chiropractic – Sam Sherrington

Prehabilitation is a Proactive/preventive approach to manual therapy, exercise, diet and lifestyle, designed to maximise health and wellness, and minimise individual risks for injury and disease. Well-studied in human medicine, prehabilitation is found to be valuable in ‘high risk’, aged, frail or obese patients, as well as younger patients who wish to maximise their athletic performance or if injured and facing surgery, to return to their chosen sports as soon as possible. It is especially valuable when an animal is requiring surgery, and as a pre-operative approach integrates biomechanical assessment and appropriate manual therapy treatment, individualised home exercises plus diet and lifestyle advice in advance of surgery. Prehabilitation has been shown to promote lower complication rates and earlier restoration of functional activities and status during the recovery from surgery. Good quality systematic reviews show a positive impact of pre-operative exercise therapy on physical function, quality of life, postoperative complications and length of hospital stay.

border collie with toy in mouth waiting for a command

Most animals have been developing compensations for minor slips, trips and falls for many months or years prior to pain or lameness becoming evident. Individualised prehabilitation helps to make sure the animal is moving well and has the best possible strength prior to undergoing surgery. This is believed to help improve the outcomes of surgery by promoting healthy circulation, minimising inflammation, reducing pain related behaviour and movement limitations, reducing strain on the healing tissues and as a bonus will often reduce the animals reliance upon medication to control inflammation and pain both before and after the surgery.

Rehabilitation takes a similar approach around the inclusion of biomechanical assessment and appropriate manual therapy treatment, individualised home exercise, diet and lifestyle advice in respect to promoting the most efficient and successful recovery after orthopaedic surgery or acute injury. Rehabilitation typically follows a pattern guided by the natural healing mechanisms within the associated tissues.

Inflammation is the main factor to manage for the first 2 – 4 weeks depending on the individual situation. This typically includes medication and rest, however these can also be complimented by gentle therapeutic options such as lymphatic drainage, laser and kinesiology taping to help the tissues clear the active inflammation and bring fresh blood supply into the healing tissues. Treatment is always considered on a case by case basis in conjunction with veterinary advice, as individual factors play a large role in the suitability of therapies during the acute stage. Gentle modalities such as laser, kinesiotaping and lymphatic drainage often appropriate immediately post surgery, and specific home exercises may be able to help maintain the nervous and muscular system function in relation to the injury.

Weeks 5-8, are crucial in ensuring the affected tissues are building their passive and active function in a symmetrical and biomechanically correct manner in order to ensure that the repairing tissue is as healthy and functional as possible. Again, passive and active techniques, more advanced exercises and modalities may be applied as appropriate to promote healthy tissue repair.

Remodelling, during weeks 9-12 is when the fun really begins. This is where, if previous stages have been completed with success, we can really start to challenge the body while still being aware there is much change still happening within the healing tissues. Monitoring the dog during this period is particularly important as they often begin to feel ‘like new’ and can easily overdo it. Rehab exercises can increase in complexity as we challenge both the musculoskeletal tissues as well as the nervous system which controls healthy movement.

Months 3 – 6 are the cherry on top as far as rehabilitation goes. While it may seem as though the dog is back to normal, it is very important to continue monitoring them for any signs that their tissues aren’t strengthening symmetrically or fully. Owners are coached on how to monitor their animals for small asymmetries or movement patterns in their own animals specific case, to help pick up early signs of trouble. This helps to reduce the likelihood of long term development of osteoarthritic changes that are common when surgical procedures have occurred. Typically at this stage home exercises should be part of normal daily life, with lifestyle changes well integrated to help the animal continue well into their older years. I always aim to make these lifestyle factors and exercises as easy to integrate into daily life as possible, which makes it significantly more likely that they will be maintained through the animals lifetime.

Aka – Things to do with every puppy to give them the best chance of a long and physically strong life.

Is there anything cuter than a puppy? Yes! A Chondrodystrophic puppy!

Image by congerdesign from Pixabay

You’ve done your due diligence and painstakingly selected a breeder who has carefully screened their breeding dogs for the common health problems in these breeds including Intervertebral Disc Disease (IVDD) and the big day arrives when you bring your new bundle of joy home.

Knowing you have a breed which is more prone to spinal and musculoskeletal problems, it is worth having a plan for prevention in place from day 1. Dachshunds are by far the most likely to be affected by IVDD, however if you have chosen any chondrodystrophic breed (Long body/Short legs) it’s well worth getting ahead of the inherent risk for back troubles from the very start.

Most breeders and breed societies have several good basic recommendations to help keep your dog healthy and injury free, including:

Prevent your dog from jumping – train your dog to wait to be lifted up and down from beds/sofas.

Avoid stair use – installing ramps and gates where needed.

Maintain a healthy body weight, especially through puppy-hood.

