human physio practice >


 
 
 
 
 


 
 


Introduction

Julia Hewitson has two separate treatment practices – for human and for small animal patients at her premises in Kloof, KwaZulu-Natal. Equine patients - racehorses and all other equine disciplines for horses and ponies – are usually treated at stable yards.

She also does hospital visits for in-patients at equine and small animal hospitals, followed up by treatments at stable yards and at the practice for small animals. When required, home visits for immobile human or animal patients are arranged.

In her care of animals, Julia also works in consultation with other professionals, providing a holistic approach, including

  • Veterinary surgeons and specialists
  • Veterinary homeopathy and acupuncture practitioners
  • Orthotic practitioners
  • Animal trainers and behaviour specialists
  • Equine dentists
  • Farriers
  • Saddle fitters
 
 

Important note

The treatment equipment and many of the treatment techniques described below should only be applied by a qualified physiotherapy practitioner. The use of specialised equipment is especially dangerous in the hands of people who have not been properly trained in assessing conditions and are not aware of the correct levels of current, intensity, treatment frequency etc that need to be applied. In many cases the use of electrical equipment is contra-indicated and will cause damage if applied. 

The use of this specialised equipment and these types of hands-on treatment techniques can be harmful if applied by unqualified people.  So, the age-old adage “do not try this at home” applies here – except where your physiotherapist has explained how you can further the rehabilitation process through an owner-managed programme.

Types of Treatments

  1. Spinal and limb joint mobilisation

  2. Therapeutic ultrasound

  3. Hydrotherapy

  4. Orthotic devices - splints, walking harnesses and carts – see Mobility Aids

  5. Massage: myofascial release, trigger point release, pre and post
              exercise prep and relaxation

  6. Photon (light) and laser therapy

  7. Electrotherapy and electrical muscle stimulation (“EMS”)

  8. Thermotherapy (heat & cold)

  9. Passive joint movements

  10. Rehabilitation - therapeutic & stretching exercises

  11. Neurological rehabilitation - postural rehabilitation & proprioceptive neuromuscular facilitation (PNF)

  12. Chest treatments – percussion & postural drainage

  13. Performance enhancement

  14. Advice for patients and animal owners

Initial patient assessment process  back to top

Prior to developing and implementing an appropriate treatment plan, the physiotherapist will first conduct a patient evaluation – specific to a human, small animal or equine patient. With an animal patient, this process is complicated by an animal only showing signs of symptoms and not being able to explain their own symptoms. Clinical Reasoning forms the basis of this evaluation process and is based on knowledge of anatomy and biomechanics. The process includes history taking, a clinical examination and a neurological examination. Click here to see complete Patient Assessment Process



Spinal and limb joint mobilisation  back to top

Joint assessment and mobilisation techniques are very effective in the treatment of painful arthritic joints (spinal or limb) and any injured joints which would also include damage to cartilage, ligaments, muscles or tendons.   

There are many causes for joint dysfunction, the most common having trauma and arthritic/rheumatic origins. Trauma results in an injury which ranges from a simple stretch to a severe ligament tear or even a fracture. Arthritis (“arth” meaning “joint“ and “itis” meaning “inflammation”) can be acute or chronic and even infective. It may be due to a congenital disorder (e.g. hip dysplasia) or a secondary cause (e.g. after trauma to the bone, poor conformation, repetitive joint strains or overuse at young age, poor nutrition etc.).

Physiotherapists use a combination of manual techniques to treat both spinal and limb joints. Joint mobilisation is a technique applied to move a joint within its normal range using graded rhythmical passive movements, i.e. the physiotherapist moves the joint. It is not a voluntary movement performed by the patient but it is under their control and can be stopped at any time.

A manipulation is defined as an accessory movement beyond the normal physiological joint range of movement and is not under the control of the patient. This treatment requires a sound knowledge of anatomy and pathology of joints.

With these techniques, the physiotherapist would be looking for joint restriction due to muscle spasm; evidence of swelling inside the joint; heat in the joint and normal “feel” at end-of-range movement for that particular type of joint, etc

Therapeutic Ultrasound  back to top

Ultrasound is a very effective treatment used in musculo-skeletal conditions where there is injury to muscles, tendons or ligaments and in conditions where there is restricted joint movement, pain, muscle spasm and wound healing. 

