39:13

An Introduction to Veterinary Sports Medicine and Rehabilitation

https://d360v0nslzk1hl.cloudfront.net/thumbnail_images/57/thumbnail_57.png?Expires=1775048859&Signature=duaqaaaiRzMNJsOkr6MuysIAgW4gATNUFV7HwCC4kr9srHZfIRDNeoweK2Fspv8~8Uk3xH8YcCwilDjHwo~JIzIbYk5NYzu-xnYg-7HmjgTC7gOrmPxOgKnPrGWArH6GKFOLOCynlM5NsF7XEEjhfZaYpVdqjGLlExf~O-doaR7FnIOVnF-FZEjrUuJB6aukskEbxuQznBxxsCvqarxvUfbpSqvIzTHePmcAVkbOrhAxhqqCLtIdVs2W2PPuY4RA7axHuZKwf3xcZhiShzrXVneZR13gOCZNMn2dZBMk1jqB2OEaRmNG2X7MrflEMBaWTMLuxictlVDK2iQUXzuwVw__&Key-Pair-Id=APKAJYRCU5335P523QIQ

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

Slides

Related Videos

Show All

p.1

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

p.2

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

p.2
p.3

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

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

p.5

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

p.5
p.6

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

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

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

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

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

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

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

p.13

Basic Equipment

p.13
p.14

p.14

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

p.14
p.15

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

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

p.17

Results

p.17
p.18

p.18

Gait Analysis – Pressure Walkway

p.18
p.19

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

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

p.21

But collimate and be safe!

p.21
p.22

p.22

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

p.22
p.23

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

p.24

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

p.24
p.25

p.25

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

p.25
p.26

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

p.27

Other modalities
Therapeutic Ultrasound
Electrical Stimulation

p.27
p.28

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

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

p.30

Therapeutic Exercises

p.30
p.31

p.31

Other examples

p.31
p.32

p.32

Core Strengthening

p.32
p.33

p.33

Advanced Core Strength

p.33
p.34

p.34

Underwater treadmills

p.34
p.35

p.35

Carts

p.35
p.36

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

p.37

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

p.37
p.38

p.38

Image of Prosthetic leg made for not fully developed leg

p.38
p.39

p.39

Stifle brace

p.39
p.40

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

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

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

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

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

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

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

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

p.48

Where do we do rehab?

p.48
p.49

p.49

Before and after

p.49
p.50

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

p.51

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

p.51
p.52

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

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

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

p.55

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

p.55
p.56

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

Please log in to watch this content

Haven't created an account yet?