By Jennifer Au, DVM, DACVS, CCRT
Hip dysplasia, and the osteoarthritis that comes with it, can be a potentially devastating disease for dogs. The good news is 70% of dogs with hip dysplasia do not need surgery if they are appropriately managed medically or conservatively. This is a combination of weight control, as-needed use of NSAIDs (under your veterinarian’s supervision), omega 3 fatty acids, joint supplements and low-impact activities such as walking and swimming. In addition, physical rehabilitation is a very useful and effective tool in the management of hip dysplasia and osteoarthritis as well as weight loss.
Veterinary physical rehabilitation is decades, even centuries, behind human physical therapy. Humans have known the benefit of physical therapy since Hippocrates first used hydrotherapy (water therapy) to treat rheumatism and paralysis in 460 B.C. The importance of physical therapy quickly became realized during World War I to help wounded soldiers recover and return to battle. At that point in time physical therapists were called reconstruction aides. Physical therapists were again called to action during the poliomyelitis (polio) epidemic of the early 1900’s. During this time period, rapid advancements were made in the field of physical therapy. Veterinary rehabilitation has greatly benefited from the advancements of human physical therapy. Typically advancements in human medicine come initially from animal research. This is one of the unique areas in veterinary medicine where the humans have been the research models for veterinarians and veterinary rehabilitation. Collaboration with the human physical therapists has been an essential component.
Why do we use the term physical rehabilitation or rehab when talking about animals instead of physical therapy or PT? Human physical therapists or PTs have undergone years of schooling along with passing licensing exams to earn the title of Physical Therapist. It is actually a legally protected term in all 50 states just as Doctor of Veterinary Medicine or DVM (VMD if your veterinarian graduated from the University of Pennsylvania; they prefer the Latin derivation) is legally protected. On the veterinary side, veterinarians, veterinary technicians (similar to human nurses) and human physical therapists and physical therapist assistants can become certified in canine (or equine) physical rehabilitation by completing the required course work, hands-on training, case write-ups, externships with certified practitioners and passing a qualifying exam. Currently only the Canine Rehabilitation Institute (www.caninerehabinstitute.com) and the University of Tennessee (www.canineequinerehab.com) provide the necessary training and certification. Graduates earn the title of Certified Canine Rehabilitation Therapist (CCRT), Assistant (CCRA) or Practitioner (CCRP) depending on the program attended. Both groups have websites that allow you to find a certified therapist in your area.
Physical rehabilitation enlists a large number of therapy options to treat osteoarthritis secondary to hip dysplasia or any other cause. Some of the therapy options used for an osteoarthritic hip or other joint include thermal therapies, passive or active exercise, laser therapy, therapeutic ultrasound, electrical stimulation (e-stim or TENS), land treadmill and hydrotherapy to name a few. Thermal therapies are simply the application of heat or cold to the joint. Cryotherapy or cold therapy is used in acute flare-ups of OA to reduce swelling and inflammation. In addition, cold therapy helps with pain control by slowing nerve conduction. Anyone that spent anytime up north in the winter will understand this well. Think of cold, wet mittens and what happens to your fingers. They get numb because the cold is slowing the nerve conduction or nerve signals. Heat therapy is used for pain relief, to decrease muscle spasms, increase circulation, and loosen stiff or tight joints and muscles in more chronic OA joints.
Passive exercises, including range-of motion exercises, stretching and massage, help loosen stiff joints and improve movement. Typically the rehab therapist is performing the passive exercises while the patient relaxes and ‘enjoys the ride’. Active exercises, however, require the patient to do the work and participate in their own rehab. Active exercises use a number of tools such as physioballs (think yoga ball), wobble/balance boards, cavaletti rails (elevated poles), obstacle courses, stairs, ramps, etc. to improve range-of-motion in osteoarthritic joints and strengthen the supporting muscles of the limb.
Therapeutic lasers, also termed cold lasers, are used to reduce pain and inflammation while aiding in tissue repair and healing. Lasers emit radiation in the form of photons. The photons enter the skin and tissues, providing energy for cells in the osteoarthritic joint and surrounding tissues to function better.
Therapeutic ultrasound, different than a diagnostic ultrasound used to evaluate a fetus or heart, is used as a form of thermal therapy but also has nonthermal effects too. Therapeutic ultrasound uses sound waves to warm tissues resulting in increased circulation and pain control in osteoarthritic joints. The ultrasound is able to penetrate deeper into tissues than a topical warm compress. The nonthermal or nonwarming effects of therapeutic ultrasound also result in tissue healing, reduction of swelling and pain control.
Electrical stimulation, e-stim or TENS, is the use of a controlled electrical current to stimulate a nerve and surrounding muscles. The electrical stimulation causes a sensory (sensation) or motor (muscle movement) in the tissues. Depending on how the electrical stimulation is applied it can aid in pain control, muscle relaxation and reduction of muscle atrophy and edema. Many people with back or neck issues are familiar with e-stim or TENS to aid in pain control.
Hydrotherapy or water therapy, which typically consists of using an underwater treadmill or swimming, is a great tool for pets with hip dysplasia, osteoarthritis or neurologic problems and those pets needing help with weight loss or staying in shape. When using an underwater treadmill, the pet walks into a dry treadmill surrounded by four waterproof walls and floor. Warmed, filtered and conditioned water gradually fills the treadmill to the required level. Many owners believe, incorrectly, that their dog or cat will never tolerate an underwater treadmill. Many pets show no hesitation, especially water loving dogs like Labradors. Some pets are a little hesitant because it is a new experience but with the right encouragement and positive reinforcement (toys and treats) they come to enjoy the experience. I have seen a number of dogs run into the treadmill when it opens up even when it is not their turn. The water level can be adjusted for the size of the pet and the type of activity or work the rehabber needs the pet to perform. The more water, typically to the level of the hip, the less weight the osteoarthritic joints have to carry while in the water making it easier for the joint to function. While the pet is walking in water, all four legs are working against the water resistance; building muscle, stamina and providing an aerobic workout. Swimming is another form of low-impact, aerobic activity for osteoarthritic joints.
At Charleston Veterinary Referral Center we are fortunate to have three certified physical rehabilitation professionals on staff. Our newly expanded rehabilitation center is in full swing and we would love to talk to you about how rehab can benefit your pet.