| Virtually all major orthopedic cases can benefit from some form of postoperative rehabilitation (therapy). The goal of physical therapy is to enhance return of function to the injured part. Gone are the days where the patient is dismissed to the owners own devices following suture removal. Follow up visits to determine post-operative progress significantly impact how well the patient recovers.
Physical therapy begins in an effort to reduce postoperative inflammation, preserve normal joint dynamics and muscle mass and progresses to more vigorous muscle training and strengthening, reclaims proprioception and return of athletic ability.
All surgical wounds create inflammation and it is a necessary prerequisite to normal tissue repair. Initial physical therapy efforts are directed to reduce excessive inlfammation through the use of regional tissue cooling, ultrasound therapy and NSAID's. Early passive manipulation helps reduce pain and preserve range of motion.
As inflammation resolves, capillaries, fibroblasts, nerve, muscle, cells and bone cells begin their growth and repair. Here the role of physical therapy is to preserve muscle mass, preserve rage of motion of affected joints and gradually challenge the healing tissues.
It may require months or even years of therapy to rehabilitate a leg that has severe muscle wasting, "frozen" joints and reduced weight bearing and proprioreceptive ability.
Electrical Stimulation
Elecrical stimulation is used for several different reasons; to enhance muscle reeducation, to promote healing and to reduce pain and swelling.
Ultrasound
Ultrasound itself will increase fibroblastic activity, hasten wound healing, increase acoustic streaming and hence promote healing in and around the area and will enhance cell metabolism.
Massage
Historically massage has been discussed as early as 1000 B.C. in Chinese literature. Recent studies indicate that massage will enhance spinal motor neuron excitability. No one can question the psychological or physiological effects of massage. Massage can also remove exudate from an area, increase circulation and stretch collagen matrix.
Excercise
Progression through an exercise program is dependent upon what we want our animal to do. We want to return them to function, whether they are doing bird work, coursing, or racing, functional exercises must be based upon what activity the animal has to perform.
Passive Range of Motion
Passive range of motion (PROM) is similar to manipulation in that it is moving a joint through and beyond its normal range of motion. Some of the important aspects of passive range of motion is that a muscle needs to be relaxed, and movement must be performed slowly. Moving through the normal range of motion prevents contraction's from forming. By performing PROM, an animal's owner can get involved with their animal's home care as well. Ideally, range of motion should be initiated the day of surgery and continued for two to three weeks. Our goal certainly is to maintain or increase range of motion.
Certainly, contraindications for PROM would be around unstable fracture sites, luxations, or hypermobile joints. Caution should be exercised when working around unstable facture sites, or areas around bone tumors, or in recent skin grafts.
Active Range of Motion
To perform and active range of motion (AROM) basically, the muscle moves the jont through its range of motion. once way to enhance active range of motion is to utilize hydrotherapy. In any animal that may have neurological conditions, hydrotherapy also will help prevent urine scalding and to decrease the chance of ulcers associated with paralysis. Animal hydotherapy pools are specially designed to create a current or resistance against which the animal may swim. This may improve circulation and improve their return to full activity.
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