FREQUENTLY ASKED QUESTIONS

Rehabilitation is simply defined as the restoration to health or normal life. Canine rehabilitation is focused on restoring mobility and fitness to our canine companions, keeping them as fit, active and pain free for as long as possible. This can involve life style changes, diet and supplements. It can involve physical modalities such as laser, meridian therapy (needleless acupuncture) and PEMF. It can involve manual therapies such as chiropractic, joint mobilisation, trigger point therapy, stretches and finally it can involve therapeutic exercises to build strength and restore range of motion and function. If your rehabilitation therapist is a veterinarian then they can also employ prescription medications as required (for example for pain and inflammation), make veterinary diagnoses, request or undertake diagnostics such as pathology and imaging and perform surgery. In addition to her qualifications as a veterinarian and veterinary chiropractor Dr Sandra Hassett is a certified canine rehabilitation therapist.

Laser therapy enhances the body’s natural ability to heal. It is a safe, gentle and effective treatment for many conditions. LASER stands for Light Amplification by Stimulated Emission of Radiation. The therapeutic laser we use allows for the production of a collimated (focused) and coherent (organized) beam of photons (particles of energy). Laser therapy is also known as photobiomodulation therapy (PBMT). This is because it causes biological changes at a cellular level. When a beam of the appropriate wavelength is directed into tissue the photons are absorbed by by cytochrome c oxidase (CCO) in the mitochondria of cells. This in turn stimulates the signaling molecules adenosine triphosphate (ATP), reactive oxygen species (ROS) and nitrous oxide (NO). As a result cell signaling cascades are activated: ATP related cascades enhance cell metabolism, improving healing. ROS also improves healing but additionally modifies inflammatory cascades. Increased NO improves cellular respiration rates and hence healing but also pain relief through production of increased endorphins and endogenous opiods and by reduced oedema and enhanced lymphatic drainage and angiogenesis. PBMT also impacts on gene expression, enhancing expression of anti-inflammatory genes and suppressing expression of pro-inflammatory genes. PBMT also upregulates the production of growth factors that enhance healing. So the key effect of Laser/Photobiomodulation therapy include: Accelerated healing: in response to increased energy and growth factor levels, the cells divide and grow faster, the healed tissue is stronger and there is less scar tissue. Pain relief: the cells produce more natural pain relievers such as B endorphins and nitrous oxide, are better able to modulate the production of pain chemicals such as substance P and better able to normalize nerve function so nerves carrying pain are less reactive. Reduced inflammation: less swelling, redness and pain as the cells produce more natural anti-inflammatories such as prostacyclin and superoxide desmutase whist modulating their production of inflammatory cytokines such as interleukin 1 and prostaglandin PG12. Improved nerve function: reduced hyper aesthesia with normalization of nerve action potentials, blocking of pain receptor nerves, normalization of nerve transmission via increased acetylcholine release, enhanced nerve cell regeneration. Laser therapy is not painful, takes only minutes to perform and you can stay with your pet. Most dogs relax and lie down once they become accustomed to the laser. Pain relief occurs almost immediately and digital thermal imaging has shown that inflammation reduces within 2-3 hours. Treatment can be one-off, for example to accelerate healing and reduce pain after an operation or acute injury, or can involve a course of treatments. A course of treatments can be daily or every second day for some acute conditions. More typically it is twice weekly for 2-3 weeks then weekly for 4-6 weeks then as required. This approach is commonly used in longer standing conditions for example osteoarthritis and back injuries.

Laser therapy is safe, gentle and effective, enhancing the body’s natural abilities to heal and reduce pain and inflammation. The list of conditions that respond well to laser therapy is a long one! Joint diseases such as osteoarthritis Tendonitis Ligament injuries Muscle injuries and tears Developmental conditions such as hip and elbow dysplasia and osteochondrosis (OCD) Spinal conditions such as interveterbral disc, degenerative myelopathy and spondylosis Nerve conditions such as nerve damage Wounds Injuries such as lacerations and bruises Post-surgical pain Otitis Gingivitis Dermatitis Lick granuloma Abdominal conditions such as cystitis And many more!

Not all lasers are created equal! The ability of laser therapy to target deeper tissues, to be focused on specific areas and to be delivered quickly and safely depends on the type of laser used. Canine Rehabilitation Canberra’s laser is the latest generation of therapeutic lasers – a Class 4 non-heating laser with a multiwave locked system (MLS) that combines power to penetrate deeply and work quickly with synchronized emissions that minimise the risk of thermal injury and maximize efficacy and results. It is so accurate and controlled it can even be used for meridian therapy (also known as needleless acupuncture) and myofascial release (also known as trigger point therapy).

