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Contraindications and Cautions of Animal Rehabilitation,  Physiotherapy and Hydrotherapy?

RA Healing Centre is the first and only full physiotherapy and rehabilitation for Singapore pets.

We started RA Healing Centre because we feel that Singapore should have a more complete health care for dogs. We love dogs, cats, hamsters and everything else and it is our passion and purpose to help Singapore pet owners have their best relationship with happy and healthy pets all their lives long. So we believe in empowering pet owners with the knowledge, services and quality health care they need to take better care of their pets, especially when they are in their senior years.

Many Singapore Veterinarians will generally advise pet owners to use swimming or hydrotherapy as a form of non invasive therapy for Senior dogs. Hence we see the importance to have this segment to inform pet owners each therapy, what it does and what to look out for.

REFERENCES

Darryl L. Millis, MS, DVM, DACVS, DACVSMR, CCRP
Professor of Orthopedic Surgery & Director of Surgical Service

Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Diplomate of the American Academy of Pain Management, is a a founder and past-president of the International Veterinary Academy of Pain Management.

Janet B. Van Dyke, DVM
Diplomate American College of Veterinary Sports Medicine and Rehabilitation, CCRT, CEO

Ludovica Dragone, DVM, CCRP
Vice President of VEPRA, Veterinary European of Physical Therapy and Rehabilitation Association.

Andrea L. Henderson, DVM, CCRT, CCRP
Resident, Canine Sports Medicine and Rehabilitation

Steven M.Fox, MS, DVM, MBA, PhD
President Securos. Inc

 

Contraindications, Cautions of Hydrotherapy and all Aquatic Rehabilitation Exercises

hydrotherapy underwater treadmill swimming contraindications and cautions

Canine hydrotherapy is a form of hydrotherapy, using both controlled pool environement and hydrotreadmill, directed at the treatment of chronic conditions, post-operative recovery, and pre-operative or general fitness in dogs. Hydrotherapy in conjunction with veterinary treatment can significantly improve the quality and rate of healing following surgery or traumatic injury. In these cases the appropriate use of hydrotherapy can help with rehabilitation and increase the chance of a successful return to full fitness. Hydrotherapy is also beneficial in young growing dogs diagnosed with developmental conditions.

Hydrotherapy has specific therapeutic effects on body tissues

  1. Relief of pain, swelling & stiffness
  2. Muscle strengthening and maintenance.
  3. Alleviating muscle spasm.
  4. Increased range of motion in joints
  5. Improved circulation
  6. Cardiovascular fitness (heart & lungs)
  7. Increased tissue healing
  8. Increased speed of recovery
  9. Gait modification
  10. Increased proprioception
  • Obesity
  • Breeds with elongated soft palate
  • Brachycephalic Breeds
  • Laryngeal Paralysis and tie back
  • Decreased Exercuse Tolerance
  • Cushing / Addisons Disease
  • Diabetes
  • Epilepsy
  • Heart Murmur
  • Renal Failure
  • Incontinence and/or diarrhoea
  • Vomiting
  • Suffering from contagious disease
  • Open Wounds
  • Prior to fibrous seal formation for surgical wounds
  • Surface Infections
  • External Skeletal Fixators
  • Certain Spinal Conditions
  • Cervical Spinal Problem

Contraindications, Cautions of Passive Range of Motion (ROM) Exercises

PROM Passive Range of Motion contraindications and cautions

Passive range of motion (PROM) are gentle exercises designed to increase the movement possible in a joint or limb by carefully stretching the muscles and tendons, through flexion and extension. PROM exercises are done 2 – 3 times a day and for short periods of time. The motion of each joint should be isolated from all other joints as much as possible.

Moving a joint helps to nourish the cartilage, maintain function and is critical to the optimal healing of any injury.

  • Enhance your dog’s joint nutrition and lubrication
  • Reduce joint inflammation or pain.
  • Possibility of stimulating new cartilage production

Caution needs to be adhered while stretching patients with known or suspected osteoporosis.

