Rehabilitation Therapy is more than fancy modalities—you already own the two most important tools—your 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.
Rehabilitation is an exciting field that is becoming increasingly more popular in veterinary medicine. It is imperative for the proper recovery of most of our post-operative patients or soft tissue injuries and can be beneficial to geriatric/osteoarthritic patients. Rehabilitation is basically physical therapy for animals. Because “physical therapy” is a protected term that can only be used for “humans” we have to call it rehabilitation therapy when talking about non-humans! The definition of physical therapy is therapy for the preservation, enhancement, or restoration of movement and physical function impaired or threatened by disability, injury, or disease that utilizes therapeutic exercise, physical modalities (i.e massage), assistive devices, and patient education and training—called also physiotherapy.
Every animal can qualify and by using your creative mind will be an eager participant in activities that will be beneficial to their health and well-being! Clients are willing and excited to help be an active part of their pet’s recovery and many of these techniques can be taught easily and are more effective when done on a daily basis. Veterinarians and technicians can become certified in rehabilitation therapy. I became certified at Canine Rehabilitation Institute.
Clients are willing and excited to help be an active part of their pet’s recovery and many of these techniques can be taught easily and are more effective when done on a daily basis. Veterinarians and technicians can become certified in rehabilitation therapy. I became certified at Canine Rehabilitation Institute.
When injuries occur, either through trauma or surgery the body acts by protecting that area. If a joint is painful the body will react by using it less. Muscles that are utilized to carry that leg or muscles that are overworked from compensation can quickly become injured or develop trigger points. Sometimes muscles are utilized that aren’t designed to carry this load and sometimes the body isn’t in condition to bear this burden. These spasms and trigger points are extremely painful and can cause referred pain and further disuse of the area. This can become a vicious cycle and over time muscle loss will occur. As muscle loss develops the joint will become less stable and even further pain will ensue!
. By paying attention to these areas and helping these muscles heal pain relief will occur, the patient will use that area more, muscle is built and the vicious cycle can be stopped
Massage and touch can be a very simple and effective means of helping these areas heal. A simple example of this is when you become stressed out often you start to hold your shoulders tight. This then becomes referred to your neck and pretty soon you can’t move your head and you get a headache. If someone comes along and rubs your shoulders down your headache and pain can quickly become relieved. Everyone is different in their tolerance for massage and our animal patients are no different. With massage on animals it is all about what THEY like. If you have ever received a massage that you thought was too rough, you likely tensed your muscles through it and therefore didn’t receive the benefits intended. The same is true with our patients. I like to work up to full range of motion and myofascial release techniques slowly and have found that patients are very individual in their tolerance of these techniques. It is most important that the patient enjoy this touch as we would like to do more as time goes on.
There are different types of massage to incorporate in different scenarios and of course patient tolerance and preferences. I generally rub with the muscle fibers to help relax and lengthen tight or restricted areas. To really bring blood supply to an area or to try and break up scar tissue a firm touch can be used with a cross fiber massage.I generally try to isolate the muscle and separate it from other muscles to break up adhesions—this can be achieved by lifting the muscle and encircling it entirely with your fingers. For dogs that don’t like massage in this way I will rub over the muscle quickly (or slowly) to bring friction and heat to the area. Again I tend to rub with the muscle fibers. Some dogs enjoy rolling of the skin to ease into a massage—you take the skin and roll it between your fingers. I generally use this technique when I am getting to know a patient or down their spine. One of my favorite spinal motions is a myofascial release. This is better demonstrated than described. It will help traction the spine slightly and will help release spastic para-spinal muscles. With extremely gently pressure down you cross your hands and place one palm at the dorsal shoulder blades and crossed hand in front of the pelvis. You then gently push your hands apart. Some dogs love this maneuver and others find it to be too much. When you get it right they will relax into the stretch and generally roll onto your hands!
Trigger points can be treated this way, or by applying firm pressure and holding it for 10 seconds, release and repeat. Dogs don’t tend to appreciate trigger point work too much—if you’ve ever had work done on trigger points you will know how painful it can be.
One of my favorite spinal motions is a myofascial release. This is better demonstrated than described. It will help traction the spine slightly and will help release spastic para-spinal muscles. With extremely gently pressure down you cross your hands and place one palm at the dorsal shoulder blades and crossed hand in front of the pelvis. You then gently push your hands apart. Some dogs love this maneuver and others find it to be too much. When you get it right they will relax into the stretch and generally roll onto your hands!
