PHYSIOTHERAPY and

REHABILITATION
Dr. Pınar CAN
pcan@ankara.edu.tr
 LECTURE PLAN

• Neuromuscular anatomophysiology • Laser Therapy

• Anatomy and basic biomechanical • Thermotherapy

concepts • Hydrotheraphy
• Sports Horse Care • Acupuncture and its basic principles
• Sports Horse Exercise • Acupuncture and application areas

• Massage Therapy • Rehabilitation of Physical Therapy in

Tendo and Joint Diseases
• Electrotherapy
• Physical Therapy Rehabilitation in Horse
• Ultrasound Therapy with Low Back Pain 18.04.2021 2
What is physiotherapy or physical
therapy?
• Physical therapy includes examining and evaluating
patients with impairments, functional limitations, disability,
and other health-related conditions to determine a
diagnosis, prognosis, and intervention (APTA).
• Aims; improve quality of life, helping to prevent injury,
impairments, functional limitations, and disability, reduce
pain

18.04.2021 3
 Veterinary physiotherapy and rehabilitation?
• Veterinary physical rehabilitation is the use of noninvasive techniques, excluding veterinary
chiropractic, for the rehabilitation of injuries in nonhuman animals. Veterinary physical rehabilitation
performed by non-veterinarians should be limited to the use of stretching; massage therapy;
stimulation by use of low-level lasers, electrical sources, magnetic fields, and ultrasound;
rehabilitative exercises; hydrotherapy; and applications of heat and cold.

18.04.2021 4
 5

18.04.2021
 The first record of animal physiotherapy being practised comes from 1939
https://history.physio/wp-content/uploads/2019/02/Sir-
when Lord Luis Mountbatten asked the Royal physiotherapist, Sir Charles
Strong, to treat his horses (Calatayud, 2019).

The first official animal physiotherapy association, the

charles-strong-300x264.jpg

Association of Chartered Physiotherapists in Animal Therapy

(ACPAT), was formed in the United Kingdom in 1985 (Veenman,
2006).
* Sir Charles Strong applying a low 18.04.2021 6
frequency current
 REFERENCES

• Levine D, Millis D. Regulatory and practice ıssues for the veterinary and physical therapy professions, In; Canine rehabilitation and physical
therapy, 2nd ed, Saunders, 2014.

• Calatayud M. A royal history of animal physiotherapy. Available from: http://history.physio/a-brief-history-of-animal-physiotherapy/

(accessed 2 January 2021)

• Veenman P. Animal physiotherapy. Journal of Bodywork and Movement Therapies. 2006; 10(4): 317-27.

18.04.2021 7
 Useful reference books for animal physiotherapy
• Levine D, Millis D. Canine rehabilitation and physical therapy, 2nd ed, Saunders, 2014.

• McGowan CM, Goff L. Animal physiotherapy assessment, treatment and rehabilitation of animals, 2nd ed, Wiley Blackwell,
2016.

• Zink C, Van Dyke JB. Canine sports medicine and rehabilitation, 2nd ed, Wiley Blackwell, 2018.

• Bromiley MW. Equine injury, therapy and rehabilitation, 3rd ed, Blackwell Publising, 2007.

• Williams G, McKenna A. Horse movement structure, function and rehabilitation, JA Allen, 2014.

18.04.2021
NEUROMUSCULAR ANATOMOPHYSIOLOGY

18.04.2021 9
 Posture?
• defined as the attitude assumed by the body either with support during the course of muscular
activity, or as a result of the coordinated action performed by a group of muscles working to
maintain the stability.

Static
. Siting, standing, sleeping

Posture

Dynamic
. Walking, running, bending
etc.
18.04.2021 10
 Why posture is important?
• poor posture is significantly implicated in primary injury and secondary dysfunction
• It is more very important for horses, because it helps us to understand how their complex neuro-
musculoskeletal system is functioning

18.04.2021 11
 Postural changes
• In nature, predators select the weak, sick or lame individuals
• Horses develop postural compensation strategies to hide their weakness or lameness
• Postural changes can be the sign of subclinic lameness in horses

18.04.2021 12
 Somatic
distorsion

Delayed Impaired
healing proprioception

Abnormal
compensatory
posture
Predisposition to Poor gait
injury timing

Chronic Physical and

lameness emotional 18.04.2021 13
stress
 Cause of abnormal postural changes
• Restricted exercise
• Dietary changes (can change the masticatory pattern thus leading

https://www.americanfarriers.com/ext/resources/images/2012plus/2008/01/5730/before_after.jpg
temporomandibular joint problems)

• Use of force by humans- improper shanking etc.

• Improper hoof trimming – especially long toes
• Inadequate dental care- malocclusions

18.04.2021 14

https://www.texasequinedentist.com/images/incisors.png https://www.quarterhorsenews.com/wp-content/uploads/2015/03/DMT_shank-800x500.jpg
https://ivcjournal.com/wp-content/uploads/posture_figure1ab.jpg

18.04.2021 15
 If a horse refusing to do what you want him

• He doesn’t understand what you want

• He is not physically capable of doing what you want
• Or It hurts (cause pain) him

18.04.2021 16

https://cdn.shortpixel.ai/client/q_lossy,ret_img,w_540/https://horseauthority.co/wp- https://www.medequestrian.co.uk/wp-content/uploads/2012/09/horses_534146.jpg
content/uploads/2016/05/Q33.jpg
 Functional anatomy?
• the study of movement and physical activity
• functional anatomy is the cornerstone of biomechanics.

The difference between equine and canine back movements

(Williams and McKenna, 2014)

18.04.2021 17
 Vertebral column=axial skeleton

https://cdn.britannica.com/72/106172-050-12622D01/dog-skeleton.jpg

Limbs=appendicular skeleton
18.04.2021 18

https://inkymousestudios.com/wp-content/uploads/2015/07/equine-skeletal-anatomy-poster.jpg
 Muscle contracts&relaxes

Force
https://skequestrian.files.wordpress.com/2018/12/a454e6df3f1ef979e8c8bbd5d24b9833.jpg?w=370&h=&crop=1

the more efficient the levers, the

Tendons greater the power produced and
the more effective the movement

Force
generated

Joint=lever

Bone

Locomotion or standing

18.04.2021 19
 http://wvc.com.au/wp/wp-content/uploads/2017/05/pony_trotting.png
Injury >> musculoskeletal pain >> impairment of joint function >> changes in static and
dynamic posture

18.04.2021 20
• Injury: The damage caused by physical trauma to musculoskeletal tissues.
• Such trauma may be sub-clinical and induce subtle postural adaptations, or
• it may be major and immediately give rise to observable injury.
• But these major traumas in themselves produce postural compensations.

18.04.2021 21
 Effects of forces on musculoskeletal tissues

• Bone; particularly, is a remarkably adaptive tissue, and

• adapts to the stresses and strains put upon it by remodelling by reducing bone density in skeletal
areas that are experiencing reduced loading, and
• increasing the bone density in skeletal areas that are experiencing increased loading
• Immobilisation >> to disuse osteoporosis in the bones that are immobilised

Radiographs showing the anteroposterior (Fig. 1) and lateral (Fig. 2)

projections of the third metacarpal from the control (left) and
experimental (right) limbs after forty weeks of immobilisation.

18.04.2021 22

Jaworski et al., 1980

 Effects of forces on musculoskeletal tissues

• Ligaments: Stabilise joints by joining bone to bone

Ligament__4e69/zoom462x600z80838cw572.jpg?77924f00347ee53dac499cfdd4fa259e
• Tendons: Attach the muscle to the bone,
• Both respond to stress and strain

https://www.animal-mrt.com/images/blog/Cranial-Cruciate-
• Exercise leads to hypertrophy (increased diameter of fibres) and
an increase in strength
• immobilisation >> a rapid deterioration in strength and stiffness as
well as loss of important tissue constituents such as
glycosaminoglycans

18.04.2021 23
 Effects of forces on musculoskeletal tissues

• Joints: each joint has a range of motion (ROM)

• ROM is joint specific and relative to individual conformation
• Joints with more than one movement plane have a ROM for each plane
• Injury to joints occurs when the joint exceeds its normal ROM

Sabancı and Ocal, 2016

18.04.2021 24
 Effects of forces on musculoskeletal tissues

• Fasciae: Has a marked role as a force transmitter in

animal posture and movement regulation
• Fasciae are dense connective tissues that surround
muscles, groups of muscles, blood vessels, nerves and
internal organs
• Fascial tissues are commonly utilised in dynamic energy
storage for postural stability during movement

Chong and Davies, 2017

18.04.2021 25
 Proprioception

• the ability of an animal to know where his limbs/joints are in space and time without looking at
them
• the fascial network serves as a sensory organ because it is densely innervated by myelinated
sensory nerve endings including very specialist neural tissues such as Pacini corpuscles, Golgi
tendon organs and Ruffini endings.
• In fact, the extent of the fascial system makes it the largest sensory organ in the body.

18.04.2021 26
 References

• Gellman K. Normal and abnormal equine posture: how PRI can help performance and health, 2015. access;
https://ivcjournal.com/normal-and-abnormal-equine-posture/

• Chong, T.E. and Davies, H.M.S. (2018), Investigating canine elbow joint stabilisation through mechanical constraints of the
deep fascia and other soft tissues. J. Anat., 232: 407-421.

• Williams G, McKenna A (2014). An introduction to functional anatomy, In: Horse movement structure, function and
rehabilitation.

18.04.2021 27
ANATOMY and BASIC
BIOMECHANICAL
CONCEPTS
Dr. Pınar CAN
pcan@ankara.edu.tr

18.04.2021 1
 Axial Skeleton
✓ Cervical vertebrae are long and voluminous,
✓ the mobility of the neck is due to the depth
of the fossa and the hemisphere shape of
the vertebral heads

Rhodin, 2008 ( )
https://pub.epsilon.slu.se/1680/1/Rhodin_2008_1.pdf

https://www.imaios.com/i/var/ezwebin_site/storage/images/media/images/vet-anatomy/horse-osteology-illustrations/horse-equus-cervical-
vertebra-illustration-antoine-micheau-en/24231829-1-eng-GB/horse-equus-cervical-vertebra-illustration-antoine-micheau-en.jpg

18.04.2021 2
 Axial Skeleton

• Long proc. spinosus of thoracic vertebrae >> strong levers

• Long proc. transversus of lumbal vertebrae and tight attachment of the proc. articularis to
eachother >> reduce lumbar mobility, especially lateral flexion and rotation
• Proc. spinosus of L6 extends dorso-cranially in most of the horses >> helps lumbo-sacral mobility in
flexion and extension

18.04.2021 3
 https://horsesidevetguide.com/wp-content/uploads/2017/05/Superficial-Structures-of-Head-Neck-FINAL--672x504.png https://www.animal-mrt.com/images/blog/horse-muscles-02-
large__8c47/zoom649x600z62425cw1041.jpg?77924f00347ee53dac499cfdd4fa259e

➢ Ventral cervical muscles >> are the flexors of the neck; brachiocephalic, sternocephalic, scalenus, longus
capitis
➢ Dorsal cervical muscles >>> are the extensors of the neck; trapezius, omotransverse, rhomboid, cervical
serratus, splenius, semispinalis capitis, longisimus capitis and atlantis, spinalis cervicis
18.04.2021 4
 Denoix and Pailloux, 1998

✓ Juxtavertebral muscles >>> rotation and lateral flexion, intervertebral stability; longus colli,
multifidus cervicis, intertransverse
✓ Muscles of the head >>> extension and lateral flexion of the head
18.04.2021 5
 Nuchal ligament
✓ It is powerful and moderately elastic
✓ Plays an important role in the vertebral column
function
✓ The two parts work passively together
✓ When the head and neck are lowered, they exert a
forward traction on thoracic spinous processes causing
flexion of the thoracic vertebrae

18.04.2021 6
 https://open.oregonstate.education/app/uploads/sites/48/2019/07/1001_Muscle_Tissue_revised.png

18.04.2021
7

https://open.oregonstate.education/app/uploads/sites/48/2019/07/1010a_Contraction-and-Relaxation-1024x751.png
 Vertebral Biomechanics

➢ Each of the bars on the graph relate to the

amount of movement in the corresponding
intervertebral joint

➢ There is little movement in any of the joints

except in the neck and in the lumbosacral joint

18.04.2021 8

Williams and McKenna, 2014

Movement in axial rotation (twisting around
the spine).

➢ Axial rotation capacity of the

atlantoaxial joint is the highest one

18.04.2021 9
Movement in lateral flexion (bending
to the left and right).

18.04.2021 10
Anatomical representation of complete self-carriage in the horse

11

18.04.2021
 ➢ Elongation of Descending
pectoral and trtransverse
pectoral

➢ Concentric contraction of
Infraspinatus, deltoid,
rhomboid and trapezius

18.04.2021 12

Denoix and Pailloux, 1998

 ➢ Elongation of adductors of
the thigh and iliopsoas

➢ Concentric contraction of
middle gluteal, deep gluteal,
gluteobiceps, iliopsoas and
tensor fasciae lata

18.04.2021 13

Denoix and Pailloux, 1998

BEHAVIOUR

14
18.04.2021
 https://joyfuldogllc.com/jd/wp-content/uploads/2015/08/Lili-Chin-Doggie-Language-1.jpg
15
18.04.2021
https://i.etsystatic.com/5657160/r/il/c5a924/782356051/il_1140xN.782356051_rmnu.jpg
18.04.2021
16
 https://colombianhorses.files.wordpress.com/2015/08/body-language.jpg

For more information > https://jhtr.org/wp-content/uploads/2020/04/JHTR-Horse-and-Herd-Behavior.pdf

18.04.2021 17
 Effectiveness of FTR applications

• Effective communication between doctor and patient

• Motivating the patient
• Applications should not cause suffering to the animal
• Interventions to be safe for physician and patient

18.04.2021 18
 References

• Denoix JM, Pailloux JP. Physical therapy and massage for the horse, Manson Publising, 1998.