  • Use caution stretching patients with frail integument
  • Use caution stretching older patients because their collagen loses its elasticity and they have reduced capillary blood supply.
Passive ROM are contraindicated under any circumstance where motion to a part will be distruptive to the healing process such as

  • Immediately following a tear to liagements, tendons or muscle
  • In the region of unhealed fracture
  • Immediately following surgical procedures to tendons, ligament, muscle, capsule or skin

Contraindications, Cautions of Low Level Light (Cold Laser/LLLT) Therapy

PROM Passive Range of Motion contraindications and cautions

Laser treatment is used for pain management, inflammation control and tissue healing. The physiological effects include accelerated cell division via mitochondrial stimulation, increased leukocyte phagocytosis, stimulation of fibroblast production, enhanced synthesis of ATP and angiogenesis. Lasers are divided into four classes based on their power.

Most therapeutic or “cold” lasers are in Class 3 with power ranging from 1 milliwatt to 500 milliwatts. “Hot” lasers, which are commonly used in surgery, fall into Class 4 with more than 500 milliwatts of power. Laser therapy is measured in joules (the energy delivered by 1 watt of laser energy in 1 second). Most therapeutic regimens call for 1 to 8 joules of energy. The penetration depth is determined by the laser’s wavelength. Higher power simply delivers this energy to the same depth at a faster rate.

  • Joint injuries
  • Ligament or tendon injuries
  • Fractures
  • Muscle sprains or strains
  • Skin lesions or abrasions
  • Post-trauma wounds
  • Post-surgical incisions
  • Arthritis
  • Musculoskeletal diseases
  • Nerve injury
  • Impaired cognition or communication
  • Infection
  • Photosensitivity or systemic lupus
  • Recently radiate tissue
  • Anterior neck, carotid sinus
  • Cancer
  • Pregnancy
  • Thyroid
  • Very dark skin
  • Hemorrhagic conditions
  • Eyes, reproductive organs
  • DVT or thrombophlebitis (local)
  • Malignancy (local)
  • Tuberculosis (local)

Contraindications, Cautions of NMES and TENS

NMES TENS contraindications and cautions

Electrotherapy can be used for wound healing, pain control or relief, reduction of inflammation, muscle re-education, reversal of atrophy and strengthening. This modality works at many levels, affecting both the sensory and motor nerves. At the cellular level, electrotherapy causes nerve cell excitation and changes in cell membrane permeability, therefore stimulating protein synthesis, osteosynthesis and fibroblast formation. At the tissue level, electrotherapy causes skeletal muscle and smooth muscle contraction. At the segmental level, it facilitates muscle-pumping action, resulting in improved joint mobility as well as circulatory and lymphatic drainage.

An application of electrical current through the skin, transcutaneous electrical nerve stimulation (TENS) is used primarily to manage pain. TENS works by stimulating faster sensory nerves with an electrical impulse, causing an overload of interneurons, which limits the ability of sensory nerves to transmit pain signals to the brain, creating analgesia for the patient. The effect of this modality is short-lived, however, as it generally does not last for more than an hour. Stimulating the nerve that causes the muscles to contract, neuromuscular electrical stimulation (NMES) is used to rehabilitate muscles. This method is delivered to the patient via leads and flexible, low-resistance electrodes that conform to the skin. NMES can be used to help prevent muscle atrophy, increase local blood circulation, and maintain or increase joint mobility. It is particularly useful in patients with edema, delayed wound healing, or in those unable to perform voluntary movement.

Electrical stimulation has most commonly been used for the modulation of pain through stimulation of cutaneous sensory nerves and the following analgesic mechanisms:

  1. Activation of large diameter A-beta fibers inhibits the pain transmission, carried by A-delta and C afferent fibers, from the spinal cord to the brain – also known as the gate control theory of pain
  2. Stimulation of A-delta and C fibers causes the release of endogenous opioids (endorphin and enkephalin) resulting in prolonged activation of descending analgesic pathways An NMES treatment generally lasts 15 to 20 minutes and achieves best results when used two to three times a week.
    • Wound healing
    • Relief of pain, swelling & stiffness
    • Muscle strengthening and maintenance.
    • Muscle re-education.
    • Reversal of Muscle atrophy
This modality should be avoided (or at least used with caution) in pregnant patients or in those with a malignancy.

