Rehabilitation can be used with conservative management of IVDD; however, treatment is most often done with the patient post operatively. Dogs should be strictly confined for 4 weeks, with appropriate pain control and bladder management. Neurological assessment will guide treatment plans and periodic assessments of ambulation, balance, proprioception, pain, and range of motion will gauge improvement.

Cryotherapy should be applied to the incision immediately.  Ice packs, cold packs, or ice compression units are common forms of cryotherapy.  Cryotherapy only penetrates one to two centimeters of tissue depth, so its effects are more pronounced in the skin. Compression increases cold penetration. This can be done a few different ways: by maintaining a cold pack in position with an elastic bandage or using a commercial grade compression unit. Cryotherapy, used in the acute post-op or post-injury period, is best used within 72 hours. It is used for about 20 – 30 minutes three to four times daily while monitoring the skin for irritation and discomfort.

Pulsed Electro Magnetic Field Therapy (PEMF) a non-invasive, non-pharmacologic micro-current used to enhance nitric oxide production, a principal anti-inflammatory molecule that reduces pain and edema, and, improves blood flow.  It further triggers downstream effects, including cyclic GMP, which drives growth factor production, supports new blood vessel formation, tissue regeneration and ultimately tissue remodeling. Recent randomized clinical trials demonstrated a long-term reduction in post-operative pain, improved wound healing, and about a 50% reduction in opioid use with the Assisi Loop. At the time of the two IVDD clinical trials in which the Assisi Loop was used for control of pain and inflammation, the Assisi Loop Lounges were not in production. Today the Loop Lounges are frequently used (4 sizes) at home to control post- surgical wound care, and to enhance healing without the need for additional medication. The Loop Lounge is a grid of Loops and the entire dog fits onto the lounge.

Laser increases the speed, quality, and strength of tissue repair, resolves inflammation and provides pain relief. The main advantages of laser therapy are related to enhanced wound care, tissue repair, anti-inflammatory properties and the ability to assist with pain control. The effects of pain relief are due to the result of enhanced endorphin release. Laser can be also be applied to the incision site to encourage more rapid healing.

Passive range of motion is a motion that is performed without a muscle contraction. Additional pressure at the end of the ROM is stretching. PROM helps prevent joint contracture, soft tissue shortening, maintains mobility between soft tissue layers, enhances blood and lymph flow and improves synovial fluid production and diffusion. It is best to involve only one joint at a time while keeping the other joints in neutral position. The movements should start slowly and progress until the endpoint of the range of motion is reached. Apply gentle pressure for 15-30 seconds at the end of flexion and extension to add stretching to the treatment. It is recommended to perform 15-20 repetitions two to four times a day.

Neuromuscular electrical stimulation (NMES) is used to rehabilitate or strengthen muscles by stimulating the nerve that causes the muscles to contract. NMES is effective in promoting muscle re-education in cases of prolonged disuse/atrophy however the recruitment of muscle fibers is not the same as for voluntary muscle contraction. NMES will only generate 80-90% of maximal voluntary muscle contraction, therefore exercise is preferred over NMES whenever possible.  Depending on the patient’s ability NMES can be applied while in lateral recumbency or added to a therapeutic exercise for a better muscle contraction and more challenging exercise.

Under Water Treadmill – In the UWTM, the buoyancy of the water unloads weight on the joints, which is particularly useful when minimal joint stress is desired (post-operatively, arthritic, obese). The buoyancy provides support so a very weak, post-operative patient can stand with the water’s support. Warm water increases circulation, alleviates pain and causes peripheral vasodilation, which increases cardiovascular demand and conditioning. Animals should be monitored for signs of fatigue, as aquatic therapy can be quite strenuous. Neurological patients generally walk first in the UWTM before independently ambulating on land.  

Land Treadmill – Most LTMs come with variable speeds and the ability to incline or decline. The rotating belt provides sensory feedback to the brain to relearn ambulation. It is particularly useful to build endurance when all injuries have healed and a return to play, work or competition is expected.

Massage is the non-invasive, inexpensive therapeutic manipulation of soft tissues by rubbing or kneading and is one of the most effective means of stress reduction, increasing circulation, attenuating edema, enhancing tissue oxygenation, enhancing range of motion, mobility and breaking down scar tissue. In neurologic patients three of the four common techniques can be used. Effleurage is a light stroking to relax the patient. Pétrissage uses deep kneading and muscle squeezing. Cross-fiber massage is deeper, concentrated on restrictive scar tissue and aimed at promoting normal range of motion.

Therapeutic exercises should focus on balance and strengthening.  Standing (isometric) exercises can begin as soon as treatment begins.  Support can be given using slings or physiorolls. Moving the hind limbs in a reciprocal walking pattern can mimic assisted walking. This can also be done on a land treadmill or in an underwater treadmill.  As the patient progresses in treatment, changes to the treatment plan should be made to make the sessions more challenging. Exercises such as figure 8s, assisted or unassisted sit to stands, walking on an air mattress, cavaletti rails, etc. can be added. Exercises should be added to strengthen the core muscles.

Three home exercises should also be given.  It is important to be sure the owner has a full understanding how to perform the assigned exercises.  Have the owner practice the exercise before sending them home with written instructions.  In addition to home exercises the owners can continue to treat with ice, heat, PROM, massage and pulsed electromagnetic field therapy (either the Loop itself, or the Loop Lounge Therapy pad, both have a 10 inch depth of field.)