Physiotherapy in working dogs

Physiotherapy in sporting dogs : 

Physiotherapy in sporting dogs Prof. Dominique GRANDJEAN DVM, PhD, HDR Unité de Médecine de l’Elevage et du Sport Ecole Nationale Vétérinaire d’Alfort France

What is physiotherapy ? : 

What is physiotherapy ? Non invasive physical methodologies helping the treatment of disease or trauma Physiological benefits include  Reduction of muscle atrophy  Earlier resolution of inflammation  Improved joint hemostasis and biomechanics  Promotion of wound healing  Earlier functional return

Physiotherapy methodologies : 

Physiotherapy methodologies  Passive range of motion  Massage  Controlled exercise  Cold and heat  Electrostimulation  Ultrasound  Laser  Electromagnetic therapy  Magnetic field therapy  Faradism …  Nutrition

Therapeutic ultrasound : 

Therapeutic ultrasound Ultra sound Diagnosis [imaging of internal structures] Tissue destruction [surgery for tumor irradiation] Physical therapy [Deep tissue healing ; joints function restoration ]

Therapeutic ultrasound : 

Therapeutic ultrasound Physical principles Heat 4 to 6 cm deep in tissues Compression Rarefaction

Therapeutic ultrasound : 

Therapeutic ultrasound Physical principles Heat Ultrasound absorption by proteins  Healing  Beware : bones  pain

Therapeutic ultrasound : 

Therapeutic ultrasound Physical principles Ultrasound wave Rarefaction Compression [Areas of decreased density and pressure] Air bubbles in blood and tissues Enter of gas in the bubbles Gas flows out of bubbles Compression Gas exchange Mechanical stress Increased chemical activity

Therapeutic ultrasound : 

Therapeutic ultrasound Therapeutic effects 1. Increase in range of motion Facilitates stretching exercises vs stiffness and decrease in flexibility  Preheating of periarticular connective tissues Reduces size of scars (<3 months old)  Lenght of time between injury and onset of treatment increases less satisfactory results 2. Decrease in pain and muscle spasm Still unexplained effects on nerve fiber conduction  Post-operative scars (1.5Wcm-2/6 min)  Back muscles pain (0.5Wcm-2/12 min)

Therapeutic ultrasound : 

Therapeutic ultrasound 3. Calcium deposits Stimulates resorption of calcium deposits  vs exostosis 4. Wound healing Acoustic streaming seems to play a role in tissue repair [skin temperature rise too small] Very efficient on tendons if applied at low intensities two weeks after injury / surgery Therapeutic effects

Therapeutic ultrasound : 

Therapeutic ultrasound  Equipments . Head size . 1 MHz  penetration 4 to 6 cm to 3 MHz  superficial tissues Treatment methods

Therapeutic ultrasound : 

Therapeutic ultrasound  Utilisation . Direct application Head in contact with skin [conductive gel] . Immersion Treated surface irregular Contact is painfull Treatment methods

Therapeutic ultrasound : 

Therapeutic ultrasound  Utilisation . Continuous mode Induces thermal effect  unstable cavitation  tissue destruction . Pulsation mode Dissipation of induced heat between two pulses  No thermal effect Treatment methods

Therapeutic ultrasound : 

Therapeutic ultrasound  Protocoles . Lenght of sessions 1 minute/cm2 with a maximum of 15 minutes . Acute trauma Start at T + 24/36 hours ; daily . Chronic problems 2/3 times a week Treatment methods

Therapeutic ultrasound : 

Therapeutic ultrasound Indications . Inflammatory problems Periostitis, Bursitis, Capsulitis, Tendinitis . Muscle healing . Reduction of deep scars . Fractures :  pain ;  maturation of bone callus

Therapeutic ultrasound : 

Therapeutic ultrasound Danger . Eyes . Heart . Testicules . Metallic implants . Bacterial infections . Rapid growth tissues  Tumors  Fetuses

Massage : 

Aims  Increase local circulation  Eliminate an exsudate  Stretch the matrix of collagen fibers of a scar  Increase muscular relaxation  Allow other exercises to begin more calmly Massage

Massage : 

Massage Indications  Race warm-up/recovery  Limit and reduce adhesion under a scar  Maintain a maximum degree of articular mobility  Reduce muscle stiffness / contractures

Massage : 

Massage Different methods of massage 1/ Effleurage  Effective to reduce swelling  Sedative effect Large movements Damages vein valves

Massage : 

Massage Different methods of massage 2/ Petrissage . Small movements concentrated on one zone . Muscular body gradually pinpointed and relaxed  Improves circulation in deep zones  Effective on contractures

Massage : 

Massage Different methods of massage 3/ Friction . Other type of deep massage . Performed along scars or accross muscle fibers  Elimination of scar tissues  Promotion of healing  Reestablishment of full mobility of a joint

Massage : 

Massage Chronology Massage can start on the day of injury / surgery  continue throughout the rehabilitation period

Massage : 

Massage Danger No massage when facing an acute muscle lesion  partial rupture  hematoma

Mobilization : 

Mobilization Passive range of motion P.R.O.M. Active range of motion A.R.O.M.

