An Introduction to Veterinary Sports Medicine and Rehabilitation

https://d360v0nslzk1hl.cloudfront.net/thumbnail_images/57/thumbnail_57.png?Expires=1569111938&Signature=QNGjMbhS-Cro5REVZ14TSPZoch7K50NY6qf-EWxzWXjyip9~crsH-wRv-BkuDYeqbYJwqDv7FgN0VrWY6wcNepYcEC7dtHQ3ML~f1ziPcHXB7MNwgptHCA-rNqFX2ip-luG9ugGDxeB8HA7N1vu2dXAljtuRzrtA5wHqSI4wcWUcFNREgyhwNkyck5CDnhaES8QzA2T2jHrxgfXrJKqAUIHzpgn0nJ80I5hmkG7qks3GkhlhE7kJj5Da-qRYugui2MQ~UiRNXr9RmaP~Qq2VuDNLiYn6QpLnFckqEpU3t66knY4IpbkuIUCt5EAXjSkqlU55t2uuFwkg5mc5RlpW1w__&Key-Pair-Id=APKAJYRCU5335P523QIQ

Matt Brunke, DVM, CCRP, CVPP, CVA Matt Brunke 2019-07-01

Free Content

Show All

p.1 - Play the video from this slide.

p.1

An Introduction to Veterinary Sports Medicine and Rehabilitation
Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, American College of Veterinary Sports Medicine and Rehabilitation

p.1
p.2 - Play the video from this slide.

p.2

A little about me..... I like to keep busy

p.2
p.3 - Play the video from this slide.

p.3

Acknowledgments
- Ms. Rebecca Chase
- Dr. Darryl Millis
- Dr. Deb Gross
- Dr. Joe Wakshlag
- Dr. David Levine
VETERINARY MEDICINE IS A TEAM SPORT
TEAMWORK IS NOT OPTIONAL.

p.3
p.4 - Play the video from this slide.

p.4

Origins of Veterinary Rehab
- Human Physical Therapy
- Treating the soldiers of World War I (1914-1918)
- Equine Rehab
- 1960’s
- Equine and Canine Rehab
- Mainstream in Europe and UK by 1980’s
- University of Tennessee - 1998
- Canine Rehabilitation Institute -2003
- American College of Veterinary Sports Medicine and Rehabilitation - 2010

p.4
p.5 - Play the video from this slide.

p.5

Objectives
- 5 questions about rehab
- Apply in your practice
- When/where to refer
- Quick case examples

p.5
p.6 - Play the video from this slide.

p.6

Who, what, when, where, why and how?
- Guidelines not rules - Adapt for the individual

Briefcase with important lab results.

p.6
p.7 - Play the video from this slide.

p.7

Who?
Who can do it?
- Veterinarians and Vet Techs
- Physical Therapists/Physio
- Depends on state/province
- Check your practice acts
Who can train me?
- CCRP : UTVetCE.com
- CCRT : CanineRehabInstitute.com
- CVMRT - HealingOasis.edu
- ACVSMR Residencies - VSMR.org

p.7
p.8 - Play the video from this slide.

p.8

More importantly.... Who needs rehab?
- EVERYBODY!
- Old – mobility issues
- Young – start with good habits. Congenital defects
- Arthritic
- Overweight
- Post-op (CCL, FHO)
- Pre-op - Non-operative
- Athletes – agility, law enforcement, military
- Alternatives to meds?
- IVDD
- Lumbosacral Dz
- Degenerative Myelopathy
- FCE
- Amputees
- Trauma cases
- Brain surgery (ok, that one you may want to refer)

p.8
p.9 - Play the video from this slide.

p.9

Just remember
- They don’t read books
- See the big picture
- More than one issue
- DJD and CRF
- CHF and IVDD

p.9
p.10 - Play the video from this slide.

p.10

A moment for our feline friends
- They need our help too!
- They are NOT small dogs
- Have special requirements (carnivore)
- Do great in rehab (acupuncture)
- Yes they can swim!

p.10
p.11 - Play the video from this slide.

p.11

What is involved in rehab?
- More learning!
- Being practical
- A good knowledge base (anatomy, diseases, meds, tissue healing)
- Communication (owner’s goals, specialist’s input, doctors and techs)

p.11
p.12 - Play the video from this slide.

p.12

What else?
Things you already have
- NSAIDs
- Chondroprotectants
- Gabapentin, amantadine
- Prescription food
- Ice packs
- Microwave
- Towels
- Bedding
- LASER?
- Space?
Or you may have to buy
- Hydrocollator
- Goniometers
- Girth tape
- Cavaletti rails
- Physioballs
- Agility equipment
- Electrical stim units
- Land treadmill
- Underwater treadmill
- Pool

p.12
p.13 - Play the video from this slide.

p.13

Basic Equipment

p.13
p.14 - Play the video from this slide.

