The role of the Vet Tech in canine rehabilitation

Introduction 

In human medicine, physiotherapy has proven to be a successful part of many rehabilitation programs for injuries and chronic conditions. The same applies in the veterinary field, where addressing orthopedic and neurological conditions with a personalized rehabilitation approach is warranted and has increased in popularity over the last few years. The benefits of physical therapy are vast and encompass mobility restoration and pain management related to chronic diseases [1]. Several modalities used in the rehabilitation field are designed to alleviate pain, increase blood flow, reduce swelling, and more. The administration of physical rehabilitation is recommended to be carried out by a licensed veterinarian, but where local regulatory requirements allow, it can be conducted by a licensed, certified, or registered veterinary technician/nurse with expertise in veterinary physical rehabilitation, or a licensed physical therapist educated in the anatomy and physiology of animals. If physical rehabilitation is undertaken by a non-veterinarian, it should be performed under the supervision of, or with a referral from, a licensed veterinarian concurrently providing care [2]. 

Massage therapy  

Massage therapy is a simple yet effective technique to foster a bond between pet owners and their animal. It is characterized as the therapeutic handling of soft tissues, resulting in positive mechanical, physiological and psychological impacts [3]. Massage can be beneficial for a dog suffering from osteoarthritis, a patient in the postoperative period of orthopedic surgery, a non-ambulatory dog, and so on – the overall goal is to increase mobility, improve the Range Of Motion (ROM), and reduce stiffness. Several techniques are listed in the literature, and three will be discussed here: compression, trigger point therapy and friction massage. It is recommended to start every massage session with what is called effleurage; this technique involves applying light stroking movement onto the targeted region to stimulate blood flow while allowing the patient to relax and get accustomed to touch [2].

Compressions

While performing effleurage, the hand is placed over a muscle, and pressure is exerted for 10-15 seconds, followed by more effleurage and then compression again (Figure 1). This technique allows the dog to relax before the next manipulation. The benefit of this technique serves to increase tissue mobility and flexibility while aiding lymphatic flow [2],[4].

Trigger point therapy

During the initial phase of the massage, spasm-related trigger points may be noticed. These usually develop as a result of lactic acid build-up causing motor nerve irritation [4]. Think about when you receive a massage, and the therapist hits a knot in your trapezius muscle and your body naturally reacts to the touch; these knots can be targeted and assessed with trigger point therapy. Apply pressure for 10-15 seconds, followed by effleurage, then repeat the pressure application, and so on. The benefit of this technique is to increase blood flow and loosen the targeted muscle (Figure 2). 

Friction massage

Friction (or transverse) massage was developed by Dr. James Cyriax, a renowned human orthopedic surgeon. This massage method focuses on the soft tissue components of ligaments, tendons and muscles to preserve mobility and deter the formation of adherent scarring [5]. While applying pressure on the area treated, small rotary movements are exerted with the thumb or fingertip at a 90-degree angle to the muscle fibers [2],[4] (Figure 3). One of the differences between standard friction massage and deep friction is that the latter will encourage spontaneous hyperemia [2].

When performing massage on a dog, the veterinary technician/nurse’s posture is just as important as the dog’s position. Ensuring comfort for both the dog and the practitioner involves positioning the dog comfortably, typically in lateral recumbency, in a quiet room on a table or adaptable surface. Material needed include (but are not limited to) an anti-slip mat, a leveling table, and blankets.

Therapeutic exercises

Collaboration with the rehab team and the attending veterinarian is essential to ensure a comprehensive and well-coordinated rehabilitation plan. By actively participating in the exercises at home, pet owners can significantly contribute to the overall success of the plan. Establishing open communication channels between the veterinary technician/nurse and pet owner will encourage questions and provide a platform for ongoing support, as it is important the owner feels comfortable reaching out for guidance or clarification. The exercises chosen will depend on the patient and its history, as there are two types of exercises: passive and active. The duration and repetitiveness of each exercise should be adapted to every patient.

Passive exercises and ROM

Practicing joint movement is important in many cases such as osteoarthritis, during the postoperative period of orthopedic surgery, after an injury, or in older patients. The goal is to increase flexibility, stimulate vascularization and healing. Passive Range Of Motion (PROM) is defined as a movement performed in the absence of a muscle contraction [2], and is used when the dog is unable to perform the movement on its own. There are two components: flexion/extension (Figure 4) and a bicycle movement. Note that if the animal shows signs of pain at any point, such as reluctance to participate, or any other sign of distress, it is crucial to immediately stop the exercise. Pain is an indicator that the current activity may be too strenuous or inappropriate for the pet’s current condition, and the medical team should be notified to assess the situation and, if necessary, adjust the rehabilitation plan or provide additional pain management strategies.

