Passive therapy

updated Nov. 2011 by: Giuliana G. Lerch, LVT, CCRP, Member IVAPM, IVARPT, Veterinary Medical Center of Long Island

Check with your veterinarian or surgeon to see when and which of these exercises are appropriate for your dog. Any sign of pain, discontinue. Usually PT can be started immediately after surgery with the OK from your surgeon.

Passive exercise or passive physical therapy (PT) means you provide movement for your dog. Active exercise is when the dog causes his limbs to move.

Therapy during conservative treatment for the paralyzed dog

Illustration reprinted with permission by the copyright owner, Hill's Pet Nutrition, from the Atlas of Veterinary Clincal Anatomy.

As the dog moves, the boney vertebrae will push on the discs. A healthy disc provides a cushion to the bones of the vertebrae. While a disc is healing without benefit of surgery, pressure can easily cause the disc to be further damaged and cause more pressure on the delicate spinal cord. Therapy must be performed with utmost care.

Dogs on conservative treatment crate rest who are not paralyzed are able to move around a bit in the crate and at potty time to keep their joints and muscles toned. No additional therapy is necessary.

However, a downed dog can't move his back legs and the owner will need to help. Very light passive PT and massage must be limited to the least aggressive methods during crate rest for the downed dog. Delay passive PT activity until off medications and all swelling has gone down and the dog is no longer in pain. Check with your vet before starting.

A warm towel from the dryer will help to warm up the legs prior to beginning passive PT. Give the passive PT 3x a day building up to 10 or 15 minutes each time. The key is to avoid making your dog move the spine which will put pressure on the healing disc. The aim is to provide a bit of gentle movement to maintain circulation in the muscles and keep joints flexible. Do not pull on legs or tickle which can cause the body to jerk or move. Start slowly. If he resists you, try again later or another day. Do not force him causing a struggling situation.

Perform only the Massage and Exercise in the red text which are for the paralyzed dog on conservative treatment. Start with 5 reps each joint and build to 10-15 reps each joint in a couple of days).

Physical rehabilitation for the conservative or post-op dog

The purpose of PT and massage is to stimulate blood circulation and help maintain muscle and joint flexibility. When neuro functions return, the muscle and joints will then be capable of response. The importance of passive exercise continues until voluntary movements begin to return, then passive exercise is no longer needed. Muscles need to fatigue to gain strength. Weight bearing standing exercises should be continued until strong walking movements are present.

Warmth therapy before a session will warm up joints and muscles as well as relax the dog for therapy cooperation. Never apply heat to the surgery site as it may increase possibility of infection due to bacterial growth encouragement. After exercises cold pack therapy can help with soreness.

Start the session by earning your dog’s trust. Some dogs will not react well to physical therapy, or any kind of therapy, if previously you did not earn your dog’s trust. Dachshunds usually do not like their paws being touched, so it’s important to relax the dog before you attempt to manipulate it’s paws in order to avoid tense muscles that might get sore later on.

To get a dog to accept therapy, you may:

Slowly approach the dog and gently talk to him. Start sliding your hands, placing each hand at each side of the spine, but not directly on the spine, very gently from the occipital region (base of the head), down the neck, and around the shoulders and down the arms. Repeat 5-10 times. If the dog seems restless at any point. Stop and try again later.
Afterwards, gently slide your hands, placing each hand at each side of the spine, but not directly on the spine, from the withers (between the shoulder blades) to the hips and down the legs. Repeat 5-10 times. Do both massages very slowly and gently, without pressure. Just stimulate blood flow.

Paralyzed dogs doing conservative crate rest will do only "Massage" plus "Exercises" #1-4.
Your dog will need to be crate rested at all times except for being carried to and from the potty place and may come out to do the following:

Massage
(Have your dog lie on it's side on the floor with a blanket or on his bed to provide a safe firm, stable and supportive surface for the conservative or a post-operative dog)

Warm up stroking: Starting at the hip, cup your hand and "pet" your dog from the hip to the foot, repeat 10 times. You may use a soft bristled brush if your dog has a lot of fur.

Massage: : Use a kneading motion to the hamstrings (back of the leg) and quadricepts (front of the leg) for 3-5 minutes.

Leg pump: hold the hock (ankle which bends opposite of human's) and support the stifle (knee). In a slow and controlled motion, flex and extend the limb at the hock while supporting the stifle. Repeat 10-15 times.

