Canis ISSN: 2398-2942

Physical rehabilitation (after traumatic injury)

Contributor(s): Courtney J Arnoldy, Jacqueline Davidson, Helen Fentem-Jones

Rehabilitation principles/healing time frames

  • A thorough examination and evaluation is essential to determine the most appropriate therapeutic plan of care.
  • Collaboration between the veterinary and physical therapy professions is an essential team approach to ensure safe and effective rehabilitation.
  • The rehabilitation team must have a working knowledge of anticipated outcomes based on the injury and surgical procedure (as applicable). A complete and in depth understanding of tissue healing and repair is necessary. The following patient-specific factors are essential when establishing your plan of care:
    • Patient's signalment (age, breed, sex). 
    • Personality of the patient. 
    • Patient use, eg companion, agility dog. 
    • Pre-existing medical conditions and disabilities. 
    • Body condition. 
    • Specific description of injury. 
    • Tissues involved (location and severity of tissue damage). 
    • Surgical procedure - and when carried out. 
    • Owner compliance. 
  • Healing time frames can be divided into three phases:
    • The inflammatory phase of tissue healing (phase 1). The inflammatory phase predominates until about day 5. It is characterized by inflammation and pain.
    • The repair phase (phase 2) starts around day 3-5 and predominates until 17-20 days after injury. Inflammation and pain are decreasing, while collagen and capillaries are formed in the wound. Pain may be noted at the end of available active and passive ROM (range of motion). Soft tissue contractures and muscle weakness may develop during this time, and at any point during the healing process without the application of appropriate therapeutic strategies.
    • The maturation or remodeling phase (phase 3). This phase begins around 3 weeks and continues for months or years. Alignment of collagen occurs and the scar contracts and remodels. There are no clinical signs of inflammation but there may be pain apparent after tissue resistance is encountered at the limits of active or passive ROM.
  • The inflammatory phase (phase 1) of wound healing is the protection phase, as well as the destructive phase, physical rehabilitation treatment should be aimed at supporting the tissues as well as expediting the next phase of tissue healing. The primary problems include inflammation, pain, edema, and muscle spasms. The goals are to reduce inflammation and edema, promote early healing, and prevent the secondary complications associated with enforced rest, by the use of techniques including PROM and massage Physiotherapy: massage Physiotherapy
  • The repair phase (phase 2) of wound healing corresponds with the controlled-motion phase of rehabilitation. Goals are to promote healing and develop mobile strong scar tissue. Joint mobility may be progressively restored with passive and controlled active ROM. Muscle strengthening and endurance exercises may begin, with careful progression in frequency, intensity and time (the F.I.T. principle of exercise prescription). 
  • In phase 3, maturation or remodeling begins as inflammation is resolving. This phase focuses on strengthening of new tissues and continues approximately 3-4 weeks post-operative until full recovery. Goals in this phase of therapy include re-establishing range of motion (active and passive) of the effected joints and associated soft tissues, mobilizing scar tissue, improving strength and proprioception and addressing dysfunctional movement patterns. The maturation and remodeling phase is the return-to-function phase for rehabilitation intervention. Methods used may include progressive stretching, strengthening, endurance training, and functional exercises. Choice of methods used are based upon the findings during the assessment and reassessment process at the start of each session. 
  • During each phase, appropriate inputs are applied to the healing tissue. It is important to direct the healing tissues as to in which direction, and under what forces they need to be strong, although not to a point of failure. In phase two, strengthening and proprioceptive exercises can be initiated with a goal of re-establishing function. Wolff's law can be summarized as: tissues respond to the physical demands placed upon them, as well as the ‘use it or loose it’ principle. Understanding this principle is important when determining the progression of your rehabilitation plan. It is important to understand what stress the new tissue is likely to be subjected to, and so use your rehabilitation program to progressively strengthen the tissues appropriately, as well as, maintain tissues not being fully utilized during the restricted phase of recovery, eg muscle strength and soft tissue length.
  • During the rehabilitative process, it is important to understand all phases of healing as the phases are not really distinct. The therapist should be cognizant of which phase is likely to be predominating and understand and monitor for the potential complications during that phase of healing. A comprehensive assessment directed rehabilitation program is essential throughout the healing process. Understanding of the purpose and clinical reasoning, as well as the contraindications is crucial prior to implementing any exercise, technique or modality.
    Print off the owner factsheet on Physical therapy and rehabilitation Physical therapy and rehabilitation to give to your client.

Post-operative phases of healing and therapeutic interventions

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Therapeutic activities and modalities

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Reassessment

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Summary

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Davidson J R, Kerwin S C, Millis D L (2005) Rehabilitation for the orthopedic patient. Vet Clin North Am Small Anim Pract 35 (6), 1357-1388, viii PubMed.
  • Doyle N D (2004) Rehabilitation of fractures in small animals: maximize outcomes, minimize complications. Clin Tech Small Anim Pract 19 (3), 180-191 PubMed.
  • Mann F A & Payne J T (1989) Bone healing. Sem Vet Med Surg (4), 312-321 PubMed.

Other sources of information

  • Millis, Levine & Taylor (2004) Canine Rehabilitation and Physical Therapy. Saunders.
  • Rehabilitation of Fracture Patients. Proceedings 3rd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine 2004.


ADDED