114 Canine Sports Medicine and Rehabilitation
Physiological considerations
Regardless of professional background, the
canine rehabilitation and sports medicine
therapist must have the ability to consolidate
the history, physical examination, and evalua
tion, and synthesize a rehabilitation plan based
on a number of factors, including:
● Patient‐specific considerations, including
prior medical history, comorbidities, and red
flags.
● The diagnosis or disorder being treated, as
well as the expected response of the body’s
tissues to injury, especially with regards to
healing and pain.
● The treatment strategies and tactics, and
their effect on the various systems of the
body, including neuromuscular, musculo
skeletal, integumentary, cardiovascular, and
cardiopulmonary and considering indica
tions, precautions, and contraindications.
● The physics of potential rehabilitation
interventions.
Patient‐specific considerations
Characteristics of the patient need to be consid
ered when setting the rehabilitation plan, espe
cially with regards to physiological responses
to interventions. Interventions in which forces
are applied by the body or to the body will have
varied effects on the body depending upon the
patient breed and conformation, weight, body
condition, and general level of conditioning.
Patient age, prior level of functioning, nutri
tional status, duration of immobilization or
activity restriction (and therefore, phase of
healing of tissues), and prior medical history
and comorbidities will alter the patient’s toler
ance of an activity or therapeutic procedure.
The patient’s stress and anxiety level and/or
familiarity with the therapeutic procedure or
environment in which it is applied, will also be
a predictor of his success and tolerance of a
therapeutic activity. For example, attempts to
walk a dog in an underwater treadmill might
be challenged when the patient reportedly
“hates the water” or in a rehabilitation facility
that is housed within the emergency hospital in
which he was previously treated, leading to a
fear response or heightened level of anxiety.
Comorbidities, or medical conditions that
exist simultaneously but independently with
another or a related medical condition, may
cause unforeseen complications and affect the
outcome of the rehabilitation interventions
applied. Of significant concern are disorders
that affect healing (i.e., diabetes mellitus, kidney
disease, and use of corticosteroids), the effi
ciency of the cardiovascular/cardiorespiratory
systems, and/or the ability of another limb to
accept weight during functional activities or
gait (i.e., hip dysplasia, elbow dysplasia,
prior peripheral nerve injury due to being hit
by a car).
Red flags are indicators of possible serious
problems, such as inflammatory or neurological
conditions, structural musculoskeletal damage
or disorders, circulatory problems, infection,
tumors, or systemic disease. If suspected, these
require further investigation with immediate
referral to the managing veterinarian (veteri
narian of record or primary care practitioner or
case manager), with potential for referral to a
specialist. There are certain signs that, when
observed in a patient’s examination or history,
might alert the rehabilitation therapist to the
potential for a serious or potentially emergent
condition. For this reason, the rehabilitation
therapist must maintain open communication
with the referring/managing veterinarian, and
potentially, with a nearby veterinary emer
gency facility (Physiopedia, 2017b). Physical
therapists are trained to recognize the presence
of disease or impairment that may present as an
injury to the neuromusculoskeletal system;
however, they are not expected to diagnose the
specific pathological process. They are trained
to recognize when a referral to another health‐
care provider is required.Tissue healing response to injury
The canine rehabilitation therapist must not
only consider the diagnosis (disorder, disease,
injury, or surgical procedure) that has brought
the patient and client to consult the rehabilita
tion team, but also the tissues involved. Skin,
fascia, nerves, blood vessels, muscle, tendon,
ligament, bone, and cartilage heal at different
rates and with varied outcomes with regards to
strength of the repair. The animal’s age, nutri
tional status, comorbidities, and activity level