Physical Therapy/Core Strengthening Exercises

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Suzan Mathews
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303 91 st Ave. NE Ste. A106 Lake Stevens, WA 98258 425-377-8620 www.lakestevensanimalhospital.

improving active ROM of all joints, strengthening the core muscles, and maintaining or improving proprioception and balance.

Passive Range of Motion Exercises Passive range of motion exercises (PROM) are gentle movements of a joint or joints through flexion and extension.

There is NEVER an attempt to push a joint to a painful end, rather a light two finger touch that gently, smoothly moves the joint.

1 st Ave. NE Ste. A106 Lake Stevens, WA Physical Therapy/Core Strengthening Exercises Dogs with osteoarthritis or those recovering from a major surgery benefit from strengthening the muscles supporting a painful joint, maintaining and improving active ROM of all joints, strengthening the core muscles, and maintaining or improving proprioception and balance. 4,5 The following are basic therapeutic exercises that we recommend for increasing the core and leg muscle strength for dogs with osteoarthritis or for post-op rehabilitation. Passive Range of Motion Exercises Passive range of motion exercises (PROM) are gentle movements of a joint or joints through flexion and extension. Moving a joint helps to nourish the cartilage, maintain function and is critical to the optimal healing of any injury. There is NEVER an attempt to push a joint to a painful end, rather a light two finger touch that gently, smoothly moves the joint. We suggest moist heat applied to the area and a pillow between the dog s legs to allow proper body alignment. All joints in the body have some movement. We demonstrate appropriate technique of the listed joints in the following photos and video clips. Foot/toes We utilize gentle pressure on the bottom of the foot, contacting the pads to mimic weightbearing. Each toe can also be gently flexed and extended to maintain proper range of these small joints. Carpus (wrist) The wrist of a dog has movement in several planes. It extends and flexes as well as moves side to side. Most often we need to address dogs who have lost some extension. We normally suggest heating the affected joint, then move to the end of the movemnet and hold in a gentle stretch as demonstrated.

Hock (ankle) The hock of a dog is like the human ankle. We will have an owner perform basic extension and flexion of this joint to maintain a normal range or to regain normal range.

2 Hock (ankle) The hock of a dog is like the human ankle. We will have an owner perform basic extension and flexion of this joint to maintain a normal range or to regain normal range. Most frequently dogs will lose flexion ability due to partial weight bearing (tip toeing). Shoulder Scapular mobilization: this movement is not a joint range of motion but rather the movement of the shoulder blade on the surface of the rib cage. The scapula can move in all directions on the rib cage. Stifle (knee) The stifle of the dog has flexion and extension movement as well as some rotation. We encourage basic movements after all knee surgeries as well as in rehabilitation or rear limb injuries. We will suggest heat or ice on the joint as appropriate. Elbow The elbow is a hinge joint in a dog like it is in humans. The movements are slow and controlled as demonstrated. Hip Movement of the hip joint is critical to effective walking. Dogs may have hip pain secondary to a hip injury or to a problem in another limb. Maintenance of a normal range of motion in flexion and extension can help to avoid complications after surgery. Heat prior to movements is usually helpful. We suggest a pillow between the pet s legs to maintain the limb parallel to the ground. Sit-to-Stand This exercise is prescribed for improving or maintaining muscular strength and active hind-limb ROM. The key to success is ensuring that the dog flexes the stifles and tarsi of both limbs fully so that the limbs are both tucked in a normal position against the body. A dog asked to stand should use both back legs to move to the standing position. For dogs that sit to one side, with the contralateral hind limb held away from the body, the client or assistant should stand behind the dog and use his or her feet to scoot the dog s back legs into a tucked position. That person remains behind the dog while a second person stands in front and asks the dog to stand. Reward the dog each time (and only if) it sits square and stands with both limbs.

Start with 3 to 5 repetitions several times a day and gradually work up to 3 sets of 10 to 12 every day.

muscles. Down-to-stand can be a beginning-level core-strengthening exercise. Ask the dog to move to a down position.

