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PHYSIOTHERAPY IN VETERINARY SURGERY AND RADIOLOGY
- 1. By: Dr. Kanteshkumar M J BVSc, MVSc (Surg.), PGDAW, PGDRD PHYSIOTHERAPY
- 2. •Physiotherapy deals with the treatment of diseases by physical methods. Mahaseth et al., 2021 •Physiotherapy accelerate tissue healing by galvanizing normal physiological process so that the functional normalcy of an affected part is restored faster. Brian sharp, 2016
- 3. • Correcting deformities. • Making the joint movement more supple. • Preventing deforming tendencies. • Developing paralyzed muscles. • Promotes tissue healing. • Restoring the functional ability. Samoy et al., 2016
- 4. • Decrease pain & facilitates healing of inflamed & injured neurological & musculoskeletal tissues. • Maintain normal range of motion in affected joints, i.e. hind & fore limb. • Prevent soft tissue contracture & fibrosis in weak or paralyzed limbs. • Prevent further disuse atrophy of affected musculature of hind limb/fore limb during the healing process. • Improve strength & function of weak or paralyzed limbs. • Maximize post-surgical recovery & function of the patient. • Provide positive psychological effects for the patient & owner.
- 5. • Physical methods: - Massage - Exercise • Conduction–Water-Hydrotherapy: Treatment by using water, either cold or hot. • Thermo therapy: Treatment by using heat through conduction, convention, radiation methods. • Radiation:- Infrared therapy, UV therapy • Conservation Diathermy: Use of high frequency currents • Ultrasonic Therapy :- Use of high frequency currents with oscillations • Electrotherapy : Treatment using electrical current, Electrical stimulation, electrodiagnosis, faradism and galvanization
- 6. Massage may be defined as manipulation of soft tissues with hand & fingers. INDICATIONS: Subacute, Chronic inflammatory conditions can be combined with the use of liniments
- 7. Massage improves – Circulation – Nutrition supply – Removes waste products – Reduces edema – Reduces indurations – Loosens contracted tendons, ligaments and muscles.
- 9. METHODS OF APPLICATIONS: • Slight Friction: Fingers of the hand is used in centripetal direction. It gives feeling of warmth & has a numbing effect. • Methodical pressure: It is applied by firm pressure on to tissue with the pulp of the thumb or with fingers or the hell of the palm or with closed fist.
- 10. • Individual compression of muscles: A portion of the muscles is hold between the fingers & thumb & uniform pressure is applied from its insertion towards its origin. • Percussion: consist of superficial or deep percussion of the tissue by striking the part perpendicularly with the fingers or closed hand.
- 11. EFFECTS: • Sensory nerve endings stimulated/sedation. • Liberation of histamine substances with local hyperemia results in dilatation of blood vessels. • Improves venous & lymphatic return by mechanical assistances due to alternative pressure & relaxation. • Mechanical movement causes stretching & softening of fibrous connective tissue. CONTRA-INDICATIONS: • Acute inflammatory conditions. • In danger of hemorrhage. • Presence of foreign bodies under skin. • Existence of new growth.
- 12. Exercise constitutes active and passive movement of a part or whole body to strengthen or maintain the muscle & skeletal system Brian sharp, 2016 INDICATIONS: • Joint stiffness • poor posture • Spasticity • paralysis • Orthopaedic problems Artz et al., 2015
- 13. EFFECTS: • Mechanical movement of joint & muscles improves venous & lymphatic return. • Sensory stimulation by keeping cortical pathways open. • Mobility & range of movement of joints can be increased. • Balance & coordination can be improved. • Passive movements stretch and soften the fibrous tissue. • Improves cardiovascular & respiratory capabilities. Taylor et al., 2007
- 14. METHODS: • Passive exercise: The affected joint is grasped & its flexion & extension is done for 10-15 times. Samoy et al., 2016 • Active exercise: This includes walking, grazing & slow running up on a slope. Passive exercise Active exercise
- 15. • Water absorbs more heat per unit of weight than any other substance. • The solvent properties of water help checking infection and accelerate wound healing by removing dirt and necropsied tissue. • A treatment time of 10-30 min. is sufficient for this effect. Brian sharp, 2016
- 16. TECHNIQUES: • (A) BUOYANCY OF WATER: This is used to relieve pressure on effected parts. The method is used in the form of an aqua lift system. Samoy et al., 2016
- 17. • (B) WHIRLPOOL HYDROTHERAPY: In this extremity or the entire body is submerged in either warm or cold swirling water. The water is kept in constant agitation & mixed with air by the action of turbine thus producing a gentle massaging effect.
- 18. (C) IRRIGATION: Irrigating the affected part with a stream of water through a hose pipe is a simple and cheap method.
- 19. (D) SWIMMING: It is another method of hydrotherapy. Conditions involving limb problems, helpful in recovering from injury or operation Penny Veenman, 2006
- 20. • PRECAUTIONS: 1. Animal with recent skin grafts 2. Acute oedema 3. Fever 4. Marked circulatory disturbances.
