promexercises

Canine Passive Range of Motion Exercises

Physical rehabilitation should begin immediately after surgery, beginning with icing inflamed tissues, and in the following days, incorporating passive range of motion, electrical stimulation, ultrasound therapy, and massage therapy (to reduce the possibility of the scar tissue adhereing to the muscle) and reduce stiffness in the joints. The goal of physical therapy during this time is to minimize inflammation and pain, preserve joint range of motion, and to prevent or further minimize muscle and soft tissue atrophy. Hydrotherapy is begun after suture removal.

Activities begin as inflammation is resolving and healing begins to be the predominate theme in the wound. It is very important to combine these activities with the temporal aspects of wound healing. By that, we mean applying appropriate stresses to healing tissues so as to optimize their healing but not so much that the biomechanical stability is threatened. Ideally, these activities should parallel the gradual increase in tensile strength observed in the wound. It is important to know that tendons subjected to surgical repair only have 40% of their tensile strength at four months. If one is too aggressive with PTH during this period, failure can occur; conversely, if one lags in PTH activities, the goal of early return to function is not accomplished.

Passive range of motion (PROM) exercises increases blood flow to the joint cartilage, stimulate new cartilage production, and are used to increase range of motion (ROM) at the joint. When neuro functions return, the muscle and joints will then be capable of response. Passive exercises are performed to help maintain or improve joint mobility, improve flexibility of muscles, tendons, and ligaments, and to help enhance awareness of neuromuscular structure and function. The importance of passive exercise continues until voluntary movements begin to return, then passive exercise is no longer needed. Muscles need to fatigue to gain strength. Weight bearing standing exercises should be continued until strong walking movements are present.

An important factor to acknowledge is the need to match the specific injury/and or surgical repair with the appropriate exercise. It is known from clinical/research data in animals and man that following cranial cruciate loss/repair the quadriceps, biceps and semimembranosus under go significant atrophy. When developing a rehab plan for a postoperative cruciate patient, we concentrate specifically on these muscles. In man, ability to achieve full extension of the knee is a desired endpoint, however, due to the functional angle of the dog’s knee, this is less important.

Listed below are some post-operative cruciate repair therapeutic exercises:

1.   Sit/stand.

2.   Corner stands.

3.   Figure of 8/circle walks.

4.   Wheel barreling.

5.   Electrical Stimulation of hamstrings/quads.

6.   Ultrasound/stretching of hamstrings, quads.

7.   Initial decline treadmill followed by incline treadmill.

Warmth therapy before a session will warm up joints and muscles as well as relax the dog for therapy cooperation. Never apply heat to the surgery site as it may increase possibility of infection due to bacterial growth encouragement. After exercises cold pack therapy can help with soreness.

In passive exercises, all the joints of the limb are flexed and extended through their normal range of motion. After each joint is treated with these exercises, the entire limb is moved through a range of motion similar to that of normal walking. Do all the joints in the back legs. Working down the leg there are four joints. Hip, then hip to the first leg bone (knee?) then ankle then paw. The hip has already been done so supporting the hip stretch the upper leg back as far as it will go and hold for a few seconds. Then as far forward as it will go and hold for a few seconds. Do this five times then move down the leg to the next joint remembering always to hold the leg above the joint you wish to work on. So if you were flexing the paw you would be holding the leg between the ankle and the paw.

Stimulation is an important factor of nerve reconnection. Tickle between the toes and the foot pads of the paralyzed or weakened limbs. Tickle all along the legs. Do not exaggerate and make the dog twist, just stimulate for a few seconds.

Withdrawal Reflex: This is a reflex and not true motor movement but it encourages all muscle stimulation, joint movement and can be done on both front and hind limbs whatever is affected. You just apply firm pinch between toe webbing (Not enough of a pinch to cause a pain reaction, just enough to stimulate the reflex), this will stimulate the reflex causing dog to withdraw/pull-up leg into body. Owners are encouraged to do this on each side 5-10 reps 2-3 times a day.

Stretching exercises increase circulation and muscle flexibility.

Hip Flex/Rotation. Very gently start at the hips. Rotate the hip joint by grabbing the femur and thigh with one hand and the hip with the other, and proceed to move the femur and thigh forward and backward slowly and gently 15 times. Do not over extend, just move the joint at the extension the dog would move it naturally. Grabbing the femur and hip the same way, rotate the femur in a semi circle outwards and backwards, then bring it forward again. Slowly and gently without over rotating. Repeat 15 times.

Knee Flex: With one hand grab the thigh and femur and with the other grab the leg. Gently flex the knee forward and back into position 5-10 times.

Foot flex: With one hand grab the leg and press it against the palm of your other hand, simulating the pressure the foot would receive if the dog was taking a step. Repeat 15 times This movement is particularly important as a dog can regain movement in the legs, but be unable to bend the foot against the floor, this means they are too unstable to walk and the foot drags across the floor damaging the flesh. Make sure you really press against the foot as if you were the floor pushing up against his weight.

Ankle flex: With one hand grab the leg and with the other bend and straighten the ankle 15 times.

