Services : Small Animal Services : Physical Rehabilitation

Physical Rehabilitaion at the Lindale Veterinary Clinic

 

Dr. Renee Smith, CCRT and Technician Casey Maxfield, CCRP both hold certification in physical therapy and have attended nationally recognized rehabilitation training. Contact us today for a tour of our rehabilitation facility.

 

INDICATIONS

Hydro-treadmill therapy is primarily used in veterinary patients to enable early return to function and improve muscle strength after limb, neck, or back surgery or injury and improve range of motion in compromised joints. Hydro-treadmill therapy is also becoming more frequently used in animals for athletic conditioning and weight management.

 

Orthopedic and neurologic patients can benefit from earlier return to function with underwater treadmill therapy. It provides a reduced weight-bearing environment that increases functional use of a limb without marked weight loading and resultant discomfort to a postsurgical joint.1 Patients healing from fractures in which immobilization is necessary often perform well when exercise is first initiated in water. The water's viscosity also provides increased proprioceptive and tactile stimulation.2

 

In addition, most postsurgical and neurologic patients have some degree of muscle atrophy or loss of strength. Muscle atrophy also occurs secondary to osteoarthritis and, to a smaller degree, as a result of normal aging. Walking on an underwater treadmill once a week or more can help patients with muscle atrophy improve strength and mobility because of the increased resistance to forward motion. More frequent sessions, as often as every other day, can help build strength even faster.

 

Many dogs that are unwilling to use a limb after injury will use the limb to help maintain balance and stability in the water because of increased comfort and because of the resistance to forward motion in the functional limbs, which slows the gait pattern. Underwater treadmill therapy is particularly useful in small dogs that have undergone femoral head ostectomy. In these patients, we want healthy pseudo-joint formation rather than excessive scar tissue leading to restricted motion. An underwater treadmill allows motion in a low-weight-bearing environment to help strengthen the muscles and tendons that surround this new joint as well as maintain strength and balance in the rest of the body. The reduced weight-bearing stress on the limb in the initial phases of pseudo-joint formation appears to help to reduce the amount of functional limb length discrepancy associated with dorsal displacement of the femur in these patients.

 

Injured joints often show reduced range of motion. Underwater treadmill walking allows a correct but exaggerated gait pattern, which improves joint flexion, and to a lesser degree, extension.3 The most common example of a patient that would benefit from this exaggerated gait pattern is a patient with limited stifle and hock flexion after undergoing surgery to repair an anterior cruciate ligament injury (see the related sidebar titled "A case example of physical rehabilitation in a dog after bilateral stifle surgery").

 

The pain relief provided by warm water facilitates muscle relaxation and tendon stretch in situations in which splinting, protection, or contracture has occurred.1

 

Athletes benefit from conditioning on an underwater treadmill both in muscle strengthening and cardiovascular endurance because of water's increased resistance.

 

Finally, obese or overweight patients can exercise more safely in a buoyant environment than on land. The water's buoyancy reduces weight-bearing stress while at the same time its resistance increases metabolic demand and improves muscle strength.1

 

Swimming

Swimming can also be used as a mode of aquatic therapy. Its uses and benefits are similar to those of an underwater treadmill, but it has a few key differences.1,4 Swimming dogs use a different pattern than a walking gait, so it may not be ideal for gait retraining in a dog with a neurologic injury.5 Water in most tanks can be adjusted to a sufficient depth to allow even a large dog to free-swim. Some equipment allows the use of jets to provide resistance.

Some facilities use a separate pool for swim therapy, allowing more room for a natural swim environment. In some cases, swimming can be done in lakes or in the ocean, but these are less-controlled and, thus, more risky environments.

CONTRAINDICATIONS AND PRECAUTIONS

Some patients may be fearful of water, but most are willing to exercise on an underwater treadmill if they are slowly introduced to the equipment and the water. If a patient is fearful of the underwater treadmill, treats placed on the ramp and tread, or a frozen cup smeared with peanut butter, can often motivate such a patient to get into position to walk.

 

Patients with cardiac or respiratory disease may experience more difficulty exercising in water than on land. However, most of these patients can exercise on an underwater treadmill if properly monitored and exercised conservatively.1 Increased resistance in the water causes increased cardiovascular and respiratory demand. Short sessions of exercise followed by sessions of rest (initially walking one minute, resting two minutes, repeating twice) may be more appropriate for these patients. The patient is never exercised to the point of fatigue, and its respiratory rate is closely monitored with exercise ceasing before panting occurs.

 

As with any active therapy, each patient's general health must be evaluated before initiating therapy to ensure it is capable of safely and comfortably performing the activity. In addition to general health concerns, the practitioner must determine if a patient's pain level is too great to initiate active exercise. In most situations, patients in pain derive relief from aquatic activity.1 Initially, a therapist may choose to perform passive range of motion or standing exercises with the patient in the water and progress to active walking when the patient is more comfortable.

Certain instabilities (such as spinal instabilities) may need to be resolved before initiating underwater treadmill therapy. Some patients with instabilities may be safely exercised underwater.3 Many experienced practitioners will initiate underwater treadmill therapy before anterior cruciate ligament surgery and in some instances when surgical correction is not possible.

 

It is also best to avoid immersing a newly sutured area, a large wound, incontinent patients, or patients with diarrhea. Hot spots will heal faster because of the sanitation system in the water as long as the patient is dried thoroughly in the affected area. As a general rule, any condition that would warrant caution for land exercise would also warrant caution for water therapy.

 

If a dog is tetraparetic, there should be at least two or three people in the pool with it: one to work with the rear limbs, one to work with the forelimbs, and if the patient is unable to control neck motion, a third person to prevent head submersion. Several tanks are too small to accommodate this many people, so this need should be a purchasing consideration if a practice works with neurologic patients frequently.

 

TREADMILL VARIABLES

 

Many treadmill parameters, such as water depth and turbulence and walking speed and direction, need to be determined each session to best achieve the desired outcome for a patient. Water temperature may also vary, but this variation occurs less frequently in practice than the other parameters.

 

Water depth

 

Changing the water depth can markedly alter a patient's motion and exercise exertion level. A low water level, just above the carpus (91% weight-bearing), increases carpal and hock flexion more than any other level does and is useful in patients with reduced flexion of these joints.6 When the water is at elbow level, there is significant resistance with minimal buoyancy (85% weight-bearing)6 since the chest is not displacing water. This level is excellent for dogs you want to increase strength and endurance in, such as athletes. Water levels at or just above the shoulder have maximum buoyancy for strengthening the limbs with minimal joint load (38% weight-bearing) and are most beneficial in patients with osteoarthritis or recovering from surgery in which full weight-bearing is contraindicated or painful.6 CONCLUSION

 

In our experience, underwater treadmill therapy can be beneficial not only in patients with injuries but also in patients with osteoarthritis and obesity. Additionally, it can be used for conditioning healthy canine athletes. This wide scope of use can make underwater treadmill therapy a great addition to many practices.