• Williams G, McKenna A. Axial skeleton, In: Horse movement structure, function and rehabilitation, JA Allen, 2014

• Rhodin M. A Biomechanical analysis of relationship between the head and neck position, vertebral column and limbs in the
horse at walk and trot, Doctoral thesis, Uppsala, 2008.

18.04.2021 19
WOUND HEALING

1
 2

http://www.shieldhealthcare.com/community/wp-content/uploads/2015/07/Stages-of-Healing_image.jpg
Falanga, 2005 3
Macrophages have 5 basic
functions;

1. Phagocytosis
2. Debridation
3. Regulation of matrix synthesis
4. The attraction and activation of
cells to the area
5. Angiogenesis https://woulgan.com/wp-content/uploads/2017/06/beta-glucans-and-wound-healing.jpg

4
BONE HEALING

5
❖35 % organic component

Osteocytes; mature bone cells, locate in

lacunas, take part in mineral homeostasis
Osteoblasts; produce bone tissue
Osteoclasts; bone resorption
Bone matrix; type 1 collagen and
glycosaminoglycan (GAG)

❖65 % inorganic component

Calcium, phosphor, hydoxyapatite

6
0-2 weeks 2-3 weeks 3-6 weeks 8 weeks-2 years

https://upload.orthobullets.com/topic/9009/images/fractue%20healing.jpg

7
 Contact healing: interfragmentary
Primary space <0,1mm
(direk) GAP healing: 0,1 -0,5 mm
Rigid fixation is needed

Bone
healing

If there is no rigid fixation

Secondary İnterfragmentary space > 0,5 mm
(indirek) Callus formation occurs

8
MUSCLE HEALING

9
 https://www.atlantaequine.com/images/fibrotic_myopathy_pic.jpg
➢ Muscle injury; as a result of laceration, contusion,
rupture, ischemia and strain
➢ Usually as a result of the sudden contraction of the
muscle body when the muscle is in passive
extension (except as a result of a penetrating
impact).

10
➢ Damage to the muscle results in
rupture of muscle fibers and impaired
vascular or connective tissue support.
➢ The problem can be acute or chronic
and can range in severity from minor
injuries to complete rupture.
https://www.epainassist.com/images/types-of-muscle-tears.jpg

11
Laumonier, 2014
12
➢ Hemostasis
➢ Hematoma (edema and ischemia adjacent
necrosis of ruptured muscle fibers)
➢ Inflammation (removal of necrotic debris by
neutrophils and macrophages during the first
24-72 hours)
➢ Repair depends on restoring vascular
nutrition to damaged fibers

13
➢ Repair depending on the severity of the injury and the size of the muscle cavity
regeneration of functional myofibers
fibrous scar tissue formation
➢ Repair by scar tissue production is undesirable due to the high chance of repetitive
injury and an approximately 50% reduction in muscle contraction force.

14

Sato ve ark., 2014

To ensure proper healing of muscle;
✓ Good vascularization
✓ Adequate amount of myoblasts
✓ Adequate innervation
✓ Enough immobilization

Forcina ve ark., 2020 15

TENDO HEALING

16
Structure of a tendon

17
 Extrinsic Healing
➢ influx of cells from synovial
sheath, paratenone or
epitenone >>> phagocytosis,
fibroplasia, collagen
deposition
➢ Excessive adhesion occurs
Intrinsic healing
➢ Synovial sheathed tendons
➢ Epitenon and endotenon
effective
➢ Minimal adhesion
➢ It can be encouraged by
adequate immobilization

Inflammation (first 72 hours) > repair (4-6 weeks) > maturation (up to 120 days)

It should be waited for 240 days for providing the normal tensile strength!!
18
SPORT HORSE CARE

19
 Horse Grooming

✓ For the horse to look good and relax,

✓ To examine the horse's body for all kinds of injuries and
skin problems,
✓ Increasing blood circulation,
✓ To provide releasing the natural oils in the skin into the
hair,
✓ Creating a bond of trust between horse and rider/owner

20
21
 https://ae01.alicdn.com/kf/HTB18PzEbGSs3KVjSZPiq6AsiVXaT/10-IN-1-Horse-Grooming-Tool-Set-Cleaning-Kit-
Mane-Tail-Comb-Massage-Curry-Brush-Sweat.jpg_960x960.jpg
22
 1. Secure your horse

https://lh4.googleusercontent.com/06H0KCZ3H0fJug8x05vS7fb-rrkv_DDtNlEecej1QuQ-
UrvGWzYjo4dl5S6P3tHFIi8nGEZDiPfx_7T9vIBQ_xNdaGw_lRem4rruCk2dCpqCj_8ruX22e7i4HvG9iiDUhb1qG_tb

Always use a quick release knot in case your horse gets

spooked and tries to escape by pulling in a backward motion.
23
 2. Pick your horse’s hooves

https://lh6.googleusercontent.com/h_Jlg7yH_d52ZmpIWXK9txRZeRGQJpQJQqH8VTO0bNHqC5jnMP_6zxqtcyp520PdsTzQYlTjAhUw7-
DMdR16CQ5SNmJC-WRS-15bunLYGAXnpLhQWPq94a1a3LPWZAqpiURaLYYr

Pick up each hoof in turn and, using a hoof pick, remove all
dirt and debris, checking for loose shoes and lost nails. 24
 3. Use a Curry comb to loosen hair and dirt

➢ Work from ear to tail without currying

the head, mane, tail and lower legs,
being extremely careful over bony
areas.
➢ Move your comb along the horse's coat
in small circular motions in the opposite
direction to the hair growth.
➢ Don’t apply too much pressure but be
firm enough to lift the dirt from the coat.
➢ Whilst circling the brush you’ll start to https://lh6.googleusercontent.com/peiM9aDVg66KKxYJcV-
m39xHv5nSP6KrtvEhB77YJSWxXXMhZ55gIsNsgYdSsFbp8tStUzL9VYff98uoCKSI

see grains of dirt that have risen up from WK1UEN1ZqjZAn4Xu53Th-ldG5aRMG8NI5gAmO525Cj90hvV0E0ta

the horse's skin.

25
4. Use a Hard brush/Dandy brush to remove hair, dirt and sweat

https://lh6.googleusercontent.com/JfNlwk8UW2x-n9maZQV8Ljc8KN7W8oOgwnLDsJQ-juvHnjpRgaFWOX77IZ-
7JRTPZPJ4jrN0weexLdId41jZFmE0FZPaZoK6x2N78HiMFJToLjekRgO7sBRurWOhYtpZJMng0NAg

Don’t use this brush on your horses head, mane, tail or lower
legs. Start along the neck and work your way down and along the 26
body using short straight flicking motions to ‘flick’ off the debris.
 5. Smooth and clean up with a Soft brush/Body brush

https://lh6.googleusercontent.com/RcFPlHa3bOLoWTpBkz5sbGVHKton8qSsRcozBPh-lWWYhBOmIm76IIr9qM_ouIMYqVr8-
DnCx7VJOrj5BSjiDrnC7REaMvwMcHh7KZooWoNBFJc_aQYT2g1ojOXpAz3dOGK7tiJc

This brush is used to finish off your horse's coat and give it a softened, shiny
feel. It’s also great for brushing out the mane and the tail. You need to use this
brush in long, smooth strokes, starting at the head and working your way
along the body and down the legs. 27
 6. Clean your horse's face

https://www.equi-clean.com/wp-content/uploads/2019/01/v4-760px-Groom-a-Horse-Step-6-Version-3-1.jpg

Using a damp sponge or cloth, gently wipe your horse’s eyes, and clean
out the nose. You will also need to clean the dock area beneath the tail.
Be sure to use a different sponge or cloth for this part and be very gentle
28
as this is a very sensitive area.
 7. Brush out the mane and the tail

https://lh4.googleusercontent.com/hqZoghneBjvRGYCqnGqhI0NWQsxE02FGpCLLP6eAxIXE2c8sWTuKa3JPxf
Lz6PR9dlY6487mjkUDVRLaIRYeK06J8a_z4y707bEDhK-mhSatlhFFEA9FRMC_0WlAVEmgUkQp2Pti

Stand to the side of the horse to be a much safer position when

brushing the tail. First, separate the worst of the tangles with your
fingers. With a wide tooth comb or brush, detangle the rest of the 29
mane and tail.
 8. Spray the horse with fly spray

https://www.wikihow.com/images/thumb/b/b1/Groom-a-Horse-Step-8-Version-3.jpg/aid13419-v4-728px-Groom-a-Horse-Step-8-Version-3.jpg

Flies can be a nuisance to horses, especially in the summer so you may

want to spray your horse with fly spray to avoid them spreading infection
or even biting and causing your horse pain. 30
 REFERENCES

• Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005; 366:
1736–43
• Laumonier T., Menetrey J., Huard J. (2014) Basic Principles of Muscle Healing. In: Kerkhoffs
G., Servien E. (eds) Acute Muscle Injuries. Springer, Cham.
• Sato F, Shibata R, Shikichi M, Ito K, Murase H, Ueno T, Furuoka H, Yamada K. Rupture of the
gastrocnemius muscle in neonatal thoroughbred foals: a report of three cases. J Equine Sci.
2014;25(3):61-4.
• Forcina L, Cosentino M, Musarò A. Mechanisms Regulating Muscle Regeneration: Insights into
the Interrelated and Time-Dependent Phases of Tissue Healing. Cells. 2020; 9(5):1297.

31
SPORTS HORSE EXERCISE
Dr. Pınar CAN
pcan@ankara.edu.tr

1
EXERCISE PHYSIOLOGY
• The aim of training the performance animals is to maximise
the animal’s capacity for exercise.
• This means maximising the availability of energy for muscle
contraction, in the form of ATP and the fuels required to
produce it.

http://www.boxerclubportugal.com/wp-content/uploads/2020/05/How-Does-Horse-Racing-
Betting-Work.jpg 2

https://media1.fdncms.com/orlando/imager/u/original/5685763/jer_4269_jeremy_reper.jpg https://missourilife.com/wp-content/uploads/2018/12/WebOpenerPic1_HannahStonehouse.jpg
Aerobic Energy Production

• occurs via a series of reactions within the mitochondria called aerobic

or oxidative phosphorylation
• the phosphorylation of adenosine diphosphate (ADP)
• aerobic energy production can occur using stored muscle glycogen or
glucose from blood as an energy substrate.

3
 cell cytoplasm
glycogen or glycolysis Mitokondria
glucose
Asetil Koenzim A
Pyruvat (CoA)

TCA
cyclus
ATP
ATP
Coenzymes nicotinamide
adenine dinucleotide Electron
(NADH) and flavin adenine transport
dinucleotide (FADH2), chain

4
• Complete aerobic metabolism of one glucose unit from glycogen yields
39 molecules of ATP – three from glycolysis, two from the TCA cycle
and 34 from the electron transport
• If blood glucose is used, it must first be converted to glucose-6-
phosphate, requiring one molecule of ATP, so the net energy yield is
only 38 molecules of ATP.
• Fatty acids can also be used as substrate for oxidative phosphorylation
via a process called beta-oxidation, producing acetyl CoA.

5
Anaerobic Energy Production

• is reliant on the metabolism of stored muscle glycogen or glucose via

glycolysis with the resultant production of pyruvate, but pyruvate
remains in the cytoplasm and is converted to lactate
• The amount of ATP produced via anaerobic glycolysis is much less
than aerobic glycolysis and oxidative phosphorylation.
• If glycogen is the original substrate, there are three ATP molecules per
glucose unit produced, while only two ATP molecules are produced if
blood glucose was the original substrate.

6
Energy Sources During Exercise

• The usual sources of energy are carbohydrates and fat.

• Glycogen is predominantly stored in the muscles and liver, and glucose
is available in the blood.
• Fats are stored in the body as triglycerides but can be broken down to
free fatty acids,which can circulate in the blood and be taken up by
exercising muscle.

7
 If the oxygen supply is limited; during high-intensity exercise, when the
requirement for ATP exceeds the rate of ATP production aerobically,
substrates are predominantly utilised anaerobically

 Anaerobic energy production is rapid and does not require the delivery
of oxygen to the muscle, but the ATP yield is low compared with aerobic
pathways

 the production of lactate will decrease muscle pH.

8
 During low- to moderate-intensity exercise, aerobic
metabolism predominates and will be a mixture of fatty acid
and carbohydrate utilisation.

 Horses and dogs have both been shown to have the ability to
utilise fatty acids for energy production

 At any moment during exercise, there are aerobic and

anaerobic contributions to energy production.