The key to success with this exercise is to take a step back from the dog while asking it to stand so that it moves directly from a down-to-stand position without sitting in

To advance this exercise and engage the core muscles, the dog should move from down to stand and back down again without taking any steps forward or backward (the feet stay in

3 Start with 3 to 5 repetitions several times a day and gradually work up to 3 sets of 10 to 12 every day. Down-to-Stand This exercise is also prescribed for improving or maintaining muscular strength and active hindlimb ROM and is particularly useful for strengthening the gluteal muscles. Down-to-stand can be a beginning-level core-strengthening exercise. Ask the dog to move to a down position. Ensure that both back limbs are tucked against the body and the dog is in a sphinx position. Stand in front, facing the dog with a treat. The key to success with this exercise is to take a step back from the dog while asking it to stand so that it moves directly from a down-to-stand position without sitting in between. To advance this exercise and engage the core muscles, the dog should move from down to stand and back down again without taking any steps forward or backward (the feet stay in the same position while the body moves over them). Start with 3 to 5 repetitions several times a day and gradually work up to 3 sets of 10 to 12 every day. Half sit This is essentially a squat movement. With dogs recovering from surgery it is useful to strengthen the hamstring and quadricep muscles. We find that having the dog back-up and sit between that owner/handlers legs on a step is useful. The handler can control the position of the legs as the dog sits and support the pelvis as the dog stands back up.

4 Sit, give paw This exercise is a good tool to strengthen shoulder extensor muscle. It also requires body control and strength on the supporting forelimb. This exercise should be done on both front legs, not just the affected leg. Stand, give paw This is a more advanced form of shoulder exercise. It requires strength, balance and shoulder extensor strength. Do several repetitions of this on both forelimbs. Have the dog reach out and low toward your hand or toy. Cookie stretch

The cookie stretch is a useful basic flexibility tool.

Offer the cookie on either side near the chest, flank, hip and also down to hind paw for core

Stretch neck out, up and then down between front legs, around your leg for further stretching.

Three-Leg Standing This exercise, which is prescribed for improving muscular strength in a weak limb by

is being targeted for strengthening; lift the right front limb if the left front is being targeted).

5 The cookie stretch is a useful basic flexibility tool. We ask the dog to gently look in all directions with a neutral neck position. Offer the cookie on either side near the chest, flank, hip and also down to hind paw for core strengthening, stretching and neck flexibility. Stretch neck out, up and then down between front legs, around your leg for further stretching. This should only be done if instructed to do so by your veterinarian. Three-Leg Standing This exercise, which is prescribed for improving muscular strength in a weak limb by encouraging isometric muscle contraction, is also is a beginning-level exercise for improving core strength and balance. Lift the dog s leg on the opposite side of the weak limb (ie, lift the left rear leg if the right rear leg is being targeted for strengthening; lift the right front limb if the left front is being targeted). Extend the leg slightly back if hind-limb or forward if front-limb so that the dog cannot bear weight through the hand. Hold the leg off the ground for 5 to 10 seconds and then allow the dog to stand on all 4 limbs to rest. Repeat 3 to 5 times a day. Work up to holding the limb off the ground for 30 seconds, 8 repetitions, 3 times a day. If multiple limbs are weak, repeat the exercise targeting each weak limb.

Cross-Leg Standing This exercise, also known as 2-leg standing or bird-dog, is prescribed for

It is an advanced form of the 3-leg standing exercise to increase a weak limb s muscular strength.

Extend the front leg forward and the rear leg back.

