Our Rehabilitation gets you BACK IN SHAPE (in addition to your regular spinning classes).

Transcription

1 Our Rehabilitation gets you BACK IN SHAPE (in addition to your regular spinning classes). Caroline Adrian PT, PhD, CCRP Certified Canine Rehabilitation Practitioner Director, Rehabilitation Services VCA Animal Hospitals

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3 WHY Rehabilitation? Rehabilitation Can Treat All Kinds..

4 Translating Human Protocols to Animals

5 Similar Tools Are Used

6 Rehabilitation Offers Proven Physiological Benefits Improved function and quality of movement Reduction of pain, swelling, and complications Overall, increased speed of recovery Increase of strength, range of motion, endurance and performance Non-invasive approach Reduced costs for owner Psychological implications for both animal and owner Improved and prolonged quality of life Prevention Alternative care

7 Basic Science Anatomical Biomechanical Tissue healing Neural plasticity Mechanical loading Physiology Modalities Pain (+/- function) Aging As to science itself, it can only grow. Galileo

8 Human Rehab Research Motor Control Hodges, 2001; Hodges & Richardson,1997, 1999 Low back pain (5,666) Orthopedics Fu, Wu & Irrgang, 1992; Arangio, et. al., 1997; Gobbi et. al, 2011 ACL: 803 Neurology Stroke (5,453) TBI (269) Oncology Exercise and cancer (6,430)

9 Canine Rehabilitation Research Intensive Care Smarick DS, et. al., JAVMA Feb 2007 Cervical myelopathy Orthopedics Adamson C, Wolfe T. ACVS October 2007 Iliopsoas strains Monk ML, Preston CA, McGowan CM. JAVMA, Post TPLO Marsolais GS, et.al. Post lateral stabilization Motor control: Adrian et.al., CCLR Modalities Jaegger, et. al., Am J Vet Res Reliability of goniometry in Labrador Retrievers Levine, et. al., Vet Surg 2001 Ultrasound on thigh muscle temperature Johnson, et. al., Am J Vet Res 2007 CCL + e-stim Regenerative Rehabilitation Ambrosio, 2010; Badylak, 2010 mechanical loading

10 Rehabilitation Is Not Just for Post-Op ICU Neurology Medicine Oncology General Practice Surgery Zoo Medicine

11 Quality of life! Indications for Referral to Rehabilitation Movement dysfunction: promote normal osteo/arthrokinematics Pain: from injury, surgery or disability Soft tissue injuries: strains, sprains, tendonitis Joint injuries: contractures, osteoarthritis Gait abnormalities: lameness, compensatory movement strategies after injury Orthopedic or neurosurgery Geriatric conditions: difficulty with functional mobilities, decreased balance, muscle atrophy Not a surgical candidate conservative treatment only Obesity and deconditioning Canine athletes and working dogs: strength and conditioning Wound care Injury prevention Osteoarthritis / RA Weakness muscle atrophy, neurogenic Neurologic involvement Neck or back pain

12 Orthopedic Conditions May Be Referred to Rehabilitation Hip dysplasia/arthritis Fracture repair OCD Strains/sprains Amputations Cruciate ligament repairs Overuse injuries Post-operative

13 Neurologic Conditions Are Also Candidates For Referral Fibrocartilagenous embolism Hemi-/laminectomy Neck/back pain Proprioception / motor function Tone Nerve injuries Balance / vestibular disorders Nonsurgical back pain

14 Neuromusculoskeletal Diagnoses Guide the Plan of Care range of motion and flexibility (soft tissue / joint) endurance and mobility (pneumothorax, obesity, arthritis) strength Muscle atrophy (disuse, neurogenic) Contracture (prevention) Pain (acute or chronic) Inflammation Neurologic involvement Scar tissue (retard, break down) Muscle guarding / spasm Abnormal gait / decreased function (non- / partial weightbearing / ataxia) Joint stiffness Spinal dysfunction Depression

15 Physical Rehabilitation Medical treatment is generally directed at the pathology Rehabilitation focuses on minimizing associated functional impairments Restore Maintain Promote optimal physical function Alleviating impairments, functional limitations & disabilities by designing, implementing & modifying treatment interventions