The sound waves create a mechanical vibration generated by an acoustic source.  The mechanical energy in the tissues is converted to heat, thereby improving circulation which provides pain relief, reduces muscle spasm and promotes healing.

Superficial heating treatments penetrate to about 1cm, but ultrasound can produce deep heat, increasing temperatures in the tissues to a depth of 3cm or more. There are many benefits to this modality, but used without the correct training and knowledge it can cause damage instead of healing.  It should therefore only be used by a trained practitioner. The mechanical effect is created by ultrasound waves exerting pressure and tensile forces at molecular level in the tissues, i.e. a micro-massage effect.

Hydrotherapy  back to top

The Kloof Physiotherapy animal practice includes a heated hydrotherapy pool for the treatment of dogs recovering from injury or surgery or coping with chronic mobility problems.

This is a natural approach using heated water as an exercise environment to assist healing.  The heated water (+30ºC) creates a wonderfully therapeutic medium to provide relaxation and pain relief, in a non weight-bearing environment that allows dogs to exercise without concussive jarring forces on painful joints.  The therapist can also vary the exercise resistance using turbulence or manual resistance techniques for harder workouts. 

Conditions such as cranial cruciate ligament repairs or injuries, post-spinal operations, post repair of fractures, geriatric patients with osteoarthritis, obesity and generally any conditions with acute or chronic pain or stiffness benefit from the treatment.  The aim of hydrotherapy treatment is to increase joint mobility by reducing swelling and relieving pain and muscle spasm.  Muscle strengthening and increased cardiovascular fitness can also be achieved.


 

Orthotic Devices - see Mobility Aids (link)   back to top

After an accident, illness or surgery it is important to encourage movement as soon as possible. As most pets will drag themselves around if given the opportunity, it is important that they are properly confined. But the question is: how can you get your pet moving without risk of further injury? If your dog has a mobility problem, then splints, braces, walking harnesses and custom-made wheels and carts can assist.

Physiotherapists are trained to assess patients and take measurements for the correct orthotic appliance or walking aid and can provide the appropriate device.

Massage  back to top

There are many types of massage. However, the choice of technique is based on the effect that is required. Massage can be used for relaxation and general well being, to increase circulation, lymphatic drainage, to relieve muscle spasm, improve body awareness, tissue lengthening and to build a bond with the animal. Physiotherapists use various massage techniques aimed to mobilise soft tissues in areas where there is restriction and lack of mobility. Assessment and treatment occur at the same time. Massage can be superficial or deep and again the medical condition of the patient must be known to the therapist to ensure the correct treatment is given.

Although massage can be very relaxing, there are situations which massage could be contra-indicated, for example in patients presenting with any of the following: fever, tumours, infections or hypersensitive areas.


 

Photon (Light) and Laser Therapy  back to top

This treatment produces the emission of a beam of radiation and different wavelengths penetrate to different depths of tissue.  Laser therapy and light therapy are particularly effective in the treatment of wounds as they stimulate at an intra cellular level therefore promoting healing.  These techniques are non-invasive and have been shown to be very effective for treating ligaments and tendons when combined with ultrasound treatment. See Light Therapy article (link)

Electrical Muscle Stimulation (EMS)  back to top

Electricity has been used therapeutically since the 18th century and the faradic current generator invented by Faraday in the early 1800’s is the basis for most modern muscle stimulators.  Electrotherapy is used for the restoration of muscle function after injury. These stimulators deliver an electrical signal which causes the muscle to twitch. Varying currents are used: to relieve pain; for muscle re-education even when the nerve has been damaged; for prevention of muscle atrophy; to maintain or improve circulation and to improve joint movement. The electrical frequencies vary and it is important that they are applied correctly under professional supervision.


