Rehabilitation and Strengthening
by Bobbie Lyons CCFT, FP-MTI, Cert CF, Alan Gardner PgD A. Phys, MDip, DipMgmt, IAAT, ASSVAP and Niki Warren RVN CertVNECC MCAM
Animals can mask pain or discomfort by altering their posture and gait. From the perspective of a rehabilitation and strengthening team this is a critical point. If not treated in a timely manner, issues such as this can lead to compensatory injury factors.
For example, inflamed soft tissues can sometimes impinge on nerves and blood vessels. Additionally, shortened muscles may pull bones out of alignment, causing joint imbalances. These factors can cause additional pain and muscle atrophy. If left unchecked overtime further instabilities and abnormal wear on joint surfaces will occur with a potential for the premature development of osteoarthritis.
An area often identified for secondary (compensatory injuries) are the muscles of the canine back. Hourdebaigt (1998) refers to these as ‘lines of compensation’. In a performance dog this may be related to ‘off-loading’ of a limb, usually identified from a visual / GLS based gait analysis.
Animals have the ability to mask pain or discomfort by altering their posture and gait, potentially leading to secondary compensatory issues
Working alongside the veterinary, the rehabilitation team, which may consist of the physiotherapy, MCST, Hydrotherapist and K9Fitness practioner, (see Table 1) will often treat compensatory¹ factors of the back to assist in skeletal realignment, relief of muscular tension and strengthening the of the core. In many cases they may refer the patient back to their veterinary for guidance on specific issues, particularly if the dog is not responding to treatment.
A cross function team brings a wealth of skills including ability to work with both soft tissue and joints, and prescribe an individualized program to restore optimum function.
The canine vertebrae column has 5 distinct regions (see Table 2) which is curved in a single arc to aid locomotion. Stress points along the canine spine include the cervical, thoracic-lumbar junction (containing the longissimus dorsi muscle), lumbar spine and sacro-iliac areas. Professional spinal assessments may involve advanced diagnostic techniques such as X-ray, MRI or CAT scan which will aid potential conservative treatment protocols.
After referral by a veterinary professional the physiotherapist evaluation would include a Gait analysis, on the Gait4Dog treadmill system and palpation of the muscles along the spinal column.
Additionally, an evaluation by a MCST (often seeing patients as referrals from veterinary practice or other physical therapist’s due to skeletal misalignments) will also include a visual and palpatory examination, in particular (the MCST) will be looking for skeletal misalignments and reactive muscle areas.
The importance of these combined approaches is that skeletal and muscular systems work in conjunction with each other, so to treat one you must treat the other. Tight muscles can cause skeletal misalignments and vice versa. Therefore, it is very important to work alongside other practioners to help achieve restoration of full fitness in the patient. This multi-evaluative approach is carried out to both assess both primary and any possible compensatory / related issues.
Common Issues that Can Contribute to an Injury of the spinal muscles
There are many contributing factors that could cause injury to the spine and core muscle group. The core muscle group consist of those muscle along the “trunk and spine” as well as the hip flexors and abdominal muscles.
Some general causes of injury
- Improper jumping - in performance sports as well as on/off the bed or in/out of a car
- Transverse (twisting) movement through the spine that is unsupported with strength
- Repetitive activities without proper strength to support the movements
- Movements that are repetitive in one direction only – such as flyball dogs
- Blunt force injury to the spine - dogs colliding in play
- Limb injuries or joint injury that causes secondary compensatory issues in the spine
- Surgery recovery – compensatory movement
- Post-surgery (e.g. carpal arthrodesis) – compensatory movements
- Congenital limb deformities
Risk factors of injury
- Inactive dogs
- Poor core strength and conditioning
- Dogs that do not participate in cross training activities
- Improper use of body – compensatory muscle activation
- Long backed dogs – any breed. This applied to any dog with a longer back – not just the Dachshund, Corgi and Basset type body types
Some common signs of injury to the spine
- Inability to stand with a neutral spine
- Inability to bend through the spine
- Lack of extension in the neck, shoulders and/or pelvis
- Stiffness or observable soreness along the spine
- Reluctance to even jump in the car
- Behavioral changes – guarding/ aggression/fear
Experience Based Rehabilitation Protocols
The first stage when treating muscles of the spinal column is to reduce any myofascial adhesions and muscular tension which may have been noted during the evaluation. These issues may lead to pain and ‘holding’ patterns. Electrotherapies coupled with physiotherapy based manual manipulations are excellent methods to achieve this. With the spinal area, we must take into consideration that (i) it is often an area with a dense fur covering (ii) sensitivity of the soft tissue located around the spinal column and spinous processes.
