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Success does not have to start with failure

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Kristin Wolter, CVT, CCRA, CCFT                             
October 25, 2017

I started off intending for this blog post to be about post operative complications. Quickly, I realized that while complications are important to the topic they are not really what I wanted to address. What I really wanted to address was the why and when patients should begin a physical rehabilitation program post-operatively.

We get many calls from veterinarians and prospective clients in regards to when a patient should start a physical rehabilitation program.  In all honesty, for most orthopedic and neurologic surgery, we would love to start a program within the first week of surgery. However, most often, we begin a program after sutures are removed and occasionally even several weeks post op. With all cases, the key to a successful physical rehabilitation program is to start it when the patient is doing well, not after it has been determined that they aren’t making desired progress.

Why does it matter?

Getting an early start with physical rehabilitation allows us to help address residual inflammation and pain, which helps increase function, reduce scar tissue and promote healing. In addition, starting early empowers the client by having them actively participate in their dog’s recovery from the very beginning. Thoughtful progression of therapeutic modalities early in recovery, followed by appropriate exercise when the patient is ready can help mitigate the risk of short and long term post-op complications.

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An electrode is applied to the skin for TENS/NMES treatment

Because there are no cookie cutter dogs, we do not use cookie cutter protocols nor expect every patient to recover in exactly the same way. We regularly assess gait, function, strength, surgery site and compensatory pain and inflammation. Close monitoring allows us to tailor a rehabilitation protocol for the patient that is in front of us, not the patient we saw last week. Progression is malleable and adapting to the patient’s needs is imperative in helping them achieve the best return to function possible. If a patient is not meeting our goals we can then refer them back to the surgeon for more in depth evaluation.

Occasionally we are referred patients who simply aren’t making any progress post operatively, or, who started to make progress and then things went sideways or backwards. (Hint – these are the patients we wish we could have seen from the beginning of their recovery.) The hope is that physical rehabilitation will turn things around.

I am going to be blunt…generally speaking, if a patient is not making some steady (even slow) progress without physical rehabilitation, adding a physical rehabilitation program will probably have marginal impact. It is virtually impossible to increase function and strength when a patient’s pain or continued dysfunction is not addressed. If a limb is comfortable to use, has relatively normal range of motion, good alignment, is structurally stable, has normal neurologic function and no secondary injury, infection or tumor has been diagnosed, then, regardless of how long the patient had been hopping, skipping or limping before surgery, they should begin to make steady progress after the initial post-op inflammatory response has resolved. Teacup and micro-dogs can sometimes be an exception to this rule, but perhaps not as often as one might think.

Additionally, It is very important to couple pain management with dedicated strengthening, balance and coordination exercise. Doing one without the other is a bit like trying to ride a bike without both pedals. It can be done, but it’s not as efficient. There is still a misconception that discouraging over use by means of reduced pain control is an effective method in reducing complications. While the patient may certainly not overuse the limb due to pain, the long term complications from the increase in compensatory movement is often overlooked with this particular methodology.

Physical rehabilitation should be used to enhance and improve the outcome of surgery both in the short and long term. When we miss the opportunity to begin a physical rehabilitation program early in a patient’s recovery, we also lose the opportunity to quickly address setbacks that sometimes occur. Complications will unfortunately always be a possibility for patients recovering from surgery. Our hope is that with patient specific monitoring, appropriate pain management and therapeutic work, hopefully some of those complications can be avoided all together.

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Cheers!

Kristin