9
 %70 anaerobic % 70 aerobic

High intensity
short-term
exercise

https://static.americasbestracing.net/s3fs-
https://cdn.britannica.com/53/189853-050- public/styles/large_hero_16_9/public/article/mitoleBCsprinteclipse.jpg?qmkQ0j_yyGbBTJAe4jRlN
Epqdm_jmgMy&itok=OxBZ_xMG&c=66ea8f80b634d424e9c0ac141201d3db
F1F6B04E/Footraces-distances-Summer-Olympics.jpg

https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSmFnufmHk-
CiozRZUhKnhL_0q07eVsX6PIxQ&usqp=CAU

Aerobic, during jump anaerobic % 96 aerobic (endurance race) 10

 O2 in air

O2 diffusion
O2 transport via across alveolar O2 binding to
conducting airways capillary haemoglobin
interface

O2 distribution
O2 utilisation by
via the
mitochondria
circulation

Limitations to oxygen supply anywhere along this pathway can

seriously limit performance 11
Maximal oxygen uptake (VO2max)

McGowan and Hampson, 2016

The relationship between VO2 and speed in a horse during 12

incrementally increasing speed
 Animals with rapid oxygen kinetics have an advantage for performance;
 the faster the increase in aerobic energy production,
 the smaller the oxygen debt and lactate accumulation from anaerobic
energy production at the beginning of intense exercise

time to reach 63 % VO2max

30 second 20 second 10 second

13
Oxygen kinetics have been shown to be improved by training
in horses
Also generally improved by a warm-up before exercise

https://horseandrider.com/.image/c_limit%2Ccs_srgb%2Cq_auto:good%2Cw_700/MTYyNTc0MjY5NzgyNDM1
NDk0/horseandrider_spr19_eruekamoments_01.webp 14
 Physiological adaptations during the warm-up include cardiovascular and
respiratory responses that ensure an adequate supply of oxygen to the
working muscles where the working muscles receive a greater proportion
of the blood flow at the expense of other organs such as the digestive
system.

15

https://arkagency.com/wp-content/uploads/2014/06/Horse-Training.jpg
 Cardiorespiratory Function During Exercise

https://practicalhorsemanmag.com/.image/c_limit%2Ccs_srgb%2Cq_auto:good%2Cw_700/MTU
 flaring of the nostrils and in some species
mouth breathing to reduce upper
respiratory tract resistance

xMjU2NTE1NTYxMzk5NDg4/repiratory-opener.webp
 increased ventilation of the lungs
(increases in minute ventilation from 80
L/min at rest to 1800 L/min in the horse)

16
 increased tidal volume (ventilation per minute)
owing to frequency of respiratory cycles and
decreased physiological dead space
 increased perfusion of alveoli – due to
increased cardiac output and dilation of
pulmonary blood vessels https://pediaa.com/wp-content/uploads/2018/12/What-is-the-Difference-
Between-Perfusion-and-Diffusion_Figure1.jpg

 decreased transit time of pulmonary capillary

blood flow – faster blood flow past the alveoli
 increased diffusion of O2 and CO2 from the
alveoli into the capillaries perfusing the alveoli
– due to increased gradient, increased blood
flow https://pediaa.com/wp-content/uploads/2018/12/What-is-the-
Difference-Between-Perfusion-and-Diffusion_Figure2.jpg

17
 https://veteriankey.com/wp-content/uploads/2016/07/B9781437707465000835_f083-
 increased haemoglobin concentration (in the
horse) due to splenic contraction – increased
oxygen-carrying capacity (the splenic reserve)
 increased heart rate (HR) and stroke volume (SV)
= increased cardiac output and overall transport of
oxygen to the lungs and exercising muscle

001-9781437707465.jpg
18
 increased peripheral perfusion – capillaries in the periphery
(muscles) are better perfused
 increased diffusion of O2 and CO2 from capillaries to or from
exercising muscle due to increased gradient, temperature and blood
flow and decreased pH.

19

https://assets.eventingnation.com/eventingnation.com/images/2015/06/thumb.jpg
Effects of Warm up before Exercise

• Increasing muscle strength

• Increasing muscle contraction and relaxation speed
• Increasing oxygen delivery to the muscles
• Increasing the speed of nerve conduction
• Vasodilation > increases peripheral perfusion

20
• increasing ATP production
• decreasing pulmonary blood flow resistance
• decreasing lactic acid accumulation during exercise
• decreasing heart rate during exercise
• reducing the risk of injury

21
Effects of Cooling after Exercise

• acceleration of heart beat, respiration and blood pressure returning to

normal
• increasing venous return to the heart
• increasing heat loss
• increasing lactic acid excretion

22
MANUEL THERAPY
Dr. Pınar Can
pcan@ankara.edu.tr

1
 Manual skills are critical to successful evaluation and treatment
 used in assessment and treatment of soft tissue abnormalities,
osteokinematic and arthrokinematic dysfunction, and pain.
 manual skills;
- soft tissue mobilization (massage),
- passive range of motion (PROM),
- stretching
- joint mobilization
2
 MASSAGE
 the systematic application of manual pressure and movement of
soft tissues, including skin, tendons, ligaments, fascia and muscle
 positive effects on the circulatory, muscular, lymphatic and
endocrine systems

https://s3.amazonaws.com/cdn-origin-etr.akc.org/wp-
content/uploads/2018/10/10161422/ThinkstockPhotos-177754174viszlamassage-800x600.jpg
Aims

• Increase circulation
• Decrease swelling
• Increase tissue extensibility
• Reduce adhesions
• Increase scar mobility https://horseandrider.com/.image/c_limit%2Ccs_srgb%2Cq_auto:good%2Cw_700/MTY
0MjkwMzc5ODAwMTI3NDM1/hr_sum19_massage03.webp

4
• Eliminate trigger points or tender
points
• Promote tendon and ligament healing
• Increase ROM
• Decrease pain
• Decrease muscle spasm
• Facilitate or inhibit neuromuscular
activity https://www.echiropractor.org/wp-content/uploads/2014/10/Animal-Massage.jpg

5
 Effects of Massage

• Provides nourishment and regeneration of cells by increasing blood

circulation in the skin
• dilation of the superficial capillaries
• increases the elasticity of the skin
• increases sebum production and makes the skin more resistant to
infections

6
• loosens subcutaneous scar tissue, prevents fibrosis and scar formation
• decreases complaints such as constipation, colic and gas by increasing
peristalsis in the large intestines
• provides the removal of toxins and other waste products accumulated
in the muscle after excessive muscle activity
• helps toxic substances to pass into venous and lymphatic flow

7
• increases blood circulation, allowing the muscle to receive more nutrients
and oxygen. With this effect, it reduces muscle fatigue and muscle pain.
• helps to increase arterial circulation by increasing venous pressure
• prevents venostasis

https://pets-corner.co.uk/wp-content/uploads/2020/01/Massage-For-Animals.jpg https://i0.wp.com/img.huglero.com/2018/07/dog-massage.jpg?fit=653%2C436&ssl=1
• It has an anticoagulant effect and causes hemodilation.
• reduces edema (by increasing lymphatic drainage)If done regularly, it
strengthens the immune system by increasing the white blood cells.
• reduces delayed muscle pain after sports activities

https://encrypted- https://www.vettimes.co.uk/app/uploads/2018/09/front-cover-dvd-photo-background-copy.jpg
tbn0.gstatic.com/images?q=tbn:ANd9GcQPWlPOvVi8iEDEYfNuSF_yTxQEN8JY4QWrRg&usqp=CAU

9
• increases blood flow in the muscles, helps to remove lactate from the
muscle by increasing oxidation and diffusion
• helps to reduce the white blood cells that accumulate in the vascular
wall in muscle damage caused by excessive activity
• decreases the level of fatigue after activity

10
• Helps increase muscle mass
• Helps remove lactate from muscle by increasing oxidation and diffusion
• Helps reduce pain by releasing endorphins
• Reduces stress and anxiety by providing relaxation

11

https://s3-media0.fl.yelpcdn.com/bphoto/37vjL1PdtVHARiiWgdX7aQ/o.jpg
Attention!!!

• Sudden movements should be

avoided in horses
• Massage should be done in the box
• Massages should not be done against
the hairs
• Circular movements in cramped areas
https://i.pinimg.com/564x/61/3f/35/613f35324ec46af945084fb89325b9f2.jpg

12
• Movements in the direction of the muscle fibers or transverse
• It shows the pain in the region with horse movements
• The person applying the massage should be comfortable
• the dog should be in a comfortably lying position

13

https://i.pinimg.com/originals/f4/c0/c9/f4c0c9a69ffcfdb84981473bf65867d8.jpg
https://i.pinimg.com/originals/93/0d/0f/930d0f954fba3e326c0fa0042d685766.jpg
Massage Techniques
Stroking
consists of long slow strokes, generally light to
moderate pressure, usually parallel to the direction
of the muscle
Coates, 2018

 It is a good way to start therapy

 Reduces pain and muscle spasm
 Has a stimulating effect

14

https://cdn.shopify.com/s/files/1/0062/5036/4993/files/Equine-Effleurage-and-Reiki-Plex_large.jpg?v=1548346704
Effleurage

http://www.kirsty-davis-equine.co.uk/images/massage-images/KD_Image9_2_LG.jpg
 often performed to begin a massage, and is useful
for relaxation, and to decrease swelling
 beginning at a distal area, such as the paws, the
hands move proximally, using medium pressure
 This helps to move any toxins in the body toward
the lymph nodes and aids drainage

15

Sutton ve Whitlock, 2014

 Compressions

• The palm or heel of the hand is placed over the

muscle and pressure is applied.
• This pressure is maintained for 15 seconds before Sutton ve Whitlock, 2014
moving on to another area.
• This maneuver should be repeated several times.
• By restricting blood flow and then releasing pressure,
the circulation increases, and this is thought to help
to decrease tone
Palmer, 2012
16
Holding and Placing

• An area of increased tone or spasm may be relaxed by placing a

hand over the area.
• This technique traps heat in the area, increasing the local
circulation and promoting local relaxation

https://www.yourhorse.co.uk/advice/questions-and-answers/article/what-massage- 17
Sutton ve Whitlock, 2014 can-i-do-in-winter-to-help-my-horse
Percussion (Clapping, Hacking, Pounding)

 If there is a general area of increased tone, such as in the caudal

thigh or gluteal muscles, clapping or hacking
 This technique may also be used in areas of muscle weakness
 Clapping is performed by using a cupped hand. Gently but firmly,
a clap is applied to the area

18
Sutton ve Whitlock, 2014 Palmer, 2012
 Hacking is performed by alternately using open hands,
with the ulnar border of the hands falling vertically on the
muscle mass
 Both clapping and hacking improve general circulation in
the areas treated, promoting relaxation.

Sutton ve Whitlock, 2014

19
 Deep Transverse Friction

https://practicalhorsemanmag.com/.image/c_limit%2Ccs_srgb%2Cq_auto:good%2Cw_600/MT
 Scar tissue forms within muscles as a result of injury.
 Deep transverse frictions may be applied to help

Q0ODEwNTE0NTY3MzQxNDMw/ph-09-horse-hock-massage.webp
reduce the scarring
 Using the index and middle fingers at a 90-degree
angle to the muscle fibers, pressure is applied
perpendicular to the direction of the fibers.
 This is repeated 10 times and performed in sets of 3
to 10.

20

Sutton ve Whitlock, 2014

RANGE of MOTION and STRETCHING EXERCISES
• Range of motion is the ability of the joint to move without any strain,
measured by a goniometer, and each joint has characteristic angles.
• Muscles also have a range of motion and are referred to as the functional
function of the muscles. This is the distance a muscle can shorten after its
maximum extension.

21
 Effects
• Helps to restore joint movements to normal after the operation or in
patients with chronic diseases,
• to increase flexibility,
• prevent adhesions between soft tissue and bones
• It is beneficial in reducing periarticular fibrosis

22

Millis and Levine, 2014

• Helps prevent further injury to joints, muscles, tendons and ligaments
by increasing the extension capacity of muscles and other soft tissues.
• Joints and muscles should be moved within their normal capacity of
movement to ensure ROM

23

https://cdn.shopify.com/s/files/1/1724/0827/articles/stretch_horse_1000x.jpg?v=1568562683
• Passive ROM is the movement of a joint with an external force within
the scope of ROM without muscle contraction.
• It decreases joint contracture,
• Provides mobility between soft tissue layers,

24

https://i.ytimg.com/vi/pwPAi5qwphw/maxresdefault.jpg
• It reduces pain,
• Increases blood and lymph flow,
• Increases synovial fluid amount and
distribution,
• Can't prevent muscle atrophy!

https://drpatbona.com/wp-content/uploads/2016/07/Screen-Shot-2016-07-20-at-9.33.54-PM-1.png

25
• Active assisted ROM is the condition in which the patient provides
some degree of joint movement with his own muscle activity under the
guidance of the therapist.
• In patients who are weak or in the early stages of recovery after lower
motor neuron (AMN) damage;
- The animal is walking on a non-slippery floor or treadmill,
- in the swimming pool by the therapist slowly moving the extremities
of the animal as if swimming

26
• Active ROM is joint movement provided by active muscle contraction.
• Increases muscle strength, provides muscle coordination.
• Activities such as water walking, swimming, climbing stairs, walking on
long grass, walking in snow or sand, crawling in a tunnel

27

http://www.tah.co.za/blog/wp-content/uploads/2015/07/IMG_2112.jpg https://www.theveterinarynurse.com/media/32137/vetn201899497_f01.jpg?&width=780&quality=60
• Stretching is a general term that is used to indicate maneuvers to
elongate tissues shortened as a result of a pathologic condition and to
increase flexibility and joint motion in normal and abnormal tissues.
• Stretching differs from ROM exercises in that stretching takes tissues
beyond the normal ROM.