Range of motion is also integral to our patients’ recoveries. If you don’t have full range of motion the body isn’t moving properly and muscles will eventually lose their ability to fully flex or extend. Again this will become a vicious cycle and the restrictions will move to other parts of the body as the body compensates in this restricted movement. Range of motion also helps move joint fluid. Joint fluid is what bathes cartilage and provides nutrition to the joint. When a joint isn’t used the joint fluid becomes stagnant and cartilage is further damaged. Moving a joint through this range of motion will help with healing and pain relief. This is most important in our post-operative patients or in patients that can’t stand
. It is imperative that range of motion is always done within tolerance. Only rarely will I really push this outside of tolerance when I am trying to break down specific scar tissue, but I would only do this with guidance. It is really important to stress to clients the importance of doing this within pain tolerance. Range of motion is best done slowly and by offering support so that the leg doesn’t dangle. Keep in mind that you are stretching the muscles at the end of the motion. Again, think of having someone stretch your hamstrings and the resistance they feel as you come to the end of your motion. In general I recommend 15-20 repetitions 2-4 times daily. It is of note that to prevent loss of muscle range of motion exercises must be performed for 8 hours a day in mouse studies! This is to stress the fact that range of motion is to help with pain relief, not to build or preserve muscle mass.
To incorporate massage on my patients I start with range of motion. Range of motion is an easy and effective way to detect restrictions. Knowing normal range of motion is vital. My initial exams are always the most detailed, but I complete range of motion on each joint of my patients every time I see them for therapy. It is easy to develop this skill and our normal (or abnormal) pets at home are great teachers. I generally start with an unaffected leg and work my way around the patient depending on their behavioral status with me and their tolerance. I prefer my patients to lay down for this, but can achieve effective range of motion on patients that prefer to stand. I tend to go very slow with patients to build the relationship over time. I prefer not to muzzle in any circumstance as a muzzled dog isn’t generally a relaxed one and will guard muscles and not allow much manipulation anyway. You can still achieve a lot on these patients with skilled palpation even if they don’t allow range of motion. It is imperative to NEVER push a dog outside of tolerance. Our goal with therapy is to work within tolerance and build it by releasing trigger points that are restricting range of motion. Abnormal muscles will feel ropey, hard, calcified, be painful or react with a spontaneous twitch.
To actually complete a therapeutic massage I generally start with the neck and have the dog follow a treat to their shoulder, hip then floor on each side. This is the best way to determine restrictions in the spine. Most dogs are very tight in C6-C7 and even if their motion is normal, you can generally palpate inflammation over the muscles in this area. I then commonly work over the spine focusing on paraspinal muscles along each vertebral body and completing the myofascial stretch as previously described
I then work with them laying down and palpate a front limb starting with the toes and folding the entire front leg up one joint at a time working from distal to proximal. The elbow can be very difficult to isolate from the shoulder, and many patients will have elbow and shoulder pain together. When you come across a restriction you palpate surrounding muscles to help determine if the restriction is from joint or muscle changes. Generally both problems can be causing restriction as muscles will spasm around a painful joint to help protect it from instability. These muscle spasms become chronic as the muscle is never allowed to relax and trigger points can develop. Gently massaging the affected muscles and slowly repeating the flexion/extension you will be able to release the restrictions and gain more movement. Once you have worked the flexion you then pull the leg into extension in front of the body. Try to start with one joint at a time to determine the restriction. Restriction in front limb extension can be from joint pain—most notably the elbow and shoulder and if these palpate normal/are comfortable then you look further away. Once extension is completed I pull the arm backwards. This is a great biceps stretch and the biceps muscle is a common muscle that will be over-worked and contain a lot of trigger points due to tendonitis, elbow or shoulder arthritis. Learn to palpate this muscle well.
Based on my patient I may then do some more specialized motions to check supraspinatus tendon, subscapularis and pectorals.
subscapularis and pectorals. A great stretch that dogs love is stretching the subscapularis. With the leg in neutral position you lift on the inner shoulder and rotate the elbow internal. This pulls the proximal shoulder blade off of the body and stretches the caudal neck muscles—dogs really seem to love this. If they have significant shoulder and/or elbow arthritis you need to be very careful, but it is still a great stretch for them if done properly.
. A common forelimb restriction is from a teres major strain—which can be palpated at the back of the mid-shoulder, or in the axilla.
. I repeat the same motions with the back leg. Flexion of the rear leg is similar to the front. With extension forward you want to focus on the hamstrings. Commonly dogs will have muscle strains in the proximal medial hamstrings and I really work to “strip” this muscle and help it stretch. The best way to achieve adequate stretch of this muscle is to flex the hip first and then gently extend the stifle.