- 21. INDICATION: •Acute congestion, •Acute inflammation •Septic lesions with diminished blood supply. • It is effective during the first 24-48hrs after injury. • TECHNIQUE: Can be done by ice water immersions, ice packs, blowing cold air, applications of volatile liquids & running cold water. Ernst et al., 1994
- 22. • Therapeutic effects of cold occur at tissue temperature between 15-190C. • Each application should last 15 to 20 minutes and there should be at least 1-2 hrs interval between the applications. Brian sharp, 2016 • Cold application is generally combined with compression bandage.
- 23. INDICATIONS: • Sub acute and chronic inflammatory conditions • Sprains, contusions and myositis • To hasten the suppuration process Ex.: abscess maturation. Brosseau et al., 2003 Effects • Heat increases the tissue temperature which leads to sedation and analgesia. • Heat produce vasodilatation and promote phagocytosis , helps in the healing process. • Heat enhances metabolism and lymph flow .
- 24. • Adverse effects – Increased permeability of blood vessels leading to tissue edema – Increased absorption of toxins. – Heat should not be applied if infection is present due to spread bacteria and toxic products deep into the tissues. – Thermo therapy should not be used during the initial 24 to 48 hrs after trauma
- 25. • INDICATIONS: 1. Sub acute & chronic inflammations. 2. Recent inflammation after the acute stage has passed. 3. Septic lesions in which the vitality of tissues lowered & they are threatened with deaths.
- 26. • Application 1. Baths 2. Fomentations 3. Compressor 4. Poultices.
- 27. • INDICATION: 1. Sub acute & chronic traumatic & inflammatory conditions. 2. Traumatic synovitis, sprain. 3. Neuralgia, arthritis & rheumatic conditions. 4. Acute, sub-acute & chronic catarrhal conditions of mucous membranes & sinusitis. 5. Infection of the skin, folliculate & furunculous. 6. Circulatory disturbance of the extremities. • SOURCE: 1. Natural- Sunlight (comprises over 60% in an average sunlight) 2. Artificial • Low temp./Non-luminous • High temp./Luminous/Heat lamps
- 28. Infrared rays are electromagnetic waves (radiant energy) of 770-1,00,000 nm. Long wave infrared [1500-12,000 nm] It is emitted by low temp. bodies like hot water bottles, electric heating pads etc. These rays cannot penetrate deeper than 2mm of the skin. Short wave infrared [770-1500nm] It is emitted by sun, incandescent lamps & high temp infraradiators. These rays can penetrate 5-10mm of skin tissues
- 29. • TECHNIQUE: the patients are placed in a comfortable, relaxed position in the radiation from the generator is directed over the part to be treated from a distance of 2-3 ft according to the sensitivity of the parts. • Duration of exposure is 10-15 minutes
- 30. • CONTRAINDICATIONS: 1. Defective blood supply to the area 2. Any blood loss 3. Defective skin sensation(nerve damage) • COMPLICATIONS: 1. Erythemal response 2. Electric shock 3. Injury to eyes 4. Faintness 5. Hypersensitivity followed by erythemia, wheal formation, local edema & blistering
- 31. INDICATION: General tonic effects • Chronic ulcers • Tuberculosis • Psoriasis, Acne SOURCES: • Natural- sunlight(major source) • Mercury Vapour lamp • Fluorescent sun lamp
- 32. TECHNIQUE: • For general irradiation, entire affected body should be exposed. The genetalia should be covered by a cloth • The centre of the part should be in direct line of irradiation • A timer should be used to measure time of exposure. Dosage : the erythemal response of the individual patient serve as a guide for dosage for general irradiation. Distance of lamp and duration of exposure are important for dosage calcutation. DURATION OF EXPOSURE • To control local infection 3-5 min for 5 days is sufficient • Usually 20 exposures are required for complete cure
- 33. INDICATION: • Paralysis • Muscular atrophy Brian sharp, 2016 Technique: • Continuous currents (DC) Galvanization • Induced currents (AC) Faradisation • High frequent currents- Dorsogalvalisation
- 34. TECHNIQUE: • A feeble current that doesnt cause pain is used. • Electrodes are placed so that the current travels • The brain or cord longitudinally from the forehead or from pole towards lumbar region. • Transversely from one temple to other. • Perpendicularly from dorsal lumbar region towards the sternum or abdomen.
- 35. Ionophorosis: Electricity is used to enhance the absorption of medicaments through the tissues. Agents: sodium chloride, salicylate of soda, iodide of potassium, zinc and lethium. Fulguration: Refers to the employement of electrical sparks or splashes in the treatment.
- 36. EFFECTS: • Increasing muscle strength. • Improving muscle tone. • Decreasing edema and enhancing circulation. • Decreasing muscle spasms and pain. • Improves muscle strength by increasing muscle contractile proteins. • Improves muscle endurance by increasing vascularity, aerobic capacity & mitochondrial size. • Electrical muscle stimulation may be used to reeducate denervated muscle.
- 37. CONTRA-INDICATION: • Over a gravid uterus. • In animals with seizures. • Over tumours or infected areas.
