In the U.S., physical therapy is a protected term on the human side, as is physiotherapy in Canada. This is why we use “rehab” when referring to what are essentially some similar modalities used in animals. It is a rare surgical procedure in humans that is not preceded by or followed by physical therapy. This is because of improved pain control, earlier return to function and better surgical outcomes. Why do we not do the same for our animal patients? Although we are often on par (and sometimes ahead) of our single-species doctors, most of us have not been taught to perform rehabilitation therapy or refer for it. I hope this article will convince you otherwise. Rehabilitation is a term that encompasses a vast basket of modalities. The first thing that comes to mind for many people is directed exercises to improve function and strength. However, rehabilitation also encompasses many other modalities, including hot and cold therapy, compression therapy, photobiomodulation therapy (PBMT or laser), shockwave therapy, pulsed electromagnetic therapy, and massage, just to name the most common modalities. Each one of these is within the ability of the general practitioner/surgeon, with only two of them, PBMT and shockwave, requiring a commitment to invest in more costly equipment. What is the evidence? A PubMed search brings up a plethora of studies proving the benefit of post-operative rehab. One study was published in the Journal of the American Veterinary Medical Association (JAVMA), which looked at recovery from cruciate surgery, states: “Dogs that have surgery for RCCL and a torn medial meniscus benefit from postoperative rehabilitation; rehabilitation should be considered part of the postoperative management of these patients.”1 Another article in the Biomed Veterinary Research Journal2 concludes, “The use of laser therapy in the post-operative rehabilitation of dogs affected by intervertebral disc extrusion and submitted to surgery for spinal decompression could help improve their neurological status.” Things you can do today Icing. Cold therapy on a wound immediately out of the OR will have an immediate benefit by reducing pain and inflammation. There are some general considerations: Ice appropriately according to body size: Our surgical patients can range from a few pounds to more than a hundred pounds, and we need to consider the area of coverage. In a Great Dane, an ice bag on the knee will not significantly lower the dog’s body temperature, even if the bag is oversized. Putting the same ice bag on the knee of a Chihuahua could cause a serious drop in body temperature, endangering the dog. Always use a towel between the ice and the patient’s skin to avoid frostbite. Apply ice for 15 minutes twice daily. Icing with compression enhances the action of the ice and reduces the amount of time necessary to ice. This only works on extremities where you can wrap the ice in a compression bandage (Figure 1). There are also icing devices on the market that might be more convenient if you do a lot of orthopedic surgery (Figure 2). Figure 1.Compressed icing using a gel pack and compressive tape. Flexible gel packs can be bought commercially, or you can make your own by combining one part isopropyl alcohol with three parts water in a freezer bag. Photos courtesy Dr. Michael C. Heat should not be used in an acute situation: there is inflammation that does not need more heat. It also has the potential to dilate blood vessels and cause post-operative hemorrhaging. Heat should be used when massage therapy is indicated: chronic pain and inflammation. Massage therapy can be employed on sore muscles to stimulate a neuronal response in those cases where there might be nerve damage. There probably is not a person reading this who has not experienced or witnessed a massage and has a basic idea of what to do to knead a muscle gently. There are three basic types of massage, and they can all be easily mastered. I recommend referring to Canine Medical Massage: Techniques and Clinical Applications by Narda G. Robinson, DO, DVM, MS, FAAMA, and Shelley Sheets, BA, CMT, CAMT for more information. Figure 2. Icing devices offer convenience for frequent orthopedic surgeries. Things you need equipment for Pulsed electromagnetic field therapy (PEMF) has been shown to help in several different ways, including increasing circulation, speeding up bone healing, and reducing pain. Several devices are on the market, ranging from relatively inexpensive hand-held loops to more expensive PEMF cage mats. These tools can be used in the clinic or sold to clients for home use. Shockwave therapy can reduce chronic pain. I have included it here, even though I would not necessarily use it in the immediate postoperative period, as it is intended for the treatment of chronic pain, not acute. Shockwave therapy has a known benefit of reducing pain, especially myofascial pain. These chronic pain conditions can arise a few weeks after surgery, secondary to reduced limb function. This modality requires a substantial investment but does have limits as to where you can use it. Photobiomodulation (PBMT) or laser therapy is one of my favorite modalities. It is known to speed healing, reduce pain, and hasten return to normal function (Figure 3). The first treatment can be used while the animal is recovering from surgery and daily, if need be, for those animals that are not healing as expected. I especially like the idea of having a laser unit, as there are so many other nonsurgical applications that can help pay for the purchase of the unit. Figure 3. PBMT for a dog that has just undergone a neuter procedure. Things you need training for Advanced hands-on techniques cannot be learned from a book, but must involve training, preferably through a reputable and established rehabilitation school. However, once you have gone through that training, there are endless possibilities for expanding your practice and treatment of not only post-operative patients but also patients suffering from a host of ailments, such as degenerative joint disease and neurologic disease. Below is a list of programs I feel are reputable, but it is not an exclusive list. I encourage one person from each practice to go through the training to help you deliver even better care: Curacore Canine Rehabilitation Institute https://cpell.utk.edu/programs-courses/canine-rehabilitation-certificate-program/ Chi University VPN Plus+ members can learn more about massage therapy techniques with demonstration videos. Not a member? Sign up today at the VPN Plus+ website! Michael C. Petty, DVM, is a graduate of the veterinary school at Michigan State University. Dr. Petty has devoted his professional life to the care and well-being of animals, especially in the area of pain management. Petty is the past president of the International Veterinary Academy of Pain Management. A frequent speaker and consultant, he has published articles in veterinary journals and serves in an advisory capacity to several pharmaceutical companies on topics of pain management. Petty has been the investigator/veterinarian in 12 FDA pilot and pivotal studies for pain management products. He has lectured both nationally and internationally on pain management topics. References 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 May 1;220(9):1325-30. Bruno, E., Canal, S., Antonucci, M. et al. Perilesional photobiomodulation therapy and physical rehabilitation in post-operative recovery of dogs surgically treated for thoracolumbar disk extrusion. BMC Vet Res 16, 120 (2020).
