By: Stacey George, DVM CCRT cVMA and Kimberly Hassen, DVM CVA DACVAA
In this article:
Physical rehabilitation is a specialty of veterinary medicine that focuses on strength, mobility, and comfort of pets. Rehabilitation therapy utilizes a combination of therapeutic exercises, physical modalities like laser, and hands-on techniques to alleviate pain and improve function. While rehabilitation helps everyone from canine athletes to senior pets, it provides particular advantages to dogs recovering from orthopedic surgery.
Laser therapy can be initiated right after surgery to stimulate healing.
Why dogs need physical rehabilitation after surgery
Just as your physician might recommend that you pursue postoperative physical therapy to enhance your recovery, rehabilitation plays a key role in optimizing recovery for dogs after surgery.
Consider a common canine orthopedic injury like the cranial cruciate ligament (CCL) tear. Before surgical correction, limping and the associated disuse of the limb can lead to leg muscle atrophy. While TPLO surgery is effective at restabilizing the stifle (knee) joint, surgery alone cannot restore normal muscle mass and stifle joint mobility. Additionally, there is evidence that prolonged immobilization after surgery leads to muscle atrophy, decreased limb function, reduced range of motion, and potentially irreversible cartilage damage.1-4, 6 This is where rehabilitation comes in.
Early engagement in a professional rehabilitation program focuses on building strength and mobility, helping to restore muscle mass and range of motion. Dogs enrolled in a postoperative rehabilitation program regain strength and mobility faster and more effectively compared to dogs on stricter exercise restriction.5-8 In one study, dogs enrolled in early postoperative rehabilitation were nearly two times more likely to reach full function 8 weeks after surgery compared to dogs restricted to short leash walks and crate rest.4
Therapeutic exercise helps to build strength and mobility after surgery.
Goals of postoperative rehabilitation at AESC
At AESC, our Rehabilitation Service is passionate about enhancing pets’ recovery after surgery. We do this by optimizing:
- Pain management: In the early phases of healing, rehabilitation aims to reduce pain, inflammation, and swelling.
- Weight bearing: Appropriate limb use after surgery is important both for healing and for restoring normal limb function. In addition to making sure our patients are comfortable enough to use the limb, we prescribe a combination of therapeutic exercises and hydrotherapy (underwater treadmill) to encourage standing on the surgical limb.
- Strengthening: Muscle atrophy and weakness are common after injury and surgery, but structured rehabilitation has been shown to result in earlier and more complete recovery of muscle mass. That is why we design our patients’ rehabilitation and exercise programs to help rebuild muscle that was lost due to injury.
How soon after surgery should dogs begin rehabilitation?
The earlier the better! Patients that have orthopedic surgery at AESC receive rehabilitation therapy immediately after surgery and throughout their stay in the hospital. These in-hospital treatments are included in the cost of surgery. Upon discharge from the hospital, our rehabilitation staff give owners instructions for home care in the initial recovery period. About two weeks after surgery, patients return for an in-person consultation with one of our Certified Canine Rehabilitation Therapists (CCRTs). At this time, we evaluate healing and discuss recommendations for ongoing care. This initial consultation is also included in the cost of surgery at AESC.
It is never too late to pursue rehabilitation. We see pets in all stages of recovery, even those who have had surgery months or years earlier. Regardless of timing, most pets can benefit from a rehabilitation program.
Safety of early postoperative rehabilitation
Rehabilitation under professional guidance has been shown to be safe and effective after orthopedic surgery. Expertise is important, especially because inappropriate types of exercise can cause pain and complications. A CCRT has the knowledge and experience to recommend exercises that have realistic goals appropriate for the stage of healing. The CCRTs at AESC tailor therapeutic exercise programs to each of their patients. This means customized treatment plans based on the type and duration of the initial injury, the patient’s current strength level, the type of surgery performed, and the stage in the healing process.
Treatments used in postoperative rehabilitation
Rehabilitation offers several treatment modalities to aid in post-surgical recovery:
Underwater treadmill therapy is often a central component of our rehabilitation programs.