6 Cross-Leg Standing This exercise, also known as 2-leg standing or bird-dog, is prescribed for improving core muscular strength and balance. It is an advanced form of the 3-leg standing exercise to increase a weak limb s muscular strength. Lift one front leg and the contralateral hind leg, allowing the dog to stand on 2 legs. Extend the front leg forward and the rear leg back. Hold the leg off the ground for 5 to 10 seconds and then allow the dog to stand on all 4 limbs to rest. Repeat 3 to 5 times a day. Work up to holding the limbs off the ground for 30 seconds, 8 repetitions, 3 times a day. Repeat with the opposite 2 legs. For an advanced exercise, wiggle the 2 legs that are off the ground to challenge balance and core stability. The dog should be able to stand on 2 legs for approximately 30 seconds before trying this exercise. Weight Shifting This activity requires the dog to shift its weight and maintain balance requiring strength and coordination. It is important to make slow purposeful movements with the toy or treat to have the dog s movements be measured and smooth. These can be done flat, on stairs, and/or with the aid of a pilates ball or foam/mattress.

Standing on Mattress/Foam/Trampoline (weight shifting) Altering the ground surface

The activity causes the dog to think and negotiate with all four limbs during

Basic standing and shifting can progress to walking.

patterns and changes in direction. Initially this must be performed very slowly!

7 Standing on Mattress/Foam/Trampoline (weight shifting) Altering the ground surface provides a challenge to the dog s walking and proprioceptive ability. The activity causes the dog to think and negotiate with all four limbs during movements. It also improves balance and coordination. Basic standing and shifting can progress to walking. Pattern Walk Walking in small circles and figure eights varies the stride patterns and distances in obvious ways. Dogs with subtle injury, both orthopedic and neurologic will be challenged by patterns and changes in direction. Initially this must be performed very slowly! Single curbs This activity helps improve balance and coordination and straightens the leg muscles. Walk up and down a single step or curb, very slowly and precisely. The pet should be on a leash, and do not allow them to jump or trot at this point.

Inclines/declines Begin slowly walking up and down gradual inclines that provide good footing for your dog.

This activity is low impact and increases strength of the leg promoting extension of the knee and hip.

It will help improve coordination and power in the rear legs.

8 Inclines/declines Begin slowly walking up and down gradual inclines that provide good footing for your dog. As your dog s muscles strengthen and range of motion improves, steeper inclines can be introduced. This activity is low impact and increases strength of the leg promoting extension of the knee and hip. Stairs Slowly walk the dog up and down stairs that have good footing. This activity requires strength and balance. It will help improve coordination and power in the rear legs. For very small or short legged dogs, this activity requires extreme physical effort and would therefore not be part of early therapy. ADVANCED EXERCISES Wobble Board The wobble board is a device that actively destabilizes the ground under all or part of the dog. We normally place the healthy part of the dog on the board and require the affected legs to participate more in maintaining balance and position. This is harder than it looks.

Stair Stand Having the dog place their forelimbs on a stair or elevated platform

and with the abdominal muscles and hips in an extended position.

Cavaletti Rails, High-Stepping, or Obstacle Course This exercise is prescribed for

s shoulder height. The poles should be on the ground at first.

The height should be based on the dog s size and the joints targeted for improving

9 Stair Stand Having the dog place their forelimbs on a stair or elevated platform provides opportunity for balance work with extra weight shifted to the rear limbs and with the abdominal muscles and hips in an extended position. We may have the dog eat in this position or just do weight shifting. Cavaletti Rails, High-Stepping, or Obstacle Course This exercise is prescribed for improving cardiovascular endurance, proprioception, and active ROM and muscular strength in all limbs. To perform this exercise, place 6 cavaletti rails, spaced as far apart as the dog s shoulder height. The poles should be on the ground at first. Advance to raised poles when your dog is ready for more of a challenge. The height should be based on the dog s size and the joints targeted for improving flexion. For example, setting the bars at the height of the dog s carpi can target stifle and tarsal flexion. The bars can be set at the level of the elbow for targeting elbow flexion. Walk the leashed dog slowly

so that it steps over each rail with individual limbs rather than hopping. Walk back and forth 3 times. Work up to 6 times back and forth.

If cavaletti rails are not available, walk the dog through tall grass so that each hind limb is lifted and flexed at the hip, elbow, and carpus, or create an obstacle course with objects the dog will

Walking up and down hills and stairs can also improve range of motion. Straight cavaletti Cavalettis are wooden poles arranged in a straight line on the ground.

