Physiotherapy options in a nutshell and physiotherapy examination

From the first part we know what rehabilitation and physiotherapy in a nutshell entails. We have defined physiotherapy as a part of comprehensive rehabilitation that deals with the diagnosis, treatment and prevention of disorders of the locomotor system of an individual. To do this, we use manual and movement therapy as well as various physical methods. In conclusion, we have made a basic breakdown of the various treatments or methods. In the last piece, we talked about physiotherapy education. It cannot be assumed, as in human physiotherapy, that if someone even the most skilled takes a course or two in massage or balance exercises that they will fully understand your dog's movement problems and ailments. It is also unlikely to be enough, despite the experience gained, to help an adequately exercising dog after exercise or in preparation for training. Similarly, from my perspective, it is inadequate to the point of being silly to address misaligned vertebrae without having a real (and I emphasize real) understanding of intervertebral disc prolapse, how the nervous system responds to irritation or oppression, and what a pinched nerve does to its executive organ, the muscle. Otherwise, I wouldn't try to fix the end result, just one piece of the whole mosaic, but I would start at the cause, i.e., I would let them figure out why the vertebrae are dodging. That is why a veterinary physiotherapist also needs to have an overview of anatomy, neurophysiology, physiology and pathology of connective tissue, he needs to know the neurological and orthopaedic diseases, and the principle of surgical interventions to know what happens to the musculoskeletal system, what changes occur, what consequences it may have on the other limb or other end of the body. The physiotherapist also needs to have concepts in veterinary medicine from other medical disciplines such as internal medicine, to know the basics of nutrition, how the body of an old or obese dog or cat works, to be familiar with the cynology of sporting and service breeds, animal behaviour, and last but not least, to be, in a sense, a good psychologist for the owners of four-legged patients. Even when an animal patient presents with a diagnosis or a report regarding surgery and post-operative care with recommendations, including rehabilitation procedures (some veterinarians are more, others less, up to date on all that animal physiotherapy entails and entails today), the physiotherapist must do his or her own examination. This is preceded by a sort of check of the anamnestic data, or he supplements the data with information of the type: what kind of environment the dog is in, whether it is exclusively an apartment dog, living in a kennel, in the garden, stairs and jumping on couches, frequency and intensity of walks, playing habits, recreational or competitive sports, working breed, other animals in the household, it is necessary to estimate the temperament of the animal, whether it is a more timid type, for some reason it may be aggressive (fear, dominance). An indication of whether the dog is running vigorously around the fence (chasing a potential intruder) is also of value. Of course, details of previous illnesses and injuries, medications, and assurances from the owner that the animal does not have an infectious disease and has not been in contact with such a source. The physiotherapy examination should consist of an examination of posture and movement, as well as gentle superficial and deeper palpation of the body, or skin, subcutaneous tissue, muscles. This is followed by a neurological (reflexes and reactions) and orthopaedic (examination of bones, joints, tendons) examination. Finally, we should localize the soreness. If we know the painful areas in advance from the owner or assume it from the medical report, we try to avoid them at the beginning of the examination so as not to induce negative reactions in the patient right from the start. This examination should set the physiotherapy localization, diagnosis and set short and long term goals with the owner, put together a program of treatments and also create homework for the owner. The physiotherapy localization does not have to be only the site diagnosed by the veterinarian clinically, on the radiograph, CT or MRI scan, or not just the body part operated on. The physiotherapist may find - locate other problem areas on the overused limb, painful or stiff (in tension) muscles, shortened tendons, trigger points on muscles, limitations in range of motion in a joint, etc. These are then the physiotherapy diagnoses that describe the changes in the musculoskeletal system. A physiotherapy diagnosis may also describe an abnormal posture or movement pattern, ideally also with a possible cause for this musculoskeletal abnormality, for example due to arthritis of the joint, chronic prolapse of an intervertebral disc, etc. After elucidation of the findings to the owner, this is followed by the establishment of a short- and long-term goal. The owner must understand and be identified with the goals. I always consider it important in medicine that the patient, and in veterinary medicine the owner, understands the diagnosis and its cause, and of course the possible treatment of the disease or injury, even though it may have a cautious or poor prognosis. In order to achieve the goals, individual physiotherapy sessions, physical therapy and the use of possible aids are planned, nutrition and exercise regimen or lifestyle changes are consulted. The so-called homework for the owner must not be forgotten. After all, without regular exercise in the home environment, all the work will be half done or even less. I always find it ridiculous if someone thinks that it will save everything to attend rehab once or twice a week for a few weeks and think that it will save my dog or myself. Even worse is the modern rehabilitation path based almost entirely on machines - i.e. physical therapy. I see this as a major failure in the rehabilitation of many patients and the haste of today's times is contributing to this. Often people or even dogs are only fitted with physiotherapy devices (for people, it is "chasing" points for insurance companies; in this way, a physiotherapist can attend to several patients at the same time, one is lying on magnets, another is having electrotherapy, the last one is exercising, all as quickly as possible, the next one is already waiting, and there are still "papers" to be filed - surely a bad example, isn't it?). Communication and explanation of each step, including instruction on exercises for the home regime, must not be missed. In short, the erudition and empathy of the physiotherapist is important, along with the motivation of the patient (i.e. in veterinary physiotherapy, the animal and the owner at the same time). Our physiotherapeutic methods, using various physical variables, will be presented in detail in the following chapters: manual techniques - massage, passive joint movements (so-called ROM - range of motion), joint mobilisation, stretching (stretching); as well as active movement therapy (assisted exercise and walking, balance exercises, self-movement therapy on various surfaces and using obstacles, or conditioning walking, trotting, etc.). Here we use our hands and movement therapy aids (balancing aids, cavalcade and slalom obstacles, natural materials). Elements related to the coordinated function of the nervous system and muscles can also be used for rehabilitation. Here we include elements from neurophysiology and neurodiagnostics: training of postural reactions (proprioception is responsible for posture and awareness of individual body parts in space) or spinal reflexes, or training of certain movement patterns, similar to the renowned methods of Vojta, Mojžíš or DNS (Dynamic Neuromuscular Stabilization according to Prof. Kolář). Separately, we will also deal with physical therapy, which uses other physical variables: hydrotherapy (use of water in the context of walking and swimming in water or on the so-called underwater walking belt), electrotherapy (TENS, ENM - electrical neuromuscular stimulation, galvanic currents), thermotherapy (heat and cold), magnetotherapy (pulsed magnetotherapy), laser, therapeutic ultrasound and shock waves.

MVDr. Aleš Tomek, DipECVN