- 38. • INDICATIONS: 1. Useful to get rid of stiffness & decrease in flexibility of skeletal muscle. 2. It improves range of motion of the joints. 3. Improves circulation to the scar tissue. 4. Decreases pain & muscle spasm. 5. Stimulates the resorption of calcium deposits e.g. splints, spondylosis. 6. Stimulates tissue repair by acoustic streaming & promoting the healing of pressure sores by increasing the rate of protien synthesis by fibroblasts & increased lysosomal activity. Brian sharp, 2016
- 39. TECHNIQUE: The area to be treated should be clipped/shaved & cleaned. Ultrasound gel are applied liberally & sound head is placed over the skin. After setting required frequency & time, sound head must keep on moving slowly over the target area.
- 40. 1. Ultrasound penetrates deeper(3-5 inches) than diathermy and also causes micromassage. 2. Tendons and superficial tissue: 0.5 watts/sq.cm 3. Deep penetration: 1- 2 watts/sq.cm 4. Duration: 5-10 min. Over heating can cause damage. • CONTRA-INDICATION: i. Pregnant uterus ii. Malignant tumor iii. Should not be used upto 48-72hrs of injury as it may cause seroma and hematoma formation. iv. It can disseminate cancerous cells.
- 41. • Animal physiotherapy is to be considered in every orthopedic or neurological condition that causes pain and/or discomfort or dysfunction. Because of the versatility of therapy, it is not always easy to attribute clinical progression exclusively to one technique in physiotherapy (or even to physiotherapy itself). • Based on the current literature, it can be concluded that there are strong indications that physiotherapy aids in the rehabilitation of clinical patients, whether it is used as pain relief or for intense mobility revalidation.
- 42. SUMMARY • The growing interest in physiotherapy and rehabilitation within small animal practice presents a number of challenges for the veterinary surgeon. • There is an expectation among the public, and within veterinary law, that veterinary practitioners should be the experts on physiotherapy and rehabilitation for animals, but current training does not prepare them for this role. • While the non-specialist vet and nurse can easily and effectively provide simple physiotherapy modalities with just basic training, qualified veterinary physiotherapists can offer a new dimension to the small animal practice and bring additional expertise and skills to the veterinary team. • The integration of physiotherapy in practice can help to improve outcomes and promote a positive, caring image to clients.
- 43. • Hopefully, when the established post-graduate programs of study begin to produce quality research the scientific evidence base for animal physiotherapy will broaden and strengthen, ultimately enhancing the quality of overall veterinary care. • Physiotherapy has immense potential as an alternative treatment. It is cost effective and nowadays, this important branch is also rapidly becoming recognized tool in the prevention, cure and rehabilitation of many equine, canine and feline injuries.
- 44. RECENT ADVANCES • Laser biostimulation involves applying a laser beam to the tissue to facilitate healing and regenerative processes. Laser therapy is one of the most important physical methods used in human physiotherapy. In veterinary medicine, laser therapy is a new and so far poorly examined method. The results of studies conducted so far are very promising, yet the positive effect of laser light, especially that of class IV, has yet to be confirmed. Zielinska et al., 2017
- 45. References • Mahaseth, P.K. and Raghul, S., 2021. Veterinary physiotherapy—A literature review. Int. J. Sci. Healthc. Res, 6, pp.288-294. • Samoy, Y., Van Ryssen, B. and Saunders, J., 2016. Physiotherapy in small animal medicine. Vlaams Diergeneeskundig Tijdschrift, 85(6), pp.323-334. • Veenman, P., 2006. Animal physiotherapy. Journal of Bodywork and Movement Therapies, 10(4), pp.317-327. • Ernst, E. and Fialka, V., 1994. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. Journal of pain and symptom management, 9(1), pp.56-59. • Artz, N., Elvers, K.T., Lowe, C.M., Sackley, C., Jepson, P. and Beswick, A.D., 2015. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC musculoskeletal disorders, 16(1), pp.1-21.
- 46. • Taylor, N.F., Dodd, K.J., Shields, N. and Bruder, A., 2007. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002–2005. Australian Journal of Physiotherapy, 53(1), pp.7-16. • Sharp, B., 2008. Physiotherapy in small animal practice. In practice, 30(4), pp.190-199. • Welch, V., Brosseau, L., Casimiro, L., Judd, M., Shea, B., Tugwell, P. and Wells, G.A., 2002. Thermotherapy for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews, (2). • Gupta, A., Avci, P., Dai, T., Huang, Y.Y. and Hamblin, M.R., 2013. Ultraviolet radiation in wound care: sterilization and stimulation. Advances in wound care, 2(8), pp.422-437. • Potter, C.L., Cairns, M.C. and Stokes, M., 2012. Use of ultrasound imaging by physiotherapists: a pilot study to survey use, skills and training. Manual therapy, 17(1), pp.39-46. • Veterinary Surgery And Radiology by Samit Kumar Nandi • Small Animal Surgery by Theresa Welch Fossum, Fourth Edition.