  • Active epiphysis
  • Skin disease
  • Impaired circulation
  • Chest, heart
Contraindications for electrotherapy include treatment over areas of electrical current, such as pacemakers, the carotid sinus, the cervical ganglia and the heart.

  • DVT or thrombophlebitis
  • Hemorrhagic conditions
  • Reproductive organs
  • Impaired cognition or communication
  • Acute injury or inflammation (local)
  • Impaired circulation or sensation (local)
  • Damaged or at-risk skin (local)
  • Infection or tuberculosis (local)
  • Malignancy (local)
  • Recently radiated tissue (local)
  • Skin disease (local)

Contraindications, Cautions of Proprioception Exercises

Proprioception Exercises contraindications and cautions

Therapeutic exercise can provide a wide range of benefits for veterinary rehabilitation patients. It can be used to increase range of motion, flexibility, endurance, strength and proprioception. Exercise can help dogs recover more quickly from surgical procedures or injuries, promote functional independence, and keep canine athletes at peak performance levels. Creating and evaluating a therapeutic exercise program requires training and experience. In fact, honing these skills is an integral part of the education of a certified canine rehabilitation professional.

Exercises that develop core muscle strength and proprioception are vital to maintain optimal fitness for all dogs, but especially for canine amputees. The best exercises to do with pets going through rehabilitation are using inflatables of different shapes and sizes, including unstable surface work and weight bearing activities. These fitness games help with core strengthening, increased range of motion and flexibility, sensory and perceptual stimulation, joint alignment, and balance control.

Remember, walking is great for endurance, but it does not build strength.

  • Non weight bearing exercise
  • Relief from pain, swelling and stiffness
  • Promotion of relaxation
  • Joint mobilization
  • Cardiovascular fitness (heart and lungs)
  • Muscle strengthening, maintenance & restoration
  • Increase in range of motion of affected joints
  • Improved circulation

Balance and proprioceptive training can place heavy loads on the kneecap, patellar tendon and knee joint surfaces. Excessive sessions should be avoided to minimize pain at these areas during these exercises .

If the exercises might lead to further instability or injuries

  • Unstable fractures
  • Unstable injuries of tendons or ligaments

Contraindications, Cautions of Cryotherapy &Thermotherapy

cold contraindications and cautions hot therapy

Thermotherapy is generally used to reduce pain from arthritis and muscle spasms, and to prepare tissues for exercise or stretching. Heat can be applied by hot packs, infrared light, hydrotherapy and therapeutic ultrasonography. Thermotherapy can result in vasodilation with secondary increased local circulation, a decrease in pain, relaxed muscle tone, reduced muscle spasm, and an increase in tissue extensibility, cellular metabolism and local tissue oxygenation.

Includes warm whirlpool, warm hydrocollator packs, paraffin baths, and fluidotherapy. Primary physiological effects of heat include

  • Vasodilation and increased blood flow
  • Increased metabolic rate
  • Relaxation of muscle spasm
  • Pain relief via the gate-control mechanism
  • Reduced ischemia
  • Increased elasticity of connective tissue

Cryotherapy applied via ice bath/massage/pack, vapocoolant gel or circulating ice compression units, cryotherapy is commonly used in the acute period after injury or surgery. The benefits include vasoconstriction, reduced cellular metabolism, decreased nerve conduction velocity (leading to analgesia), reduction of edema and decreased muscle spasm. Use caution when applying cold therapy to patients with decreased sensation, cold hypersensitivity, or the potential for reflex vasodilation (the “Hunting Reflex”), a profound vasodilation caused by extended exposure to cold.

