Weeks 4 & 5 pain free

We have now reached the end of week 5 post-op and the most noticeable aspect (aside fur almost fully re-grown over shoulder) is that Jaidi no longer shows any post-op lameness. This means he is fully weight bearing and has full ROM on right forelimb.

In this time we had our post operation follow up with the surgeon. He also confirmed good ROM, but still advised lead walking / straight lines to avoid any high speed twisting of limb and potentially damaging the repair.

So our modalities during these weeks have had a strong concentration on our strengthening work, with a focus on

• Proprioception
• Balance
• Joint flexion

Additionally, we still continue stretching (with PEMF and massage) but now focusing back on all limbs and spine, not just the right fore. We also continue with treadmill work but had gradually

• Increased speed to a peak speed of 2.9 kph (which is above Jaidi's warm up speed of 2.5 kph). Distance per session is now >0.8 kilometer.
• Introduced incline / decline to shift body weight back and forwards respectively (therefore increasing load)
• Changed time to first 15 minutes per day and now up to 20 minutes every other day

Eventually the aim is to have Jaidi back trotting which significantly increases the weight bearing per limb (at a walk its around 100 - 110% body weight per limb, rising to 200% at a trot, as only 2 limbs contact ground at any one time at this gait).

Strength work

As mentioned above, this is now where we concentrate. These are examples of some of the exercises we are doing:

Shifting from side to side placing each front paw in turn on a pod

Higher cavaletti poles to further encourage active flexion

Balance on bones shifting weight from side to side

Week 3 - moving to strengthening

Our goals for week 3 were to encourage independent limb use, so Jaidi can begin the strengthening process

So our modalities this week have been:

• Stretching
• Massage
• PEMF*
• Treadmill walking
• Inducing isometric muscle contractions

As we move from ROM manipulations to stretching of the limb, I incorporate PEMF and massage pre-stretching to improve blood flow by vasodilation this increasing circulation, oxygenation and removing toxins.

The action of stretching helps in rehabilitation by:

• Improving ROM
• Reduce tightness in tendons
• Improve flexibility by increasing the number of sarcomeres and giving sensory feedback

Our treadmill walking is now up to 1.8 kph for 5 mins without any rest periods. As Jaidi's normal walking speed on the treadmill is 2.5 kph, he is more comfortable now and wagging his tail. I will share some video of the tail wagging next week!




We carried on with the paw pod proprioception and also introduced some isometric strengthening using a 4" x 2" plank which means that Jaidi has to stand with his paws adducted, inducing isometric contractions in the shoulder stabilizers.

*PEMF modes of action

• Promote sodium / potassium exchange, which reduces pain
• Electroporation - Better fluid transfer aiding dissolution of toxins
• Wound healing increases by 30%
• Atomic excitement/electron spin to increase and store energy
• Promoting alignment of molecules making combine easier
• pH becomes more alkaline, facilitating better oxygen uptake
• Viscosity shift - allows liquids to flow into cell gates
• Red blood cells separate allowing better transport of oxygen
• Relaxes the vascular system

Week 2 - Improving ROM

Our goals for week 2 included improving ROM and encouraging better use of the affected front limb

So our modalities this week have been:

• LASER
• PROM
• Treadmill walking
• Active forelimb targeting

LASER initiates photochemical reactions at a cellular level . It  has a stimulating effect on cells and tissue Leading to an increase of:

• Antibodies
• Specific enzymes
• ATP formation
• Lymph drainage

Which collectively optimise the healing process.

PROM involves moving the limb in a controlled and pain free manner. At this stage we were able to go to mid range of Jaidi's natural range on movements further mobilizing the soft tissue.

We have been slowly increasing the treadmill speed to encourage controlled and even limb use. We finished week 1 at 0.9 kph for 2 mins, then 0.5 mins rest with a further 0.9 kph for 3 mins. Each day I added 0.1 kph to the speed by the end of week 2 we were up to 1.5  kph.


Finally we introduced pods placing them to his right side and encouraging Jaidi to find the pod with his right forelimb, therefore stimulating his proprioception and building foundation for the next strengthening stage.

Bicipital tenosynovitis - Week 1 rehabilitation

So the first week post operation is completed and pleased to say that the patient (Jaidi) is doing well.

Even after the first day post surgery, rehabilitation can begin. In fact an early and tailored program will give the best chance of an optimal recovery. Why is this?  Post-operative physiotherapy has the following aims and benefits:

1. To promote healing - minimize scar tissue after and retrain muscles
2. Regain mobility - having a program which progresses treatment to help prevent re-injury or delay recovery time
3. Optimising recovery - rehabilitation helps the body recover in a more optimal way than if left to its own devices
4. Active rehabilitation - To take an active role in the dogs recovery and offer mental stimulation

Our first goals post-op (for this condition) are to reduce pain / swelling, aid joint mobility and encourage controlled limb usage.

So our modalities this week have been:

• Cryotherapy (i.e. ice packs)
• PEMF (Pulse mag)
• PROM
• Treadmill walking

 The first 2 work in a similar way, by restricting blood flow to the area, they reduce swelling and pain. PEMF offers much deeper penetration into the muscle joints, whereas ice works at a relatively superficial level (so is more targeted at the surface operational wound).

PROM involves moving the limb in a controlled and pain free manner using grade 1 movements, so within his early natural range of movement. This will also help alleviate pain as well as mobilizations the soft tissue.

