Physical Therapy Treatments Part II-Exercise
Once pain is managed, exercise is key to maintaining or improving range of motion, strength, and stability. Exercise generally starts with more simple movements, lower repetitions, and builds to more difficult exercises and greater repetitions. As the muscles and joints heal, the exercise is progressed to build muscle and endurance. There are three types of muscle contraction: isometric, concentric, and eccentric.
Isometric exercises are the simplest form of exercise. The targeted muscle contracts, but does not shorten or lengthen. Think of just tensing a muscle without any active movement. This is a great place to begin exercise because it is safe, well tolerated, and forms the foundation for advancing exercise. An example in a dog is a three legged stand. If I want to work on the dogs right hind limb, lift the left hind limb so that he has to actively contract the muscles in the right hind leg to maintain standing. Holding this position for 20 seconds helps build the muscle and the stamina.
Concentric exercises take the level of difficulty up a notch. In this type of exercise, the muscle contracts and shortens as it moves through a range of motion. An example of this is a biceps curl. The biceps shortens and contracts as your hand moves toward your shoulder.
Eccentric exercise is the most challenging type of muscle contraction. With eccentric exercise, the targeted muscle lengthens as it contracts and moves through a range of motion. It is challenging because it works on controlling the movement. An excellent example of this is a squat. When you perform a squat you are controlling the quadriceps muscle with that slow lowering and holding the squat position. The quads are lengthening as you move through that motion, not to mention burning!
So based on these descriptions, you can see that taking a dog who just had an injury or surgery through eccentric exercise is way too much work too soon, especially when you consider the dog may have muscle atrophy from disuse prior to surgery, as well as the pain and inflammation associated with surgery or an acute injury.
Other considerations for developing or progressing an exercise program:
Stage of healing: Is the injury acute, subacute, or chronic?
Range of motion limitations: Is it muscular shortening or a tight joint capsule?
Strength: What strength grade is dog starting at?
Age of the dog and baseline functional status: What was their routine day prior to injury and how long has it been since they were at that baseline? Where are they now?
What are the client’s goals for the animal? What do they need to do?
A thorough evaluation of the animal is needed to determine all these factors and that begins with a comprehensive medical history review. Some of the issues found on evaluation may be due to the acute or subacute injury they were referred for, but there may be chronic issues from a past issue or from compensation from the current issue if it has been longstanding. Home exercise programs may seem routine, but a lot of thought goes into developing a plan that is appropriate for your pet, manageable by the owner, and achieves the goals established on the initial evaluation. It is important to note that the initial home exercise program is not the final program. In order to progress the patient, the exercise has to be adapted to build muscle. Many clients think “Okay, I have the exercises, I can continue from here” but that is erroneous thinking. The baseline home exercises are not enough to get your pet where he needs to be, it is only the starting point. The exercises should be adapted based on how the dog progresses, sometimes that is weekly, especially in the beginning when the exercises are simpler, but sometimes it takes a few weeks for the dog to master the exercise plan before they are able to move on. This is why frequent rechecks by your rehab provider are a very important part of the process.
A key aspect of this ability to progress is the follow through of the owner. Sticking to the plan and carrying it out regularly is vital to success. Think about it-if you only go to the gym once a week, how successful will you be at gaining strength? Not very! However, if you do a little bit every day, that leads to success in the goals you are trying to achieve. I am not with your dog every day-you are. I am just there to guide you through the steps needed to reach your goals. It takes a least 2 months to build strength and to see a measurable difference, so it is a process, but through patience and diligence you and your dog will reap the rewards of your work!
Next week: Why Physical Therapists Are Best Suited To Be Your Canine Rehab Provider