Passive range of motion : 

Passive range of motion . Manipulation that consists of mobilizing a joint through and beyoung its normal range of motion . Muscles need to be relaxed  contractures . Movement must be performed slowly

Passive range of motion : 

Passive range of motion Aims . Maintain or increase the range of motion in one or more injured joints . Avoid formation of undesired connect tissue Methods . Slowly bring the joint to the limit of its range of motion . Hold in place for a few minutes . Bring to a new range of motion  10 to 15 movements / 3 times per day Contraindications . Unstable fracture sites . Luxations . Hypermobile joints

Active range of motion : 

Active range of motion Active exercises  Obedience exercises [« sit », « down », « up », « stay »]  Exercises involving muscular resistance . Gradually increase weight supported by affected limb . Walking, trotting,weight-pulling, weight-bearing  Hydrotherapy [swimming] . Temperature 64 to 68°F . 5  20 minutes .  current of resistance

Cryotherapy : 

Cryotherapy Still poorly understood   Temperature in joints and muscles  Constriction then dilatation of blood vessels  Analgesic effects   Swelling Physiological effects

Cryotherapy : 

Cryotherapy  Ice packs  Reusable cold packs  Instant cold packs  Cryotherapy units Methods Indications  Muscular spasms  Acute inflammation  Relieving muscular-skeletal pain

Heat therapy : 

Heat therapy   blood flow and blood pressure   temperature in tissues  Sedative and analgesic effects   supply in O2, nutrients, antibodies Physiological effects Methods  Heat packs

Heat therapy : 

Heat therapy Indications  Subacute or chronic pathologies [contusions, sprains, myositis] Contraindications  Swelling  Acute inflammations [tendinitis, bursitis]

Electrostimulation : 

Electrostimulation Electrical stimulation Enhance muscle reeducation Promote healing Reduce pain and swelling  stimulation of motoneurons  stimulation of muscle cells  enhanced production of endorphins

Electrostimulation : 

Electrostimulation 1/ Treatment - Prevention of Amyotrophy . Prolonged immobilization   50 p.100 muscle mass in 10 days . Monophasic mode  a. warm-up 2 minutes at low frequency  b. work 10 minutes alterning - high frequency tetanic contraction - low frequency relaxation  c. recovery-relxation 3 minutes at low frequency

Electrostimulation : 

Electrostimulation 2/ Treatment of muscle contracture . Stimulation of the opposing muscles to the contractured one or . Decontracture and tonolysis option [f(equipment)]  monophasic mode

Electrostimulation : 

Electrostimulation 3/ Nerves traumas . Includes : - traumatic avulsion of the brachial plexus - lesion of the sciatic nerve - ... . Biphasic mode to avoid muscular fibrosis by waiting for the nerve structures to recuperate

Electrostimulation : 

Electrostimulation Contraindications  Cervical and cephalic zones  stimulation of the carotid sinus  cardiac syncope

Pulsing short-wave therapy : 

Pulsing short-wave therapy Electromagnetotherapy  same indications than ultrasounds  pulsating electromagnetic fields  poorly explained physiological effects . Athermal effects [metabolism modifications] . Thermal effects [increase in local temperature]

Laser therapy : 

Laser therapy Cold or low-energy lasers Used by lots of people, but no scientific evidence  muscle injuries  pain relief  collagen synthesis increase . Local focussed treatment applied directly on the skin . Trigger points (acupuncture like)

Functional survey : 

Functional survey Means of documentation  Girth measurements  Goniometric measurements  Amount of weight bearing  Palpation and observation . Forced plates (expensive) . Treadmill with pression captors (very expensive) . Rolled-up blood pressure cuff (Taylor)

Functional survey : 

Functional survey Gait observation Head down  injury in the rear end Head up  forelimb injury Walking, trotting, galoping 8 O

Physiotherapy protocoles : 

Physiotherapy protocoles 1 to 3 Immobilization of the limb Mobilization of joints next to the cast 4 Documentation Control X Ray Mobilization of joints next to the fracture Walk short leash with a strap : 10 min x 3 times per day 5 to 6 Walk normal leash : 15-20 min x times per day Slow trot : 5 min x 2 times per day Electrostimulation End week 6 Clinical reevaluation and X Ray Long Bone Fracture [UMES] Week Therapy

Physiotherapy protocoles : 

Physiotherapy protocoles 1 Documentation : limb circumference, ROM ,gait... Postsurgical : PROM (10 x 4 times per day) ice packs (10-15 min x 3 times a day) short leash walks 2 Ice packs Short leash walks Electrotherapy 3 Electrotherapy Extended leash walks Sit/stays Figure of eights Anterior cruciate injury [Taylor] Week Therapy

Physiotherapy protocoles : 

Physiotherapy protocoles 4-5 Continued leash walks 30-45 minutes x 3 times per week Gentle incline work No stairs Sit / Stays 6 Leash walks / trots Swimming Anterior cruciate injury [Taylor] Week Therapy

Physotherapy in sporting dogs : 

Physotherapy in sporting dogs  New field of investigation for canine sport medicine  Still very few scientific datas… but it works !  Massage, PROM, AROM  Ultrasounds, Electrotherapy, Ice packs  GAGs (per os)  Antioxidants (per os)  Hyperoxygenated fatty acids (local) From Empirism to Demonstrated Science...