28
It increases the flexibility of joints
and helps to increase the
extensibility capacity of periarticular
tissues, muscles and tendons.
Conditions that result in adaptive shortening
of tissues, including immobilization, reduced
mobility, injury, and fibrosis of periarticular
tissues, or neurologic conditions, may
respond favorably to stretching
29
 References

• Palmer S (2012) Horse Massage for Horse Owners: Improve Your Horse's Health and
Wellbeing, J.A.Allen & Co Ltd, London, UK.
• Sutton A, Whitlock D (2014) Massage, In; Canine Rehabilitation and Physical Therapy, editors
Darryl Millis, David Levine, 2nd Edition, Saunders, Philadelphia, USA.
• Millis D, Levine D (2014) Range of motion and scretching exercises, In; Canine Rehabilitation
and Physical Therapy, editors Darryl Millis, David Levine, 2nd Edition, Saunders, Philadelphia,
USA.
• Coates JC (2018) Manual therapy, In; Canine Sports Medicine and Rehabilitation, Chris Zink,
Janet B. Van Dyke, 2nd Edition, Wiley Blackwell,

30
ELECTROTHERAPY
Dr. Pınar Can
pcan@ankara.edu.tr

1
 Definition
• There are many different terminology in electrical stimulation
• Examples; galvanic current, faradic current, diadynamic current, high voltage, low
voltage, low frequency, medium frequency, transcutaneous electrical nerve stimulation
(TENS), electrical muscle stimulation (EMS), functional electrical stimulation (FES),
Russian stimulation, and interferential stimulation.

2
https://www.researchgate.net/profile/Maijke-Van-
Bloemendaal/publication/308796211/figure/fig2/AS:413198353223683@1475525572182/The-
functional-electrical-stimulation-device-including-two-cuffs-a-foot-switch-and-a.png
• TENS has been widely used to identify stimulators
that modify pain,
• NMES or EMS has been identified with muscle
reeducation, prevention of muscle atrophy, and
enhanced joint movement.
• If the muscle is innervated by a motor nerve > NMES
• when a muscle is denervated and requires direct
muscle fiber activation through electrical stimulation
> EMS

3
 NMES is the administration of an electrical current generated
by a stimulator that travels through leads to electrodes placed
on the skin to depolarize the motor nerve and produce a
skeletal muscle contraction.
 Stimulation of motor end plates with electrical current causes
nerve depolarization and subsequent activation of muscle
fibers.

4
Basic Principles of Electrical Stimulation

• The emergence of a number of biological events in

cells, which are the building blocks of the organism,
is partially or completely dependent on the
membrane potential.
• Intracellular (-), extracellular (+)
• Electrical currents change this membrane potentials
and lead to an action potential
• By means of this action potentials, muscles contract

5
 Electrical Current/Waveforms

• Three types of currents are commonly used:

1. Continuous direct current (DC) > A
2. Continuous alternating current (AC) > B
3. Pulsed current (either AC or DC) > C

Levine and Bockstahler, 2014

6
• Continuous direct current is a unidirectional electrical current that flows
for 1 second or longer
• Alternating current changes the direction of flow at least once every
second.
• Continuous direct current (galvanic current) is used only for
iontophoresis in clinical practice.
• Pulsed current consists of a unidirectional or bidirectional flow of
charges (DC or AC) that periodically stops for a limited time period.
• All NMES devices are pulsed current stimulators.

7
Aims

• To increase muscle strength,

• muscle reeducation,
• To increase range of motion (ROM),
• correction of structural abnormalities,
• To improve muscle tone,
• To enhance function, https://www.globusvet.it/wp-content/uploads/2018/12/Tens01-LOW.jpg

8
• pain control,
• To accelerate wound healing,
• edema reduction,
https://international.chattgroup.com/sites/default/files/styles/product_detail/public/chatt_products/id_2756_detail3_4.jpg?itok=h-rh3tyV

• muscle spasm reduction,

• enhancing transdermal administration of
medication (iontophoresis)

https://www.pawsitivestepsrehab.com/blog/wp-content/uploads/2016/12/TENS-Herc-800x600.jpg
 Effects of electrical stimulation

• At the beginning and as a result of each

application, the electrical potential of the
cell membranes changes.
• It causes a muscle contraction by https://horse-canada.com/wp-content/uploads/2015/07/2996.jpg

depolarizing the motor nerve with an

electrical current delivered via electrodes
placed on the skin.

10
• They provide analgesic effects through
sensory blockade that caused by
stimulating the nerves.
• Some currents have trophic (growth
stimulating) effects. This effect occurs
with vasodilation and an increase in
blood supply.
Application of electrical stimulation for
cocontraction of the cranial and caudal thigh
muscles (Levine and Bockstaler, 2014) .
11
• It decreases muscle spasm.
• It has edema-reducing effects.
• Muscles that are not disconnected from the
nerve can be stimulated with low levels of
low frequency currents.
• It can be used to increase the strength of a
normal muscle, but is not as effective as
active exercise. Application electrodes for chronic pain using
flexible E-pads because of elbow dysplasia
(Levine and Bockstaler, 2014)
12
• To prevent muscle atrophy in patients
with neurological damage,
• to stimulate motor recovery and
strengthening,
• to provide retraining of muscles
• to diminish joint contractures
Application of electrodes for lumbar pain
utilizing flexible E-pads (Levine and
Bockstaler, 2014)
13
Iontophoresis

• Iontophoresis is a process of transdermal

drug delivery by use of a voltage gradient on
the skin.
• Molecules are transported across the stratum
corneum by electrophoresis and
electroosmosis and the electric field can also
increase the permeability of the skin.
https://images-na.ssl-images-amazon.com/images/I/819IyswjhSL._SL1500_.jpg

14
Positive ions Negative ions

Cefazolin Chloride
Dexamethasone Ciproflaxacin
Hyaluronate Gentamicin
Idoxirudin Iodine
Lidocaine Ketocanazole
Magnesium Salicylate
Zinc Tobramycin

15
Indications and Contraindications for NMES

• Indications;
 fracture repair, ACL reconstruction, and meniscal
debridement or repair
 patients with neurologic conditions, such as
cerebrovascular accidents, closed head injuries,
spinal cord injuries, or other neurologic disease
involving paralysis or paresis

Niebaum et al., 2018

16
• Contraindications;
 High-intensity stimulation directly over the heart
 In animals with pacemakers
 In animals with seizure disorders
 Over areas of thrombosis or thrombophlebitis
 Over infected areas or neoplasms
 Over the carotid sinus
 Any time active motion is contraindicated
 Over the trunk during pregnancy

17
• Be careful;
 In areas with impaired sensation
 In areas of skin irritation or damage
 Near electronic sensing devices such as
ECG monitors (possible interference)

Niebaum et al., 2018 18

 References

• Niebaum K, McCauley L, Medina C (2018) Rehabilitation physical modalities, In;

Canine Sports Medicine and Rehabilitation, editors; Chris Zink and Janet B. Van
Dyke, 2nd edition, Wiley Blackwell
• Levine D, Bockstaler B (2014) Electrical stimulation, In; Canine Rehabilitation and
Physical Therapy, editors Darryl Millis, David Levine, 2nd Edition, Saunders,
Philadelphia, USA.

19
THERAPEUTIC ULTRASOUND
Dr. Pınar Can
pcan@ankara.edu.tr

1
• It is applying of high-frequency sound waves to the tissues with the
help of a probe similar to the one used in diagnostic ultrasound (US).
• Superficial heating agents penetrate soft tissues to a depth of
approximately 1 cm.
• Deep heating agents like as therapeutic US and diathermy can elevate
tissue temperatures at depths of 2 cm or more.

https://images.squarespace-cdn.com/content/v1/59933811197aeaa6c78fa74d/1504829129407-
8MJ9Y4XQEN0K0BW004KR/ke17ZwdGBToddI8pDm48kLkXF2pIyv_F2eUT9F60jBl7gQa3H78H3Y0txjaiv_0fDoOvxcdMmMKkDsyUqMSsMWxHk725yiiHCCLfrh8O1z4YTzHvnKhyp6Da-
NYroOW3ZGjoBKy3azqku80C789l0iyqMbMesKd95J-X4EagrgU9L3Sa3U8cogeb0tjXbfawd0urKshkc5MgdBeJmALQKw/Therapeutic+Ultrasound.JPG
 Physical principles
• US is a high frequency sound wave (20,000 vibrations a second).
• Sound waves are produced via the reverse piezoelectric effect (compression
and expansion of a piezoelectric crystal).
• Sound waves have the properties of reflection, scattering and absorbtion by
the tissues.
• Absorption is the transfer of energy from the sound beam to the tissues.
• Absorption is high in tissues with high protein content and relatively low in
adipose tissue
• US energy is absorbed in tissues due to acoustic impedance and turns into
heat energy.

3
 US has direct effect on cells and healing

 US effect can be thermal or non-thermal,

 It depens on the density, frequency, area
treated, duration of treatment and speed of
movement of the probe or the absorption
rate of tissues.

4
 Intensity is the amount of energy applied per unit area (watt /
cm2).
 The higher the intensity, the faster the tissue temperature
increases.
 Frequency defines the penetration depth (MHz).
 Penetration decreases as the frequency of the US waves
increases.
 1 MHz ultrasound wave can heat 2-5 cm depth.

5
• if the soft tissue thickness is low in the treated area or if the
area is close to bone tissue >> Low intensity-high
frequency.
• Experimental studies have shown that 5-10 minutes of US
therapy provides sufficient temperature increase in an area
2-3 times the probe surface.
• Clip the area before applying.

6
 Effects of Therapeutic US

• The most important effect of US is heating.

• US waves are essentially mechanical pressure waves and, as they
move through tissues, absorbed energy is converted into kinetic energy
which increases the local temprature.
• It creates compression and expansion movement on the surfaces of
adjacent tissues, and increases regional blood supply with the effect of
micromassage.
• This causes a chain reaction of molecules vibrating and colliding into
neighboring molecules.
7
• Absorption is greatest in tissues with high protein content.
• The absorption of ultrasound energy is optimal in the dense
collagen-based tissues (tendon, ligament, fascia, joint capsule and
established scar tissue), and it is in these tissues that it is at its
most effective.

8
• The degree of warming depends on the acoustic impedance of the
tissues.
• Acoustic impedance is the resistance to the propagation of ultrasound
waves through tissues.
• Acoustic impedance Air < Fat < Muscle < Bone
• Increased tissue temperatures may increase collagen extensibility,
blood flow, pain threshold, and enzyme activity, as well as mild
inflammatory reactions, and changes in nerve conduction velocity.

9
 https://healingartsanimalcare.com/wp-content/uploads/2014/11/IMG_5306.jpg.webp
• Heating is thought to alter the viscoelastic
properties of collagen and collagen molecular
bonding.
• Heat can increase the endorphins by this way
reduces pain.
• Nerve tissue absorbs US energy more than
muscles and warms up >>> analgesic and
antispasmodic effect

10
 https://www.equltrasound.com/wp-content/uploads/2015/05/therapeutic-ultrasound-treatment.jpg
• It has an inhibitory effect on sympathetic
fibers.
• Very high dose US application may cause
pathological fractures.
• Increasing circulation with vasodilation helps
to remove metabolic wastes that stimulate
pain from the area.

11
• The nonthermal effects include cavitation and acoustic streaming
• Microstreaming, or acoustic streaming, refers to small‐grade, unidirectional pressure
waves created in the fluids around cells.
• Cavitation is the compression and expansion of small gas bubbles in body fluids.
• Both may modify cellular function and membrane permeability, thus assisting with
tissue repair and swelling reduction.

12

https://cdn11.bigcommerce.com/s-13ttxa/images/stencil/400x400/uploaded_images/ultrasound-
therapy-for-animals.jpg?t=1465409275
• But cavitation can lead to
hemolysis, bleeding, and tissue
necrosis.
• In order to prevent detrimental
effects of cavitation, constant
application should be avoided and
unnecessarily high doses should
not be applied.
• Recomended application velocity is http://www.heatheroxford.com/uploads/3/4/5/4/34547934/6616999_orig.jpg

approximately 4 cm per second

13
• 1-4 ºC temperature increase can be provided in 2-5 cm or more deep
tissues thanks to the thermal effect of US.
• Collagen fiber extensibility, regional blood circulation, enzyme activity
and pain threshold increase.
• In cases such as joint contracture, muscle spasm and pain, limited
range of motion as a result of wound healing, US therapy can be
effective.
• Accelerates wound and fracture healing

14
 Phonophoresis
• The use of US to enhance the delivery
of topically applied medications
through intact skin
• The target for the drug may be local
(antiinflammatory or analgesic) or
systemic.
• Phonophoresis enhances transdermal
drug delivery by altering the stratum
corneum, which is the major barrier to https://www.researchgate.net/profile/Ritesh-
Bathe/publication/311444050/figure/fig11/AS:436289792155662@1481031000775/The-basic-
drug penetration. principle-of-phonophoresis-Ultrasound-pulses-are-passed-through-the-probe-into_W640.jpg

15
 The possible action of mechanism is that US denatures the structural
keratin proteins in the stratum corneum, strips or delaminates the
cornified layers of the stratum corneum, changes cell permeability, or
alters the lipid-enriched intercellular structures between the cells.
 After the stratum corneum is crossed the pharmaceutical molecules
penetrate the dermis, are absorbed into the tissues and capillaries,
and travel throughout the circulatory system.

