Your Dog Magazine, January 2007
Tufts University College of Veterinary Medicine
Pet Rehabilitation Goes Mainstream
workouts and ultrasound are among techniques speeding recovery
Many of the dogs veterinarian Laurie McCauley sees have a condition called ADR: "Ain't doin' right. They're not moving as well, they sleep a lot more during the day, they have trouble getting up, and they're not going for long walks anymore," she says.
Fortunately for her patients, Dr. McCauley, who practices in Grayslake, Ill., offers physical rehabilitation for dogs with arthritis, herniated disks, hip dysplasia and other orthopedic and neurologic conditions that cause stiffness, pain, lameness, or paralysis.
She and other veterinarians are increasingly discovering that rehabilitation -- in the form of water workouts, massage, therapeutic exercise, heat and ice, electrical stimulation, laser therapy and more -- helps dogs recover more quickly from surgery, lose the weight that makes their joints ache, move better in old age and even recover from paralysis. While not every pet rehabilitation technique has been proven scientifically, strong anecdotal evidence points to their effectiveness.
Take Belle, for instance. The 12-year-old chocolate Labrador retriever had such severe arthritis that she could barely walk. Her owners took her to Julie Stuart of Uxbridge, Mass., a licensed physical therapist, founder of New England Physical Therapy for Animals and a consultant at the Cummings School of Veterinary Medicine at Tufts University. "Within the first session, Belle showed so much improvement simply by swimming," Stuart says. Being in the water increases a dog's buoyancy, so that even obese dogs like Belle can move freely without pounding their joints.
"Belle's lost a lot of weight now," Stuart says. "In the pool she can move freely, so we were able to build strength and get weight off her. She used to just lie around the house and never move, and now her people tell me she walks around all the time and wants to go outside, so it's given her her life back."
Belle's rapid response to rehabilitation isn't unsual. Most practitioners say that at least some improvement is seen during the first week or even after the first visit. The pace of improvement depends on factors such as the condition being treated, the age of the patient and the owner's compliance with homework assignments, says Maria Sanchez-Emden, DVM, of Animal Health and Rehab Center in Miami, Fla. Full recover can take as little as two weeks or as long as several months.
"I just treated a police dog with a torn muscle," Dr. McCauley says. "It took us six weeks. A torn cruciate [knee] post-surgery may take 12 weeks. Some of my older arthritic cases come in weekly for four or six weeks and then I see them every 10 or 12 weeks. some of them I've been treating for four or five years."
Veterinarians used to advise weeks of cage rest for dogs recovering from orthopedic surgery, but rehabilitation practitioners now say that the sooner rehab begins, the better.
Benefits of icing
"The actual physical part begins as soon as that animal comes home or in the clinic, doing massage, passive range of motion, and icing," says John Sherman, DVM, of VetHab in Raleigh, N.C. "The sooner and the better we can get that surgical wound to heal, the better off that patient is going to be and the less pain it will go through. It's almost parallel to the human medicine, where as soon as people have surgery, you're going to be trying to get them up and get them moving the day of or the day after surgery."
If nothing else, icing the wound after surgery helps reduce inflammation, which speeds recovery. "Icing should be started right away," Dr. McCauley says. "I preach to the surgeons, 'Please, ice them before you bandage them,' or, 'Even if you're not bandaging them, ice them.'"
Depending on the type of surgery, range-of-motion exercises can begin the next day as long as they're done by a trained professional, Dr. McCauley says. "I don't like the owners to be doing it that early."
However, owners often play a big role in helping dogs through rehabilitation. Between treatments, they can apply hot or cold packs, massage tight muscles and perform range-of-motion and other therapeutic exercises such as stepping over cavaletti, which are low-lying poles.
"The more the owner wants to get involved, the quicker their animal will progress," Dr. Sherman says. "We ask clients to do homework between treatment days if their animal is ready for it, even if it's just ice."
Stuart is a big believer is hands-on therapy from owners. For a dog with tight triceps in the front legs, she might teach the owner how to stretch out those muscles. An owner whose dog has muscle spasms can learn massage techniques that will help.
"For arthritic dogs or dogs that have had orthopedic surgery, a lot of it is teaching people the proper exercise program," Stuart says. "A lot of people will go for an hour-long hike and that gets the dogs really sore, so I teach them to slowly build up and do the right forms of exercise."
Perhaps the most important way owners can assist in rehabilitation is to control their dogs' calorie intake. Whether a dog suffers from arthritis, hip dysplasia or an anterior cruciate ligament tear, obesity worsens the condition, says Pam Nichols, DVM, of K-9 Rehab Center in West Bountiful, Utah.
"People say, 'Five pounds in a Lab -- that's not that much.' Well, in most dogs it's probably more than 10 percent of their body weight, which is a lot of weight. If they can reduce that, it will help the dog do better," she says.
The cost for rehabilitation is more reasonable than you might expect. Dr. Sherman says the charge for a typical treatment day might range from $60 - $120, depending on the locale, size and condition of the animal, and the procedures involved. A paralyzed mastiff is going to be more expensive to treat than a pug, but in general prices might range from $40 to $75 for a session in the underwater treadmill, Dr. Sanchez-Emden says. Pet health insurance often covers all or part of the expense.
Success stories abound in pet rehabilitation circles, but the most special may be those where people have been told their dogs will never walk again. In November 2005, Dr. Nichols treated a Portuguese water dog named CeCe, who suffered a traumatic fracture of her last thoracic vertebra when a car accident resulted in her crate being thrown from the car and crushed. The surgeon at the emergency veterinary hospital advised euthanasia.
"The family didn't feel up to making the decision to euthanize her that night because they were concerned about the wife, who was in the hospital in a coma as a result of the same car accident," Dr. Nichols says.
In the meantime, they saw an ad for K-9 Rehab Center and gave Dr. Nichols a call. "They brought CeCe in 10 days after the accident, and she had horrendous sores on her little bony ankles and hips," she says. "She had muscle atrophy from [damaged] nerves, she had some urine scalding, and she and the owners were very depressed. We talked to them about doing an MRI because without one there was no way of knowing whether CeCe would walk again. they said, "We don't care how much it costs. We just want this dog to walk if it's possible.'"
The MRI showed that repair was maybe, just maybe, possible, and surgeons operated on CeCe that same night. For the next two weeks, she stayed at K-9 Rehab. Little by little, she began to regain sensation.
"They took her home for the first week of December because the mom came out of her coma, and we referred them to a physical therapist in California where they lived," Dr. Nichols says. "On Jan. 26 I got a video of CeCe trotting down the hall of their home -- total return to function. CeCe is my absolute favorite patient ever because she had such a poor prognosis and they got such a great outcome."