Rehabilitation Modalities

There are many different modalities that rehabilitation therapists use to help enhance a pet’s recovery from acute injury or maintain optimal mobility and comfort in chronic conditions.

The choice of modalities depends on a thorough assessment of your pet’s health, including diagnostic tests, surgical treatments, and a thorough orthopedic and neurologic assessment. There should also be reliable evidence that the modality will improve your pet’s outcome. Certain modalities can be harmful to pets with specific conditions – your pet’s rehabilitation therapist can discuss any risks with you.

What is passive range of motion and stretching?

Passive exercise occurs when a therapist moves joints through their comfortable range of motion without muscle contractions occurring.

When motion is limited, such as from an injury or surgery, joints can lose their flexibility and muscles can become shorter and atrophy, restricting motion further.

Passive range of motion (PROM) and stretching improve or help maintain joint flexibility. These exercises also improve the elasticity of soft tissues (muscles, tendons, and ligaments) and help nerves and muscles interact more effectively. Stretching acts to elongate muscle and improve flexibility in the joint. It is best performed when the tissues are warm, so after exercise or after superficial warming of the affected area. Patient stretching can decrease pain, prevent injury and be quite relaxing for your pet.

What is therapeutic exercise?

Therapeutic exercise is considered the most important modality used in rehabilitation. Exercise programs of increasing intensity designed for in-clinic and home use help pets regain the best mobility possible. They are specifically designed for each pet, taking into account their disease, stage of healing, and current abilities and limitations. The exercises are designed to improve comfortable range of motion, muscle mass, strength, and balance. They require routine re-assessment with a rehabilitation therapist to ensure they are challenging the pet enough to help them improve, but not so much that they become painful.

What is thermotherapy?

Superficial heat and cold are often recommended to improve tissue response to certain modalities. These can include hot or cold packs, ice massage, and cold compression units. Superficial cooling (cryotherapy) can provide pain relief, control bleeding, and decrease inflammation and muscle spasms. It is most often used in the early stages after surgery or trauma but may be recommended at other times.

Superficial warming can help improve flexibility prior to activity and stretching. Heat can increase blood flow to the area, relieve pain, and also relax muscle spasms.

What is therapeutic ultrasound?

Therapeutic ultrasound uses inaudible sound waves to transfer energy as heat to tissues deeper than thermotherapy can reach. Ultrasound is often used with other modalities like massage and stretching in soft tissue injuries. It can reduce tightening or contracture, scarring, and pain as the soft tissue heals. When used at the right time, ultrasound can help these tissues repair more effectively by recruiting helpful cells called fibroblasts, endothelial cells, and myofibroblasts.

How is electrical therapy used in rehabilitation?

The two main types of electrotherapy are transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES).

TENS uses electrodes placed on the skin to transmit small electrical pulses to nerves under the skin. The pulses are believed to block transmission of pain from the treatment area to the brain. There may also be release of endorphins and other chemicals that relieve pain.

NMES is used to stimulate muscle contractions in patients who are not using those muscles very much, like patients who have restricted activity or are paralyzed. NMES helps by reducing muscle atrophy and joint contracture (stiffening in a flexed position). It can also increase beneficial blood flow to the area and reduce edema (fluid buildup) and swelling.

How does massage therapy help my pet?

Massage is an excellent modality to use in all patients. Massage increases blood flow to muscle and fascia, which then increases oxygen and nutrient delivery to, and removal of waste products from, these tissues. Massage can stimulate the release of endorphins and provide pain relief. It also stimulates weak muscles and relieves tension. It can reduce swelling and pain and helps build a bond between the masseur and the pet. A good massage can also find areas of pain or sensitivity that may be compensatory for the original injury or may be reflective of another condition. Massage can break down sticky adhesions in the subcutaneous tissues or fascia, allowing tissues to move more freely.

What is joint mobilization?

Joint mobilization is a passive movement within a pet’s comfortable range of motion. Joint mobilization is used for pain, as well as to improve mobility in pets with reduced flexibility (ROM) like those with elbow dysplasia and osteoarthritis. It can be relaxing for many pets.

How can my pet benefit from walking on a treadmill?

A form of controlled exercise, walking on a treadmill can increase muscle mass; improve quality of movement, balance and coordination; and can encourage better weight bearing after trauma or surgery. It can be useful in helping a dog learn to walk again after a paralyzing event.

Why is aquatic therapy useful?

Water has unique properties that make it a valuable tool for relieving pain and improving mobility in pets. The floating or buoyancy effect in water decreases the weight placed on your pet’s joints and helps your pet move easier if they have weakened muscles from chronic orthopedic disease or partial paralysis. 

Water also exerts constant pressure (hydrostatic) on any submerged areas of the body that can reduce swelling and pain. Water also offers resistance – it is harder to walk through water than air – so while moving in water, your pet is strengthening their muscles and improving their fitness. This resistance also provides constant sensation (sensory input) and can help prevent falls as it gives pets more time to keep themselves upright if they start to fall. A warmer water temperature can also provide a warming effect with the beneficial effects described above.

"Water has unique properties that make it a valuable tool for relieving pain and improving mobility in pets."

Underwater treadmills allow for more control of a patient’s movements and the benefits of the land treadmill are combined with those of aquatic therapy. Different water levels can be used to achieve different goals, including muscle strengthening, improved joint flexibility, and pain relief.

Pool therapy takes almost the entire weight off the joints and can be especially useful for increasing fitness in overweight dogs or for dogs who have trouble maintaining their balance or standing.

What is photobiomodulation?

Photobiomodulation, also known as laser therapy, cold laser therapy, or low-level laser therapy, uses certain wavelengths of light (outside the visible spectrum) to cause beneficial changes at the cellular level. Laser helps to reduce inflammation and edema in the target tissues and can relieve pain. Laser also stimulates tissue repair by modifying cellular functions. Using different wavelengths, intensities and doses can change how laser treatment works.

What is extracorporeal shockwave therapy (ESWT)?

ESWT applies high-energy soundwaves through the skin and into target tissues. The soundwaves interact with cells, ultimately leading to reduced inflammation, improved healing and decreased pain.

A well-trained veterinary rehabilitation team will offer specific modalities because they have proven to be effective in multiple clinical studies for certain conditions. Certain modalities may not be proven to be beneficial for your pet, or worse, could be harmful, so they will not be included in their treatment plan. There are benefits and risks to each modality that your pet’s veterinary rehabilitation team will discuss with you.