p.14

What about the environment?
- Hot?
- Cold?
- Indoor?
- Outdoor?
- Footing?
- Diseases? Heat stroke, ticks, snakes
- Are we feeding?

p.14
p.15 - Play the video from this slide.

p.15

What am I looking for?
- Full PE (ortho/neuro)
- Symmetry/girth
- Range of motion
- Shifting weight/lameness
- At a walk/trot (treadmill)
- Secondary effects
- RADIOGRAPHS
- What goals are you aiming for?

p.15
p.16 - Play the video from this slide.

p.16

Stance Analyzer
- Scale
- Measures weight on each leg
- Normal – 30% on each front leg, 20% on each hind leg

p.16
p.17 - Play the video from this slide.

p.17

Results

p.17
p.18 - Play the video from this slide.

p.18

Gait Analysis – Pressure Walkway

p.18
p.19 - Play the video from this slide.

p.19

Treadmills
- Diagnostic tool also
- Safe and contained
- Feet always touching ground
- Buoyancy
- Takes a few seconds/minute to get them used to it

p.19
p.20 - Play the video from this slide.

p.20

SOAP BOX
- ALWAYS, ALWAYS TAKE RADIOGRAPHS
- 2 views, and the other leg
- Radiology Consult
- VIN Post
- VSMRI Post
- Phone a friend

Why Radiologists want 2 views - Lateral view vs AP view

p.20
p.21 - Play the video from this slide.

p.21

But collimate and be safe!

p.21
p.22 - Play the video from this slide.

p.22

Other diagnostics
- X-rays
- Ultrasound (diagnostic)
- CT Scan - MRI
- Arthroscopy
- Gait analysis software
- Force plate

p.22
p.23 - Play the video from this slide.

p.23

Goals of rehab
- 4 phases
1) What’s the problem?
2) Control pain
3) Improve strength
4) Maintain/return to function

p.23
p.24 - Play the video from this slide.

p.24

Be Active
- Leash walking, jogging
- Treadmill????
- Agility activities
- Hiking
- Be inventive

p.24
p.25 - Play the video from this slide.

p.25

Thermotherapy
Be creative.
DON’T USE ELECTRIC HEATING PADS.

p.25
p.26 - Play the video from this slide.

p.26

Running hot and cold
Heat
- Vasodilation
- Increase blood flow
- Warm up before stretching
- Pain relieving
- Reduce muscle spasm
- NOT: on cancer, open wounds, impaired circulation
- Test on yourself first
Cold
- Vasoconstriction
- Decrease blood flow
- Anti-inflammatory
- Pain relieving
- NOT: advanced CV dz, open wounds, cancer, never directly to skin use a thin towel ).Careful around implants

p.26
p.27 - Play the video from this slide.

p.27

Other modalities
Therapeutic Ultrasound
Electrical Stimulation

p.27
p.28 - Play the video from this slide.

p.28

In further detail...
Therapeutic Ultrasound
- Deep heating of tissues.
- Quadriceps, biceps tendonitis, fibrotic myopathy
- Heat and stretch contractures
- Not on cancer or pregnancy (E- stim too)
Electrical Stim
- Two types
- NMES (Neuro Muscular Electrical Stim)
- Mimic muscle movement
- LMN Disease
- TENS (Transcutaneous Electrical Nerve Stimulator)
- Pain relieving

p.28
p.29 - Play the video from this slide.

p.29

Light Amplification by Stimulated Emission of Radiation
- Photobiomodulation
- Amplification or Oscillation? (better acronym)
- Activate cytokines and other tissue factors
- Decrease pain and inflammation - Increase wound healing
- Always use goggles
- Can use in acupuncture
- Not on cancer or pregnancy

p.29
p.30 - Play the video from this slide.

p.30

Therapeutic Exercises

p.30
p.31 - Play the video from this slide.

p.31

Other examples

p.31
p.32 - Play the video from this slide.

p.32

Core Strengthening

p.32
p.33 - Play the video from this slide.

p.33

Advanced Core Strength

p.33
p.34 - Play the video from this slide.

p.34

Underwater treadmills

p.34
p.35 - Play the video from this slide.

p.35

Carts

p.35
p.36 - Play the video from this slide.

p.36

Carts
- Can be set as wheelchairs or walkers
- Adaptive - Make pet twice as wide
- Always supervised
- Front wheel, rear wheel, 4 wheel
- Ferrets, cats, dogs, goats, sheep, llamas

p.36
p.37 - Play the video from this slide.

p.37

Orthoses and Prostheses
- Variable applications
- Numerous Companies
- K9 Orthotics/Prosthetics
- Support braces
- Therapaw

p.37
p.38 - Play the video from this slide.

p.38

Image of Prosthetic leg made for not fully developed leg

p.38
p.39 - Play the video from this slide.

p.39

Stifle brace

p.39
p.40 - Play the video from this slide.

