1. How Does One Get into Rehab? CRI (Canine Rehabilitation Institute) Training started 2009 Received certification 5/2011 House Call ServiceOn the Go Animal Rehabilitation Service (onthegoanimalrehab.com) True Veterinary Clinic, Lake Mills Veterinary Clinic, West Towne Veterinary Center, Odyssey Veterinary Care

2. How to Utilize Rehabilitation Therapy in Post-operative and Geriatric Patients Rehabilitation Therapy is more than fancy modalitiesyou already own the two most important toolsyour hands! This session will focus on massage techniques, other manual techniques and exercises you can perform and then teach clients to do for their pets.Presented by Deanna Clark DVM, CCRT at WVTA Meeting 10/12/2013 3. What is Rehabilitation? Physical Therapy is protected term Preservation, enhancement, restorati on of movement and function Utilizes therapeutic exercise, modalities, devices, patient education and training Physiotherapy 4. Who Qualifies? Any animal Creativity is vital Motivation can be difficult! 5. Our Various Roles VeterinariansDiagnosis and monitor progression/set limitations Technicianscarry out treatment plan, communicate between owners and veterinarian, help progress patient Ownerswilling and excited as many techniques/exercises best done more frequently 6. Certifications Veterinarians, Physical Therapists, Veterinary Technicians CRI Certified Canine Rehabilitation Assistant University of Tennessee 7. The Full Effect of Injury Pain is protectiveallows area to heal Disuse causes atrophy Muscles overworked from compensation Develop trigger points Referred pain Vicious cycle! 8. Break the Cycle! Provide pain relief Treat the muscles 6 weeks to build muscle Every day of rest requires 3 days to rebuild May no longer need pain medications! 9. The Healing Touch Massage Personal preferences Rough massage or anxiety creates rigid muscles-less benefit Some patients tolerate very little (laser?) Ease into relationship and tolerance Brings blood supply and energy 10. Massage Techniques Rolling of skin to ease into massage Rub with muscle fibers to relax/lengthen Break up scar tissue with firm touch and cross fiber direction Isolate the muscle and lift to break adhesions Rub over muscle with fibers to bring heat works well for dogs that dont enjoy massage 11. Trigger Points Painful Muscle will jump when palpated Treat by applying firm pressure and holding it for 10 seconds, release and repeat Treat with massage techniques Dogs dont appreciate trigger point work 12. Myofascial Release Over spinewill cause mild traction to release spastic para-spinal muscles Extremely gentle pressure-cross hands and place one palm at dorsal shoulders and crossed hand to cranial pelvis--push hands apart Patient relaxes into stretch and rolls onto your hands! 13. Range of Motion If you dont use it you lose it! Vicious cycle affects the rest of the body and movement 14. Benefits of Range of Motion Most important in post-operative or disuse Moves joint fluid Joint fluid bathes cartilage providing nutrition Helps healing and pain relief Reduce swelling 15. Proper Range of Motion Within tolerance! Rarely push beyondonly with guidance Stress this to clients! (remember you wont go back to the painful masseuse) Slowly and with support (no leg dangling) Stretching muscles at end of motion 15-20 repetitions 2-4 times daily Dont prevent loss of muscle (8 hours a day!) Have client demonstrate for you 16. Putting it Together Range of Motion finds restrictions Know normals your pets will love you for this!! Do this every visit (though generally less intense) Start with unaffected leg and work around Prefer laying down, but can do standing NEVER push a dog outside of tolerance Muzzles? 17. Abnormal Muscles Ropey Hard Calcified Painful Crepitance React with spontaneous twitch (tendons too) 18. Abnormal Joints End Feel Emptypain stops motion Capsular--firm Bony--bone-to-bone contact Abruptprotective muscle spasm Springy blocksoft tissue approximation 19. Checking the Neck/Spine Have the dog follow treat to shoulder, hip then floor C6-C7 can generally palpate inflammation Focus on paraspinal muscles along each vertebral body Myofascial stretch 20. Elbow Fold the front leg like an accordion The infamous shelbow (Dr. Canapp) Biceps--Learn to palpate this muscle well Early arthritis can be difficult to detect 21. Shoulder Supraspinatus tendon Arthritis Medial shoulder 22. Dorsal Scapula Ties into thoracolumbar junction and C6-C7 Often over-worked Often crepitance 23. Shoulder/Neck Stretch Subscapularis and Pectorals Great Stretch--With leg in neutral position lift medial shoulder and rotate elbow internal Pulls cranial scapula off the body stretching caudal neck Caution significant shoulder/elbow arthritis 24. Forelimb Extension Restriction Teres major strainpalpated at caudal midshoulder or in axilla 25. Rear Limb ROM Again flexion like accordion Commonly lose flexion in stifle Dont forget the tarsus! 26. Hamstrings Hip flexion/stifle extension to stretch Check proximal medial hamstrings (semitendinosis) Fibrotic myopathy Strip this muscle to help it stretch Distal medial attachment to stifle (semimembranosis) 27. Quadriceps Hip/stifle extension to stretch Pull rear limb caudal and rub down quadriceps to encourage the patient to stretch Also helps relieve spasms Frequently over-worked 28. Iliopsoas Major hip flexor and tender loin/groin Resent rear extension of leg Very sensitive and sometimes best treated using laser therapy Stretching will help Chiropractic? 