16
 tendinitis, bursitis, osteoarthritis, and
neuroma
 Steroids such as hydrocortisone and
dexamethasone sodium in the
treatment of osteoarthritis
 Lidocaine, one of the local anesthetics,
to reduce pain
https://www.equltrasound.com/wp-content/uploads/2015/06/ultrasound-deep-heat-after-surgery.jpg

17
 Precautions and Contraindications

• Local burns may occur if the intensity is too high, treatment times are
too long, or the transducer is held stationary, thereby concentrating
energy in a small area.
• Avoid direct US exposure to;
 Cardiac pacemakers
 Carotid sinus or cervical ganglia
 Eyes. Because blood supply to the lens is poor, heat is poorly dissipated
and could result in cataracts. Retinal damage could also result.

18
 Gravid uterus
 Heart. Electrocardiographic changes have occurred in dogs.
 Injured areas immediately after exercise
 Malignancy
 Spinal cord if a laminectomy has been performed
 Wounds that are contaminated. Ultrasound could drive bacteria
into the tissues
 Recent incision sites. It is not recommended to treat incision sites
with continuous US for the first 14 days to avoid dehiscence

19
 Indications

• Main indications;
 Soft tissue shortening (e.g., contracture,
scarring)
 Subacute and chronic inflammation
 Pain (such as muscle guarding, trigger
points)
• Tendinitis and bursitis
• Joint contracture and scar tissue https://www.frontiersin.org/files/Articles/446925/fvets-06-00185-HTML/image_m/fvets-06-00185-g001.jpg

• Pain and muscle spasm

20
21
22
LASER THERAPY
Dr. Pınar Can
pcan@ankara.edu.tr
 Healing properties have been attributed to light for
thousands of years.
 Light provides electromagnetic radiation in the form of
photons.
 Up to now, different light sources have been used for
therapy;
 Sunlight (heliotherapy),
 incandescent light,
 infrared light, ultraviolet light,
 light-emitting diodes (LEDs),
 therapeutic lasers
 Definition

 “Light Amplification by Stimulated Emission of Radiation”

 The concept of the use of light for therapeutic purposes, called
phototherapy
 The lasers used in rehabilitation help to modulate cellular
functions.
 This process is known as photobiostimulation and is defined as
nonthermal interaction of monochromatic radiation with a target
site.
 New terminology; photobiomodulation therapy (PBMT),
 A therapy laser is a medical device, whereas laser therapy is
the application of the light produced by this device.
 The exact mechanism of action is still not fully understood.
 But low-energy lasers have been reported to modulate
various biologic processes, such as mitochondrial respiration
and adenosine triphosphate (ATP) synthesis to accelerate
healing
 Properties of Lasers

 Laser light is monochromatic;

https://useruploads.socratic.org/pYwQHlWR62LHYnNgITMY_fis1.jpg
means that all light produced
by the laser is of one
wavelength, and therefore a
single color.
 Laser light has
electromagnetic radiation of
only one wavelength
 The coherent properties of light mean that the photons
travel in the same phase and direction.
 Laser light is also collimated, which means that there is
minimal divergence in the laser beam over a distance.

https://qph.fs.quoracdn.net/main-qimg-
30201d9a3339b579c936f45d95f4e51d.webp
 Monochromatic property allows the absorption of the
light to be targeted to specific wavelength-dependent
chromophores, or photon acceptors.
 The properties of coherence and collimation provide the
light to be focused precisely on small areas of the body.
 These properties allow low-level laser light to penetrate
the surface of the skin with no heating effect, no
damage to the skin, and few or no side effects when
properly used
https://images.squarespace-cdn.com/content/v1/5c65c5580cf57db461b286f7/1550856195097-O6N95X70TPBBJSGI7NO9/ke17ZwdGBToddI8pDm48kAt3gXPhEeM7D9Z34DYJgpRZw-
zPPgdn4jUwVcJE1ZvWQUxwkmyExglNqGp0IvTJZamWLI2zvYWH8K3-s_4yszcp2ryTI0HqTOaaUohrI8PInBIYnlwPmKznqnfMesCAIeu6Bcj6WD95nKtIOPjqSRsKMshLAGzx4R3EDFOm1kBS/laser_diagram.jpg?format=750w
 Biological Effects

 Activation of respiratory chain enzymes (cytochrome C

oxidase)
 Oxygen production
 Formation of proton gradients across cell and mitochondrial
membranes
 Adenosine triphosphate production
 Increases DNA production
 Induces cell proliferation
 Reduced cyclooxygenase and
prostaglandin E2 production
(antiinflammatory effects)
 Increases the release of fibroblast
growth factor and the synthesis of
collagen.
 Neurochemically, laser application
has been shown to increase the
metabolism of endogenous opiates,
acetylcholine and serotonin.
https://litecure-assets.s3.amazonaws.com/images/1536066833.png
https://respondsystems.com/wp-
content/uploads/2015/12/equine_conditions.jpg
Clinical Application of Laser Therapy
 Wound Healing
• Fibroblast stimulation
• Capillary formation and angiogenesis
• Collagen formation
• Enhanced ATP, protein, and growth
factor
• Vasodilation
• Lymphatic drainage
• Potential inhibition of wound healing
at high doses
https://cdn.shopify.com/s/files/1/0665/0095/files/Laser-Horse-Pics_df34aa45-914c-4593-822f-
9806967d9260_1024x1024.jpg?10030085714472510728
https://images.squarespace-cdn.com/content/v1/5e9b70d660b284611b6761ee/1591846026431-4HY1BRQ7STSCBZP0WGZJ/ke17ZwdGBToddI8pDm48kCfpvOXczDhOQkbnd0wqFHpZw-
zPPgdn4jUwVcJE1ZvWQUxwkmyExglNqGp0IvTJZUJFbgE-
7XRK3dMEBRBhUpwk3e6tswcJUcQp3k3SR41pUcjGGmD7HwqPDxMFHpunIgM_Y9ZtngDYGaDaWGAnk34/Laser+Therapy+Patient.jpg?format=750w
 Bone and Cartilage
• Enhanced early bone repair
• Increased collagen deposition and bone
trabeculae
• Adjunct to treatment of osteomyelitis
• Fibrous healing of cartilaginous defects
• Improved maintenance of cartilage in
immobilized joints

https://www.klaser.eu/wp-content/uploads/2018/04/Cube-4-VET-2.0-
813x800.jpg
Kim et al., 2012
 Arthritis
• Inhibition of inflammation
• Inhibition of COX-2 enzyme and
prostaglandins
• Reduced pain
• Possible reduction of morning stiffness
in rheumatoid arthritis
 Ligament and Tendon
• Pain reduction in acute tendinitis
• Improvement with lateral
epicondylitis
• Reduced pain and inflammation in
Achilles tendinitis
• Improved collagen organization
• Improved biomechanical properties
https://images.squarespace-cdn.com/content/v1/5c8fbfe87d0c914f25ad6fa4/1601045832318-
JJDZHNK9YJNNKSKW5QYA/ke17ZwdGBToddI8pDm48kNbkQCeViJ4YFI17nDR2t4h7gQa3H78H3Y0txjaiv_0fDoOvxcdMm
MKkDsyUqMSsMWxHk725yiiHCCLfrh8O1z4YTzHvnKhyp6Da-NYroOW3ZGjoBKy3azqku80C789l0plef_PmwB6-
3GP4qDbCUv982HKAH5p8lejpcYDyk26rNNG8hhNLO0e4-YkR9D2ZeQ/Emily+lasers.jpg?format=750w
 Analgesia
 Reduced pain in postoperative incisions,
 Potential reduction in transmission of pain
signals to pain centers in the brain
 Increased release of endorphins and
enkephalins
 Stimulation of trigger points and
acupuncture points
 Slowing of nerve conduction velocity
 Reduced action potential
 Suppressed substance P
 Disruption of axonal flow
 Peripheral Nerves and Spinal Cord
• Promotion of nerve recovery after injury
• Increased axonal sprouting and growth
• Increased myelinization
• Reduced degeneration of neurons
• Increased growth-associated protein-43
and calcitonin gene–related peptide https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2019/06/TVP-Article-Main-
Image-Template-copy-2.png
 Clinical conditions can be treated with
Laser
 Wounds and ulcers: Decubitus wounds,
chronic/delayed healing wounds,
diabetic ulcers, burns, licking
granulomas and skin abrasions.
 Acute injuries/traumas: Tendon and
muscle ruptures/hematoma; ligament
ruptures; fractures; subluxation; various
soft tissue injuries.
 Inflammatory conditions: Tendinitis,
bursitis, myositis, synovitis.
https://essexequineandcaninelasertherapy.co.uk/wp-content/uploads/2019/10/K-
LASER-TREATMENT-8-887x1024.jpg
 Musculoskeletal disorders: Injuries due to repetitive
straining, carpal tunnel syndrome, complex regional pain
syndrome/reflex sympathetic dystrophy, fibromyalgia
and temporomandibular joint pathologies.
 Arthritis and related conditions: Rheumatoid arthritis,
osteoarthritis, chondromalacia patella.

http://science-
equine.com/images/articles/p3/f1764/laser_therapy.jpg

https://www.celticsmr.co.uk/media/1290/new-laser-pic-horse-
charlie.jpg
 Precautions and Contraindications

 Use protective eye wear.

 Do not direct laser treatment to the
eye.
 Use caution with laser beam reflection
from metal surfaces.
 Dark colored skin, tattoos, and hair can
absorb laser light and undergo
excessive heating, resulting in
discomfort.

https://pemah.com/wp-content/uploads/2019/09/LaserTherapy1-
1200x771.jpg
 Use caution with treatment in the presence of the
following conditions:
• Pregnancy
• Open fontanels
• Growth plates of immature animals
• Malignancies
• Photosensitive areas of the skin
 References

 Son, Jinna et al. “Bone healing effects of diode laser (808 nm) on a
rat tibial fracture model.” In vivo 26 4 (2012): 703-9.
 Millis DL, Saunders DG (2014). Laser therapy in canine rehabilitation.
In: In; Canine Rehabilitation and Physical Therapy, editors Darryl
Millis, David Levine, 2nd Edition, Saunders, Philadelphia, USA.
THERMOTHERAPY
Dr.Pınar Can
pcan@ankara.edu.tr
• Thermotherapy is the use of superficial heat and cold as a therapeutic
modality for the treatment of disease or trauma.
• For centuries superficial heat and cold has been used for;
 managing soft tissue and joint injuries
 relieving pain,
 altering the physiologic processes underlying tissue healing,
 affecting the elasticity of connective tissue, including muscle, tendon,
ligament, and joint capsule.
• Superficial thermal agents are convenient modalities as they are
readily available, involve minimal expense
• They are frequently safe to include as part of a home treatment
program

http://rehabvets.org/img/content/thermotherapy.jpg https://4pawsrehabclinic.com/wp-content/uploads/2017/01/thermotherapy.jpg
The Physics of Thermotherapy
• Thermotherapy applications fall in the infrared portion of the
electromagnetic spectrum just beyond the wavelength and frequency
ranges for visible light.
• The shorter the wavelength, the greater the
frequency and the more superficial the depth of
penetration.
• Tissue must absorb the energy produced by the
thermal agent to stimulate the tissue’s normal
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function.
• If the energy absorbed is insufficient to
stimulate the tissue, there is no effect.
• If too much energy is absorbed, tissue damage
may occur.

https://redlightman.com/wp-content/uploads/reptile-bulb-510x392.jpg
• Most infrared thermal modalities (cold or hot packs, whirlpools,
paraffin baths, or luminous infrared devices) can penetrate to a depth
approximately 1 to 2 cm.

