334 Canine Sports Medicine and Rehabilitation
Overview of orthopedic rehabilitation
Current evidence in canine rehabilitation indi-
cates that, when treated by a certified rehabili-
tation professional, rehabilitation is safe and
may improve outcomes in postoperative tibial
plateau leveling osteotomy (TPLO) (Romano &
Cook, 2015). Historically, postsurgical out-
comes of TPLO without rehabilitation indicate
that dynamic and static weight bearing of the
surgical limbs return to control limb levels, but
that passive range of motion of the stifle, active
range of motion of the stifle, and thrust force
from the ground remain inferior to the control
limb (Molsa et al., 2014). Another study sup-
ported these finding by indicating that thigh
circumference and stifle range of motion do not
return to control limb measurements 1–5 years
after TPLO surgery (Moeller et al., 2010). The
historical standard practice of crate rest after
orthopedic surgery may need to be re‐evalu-
ated as a study has shown that crate rest‐
induced cartilage atrophy is not reversed
(Kiviranta et al., 1994; Haapala et al. 1999).
Because these studies indicate standard ortho-
pedic care without rehabilitation may have last-
ing negative impacts on the patient, early
intervention rehabilitation should be consid-
ered (Marsolais et al., 2002). Studies are cur-
rently showing that, after surgery for a
cruciate‐deficient stifle, early intervention may
prevent muscle atrophy, build muscle mass and
strength, and increase stifle flexion and exten-
sion range of motion (Monk et al., 2006).
Sequencing the orthopedic evaluation
For all rehabilitation, from acute postoperative
care through return‐to‐sport conditioning, a
thorough evaluation must be completed.
Proper sequencing of the six components of the
rehabilitation evaluation—capturing subjective
data, obtaining objective findings, completing a
problem list, developing an assessment, build-
ing a treatment plan, and re‐evaluating to
determine if the treatment plan is effective—
assists the therapist with capturing detailed
information while promoting a lasting thera-
peutic relationship with the client and patient.
At the initial meeting, the therapist greets the
client in a warm and friendly manner taking
breed‐specific preferences for patient interac-
tion into consideration. For all patients, initially
avoiding direct eye contact and physical inter-
action helps the patient perceive the therapist
as nonintrusive. The therapist then leads the
client and patient into the therapy room, allow-
ing the patient the freedom to become familiar
with the new setting. As the patient explores
the environment, the therapist interviews the
client capturing subjective data and medical
history. The objective evaluation, which may be
done with or without the client present, begins
with the hands‐off elements of the exam includ-
ing posture, function, strength, and gait. If the
patient is provided with rewards in the form of
food or toys during the initial phases of the
evaluation they may be more agreeable to the
manual portions of the exam which include
muscle and bone palpation, passive range of
motion, muscle flexibility, fascial mobility,
clearing the spine, joint play, and special tests.
Patient preference for body position (standing,
sitting, or lying) and order of manual exam
elements is respected and modified to meet a
particular patient’s behavioral needs. To
avoid pain and fear responses early in the
examination, the involved limb is typically
evaluated last.
Findings from each of the objective exam
areas are placed on a problem list and the thera-
pist critically analyzes the list to develop an
assessment. The assessment is a working
hypothesis that explains all the findings on the
problem list. It may be an expansion of the pri-
mary orthopedic diagnosis, including the
sequelae of the primary diagnosis, and it may
also include underlying physical limitations
that may not be associated with the primary
orthopedic condition.
The treatment plan is then developed based
on the prioritized problem list. For each prob-
lem on the list, the primary tissue type and the
chronicity of the injury is determined. Common
injured tissue types for orthopedic treatments
may include muscle, tendon, ligament, joint
capsule, intra‐articular structures (cartilage and
meniscus), and bone. Chronicity of injury is
defined in three phases of healing: (1) acute,
recent onset with effusion and/or edema; (2)
subacute, with tissue effusion/edema resolved
but time to tissue healing not yet complete; and
(3) chronic, with tissue primarily healed.