Successful rehabilitation requires an extensive evaluation and thorough understanding of the patient’s history, presentation and unique comorbidities.  Although we cannot apply a cookbook approach to rehabilitating our patients, we can set up some simple guidelines.

Understanding which rehabilitation techniques and modalities to apply for a particular injury, requires first and foremost a diagnosis. Owners may decline diagnostic tests due to financial constraints; however, they should understand that saving money in the short-term may lead us down the wrong path and our treatments may be less effective.

The type of tissue that has been compromised (skin, fascia, muscle, tendon, ligament, bone, cartilage) will determine the speed and pattern of healing.  It is critical to understand which tissues have been injured, in order to choose the best therapies.  In addition, the degree of tissue damage (i.e. grade 1, 2, 3 muscle tear), vascular or nerve compromise, presence of infection and other comorbidities can also influence rate of healing.

In order to build a successful rehabilitation plan, one most develop SMART (specific, measurable, attainable, relevant and time-bound) goals. These should be developed not just for the specific injury, but relevant to the whole patient. Client education regarding rehabilitation goals is instrumental to building a strong and trusting relationship.

Each tissue has a predictable and time-specific pattern of healing. In general, all tissues follow similar stages of healing (inflammatory, reparative, remodeling); however, the length of each stage varies according to the specific tissue.  Bone is the only tissue that is able to regain 100% tensile strength following complete injury. Other tissues, such as tendons, ligaments and cartilage have a much poorer capacity to regain strength and often never return to normal.  For this reason, targeting rehabilitation according to tissue and stage of healing is beneficial for promoting optimal repair.

In the inflammatory stage, reducing pain and modulating severity of inflammation is key.  Recommended therapies include cryotherapy, manual therapy (joint distractions and compression) and modalities including TENS, photobiomodulation, PEMF, and ESWT.

In the reparative stage, weaker collagen is replaced with stronger collagen and growth factors and other cytokines signal to repair primary tissue damage. Manual therapies (including passive ROM, joint and soft tissue mobilizations), as well as modalities (electrical muscle stimulation, photobiomodulation, PEMF, therapeutic ultrasound, and ESWT), and therapeutic exercise (prescribed to meet the specific goals) are vitally important.

In the maturation/remodeling stage of healing, there is a race between primary tissue repair and fibrosis (or scarring).  Tissues will heal according to the lines of stress and therefore, appropriate therapeutic exercises are key at this stage.  Manual therapies to reduce scar tissue formation and therapeutic exercises customized to improve strength, flexibility, endurance and complete return of function. Modalites are generally less indicated at this stage.

Each patient is unique and must be assessed for pain, degree of strength, flexibility, level of function and response to treatment on a regular basis.  Patients should be closely monitored and treatment plans should be adjusted accordingly to maximize results.

For further details and understanding of the recommendations presented here, readers are encouraged to read: K Kirby-Shaw, L Alvarez, J Tomlinson, et al. Fundamental principles of rehabilitation and musculoskeletal tissue healing. Veterinary Surgery. 2020; 49:22-32.

Abbreviations

ESWT- extracorporeal shockwave therapy

PEMF- pulsed electromagnetic field

ROM- range of motion

TENS- transcutaneous electrical nerve stimulation