Canine Rehabilitation and Modalities

Canine rehabilitation is the application of the science of rehabilitation medicine as it is adapted to canine patients. Canine rehabilitation has evolved from the practice of both veterinary medicine and human rehabilitation medicine, specifically, physical therapy.

Rehabilitation specialty with a focus on the restoration, maintenance, and promotion of optimal physical function throughout the life span. Physical therapy is provided by physical therapists to individuals who have or may develop impairments, activity limitations, and participation restrictions related to conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems; or the negative effects attributable to unique individual and environmental factors as they relate to performance. Physical therapy might be used in circumstances in which movement and function are reduced by aging, injury, pain, diseases, disorders, conditions, or environmental factors.

Acknowledging that a variety of professionals contribute to the canine rehabilitation team, a challenge is the coordination of these practitioners, each of whom fills an important role in the management of the canine patient. Optimal outcomes are achieved when the team is coordinated and collaborative, thus exploiting each team member’s knowledge, skill, experience, and expertise while leaving ego at the door for an appropriately balanced and patient‐focused approach to management, whether the patient is an athlete, working dog, or pet.

Modalities we use with our patients:

Superficial thermal agents: cold and heat

Superficial thermal agents are primarily used to reduce swelling and pain, but can also promote healing and improve mobility. Some evidence also indicates that their use can assist with muscle activation. Superficial thermal agents are convenient modalities as they are readily available, involve minimal expense, and are frequently safe to include as part of a home treatment program.

Superficial cold: cryotherapy

Cryotherapy is the use of cold with a goal of removing energy from tissues in the form of heat. Its application can result in tissue cooling 2–4 cm deep. In canine rehabilitation, this energy transfer generally occurs through conduction as the cold source is placed in direct contact with the body. The initial physiological response is cutaneous vasoconstriction with a resultant reduction in blood flow to the area. Cryotherapy is therefore most often used in the acute phase of injury with the goals of reducing inflammation and pain. However, it may also be used in the rehabilitation setting to decrease muscle spasm, lessen muscle spasticity, elicit stronger muscle contraction during functional movements, and limit post‐exercise soreness.

Evidence supporting cryotherapy use as therapeutic effects on:

• Pain
• Tissue protection and healing
• Tissue flexibility and joint ROM
• Therapeutic effects on muscle strength

In the canine rehabilitation setting, cryotherapy is typically provided with cold packs or ice massage, although devices that provide cold and compression together are also being used more. When determining which method to use, the size and accessibility of the body part should be considered as well as the patient’s tolerance of straps, massage, and/or compression.

Superficial heat

Superficial heat is used in the rehabilitation setting to reduce pain, increase blood flow, improve connective tissue extensibility and joint mobility, and promote muscle relaxation. During the subacute and chronic stages of healing, heat application may also help alleviate remaining inflammation. As with cryotherapy, superficial heat is most frequently delivered through conduction, with the heating agent placed directly onto the body part.

A tissue temperature rise of 1 °C leads to an increase in metabolic rate, a 2–3 °C temperature increase helps to alleviate muscle spasm, pain, and chronic inflammation, and an increase of 4 °C promotes collagen extensibility.

Evidence supporting the use of superficial heat:

• Effect on pain
• Effect on Tissue healing and protection
• Effect on tissue flexibility and joint range of motion
• Effect on muscle strength

Laser

LASER is an acronym for “light amplification by stimulated emission of radiation.” Laser application is also referred to as photobiomodulation. Lasers produce electromagnetic radiation that is monochromatic, coherent, and collimated. These qualities allow laser light to penetrate tissues. Photobiomodulation (PBM) therapy occurs when a dose of light energy reaches target tissue and results in decreased inflammation, decreased pain, and accelerated healing.

Evidence supporting the use of laser therapy:

• Therapeutic effects on pain
• Tissue healing and protection
• Effect on tissue flexibility and joint range of motion
• Effect on muscle strength

Extracorporeal Shockwave Therapy

Shockwave therapy is a non-invasive procedure used to treat acute and chronic pain of the musculoskeletal system.

Shockwave therapy is a non-invasive procedure used to treat acute and chronic pain of the musculoskeletal system. The source from which the shockwaves are generated is located outside the body (extracorporeal) and the shockwaves are delivered to areas deep inside the body. The focused shockwaves used in ESWT procedures reach their peak pressure precisely in the target tissue.

Use of PiezoWave in small animal veterinary medicine

Shockwaves are mechanical stressors which induce biochemical changes in living tissue3. Mechanical stimuli affect almost all cellular functions in living tissue, including growth, cell differentiation, cell migration, protein synthesis, physiological apoptosis, and tissue necrosis11. On a molecular level, the biochemical changes ultimately affect the gene expression of cells by eliciting specific tissue reactions. Below is a list of specifically studied effects of shockwave.

• Stimulates new blood vessel formation
• Regulates inflammation
• Releases nitrogen monoxide (NO) which contributes to vasodilation, increases metabolic activity and angiogenesis, and exerts an anti-inflammatory effect
• Changes the levels of Substance P
• Stimulates bone metabolism
• Releases growth factors; IGF, TGFbeta, VEGFgamma
• Exhibits chondroprotective effects
• Dissolution of calcified fibroblasts
• Stimulates lubricin production
• Stimulates stem cells
• Antibacterial effects

The treatment of orthopedic disorders plays an important role in small animal medicine. Shockwave is one of the few medical technologies which treats pain syndromes of the musculoskeletal system by repeatedly triggering the body’s own self-healing processes. There are many studies that describe the use and verify the efficacy of shockwave for healing of both bone and soft tissue in veterinary medicine.

Shockwaves are able to stimulate the endogenous production of lubricin in the tendons and at tendon insertions. Lubricin helps tendons slide within joints and an increased amount of lubricin could provide pain relief and decreased joint erosion and account for some of the clinical success of shockwave when treating chronic osteoarthritis. The efficacy of shockwave for trigger point treatment and the effectiveness of focused piezo shockwaves has also been studied.

A representation of conditions that can be treated with a piezoelectric shockwave in small animal veterinary medicine is listed below. More information can be found in the remainder of this document.

• Shoulder diseases - Bicipital tenosynovitis, Supraspinatus and Infraspinatus insertional tendinopathy
• Elbow diseases - Degenerative joint disease
• Carpal diseases - Degenerative joint disease, Tendon/Ligament injuries acute and chronic
• Intervertebral disc disease & Lumbosacral stenosis
• Coxofemoral diseases - Degenerative joint disease, Iliopsoas trigger points
• Stifle diseases - Cranial cruciate disease, Patella luxation, Degenerative joint disease, Patella tendonitis, Medial and lateral collateral ligament inflammation, Long digital extensor tendonitis
• Tarsal diseases - Ligament injuries acute and chronic, Achilles tendinopathy
• Wounds
• Osteochondritis dessicans (OCD)

Targeted Pulsed Electromagnetic Field (tPEMF) therapy delivers electromagnetic waves precisely tuned to stimulate an animal’s natural anti-inflammatory recovery process.

Proven to reduce pain and accelerate healing

For animals experiencing pain or inflammation, Assisi LOOP® products employ a tPEMF signal specifically tuned to stimulate the body’s own natural anti-inflammatory process, lowering pain while speeding healing.

Assisi LOOP products are available without a prescription for animals under veterinary care. They are effectively used in a wide range of conditions, including:

• Post-surgical recovery
• Wound care
• Spinal and nerve disorders
• Internal inflammation
• Osteoarthritis
• Bone, joint, and soft tissue injuries