Includes ice massage, cold hydrocollator packs, cold whirlpool, cold spray, contrast baths, ice immersion, cold compression, and cryokinetics, Primary physiological effects of cold include

  • Vasoconstriction and decreased blood flow (within first 15 – 20 minutes)
  • Decreased metabolic rate
  • Pain relief with decreased muscle spasm via gate-control mechanism and decreased nerve conduction velocity
  • Active epiphysis
  • Cardiac insufficiency or failure
  • Pregnancy
  • Eyes, anterior neck, carotid sinus
  • Metal (jewelry, metal implants or staples, bullets)
  • Topical irritants
  • Burn
  • Fainting or dizziness (vaso-vagal response)
  • Bleeding (open wounds)
  • DVT or thrombophlebitis
  • Hemorrhagic conditions
  • Reproductive organs
  • Impaired cognition or communication
  • Acute injury or inflammation (local)
  • Impaired circulation or sensation (local)
  • Damaged or at-risk skin (local)
  • Infection or tuberculosis (local)
  • Malignancy (local)
  • Recently radiated tissue (local)
  • Skin disease (local)

Thermotherapy should be used with caution around the uterus in pregnant animals to treat acute inflammations but should be avoided with orthopedic implants, not because of the heat, but because ultrasound waves reflected from the implant can generate tissue damage.

  • Damaged or at-risk skin
  • Cardiac failure
  • Hypertension
  • Impaired sensation
  • Infection
  • Eyes
  • Superficial main branch of a nerve
  • DVT or thrombophlebitis
  • Hemorrhagic conditions
  • Chronic wound
  • Impaired cognition or communication
  • Cold hypersensitivity or urticaria
  • Vasospastic pathology
  • Cryoglobulinemia or hemoglobulinemia
  • Anterior neck, carotid sinus, regenerating nerves
  • Impaired circulation (local)
  • Tuberculosis (local)

REFERENCES

  1. Heinrichs K. Superficial thermal modalities. In: Millis DL, Levine D, Taylor RA, eds. Canine rehabilitation and physical therapy. Philadelphia: Saunders, 2004;277-288.
  2. Hynynen K, Deyoung D. Temperature elevation at muscle-bone interface during scanned, focused ultrasound hyperthermia. Int J Hyperthermia, 1988;3:267-279.
  3. Plews-Ogan M, Owens JE, Goodman M, et al. A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. J Gen Int Med, 2005:20:12;1136-1138.
  4. Amaral AB, Cinesioterapia. In: Mikail S, Pedro CR, eds. Fisioterapia veterinária. São Paulo: Manole, 2006;50-62.
  5. Millis DL, Lewelling A, Hamilton S. Range-of-motion and stretching exercises. In: Millis DL, Levine D, Taylor RA, eds. Canine rehabilitation and physical therapy . Philadelphia: Saunders, 2004;228-243.
  6. Mikail S. Eletroterapia. In: Mikail S, Pedro CR, eds. Fisioterapia veterinária. São Paulo: Manole, 2006;96-102.
  7. Johnson J, Levine D. Electrical stimulation. In: Millis DL, Levine D, Taylor RA, eds. Canine rehabilitation and physical therapy. Philadelphia: Saunders, 2004;289-301.
  8. Mikail, S. Laser Terapêutico. In: Mikail S, Pedro CR, eds. Fisioterapia veterinária. São Paulo: Manole,2006;81-90.
  9. Tuner J, Hode L. The laser therapy handbook. Grängesberg, Prima Books, 2004;589.
  10. Monk M. Hydrotherapy In: McGowan CM, Goff L, Stubbs N, eds. Animal physiotherapy assessment, treatment and rehabilitation of animals . 1st Ed. Oxford, Blackwell, 2007;187-197.
  11. Levine D, Tragauler V, Millis DL. Percentage of normal weight bearing during partial immersion at various depths in dogs. In: Proceedings 2nd International symposium on rehabilitation and physical therapy in veterinary medicine. Knoxville, Tenn, 2002;189-190.
  12. Shoen AM. Acupuntura veterinária: da arte antiga a medicina moderna. 2nd ed. São Paulo: Roca, 2006;190-195,707.
  13. Maciocia G. Os fundamentos da medicina Chinesa: Um texto abrangente para acupunturistas e fitoterapeutas. São Paulo: Roca,1996;658.
  14. Xie H, Preast V. Xie’s veterinary acupuncture. Oxford: Blackwell, 2007;376.