16 WHEN to Refer to Rehabilitation? What is Injury? Damage caused by physical trauma sustained by tissues of the body (Whiting WC, Zernicke RF 2008) Contributing factors (age, gender, nutrition, genetics, fatigue, environment, equipment, disease, previous injury, pain, skill level, anthropometric variability, fatigue) Injury types Primary vs. secondary Acute vs. chronic Microtrauma vs. macrotrauma Compensatory

17 Tissue Healing Stages of Tissue Healing: 1. Inflammatory Response 2. Proliferation (Repair) 1. Remodeling (Maturation)

18 Physiology of Tissue Healing: Inflammatory Response 1. Inflammatory Response (Whiting WC, Zernicke RF 2008) Generalized response to injury Occurs in all cases, regardless of tissue affected Can lead to damage if not controlled Blocks proliferation / remodeling Clinically: rubor et tumor cum calore et dolore / functio laesa Redness Swelling Heat Pain * * 5 th SIGN: Functional Loss

19 Physiology of Tissue Healing: Inflammatory Response 1. Inflammatory Process/Response NOT active healing Exudate (fluid and plasma proteins) brought to area to initiate healing Fluid/swelling caused by exudate may contribute to pain Serves several positive functions Chemotaxis Phase controlled by chemical mediators Phagocytes Macrophages, neutrophils Pain/impaired movement from altered chemical state: Irritates nerve endings Increased tissue tension from edema or joint effusion Muscle guarding (body s way of immobilizing a painful area)

20 Physiology of Tissue Healing: Inflammatory Response Clinical Implications GOALS Control excessive inflammation Decrease pain Protection of injured tissue Facilitate wound healing Maintain integrity/function of associated areas Improve proprioception Target compensations Client education First 2-4 days after injury; up to 4-6 days, unless injury is perpetuated Send signals to fibroblasts Tissues go into proliferation phase

21 2 Options: Regenerate or Repair Regenerate new tissue ** OR ** Repair it Start in 24 hrs Fibroblasts come into the area Synthesize proteins (proteoglycans, elastins, collagen) responsible for repair Fill with scar tissue connective tissue Tissue healing and clinical implications. in skeletal muscle, bone, tendon and ligament injury, cartilage, nonmusculoskeletal injury (skin, nervous tissue)

22 Exercise for Tissue Healing PROTECTION PHASE (Kisner & Colby, 2002) 1. Educate the client Anticipated recovery time - how long, how often, how much Protection, with appropriate functional activity Precautions: Proper dose rest and movement Too much movement increased pain/inflammation Contraindications: Stretching Resistance exercises at site of inflamed tissue (Zohn & Mennell, 1976) 2. Control effects of inflammation Control pain, edema, spasm Immobilize short term Rest, splint, orthotic, taping Modalities Cryotherapy Game Ready Laser

23 Exercise for Tissue Healing PROTECTION PHASE (Kisner & Colby, 2002) 3. Promote early healing and prevent deleterious effects of rest Manual therapy (Grade I-II joint mobilizations) Massage Passive movement; joint compressions; muscle setting with caution Target compensations

24 Tissue Healing Mobility Framework for Therapeutic Exercise Prescription Initiate Performance, Stabilization and Motor Control Improve Performance Advance Coordination and Skill Adapted from Anemaet, 2017

25 HOW is Rehabilitation Performed Manual Therapy Gait / transfer training Hydrotherapy Dry needling NMES/TENS Ultrasound Cryotherapy / Thermotherapy Therapeutic Exercise Land treadmill Laser (PBM) Therapeutic Massage Pulsed Magnetic Therapy ESWT Orthotics and Prosthetics Assistive Devices

26 Underwater Treadmills

27 Rehabilitation Addresses Pain Acute / chronic Osteoarthritis Post operative pain Therapeutic lasers In conjunction with anesthesiologist, acupuncturist, etc.