When pulling the rear leg backwards you can rub down the quadriceps to encourage the patient to extend their own rear leg. This also helps relieve spasms as the quadriceps is a frequently over-worked muscle especially in cruciate patients. Pay a lot of attention to quadriceps!
If the patient resents this rear extension of the leg consider the iliopsoas as a common problem (major hip flexor/groin.) This is a very sensitive area to palpate and unfortunately is best treated using laser therapy or other modalities. Stretching will certainly help if no modalities are available.
Another muscle of interest is the pectineus. This is the medial most proximal thigh and is the muscle that connects the femoral neck and acetabulum. This muscle becomes incredibly spastic in patients with hip dysplasia as it is put under constant strain from bony remodeling. You can gently stretch it by pulling the leg into a butterfly position (hip abduction.) I then move onto the other two legs and the patient will feel so much better when completed!
After completing a full massage I move onto exercises and stretching. As previously touched on, stretching is very important to help restore motion. It is preferred to have a patient complete their own stretching. Stretching a cold muscle or stretching a muscle out of tolerance can cause muscle strains. It is therefore best to warm up a bit prior to stretching and to have a patient perform active stretches. Active stretches are good for all patients. I will also commonly use these to warm up my athletic patients prior to work/performance.
An easy regime to follow is to start with the spine. Remember the test for the spinal flexion? I bring this test back to warm up the spine and work on flexion. This motion has really helped heal some of my chronic spine patients and is also great for any IVDD cases. Again, the key is that the patient does this within tolerance and so doesn’t cause harm. Have them follow a treat to their shoulder, hip then floor. I will also add some cervical flexion by having them follow the treat between their front legs, but avoid cervical extension. The next stretch is the play bow which can be easily taught and held. You may be able to teach your patient to extend their rear legs, or you can have them stand up with their front feet up on an object to stretch the rear legs. This motion can be painful for many rear-limb pain, weakness or spinal cases (especially lumbo-sacral) so again it is imperative that they work into this stretch and aren’t asked to stretch out of their limit. Hold stretches for 30 seconds.
The next stretch is the play bow which can be easily taught and held.
You may be able to teach your patient to extend their rear legs, or you can have them stand up with their front feet up on an object to stretch the rear legs. This motion can be painful for many rear-limb pain, weakness or spinal cases (especially lumbo-sacral) so again it is imperative that they work into this stretch and aren’t asked to stretch out of their limit. Hold stretches for 30 seconds.
Exercise is of course imperative to physical therapy! It can be quite an art to figure out targeted exercises for some of our less cooperative or more challenged patients, but by using a few rules of thumb you can decide what is safe and effective for many conditions. As stated prior, if we can build up muscle around a joint we can add to pain relief and help break these vicious cycles. Most clients don’t want to hurt their older dogs and so then avoid exercise. As these patients become more painful, they become less active and soon you have a situation similar to a bed rested human. As well as with injuries that require or result in disuse, for every day of rest it takes 3 days to build back muscle! It can take 4-6 weeks to really build this muscle back, and this of course is further delayed in debilitated patients or patients with other medical conditions. Prepare your clients for realistic goals.
The rules of thumb for physical therapy exercise are fairly straight forward. Ensure that you don’t ask a patient to do too much. If a patient becomes more sore during or after an exercise we have requested either too high of intensity or too long duration. With neurologic patients the key is to exercise right up until fatigue, but not go beyond. This generally means frequent, but short exercise sessions. The best exercise for most of our patients is low impact until you are recovered and entering into a conditioning program for work/return to full function
Every patient is different and every recovery is different. Dogs tend to be very honest and I have only met a few truly lazy patients. Most patients that become fatigued will start to avoid what you are asking them to do, sit down, start panting and in general try to disengage from the activity. Think of these activities like you would yoga. Holding a “plank,” though it looks very easy will have your entire body shaking within a minute if you aren’t conditioned for it.
. Exercises are generally most effective when done for short periods of time (about 15 minutes max) and more frequent (2-4 times daily for maximal benefit.)
