Patient-Related Instruction
Dr. Pollard-Wright creates a customized therapeutic rehabilitation program for the patient. Between therapeutic rehab sessions with Dr. Pollard-Wright and to maximize beneficial therapeutic outcomes, customized programs often include activities and exercises for the veterinary patient to be administered by the owner. These activities and therapeutic exercises will be demonstrated to you by Dr. Pollard during the rehabilitation session, and she will answer questions you may have before they are emailed or texted to you (whichever you prefer) in video format.
Infrared Thermography (IRT)
Evaluations performed by Dr. Pollard-Wright often include IRT, a remote and noninvasive method to assess a body’s surface temperature through the electromagnetic radiation emitted. This process produces immediate information using a highly sensitive infrared camera. The device measures, compiles, and analyzes the electromagnetic energy emitted from the patient in a way that can be easily visualized. Thermal emissions temperature data directly correlates to changes in anatomic areas related to the circulatory, nervous and musculoskeletal systems.
Laser Therapy (LT) (also Photobiomodulation, PBM)
Laser is an acronym for light amplification by stimulated emission of radiation. Light is an oscillating electric and magnetic field. The major difference between laser light and regular ambient light is the type of wavelength that is formed. Laser lights are monochromatic, polarized, and coherent and thus travels through tissue in an orderly fashion. LT is a non-destructive light-based modality that helps to modulate cellular functions and various biologic processes which may include the acceleration of wound and joint healing and the promotion of muscle regeneration. In veterinary rehabilitation, LT treats pain and acute and chronic conditions such as skin wounds, muscle, tendon, and ligament injuries, arthritis, and neurologic disorders.
Electrotherapy or Electrical Muscle Stimulation (ESTIM)
This therapy is used to depolarize sensory and motor nerves. There are only two things that can happen when a nerve is depolarized regardless of the parameter or current used: the patient feels something (a mild electrical pulse) if a sensory nerve was depolarized, and depolarization of a motor nerve causes a muscle contraction. Neuromuscular electrical stimulation (NMES) is where a motor nerve is depolarized, resulting in a muscle contraction. NMES is used for strengthening and enhancing muscle performance, muscle reeducation, and conditioning. In contrast, transcutaneous electrical nerve stimulation (TENS) reduces edema, improves healing, and controls pain.
Pulsed Electromagnetic Field (PEMF) Therapy
This therapy delivers electric and magnetic fields to tissues via inductive coils using a device. Clinical evidence supports the use of PEMF therapy in both animals and humans. Electromagnetic fields generated by the therapeutic device have been found to affect a variety of biological processes. It is a safe, noninvasive treatment modality used for anxiety, bone healing, wound healing, osteoarthritis, inflammation, pain, and edema.
Acupuncture: Dry Needle (DN), Aqua-acupuncture (Aqua-AP), Electro-acupuncture (EA), and Myofascial Trigger Point Treatment
Acupuncture: Dry Needle (DN), Aqua-acupuncture (Aqua-AP), and Electro-acupuncture (EA) are part of multi-modal pain management with neuro-biomodulation effects. They can also prevent anticipated pain, such as post-surgical pain and have been used successfully to treat patients previously unresponsive to treatment with corticosteroids or nonsteroidal anti-inflammatory drugs.
In contrast, trigger points are sensitive areas in the body that occur most frequently in the fascia or muscle and can be a source of pain that results in lameness. In muscle, a trigger point can be localized in a taut band of muscle fibers and feels like a hard, nodular structure. Myofascial trigger point treatment consists of local trigger point stimulation through dry needle insertion, a local anesthetic, transcutaneous electrical stimulation, laser therapy, or myofascial stripping.
Extracorporeal Shockwave Therapy
Extracorporeal shockwave treatment (ESWT) consists of acoustic sound waves of high pressure. This treatment is a way to deliver physical energy to tissue and cells to cause a biological effect. ESWT treats osteoarthritis (OA), lumbosacral disease, shoulder injuries and instability, wound/lick granulomas and improves bone healing post-surgery (e.g., TPLO). As shown through research, the benefits of ESTW include pain relief and physical function improvement for up to 12 months. The general recommendations are 1-3 treatments delivered 2-3 weeks apart. Post-treatment, the patient may experience increased discomfort, which should resolve within 1-2 days. Shaving the treatment area may be necessary for medium-coat dogs to optimize the result.
Kinesiology Taping
This therapy uses self-adhering tape to facilitate better movement, reduce perceived pain, and improve lymphatic drainage and microcirculation. It causes tissue decompression with two primary effects on the body. Tissue decompression relieves pressure on the free nerve endings in the tissues responsible for nociception (i.e., detection of painful stimuli), reducing pain perception. Through the lifting action of the tape, there is decompressive action, resulting in better circulation to and from the taped area. The goal of kinesiology taping related to veterinary physical rehabilitation is to promote proper movement.