LASER and Pulse Magnetic Field Therapy (PEMF) are particularly suited to treating spinal areas as:
- They can be used to treat large areas in single sessions
- Canine fur² is not an issue when using animal specific equipment
- They are not typically contraindicated to bone tissue
- Ability to penetrate deep tissue (particularly PEMF)
Benefits of LASER includes the stimulation of cell mitochondrial activity, increased production of adenosine triphosphate (ATP) / specific enzymes, growth factors, and formation of anti-bodies. This can be summarized as “restarting metabolic reactions at the cellular level, stimulating the production of the energy to maintain all the cell’s mechanisms in, muscles, tendons, ligaments and even disc tissue.”
For treating specific areas of the spine, we would use typically use 4j/cm3 of energy (IIIB LASER) using multi or specific wave frequencies. The reason for using these frequencies is that different cells are able to pick up their particular resonant frequencies. If there were many areas to treat in one session, for a medium size dog (i.e. 20 kilos), 16j/cm3 of energy would enable treatment from lower cervical to the sacro-iliac joint in one session.
This can be complimented with home treatments of PEMF at 50 Hz Base / 17.5 Hz Pulse, usually twice a day. This frequency is particularly recommended for muscle, tendon, ligament and joint injuries. It also helps reduce secondary inflammation due to Osteoarthritis. A major advantage of PEMF treatments is the depth of penetration, the pulsed waves easily being able to penetrate into most dogs deep laying tissues. PEMF benefits secondary injuries by redistributing ions across the cell membrane, thus modifying resting membrane potential and certain cellular metabolic processes.
The next stages involve overcoming muscle inhibition, restoring range of movement and skeletal realignment. Complementary physiotherapy and MCST techniques are typically employed at this stage. Physiotherapy based treatments may combine both passive and active manipulation techniques such as:
- Skin rolling, with the aim of releasing areas where the skin is tightly held by adhesions to the spinal muscles. Adhesions can be thought as bands of internal scarring that binds all the tissues together.
- Mulligan concept which uses techniques such as sustained natural apophyseal glides to reduce pain and increasing mobility of the individual vertebrae.
- Active stretching by encouraging the canine patient to bend laterally, downwards so creating a ‘C’ stretch and extending upwards to lengthen out the spine/
MCST often see patients post these 2nd stage physical therapy treatments. Muscle tension will have been reduced but skeletal misalignments may still be present. The skeletal system will be manipulated back into place through adjustments along the spine and pelvis and associated muscle releasing techniques will be used such as massage.
MCST rehabilitation exercises are based on physiotherapy activities. We may often refer to the physiotherapists we are working in partnership with for additional work or if the animal requires extensive rehabilitation.
Strengthening and Return to Work
It is important to work closely with a rehabilitation expert when designing a proper strength training plan after a spinal injury. The spine and the muscles that support it are a very complex system and an emphasis is placed on strengthening both the spinal and core³ muscles. Re-injury is very common in dogs that go back to normal activity to soon, complete the wrong strengthening protocol or suffer from secondary compensatory issues.
Strengthening exercises should be performed when the healing process has moved out of the acute phase
Strengthening exercises should be performed when the healing process has moved out of the acute phase and when starting to return to normal activity.
Nose to body part bends for flexibility are particularly recommended. They increase
flexibility in the neck, spine, shoulders and hips –
- Nose to chest
- Nose to each shoulder
- Nose to each front foot
- Nose to mid spine (both sides)
- Nose to each hip
- Nose to each rear foot
Under Water Treadmill
These can be used from an earlier stage than swimming due. This is because the Hydrotherapist can control the movements of the patient in addition to the buoyancy from the water supporting the body weight. This will help prevent muscle wastage and help return functional ROM when normal exercise is restricted. This can be progressed onto normal swimming when the animal is no longer lame. The primary advantages of water treadmill can be summarized as aiding movement of the body evenly on both sides and strengthening the core muscles.
Cavaletti – Straight - (Using six poles)
Lengthens through the spine, while swinging the hips and shoulders in full range of motion. Space between the cavaletti poles should be equal to the measurement at your dog’s withers (this is a good staring place). If your dog has a longer stride it is ok to increase the distance between the poles 1” at a time to help lengthen through the dog’s stride, lengthen through the spine and get good range of motion through both shoulders and hips. The height of the poles should be just over hind foot (1-2” [2.5 – 5.0 cm] in most cases) – NEVER over hock height. The dog should be at a trot and repetition should typically be done to exhaustion. When the dog starts repeatedly hitting the poles or refuses the exercise, this is the sign to stop.
