Therapeutic exercises are possibly the most beneficial to any rehab program. It is fun – for us and the patient, allows the therapist to think out of the box, involved the client on various levels, and can be applied to so many cases. These cases include but is not limited to the pre-and-postoperative patient, the geriatric OA patient, teaching puppies new skills or the canine athlete with the goal of peak performance.
The aim of a therapeutic exercise program is to address motor control, proprioception, balance, coordination, stability, flexibility, muscle strengthening, endurance and performance, range of motion (AROM or PROM) osteokinematics and gait retraining. The end goal is to achieve improved gait, normal to optimal mobility, promote functional independence, improved muscle circumference and tone, pain reduction and improve weightbearing tolerance.
Each patient is assessed and evaluated on an individual basis, and to embark on a successful therapeutic exercise program, the therapist should holistically consider the patients’ clinical history, current status and the owner expectations. Therefore, it is imperative that the therapist create short‐, medium‐, and long‐term goals, which are reassessed at each session. Therapeutic exercise programs should contain the following variables:
Frequency (how many times per day or week), Speed/intensity, Duration of work (number of reps), Impact (high, low or no impact) and Environment (terrain, footing, substrate).
As exercises are designed to address specific impairments, an array of equipment is being used for therapeutic exercises, and commonly, we will incorporate a wide variety to accomplish our end goal. The exercise equipment may include physio balls, cavaletti rails, balance blocks and discs, weights, tunnels, rocker boards, wobble boards, steps, ramps, weaving poles, and treadmills just to name a few. Assisted devices such as harnesses, balance leads, and other supportive equipment may also be added to complete the program.
At the WSAVA/FECAVA/BSAVA World Congress 2012, Janet B. Van Dyk, DVN, DACVSMR – Canine Rehabilitation Institute, Wellington, FL, USA, presented a paper on the following aspects and focused on special consideration is given to the patients’ flexibility, level of endurance, current strength, and proprioception.
In terms of flexibility, the ambulatory patient, some form of warm-up is recommended before initiating any stretching work. In the non-ambulatory patient, electrical stimulation or therapeutic ultrasound may be used for this warm-up.
For the very debilitated patient, early endurance work may involve little more than assisted standing. When muscle is immobilised for a length of time, the first fibres that are lost are the slow twitch fibres. These are the most common fibres in our muscles of posture or gravity resistance. The patient recovering from a period of recumbency will have very little endurance due to this lack of slow twitch fibres. Early rehabilitation will focus upon these postural muscles rather than on the cardiovascular system. The therapist will monitor heart rate and respiratory rate for evidence of fatigue.
Exercise designed to improve endurance in an athlete is focused upon the cardiovascular system. As with any cardio programme, the patient will gain stamina as well as increased speed and strength. As the programme progresses, the therapist will monitor heart rate, respiratory rate and the rate at which each recovers after a maximal effort. Endurance training can be done on the ground, on a treadmill or using hydrotherapy equipment.
To augment the effects of an exercise programme, resistance can be added to the routine. This can be done using weighted vests, sleds or resistance bands, hill work and water. This is an area where the underwater treadmill has gained great interest.
The emphasis in strength training will be upon resistance. In our debilitated patient, strength training may include little more than moving from down to sit and sit to stand. Here, gravity is the only resistance needed. External resistance will be added as the patient progresses.
An area of strength training which has received a great deal of interest lately is core strengthening. This is done to help prevent thoracolumbar and lumbosacral injuries, especially in the canine athlete and in chondrodystrophic breeds. Core strengthening exercises include begging, two-leg standing and stability work done on a physio ball or wobble board. Care must be taken to avoid excessive work in this area, as fatigue occurs rapidly.
Many rehabilitation patients struggle with body awareness, especially with proprioception. This is defined as the awareness of body position. Therapeutic exercise can address this problem through many avenues. In the debilitated patient, proprioception training might be as simple as assisted standing, which progresses to standing with the addition of gentle perturbations by the therapist. When the patient is able to resist these movements without losing balance, more challenges can be added, such as performing these exercises on rocker boards, wobble boards and other unstable surfaces.
At Paws-itive Paws-abilities, Therapeutic Exercises are incorporated in almost every session and for most conditions, and we believe therapeutic exercises are the cornerstone of our rehabilitation regime. We have a world class custom build indoor dog training arena and a Pet Active Gym which is fully equipped to cater for any Therapeutic Exercise Program we wish to implement.
We have 2 specially designed programs to accommodate our patients: These programs are designed with the following aspects in mind:
- Consider any underlying pathology that may affect the patient’s ability to exercise.
- Consider the patient’s psychological state and willingness to perform exercises.
- Consider the experience of the client.
- Set short- and long-term goals.
- Evaluate the patient at every visit.
- Ensure proper body mechanics for both therapist and patient.
- Use assistive devices if needed.
- Watch for signs of fatigue.
- Finish on a positive note.
- HAVE FUN!
12 Week Strengthening Home Exercise Program (HEP)
A home exercise program is vital to the success of a patient’s rehabilitation; therefore, both the pet and the owner’s capabilities must be met. Owner compliance must be reiterated, and competence in performing these exercises are very important. Our 12-week program has been developed with a special focus on the Geriatric and OA patient, but is adapted for each individual patient’s condition. As every patient is different, so the exercise program is individualized and each week the progression of the exercises depends upon the patient response, which is evaluated during each session.
Pet Active Gym Program (PAG)
Our imagination is the only limitation on the equipment used and the exercises created. As listed above balance and proprioception, core strengthening, endurance and flexibility are considered. For canine athletes, such as working dogs, we incorporate exercises that enhance strength and speed.
In general, our PAG Program are for dogs who have been completely rehabilitated and the owners which to keep them in an optimal condition and minimise the re-occurrence of injury. In most cases, I will incorporate hydrotherapy, therapeutic exercises, mind stimulation and some basic obedience.