Therapeutic Ultrasound & Heating
This therapy uses sound waves above the range of human hearing as short bursts or continuous waves. This is ultrasound without images and thus differs from diagnostic ultrasound. Veterinary physical rehabilitation aims to re-establish normal joint function; therapeutic ultrasound can help with that goal. This modality is considered an effective treatment for rehabilitating musculoskeletal conditions such as restricted range of motion (ROM) due to joint contracture, pain, muscle spasms, and wound healing. Heating tissue superficially with hot packs or using therapeutic ultrasound to heat deeper tissues may decrease pain, and there are many theories as to why this occurs. The application of heat may reduce pain by increasing blood flow, which may interrupt a chronic muscle spasm cycle. With increased blood flow, nutrients and oxygen in the area may be increased. Additionally, heat application may improve range of motion (ROM) and have counter-irritant effects (i.e., heat is felt via sensory nerve endings, and in this process, pain is diminished).
Cryotherapy
This therapy uses cooling to slow the metabolic rate, slow enzymatic reactions related to the inflammatory process, decrease nerve conduction velocity all of which may help decrease pain. It has been found through research to be more effective than bandaging alone to decrease swelling, minimize pain, and decrease processes related to inflammation that include minimizing tissue damage. Modes of cooling include conduction (direct contact), convection (using a gas or fluid medium), and evaporation (using a vapor coolant or alcohol that causes evaporation resulting in cooling). The main mode used in veterinary physical rehabilitation is conduction using a cold compression device, ice packs or cold packs.
Massage Therapy
This is manual therapy and may be considered in the category of soft tissue mobilization. It includes techniques used to stretch soft tissues such as muscle, tendons, and facia, where the hands and body are used to massage the veterinary patient’s soft tissues; this can also help with diagnosis. The physiologic effects of massage include local vasodilation, increased nutrient supply to an area, improved healing response, and improved lymphatic return with decreased edema, which can be important post-surgically. Regarding the nervous system, massage provides sensory input, which can be beneficial to a neurologic patient and promote healing of the nervous system. Massage encourages circulatory movement and the relaxation of muscles, which may result in increased flexibility and an accelerated healing rate. Massage can decrease muscle spasms and tension. Depending on the technique, the goals of massage therapy vary and may include increasing range of motion, decreasing pain, or breaking up scar tissue. Some different massage techniques include effleurage, petrissage, friction (which could be cross friction or transverse friction) massage, myofascial release, and acupressure.
Proprioceptive & Balance Exercises
Veterinary Kinetics Rehab develops a program to improve proprioception and balance to support the neurologic system or the joint. Proprioceptive exercise is essential for the neurologic system or the joint to minimize arthritis due to improper gait. When used for post-surgical care these exercises begin when the veterinary patient can stand either by themselves or with assistance. For example, these exercises may start on day two after joint surgery with some simple weight shifting. When the patient shows improved motor function and proprioceptive ability, these exercises are varied to achieve balance control, muscle strengthening, and contraction.
Range-of-Motion (ROM) Exercises and Stretching
ROM exercises are among the most basic therapeutic exercises performed in almost every post-operative or post-injury case. These exercises improve joint motion and are applied slowly and often combined with stretching to improve the flexibility of joints and the ability of tissues, muscles, and tendons to stretch. This is achieved by putting a little biomechanical stress on the lines of stress and very gently trying to encourage tissue healing and remodeling rather than ripping and tearing tissues. Stretching is different from ROM because when stretching, muscles and connective tissue need to be positioned into an end range and held for a minimum of 15 seconds. Importantly, experimentally, there’s no advantage to holding a stretch for more than 30 seconds. So usually, 15 seconds of a stretch is adequate. Dr. Pollard-Wright does not use stretching every day in a chronic situation because a bit of time is needed for remodeling and adaptation, including stimulating growth factors.
Therapeutic Exercise (also TherEx) & Exercise for Speed and Strengthening
Therapeutic exercises are used to correct or improve a problem and are a very important part of therapy. They make up about 70% of a good veterinary rehabilitation program. In contrast, speed and strengthening is the final phase of rehabilitation. Some of the goals of TherEx include improving active, pain-free range of motion, improving limb use and reducing lameness, working on muscle mass and muscle strength, and improving daily function and daily living activities. Therapeutic exercises are noninvasive and can strengthen all parts of the body in ways that might prevent injury. Research has shown that therapeutic exercise can improve the recovery rate for injury and biomechanics post-surgically by improving the quality of movement. Enhanced performance and endurance, including for overweight animals, is another benefit of therapeutic exercises. Therapeutic exercise can also provide positive psychological benefits for the owner and the pet. Veterinary Kinetics Rehab uses multiple therapeutic exercises to vary the routine and address the same joint or body part. For example, a treadmill is a versatile and valuable piece of rehabilitation equipment. Most dogs that can walk on a leash only need one or two sessions to learn how to walk on a treadmill. The treadmill is used postoperatively for conditioning and to encourage initial weight-bearing. Treadmill work is also helpful in strengthening and gait patterning after an injury or in chronic disease. In addition, it can be helpful with weight management and behavioral issues such as leash aggression.
Conditioning Programs
There are two general categories of conditioning programs: strength-power programs and endurance programs. The metabolic changes that occur during a conditioning program depend on the principles of intensity, duration, frequency, and method of training. Central and peripheral physiological changes occur because of conditioning. Central changes include alteration to the cardiovascular, pulmonary, and endocrine systems. Peripheral changes occur in the musculoskeletal system. Veterinary Kinetics Rehab programs include exercise for the spinal muscles because it has been theorized that the spinal muscles are the first to fatigue during sprinting.