Most of our patients will develop a weak core—especially our geriatric or severely exercise restricted patients. Three and two legged stands are a great exercise to help build leg and core strength. You always want to start with the easiest form and add difficulty. For instance, start by holding up a front leg if the affected leg is a rear leg. This will weight shift them back to the rear. Normally dogs carry 60% of their weight on the front legs so by doing this we are really forcing weight bearing on the rear. Moving the leg slightly will engage core. When this is easy you can lift the opposite leg from the one affected and eventually progress to a two legged stand. Moving both the legs will further engage core. This exercise is quite safe for most post-operative, cruciate and geriatric patients. As we are doing this within tolerance the patient may only be able to hold it 5 sec to start, but will increase in ability.
To build on this further ask the patient to stand on an unstable surface. I love physio-balls for this, but since not everyone has a physio-ball and not all animals are safe for them I will use a wobble board. To mimic this at home consider a couch cushion or an air mattress.
The ultimate core exercise is a sit pretty and beg. This is NOT safe for patients with active IVDD or for patients with significant stifle/hip arthritis or active ACL. You basically take a treat and pull it over the patient’s nose to encourage them to sit up on their rear legs. If they can stand from this position and then sit back down they are amazing athletes! It will take an athletic dog 3 weeks to master this exercise and some of our geriatric patients may never get there. Just attempting this motion 3 times once daily will help build muscle.
For significantly muscle wasted or fragile patients you can build core by doing tummy tickles. Just annoy the dog’s abdomen and they will complete a crunch and over time build this muscle back.
Targeting legs is also very simple. One of my favorite exercises is stair stands. When targeting the rear legs have the dog stand up with the fore feet up 6 inches and increase time and duration as able. Eventually most patients graduate to standing on the couch. This not only builds muscle in the rear, but really helps stretch quadriceps and iliopsoas. This is one of my favorite exercises for post-operative ACL. You can start with low stairs as early as the dog is weight bearing. Remember to start low and for short periods of time (30 sec.)
If this is too hard you can gently just push the dog onto the affected leg in differing intervals and angles. This is just weight shifting and the muscles will build as they catch the dog from falling—remember to be careful—we don’t want them to fall. A simple form of this is to scratch their rear and let them bounce around. You can easily reverse these exercises to build the front end.
Sit to stands are a fabulous exercise that target the muscles in the rear. They also cause full flexion of the stifles and hocks. ACL disease is notorious for causing a loss of flexion in the stifles and hocks. A square sit is a sure way to help maintain and restore this motion. It can be tricky getting a dog to do this, but you can help them by placing the leg, you can make them sit on a plank that is elevated, or you can use a treat to lure them into a square sit. If this is too hard, start with an assisted sit to stand. Have them sit on a pillow or an assistant in a half squat. This is actually quite hard to then push into a stand and is equivalent to our squats. I generally start with 3-6 repetitions.
WVTA 10/2013 How to utilize rehab therapy post operative/geriatric
How Does One Get into Rehab?
• CRI (Canine Rehabilitation
• Training started 2009
• Received certification 5/2011
• House Call Service—On the Go
Animal Rehabilitation Service
• True Veterinary Clinic, Lake
Mills Veterinary Clinic, West
Center, Odyssey Veterinary
How to Utilize Rehabilitation Therapy in
Post-operative and Geriatric Patients
Therapy is more
already own the two
This session will
focus on massage
and exercises you
can perform and
then teach clients to
do for their pets.
Presented by Deanna Clark
DVM, CCRT at WVTA
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
• Any animal
• Creativity is vital
• Motivation can be difficult!
Our Various Roles
• Veterinarians—Diagnosis and monitor
• Technicians—carry out treatment
plan, communicate between owners and
veterinarian, help progress patient
• Owners—willing and excited as many
techniques/exercises best done more frequently
• Veterinarians, Physical Therapists, Veterinary
• Certified Canine Rehabilitation Assistant
• University of Tennessee
The Full Effect of Injury
Pain is protective—allows area to heal
Disuse causes atrophy
Muscles overworked from compensation
Develop trigger points
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!
The Healing Touch
• Personal preferences
• Rough massage or anxiety creates rigid
• Some patients tolerate very little (laser?)
• Ease into relationship and tolerance
• Brings blood supply and energy
• Rolling of skin to ease into massage
• Rub with muscle fibers to relax/lengthen
• Break up scar tissue with firm touch and cross
• Isolate the muscle and lift to break adhesions
• Rub over muscle with fibers to bring heat—
works well for dogs that don’t enjoy massage
• Muscle will jump when palpated
• Treat by applying firm pressure and holding it for 10
seconds, release and repeat
• Treat with massage techniques
• Dogs don’t appreciate trigger point work
• Over spine—will 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
• Patient relaxes into stretch and rolls onto your
Range of Motion
• If you don’t use it you lose it!
