Physiotherapy in orthopedics

Ideal it would be to perform physiotherapy on animals which do not suffer any pain. Unfortunately it is almost impossible in orthopaedic patients as the most usual reason for lameness is pain of joint(s), bone(s), muscle(s) or the combination of them. Furthermore, animal in pain will avoid using the affected limb. This will cause stiffness and compensatory changes in posture and gait and elsewhere in the body. If such a pathological situation is going on for a long time the rehabilitation time to correct the posture and the gait will be also longer as the animal has already adapted to the unwanted movement pattern. In these situations regular visits at physiotherapist will guarantee careful follow-up of situation, modification of therapy plan and prevention of possible complications. Further in the text short presentations of the most common orthopaedic disorders that are treated with physiotherapy will be provided.

Cranial cruciate ligament rupture

Physiotherapy for patients that have undergone surgery for cranial cruciate ligament rupture is depending on the operation method and the instructions from the surgeon. With usual extracapsular and intracapsular techniques the physiotherapy can usually be started 1-2 weeks postoperatively. Tibial Plateau Leveling Osteotomy- (TPLO) and Tibia Tuberosity Advancement (TTA) changes the biomechanics of the joint and surrounding tissues. These techniques require longer recovery. Usually 4-8 weeks have to pass before physiotherapy can be safely performed.

Physiotherapy is helpful in the acute phase postoperatively in addition to medical treatment. Usually cryotherapy to reduce swelling and pain, passive range of motion of the joints to maintain joint mobility and more seldom electrotherapy to prevent muscle atrophy is prescribed. Leash walking is started on the approval from the surgeon. The physiotherapy goals are early and if possible normal weight bearing of the operated limb initially. Later normal joint movement, stability and restoration of neuromuscular function is of primary importance. Until the earlier mentioned goals are achieved and the veterinarian has given approval no strengthening and endurance exercises are introduced into the rehabilitation program.

Hydrotherapy can usually be started 1-2 weeks after surgery. The intensity and progress of hydrotherapy depends on the surgery technique used and on the stage of recovery. Rehabilitation of cranial cruciate ligament problem patients should continue regularly for 12-16 weeks or according to the surgeon’s instructions. Return to sports is important for many owners and is to be done gradually under supervision of the physiotherapist.

Patella luxation

Physiotherapy for patella luxation patients depends on the grade of the luxation. If the luxation is very mild, physiotherapy can be tried as an alternative to surgery. The veterinarian however is the one to decide whether conservative or surgical therapy will be chosen.

The postoperative patella luxation patient requires caution in the beginning. In early stage of rehabilitation just movements and exercises in the sagittal plane are performed. The physiotherapy goals are to improve the stability, neuromuscular function and proprioception of the joint together with maintaining the joint movement and developing muscle mass. Exercise on the underwater treadmill, electrotherapy and balance exercises are effective methods. Swimming might be too strenuous for an unstable joint, especially early after surgery. The underwater treadmill is a better alternative, because there the dog is allowed to exercise under better control and quietly in a closed kinetic chain.

Stability of the knee joint is improved by using devices for balance training.

Osteoarthritis

Osteoarthritis is a common problem among dogs and it is usually affecting the activities of daily life remarkably. There might be difficulties in climbing stairs, jumping into the car or the dog might be unable to walk long distances. Lameness may occur occasionally or continuously.

Physiotherapy and especially hydrotherapy is able to help these dogs. The goals are in relieving pain, maintaining and improving joint motion and functional ability. The maintenance of a normal activity level is also important.

Regular pain medication or other pain relieving care (acupuncture, electrotherapy) may be necessary to make it possible to mobilise stiff joints and exercise muscles. Low impact training is proven beneficial in human studies and is easily applied to dogs. Exercise on the underwater treadmill or in the swimming pool improves joint motion, endurance and strength without putting stress on the painful joints. Passive movement exercises, mobilisation and massage are improving joint motion, relieving pain and encouraging blood flow. It is important to keep the dog in a good physical condition, often short leash walks is a good rule to follow.

Weight loss plays a great role in the management of osteoarthritis. Hydrotherapy is effective also in the management of obesity. Different nutritional supplies may be added side by side with the rehabilitation.

Careful passive movement exercises improve joint motion.

Elbow dysplasia

Elbow dysplasia includes three different disorders: osteocondrosis of humerus, fragmented coronoid process and ununited anconeal process. The medical treatment of these disorders can be successfully supported with physiotherapy, mainly postoperatively. Hydrotherapy, assisted active exercises, passive joint movements, mobilisation and quiet controlled leash walks are mainly used. The aim is to improve and maintain joint motion, stimulate weight bearing on the operated limb, decrease lameness and relief pain. Physiotherapy is usually started after removal of sutures and should continue on regularly basis 12-16 weeks postoperatively.

Fractures

Physiotherapy in the management of fractures depends on the fracture type, the fixation method used, the stage of recovery and close cooperation with the treating surgeon. Guidance of the owner about the rehabilitation at home is important to guarantee a safe and optimal rehabilitation.

The physiotherapy aims are in supporting fracture healing, maintaining and improving joint motion, preventing contractures and osteoporosis and improvement of muscle mass and functional ability. In the acute phase after the osteosynthesis cryotherapy, passive movement exercises and light massage within the ranges of the cast/ bandage are always indicated. Therapeutic exercises and hydrotherapy is included in the physiotherapy program after careful assessment, control x-rays and the surgeons approval individually. Possible complications must be noticed and taken care of before the physiotherapy can continue safely.

Tendon, ligament and muscle injuries

Most commonly treated soft tissue injuries treted with physiotherapy are biceps tendon tenosynovitis, ligament and tendon tears or injuries and different muscle tears. Physiotherapy treatment is performed hand in hand with medical treatment. Important factors are when the surgery was done, how long was the immobilisation period and when is it safe to start mobilise the injured area passively and actively. Tendon and ligament injuries require caution when it comes to increasing exercise and the follow-ups must be done carefully. The physiotherapist and the veterinarian together will give the instructions needed to make sure a safe and effective rehabilitation is guaranteed.

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