Cavaletti – Curved
Same spacing and height as for straight cavalettis – measure the distance between the poles at the inside of the curve. Most dogs will stride through the poles closest to the handler
Tuck sit and kick back stand
This can be practiced either on the flat or with front limbs elevated. Front feet stay stationing while the rear assembly moves forward to sit and then moves back to stand. This activates the core and rear assembly in the movement while the shoulders stabilize. Elevating the front limbs will put more weight to the rear.
Tight turns should be done in a controlled manner when approved by the rehabilitation staff. This will help to activate the joint stabilizers while offering an active stretch through the shoulder complex, spine and rear assembly.
Weight shifting off handler movement
Two Fitpaws discs may be utilized to assist with the general core and scapular stabilizers. Placing the dog with front feet on a disc and rear feet on another disc will initiate contractions of these muscles. Walking around the dog will encourage them to follow you with their head. When the dog turns their head to the right, it will shift weight to their left. As you round behind the dog it will shift weight to the rear and then back to the right as you complete the circle.
Crawling forward activates the scapular muscles, lengthens through the spine while strengthening the core and trunk of the dog. Using something the dog can crawl under in continuous movement is ideal. Poles should be set so that the dog can crawl under with his sternum as close to the ground as possible. Each limb should rotate forward individually. No “frogging” out of the hind legs should be accepted.
Look for signs of fatigue such as unable to reach forward and rear leg extension. Proper movement is all four limbs rotating forward.
This article has been designed to provide guidance for the rehabilitation and strengthening of compensatory issues involving the muscles and joints of the back and strengthening of the core.
Following diagnosis by the suitable qualified professional, conservative treatment can be carried out on issues related to the back. These treatments will be particularly beneficial where gait and limb off-loading have been identified, particularly as left untreated premature osteoarthritis could develop.
Due the highly complex structure of the spine and related muscles the rehabilitation team which may consist physiotherapy, MCST, Hydrotherapy and K9Fitness. Treatments will typically include reducing pain / inflammation with relevant electrotherapies, hydrotherapy to prevent muscle atrophy, soft tissue / joint manipulation followed by targeted strengthening programs. Combined, the objectives of these collaborative treatments are to optimize the healing process and strengthen the area to prevent recurrence of the injured area.
It must be emphasized that the spine is a highly complex and sensitive area. Therefore, we strongly recommend that in any doubt, an owner must get in touch with their veterinary practice before any treatment can begin and rule out any underlying orthopedic condition.
Hourdebaigt, J. 1998, CANINE MUSCULAR COMPENSATION, Massage Awareness, Inc
Bobbie Lyons CCFT, FP-MTI, Cert CF has eleven years of experience training handlers and their performance dog’s safe canine fitness practices. She obtained this knowledge by consulting with the leading veterinarians, rehabilitation specialist, and canine PT’s to ensure proper position and technique to maximize the benefits of each exercise. Bobbie has completed the FitPAWS/University of Tennessee Certified Canine Fitness Trainer Program and is a FitPAWS Master Trainer “Program Instructor”. She has also completed the Certificate Canine Fitness program through the Companion Animal Science Institute.
Alan Gardner PgD A. Phys, MDip, DipMgmt, IAAT, ASSVAP. Alan is an animal physiotherapist and practices at Hawksmoor, Nuneaton and Dunton Veterinary Clinic in the UK. He specializes in rehabilitation of performance dogs and improving gait post-surgery. At the Hawksmoor practice, there is a GAIT4DOG gait analysis treadmill which is exceptionally good for evaluating imbalances in pressure distribution of the canine limbs. This evaluation can quickly demonstrate compensatory patterns.
Niki Warren RVN CertVNECC MCAM. Niki is a registered Veterinary Nurse having 15 years’ experience working with small animals. Qualified in 2009 in McTimoney-Corley Skeletal Therapy for dogs, horses and people. Currently training to become an Hydrotherapist to enhance my skill set. I work in Alrewas with Capable Canines Agility treating and working with the agility dogs and their handlers.
- In this case means compensatory means not an initial, orthopedic or hereditary area of concern, but in all probability related to a primary strain or sprain from one of the limbs or associated soft tissues.
- *In units designed for human use the flat head will mean a substantial loss of energy due to reflection. The MKW Lasertwin 21 with comb is specifically designed for animals and overcomes this limitation.
- The dogs core muscle group needs to be strong and flexible before returning to full activity. The “core” is defined as the abdominal muscles and muscles along the lumbar spine.