Cool down: Repeat "Warm up stroking" for both legs.

Exercises
(Conservative dog will lie on on its side for #1-4):

Hip Exercise. Place one hand on the hip and use your other hand to support the leg. Move the leg gently it back and forth up to 15 times. You may also try to move the hip joint in semi circles up to 15 times
Stifle (knee) Exercise: Use one hand to support the knee from underneath and the other hand to hold at the ankle. By holding at the ankle you can make the knee flex and extend slowly up to 15 times.
Hock (ankle) Exercise: With thumb and forefinger support the ankle joint. With the other hand slowly flex and extend the ankle up to 15 times.
Toe Exercise: Move each toe up and down 10 times.
Bicycles (range of motion ROM): Place your pet in a standing position and support with 1 hand between the hind legs. With your other hand, hold the hock (ankle) to initiate ROM. In a slow, controlled motion; bring the leg back, bend at the knee, come forward, and brush the foot against the ground (this will stimulate the nerves). Repeat 15 times. Perform on the opposite limb. Do 3 alternating sets for each limb.

Toe Pinch: This exercise stimulates a reflex and is not representative of motor function. It will stimulate the nerves as well as the muscles. Apply a firm pinch to the webbing between each toe. It should not cause pain; you should feel the leg stiffen up a bit and then pull away from you towards the body. Repeat up to 5 times between each toe and then repeat on the opposite leg.

Tickles: Stimulation is an important factor of nerve reconnection. Tickle between the toes and the foot pads of the paralyzed or weakened limbs to activate the kick reflex for up to 1 minute.
Stand with support: Put your pet in a standing position and support as needed between the hind legs. Have the dog "hold" this position up to 1 minute. This will re-enforce the muscle tone in the hind legs.
Bounce: Put your dog in a standing position and support at the hips (one hand around each hip). Apply a gentle downward pressure so that you see the toes spread-the foot should never come off the ground. Repeat up to 50 times at 1 bounce per second. This will stimulate muscle tone as well as re-train the nerves.

The goal of the exercises is to stimulate blood flow to the muscles, stimulate the nerves and to keep the ligaments and tendons loose. Your pet may resist some of the exercises at times so it is okay to take a break and try again at a different time. Always remember to take your time and go slow through each exercise.

These sessions should be done 2-3 times a day for up to 15-30 minutes at a time as your schedule allows. Be sure to perform the exercises in a quiet and comfortable environment- some dogs find jazz or classical music soothing. Use a stable surface such as carpet, yoga mat or grass for exercises like range of motion or leg pumps. A blanket or towel would be best used for massage, toe pinch and tickling between the toes.

The best advice is to be patient and keep a positive attitude during the recovery process. Should you have any concerns, please contact your veterinarian or your canine rehabilitation professional.

These videos are for dogs in post-op care or dogs when they have completed conservative treatment of crate rest (always check with your vet regarding which exercises would be appropriate for your dog's situation):

Clark’s Post Surgical PT
Goliath’s PT
Water Therapy

Other References:
Steiss, J.E., Canine Rehabilitation. In: Braund's Clinical Neurology in Small Animals: Localization, Diagnosis and Treatment, Vite C.H. (Ed.)International Veterinary Information Service, Ithaca NY (www.ivis.org), 2004
http://www.ivis.org/advances/Vite/steiss2/chapter_frm.asp?LA=1 Last accessed 9/12/08

McCauley, L.L., Neurological Canine Rehabilitation. In: Â NAVC Proceedings 2006, North American Veterinary Conference (Eds). Publisher: NAVC (www.tnavc.org). Internet Publisher: International Veterinary Information Service, Ithaca NY http://http://www.ivis.org/proceedings/NAVC/2006/SAE/016.asp?LA=1 last accessed 9/12/08

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Passive therapy

Therapy during conservative treatment for the paralyzed dog

Physical rehabilitation for the conservative or post-op dog

Massage (Have your dog lie on it's side on the floor with a blanket or on his bed to provide a safe firm, stable and supportive surface for the conservative or a post-operative dog)

Massage
(Have your dog lie on it's side on the floor with a blanket or on his bed to provide a safe firm, stable and supportive surface for the conservative or a post-operative dog)