- Underwater treadmill: The buoyancy and added resistance afforded by hydrotherapy provide a low-impact exercise that helps improve muscle strength, weight bearing, and joint range of motion in the recovery period.
- Cryotherapy: Cold compression therapy is mostly used in the acute or early stages after surgery, and has been shown to reduce inflammation, swelling, and pain.
- Laser therapy: Laser therapy is the application of certain wavelengths of light to reduce pain, swelling, and inflammation and stimulate cellular repair to accelerate healing. Laser therapy can be beneficial both in the immediate post-operative period and in later stages of healing.
- Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a technique that applies electric currents to painful areas of the body. The electric signals “confuse” or disrupt pain signaling to relieve both acute post-surgical pain and chronic pain associated with the initial injury.
- Therapeutic exercise: Custom exercise programs created by our CCRTs performed in the hospital and at home aim to promote weight bearing, improve joint range of motion, and build muscle mass to support functional mobility. Home care exercises allow for consistency so that we can accelerate the recovery process and ensure the best possible outcome for our patients. With comprehensive instructions and demonstrations, a prescribed home rehabilitation program empowers you to enhance your pet’s mobility, comfort, and bond with your family.
- Manual therapy and massage: Just like in people, manual manipulation of joints and soft tissues promotes relaxation, improves circulation, and relieves muscle tension, pain, and soreness. Massage therapy may also be part of a home care program to extend the beneficial effects between sessions.
- Acupuncture: Acupuncture involves the placement of thin needles at distinct anatomic locations to stimulate nerve endings, release endorphins, and promote the body’s natural healing response. It is a Traditional Chinese Medicine technique that has been used for thousands of years, and modern medicine has confirmed its efficacy with peer-reviewed scientific studies. This treatment modality can be used for post-surgical pain and may be especially helpful for pets with compensatory soft tissue pain, chronic pain, or arthritis.
Although some modalities like underwater treadmill may be limited in the early stages while the incision is healing, other treatments such as cryotherapy, laser therapy and transcutaneous electrical nerve stimulation (TENS) are initiated right away.
In conclusion, rehabilitation helps to optimize post-surgical recovery not only in people, but also in their pets. By restoring strength and mobility as early as possible, rehabilitation gives pets the best chance at a successful surgical outcome. If you have questions specific to your pet or are interested in scheduling a consultation with our rehabilitation team, please contact us at 720-842-5050.
References
- Noyes FR. Functional properties of knee ligaments and alterations induced by immobilization: a correlative biomechanical and histological study in primates. Clin Orthop Relat Res. 1977;(123):210-242.
- Kiviranta I, Tammi M, Jurvelin J, Arokoski J, Säämänen AM, Helminen HJ. Articular cartilage thickness and glycosaminoglycan distribution in the young canine knee joint after remobilization of the immobilized limb. J Orthop Res. 1994;12(2):161-167. doi:10.1002/jor.1100120203
- Haapala J, Arokoski JP, Hyttinen MM, et al. Remobilization does not fully restore immobilization induced articular cartilage atrophy. Clin Orthop Relat Res. 1999;(362):218-229.
- Romano LS, Cook JL. Safety and functional outcomes associated with short-term rehabilitation therapy in the post-operative management of tibial plateau leveling osteotomy. Can Vet J. 2015;56(9):942-946.
- Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc. 2002;220(9):1325-1330. doi:10.2460/javma.2002.220.1325
- Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res. 2006;67(3):529-536. doi:10.2460/ajvr.67.3.529
- Moeller EM, Allen DA, Wilson ER, Lineberger JA, Lehenbauer T. Long-term outcomes of thigh circumference, stifle range-of-motion, and lameness after unilateral tibial plateau levelling osteotomy. Vet Comp Orthop Traumatol. 2010;23(1):37-42. doi:10.3415/VCOT-09-04-0043
- Mölsä SH, Hyytiäinen HK, Hielm-Björkman AK, Laitinen-Vapaavuori OM. Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs. BMC Vet Res. 2014;10:266. Published 2014 Nov 19. doi:10.1186/s12917-014-0266-8