Finally using the treadmill is a good method to encourage controlled and even limb use. We started at 0.4 kph for 2 mins, then 0.5 mins rest with a further 0.4 kph for 2 mins. Each day I added 0.1 kph to the speed. So today we are up to 0.9 kph. Jaidi, who is an experienced treadmill dog, now considers this 'too slow' and you can see him wanting the belt to turn faster! However the aim here is to make sure he uses each limb, so slow is better for the time being.

Jaidi - Shoulder arthroscopy / Day zero

Today Jaidi had his shoulder arthroscopy. As this involved a GA, it is always a nervous time but glad to say the operation was a complete success.

The procedure

The arthroscopy was to clean out calcification of the biceps tendon and investigate any other potential shoulder ligament damage. His operation was carried out at West Midlands referrals and the surgeon 'Magic' explained in detail what he intended to do and why. He also explained that the prognosis for a full recovery for this procedure is very good. I had the additional bonus of seeing the whole procedure (on video) when I collected Jaidi, as I also do some post op rehabilitation work for the referral centre.

Why?

At this stage Jaidi had shown little sign of lameness and continued to work (in fact having one of his best years in Agility in 2017). Due to understanding my dogs natural range-of-movement (ROM) very well, I was able to raise the issue before it become painful and perhaps have caught it before irreparable damage such as DJD (osteoarthritis) set in.

This underpins so much of why I choose to study animal physiotherapy some years ago. As we know, Agility dogs are athletes and prone to injury (occupational hazard). Also, for anyone who reads up on 'Agility injuries' bicipital tenosynovitis is not uncommon. Getting to this diagnosis is a testament to understanding canine range-of-movements (ROM) and also having our first-line veterinary, Emma at Star clinic, also being a physiotherapist. Doing Jaidi's routine MOT, I wasn't happy with his shoulder flexion on right hand side. Our vet concurred and we agreed an X-ray and palpation under sedation

 The result was visible calcification in the shoulder joint, which can be seen on the image on the right in the joint between head of the humerus and the bottom of the shoulder blade. The arthroscopy also revealed a partial tear in the medial glenohumeral. The latter I will work with during Jaidi's operation rehabilitation.

Rehabilitation

Now the road to recovery starts. We started as soon as Jaidi was home with cryo and pulsed magnetic field therapy with the aim of reducing swelling and pain.

Tomorrow we will begin passive ROM exercises and controlled walking. These will help prevent muscle atrophy and tension (due to restricted limb use).

The Power of a Collaborative Approach to Canine Physiotherapy

The Power of a Collaborative Approach to Canine Physiotherapy

My client was presented to me some 3 months ago as a direct veterinary practice referral.  The Vet explained that the dog had HD in the RH hip and was in discussion with the client about conservative or surgical management. 

However there was an added complication...

This active dog had also strained the iliopsoas muscle on the same side as the HD issue. ROM was limited and in some planes of movement painful. The veterinary suggested a course of physiotherapy to reduce the muscle inflammation and corresponding pain and loss of movement.

I was contacted by the vet directly and offered a full case history and the opportunity to help in this interesting case. Following treatment the practice team could then make a better conservative or surgery decision for the HD.

Physiotherapy

We started with a gait analysis on the Gait4Life (fitfurlife) treadmill and full palpation. The data from these evaluations would allow us to both understand exactly where on the muscle group the diagnosed issue was and if there were any resulting compensatory problems.

The gait analysis confirmed less weight bearing on the R H/L and increased muscle tension on L H/L and R F/L. Palpation revealed scar tissue on the iliopsoas muscle. 

We embarked on a course of therapeutic ultrasound, deep friction massage and stretching. With the owner also carrying out a daily ROM and eventually muscle strengthening home exercise program.

Additionally we applied LASER, massage and ROM to the R hip to relieve muscle tension and any potential OA issues.. Also light massage was applied to reduce compensatory muscle tension in the other limbs.

And the Results?

Well I leave that to an (edited) memo direct from the veterinary practice:

Hi Alan

We were absolutely delighted by progress since the last visit to me. 

X has only been given nsaids on 3 occasions which is a good improvement on before. On palpation of the iliopsoas muscle no pain was elicited although a small swelling was still evident when compared to her left leg. 

The range of motion in her hip joint has massively increased especially on extension. At no point during the ortho exam did she seem uncomfortable whereas she has done previously and gait was good,

 I am very keen to continue with conservative  management and on discussion so are the owners. They are keen to come back to yourself for ongoing therapy for a few sessions to really change her muscle memory and make sure she doesn't slip back into her old gait.
 
Many thanks,

XXXXX  BVetMed(hons) MRCVS

IR Video of Treadmill Active Rehabilitation Session  










 

Job Satisfaction

After qualifying as an animal physio last autumn, I started to practice in December. Naturally that means that some of my initial clients are in the, what I call, the 'polishing' stage of their rehab. 

I am so pleased with their progress, with my clients putting in the 'hard yards' at home working through their exercises coupled with using the various electrotherapies they have rented or purchased themselves. 

It is a vindication of physiotherapy as a practice and our training that we have been able to focus on specific chronic / long term injuries and now start to see the progress.

Today is a great example. I first saw (a still young), handsome  show dog with intermittent forelimb lameness and typical stiffness / tension in the opposing ftront limb. When the owner said today that their dog hasn't limped for a week, it gave me immense job satisfaction. 

It wasn't easy and we had to really refine the therapies and sessions, but knowing this dog will be able to show at Crufts makes a few sleepless nights synthesizing the sessions and data to get this successful plan of action worthwhile.

If I could define why I started this journey some 5 years ago its just that. We spend hundreds of hours training and trialling our dogs, why should a soft tissue injury end that enjoyment?