Physical Medicine

HydrotherapySwimmingHot and Cold therapy

Hydrotherapy• Therapeutic use of water in any of its three forms

to restore and maintain good health in animals

hydrotherapy uses

immersion full body or partial

exercises(swimming,water walking)

local appilcation cool or warm

water wraps or packs

ingestion/inhalation (steam)

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Water properties

• Density/Specific gravity• Buoyancy• Viscosity and Surface Tension• Hydrostatic pressure

Buoyancyupward thrust force exerted to a body partly or totally submerged in water which results in an effect of decreased weight.

Archimedes Principle

When a body is entirely or oartially immersed in fluid at rest..

It experiences an upward thrust equal to the weight of water displaced.

Buoyancy reduce the weight being supported by the patient’s limbs

Buoyancy

Levine et al.,2004

Specific gravity of pure water : 1

lean animals- have tendency to sinkobese animals- float more easily

Specific Density of an Object- ratio of the weight of the object to the weight of an equal volume of water

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Viscosity and Surface tension-Water is more dense and viscous than air which increases resistance to movement-viscosity also supports the patient

easy to maintain balance than in land

Eg. For dogs, a five minute swim is often quoted as being the equivalent of a five mile run.

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• Hydrostatic PressurePascal's LawFluid exert pressure on all surfaces of an immersed body at any given depth

Lower limb immersed in water- pressure causes a massaging effect upwards which aids venous return and reduce oedema formation

Swimming• A non- weight – bearing exercise in which the limbs work against the resistance of water in a symmetrical pattern (Bromiley, 1991)

• A common form of hydrotherapy or aquatherapy used in rehabilitation of animals (dogs and horses)

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Swimming

Underwater treadmills

Hydrotherapy pool

Bath tub

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Mechanism of Action•Increases muscle strength and mass - viscosity ,surface tension• decrease pain and Increase range of motion - buoyancy and viscosity•Increase cardiovascular fitness- buoyancy and resistance• enhance venous return and reduces edema- hydrostatic pressure

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• Indications/applications in animals• Orthopedic disorders• Neurologic disorders• Muscle atrophy• Decreased joint function and range of motion• Limb edema

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• Specific disorders where hydrotherapy is indicated as part of rehabilitation include: Dogs:

• Fractures• CCL rupture • Total hip osteotomy• Arthritis• Intervertebral disk disease• joint effusions

Effects of postoperative rehabilitation on limb function after cranial cruciateligament repair in dogsMarsolais et al., 2002 Controlled studyhome exercise dogs vs. dogs hospitalised for intensive rehabilitation on three alternate weeks during their early recovery period.

Method: Hospitalized : dogs swam twice daily for between 10 and 20 minutes, five days a week on these three weeks. Result :Using force plate analysis, six months following surgery, the swimmers were less lame on their operated limb than restricted exercised dogs and in swimming dogs, there was no difference in limb function between their operated and their normal limbs. In the exercise restricted dogs, six months following surgery, limb function was still signifi cantly less in the surgical limbs compared to their normal limbs

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Limitations/Contraindications1. Open, infected draining wounds2. Unhealed surgical incisions 3. Active gastrointestinal disease 4. Elevated body temperature5. Respiratory compromise or distress6. Systemic compromise- severe cardiac, liver,

kidney problem, hypotension,hypertension7. Uncontrolled epilepsy8. Advanced debility

Recommendation • Hip dysplasia

-Definition: abnormal development of the coxofemoral joint characterized by subluxation, or complete luxation, of the femoral head in younger patients and mild to severe DJD in older patients.-Painful condition, usually dog reluctant to move ,especially large breed commonly affected, load on joint causes contact of acetabulum and head-Non use of limb usually result to muscle atrophy-Conventional treatment:NSAIDS- Carprofen (rimadyl)VIT EGlucosamine chondroitin

Complementary Physical therapy:Swimming- encourages use of limb with less load on hip (buoyancy) - decreasing pain, improve muscle mass (stabilizing the joint)

Heat and Cold Therapy

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Cold therapy (Cryotherapy)• the application of a cold agent to an affected

area of the body to provide therapeutic effects by reducing tissue temperature.

Mechanism of ActionCold

Local vasoconstriction

Reduced tissue metabolism

Reduces inflammation (reduce edema formation)And hemorrhages (blood clot)

Reduce muscle spasm

analgesiaDecrease need for oxygen and nutrients

Reduced metabolites and heat production

Decrease conduction velocity of sensory and motor nerves

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Techniques of cold application for horses and dogs 1. Crushed iced2. Cold packs-3 parts water + 1 part rubbing alcohol

(freezed)3. Running stream4. Whirlpool tubs5. Wellie boots6. Hosing7. Cold bandaging8. Frozen gamgee or cotton wool pads

Treatment: 15-25 minutes at a time ( monitor response of tissue after first 5-10mins) 3-6 times for first 72 hours for acute injury and post surgery.