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https://rehabfuryourpet.com/img/services/thermotherapy-cryotherapy.jpg
Transfer mechanisms of heat to the tissues

• Conduction is the transfer of heat by the direct interaction of the

molecules in one area with those in another area
• Example: cold/hot packs
• Convection is the heat transfer by movement of air or fluid from a
warm area to a cooler area
• Example: the circulatory system, air temperature
• Radiation is the exchange of electromagnetic energy that occurs
when there is a difference in temperature between two objects. Heat
transfers from a warmer to cooler area.
• Example: sun, infrared lamps
• Evaporation is the vapocoolant sprays are used to cool the skin and
underlying tissues by causing evaporation and extracting heat from
the tissues.
• Conversion is the conversion of a nonthermal form of energy
(mechanical, chemical) that penetrates the tissues and is converted to
heat.
• Example: therapeutic ultrasound; sound waves being converted to
thermal energy within the tissues
• Most thermal techniques transfer energy by conduction.
 CRYOTHERAPY

• is used during the acute phase of tissue injury and healing to mitigate the
effects and sequelae of tissue injury,
• also after exercise during rehabilitation to minimize adverse secondary
inflammatory responses.
• is most effectively used immediately following trauma (accidental or following
surgical procedures)
• Cryokinetics combines cryotherapy with motion (passive, active-
assisted, or active)
• The aims of cryokinetics are to facilitate normal, pain-free movement,
and to reduce edema through a muscle pumping action to facilitate
the return of lymphatic fluid to the vascular system.
• The effects of cryotherapy;

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 Vasoconstriction
 Decreased blood flow
 Decreased swelling
 Reduced enzyme-mediated tissue damage
 Analgesia
• Cooling leads to vasoconstriction and local blood
flow slows, bleeding reduces
• edema formation after injury or after surgery is
decreased
• The cooling of the tissue; https://i.ytimg.com/vi/MUH3tRVxDDI/maxresdefault.jpg

reduces the metabolic rate of the treated tissue,

decreases the rate of reactions related to the acute
inflammatory process,
causes the inhibition of enzymatic effects related to
inflammation and minimizes the release of
histamine, which reduces the tissue damage

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content/uploads/2014/09/CRC_Heat.jpg
• The vasoconstriction of blood vessels also may help to decrease pain
by decreasing pressure on nociceptors
• Pain relief may be provided by decreasing nerve conduction velocity.
• The analgesia provides a concomitant reduction of reflex muscle
spasm.
• Cold is most effective when applied during the acute phase of trauma,
typically in the first 72 hours after injury or surgery.
 Cold application ways;
• Cold water-circulating blankets,

https://vetcryo.se/vetcryo
• reusable ice packs,
• ice cubes wrapped in a towel,
• ice cups,
• cold immersion,
• cold compression devices,
• vapocoolant sprays,
• contrast baths https://www.vscsarasota.com/wp-content/uploads/2016/11/Rehab-Page_23-1.jpg
• Contrast baths;
alternate immersion of an area in warm and cold water.
produces alternating vasodilatation and vasoconstriction
is sometimes used to decrease edema
are appropriate in the acute phase, also during the early subacute
phase of tissue healing.
During the acute phase of tissue healing, the cycles of alternating
immersion should have greater emphasis on cold water (exp; 3
mins cold 1 min warm)
 Cryotherapy application duration

• The application time is usually 15 to 20 minutes and may be repeated

throughout the day.
• A common method is to repeat the cold application every 2 to 4 hours
during the first 24 to 48 hours after the injury,
• or treat 10 to 15 minutes on and 10 to 15 minutes off twice.
• An ice treatment should not be applied for more than 20 minutes per
session to avoid tissue damage.
 HEAT THERAPY

• Superficial heat applications are mostly used to increase temperature in the

tissue before stretching exercises.
• Superficial heating agents can penetrate tissue depths up to about 2 cm, while
deep heating agents can raise tissue temperature to a depth of 5 cm.
• Although the temperature of the skin can increase by 10 ° C or more, tissues
at 1 cm depth typically rise below 3 ° C and tissues at 2 cm rise to less than 1
° C.
• Effects of heat therapy;
Increasing circulation (vasodilation)
Pain relieving
Increasing the extension capacity of soft
tissues
Reduction of muscle spasm
https://www.painreliefessentials.com/wp-content/uploads/Thermotex-Infrared-12-Pad-Blanket-2.jpg
• When the tissue temperature increases, vasodilation occurs.
• Heat causes vasodilation with various effects;
Direct reflex activation of smooth muscle of blood vessels by cutaneous
thermoreceptors,
Indirect activation of local spinal cord reflexes by cutaneous thermoreceptors
Locally increasing the release of chemical inflammatory mediators (histamine,
prostaglandin, bradykinin)
• The oxygenation of the tissue and the transport of metabolites to the
exercising tissue increases due to vasodilation.
• In addition, the rate of enzymatic and biochemical reactions that will provide
tissue healing increases.
• The occurrence of vasodilation in the distal extremities may increase the
absorption of edema.
• The extension capacity of the soft tissues and the range of motion of the joint
increase.
• However, application of heat in the very early stages of tissue healing may
exacerbate acute inflammation and increase enzymatic activity (eg
collagenase and protease).
• Therefore, tissue damage may occur when applied in the early period.
• Local heat application increases the
sensory and motor nerve conduction
velocity.
• An increase or decrease in conduction
velocity reduces pain and muscle spasm.
• For every 1 ° C temperature increase, the
nerve conduction velocity increases by
approximately 2 m / sec.
• Local heat application may increase the
individual pain threshold. https://images.squarespace-cdn.com/content/v1/55ba9a1de4b08d0b7eb69388/1440623435210-
XJCTICMSUOHK1VMQ445H/ke17ZwdGBToddI8pDm48kDHPSfPanjkWqhH6pl6g5ph7gQa3H78H3Y0txjaiv_0fDoOvxcdMmMKkDsyUqMSsMWxHk725yiiHCCLfrh8O1z4YTzHvnKhyp6Da-
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Heat application ways

• Hot packs
• Warm paraffin baths (45-50° C)
• Infrared or UV lamps
• Warm water bath (27-35 °C)

https://cdn.ampmarketing.co.za/wp-content/uploads/2017/06/Thermal-Therapies-Animal-Health-Hydro.jpg
 Heat therapy application duration

• Usually 15-30 minutes, 3-4 times a day

• Maximal benefit can be achieved when tissue
temperature is increased by 2-4 ° C.
• If the tissue temperature exceeds 45 ° C, it may
cause pain and irreversible tissue damage.
• It is more effective when combined with
massage, exercise and electrotherapy.

https://fmbs.co.uk/wp-content/uploads/2018/10/solarium-800x800.jpg
Precautions and Contraindications
• Electrical heating pads and infrared lamps are types of thermotherapy with a
higher risk of burning.
• Electrical heating pads should never be placed under an anesthetized or
heavily sedated animal with reduced superficial skin sensation.

https://assets.petco.com/petco/image/upload/f_auto,q_auto/104
https://www.petguide.com/wp-content/uploads/2019/12/AILEEPET-Pet-Heating-Pad-637x397.jpg 0391-center-2
 • As a general rule, animals should never be left unattended during treatment
and the skin should be checked frequently.

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• It is contraindicated in acute inflammation because the increase in tissue
temperature may exacerbate other signs of inflammation such as heat,
redness and edema.
• Caution should be exercised in patients who are pregnant, extremely obese,
circulatory disorders, insufficient temperature regulation or heart failure.
• Contraindications;
active bleeding,
acute inflammation,
thrombophlebitis,
heart failure,
fever,
neoplasms,
presence of swelling or edema
poor thermoregulation
HYDROTHERAPY
Dr. Pınar CAN
pcan@ankara.edu.tr
o Hydrotherapy or aquatic therapy encompasses
any exercise or manual therapy completed in an
aquatic environment.

o Exercising in water allows unloading of painful

joints, as well as earlier weight bearing on
otherwise very weak or painful limbs.

o Therapy in the water often forms an important

component of the rehabilitation programme, but
it should not be the sole source of therapy.
 Principles of Aquatic Therapy

• Relative density is the ratio of the weight of

an object to the weight of the same volume
of water.
• Densities of various substances are defined
by a pure number value called specific
gravity.
• The specific gravity of pure water is 1.0.
• The relative density and specific gravity of an
object determine how well an object will float. https://cdn1.byjus.com/wp-content/uploads/2020/09/Density-Of-Water-2.png
• Lean animals and heavily muscled animals have a tendency to sink, and may
need to use a life vest to reduce effort.
• Animals with a greater amount of body fatwill float more easily.
• Animals with osteoporosis will have reduced specific gravity and will float.
• Adding weights increases self-weight. The animal has to make more effort not
to sink.

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• Buoyancy is defined as the upward thrust of water acting on a body that creates an
apparent decrease in the weight of a body while immersed.
• It aids in the rehabilitation of weak muscles and painful joints.
• By reducing the weight on the joints, it allows the animal to exercise upright and
without pain.

https://image.shutterstock.com/z/stock-vector-illustration-of-physics-bouyancy-force-archimedes-buoyancy-principle-1620904621.jpg
• Hydrostatic pressure is the total pressure
exerted by the liquid on the entire surface
of a body immersed in the liquid
• Pressure is directly proportional to the
depth of the part immersed and the
density of the water.
• Peripheral pooling of blood can be
reduced in extremities deep in the water,
assisting reduction of oedema and https://www.pawsitivestepsrehab.com/blog/wp-content/uploads/2016/06/UWT-Keeper-800x600.jpg

promotion of healing.
• Viscosity is a measure of the resistance obtained by friction caused by the tensile
or bonding force between water molecules.
• Water can therefore provide resistance that may strengthen canine muscles and
improve cardiovascular fitness.
• Viscosity may increase sensory awareness and assist in stabilizing unstable joints

https://www.vetstream.com/Vetstream/media/images/Equis/Hydrotherapy-linear-pool.jpg
• Surface tension is the force of attraction between surface
molecules of a fluid
• Surface tension is not a factor if the moving body part is
completely submerged in water.
• It becomes a significant factor when a limb breaks the surface of
the water.
• Therapeutically if a patient is extremely weak, it is better to do
movements in the water just beneath the surface rather than at or
on the surface.
 Benefits of Aquatic Therapy

• Increases muscle strength and endurance

• Increases cardiovascular resistance
• Improves the ROM
• Helps to reduce pain
• Makes the patient feel good psychologically

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content/uploads/2019/09/11986399_721951071243679_6746094838128106525_n-990x650.jpg
• Improves cardiovascular fitness and weight reduction.
• Increases blood circulation to muscles,
• Increases joint flexibility,
• Decreases pain in joints
• Maximal oxygen uptake is generally lower in water
compared with similar exercise on land.
• Maximal heart rate and blood lactate are also lower
during maximal water running.
• Water temperature should be in the
therapeutic range of 27–32◦C, depending on
the needs of the individual patient, speed of
exercise and depth of immersion.
• Aquatic therapy challenges balance and
coordination. https://i.pinimg.com/originals/0b/43/e7/0b43e7a9c2f7d570d3169edd010e1e46.jpg

• Balance exercises can be attempted earlier

and more safely in water than on land,
providing early opportunities for limb, trunk,
and postural training, resulting in improved
strength, balance, and coordination

https://fmbs.co.uk/wp-content/uploads/2019/01/FMBS-Photo-Shoot-15-e1547566128276-571x400.jpg
 Aquatic Therapy Equipments

• Underwater treadmills, pools of various sizes, whirlpools, bathtubs, large

basins, plastic pools, rivers, lakes and sea.

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wfkScI3kU1D4mRDqog&usqp=CAU
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:strip_icc-!!-/2010/03/11/4/192/1922243/whirlpoolpg2.JPG/i/Canine-Whirlpool.jpeg content/uploads/2017/06/shutterstock_359791280-770x515.jpg
 Precautions and Contraindications

• Some dogs fear water or are reluctant to swim, and this must be
considered before attempting treatment
• When receiving aquatic therapy, dogs should never be left unattended in
the water
• It can be better to wait healing of the incision wound in operated animals
ACUPUNCTURE
Dr. Pınar Can
pcan@ankara.edu.tr
INTRODUCTION
• Traditional Chinese medicine has a 5000-year history.
• In the 18th century, China entered a period of stagnation and acupuncture
was adversely affected by this situation.
• During this period, acupuncture was banned in China, and the West started to
draw attention.
• In 1958, Chinese and Western Medicine started to use acupuncture together
and established research institutes to understand its effectiveness and
mechanisms of action.
• In 1974, the International Veterinary Acupuncture Society (IVAS) was
established.
DEFINITION
• It is defined as the needling of certain points or points that are sensitive to
the pressure found on the skin spontaneously and whose locations are
precisely determined, for both the treatment and diagnosis of functional,
reversible diseases or disorders.
• Acupuncture = acus (needle) + punctura (piercing)

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• According to traditional Chinese medicine, the universe
and all formations in the world are based on forces that
contain the principle of opposition and affect each
other.
• These forces are in balance with each other.
• If the opposing systems in the body (Yin and Yang) work
in a balanced and harmonious way (homeostasis)
health occurs, this balance and harmony are disrupted,
and illness occurs.
• The interaction between Yin and Yang produces Qi (vital
energy, bipolar energy).
• Yin and Yang can be thought of as two poles of opposite electric charge, and Qi as
the current flowing between them.
• In case of illness, electromagnetic abnormality occurs in the acupuncture points of
the diseased organ or tissue or in the acupuncture points in the compatible parts.
• In other words, an energy imbalance occurs when the flow between meridians stops.
• Acu points are located on linear meridians and channels on the body surface
(skin).
• These are high voltage or low resistance electromagnetic foci.
• The aim of acupuncture is to balance the Qi energy that circulates in the body
and provides the balance between the meridians.

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• The stimuli given to the aquatic points reach the brain through nerve fibers,
after being evaluated there, self-healing mechanisms are activated either by
reflexes or neurochemical ways.
• Successful acupuncture restores the natural balance of the organism. It is not
able, however, to heal permanently destroyed tissue.
• Today, these points can be stimulated by needle, palpation, ultrasound, light
or electric current.

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Acupuncture Point and Meridian Concept
• The acupuncture points themselves are locations along the external channels
where a higher number of nerve endings and capillaries causes resistance in
the skin to be measurably lower.
• By stimulating these points, we are able to affect the flow of energy in the
entire organism from here.

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• Acupuncture points connect with each other through channels, these
channels are called meridians.
• There are 12 classical meridians in humans and dogs.
• Yin chanels; heart (HT), lung (LU), kidney (KI), pericardium (PC),
spleen/pancreas (SP), liver (LR)
• Yang chanels; large intestine (LI), small intentine (SI), stomach (ST), urinary
bladder (BL), triple heater or triple burner (TH or TB), gall bladder (GB).
Matern, 2011
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Determination of Acupuncture Points

• Based on superficial anatomical marker locations

• Measuring electrical skin resistance (where resistance is lowest)
• Finger 'cun unit' dimensions

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Effects of Acupuncture

• Analgesic effect (gate-control theory, inhibitory theory, endorphin theory)

• Homeostatic effect (autonomic nervous system)
• Immunity enhancing effect
• Sedative effect
• Psychological effect
• Motor healing effect
Acupuncture Techniques

• Needle acupuncture • Laser Acupuncture

• Acupressure • Gold Acupuncture or Gold Implantation
• Cupping/Scraping • Sound Acupuncture
• Moxibustion • Electroacupuncture
• Aquapuncture • Ear acupunctur
Needle Acupuncture
• Fine, elastic, sterile disposable needles from human medicine are used
• A subjective reaction occurs when the needle is placed in the acupuncture
point correctly; numbness, rapid inspiration, play in the ears and tail

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Acupressure
• It is known as needleless acupuncture.
• It is the application of finger pressure to acu points.
• Although it is not used frequently in veterinary medicine, it is preferred to
reduce pain and muscle spasm in cases such as diarrhea, indigestion,
contusion and paralysis.

