At Walking Paws Rehab, we take a different approach to physical therapy. We view the patient as a whole and target treatments from multiple approaches. One of the biggest misconceptions is that physical therapy is just strength building. We have learned that a more comprehensive and balanced approach leads to better results.
One of our earlier patients was a mastiff who received a total hip replacement. The implant failed and needed to be removed. He was receiving physical therapy at another practice for 6 months without any progress. Six months later he was still not bearing any weight on his leg. He was referred to us for a second opinion and to take over management of his complicated case. When looking at his previous protocol, his entire plan was focused heavily on strength building. No one considered pain management. No one considered modalities, massage, heat/cold therapy, stretching, improving range of motion of the hip joint, or medications. If a dog is in pain, strength building is not going to be successful without first addressing the pain. Everyone was focused on the muscle wasting and building muscle in his case, rather than looking at the underlying cause for his lameness. In this case, we were able to peel back the layers and ultimately diagnosed allodynia. Allodyina is a condition where chronic pain causes normal touch and movement to become excruciating and painful. After focusing on pain management for two weeks at Walking Paws Rehab, we quickly got him walking normally again and back to strength building.
This is why it is so important to view the patient as a whole, to understand the causes for the limp, and to take a step by step approach to your pet’s journey of healing. This is why patients often do not go straight into the underwater treadmill at the first appointment. Healing is a process, not a moment. As you begin this journey with your pet, understand our process, though unique and different, is based on years of experience resulting in happy endings for some of the most complicated of cases. We view each patient in their unique presentation, creating treatment plans that are individualized for that pet.
The following is an explanation of how we often progress our patients. This will vary based on the patient, your goals, and the condition we are treating. In general, we keep the following things in mind when creating an individual treatment plan:
- Is pain under control?
- Are muscles flexible and do joints have proper range of motion to allow proper biomechanics?
- Have we regained proprioception (awareness of where the limb is in space)?
- Are we ready to start benefiting from strength building?
Our first and foremost goal is to get your pet’s pain under control if it is present. When our pets are in pain, this discomfort can cause changes throughout the body. It can make them unwilling to move in normal ways, it can affect their appetite, and it can change their interactions with the family. Getting this pain under control is essential for healing.
We accomplish this with a combination of medications/supplements, massage, laser, therapeutic ultrasound, electrotherapy, pulsed electromagnetic field therapy, and acupuncture. The protocols for these modalities are created specifically for your pet. We can help adjust medications and supplements to control pain, then once your pet is comfortable, we will help wean them down to the lowest effective dose of medications and supplements. A pain free pet is a happy pet!
As we are working on pain control, we also focus our treatments and modalities to reduce inflammation and swelling. If your pet has undergone surgery recently, our initial focus will be heavily focused on good pain control, and reducing inflammation, swelling and bruising. Inflammation can be beneficial and is part of the body’s normal mechanism to start healing an injury. Too much inflammation, however, can be detrimental and delay healing. So for example, if your pet has a swollen knee and we start exercising this may cause increased swelling resulting in more soreness, pain, restricted range of motion, and limping. It is important to get swelling down before we jump into weight bearing exercises. In regions of swelling we may utilize medications, laser, ultrasound, the cold compression machine, massage strokes, and some gentle passive movement to reduce swelling.
Once pain and swelling are controlled, we then focus on improving flexibility. We need the muscles to be relaxed and moving in the correct way so they don’t restrict the joints. When muscles are tight, they change movement patterns that can lead to compensatory issues. We often spend a few rehab sessions working on massage, stretching and other soft tissue techniques to regain the flexibility of the muscles. For example, a dog with a really tight hip flexor from holding the leg up the last few weeks may not physically be able to get the paw to touch the ground until the hip flexor is relaxed and stretched. It is important to make sure muscles are relaxed to the point of allowing proper postures. We will teach you stretches you can perform at home to help us accomplish these goals. We even teach our patients yoga poses to actively stretch certain muscles.
Another main focus when creating a treatment plan is to regain normal range of motion within the joints. In order for your pet to do their daily activities, they have to be able to flex and extend the joints. Therefore, many times we will be teaching you techniques to use at home to help with passive and active range of motion and continue to work on improving range of motion in an injured limb if it is warranted.
If your pet has any underlying neurologic issues, our next focus is going to be bringing back awareness of that limb. This awareness is referred to as conscious proprioception. In a nutshell, does your pet recognize where their limb/paw is in space? Are they able to take appropriate and safe steps with all of their limbs? At this phase we are utilizing a lot of neurologic techniques working with our hands and equipment to bring back feeling and awareness to certain regions of the body.
Once all of these things have been addressed it is now time to focus on exercises. Exercises will be tailored specifically to your pet’s needs. We will target specific muscle groups that are weak or atrophied. Initially we often start with isometric exercises, where the muscle contracts while staying still. Then we work on concentric exercises, where the muscle contracts while shortening. We work up to eccentric exercises (the most difficult) where the muscle contracts while lengthening. A good example is when you lift a drink to your mouth. This would be a concentric contraction of your bicep, it is shortening to bring the cup to your mouth. When you put the cup back down on the table you are eccentrically contracting your bicep. You are lengthening your bicep in a controlled manner to set the cup on the table.
We start introducing exercises slowly to minimize overloading muscles to try and avoid excessive soreness, and then gradually increase the difficulty once they are performing the easier exercises with ease and good form. At Walking Paws Rehab, we have a variety of equipment we utilize to accomplish these goals and make exercise fun for your pet. It’s important that we have strong muscles to support the joints, allowing your pet to be more active without causing excessive strain on their joints. Sometimes your pet may be slightly sore for 24 hours after exercise, which is fine. If soreness occurs longer, then this is a sign we need to return to easier exercises. We will be teaching you how to perform exercises at home, which allows us to achieve good strengthening, and reach the goals you have for your pet.
In many of our cases another mainstay of our therapy here is the underwater treadmill. The underwater treadmill is a great tool for improving flexibility, range of motion, and strengthening while off-loading joints. The viscosity of the water provides resistance to increase the work on the muscles and naturally puts the joints through increased range of motion. Before utilizing the underwater treadmill, we need to have pain under control and have good firing of particular muscles, such as the hamstrings with a knee injury, to support the joints. Your therapist will evaluate your pet’s individual case to determine when to start the underwater treadmill. We introduce your pet to the underwater treadmill slowly to make it a fun experience. Often patients who don’t enjoy baths find the underwater treadmill enjoyable! Once your pet is walking well in the underwater treadmill, we gradually increase the speed and time as part of our comprehensive rehabilitation plan. We also have the ability to incline and decline the treadmill to work on endurance and conditioning.
All of these tools are tailored by the canine rehabilitation therapist to your pet’s condition and limitations so that we can effectively reach your goals. It can be a process that takes time, but it is very rewarding. It is not uncommon that as we meet our initial goals, we often exceed them to reach new goals you may have never thought possible for your pet. We are excited to get you and your pet back to all of your fun activities together!