Elmo, an obese sealpoint Siamese cat, had severe hip arthritis. His pain was so severe that he was unable or unwilling to use his litterbox. Elmo’s dedicated owners brought him for rehab to Marti Drum, DVM, DACVSMR, at the University of Tennessee.
Cats have a reputation for being hard to handle, but Elmo was laidback and loving. Those characteristics helped him successfully complete a weight loss program to help relieve the pain in his hips.
“He was incredibly tolerant of the underwater treadmill,” Dr. Drum said. “With a little weight loss, he began resuming normal litterbox habits and eventually began jumping small heights again.”
Rehab techniques—the term physical therapy is protected and used only by physical therapists for human patients—help canine and feline patients improve or return to normal function, whether they are suffering from health effects related to obesity or orthopedic, neurological, and chronic diseases or recovering from injuries or surgery. Canine athletes, senior animals, service animals, and pets with chronic debilitating conditions can all benefit from the many modalities used in rehab practices. Adding rehab to a practice has multiple advantages.
“When conventional medicine and surgery fall short, a rehab practice can offer additional tools to promote pain control, mobility, and rapid healing for the patients,” said Marta Sanchez-Emden, DVM, founder of Animal Health and Rehabilitation Center in Miami. “This translates to less euthanasia and maximizes the results of neurological and orthopedic surgeries and improves the quality of life of our geriatric patients.”
Animals who can benefit include those with joint injuries, traumatic orthopedic injuries such as pelvic fractures, deranged stifles, degenerative joint disease, neurologic conditions such as vascular or compressive injuries to the spinal cord, limb amputations, or deformities that cause problems with limb usage. It’s not unusual for pet owners who have experienced the benefits of physical therapy in their own lives to seek it out for their pets.
In any case, evaluating pain in a dog or cat is one of the most challenging aspects of veterinary medicine, but pain assessment is the first step in preparing a plan for rehabilitation. Making it more difficult, anxiety, fear, pain, hunger, side effects of medication, and more can affect a pet’s behaviors and responses.
In her 2018 VMX lecture Purrfect Rehab: Mobility and Pain Management Techniques for Cats, Carolina Medina, DVM, DACVSMR, said a thorough history of behavior changes is the most accurate way to evaluate pain in animals. Look at maintenance of normal behaviors, loss of normal behaviors, and development of new behaviors that may indicate adaptation to pain or response to pain relief.
Pain scales to use include the UNESP-Botucatu Multidimensional Composite Pain Scale, and the University of Glasgow facial expression tool for assessing acute pain in cats. Colorado State University has canine and feline acute pain scales, as do the American Animal Hospital Association and the American Association of Feline Practitioners.
The next step is to evaluate range of motion in the affected area and the animal’s overall fitness level and muscle mass. Gait analysis should also be part of the exam.
The goal is to rebuild muscle and improve range of motion, said Joseph J. Wakshlag, DVM, DACVSMR, at the Sports Medicine and Rehabilitation Service at Cornell University Hospital for Animals in Ithaca, N.Y.
Animal rehab frequently calls for a multimodal approach, incorporating medical treatment, weight loss, exercise, environmental changes, and rehab therapies. Some patients may respond better to one modality than to another. Each modality can have specific benefits as described in the boxed story, Rehab Modalities.
For instance, laser therapy helps reduce inflammation in easily accessible areas such as the elbow, stifle, or lower back. Because it warms tissues and improves circulation and neuronal function, it can benefit small dogs with spinal cord injuries.
“Laser therapy decreases pain, releases beta endorphins and serotonin, decreases bradykinins, blocks depolarization of C fibers, decreases inflammation, decreases prostaglandin synthesis, reduces interleukin-l, and promotes angiogenesis,” Dr. Medina said in her lecture.
Neuromuscular electrical stimulation, which causes muscles to contract so they don’t atrophy, also provides relief for chronic pain in geriatric animals or animals with chronic arthritis pain.
For a serval with a spinal fracture from jumping off a second-story balcony, underwater treadmill therapy was central to her recovery.
“Because of the spinal fracture, she was initially unable to walk, and then only in a very ataxic manner,” Dr. Drum said. “Once she began therapy, her ataxia quickly improved and her mobility returned to normal after two sessions. Keeping her quiet quickly became the primary focus as her fracture continued to heal.”