 

Thermotherapy - Cold and Hot (superficial vs deep)  back to top

Recent injuries benefit from cooling, to reduce the amount of bleeding, swelling and pain. After 48 hours the same injury can benefit from heating, to increase the metabolism and therefore healing. Overcooling has been shown to diminish healing. Generally, swelling is reduced by cold therapies and heat has an analgesic (pain-relieving) effect, reduces muscle spasm and decreases joint stiffness.  Heat is usually applied with hot-packs or infrared. Cold is applied with ice-packs, immersion in ice water or cold hosing.

Warning animals cannot verbalise discomfort easily and care should be taken when applying hot or cold therapies, to avoid ice or heat burns which can be very painful.

Passive Range of Movement  back to top

Passive range of movement applied aggressively can cause pain, resulting in delayed use of the limb and possible joint fibrosis. The objective of this treatment is to gently flex and extend the individual joint through a comfortable range of movement. The animal should not vocalize pain or attempt to bite. Post-operatively or post-trauma, mid-range passive exercises effectively prevent complications and improve the rate of recovery and ultimate outcome. Stretching techniques move into end-range movements and should only be applied by an experienced physiotherapist.


 

Rehabilitation  back to top

Therapeutic exercises

These are not complicated, but require expertise and experience to know when and how to apply them.  Knowledge of the anatomy and the condition being treated ensures the best outcome. Therapeutic exercise programmes are planned by the physiotherapist as an important part of your treatment.   Balance and coordination are an outcome of proprioception - the awareness of where our limbs are in space without having to look at them - which is dependent on learned movement patterns involving both the nervous and muscular systems.  A lesser-known benefit of some exercises is the re-education of proprioception. By improving joint movement and building up strength, exercises also help prevent secondary problems of instability and possible recurrence of injury.  This is especially important for competitive sporting animals.

Stretching Techniques

Stretching is really another topic on its own! It can involve both active involvement of the patient and also passive stretching i.e. stretches performed by the therapist or the owner of the animal. Stretching is performed in conjunction with active exercise to improve the flexibility of joints. There are many factors that can create adaptive shortening of the soft tissues surrounding a joint e.g. after immobilisation in a cast, nerve conditions, disuse due to pain etc. The shortened tissue then needs stretching.  Stretching can also be used as part of a warming up and warming down programme for athletic patients and is important in the prevention of injuries.


 

Neurological Rehabilitation  back to top

Physiotherapy aims to facilitate functional return by: taking advantage of any spontaneous recovery; stimulating the reorganisation and adaptation of neural tissue function via new experiences; preventing or minimising complications; developing mobility aids/resources that offer a better quality of life. There are various approaches and methodologies used in rehabilitating human neurological patients and a combination of the same variety of principles are useful in treating the canine patient. As verbal communication is limited and where key components of movement need to be performed, sensory stimulation techniques can bridge that gap.

Postural Rehabilitation

This technique influences postural mechanisms and contributes to postural control in the musculo-skeletal apparatus, through vertical righting reactions, rotational righting reactions, equilibrium reactions and protective extension reactions.

Proprioceptive Neuromuscular Facilitation (PNF)

This technique uses specific proprioceptive stimulation to re-educate the neuromuscular system. Mature movement patterns are reproduced as in the movement pattern we would use to bring food from the plate to our mouths or in dogs, the mass movement characteristically used to scratch an ear or hold a bone between the front limbs. Specific techniques include: slow reversal techniques and rhythmic stabilisations

Chest treatments – percussion & postural drainage  back to top

These treatments are routine in human care, but are not well documented or established in veterinary medicine. Postural drainage is the use of changes in body position to drain specific lung segments by gravity. Percussion is a rhythmical cupping action of the hands on the chest over a specific lung segment that produces a mechanical loosening of secretions.

Performance enhancement  back to top

A variety of techniques and owner advice are available to improve performance in sport horses and dogs.


 

Advice for patients and animal owners  back to top

At the end of a sequence of treatments or after surgery, human patients and animal owners are given detailed advice and demonstrations about how to manage and maintain rehabilitation in the home environment.

Finally, animal owners should please remember that it is in your pet’s best interests that you ensure that your “Physiotherapist” or “Physio” is in fact a qualified and registered physiotherapy practitioner, by asking for proof of registration and qualifications if necessary.

 
 
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