A written referral for “Rehab” from your Veterinarian is required in the State of Virginia (Click on the link on the “Contact Us” page for a printable referral form).
Susan will perform a thorough initial evaluation, including a review of medical history, medical records, diagnostic tests and medications; and will consult as needed with your Veterinarian. During the evaluation, Susan will assess orthopaedic and neurological status including range of motion, strength, reflexes, sensation and proprioception, pain and edema, incisional scar status, skin integrity, mental status, functional capabilities, weightbearing, balance, gait pattern and considerations for any home accommodations, assistive devices, weight control or dietary supplements.
include range of motion (ROM) exercises, prolonged stretches, strengthening exercises and functional activities. These may be performed actively, passively, in the home and outdoors, on land or in water. It is very important to maintain as much ROM as possible. When muscles and tendons tighten, a great deal of time and effort must be expended just to regain normal ROM in order to progress in a Rehab program.
Gait Training and Weightbearing Exercises
consist of a variety of techniques, exercises, walking and treadmill programs and activities to restore normal weightbearing to affected limbs and normalize gait pattern. In most cases, common household items can be used to facilitate return to normal function.
Balance and Proprioception Training
In many instances, following orthopaedic or neurological insult or illness, or surgical repairs; there is a loss of balance, sensation and proprioception (the ability to feel where limbs are in space). Normal function and gait pattern can not be restored until balance, sensation and proprioception are recovered. Retraining involves a progression of specifically prescribed techniques to achieve optimal results.
Pain and Edema Control
are especially important immediately following any surgery. Efforts should be made to prevent inflammation rather than reduce it later. Edema will hinder Rehab efforts and require substantial owner time in an attempt to reduce and control it. It is recommended that surgical sites be iced (a cold pack) immediately following surgery, for 15 minutes; and 3-4 times a day for 3-4 days. Owners should consult with their Veterinarians about pain medications. Depending on the condition, hot packs or cold packs, massage, ultrasound, phonophoresis, iontophoresis, TENS and ROM are all methods of pain and edema control.
Scar Tissue Management
is extremely important, but is frequently overlooked. Incisional scars can quickly thicken and bind down (adhere) to underlying bone or soft tissues; preventing normal ROM and use of a limb, perhaps permanently. There is a relatively small window during which scar tissue can be affected and controlled/reduced. With proper instruction, incisional scars can be gently mobilized even before sutures are removed. This will also increase blood flow and promote faster healing of the incision site. Once sutures are removed and the incision site is well-healed; additional soft tissue and scar mobilization techniques, including deep friction massage, can be implemented.
Joint and Spinal Mobilization
will help restore normal movement to joints and the vertebral column. When joints do not move properly, surrounding muscles, tendons and ligaments tighten; further reducing the ability to move and function normally. In addition, the loss of spinal mobility and the narrowing of intervertebral spaces can compress discs and nerves; resulting in neurological symptoms and varying degrees of neurological deficits. Joint and spinal mobilizations should only be performed by properly trained individuals.
Thermo and CryoTherapy
are methods of heating or cooling superficial tissues. Cold packs are indicated during periods of acute inflammation (pain, increased skin temperature, redness or swelling), following surgery, injury or after exercise. Hot packs are used for subacute or chronic swelling to relax muscles, prevent or relieve soreness or to briefly increase extensibility of soft tissues for ROM and stretching. Depending on circumstances, heat or cold can be used for pain relief.
Effleurage, Petrissage and Deep Friction Massage
are utilized to promote and achieve different actions and results. Effleurage massage is performed to reduce edema in a limb or body area; and must be carried out in a specific manner. Petrissage massage is a “kneading” type massage, used to relax muscles, promote increased blood flow and healing, and relieve pain, muscle spasm, contractures and soreness. Deep Friction massage is indicated for scar tissue, tendonitis, contractures, trigger points and muscle spasm.
Ultrasound, Phonophoresis and Iontophoresis
are methods by which medical equipment is used to deliver deep heat and/or medications such as Dexamethasone, Hydrocortisone and Lidocaine into the soft tissues. Ultrasound uses sound waves to produce a deeper heating effect to an area to increase tissue extensibility and blood flow and to decrease edema and pain. Ultrasound may be used in direct contact with the skin surface (requires area to be shaved) or underwater when designated areas are very small. Phonophoresis is the use of Ultrasound and sound waves to deliver drugs to underlying tissues. Iontophoresis is the use of electrical current to deliver drugs to tissues via ion transfer through adhesive electrodes placed on the skin surface (also requires area to be shaved).
Neuromuscular Electrical Stimulation and TENS
are used to determine nerve conductivity and muscular response, for strengthening and muscle re-education, reduction of tendon contractures, spasm and pain. Electrical impulses are delivered via adhesive electrodes placed on the skin (requires area to be shaved). TENS (Transcutaneous Electrical Nerve Stimulation) is used for pain relief, particularly after surgery.
Aquatic Therapy (location dependent)
is used in the rehabilitation of canines with both orthopaedic and neurological conditions; as well as for physical conditioning programs. It can be a valuable adjunct to a well-rounded Rehab program and can help dogs move limbs that are too weak to move on land. The buoyancy effect decreases the loading of joints while providing therapeutic facilitation of active movement and resistance for strengthening. Swimming or walking on an underwater treadmill are not substitutes for other therapeutic exercises or weightbearing, balancing or proprioceptive activities; and do not provide for the same range of motion as land activities. Water temperatures must be appropriate for the dog, the condition and the desired effects. Water levels can be varied to achieve specific results for strengthening, progressive weightbearing and gait training. Aquatic therapy can be carried out in pools, ponds, lakes, bays, at beaches or on an underwater treadmill; and in cases of smaller dogs, can be performed in sinks, bathtubs, children’s wading pools and various types of plastic containers. Swim vests are available if needed.
Physical Conditioning, Weight Control and Dietary Measures
are specifically designed programs for fitness, agility, athlete, show or working dogs, obese dogs, or dogs that may benefit from joint, neurological or nutritional supplements.