28 Joint mobilizations Manual Therapy for Pain Management Maitland Grades I and II, for pain Mulligan Distraction Neurophysiologic mechanism interaction of peripheral and central nervous system Peripheral mechanism affects inflammatory process Spinal mechanism effect on the spinal cord Supraspinal mechanism influence of specific supraspinal structures in response to pain

29 Joint Mobilizations EVERY movement of the body possesses some form of accessory/arthrokinematic joint motion Restrictions of accessory joint motion Pain Restriction during physiologic motion Capsuloligamentous tightening, internal derangement, bony blockage, reflex mm. guarding, bony subluxation, deformity secondary to pain, dysfunction, postoperative adhesions

30 Manual Therapy: Neurophysiologic Effects Transient mechanical stimulus to the tissue causes chain of neurophysiological effects Immediate hypoalgesia (Vicenzino et al, 2001; Paungmali et al, 2004; Mohammadian et al, 2004) Bombards the CNS with sensory input from muscle proprioceptors (Pickar & Wheeler, 2001) Counter irritant to spinal cord neurons (Boal & Gillette, 2004) Specific activation of the PAG (Wright, 1995; Sterling et.al, 2001)

31 Manual Techniques for Pain Management Ischemic compression FDN/TPDN IASTM Kinesiotaping

32 Intramuscular Manual Therapy (Trigger Point Dry Needling) What s a Myofascial Trigger Point (MTP)? (Simons, etal., 1999) Ever have a knot in your muscle? Hyperirritable/sensitive palpable nodule In taut band of skeletal muscle or muscle fascia Causes sensory, motor, neurologic, and autonomic symptoms Key S/S: (Lavelle, etal., 2007) Local and referred pain Restricted ROM Increased sensitivity to stretching Muscle weakness, due to pain No muscular atrophy

33 Modalities Cryotherapy Heat therapy Ultrasound Electrical stimulation ESWT PBM (laser)

34 Therapeutic Exercise

35 Supportive Devices

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37 Program Development: Home program hand-outs

38 Wellness, Conditioning and Prevention Conditioning Performance enhancement Injury prevention evaluations on regular basis Weight loss Geriatric support care: continuum of care

39 Athletes Suffer Frequent Injuries

40 Sports Medicine is an Emerging Field Determine musculoskeletal dysfunction to prevent future injury Wellness exams for athletes / working dogs to detect compensatory strategies Maintain athletic physique Core dysfunction

41 Working Dogs Undergo Stressful Training

42 Geriatric Patients Have Special Needs

43 Physical Therapists Collaborate with Certified Prosthetists and Orthotists

44 Non-Surgical Treatment Options Orthotics

45 Biomechanics Intact CrCL Deficient CrCL Videos courtesy of Dr. Scott Tashman Tashman S and Anderst W, J Biomech Eng, 2003

46 CCL Rupture Intact Limb Deficient Limb

47 Case Example Iliopsoas Strain Iliopsoas Muscle Hip flexor Iliopsoas psoas major + iliacus Psoas Major, origin TP L2,3, bodies L4-7 Iliacus, origin ventral surface of ilium Common insertion = lesser trochanter of femur

48 Case Example Iliopsoas Strain Excessive force on iliopsoas muscle Common in sporting dogs (jumping, cut/turn, slipping) Proposed to occur during eccentric contraction (stopping the PL from further extension) mm. is in stretched position

49 Iliopsoas Strain Altered Movement Deficit in one joint may alter movement at an adjacent joint ROM losses at 1+ joints cause compensatory changes at other levels EX: decreased hip extension causes: Decreased stance phase with early stifle flexion Opposite hip abduction (hip hiking on involved limb) Trunk rotation Compensations in swing phase of gait, impacting: Lumbar spine Pelvis Opposite PL Diagonal TL Chicken or egg?

50 Iliopsoas Strain Clinical Findings Gait Shortened stride length/stance phase Hip hike/hop during gait transitions (walk to trot) Crab to side of strain SIJ Dysfunction (cranial pelvic Rotation) Back pain Decreased spinal motion in extension Lack of spinal rotation and side bending with functional activities Moderate to several mm. spasms in L spine musculature Flexibility Iliopsoas Quadriceps Sartorius Piriformis Hamstrings Gracilis Gastroc ROM Decreased hip extension

51 Iliopsoas Strain Clinical Findings Posture Flexed spine Tucked under Kyphosis Rounded rump Low tail set Flexed stifles Lazy sit +/- pelvic rotation

52 Caroline Adrian. IAVRPT 2016 Tron

53 Physical Rehabilitation: THE VISION VCA promotes a national standard of excellence to achieve maximal health, wellness and preventative goals of neuromusculoskeletal pathologies. We maintain a national standard of excellence in the provision of rehabilitation and physical therapy services to improve outcomes within an interdisciplinary team approach to patient care. We offer a solid commitment to our community to provide an evidence-based approach to customer and patient care.

54 Questions? Lake Isabelle, Nederland, CO