Active exercises and ROM

Following the initial recovery period from any trauma episode (including surgery), the priority is to control pain, manage the inflammation, and induce gentle ROM movement. Once a pain management protocol is in place and the pet’s comfort level is satisfactory, the aim may evolve towards incorporating therapeutic exercises and enhancing the dog’s activity level [6]. In this stage, as the dog becomes more mobile, a few options may be suggested to enhance comfort and convenience: for example, regular nail trimming is essential, as excessively long claws can impact normal digit biomechanics; anti-slip mats in the house will prevent slipping which may otherwise impact the animal’s confidence (non-slip toe grips and paw pads may also be useful); elevating food and water bowls will ensure patient comfort (Figure 5); and lifting aids and dog harnesses will facilitate movement.

Joint movement accompanied by muscle contraction defines an Active Range Of Motion (AROM), and can be performed when the dog can initiate the movement on its own. The goal is to amplify the movement to create a pronounced ROM, increase tissue movement, and improve joint and limb function [7]. This is where the fun begins! Using little to no material, engaging exercises can be performed at home. Three common examples of therapeutic exercises include dancing, sit-to-stand moves and cavaletti poles:

• Dancing: this exercise (Figure 6) will encourage weight-bearing, stability, and AROM of both hip and stifle joints [8]. Assessing any limitations the dog may have prior to engaging with this exercise is something to keep in mind. If the patient has limited hip ROM or is in the early stages of rehabilitation following orthopedic surgery, using an exercise ball for the forelimbs to rest on will allow more stability. The ball is then gently rolled in a forward-backward motion. This accessory can also serve to challenge front limb stability (Figure 7).

• Sit-to-stand: practicing sit-to-stand movements will trigger the hamstring and gluteal muscle groups which will help strengthen the stifle and hip joints (Figure 8). Again, any limitations should be taken into consideration; so for example, patients with limited stifle ROM and strength will find it easier if they are allowed to sit on a step for this exercise [2],[8] (Figure 9).

• Cavaletti: stepping over poles is an engaging exercise for both pet owner and their dog. This exercise is also beneficial for more active dogs as part of an endurance training regimen or to simply burn off some energy after a long day inside the house. The exaggerated motion of stepping over poles will improve proprioception, coordination and ROM [9],[10]. The rails can be set at different heights based on the patient’s history and needs, and ideally the dog should be able to take a step between each pole to allow better coordination and greater ROM [2],[10] (Figure 10). Broom handles and cones are inexpensive and makes the perfect combination for creating a challenging course.

Additional modalities

Through collaboration with a rehab specialist, patients can benefit from additional therapeutic modalities, as follows. Electrotherapy (NMES, TENS, therapeutic ultrasound) promotes pain relief, muscle contraction, soft tissue healing and more [11]. Therapeutic lasers employ light waves with a specific wavelength to induce photobiomodulation, which involves modifying the physiological aspects of cells and tissues – the absorption of light by cellular components triggers electrons and stimulates cells, fostering processes such as tissue growth, proliferation, migration, and repair [12]. Underwater treadmills (Figure 11) use water resistance to improve strength, ROM, and physical endurance while benefiting from buoyancy to minimize weight-bearing and pain [13].

Nutrition

Nutrition and rehabilitation go hand in hand. Recognizing obesity as a potential risk for other diseases in dogs can elevate awareness and emphasize the importance of health screening. With insights from canine research studies, practitioners can strengthen their advocacy for implementing more effective plans to prevent obesity and promote weight loss [14]. The American College of Veterinary Nutrition (now the American College of Veterinary Internal Medicine) developed the ‘‘Circle of Nutrition’’ with the following three components [15]:

• Animal-specific factors: gathering basic information on the patient, such as age, breed, weight, medical history and current medications, is necessary. The body condition score (BCS) is also mandatory; usually 5/9 or 3/5 (depending on the scoring system) is considered ideal. The WSAVA Global Nutrition Committee provide a scoring chart which is helpful [16]. Muscle condition is also assessed and recorded, to be monitored throughout the rehabilitation process.
• Diet-specific factors: selecting a diet that best represents the patient’s needs is warranted. Whether it be for a dog needing to lose weight, a senior patient requiring a specific level of nutrients, or a patient needing a calorie-dense diet following trauma, this decision is entirely based on the patient’s needs. A recent survey by The Association for Pet Obesity Prevention revealed that 59% of dogs in the United States are categorized as overweight or obese (BCS between 6/9 and 9/9) [17]. Obesity can exacerbate the development and progression of osteoarthritis and joint disease. A moderate weight reduction, ranging from approximately 6-9%, will allow an animal to show substantial improvement [18], hence the importance of a thorough assessment to instigate priority settings for best success. Weight loss programs should be closely monitored by the pet’s medical team.
• Feeding management and environmental factors: Obtaining a complete nutritional history will allow a discussion with pet owners to see where the gaps are, where the extra calories are coming from, and what kind of changes can be implemented. Factors such as treats, a multidog household, or external feeding sources may be identified. Using the WSAVA nutritional assessment form checklist [19] can facilitate data gathering. 

Conclusion

Efficient rehabilitation programs can be beneficial in so many circumstances, but all instances, proper monitoring is essential to ensure successful outcomes and prioritization of patient well-being. Veterinary technicians/nurses possess a broad set of skills and can play a crucial role by utilizing their technical expertise and communication abilities to provide the best support for both the patients and their owners throughout the rehabilitation process.