Opportunities, considerations, and costs
Cats might seem like the ultimate unwilling rehab participant, but both Drum and Medina say they can be good patients for veterinarians and staff who understand their unique personalities and needs. More important, many older cats go untreated for a common painful condition and could benefit from rehab therapy.
“It is estimated that up to 90 percent of geriatric cats suffer from arthritis in one or more joints,” Dr. Drum said. “Approximately half of my practice is treating arthritis, but rarely do we treat cats because signs of arthritis often go unrecognized in cats. I would love to have the opportunity for more cats to receive the benefits of rehabilitation for arthritis.”
Unlike many areas of veterinary medicine, owner participation is an important part of the rehabilitation process. Be prepared to teach clients how to perform cryotherapy and thermotherapy, stretches, and therapeutic and range-of-motion exercises at home.
Equipment such as underwater treadmills, laser units, and shockwave therapy units can be expensive, Dr. Emden-Sanchez said. Rehab therapy is more than using a laser machine or performing massage, she added.
“Successful animal rehabilitation involves knowing what and what not to do and when, and knowing how to convince the patient to perform the behavior you want and to have specific and realistic goals for each patient. There is a huge learning curve that can only be acquired through experience.”
Common rehab modalities used in practices are manual therapies such as joint mobilizations, passive range-of-motion exercises and massage; therapeutic exercises to improve flexibility, strength, and proprioception; thermal therapy; cold laser; electrical stimulation; therapeutic ultrasound; treadmills and underwater treadmills; and extracorporeal shockwave therapy. Most require some level of training before use. Following are descriptions of various types of therapies and some potential benefits.
Acupuncture: The use of needles, heat, pressure, or laser light at certain points on the body to stimulate the nervous system. Some studies have demonstrated the effectiveness of acupuncture for analgesia in both surgical recovery and for chronic pain.
Cryotherapy: Application of cold to decrease pain and inflammation by reducing blood flow to the area. Used immediately after injury or surgery for up to one week, it can be effective in limiting swelling and decreasing pain. Surgeries for which it may be indicated include femoral head and neck ostectomy and tibial plateau leveling osteotomy.
Electrical stimulation, or e-stim: Application of electrical currents to relieve chronic pain, postoperatively aid in nerve regeneration after back surgery, reduce edema, and prevent muscle atrophy from disuse.
Extracorporeal shockwave therapy: Delivery of focused, high-energy pressure waves to a specific point in the body, causing cells to release anti-inflammatory cytokines, increasing blood flow to the area, and releasing serotonin to help reduce pain. May benefit animals with arthritis, tendinopathies, and chronic nonhealing wounds or fractures.
Hydrotherapy: Walking on an underwater treadmill or swimming both provide nonweight-bearing exercise and allow patients to move more easily than while on the ground, while water resistance increases muscle strength. Assists in improving range of motion, strength, and endurance.
Low-level laser therapy: Alteration or stimulation of cellular function through light energy. Decreases swelling, increases circulation, or blocks a nerve’s ability to send a pain signal to the brain. Useful for nerve pain or damage, muscle strains, osteoarthritis, and faster wound healing.
Massage: Focused strokes for soft tissue manipulation to relieve pain, increase circulation, promote relaxation, and ease contracted muscles.
Platelet-rich plasma: Injection or intravenous delivery of a concentration of platelets and growth factors produced from an animal’s own blood. Promotes healing of damaged tissue, cartilage, or bone for conditions such as muscle or ligament tears, osteoarthritis, or hip or elbow dysplasia.
Stem cell therapy: Injection or intravenous delivery of stem cells harvested from a pet’s fat tissue. Promotes healing and reduces pain and inflammation for orthopedic or soft-tissue injuries, degenerative joint disease, and postsurgical recovery.
Therapeutic exercises: Use of cavaletti poles, steps, wobbler boards or other equipment to improve proprioception, mobility, gait, coordination, and strength.
Therapeutic ultrasound: Application of high-frequency sound waves to improve healing of soft-tissue injuries through increased blood flow and reduced swelling, increase muscle flexibility, improve range of motion around a joint, and soften and break down scar tissue that is hindering mobility.
Thermotherapy: Application of heat to increase vasodilation and muscle flexibility.
Treadmill: Helps animals regain cardiopulmonary fitness or improve muscle strength.