Front Matter

154 Canine Sports Medicine and Rehabilitation

● On/off time ratio of 1:3 to 1:5 (a larger ratio
is used with weaker muscles to avoid
fatigue).
● Amplitude sufficient to cause a strong con­
traction is required to produce strength
gains (Snyder‐Mackler et al., 1994).
● Frequency of treatment of 3 to 7 sessions per
week.

For TENS treatments, the electrodes are often
placed over the area of pain, over the periph­
eral nerve or spinal nerve roots that innervate
the painful area, or over acupuncture points
(Montenegro et al., 2016). Various electrode
placements may be trialed to determine the best
effect for each patient.
When using TENS for improving flexibility,
the general recommendations are to apply
the stretch force after using TENS to reduce dis­
comfort when treating orthopedic diagnoses.
When addressing spasticity in neurological
patients, the stretching force should be applied
during or immediately after TENS treatment of
the antagonist muscle (Karasuno et al., 2016).
Recommended parameters for TENS are as
follows (Nolan, 2005):

● Frequency between 30 and 150 Hz.
● Pulse duration between 50 and 100 μs.
● Amplitude to elicit a comfortable sensory
response—sufficient amplitude is required to
achieve an analgesic response (Moran et al.,
2011) and may need to be increased within
each treatment (Pantaleão et al., 2011).

● Duration of treatment varies according to

the activity.

For both NMES and TENS, the therapist

should be prepared to adjust treatment param­

eters in order to achieve the best outcome

(Glaviano & Saliba, 2016).

Precautions and contraindications for ES

Precautions for ES include treatment over

areas of decreased sensation, directly over

wounds or skin irritation, in patients with

osteoporosis (because of fracture risk), and in

patients with obesity (because fat is a poor

conductor of current).

Contraindications include stimulation directly

over the heart, in areas of infection or cancer,

over the trunk during pregnancy, over areas

of  thrombosis or thrombophlebitis, over the

carotid sinus or pharyngeal area, in patients

with seizure disorders, or any time active

movement of the body part is contraindicated.

The presence of a cardiac pacemaker is a rela­

tive contraindication as recent evidence has

shown that ES is safe if the muscle stimulated

is a sufficient distance from the pacemaker

(Kamiya et al., 2016) and only patients that are

stable enough to tolerate the treatment are

selected (Cenik et al., 2016).

Finally, the therapist must monitor the tis­

sues under electrodes as burns (Ford et al.,

2005) and other skin irritations (Naderi Nabi

et al., 2015) may occur.

Case Study 7.1 Post‐TPLO rehabilitation—physical modalities

Signalment: 4 y.o. M/N Boxer.

Presenting complaint/history: Left TPLO to address

cranial cruciate rupture. Began rehabilitation 5 days

post‐surgery.

Initial evaluation findings:

● Gait (walk): left pelvic limb toe‐touch weight

bearing with lack of hip/stifle extension at

end‐stance.

● Left stifle ROM: flexion 50% of normal, extension

75%.

● Muscle atrophy: moderate atrophy L hamstrings

and quadriceps groups.

● Flexibility: L sartorius and iliopsoas moderately

tight.

● Palpation: significant swelling, moderate warmth

around the L stifle (no signs of infection).

Assessment: 5 days post‐op L TPLO, expected deficits.

Goals: Regain normal postures, transfers, and gait

quality within 9–10 weeks.

Treatment plan: In addition to manual therapies,

therapeutic exercises, and continual instruction

in  appropriate home exercises, the following

physical modalities were included in the treat-

ment plan: