Abstract<\/strong><\/p>\nRegardless of the veterinary patient species, specific rehabilitation goals (e.g., decrease pain, improve flexibility, increase strength, restore maximal neuromotor control) are believed to result in recoveries with less convalescence and morbidity. Physical rehabilitation can be considered in 3 general phases: pain mitigation, mobilization and strengthening, and athletic preparation with sport-specific\/physical goals. The rehabilitative phases are not thought to be completely separate and distinct but rather to occur on a continuum according to the patient-specific diagnosis, clinical progression (or lack thereof), and rehabilitative goal. Physical therapy strategies that improve balance, strength, flexibility, and neuromotor control offer the clinician a unique way to maximize patient outcomes. One of several crucial elements to successfully managing professional rehabilitation cases is transparent communication with the client and trainer to direct their expectations, convey case progression, and set realistic timelines.<\/p>\n
Take-Home Points<\/strong><\/p>\n\n- The most effective rehabilitation programs use regular, longitudinal patient assessments followed by appropriate protocol adaptations, with injury-specific and whole-body considerations.<\/li>\n
- Appropriate incorporation of any modality or therapeutic exercise into a successful rehabilitation program relies on an accurate diagnosis.<\/li>\n
- Physical therapy strategies that seek to improve balance, strength, flexibility, and neuromotor control offer the clinician a unique way to maximize patient outcomes.<\/li>\n
- The best patient outcomes and overall returns to function are achieved by veterinarian prescription and oversight of custom rehabilitative programs that consider the basic principles of physical therapy (in lieu of just modalities).<\/li>\n<\/ul>\n
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Sports medicine and rehabilitation is quickly becoming one of the most progressive and exciting sectors within veterinary practice. While the human athletic world has embraced the vital role of physical therapy and rehabilitation in the longevity of successful careers, the veterinary sports medicine community has been slower to identify the rehabilitative approaches that are most beneficial for patients with specific diagnoses. <\/span><\/p>\nBarriers to progress include lack of universal recommendations regarding the timing, frequency, and specific indications for modalities in conjunction with widely varied therapeutic approaches. Whether human or veterinary, the specific rehabilitation goals of decreasing pain, improving flexibility, increasing strength, and restoring maximal neuromotor control are believed to result in less convalescence and morbidity during recovery. Appropriate incorporation of any modality or therapeutic exercise into a successful rehabilitation program relies on an accurate diagnosis. The most effective rehabilitation protocols start with regular, longitudinal patient assessments and are followed by appropriate adaptation of protocols with both injury-specific and whole-body considerations. <\/span><\/p>\nThis article reviews the physical modalities and therapeutic exercises commonly used for rehabilitation of orthopedic injuries of equine patients. More information regarding rehabilitative modalities for all species is available.1-3<\/sup> Significant advances within the rehabilitation field can be expected with further research. <\/span><\/p>\nGeneral Rehabilitation Plan Considerations<\/h2>\n
In the author\u2019s experience, physical rehabilitation can be considered in 3 general phases: pain mitigation, mobilization and strengthening, and athletic preparation with sport-specific\/physical goal considerations (<\/span>FIGURE 1<\/b><\/span>). However, the rehabilitation phases are not thought to be completely separate and distinct from one another but rather are often prescribed on a continuum according to patient-specific diagnosis, dictated by clinical progression (or lack thereof), and the rehabilitative goal. For example, some patients may require only elements of phase 1 rehabilitation and others may progress directly to phase\u00a02. Serial, longitudinal clinical assessments followed by modification of protocols that include both injury-specific and whole-body considerations help optimize case progression and clarify client expectations. As the field of veterinary rehabilitation continues to evolve, efforts should be directed at prescribing patient-specific rather than generalized protocols. In the author\u2019s experience, veterinary prescription and oversight of custom rehabilitative programs that consider the basic principles of physical therapy (in lieu of just modalities) realize the best patient outcomes and return to function.<\/span><\/p>\n![\"\"](\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2024\/10\/Johnson_TVPMixedAnimal24_EquineRehab_Fig1.png\")
<\/a><\/p>\nFigure 1. Schematic of a 3-phase rehabilitative approach, beginning with initial presentation when pain mitigation strategies are high and athletic preparation strategies are minimal (phase 1). Phase 2 cultivates opportunities to more safely mobilize the patient while incorporating various physiotherapeutic aids (e.g., resistance bands, ground poles, eccentric loading). Phase 3 incorporates more sport-specific considerations and uses the careful prescription of exercise variables to gradually prepare the athlete to return to sport. The phases are not completely independent or distinct but rather occur on a continuum as dictated by the patient-specific diagnosis, clinical progression, and rehabilitative goal (or lack thereof).<\/span><\/p>\n<\/div>\n
Rehabilitation Phase 1: Pain Mitigation<\/h3>\n
The first phase encompasses the more delicate physiotherapeutic techniques (e.g., icing, compression, transcutaneous electrical nerve stimulation, heat, massage, limited amounts of controlled exercise). Goals for this phase of rehabilitation are to reduce swelling (when indicated), break the pain cycle\/wind-up, and facilitate function so that the second phase of rehabilitation can be pursued more comfortably. <\/span><\/p>\nRehabilitation Phase 2: Mobilization and Strengthening<\/h3>\n
The second phase cultivates the opportunity to more safely mobilize the patient while incorporating various physiotherapeutic aids such as resistance bands, ground poles at various configurations, blood flow restriction training (i.e., applying a specialized tourniquet to temporarily reduce blood flow to an exercising limb by using specific levels of occlusion)4<\/sup> and aquatic therapy. Incorporating such exercise modifiers enables the clinician to target rehabilitative goals (e.g., improving active range of motion, targeting muscle strength through physiotherapeutic exercises, introducing controlled eccentric loading, stimulating neuromotor control). Some patients may require only elements of phase 1, and others may progress directly to phase 2. <\/span><\/p>\nRehabilitation Phase 3: Athletic Preparation<\/h3>\n
The third and final phase of rehabilitation builds on phase 2 but begins to incorporate sport-specific\/physical demands that the patient will encounter after full return to sport. During phase 3, exercise variables such as session length, frequency, speed, carried weight, and overall intensity should be gradually introduced while pain mitigation efforts remain minimal. Sport-specific knowledge and awareness of athletic demands are integral to building a targeted and appropriate phase 3 approach. <\/span><\/p>\nVigilance and regular recheck evaluations through all phases of rehabilitation remain imperative for identifying setbacks and incorporating increases or decreases in rehabilitative workload (i.e., pivots) when necessary. Progression through the phases will vary on a case-by-case basis; patients that are more difficult to manage often lag beyond expectations in phases 1 or 2. In addition, failure to respond to phase 3 rehabilitation indicates lack of suitability for certain sport intensities. One of several crucial elements for successfully managing professional rehabilitation cases is transparent communication with the client and trainer to manage expectations, convey case progression, and set realistic timelines. <\/span><\/p>\nAquatic Therapy<\/h2>\n
In the rehabilitation setting, the proposed benefits of aquatic exercise include buoyancy, viscosity, and resistance that promote global improvements in muscular timing, strength, and neuromotor control.5<\/sup> Several options for the equine athlete are above-ground underwater treadmills, in-ground underwater treadmills (<\/span>FIGURE 2<\/b><\/span>), and swimming pools (circular or straight).3<\/sup> <\/span><\/p>\n