29. Pectineus Most proximal medial thigh Connects femoral neck and acetabulum Spastic with hip dysplasia Stretch with butterfly position (hip abduction) 30. Stretches Helps restore motion Helps maintain motion Prepares muscle for ROM expected Proven for injury prevention (humans) Detect early injury Monitor for loss of function/pain 31. Stretching Concerns Active Stretches preferred Stretching cold can cause injury Warm up prior to stretching Use these to warm up/cool down athletes 32. Active Stretches--Spine Same as test! Cookie Spinal Stretches Great for active/chronic spine patients Within tolerance Avoid cervical extension 33. Stretch Front Limb Play bow 34. Stretch Rear Limb Stand with front feet up on object Can be painful for dogs with rearlimb pain, weakness or spinal cases (especially lumbo-sacral) Work into increasing height and duration Hold stretches for 30 seconds and increase 35. Exercise Exercise builds muscle which provides pain relief Targeted exercises can be an art Motivation can be questionable! Clients afraid to exercise dogs with conditions Every day of rest takes 3 days to build back muscle! Can take 4-6 weeks to see results Prepare for realistic goals 36. Types of Muscle Contraction Isometric Isotonic 37. Isometric Best exercise to start with Rehabiliation Static Holding weight in hand Plank 38. Isotonic Dynamic Contraction results in movement Can only prescribe when injury can support movementwalking progressed to running Concentric and eccentric 39. Concentric Shortening of muscle fibers Force generated bigger than resistance Lifting 10 lb weight 40. Eccentric Resistance is greater than force Causing lengthening of fibers Lowering 10 lb weight Proven to heal tendonitis through pain 41. Exercise Rules of Thumb Dont push beyond limitations If patient becomes more sore during /after exercise it is either too high intensity or too long duration Neurologic patients key is to exercise right up until fatigue, but not go beyond Generally more frequent, but shorter sessions Lowest impact until recovered and in conditioning program for work/return to function 42. Types of Exercise Strength training Endurance training Proprioception training Stretches Skill trainingProvide strength and endurance exercise in proportion to the amount required by the dogs performance events (Dr. Chris Zink) 43. Is He Tired or Lazy? Dogs tend to be honest Avoid task or disengage Sit down Panting Like yoga how long can you hold plank 44. How often do you have to do this?? Short duration (about 15 minutes max) More frequent (2-4 times daily max. benefit) At least 3-4 times weekly But a little is still better than none! Balance different types of exercise 45. Core Exercises Dogs lose core with age like people Supports the spine Possibly contributes to IVDD? Possibly contributes to incontinence? 46. Easy Core3 and 2 legged Stand Start easy and make difficult Hold up front leg if affected in rear Moving leg slightly causes counter balance Lift opposite leg from the affected Progress to two legged standcross stance Move both legs to further engage core Safe for most any patients May only be able to start at 5 sec! 47. Making Core Harder Unstable surface Physio-balls if size is appropriate Wobble board Couch cushion or air mattress Do the same exercises 48. Ultimate Doggy AbsSit Pretty and Beg! NOT safe with active IVDD or significant stifle/hip arthritis/active ACL Use a treat lure and pull over nose Stand from this position and then sit back down Takes athlete 3 weeks to master Just attempting 3 times daily will build muscle 49. Weakest Core Significantly muscle wasted patients Tummy tickles 50. Targeting Rear Legs Dogs carry 60% of weight on front Many easy exercises work 3/2 legged stands will weight shift them to rear 51. Stair Stands Front feet up 6 inches and increase time and height --graduate to standing on couch Stretches quadriceps and iliopsoas Favorite exercise for post-operative ACL Remember to start low and for short periods of time (30 sec.) 52. Weight Shifting Gently push dog onto affected leg in differing intervals and angles Builds muscle as they catch themselves--we dont want them to fall! Can also scratch over butt and let them bounce aroundhappy butt rub dance! 53. Doggy SquatsSit to Stands Target gluteals and cause full flexion of stifles/hocks Another favorite for ACL disease Can be tricky Place the leg, sit them on an elevated plank, use a treat to lure, assist using pillow or assistant Can be very hard to push into standso help if needed Generally start with 3-6 repetitions 54. Front limb Exercises Can reverse all the ones just mentioned! Down stairs, 3/2 legged stands, physioballs Wave for biceps 55. Exercise Guidelines Veterinarian/Surgeon will guide restrictions and progression based on diagnosis A few simple daily exercises can make a big difference Listen to the patient and you cant do harm Be creative and use what the environment provides! 56. Spike Geriatric Progressive rear limb weakness 57. Mesa Post-operative ACL Severe multiple progressive joint DJD Partial ACL with severe patella tendonitis Prevented other knee from surgery Return to full function! 58. Its worth the Effort!! 59. Questions?