Avoid vigourous chasing/tugging/rumbling/tumbling games by themself or with others.

These basics are an excellent start, however there is much more you can do to help ensure your little friend has the best chance of avoiding major troubles.

Keep your dogs nails short. Long nails change the angle of the whole lower limb, and cause many of the dogs postural muscles to function in unhealthy manners. This creates increased strain both in the legs and the torso. If you can hear your dog’s nails tapping as they stroll around the house, they are too long. The best approach is to gently handle your puppy’s paws and toes as part of their daily routine, and learn to trim them regularly yourself. Whilst taking them to the vet for sedation to have them done once every few months is an option, it’s not a great one, as they’re much more likely to end up being cut too short, causing pain and bleeding and making the whole process more unbearable each time. I will do up a full post on the way I find best to trim nails without catching the blood vessel, however in the meantime you can find some quick guides on my facebook feed here, here and here.

Avoid slippery floors. If you have a house full of slipper polished floorboards or tiles, consider laying down runner mats through the main pathways your dog uses in the house. Especially don’t encourage games of fetch up and down corridors. We’ve all seen the videos on youtube of what happens when these sorts of games happen, and whilst on the surface they are amusing, the risk of serious spinal injury they pose is no laughing matter.

Next – Keep your dogs weight DOWN! Whilst yes, they can resemble sausages, little but long dogs really do need a very definite waist and palpable ribs with light coverage. A BCS of between 4 and 5 is ideal (see chart below). These little dogs generally have a low capacity for extra calories, so remember, a couple of extra snacks a day can easily add up to similar to us humans eating a couple of extra cheeseburgers a day. Keeping your dog lean will minimise the impact on both legs and spine.

Photos by Elisa Calvet B. on Unsplash, Sabrina St. from Pixabay, Own Collection – Loki Blanchard

One of the most powerful things I think you can do, is incorporate prehab (yes, like rehab, only before the problem happens!). The one basic exercise you can begin from puppyhood that I feel has the most bang for it’s buck, whilst also being super easy to incorporate into the daily routine, is changes of position.

It’s as simple as teaching your dog to do a straight sit, down and stand. Yep, that’s it. Sounds easy right? Well, yes it can be, however making sure it is properly straight is the key. Most dogs will develop a habit of slumping to one side or the other, and this often reflects a weakness in their postural muscles. This is why having them do half a dozen to a dozen repetitions of straight changes of position, once or twice a day (while they’re patiently waiting for their breakfast or dinner is a perfect time!) is so powerful. What they practice will greatly influence how they use their body for the rest of their activities.

Start by asking your dog to assume a nice straight sit position. Only pay a proper one where the dog has their weight on both rear legs, ideally with the pads touching the ground. If you’re noticing a tendency to slump onto one hip, the left one for example, you can lure their nose around to that same side so they move their front feet and this will typically bring the lazy leg back into weight bearing. If you’re noticing the pads are up off the ground and your dog is rocking back onto his hocks, ask him to stretch forwards for the reward. This will get him to push onto his pads. If he does come into a nice stand without shifting his feet that’s ok too, just try to keep those feet still.

From there, ask them to drop. Again, focus on rewarding them when they hold their back end straight. If they are slouching onto one hip simply ask them to come back up into a straight sit and repeat. If they can hold it for 1 second, great! Slowly over time they will become stronger and be able to hold it for longer.

Straight drops – the corgi is slumping slightly, with work he can do better and get stronger!

Coming into a stand we have a few options. To begin with, bringing them back up into a sit then asking for the stand is the easiest option. From there you can work towards bringing them straight into a stand from the drop. This is much harder and is essentially like us coming up to a stand from a deep squat. Give it a try and you’ll feel that to control the movement well, without your legs having to move to rebalance you, you need to have your core as well as your leg muscle active. This is exactly the power of this exercise for the dogs.

The final test is to help the dog learn to do a flip-back drop. This is where they start standing, then come into a drop via a bow position. This is an excellent one for whole torso control and range of motion as well as really great hind limb strengthening.

Image by Yama Zsuzsanna Márkus from Pixabay

Ultimately, the goal is to be able to have the dog assume any of the positions, from any other position, while keeping their feet still. Work on this over the course of a month or so, gradually building on the easy steps until you have the whole routine down pat!

This daily routine alone is capable of increasing the core strength, giving the spine a really thorough run through several important ranges of motion as well as building significant strength in the hind limbs, which in itself is hugely useful in breeds prone to spinal degeneration and compromise.

From there, we can move onto the even more fun stuff – Extracurricular activities!

Crawling

Wobble boards

Theraband

Swimming/UWT

I’ll get into those another day, you’ve plenty of work to do already! Hop to it!

Tag: chiropractic

Prehabilitation and Rehabilitation

The best way to avoid IVDD in your Dachshund puppy!