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 Cupping
• Heat + vacuum

indigestion in juvenile animals.

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• the aim is to provide local microcirculation
• Indicated for rheumatoid arthritis in large animals and

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Moxibution
• Moxa is produced from Artemisia vulgaris (mugwort)
and is used in different forms.
• In veterinary medicine, the preferred form is as pressed
moxa cigars with or without smoke development, or as
loose moxa.
• During application, moxa is lit and develops a very
particular aromatic fragrance and a very special heat
quality.

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• The smoke penetrates into the channels, to move qi and blood there.
• Moxa is effective for conditions such as cold and qi stagnation in the channels,
painful joints, numbness, infertility, and paralysis.
• For small animals, it is easiest to light moxa in cigar form and then hold it or wave it
back and forth at a distance of approximately 2 cm above the relevant acu point.
• Moxa easily brings energy into the body. The application of moxa is contraindicated
during pregnancy and in inflammatory processes.

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Aquapuncture

• We can use injection cannulas to inject fluids into

acupuncture points.
• The slow absorption of fluid in the tissue creates
longer-lasting pressure at the acupuncture point,
which is meant to amplify the effect of the needle.

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• Injectable substances are, among others, Traumeel
(Heel, Baden-Baden, Germany), echinacea, vitamin
B12 or anesthetics such as lidocaine.
• Indicated in eye infections, allergies, rheumatoid
arthritis, paresis, contusion-induced lameness
Laser Acupuncture
• Lasers are used to stimulate body cells or acupuncture points with light energy.
• Laser acupuncture is painless and therefore bearable even for patients with
needle phobia.
• Indicated for arthritis, rheumatoid arthritis, muscle-tendon injuries, paralysis
and operative analgesia in dogs
 Gold Acupuncture or Gold Implantation
• This method is applied most commonly to achieve a permanent effect and improvement in
chronic degenerative joint disease.
• For a permanent effect, gold wires or balls can be implanted into the acupuncture points.
• The most common indications include hip dysplasia, elbow arthrosis, gonarthrosis, and
spondylosis

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Sound Acupuncture

• Sound acupuncture utilizes the vibrations transmitted to acupuncture points

via tuning forks at different tuning levels, with which the points resonate.

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Electroacupuncture

• By attaching the ends of small charged wires to inserted acupuncture needles, we

can conduct electricity and hence yang energy into the acupuncture points.
• It can also be applied with devices called TENS (transcutaneous electrical nerve
stimulator) that provide electrical stimulation on the skin.
• Stimulates the endorphin system and create analgesia. Its effect lasts for a long time
and has a cumulative effect.
• Intervertabral disc herniation, paralyses, or other neurological deficits, it is very
helpful to support acupuncture with electricity.
• Contraindicated in pregnancy, with epilepsy, and with cardiovascular problems.
Ear Acupuncture

• It is accepted that the appearance of the inner part of

the auricle resembles a fetus standing vertically in the
uterus and that every organ in the body communicates
with a point on the ear.
• It can be used in diagnosis and treatment of nervous
system and locomotor system diseases.
ACUPUNCTURE and APPLICATION
AREAS
Dr. Pınar Can
pcan@ankara.edu.tr
 In small animals
 traumatic peripheral nerve injuries  hip dysplasia
 muscle rigidity-atrophy-contracture  Paresis, paralysis, paraplegia, hemiplegia
 neuralgia,
 osteochondritis dissecans
 deafness,
 intervertebral disc herniation
 syncope,
 Spondylitis and spondylosis deformans  encephalitis,
 degenerative myelopathy  tetany,

 spinal stenosis  convulsion,

 tendinitis, bursitis
 Osteoarthritis, rheumatoid arthritis,
 urinary retention and incontinence
 n. Fasialis-n. Radialis-n. Buccalis-n. Tibialis paralyses
 In large animals

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Colic
lameness
back pain
reproductive problems
arthritis, rheumatoid arthritis

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indigestion, constipation
muscle contraction, muscle atrophies
sciatic paralysis, radial paralysis
 Acupuncture in Musculoskeletal Diseases

• Musculoskeletal diseases (including arthritis, degenerative joint disease,

and intervertebral disc disease) are the most common and most responsive
disorders treated with acupuncture. These disorders are known as “Bi
syndrome” in traditional Chinese veterinary medicine (TCVM).
• The aim is to eliminate the pain and related muscle spasm, and strengthen
the muscles around the joint to make the animal walk more balanced.
 Acu points in the treatment of animals with joint diseases

• Shoulder: SI-9, GB-2, BL-11, TH-14, LI-15, and BL-10

• Elbow: LI-11, LI-10, LU-5, SI-9, TH-10
• Carpus: PC-6, HT-7, LI-4, LU-7, SI-3, TH-5
• Hip: GB-29, GB-30, BL-54, and Bai hui
• Stifle: ST-36, BL-40, GB-34, SP-9, ST-35, SP-10
• Tarsus: BL-60, KID-3, LIV-3, ST-36, SP-6, ST-41
Shoulder, Elbow, Carpus, Hip,
Stifle, Tarsus
 Acu points for hip dysplasia

3 times per week 15-20 min for 6-12 weeks, or gold implantation
 Acupuncture in Intervertebral Disc Disease (IVDD)

 The mechanism of action of acupuncture in

thoracolumbar and cervical IVDD has not been
fully understood.
 It is thought to relieve muscle spasms and pain
and stimulate axonal regeneration in the spinal
cord.
 By this way, it is thought to reduce local
inflammation, compression on the spinal cord and
scar tissue formation.
• Local and distal acu points are used in IVDD.
• Thoracolumbar IVDD: BL 14, BL 28 (local); BL40, BL60, GB34, GB39, SP10, ST36
and ST41 (distal)
• These points are stimulated for 10-20 minutes with needle, acupressure,
moxibition or TENS.
• Once a day in acute cases, once a week in chronic cases
 • Cervical IVDD: GB14, GB20, GB21, BL10 and BL11 (local); LI4,
LI11, SI3 and TH5 (distal)

GB meridian and points BL meridian and points

Acu points for treatment of colic
Acu points for the treatment of constipation
EXTRACORPOREAL SHOCKWAVE
THERAPY (ESWT)
Dr. Pınar Can
pcan@ankara.edu.tr
Introduction

• Extracorporeal shock wave therapy (ESWT), also

known as high-energy focused sound wave
therapy, was first used as a non-invasive method
for the fragmentation of kidney stones in the
early 1980s.
• Extracorporeal shockwaves have also been used
to the fragmentation of sialoliths,
choledocholiths, and pancreatoliths.
• It’s bone healing effect was discovered on pelvis
during the animal lithotripsy studies.
• In equine musculoskeletal disorders includes insertion desmopathies, bone
spavin, tendon and ligamentous calcification, navicular disease, exostoses,
fractures and microfractures, back pain, and osteoarthritis (OA) of
tarsometatarsal and distal intertarsal joints.
• In dogs as a part of the treatment regimen for hypertrophic nonunions,
tendonitis, spondylosis, and OA.

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• Extracorporeal shockwaves are acoustic waves of high
pressure and velocity produced outside of the body.
• These waves are characterized by high-amplitude
acoustic pressures (20-100 megapascals [MPa]) with a
short build-up time of approximately 5-10
nanoseconds.
• These pressure waves differ from ultrasound waves
because they have lower frequency, minimal tissue
absorption, and are lack of a thermal effect.
• Shock waves produce approximately 1000 times the
pressure magnitude of ultrasound waves and deliver
energy at a controlled focal volume.
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• Mechanical energy transferred to tissues following ESWT causes various
biological responses at the cellular level.
• Compression and tension generation occurs as the shockwave travels through
the tissue.
• Varying amounts of reflection and transmission of energy occur at varying
interfaces.
• Cavitation bubbles are made during the tensile phase of the shockwave, and
as size increases, a large amount of energy is delivered to the bubble.
• Cavitation bubbles formed secondary to shockwave-
generated compression and tension forces have the
potential for deposition of large amounts of energy
after subsequent collapse, releasing high-energy
water jets and high-temperature production
• Cavitation also leads to the production and release
of free radicals, ultimately creating chemical
reactions within the tissue.
• ESWT may also increase cell membrane permeability. https://eswt.net/wp-content/uploads/2011/06/Shockwave-Therapy-pict-002.jpg
• The exact mechanism of action of ESWT has yet to be fully elucidated;
however, the mechanical stimulation of cells is hypothesized to result in
increased expression of cytokines and growth factors leading to decreased
inflammation, neovascularization, and cellular proliferation
• The mechanism behind the pain relieving function of ESWT is thought to be
due to increased serotonin activity in the dorsal horn, and descending
inhibition of pain signals
• Treatment typically consists of 1–2000 shocks delivered in a session at 1–3 bar
• The shocks are delivered at 5–20 Hz (shocks per second), though there is no
evidence that identifies a particular rate as being more effective.
• The effect of this type of treatment is provocative in nature.
• It stimulates an acute reaction in the tissues, taking the tissue from a chronic,
unresponsive, recalcitrant state to a more responsive, acute lesion.
• ESWT is useful for;
 Analgesia
 Wound healing
 Osteoarthritis,
 Delayed and nonunion fractures,
 Ligament and tendon diseases
 Chronic wounds

Radial shock wave therapy for

osteoarthritis in a dog
• Contraindications;
 immune-mediated joint disease, infectious arthritis,
 neoplastic disease,
 diskospondylitis,
 unstable fractures,
 in dogs with neurologic deficits
 to use near gasfilled cavities or an organ
 over lung fields, brain, heart, major blood vessels, nerves
 On a gravid uterus
MAGNET THERAPY
Dr. Pınar CAN
pcan@ankara.edu.tr
• Magnet therapy has been used in human medicine as an alternative therapy
for many years.
• It has gained popularity more recently in veterinary medicine.
 Static Magnet Therapy
 Pulsed Magnetic Field Therapy

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Static Magnet Therapy

• Static magnets have magnetic fields that do not change.

• Static magnets for therapeutic purposes are usually in the 300- to 5000-Gauss.
• When used directly against the skin, static magnets will influence the
bioelectrical composition of the tissue underneath.
• While the magnetic field generated is unchanging, the blood flowing through
the tissue contains charged ions, which are drawn to the magnetic placement.
• It is thought to be usefull in joint stiffness, general tightness, muscle strains,
bruising, localised swelling
Pulsed Electromagnetic Field Therapy

• Electromagnets generate magnetic fields only when electrical current flows

through them.
• A magnetic field is pulsed through tissue fibres at a range of pre-set, variable
frequencies.
• Electromagnetism is generated by running an electric current through a coiled
wire (electromagnetic induction).
• PEMFs are hypothesized to have electric rather than magnetic effects on
tissue
 Main therapeutic purpose of PEMFT is
enhancement of bone or tissue healing and
pain control.
 It may stimulate new bone growth,
pruduction of glycosaminoglycan
 At 15-16 Hz, calcium ion transport occurs
and cartilage growth is stimulated, perhaps
because of increased transcription and DNA
synthesis.
  Relieve pain
 Osteoarthritis
• It can be used for;
 Wound healing (chronic)

 Delayed fractures or non-union

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content/uploads/2019/06/pemf.jpg

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PHYSICAL THERAPY and REHABILITATION of
SMALL ANIMAL ORTHOPEDIC and
NEUROLOGIC DISEASES
Dr. Pınar Can
pcan@ankara.edu.tr
Physiotherapy of Orthopedic Diseases

• Soft tissue lesions like as muscle, tendon and ligament injuries; osteoarthritis;
fractures and hip dysplasia are the most common orthopedic disorders which
can be treated with pyhsiotherapy.
• Soft tissue injuries are an often underdiagnosed source of canine lameness.
• Sporting and working dogs may be particularly at risk of suffering acute
traumatic muscle strains, ligamentous sprains or chronic overuse
degenerative tendinosis lesions resulting from poor healing of repetitive
strain injuries.
Rehabilitation example for grade one cranial cruciate ligament
injuries

• Clinical symptoms; mild swelling detectable at the parapatellar tendon, mild

discomfort on stress testing (unanaesthetised), partial weight-bearing use of
limb.
• Treatment suggestion;
 Keep the dog on a leash for 2–3 months without exception.
 Modalities that may encourage circulation to the cruciate ligament; you can use
PEMF or laser on a regular basis
 Joint proprioception techniques such as joint compressions and cross-leg
standing.
 Strengthening of the adjacent musculature: up-hill walking (steep going up and
gradual coming down).

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 Balancing/coordination: walking on different terrain (i.e. To cause high stepping
or somewhere with uneven footing), rocker boards, mini-trampolines, obstacle
course and cushions off the couch, etc.
 At 2–3 months (individually based): add some ‘destination jumping’ (i.e. onto a
bed or couch or over a small jump) and/or tug-of-war exercises if the dog is safe
doing so.