• Vicious cycle affects the rest of the body and
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
Proper Range of Motion
• Within tolerance!
• Rarely push beyond—only with guidance
• Stress this to clients! (remember you won’t go back to the
• Slowly and with support (no leg dangling)
• Stretching muscles at end of motion
• 15-20 repetitions 2-4 times daily
• Don’t prevent loss of muscle (8 hours a day!)
• Have client demonstrate for you
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
• React with spontaneous twitch (tendons too)
Checking the Neck/Spine
• Have the dog follow treat to shoulder, hip then
• C6-C7 can generally palpate inflammation
• Focus on paraspinal muscles along each vertebral
• Myofascial stretch
• Fold the front leg like an accordion
• The infamous “shelbow” (Dr. Canapp)
• Biceps--Learn to palpate this muscle
• Early arthritis can be difficult to detect
• Ties into thoracolumbar junction and C6-C7
• Often over-worked
• Often crepitance
• Subscapularis and Pectorals
• Great Stretch--With leg in neutral position lift
medial shoulder and rotate elbow internal
• Pulls cranial scapula off the body stretching
• Caution significant shoulder/elbow arthritis
Forelimb Extension Restriction
• Teres major strain—palpated at caudal midshoulder or in axilla
Rear Limb ROM
• Again flexion like accordion
• Commonly lose flexion in stifle
• Don’t forget the tarsus!
• 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)
• 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
• Major hip flexor and tender loin/groin
• Resent rear extension of leg
• Very sensitive and sometimes best treated
using laser therapy
• Stretching will help
Most proximal medial thigh
Connects femoral neck and acetabulum
Spastic with hip dysplasia
Stretch with butterfly position (hip abduction)
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
Active Stretches preferred
Stretching cold can cause injury
Warm up prior to stretching
Use these to warm up/cool down athletes
Same as test!
Cookie Spinal Stretches
Great for active/chronic spine patients
Avoid cervical extension
Stretch Rear Limb
• Stand with front feet up on object
• Can be painful for dogs with rearlimb pain, weakness or spinal cases
• Work into increasing height and
• Hold stretches for 30 seconds and
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
• Can take 4-6 weeks to see results
• Prepare for realistic goals
Types of Muscle Contraction
Best exercise to start with Rehabiliation
Holding weight in hand
• Contraction results in movement
• Can only prescribe when injury can support
movement—walking progressed to running
• Concentric and eccentric
• Shortening of muscle fibers
• Force generated bigger than resistance
• Lifting 10 lb weight
Resistance is greater than force
Causing lengthening of fibers
Lowering 10 lb weight
Proven to heal tendonitis through pain
Exercise Rules of Thumb
• Don’t push beyond limitations
• If patient becomes more sore during /after
exercise it is either too high intensity or too
• 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
Types of Exercise
“Provide strength and
endurance exercise in
proportion to the amount
required by the dog’s
(Dr. Chris Zink)
Is He Tired or Lazy?
Dogs tend to be honest
Avoid task or disengage
• Like yoga– how long can you hold “plank”
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
Dogs lose core with age like people
Supports the spine
Possibly contributes to IVDD?
Possibly contributes to incontinence?
Easy Core—3 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 stand—cross stance
Move both legs to further engage core
Safe for most any patients
May only be able to start at 5 sec!
Making Core Harder
Physio-balls if size is appropriate
Couch cushion or air mattress
Do the same exercises
Ultimate Doggy Abs—Sit Pretty and
• NOT safe with active IVDD or
significant stifle/hip arthritis/active
• Use a treat lure and pull over nose
• Stand from this position and then sit
• Takes athlete 3 weeks to master
• Just attempting 3 times daily will
Targeting Rear Legs
• Dogs carry 60% of weight on front
• Many easy exercises work
• 3/2 legged stands will weight shift them to
• 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.)
• Gently push dog onto affected leg in differing
intervals and angles
• Builds muscle as they “catch” themselves--we
don’t want them to fall!
• Can also scratch over butt and let them bounce
around—happy butt rub dance!
Doggy Squats—Sit 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
stand—so help if needed
• Generally start with 3-6 repetitions
Front limb Exercises
• Can reverse all the ones just mentioned!
• Down stairs, 3/2 legged stands, physioballs
• Wave for biceps
• Veterinarian/Surgeon will guide restrictions
and progression based on diagnosis
• A few simple daily exercises can make a big
• Listen to the patient and you can’t do harm
• Be creative and use what the environment