Post-surgical rehabilitation of the small animal patient is not a new idea, but it is typically underutilized and often only begun after a pet has failed to recover as expected. Gone are the days of immobilizing a joint or limb for thirty days post operatively, or the notion that the patient will use the limb when it feels good. These restrictions can lead to severe muscle atrophy, decreased range of motion, and persistent dysfunction. This can, in turn, lead to re-injury and undoubtedly to the pet owners dissatisfaction of the service provided. The objectives of physical rehabilitation immediately after orthopedic surgery are to decrease pain and swelling, increase range of motion, and prepare the patient for further therapy.
Animals frequently suffer from orthopedic and neurological conditions that can leave them with decreased mobility and limited ability to perform normal activities. This decrease in activity can cause joint stiffness, muscle atrophy and generalized weakness, as well as decreased flexibility. Physical rehabilitation can prevent these conditions and improve functional outcomes. Passive range of motion exercises are most frequently implemented when a patient is not using a limb because of pain, or is unable to use the limb due to lack of motor function. Moreover, mobilization has been found to be critical to the health of articular cartilage. Passive motion should be initiated as soon as possible after surgery. In fact, starting passive range of motion the day after surgery is preferred for patients recovering from orthopedic injury.
Passive exercise maintains the normal range of motion and prevents soft tissue contracture. Range of motion exercises maintain muscle length as well as the extensibility of tendons and ligaments while the area is healing. Many of the structures inside the joint lack direct circulation and require movement of fluid within the joint for nourishment. These exercises also help to improve blood flow and sensory awareness of these affected joints and limbs. Pain relief is also a benefit of passive range of motion. Think about how uncomfortable joints feel after spending a day or two in bed with the flu. Gentle movement of the limbs will increase the movement of fluids within the joint and remove the chemicals that create pain and inflammation. This will ultimately lead to quicker healing and a more complete recovery.
To adequately treat a patient using passive range of motion exercises, first the patient should be comfortable and relaxed with the limb well supported. Each joint on the affected limb should be treated. Treatment involves slowly flexing and extending the limbs through a normal pain-free range of motion (or until limited by joint mobility) for ten to fifteen repetitions two to three times a day. It is important to remember that range of motion exercises should only be performed on joints and limbs that are stable. Do not perform these exercises on luxations, hypermobile joints, or unstable fracture sites. Caution should be used in working with patients with bone tumors or recent skin grafts. Hold the joint and gently move the limb until the desired flexion or extension is achieved. An alternate method involves moving the entire limb through a range of motion similar to that of ambulation for ten to fifteen repetitions. By performing passive range of motion exercises, a pet's owner can become involved with the animal's home care. Early motion is effective in speeding recovery and limiting effects of disuse on bone, cartilage, ligaments and tendons. In certain patients these exercises can be used in conjunction with other therapeutic modalities for optimum rehabilitation and recovery results.
Cara Church has been a Certified Veterinary Technician for over 11 years, She works in an animal hospital, as well as having her own pet care businesses:
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