10 so that it steps over each rail with individual limbs rather than hopping. Walk back and forth 3 times. Work up to 6 times back and forth. For an added challenge, change the height of the rails and add diagonal positions (one side of a rail higher than the other). For an advanced challenge, place the cavaletti rails on a hill. If cavaletti rails are not available, walk the dog through tall grass so that each hind limb is lifted and flexed at the hip, elbow, and carpus, or create an obstacle course with objects the dog will not step on (eg, brooms, water noodles, pillows, toys). Walk the dog over the course so that it must high step or pick up its legs fully to move over the objects. Walking up and down hills and stairs can also improve range of motion. Straight cavaletti Cavalettis are wooden poles arranged in a straight line on the ground. Do not use any object that will roll if stepped on for the safety of you and your dog. This activity encourages greater active range of motion, requires full weight bearing on all limbs and challenges proprioception, balance and coordination. This helps to rebuild the autopilot walk. Place the cavalettis in a row and slowly walk your dog through them. Start with four to six in a row and build up to more. Ask your rehabilitation specialist or your surgeon for proper height and spacing recommendations. Circle cavaletti Cavalettis are wooden poles arranged in a circle pattern on the ground. Do not use any object that will roll if stepped on for the safety of you and your dog. This activity encourages greater active range of motion, requires full weight bearing on all limbs and challenges proprioception, balance and coordination. Place four of the cavalettis in a circle pattern and slowly walk your dog through them in both directions. This will require all of your dog s legs to walk in a different path which optimizes independent limb use.

Pick-up sticks cavaletti Cavalettis are wooden poles

Do not use any object that will roll if stepped on for

This activity encourages greater active range of

challenges proprioception, balance and coordination.

platforms that require some dexterity to maneuver

They build confidence and strength and they help to

These can be as low as necessary but usually 4-6

11 Pick-up sticks cavaletti Cavalettis are wooden poles arranged in a random pattern on the ground. Do not use any object that will roll if stepped on for the safety of you and your dog. This activity encourages greater active range of motion, requires full weight bearing on all limbs and challenges proprioception, balance and coordination. Stepper Walking Patterns Steppers are minor elevated platforms that require some dexterity to maneuver through. They build confidence and strength and they help to maintain interest during repetitious exercises. These can be as low as necessary but usually 4-6 inches high is a good start. The obstacles must have good footing and be on a level surface. Of course the dog is under leash control throughout the exercise.

Physioroll Supported Rolls We utilize physiorolls to support neurologic patients

movements. We will create support devices as necessary for different size dogs.

This helps with balance and proprioceptive movement.

treatment of osteoarthritis and post-op rehabilitation, it is crucial that a full

12 Physioroll Supported Rolls We utilize physiorolls to support neurologic patients and to mimic proper weight-bearing and to allow safe repetitions of walking movements. We will create support devices as necessary for different size dogs. Walking Backwards Simply have your dog walk backwards. This helps with balance and proprioceptive movement. There are some good videos on Youtube demonstrating how to train your dog to walk backwards if you need help with this. Conclusion While therapeutic exercises are an important part of the compressive treatment of osteoarthritis and post-op rehabilitation, it is crucial that a full orthopedic examination be performed by a veterinarian prior to recommending these exercises. The veterinarian should rule out other causes of lameness and pain, including bone and nerve-root tumors and neurologic disease, and ensure that pain is well managed. We do NOT allow pets to do a physical therapy regimen if their pain is not well controlled.

Passive and Active Exercises. Passive exercises. Passive exercises. Range-of-Motion exercises Stretching

Passive and Active Exercises. Passive exercises. Passive exercises. Range-of-Motion exercises Stretching Passive and Active Exercises Marion Mueller DVM, CCRP, CVA University of Veterinary Medicine, Vienna Passive exercises Range-of-Motion exercises Stretching Passive exercises Increased joint mobility Increased