ABSTRACT: Many veterinary nurses are attracted to a career in canine hydrotherapy as it combines their skills and knowledge with their desire to do more to help dogs once they leave the veterinary surgery. Hydrotherapy is an effective tool in canine rehabilitation; to understand why and how to provide the most effective treatment we will need to go back to basics.

In the beginning

The term ‘hydrotherapy’ is taken from the Greek words hydros (water) and therapeia (treatment). Water was originally used as a medium for the application of heat and cold to the body. Hydrotherapy is nowadays used in reference to swimming in a heated pool and underwater treadmills.

Canine aquatic exercise has come a long way from its early beginnings as rehabilitation for elite canine athletes, such as racing greyhounds. Because increased speed and power – while essential for a racing greyhound – are not the desired outcomes for the average canine patient, methods and techniques have been adapted to accommodate dogs of all breeds and sizes, with a wide range of neuromusculoskeletal conditions.

A form of physiotherapy

Working in canine rehabilitation requires a level of understanding of anatomy, physiology and biomechanics. Bringing a hydrotherapy pool into the equation requires additional skills, including pool water maintenance, health and safety and understanding canine behaviour.

Practising hydrotherapy as a form of physiotherapy allows a range of motion (ROM) exercises – whether passive or active – to be carried out in a weightless environment. Hydrotherapists use a variety of techniques to encourage dogs to perform active ROM exercises; although passive ROM exercises, where the therapist creates the motion, should only be carried out by qualified animal physiotherapists.

There are potentially many people involved in the rehabilitation process – vets, owners, vet nurses, physiotherapists, hydotherapists, dieticians and behaviourists – who can all work together to enhance recovery.

Shared goals for rehabilitation are:

•   improving ROM

•   increasing stability and balance

•   providing pain relief  

•   improving muscle quality and reverse atrophy

•   increasing proprioception

•   maintaining or achieving ideal weight.

Fit for function

The majority of dogs who start hydrotherapy treatment are on restricted exercise programmes. This could be the consequence of recent surgery, awaiting surgery, obesity or old age affecting their ability to walk any distance. To determine an appropriate course of treatment, we not only have to know the dog’s condition, but also what level of exercise and fitness the dog is expected to return to, as it is important to set realistic targets.

For the elderly arthritic canine patient, the emphasis is on making it more comfortable for them to stand, sit and go on short walks; but a different attitude to hydrotherapy is required for dogs whose goal is to regain fitness for a desired purpose, such as sprint or long-distance running or agility.

Physiological requirements

When planning a treatment programme, there are many considerations to bear in mind – such as age, breed, temperament, condition, fitness, lifestyle, weight, usual activity, surgery and length of confinement. These all affect the energy demands on the muscles and will determine the duration, frequency and intensity of the exercise programme; if the energy systems can’t meet the demand the exercise could be detrimental to the dog’s rehabilitation.

The canine system is much better adapted to swimming than a human’s, with a more effective oxygen supply to the muscles through the blood. Muscles are made up of:

•   Type I fibres (slow twitch) – aerobic fibres that require oxygen to work

•   Type II fibres (fast twitch) – anaerobic fibres which can only sustain short bursts of speed and power.

The ratio is genetically inherited, determined by breed and affected by age. For instance, the loss of cross¬sectional area of type II fibres is responsible for the reduction of muscle mass and strength with age, whereas type I may actually increase in some muscles. There is substantial research available which indicates that muscle atrophy begins within 24 to 48 hours following immobilisation – the muscles first affected are the postural muscles, which contain a large proportion of type I muscle fibres.

Sink or swim!

Whereas most dogs can swim, providing treatment in a hydrotherapy pool teaches a dog how to swim correctly. When out swimming in lakes and rivers, dogs are swimming in a certain way because they have to keep themselves afloat. This may involve moving their body/limbs in a way that is uncomfortable or even painful. In a hydrotherapy pool, the focus is on comfortable, controlled and correct limb movements, avoiding overly strenuous exercise (Figure 1).

