126 Canine Sports Medicine and Rehabilitation
cross two or more joints. Therefore, an assess
ment of passive joint ROM is distinguished
from an assessment of muscle flexibility or joint
arthrokinematics. If PROM is restricted, it is
important to identify the limiting structure in
order to direct the treatment appropriately. This
is accomplished by noting end‐feel.
End‐feel
The restriction to further motion as perceived
by the therapist is called end‐feel. It is the
sensation in the therapist’s hands when over
pressure is applied at the end‐range of osteokin
ematic motion. End‐feel is assessed by passively
moving the joint through its available ROM,
slowly applying moderate overpressure at the
end‐range, and noting the feel of the resistance.
PROM can be limited by pain or swelling as
well as musculotendinous tissue, bone, joint
capsule, muscle spasm, fascial tissue, soft tissue
approximation, or intra‐articular derangement.
Each structure has a characteristic feel that can be
detected by the examiner (Norkin & White, 1985).
Practice is necessary in order to develop the
ability to sense the different characteristics of
the limiting structure (Table 6.3). A pathological
end‐feel is the presence of restriction prema
turely in the ROM.
By identifying the limiting structure, the
treatment can be designed to affect the particu
lar characteristics of that structure. For exam
ple, if joint ROM is restricted by joint capsule,
the treatment of choice will be joint mobiliza
tion. However, if ROM is restricted by muscle
spasm, the treatment of choice may be a softTable 6.3 Characteristics of different types of end‐feelEnd‐feel/block Sensation
Soft tissue approximation Soft, yielding
Muscle/tendon Firm, slight give, elastic
Capsule Very firm
Muscle spasm Abrupt stop, hard
Edema Soft and boggy
Bone Hard, unyielding
Empty Pain before resistance
Springy ReboundCase Study 6.1 Manual therapy for postoperative FHOSignalment: 9 y.o. M/N Brittany Spaniel.
Presenting complaint: 1 month post‐op L FHO with
decreased ROM, decreased weight bearing, and
weakness.
Evaluation: Physical exam WNL except:
Gait: (walk) PWB L pelvic limb, decreased L stride length
and stance time, compensatory spinal side bend.
Palpation: decreased STM, trigger point and tenderness
at L iliopsoas.
PROM: hip extension L 125, R 150.
Flexibility: L iliopsoas moderately tight; R NL.
Atrophy: moderate+ at L gluteals, moderate at L
hamstrings, and quadriceps.
Strength: 3‐leg strength test: fair (3/5); diagonal limb
strength test: poor (<3/5).
Assessment: 1 month post‐op L FHO with expected
limitation in ROM, flexibility and strength.
Problem list:● Limited L hip extension.
● Tight L iliopsoas.
● R pelvic limb weakness.
● Inadequate weight bearing.
● Altered gait.Goals:● Symmetrical walking gait in 6 weeks.
● Symmetrical sit‐to‐stand transfers in 6 weeks.
● Ability to walk on stairs without difficulty in 8 weeks.
● Return to 1‐hour hikes in 10 weeks.Treatment:
Modalities: laser to L iliopsoas.
Manual therapy: gentle passive stretch of L iliop-
soas with simultaneous STM of muscle belly,
trigger point release L iliopsoas, joint compres-
sions in standing, passive gait simulation in
standing.
PROM: gentle hip extension with STM of sartorius,
rectus femoris, iliopsoas.
Therapeutic exercise:
● Weight bearing: weight‐shifting exercises, slow
walking with head elevated, counterclockwise
circle walking, low cavaletti walking.
● Strengthen: 3‐leg stands, backward walking,
front feet on wobble disc.
● Home Exercise Plan (HEP): joint compres-
sions and PROM per above; slow walking
on flat and inclines, backward walking, side
stepping, thoracic limbs on wobble board or
disc.