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Cold TherapyIndications:1. Musculoskeletal trauma (acute injury)2. Post surgical swelling3. Local edema4. Haematoma formation5. Pain relief

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Specific surgical procedures where cryotherapy is indicated postoperatively for pain and swelling include:• Femoral head and neck ostectomy• Tibial plateau leveling osteotomy • Tibial tuberosity advancement

Effect of cold compression therapy on post operative pain, swelling, range of motion and lameness after tibial plateau leveling in dogs

Drygas et al., 2011

• Objective—To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling osteotomy (TPLO) in dogs.

• Animals—34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO.

• Procedures—Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery.

• Results—No complications were observed, and all dogs tolerated CCT. Use of CCT resulted in lower values for the visual analogue scale and Glasgow pain scale and lower pain threshold scores; lower lameness scores; less swelling; and an increased range of motion 24 hours after surgery. At 14 days after surgery, there were no significant differences between groups. At 28 days after surgery, too few data sets were available for comparison.

• Conclusions and Clinical Relevance—CCT decreased signs of pain, swelling, and lameness and increased stifle joint range of motion in dogs during the first 24 hours after TPLO.

Limitation/Contraindications:1. Open wounds2. Fractures3. Areas around superficial nerves4. Very young or old dogs

Heat therapy (Thermotherapy)• the application of a heat agent to an affected area of the body to provide therapeutic effects by increasing tissue temperature via conduction, convection and

radiation.

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Mechanism of Action• Heat therapy

A. Artificial sources for delivery of heat to tissues1. Hot packs 2. Hot towels/ Hot packing3. Hot water bottle4. Heated pads5. Infrared lamps- luminous/ non luminous6. Sunlight artificial sources:

Full spectrum lightsCradle solarium

Heat therapy applied - 72 hours post injury,15-30 mins (3-4x a day)

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Indications:1. General malaise2. Post trauma3. Post surgery4. Chronic inflammation5. Sprains and muscle stiffness

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Specific procedures or disorders that benefit from heat therapy include:• Cranial cruciate ligament (CCL) rupture• Fracture repair• Tendon and ligament injury management• Neurologic disorders, such as intervertebral disk disease • Osteoarthritis

• Limitations/Contraindications:1. Acute inflammation2. cutaneous hemorrhage3. Thrombophlebitis4. Edema5. Open wounds6. Patients with poor thermoregulatory capacity

Contrast Bathing• Use of alternate cold and hot therapy

Cold – vasoconstrictionHot- vasodilation Increased circulatory

flow

Technique: alternate cold and hot towel compress every 3 minutes for 20-30 minutes

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Indications :1. Soft tissue damage2. Haematoma3. Filled joints4. Filled legs

Contraindications:1. Open wounds2. infections

Recommendations for Hot and Cold Therapy• Complementary to Conventional therapies

1.Post -operative swelling: enucleationConventional Complementary - NSAIDs cold compress-first 24 hrs-antibiotics warm compress after inflammation subsides2. Rectal prolapseConventional Complementary-NSAIDs/Corticosteroids Cold sugar solution

3. Sprainrestcold compress- first 24 hrs

References:1. Bromiley,MW. 1991. Physiotherapy in Veterinary. London: Blackwell Scientific Publications.2. Burnett, J. and Wardlow, J. 2012. Physical Rehabilitation for Veterinary Practice. Today’s Veterinary Practice. 18-20. 3. Mcgowan, C.M.,Goff, L. and Stubbs N. (ed).2007.Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals.Ames Iowa. Blackwell Publishing. Pp 187-197. 4. Drygas,KA,McLure SR, Goring,RL,Pozzi,A,Robertson,S,and

Wang C.2011.Effect of Cold Compression on postoperative swelling and Range of motion and lameness after tibial plateau Leveling Osteotomy in Dogs.Journal of American Veterinary Medical Association.238(10)1284-1291.

4. Marsolais, GS,Dvorak,G and Conzemius, MG. 2002. Effects of Postoperative Rehabilitation on limb function after Cranial Cruciate Ligament Repair. Journal of American Veterinary Medical Association. 220(9):1325-1330.

5. Millis, D. Levine D. and Taylor R. 2004.Canine Rehabilitation and Physical Therapy.USA. Elsevier.pp 264-288. 6. Owen, MR . 2006. Rehabilitation Therapies for Musculoskeletal Disease in Small Animal Practice. European Journal of Companion Animal Practice.16: 137-145. 7. Prankel, S. 2008. Hydrotherapy in Practice. In Practice. 30: 272- 277.