For an excellent and current discussion on the basic principles of laser therapy, including supporting research data and references see: Chapter 5 of Laser Therapy in Veterinary Medicine, Riegel & Godbold editors, Wiley 2017 ASALaser Veterinary website: https://www.asalaser.com For International Case Reports from ASALaser Veterinary see the hyperlink: need to link to International Case report (1).pdf American Institute of Medical Laser Applications website: https://aimla.org

Chiropractic care aims to promote the body’s inherent healing by ensuring that the nervous system is able to function normally and without impedence. One of the underlying principles of chiropractic is that the nervous system controls and coordinates the body and if it is impeded then this affects the body’s ability to function and heal. One of the most common places for impedence to occur is in the motion units of the spine. In a chiropractic examination we search for areas of reduced mobility and ‘adjust’ them to restore motion using a quick, small amplitude thrust. The nerves that pass through the area can then return to normal function. Adjustments are usually not painful unless there is spasm or inflammation in the area. If this is the case we often take steps to resolve the pain before we adjust. Interestingly, chiropractic adjustments are now recognized in physiotherapy as a Grade 5 joint mobilization that restores motion and allows normal arthrokinematics (joint motion) to occur. As is so often in rehabilitation different disciplines and modalities are recognizing common ground. Chiropractic care is effective for many conditions but especially for mechanical disorders of the musculoskeletal and nervous system. Back pain, muscle spasm and nerve dysfunction are often especially responsive. Dr Sandra Hassett has undertaken both basic and advanced study in veterinary chiropractic in the USA and has been a member of the International Veterinary Chiropractic Association since 2005.

As part of a rehabilitation program it can be used to treat: Pain including non-neurogenic, neurogenic, inflammatory and myofascial (trigger point) pain Osteoarthritis including end stage elbow, hip, stifle and paw arthritis Tendon/ligament injuries including medial shoulder instability, bicipital and supraspinatus tendonopathy, calcaneal (achilles) tendonopathy, patella desmopathy, anterior cruciate strain (not rupture), fibrotic myopathy and iliopsoas strain Wounds including chronic non-healing wounds, infected wounds and acral licks. Bone fractures and post-operative bone healing

Shock wave therapy effects include: Reduction of inflammation by stimulating the release of anti-inflammatory cytokines to down regulate inflammatory mediators Enhancement of healing by stimulating the release of angiogenic growth factors to improve blood supply Enhancement of functional healing by stimulation of stem cell differentiation, (for example into bone, cartilage and tendon), rather than healing by fibrosis and scarring. Reduction in pain by reducing inflammation, disrupting nerve polarisation, reducing substance P production and enhancing myofascial release. Release of trigger points, break down of scar tissue and dissolution of calcified fibroblasts whilst improving fibre alignment - particularly important in the healing of chronic injuries Improved bone formation and healing by stimulating the release of bone morphogenetic proteins (BMPs) Stimulation of collagen synthesis to improve tensile strength Reduction in cartilage degradation Enhancement of wound healing, including infected wounds

In most cases shock wave therapy can be applied without sedation, during a 10-15 minute visit and with the owner present. The treatment area is shaved and gel applied. Shock wave therapy is loud, so sound protection is provided if the dogs (or owners) are sound sensitive. The trode is applied to the skin and the treatment itself takes 1-3 minutes. It is not painful but is percussive. Most conditions require 1-3 treatments at 1-3 weekly intervals. Many conditions only require one course of treatment. Some chronic conditions such as arthritis, require a follow up treatment at 3-12 monthly intervals. Pain relief occurs relatively rapidly (within minutes to 3-4 days). It is very important to control activity after treatment as healing takes longer (usually 3-6 weeks but up to 12 weeks). Dogs who are sound or touch reactive can be sedated if required, usually with an oral sedative before their visit.

Shock wave therapy can be used on its own but works even better if combined with appropriate therapeutic exercises and activity control. Research indicates that shock wave and laser therapy work synergistically. Shock wave therapy can be safely combined with medical therapies but in many instances the need for pain and anti-inflammatory medication is reduced.

Shoulder lameness (biceps/supraspinatus tendonopathies and medial shoulder instabilities): 29 dogs treated – 85% excellent (no lameness) to good (minimal lameness) after 16 weeks. Lumbosacral pain: 38 dogs treated – 87% positive outcome with 77% responding within 1 week and 80% showing sustained improvement at 13.5 months. Bone healing: post TPLO surgery (for anterior cruciate rupture): at 8 weeks post-surgery all osteotomies treated with shock wave therapy were considered healed vs only 50% of non-treated dogs. Arthritis: end stage elbow arthritis – efficacy equivalent to that of non-steroidal anti-inflammatory medication.