Figure 1: Support/flotation to aid balance and swimming position

Weak muscles can make it difficult for some dogs to swim in the correct position. Holding the head high will affect limb movement, producing more ‘downward thrust’ than extension of the hind limbs and causing fore limbs to break the surface of the water, which in turn causes swimming to be more strenuous. Dogs swimming in this style will usually be more tense, which in turn will lead to shallow, rapid breathing.

Using a buoyant neck collar, such as the ‘comfy collar’ or hands-on support to the chest or abdominal areas, can bring about a more comfortable swimming position putting less strain on the spine and opening up of the airway (Figure 2).

Figure 2: Improving the ROM

Once the correct swimming position has been adopted, various exercises and incentives can be used to produce the desired limb movements. This might include reaching or working harder for a toy or ball, moving in different directions around the pool, or the use of resistance either manually or by using anti-swim jets. Moving closer to the internal ramp or side of the pool can also make a dog work harder.

A proprioception guide can promote active movements and discourage abduction or adduction from weak limbs. What we are looking for during a session is quality of limb movements, not quantity.

Warming up and cooling down

The warm up and cool down programmes are essential, but are determined by the individual dog and the methods used at each hydrotherapy centre. A typical warm-up can take five to 15 minutes depending on the age, size, and physical condition of the dog. Providing resting platforms in the pool allows a dog to benefit from being in the warm water while recovering (Fig
ure 3).

Figure 3: Warming up and cooling down

Additional benefits

The benefits to dogs undergoing hydrotherapy treatment are numerous. As well as the goals already mentioned, it can provide emotional well-being through relaxation and endorphin release, and improve mental focus and attitude.

To achieve these goals, the hydrotherapist uses his or her skills and professionalism to ensure a safe and welcoming environment and an informative experience for owners where all concerns are addressed.

Hydrotherapy is an effective, affordable and more accessible option for the treatment of many neuromusculoskeletal conditions. The dedication and commitment of the Canine Hydrotherapy Association (CHA) members www.canine-hydrotherapy.org and the high standards set by CHA mean that vets and vet nurses can confidently recommend treatment at CHA approved centres.

Case Study

Twelve-year-old GSD x OES Milly had always been an incredibly active dog. When she was diagnosed with severe arthritis of the elbows and hips, her owner – who has worked in a veterinary practice for many years – was aware of the problems associated with older dogs and arthritis and became extremely concerned.

Milly was put on a mobility food, anti inflammatories and painkillers and, although initially effective, the treatment became less so over time. She became increasingly lame and she stopped wanting to exercise because of the pain and muscle loss quickly led to increased instability. There was little else the vets could do because she wasn’t a good candidate for surgery as multiple joints were involved.

Milly’s owner was apprehensive – she had had a previous bad experience with her other dog at an unregulated centre. After plenty of research, she found a local referral centre that was a member of the Canine Hydrotherapy Association. Milly’s sessions involved wearing a harness and being helped into the pool via ramps.

Her initial swims were very relaxed with more time resting on the internal ramp or floating in the warm water, supported by the therapist. An improvement in her posture and an increase in her muscle mass and ease of movement were noted within four sessions. She appeared happier, stronger and more confident.

As Milly’s owner, Debbie, says: “I truly believe that hydrotherapy, applied correctly, can have a massive benefit for older dogs with arthritis and can extend quality of life for them. Milly is proof of that."

Author

Xanthe Randall

After completing a series of training courses in 2007 at Hawksmoor Hydrotherapy Training Centre, Xanthe Randall gained experience at a number of Canine Hydrotherapy Association centres before opening her own CHA- accredited centre in Ramsey, Cambridgeshire. In 2009, she became one of the first hydrotherapists in the UK to achieve the new level 3 Certificate in Canine Hydrotherapy.

Suggested reading

MILLIS, D., TAYLOR, R. A. and LEVINE, D. (2004) Canine Rehabilitation and Physical Therapy Saunders.

Suggested listening

Dr Darryl L Millis MS DVM at http://osteopodcasts.net/#Millis

 

Veterinary Nursing Journal • VOL 25 • No12 • December 2010 •