine sporting events, including puissance, dock diving, ‘joring,’ pulling, ring sports, and flyball, with many of your clients participating in more than one sport with their canine companions. It behooves you to ask about their dog’s ‘jobs’ and to be prepared to address their concerns. Sporting enthusiast make very valuable clients. Government awareness is also driving the demand for sports medicine and rehabilitation therapists. Increasingly, government agencies are seeking out the assistance of those who can help to keep their canine assets in the field, preventing injury, and speeding recovery from injury. Sports medicine specialists focus upon much more than musculoskeletal injuries-recognizing commonly used drugs that might impact the scenting ability of dogs trained to search for explosives or contraband, understanding the impact of heat and dehydration on search and rescue dogs, helping handlers to choose optimal nutritional plans for working dogs in extreme weather conditions - and the list goes on. There are many models for sports medicine and rehabilitation practice today, everything from veterinarians opening rehabilitation services in conjunction with boarding and ‘spa’ facilities to large multispecialty practices adding these services to augment their existing surgery, neurology, and internal medicine practices. University veterinary schools are increasingly aware of the need for both clinical services and didactic training in this field. Many rehabilitation therapists are opting to run stand-alone rehabilitation practices while others offer mobile services, offering rehabilitation therapy to multiple practices in their region. Canine sporting events need rehabilitation trained veterinarians on site to care for the athletes. Emergency and critical care practices partner well with sports medicine and rehabilitation practices, allowing for 24-hour care.