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Fig. 1

The use of electrophysical modalities, manual therapy, ergonomics, and therapeutic exercise during physical rehabilitation varies over time. As an example, when considering physical rehabilitation at 3 stages of recovery after stabilization of a cranial cruciate injury, a shift in emphasis over time is visible from electrophysical modalities in the acute phase (green), to manual therapy in the midterm (red), and to therapeutic exercise in the long term (blue).

Fig. 2

Loss of joint motion can affect all joints and has a profound impact on physical rehabilitation of dogs. Subjectively, the stifle joint is most vulnerable, as seen in a young Beagle after a bite to the thigh region (loss of flexion, A) or a Miniature Poodle with bilateral grade 4 patellar luxation (loss of extension, B). Loss of motion can also occur in the carpus, as seen a young Doberman with a developmental loss of extension associated with a lack of length in the flexor carpi ulnaris muscle (C) or in a Whippet with a lack of digit extension, resulting from a lack of length in the digital flexor muscles (D). Excess motion also impacts physical rehabilitation. Subjectively, the carpus and tarsus are most vulnerable to excess joint motion compared with other major joints. A young German Shepherd has lax carpi (E) and a young Saint Bernard has hyperextended tarsi as a consequence of hip dysplasia (F).

Fig. 3

Care algorithms representing the reliance on the 4 key aspects of rehabilitation: electrophysical modalities, manual therapy, therapeutic exercise, and ergonomics over time for various patients commonly receiving physical rehabilitation. For a patient undergoing surgery to stabilize a cranial cruciate ligament-deficient stifle joint (A), the initial emphasis of care (at day 3, acute phase, green shaded area) would be placed on electrophysical modalities (cold, therapeutic ultrasound, TENS, photobiomodulation) and manual therapy (passive range of motion, massage). At day 14 (subacute phase, red shaded area), the emphasis would shift to manual therapy (stretching) and therapeutic exercise. At day 28 (chronic phase, blue shaded area) the emphasis would shift further to therapeutic exercise. For a dog recovering from surgery to manage herniation on an intervertebral disc (B), the emphasis of care would initially be placed on ergonomics (eg, nursing care, ambulation assistance) with some care involving electrophysical modalities and manual therapy. At day 14, the emphasis on ergonomics would remain, with an increase of emphasis toward therapeutic exercise. At day 28, the emphasis would shift to therapeutic exercise while continuing the focus on ergonomics (ambulation assistance). For a dog recovering from surgery to manage a fracture (C), the initial emphasis of care would be on electrophysical modalities (cold, TENS, therapeutic ultrasound) and manual therapy (passive range of motion and massage). That emphasis would shift progressively to exercise at days 14 and 28.

First page of article
The design of a physical rehabilitation program is based on the medical condition and the anticipated progression of that condition, the profile of the patient, and the owner.

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