Methods

When we design an exercise program, several aspects must be taken into account. First, identify the patient's problems, then we propose a treatment plan aimed at the identified problems and finally, realistic objectives are established.

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Appropriate exercises are those that can be performed effectively and safely to achieve therapeutic objectives. When exercise is prescribed, the therapist must know the diagnosis, identify the structure or structures involved and know the degree of tissue recovery and its consequent functional limitations. The exercise plan should target both the affected muscles and other structures. Knowing and understanding all this, you can now make the appropriate decisions regarding the choice of exercises.

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The characteristics of the treatment and the choice of exercises vary depending on the stage of evolution of the tissues and resistance. As the animal improves and the tissues recover, the exercise plan must be readjusted to the patient's new conditions and adapted to the change in the tissues involved. The intensity of an exercise can be increased or decreased by modifying the duration of the exercise, the frequency with which the exercise is performed, and the speed at which that exercise is performed. For example, a real initial objective to combat morbid obesity in an untrained dog with degenerative joint wear would be to increase the time the dog can walk comfortably, thus improving resistance and achieving weight reduction. Increasing the speed at which the dog walks would not be a realistic or appropriate goal for this dog. A contrary example would be an athletic animal trying to recover from an injury and is challenged to improve speed and frequency to achieve the goal of performing an activity again. It is important for a therapist to have the knowledge and know how to adapt the intensity of an exercise to the patient's needs. Continuous readaptation of treatment is the best way to optimize results, ensuring that at all times we are doing the best possible and adapting to the patient's recovery rate.

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Exercise routines should be followed regularly by someone who is familiar with the patient and the exercise techniques. Inappropriate exercise or incorrect technique can be counterproductive, causing relapse or further damage. Another possibility is that although the exercise is adequate, the intensity, speed, frequency,... are not adequate, which will prevent us from achieving our goal.

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Therefore, the main aspects that must be taken into account are the following:

• Know the patient's diagnosis and understand it. Know the limitations that the injury causes in the patient and take them into account.

• Establish ambitious but realistic objectives adapted to the patient.

• Establish an exercise regimen for that patient with the intention of achieving the previously stated objectives.

• Continuously readapt to the patient. The patient's evolution will dictate the pace of treatment.

2.- Exercises in assisted stay

Patients with severe damage or weakness may not be able to stand or support their own weight. A standing phase, whether partially or fully assisted, will strengthen the patient, help train proprioception, improve circulation and breathing, and raise the patient's self-esteem and well-being. The goals of assisted standing exercises are to strengthen neuromuscular function, reeducate muscles, develop muscle strength and endurance, and improve proprioception.

3.- Proprioceptive Training

When an animal is able to stay safely unassisted, it is time to begin activities to improve balance. Dynamic balance is the animal's ability to maintain balance when its body is moving, such as when walking. The exercises will be performed to stimulate the animal's dynamic balance and must be carried out on a non-slip surface to provide them with sufficient traction and reduce the risk of falling.

4.- Dynamic walking activities 

If a dog is unable to walk independently, some device must be used to help it. Gait training must begin with the use of a sling, towel, harness or "dog cart." It is important to encourage the dog to move slowly, giving him time to move his paws as independently as possible as well as giving him adequate time to bring each foot into contact with the ground during the stay phase of each step. It may be necessary to manually assist the dog in sequencing and placing their paws as they relearn to walk. If the animal moves too quickly, they usually avoid putting their weight on the painful leg, adopting an abnormal gait, such as "3-legged lameness", jumping or dragging one leg. The main objective should be to support each and every one of the legs, encouraging a slow walk. It is important that each person who walks the dog does so by restraining him and not allowing him to move too quickly.

5.- Independent March

Walking slowly on a leash is perhaps the most important exercise at the beginning of the rehabilitation period, and the most normal thing is to do it incorrectly. Making the animal walk slowly encourages it to use all its legs following the sequential walking pattern. The walking speed should be slow enough to allow you to support your weight; If the dog walks too fast, the tendency is to keep the affected leg flexed without putting weight on it. Slow walks on a leash are indicated for when the animal is reluctant to use its paw as a result of pain, weakness or proprioceptive deficits. It stimulates the placement of all four legs on the ground, increasing the stay phase and weight support.

6.- The progression of the exercises

Many variables must be taken into account when designing a therapeutic exercise program, such as the type and severity of the injury, the stability of the surgical intervention, the number of legs or joints involved, the size of the animal, the pre-existing physical condition , the facilities available, the expertise and experience of the therapist or whether the exercises are to be performed by the therapist, the owner or a combination of both.

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The objective of each therapeutic exercise program must be to restore the animal in the most complete and active way possible. The goal should be periodically readjusted if the patient progresses to a greater or lesser extent than expected. The initial objective will be for the dog to support its weight in the room. The next step will be assisted ambulation, which must be worked on together with proprioception. Active ambulation without assistance is continued while maintaining balance. When the animal is close to achieving its capabilities as a pet, the strategies will be aimed at achieving better weight support and muscle gain.

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It is important to perform the exercises correctly and maintain a constant level of activity daily or every other day. An exaggerated amount of exercise on the weekend with relatively little activity during the week can be detrimental to the animal's recovery; Regular, daily activity will prevent the "weekend warrior" syndrome.

A decrease in the rate of progress may occur during the chronic phase of recovery, but it is important to continue to achieve the fullest ability to return to activity as possible.

 

7.- Massage
Massage is an element of physiotherapy that has gradually gained widespread acceptance as a veterinary therapeutic modality. Among its extensive benefits we find the following:

• Break the vicious cycle of muscle pain and tension.

• Increases blood flow.

• Improves oxygen supply and elimination of residual metabolic products

• Stimulates the release of endogenous endorphins, relieving the sensation of pain.

• Accelerates muscle recovery.

• Increases venous and lymphatic return.

• Mobilizes adhesions.

• Improves skin perception.

• Promotes mental and physical relaxation.

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There are many different massage techniques and all of them are proven effective. Your choice is in the hands of the therapist. The important thing is to achieve good results.

8.- Electrical Therapy

Electrical stimulation is a very useful physical therapy and rehabilitation modality for the treatment of different orthopedic and neurological disorders, especially those that cause acute and chronic pain or muscle atrophy.

Its effects vary depending on the frequency selected for the electrical impulse, but among them the following stand out:

• Analgesic effect (due to a quadruple effect):

  • Activation of the gate control system.

  • Reduced tone in tense muscles.

  • Stimulation of blood flow.

  • Stimulation of the release of endogenous endorphins.

• Increases muscle tone.

• Muscle strengthening.

• Accelerates tissue healing in patients with fractures by inducing osteogenesis.

 

Although some electrical stimulation units are suitable for use at home, the fact that both the placement of the electrodes and the selection of the appropriate intensity are decisive not only to achieve the intended objective but also to avoid further damage, is They must faithfully follow the therapist's instructions

9.- Thermotherapy
The therapeutic use of physical agents or means to heat or cool a body is known as thermotherapy.

With both cold and heat we achieve very helpful effects within the rehabilitation process.

Surface heat provides us with the following effects:

• Increased blood flow.

• Increase in the speed of impulse conduction.

• Muscle relaxation.

• Pain relief.

• Increase in the extensibility of fibrous tissues.

And through cryotherapy (applying selective cold) the following:

• Vasoconstriction.

• Reduction of cellular metabolism.

• Hunting response (physiological response to cold stress).

• Pain relief.

• Reduction of muscle spasms.

 

For both cases, the type and severity of the underlying disease and the desired therapeutic effect will determine the frequency of treatment.