p.40

Other therapies
- Pain medications (NSAIDs, gabapentin, amantadine)
- Neutraceuticals (Glu/Chond/MSM, Omega- 3)
- Disease Modifying Agents - Hyaluronic Acid
- Stem Cells, Platelet Rich Plasma (PRP)
- Surgery (minimally invasive)
- Shockwave
- Massage
- Joint Mobilizations
- Acupuncture
- Herbal/food therapy
- Chiropractic

p.40
p.41 - Play the video from this slide.

p.41

What about food?
- HUGE importance
- Obesity – diet and exercise
- Prescription diets
- Hill’s/Purina/Royal Canin programs
- Nutritional Advocate
- Technicians
- Nutrition consults
- Boarded nutritionists – web/phone
- Some patients have other "special" needs
- IBD, allergies, renal dz

p.41
p.42 - Play the video from this slide.

p.42

Life-shortening disease

Average reduction in lifespan for overweight dogs across popular breeds
Figures show average reduction in years of life for overweight dogs, compared with those at ideal weight.

- Chihuahua Male: -2.1 years, Female: -2.1 years
- Pomeranian Male: -1.8 years, Female: -1.9 years
- Yorkshire Terrier Male: -2.5 years, Female: -2.0 years
- American Cocker Spaniel Male: -1.5 years, Female: -1.5 years
- Dachshund Male: -2.3 years, Female: -2.3 years
- Beagle Male: -2.0 years, Female: -2.0 years
- German Shepherd: Male: -0.4 years, Female: -0.6 years
- Golden Retriever Male: -0.8 years , Female: -0.8 years
- Labrador Retriever Male: -0.6 years, Female: -0.6 years

German A Association between life span and body condition in neutered client-owned dogs. Journal of Veterinary Internal Medicine December 2018 Available here: https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.15367

p.42
p.43 - Play the video from this slide.

p.43

What techniques do I use?
- All of the ones we just mentioned!
- I adjust to my patient's needs, client's needs/wants
- I offer what I would do if it was my pet!

p.43
p.44 - Play the video from this slide.

p.44

When are you finding rehab patients?
- Every exam you do!
- Especially geriatrics. – Age is NOT a disease
- Know your normal – flex/extend every patient
- History ?’s – Trouble with stairs? Less active?
- Feel for: joint thickening, muscle wasting, decreased elbow flexion, decreased hip extension
- Look for: scuff marks on nails, poor posture,swayback, uneven pad wear

p.44
p.45 - Play the video from this slide.

p.45

When do we do rehab?
- Set aside parts of your schedule
- Initial consult – 60-90mins
- Rechecks - 30 minutes
- Rehab sessions (tech) - 60- 90 minutes.
- Owners drop off or stay - Start with two days a week (Mon/Thurs?)

p.45
p.46 - Play the video from this slide.

p.46

When do pets need rehab?
- Post CCL repair – 2x week for 6 weeks
- FHO – twice a week for 2-3 months
- IVDD – 2-3 times a week for 1-4 months
- "Fat Camp" – 1-2x week (treadmill) until skinny
- Geriatrics – Every 1-2 weeks – "spa days"

p.46
p.47 - Play the video from this slide.

p.47

Inpatient vs. outpatient
- Getting started – outpatient
- Down patient – might be better with daily nursing care.
- Back and forth morning and night

p.47
p.48 - Play the video from this slide.

p.48

Where do we do rehab?

p.48
p.49 - Play the video from this slide.

p.49

Before and after

p.49
p.50 - Play the video from this slide.

p.50

Where on the pet do we rehab?
- See the big picture
- "TPLO" vs. obese lab with arthritic left hip and TPLO on right leg
- Balance the body
- Focus on the obvious, but apply to whole pet.

p.50
p.51 - Play the video from this slide.

p.51

Why?
- Safe
- Fun
- Return to work
- Bonding time
- Keep/get in shape
- Conditioning
- To do it again

p.51
p.52 - Play the video from this slide.

p.52

Why do rehab?
- It helps!
- Get back to function faster
- Higher expectations by owners
- You have to like it
- You can blend different areas (physiotherapy, LASER, shockwave, acupuncture, etc..

p.52
p.53 - Play the video from this slide.

p.53

How do we get rehab done?
- Has to be a team approach
- Different departments working together
- Veterinarians and LVT/CVT (both can be certified, vets can be VSMR’d, VTS coming for technicians)

p.53
p.54 - Play the video from this slide.

p.54

Take home message
- Rehab is fun!
- You can make it easy or challenging
- It is NEEDED and we need to work as a team

p.54
p.55 - Play the video from this slide.

p.55

Contact info
- VOSM - Veterinary Orthopedic & Sports Medicine Group
- drmattbrunke@gmail.com

p.55
p.56 - Play the video from this slide.

p.56

Resources/References
- UTVetCE.com
- VSMR.org
- IVAPM.org
- IAVRPT.org
- Canine Rehabilitation & Physical Therapy 2nd edition – Millis, Levine, Taylor
- BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative Care – Lindley and Watson

p.56