We want to do everything we can to make your dog’s treatment as relaxed and stress free as possible. The treatment only takes 2-3 minutes per site and most dogs (95%) have no issues. Although it does not hurt, it is noisy and percussive. We do provide sound protection - for dogs and humans! Dogs who are sound or touch sensitive, or dogs who are generally fearful or anxious at visits, are more likely to become stressed or reactive. Here are some steps you can take to minimise any stress: Step One: We can send you a recording of the sound. Couple the sound with something your dog really loves – a licky mat or snuffle mat with food, their dinner, a favourite toy. Have this ready for them. Start playing the tape at a low volume a couple of seconds before you offer the treat or toy to them. Gradually increase the volume over time. Step Two: You can simulate the feel of the treatment by tapping over or near the intended treatment area. We can send you a video to demonstrate. Again, it is best to couple this with something your dog likes – food or toys. Start tapping gently and then introduce the food or toy whilst you continue to tap. Gradually increase the force over time. Step Three: combine 1 and 2. Step Four: bring your dog’s favourite toys or treats to the treatment. If you are still concerned that your dog will be anxious or reactive then we can also provide sedation to help them through the experience. This is given by mouth, at least 90 minutes before you leave home to come to your appointment.

In most instances the only effect after treatment is a reduction in pain. This can be immediate after therapy or develop over 3-4 days. It can last for several days, subside, then redevelop 2-3 weeks later as the tissues heal, or it can be ongoing. Do not take your dog off medication at this stage – wait until we recheck. A small percentage of cases can develop a low level ache in the area in the hours after treatment. This can be managed with rest and anti-inflammatory medication if needed. Another small percentage of cases may develop some redness or petechiation (red spots under the skin). These can be managed by gently icing the area for 10-15 minutes twice daily until the redness resolves (usually 1-3 days). Do not let them overexercise! This is very important. They may be feeling much better and want to do much more. Don’t let them! Their tissues have not healed. Tissue healing takes a minimum of 2-3 weeks and can take 6-16 weeks depending on the condition. So: Control their activity – maintain the activity restrictions that were in place before treatment until we recheck. Gentle exercises only, avoiding stress on the affected area, for 3-5 days after treatment. Walks on lead, no ball games, no running, no jumping. For dogs with tendon and ligament injuries, especially calcaneal tendon or cruciate ligament or shoulder injuries, healing takes time. You MUST avoid any high impact activity for at least 8 weeks. The treatment needs to be coupled with appropriate therapeutic exercises to maximise their recovery.

PEMF stands for Pulsed ElectroMagnetic Field therapy and it is used to manage pain and inflammation without drugs and to stimulate healing. It was originally used in humans to stimulate bone repair in non-healing fractures with a success rate (75%) - as high as first bone grafts. Essentially PEMF induces a low level electrical current across the tissue – not high enough to produce heat or induce excitability in the cells. This modulates cell signaling through cytokines and nitrous oxide and results in accelerated tissue repair, reduced inflammation and improved pain relief. We use two PEMF devices: Assissi Loop is used for localized pain such as chronic osteoarthritis in joints, cancer pain, post-operative pain, and post operative healing. It can be used at home and each Loop will last for at least 150 treatments (15 minutes per treatment). Biopulse PEMF therapy system is used for more generalized pain for example older dogs with multiple arthritic joints, back pain, post general trauma or just those dogs who are ‘sore all over’. The system is enclosed in a ‘bed’ on which the dog can lie and the field has sufficient depth to reach the entire body of the dog. Treatment lasts 30 – 60 minutes.

A certified canine rehabilitation therapist (CCRT) is a highly trained veterinarian who has undertaken additional study in canine rehabilitation. This means that in addition to utilizing physical therapies they can also employ prescription medications, for example management of pain and inflammation, make veterinary diagnoses, request or undertake diagnostics such as pathology and imaging and perform surgery. As a veterinarian it also means that they are well trained to consider the health of the patient holistically, taking into consideration many other health conditions and their impact on the mobility of their patient. A physiotherapist is a highly trained professional who has studied human physiotherapy and has at a minimum a bachelor degree in physiotherapy. Most physiotherapists who work with animals have done additional study in animal physiotherapy. Physiotherapists focus on ‘physical therapies’ such as soft tissue therapies, therapeutic exercises and physical modalities such as ultrasound, laser and hydrotherapy to resolve mobility issues.