Pumps: Place one hand on the top of the thigh and the other on the foot pads. Push the foot up, so that the ankle, knee and hip are bent and then straighten (gently) simulating the motion of the muscles the dog would do if it were sitting and standing. Repeat 10-15 times.

Bicycle: rotate the leg forward 15 times, and backwards 15 times, simulating the movement of forward and backward rotation of paddling a bicycle.

These exercises manipulate all the muscles and prevent the joints from stiffening . Of course, every movement should be done slowly and carefully. If the dog starts to regain control and pain sensation, he may resist the assisted movement by locking the leg. You can tell if he is doing this by the slight twitching in the muscles and the way he looks at you. You will need to be very careful and very slowly and gently go to the full completion of the movement.

Proprioceptive exercises are exercises used to help the animal know where their feet are in space. Assisted exercises bridge the gap between completely passive and more active activities. Many of them are proprioceptive exercises that help animals regain their ability to use and place their limbs appropriately. The goals of these exercises are to enhance proprioceptive feedback, encourage weight shifting and muscle contraction, and to facilitate balance and function.

After weeks of crate rest you will need to slowly build up your dog’s muscles and stamina. Always observe and restrict movement if there is soreness.

Some examples include:


weight-shifting on exercise ball The ball works by having him stand with his front feet on it, and then I roll the ball slightly forward and back, and side to side. This works his muscles in his rear, and also his balance.
Pictures curtesy of Lila Lippow

*******************

Hold a treat while sitting on the sofa or over the bed. Place Your dogs front paws on the sofa or bed (if he is tall enough and can easily place both front paws on either) so he is placing more of his weight on the back legs. Continue this for about a minute. Can also be done on a first step. Be certain the surface is non skid

******************

		assisted standing weight-shifting while standing Resistance Movements Figure 8's
balance board	FitBall Balance Disc	Other Exercises
Pictures curtesy Lila Lippow

Figure 8's

Sit on the floor with your legs spread. Use a treat as a lure and make your dog step over each of your legs and revolve around you. This forces your dog to use each limb individually as he is stepping over you. Do this for a few minutes. This is the same principle of weaving.

********************

Strengthening exercises (stairs, sit/stands, etc.) are used to strengthen individual muscles or muscle groups.

Sits/squats. Do 20 sits/squats a day. Use a treat as a lure. Have your dog sit squarely and then step back so that he has to stand and advance towards the treat. This is considered a dog squat. Sit stands on some foam rubber will also help with proprioception.

Weight shifting exercises are used to help the animal shift their weight to the affected limb or side to make the animal walk more balanced. When possible encourage more weight bearing onto the recovering leg by placing a plastic bag on the good leg.

While standing, lift each of your dogs 3 non-injured legs (one at a time) for several seconds- sometimes I hold the leg for a minute or more depending on his cooperation. The point is to place more weight on the leg that has atrophied to force some weight bearing. Hold the legs up or off the ground as long as it seems comfortable, without twisting them. Also try to shift the weight towards that leg when he is standing.

Ambulation exercises are exercises used to re-educate a paretic animal (severe loss of function of their limbs) how to walk.

Active exercises are voluntary activities that help animals regain strength and function. They are the most beneficial exercises for regaining muscle mass.

Some examples include:

Cavaletti rails
Pictures curtesy of Lila Lippow

The idea is you walk your dog slowly thru the poles so he/she has to stretch a tiny bit and also has to pick up the feet individually- dogs -especially ones with a sore leg will try to cheat and run thru the poles knocking them over because they don't pick up their feet-- it teaches them to pick up their feet and use the bad leg The obstacle course is a slight variation on what you've seen before. By putting sheet foam in pillow cases between the bars, Jack steps deeper- which keeps him walking straighter and picking up his feet more.

Other exercises

slow leash walks
treadmill walking
hill and stair climbing
sit-to-stand exercises

pole weaves
Massage
Range of Motion
Heat/Ice Therapy
Stretching

Sit/stands on some foam rubber as that will help with proprioception also. We have also "encouraged" more weight bearing when it was possible onto the recovering leg by placing a plastic bag on the good leg. I am not saying these are for everyone's dog but it may be useful to discuss these easy techniques with your own PT to see if they would be appropriate.

Jacks Trampoline Pictures curtesy of Lila Lippow
Put a non-slip yoga mat down first. Stand yourself and your dog on the trampoline, (dog between your legs)- and you gently bounce up and down, the dog uses his muscles to keep balance. Of course this works for a Corgi- but with a bigger dog you can put just their front, or their back on it. For a dog that couldn't stand well you could hold them in a sling and still work their legs.

Dogs who have experienced this rehabilitation process reap the rewards. They have:

More rapid recovery
More complete return of function
Decreased swelling
Increased flexibility and range of motion
Reduced pain and inflammation
Reduced muscle loss
Increased muscle mass and strength

physical Therapy Instructions	Clarks Passive Crate Rest Movie	Physical Therapy for Paralysis	Underwater Treadmill videos
Water Therapy	Muscle Stretches	DVD's	PT Homecare Instructions
Canine rehab kit

The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.