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 At 2–3 months (individually based): add some ‘destination jumping’ (i.e. onto a
bed or couch or over a small jump) and/or tug-of-war exercises if the dog is safe
doing so.
 Supplementation: glucosamine HCl and methylsulphonyl methane (MSM)

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 Owners must avoid throwing balls or playing ‘Frisbee’ with their dog for 4–6
months
 Return to normal off-leash activity should be addressed with advanced-level
neuromuscular retraining

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Rehabilitation of osteoarthritis

• Osteoarthritis is characterised by progressive loss of articular cartilage,

reactive changes at the margins of the joints and bones, and chronic joint
inflammation.

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• Clinical symptoms;
 aching discomfort that worsens with activity and is
relieved by rest,
 a restriction of activity level, a limitation in the
ability to perform,
 poorer proprioception, pain and discomfort,
 joint stiffness, effusion and enlargement,
 loss of strength and flexibility.
• The goals for the treatment of OA;
 improve the joint and overall function and quality of life of the animal,
 relieve pain and associated muscle spasm, maintain and regain joint ROM,
 improve joint health, strengthen supporting muscles,
 address proprioceptive deficits and advise on lifestyle modifications.
• Pain relieving can be provide by use of modalities; ultrasound, laser, PEMFT,
ESWT and NMES
• Massage may reduce pain, increase pain tolerance and stimulate a release of
endorphins, so long as regular massage sessions are administered
• Thermal agents such as heat or cold are both reported to have pain-relieving
effects and application of each should be taught to owners and/or utilised as
part of a therapy session
• Manual physiotherapy techniques such as joint mobilisations, stretching and
joint traction/distraction should be a part of therapy
• Weight management should be an integral part of rehabilitation of the
osteoarthritic dog.

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Physiotherapy of fractures

• Physiotherapy applications can be performed when the area is accessible (i.e.

when a bandage or cast is off) or immediately if an internal fixation has been
used.
• Aims;
 pain management,
 aerobic fitness,
 avoidance of complications related to immobility or reduced muscle mass,
 strengthening and retraining functional ctivities
 Low-intensity, pulsed US can be used to stimulate
endochondral ossification due to stimulation of bone cell

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differentiation and calcified matrix production by intracellular
calcium signalling and incorporation in chondrocytes

 0.03–0.05 W/cm2 with a 1.0 MHz or 1.5MHz or 3.3MHz

sound head used for 10–20 min per session daily, beginning
day 1 post operative is suitable for fracture repair

 US is also effective on delayed unions and non-unions

• Laser therapy is effective on bone healing.
• 830 nm, 40mW, continuous wave × 16
J/cm2/session, divided 4 points around the defect
(4 J/cm2) – starting immediately after surgery and
repeated 7 times, Q48 h (Gerbi et al. 2005).
• 830 nm, 0.5 cm2 area × 50 mW x 10 J/cm2
(fractioned into 4 points), Q48 h (Weber et al.
2006).
• 632.8nmlaser, 35mW, for 30 min, delivering 892 https://s30387.pcdn.co/wp-content/uploads/2020/02/p1bnjamc71oc41et414f01vcs1aju6-scaled.jpg

J/cm2 cumulative over 14 days (63 J/cm2 per day)

(Luger et al. 1998).
• Pulsed electromagnetic field (PEMF) has been reported to stimulate the
activity of osteoblasts and chondroblasts, but its effect on bone healing is still
controversial
• In one study it was reported that a PEMF setting of 1.5 Hz for 1 h/day at 4
weeks postoperatively and lasting for 8 weeks significantly increased stiffness
and promoted greater new bone formation (Inoue et al. 2002).
 https://dogwheelchairlife.com/wp-content/uploads/sites/91/2020/06/Josie-
• NMES has been shown as effective on
promoting bone healing in different studies.

Jen-Zarcone.jpg
• ESWT is a newer therapeutic modality and its
useful effect on non-unions/delayed unions
was reported in studies.

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• Controlled weight-bearing exercises were
found useful
Physiotherapy of Neurologic Diseases

• The main focus of neurological rehabilitation should be on functional gait

retraining and development of the stereotypical patterns of gait.
• In some neurologic cases, spontaneous recovery of function may occur as a
result of reduction in swelling or reabsorption of haemorrhage.
• Aims: To take advantage of spontaneous recovery; manipulate neuroplasticity
to assist functional return; prevent or minimise complications; and implement
compensatory strategies when poor prognosis results in the threat of
euthanasia.
• Spinal cord disease; caudal cervical vertebral malformation (CCVM), Hansen’s type I
and type II intervertebral disc disease, fibrocartilaginous embolism, chronic
degenerative radicular myelopathy (CDRM), inflammatory diseases involving central
nervous system
• Peripheral nerve disease, e.g. traumatic peripheral nerve paralysis
• Generalised neuromuscular disease, e.g. polymyositis, tick paralysis,
polyradiculoneuritis, tetanus
• Cranial nerve disease, e.g. trigeminal neuralgia, facial nerve dysfunction
• Vestibular disease
• Neuropathic pain
 https://files.brief.vet/migration/gallery/24546/prop_prom_ig_2011-12_fig-2-
• active therapeutic exercises
• passive range of motion (PROM),
• massage, electrical muscle stimulation (NMES)
• Another important part of therapy is the

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therapeutic handling and functional positioning
during resting periods

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• For intervertebral disc disease; PROM exercises,
neuromuscular stimulation and functional weight-
bearing exercises, balance and strengthening
exercises as well as hydrotherapy (swimming or
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underwater treadmill).
• For fibrocartilaginous embolism; passive range of
motion, massage, positional exercises, electrical
stimulation, physiological positions, gait training
with support and hydrotherapy.

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 https://k9carts.com/wp-content/uploads/2016/10/towel_test_dachshund.jpg
 Educate the owners for evacuation of rectum and
manuel expression of the bladder in patients with
fecal and urinary retention
 Prevent decubitus ulcers
 Weight control
 Basic home therapy and care; PROM, active ROM,
stretching exercise, assisted standing excercise,
soft bedding etc.

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EQUINE PHYSICAL THERAPY and
REHABILITATION
Dr. Pınar Can
pcan@ankara.edu.tr
 INTRODUCTION
• Horses are fantastic athletes, from the pony
club horse to the racing Thoroughbred.
• As athletes, horses are under the risk of
injuries and conditions related to their sport.
• Physiotherapists have a pivotal role as part of
the equine sport medicine team, from
assisting to manage the acute stage of injury
to ongoing rehabilitation to ensure return to
optimal performance http://www.wur.nl/upload/bf67bf60-1b3c-4dc6-b529-
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• Horse physiotherapy is diffent from human and
canine physiotherapy from some aspects.
• The horse is treated in standing in the majority
of situation; thus much of the musculoskeletal
system is treated in the weight-bearing (WB) or
partially weightbearing (PWB) postures.
• A horse can be lie down only under anesthesia,
so it is not prefered
• Many techniques like manual therapy, soft tissue
and skeletal mobilisation and manipulation,
proprioceptive facilitation techniques, https://lh3.googleusercontent.com/proxy/hMz-xoZvWRwQTwiz3yCWjmpg8JwwFEQqtnuM_INUB-
5gmHVrCQnDCF4HQnSiIv1Wuvr5yCcqT5ze8VSCS3thOu35MFM5BEu-uiRvRPm9if2uzreX_PeNNHJwOQ

electrotherapy and exercise-based rehabilitation

can be adapted and performed successfully
 Rehabilitation of Musculoskeletal Disorders

• After a thorough clinical examination

and motion evaluation, the first
technique of rehabilitation of
musculoskeletal disease is to provide
controlled movement and stimulation
of the affected areas.
• Owners can apply various mobilization
techniques when the horse is cold
(before exercising), warming up and
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 Before exercise
• Stretching exercises using prizes such as carrots to enable the
horse to use its cervical and thoracic areas
• Massage of a qualified physiotherapist
• To walk forward, backward and on the number eight in the hand,
• Keeping the horse warm with a blanket or hot packs

https://thehorse.com/149547/rehabilitating-horses-with-
back-problems/
 When warming up

• Electrical stimulation from a veterinarian

• Applying weighted boots around the hind legs to
improve proprioception (awareness of where a
horse's foot is) and increase hip, knee, heel and ankle
flexion
 • Working on a sponge line with a training device such as side bridles, a Chambon, a
Gogue or a Pessoa to encourage the horse to properly move and use its body.

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amazon.com/images/I/51Pc%2B56WS%2BS._AC_SX425_.jpg

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reins-1157-p.jpg
 After warm up
• Working on different floors and slopes: “Up-hill running promotes
engagement and abdominal wall contraction”,
• “Down-hill running increases passive interaction and will be challenging for
horses with sacroiliac joint disease.
• Exercise on the hard ground is not recommended for patients with joint problems in
the vertebra, as the hard ground will increase vibration.
• Soft and deep floors encourage the horse to lift its foot higher.
• Cavalettos can be used to induce conscious proprioception and greater hip and
gluteal muscle function.
• Massage can increase blood flow and help identify muscle spasms.
• There are many massage techniques available, the owner or groomer can apply
simple techniques.
• The laser can be used to stimulate specific trigger (myofascial pain) points and aid
recovery.
• Electrotherapy can be used to stimulate nerves and reduce pain.
• Kinesiotape, applied to limit the movements of certain joints, can “relax and
strengthen muscles, support ligaments, stimulate circulation and reduce
inflammation, depending on how and where it is applied.
• Therapeutic ultrasound can increase blood flow, relax muscles and stimulate trigger
points.
• Shock wave therapy can help treat myofascial pain and muscle spasms.
• Magnetic therapy can increase new blood vessel formation.
• Hydrotherapy, including underwater treadmill use and swimming, helps the horse to
strengthen its muscles without overloading their limbs.
 Rehabilitation of Tendon İnjuries

• Strain-induced tendon injury of the

tendons and ligaments is commonly
occured in the equestrian athletes.
• Superficial digital flexor tendon (SDFT)
is the most commonly injured tendon
• Less commonly injured ones; deep
digital flexor, interosseous tendon and
accessory ligament of the deep digital
flexor tendon

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• In chronic tendon injuries:
Exercise should be restricted to walking from onset of clinical signs
However, prolonged immobilisation may contribute to further detrimental
changes
Keep the horse in a small paddock or yard, where they can mobilise in a limited
way
Decide to start exercise according to clinical and ultrasonographic examination
Loading to the tendon should be increased gradually; in early, middle, late
stages
• In early stages
Standing/walking on varying surfaces, such as springy grass and sand, will
increase the loading.
Progressing walking into trotting.
Walk/trot on a lunge or circle will load different parts of tendon.
• In middle stages
Progression of in-hand exercise to variable terrain, gentle gradients.
Ridden work at trot; straight line then circle – weight of rider will increase
tendon load.
Graduate into canter; straight line then circle.
 https://c8.alamy.com/comp/PFR1PE/girl-on-horse-going-down-a-slope-PFR1PE.jpg
• In late stage (36 weeks +)
Use of slopes and speed work
Jumping horses – slopes, poles and cavalettis
should be introduced
Reduction in fence height may limit risks for SDFT
injury but not affect accessory ligament or
interosseous tendon

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• It is better not to allow horses with severe tendon injury to do
gallop until 6 months post injury, but preferably 9–12 months
• Deep transverse friction massage
• If there is inflammation > cryotherapy
• Ultrasound, laser, pulsed electromagnetic field or
extracorporeal shockwave therapy may be beneficial in the
treatment of muscle and tendon lesions

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content/uploads/2016/04/therapy-ultrasound-for-horses.jpg

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• In acute tendon injuries, there should be a short period of
immobilisation followed by controlled and progressive
mobilisation
• Protect, rest, ice, compression, elevation
• In early stage (up to 72.hour, mostly 48.hour) application
of cold may minimise inflammation and limit the action of
proteolytic enzymes
• A compression or elastic bandage should be used around
the affected tendon, but care should be taken to avoid
impairment of circulation
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• Provide the animal with non-slip surfaces, adequate Cw_300/MTQ1MjM0OTQwMDIxNjQ2ODE3/photos-by-darrell-dodds.webp

confinement and resting surfaces

• In chronic stage 1 (3-5 days) as pulsed (non-thermal) ultrasound, low-dose laser or
pulsed electromagnetic field therapy (PEMF) at the lowest setting
• In chronic stage 2 (5-21 days) within the first 2 weeks following injury (severity
dependent), it is best to adhere to relative rest incorporating pain-free activity and
range of motion (ROM), then stretching
• Exercising with NMES
• Heat, cyclical hot/cold, laser, ultrasound, PEMF
• Gradually increasing the exercise level
 Rehabilitation of Equine Back Pain
• Horses may experience musculoskeletal pain and injuries anywhere along the
axial skeleton consisting of the skull, columna vertebralis, sternum, and costa.
• The backbone of the horse, the main scaffold rod of the axial skeleton,
consists on average of 54 interlocking bones or vertebrae
• Many horses with ‘sore’ backs have been ‘cured’ by repositioning their head
at exercise.
• Severe problems are very incapacitating and give rise to obvious clinical and
X-ray findings.

Kissing spine

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• Back pain in horses can originate from: the skin (eg saddle sore), ligaments
(eg sacroiliac strain), vertebrae (eg overriding dorsal spinous process or
“kissing spine“) or muscles
• Vertebral and pelvic fractures manifest with reluctance on the animal’s part
to move, and every indication of severe crippling pain associated with gross
muscle wasting.
• Any form of treatment calls for close veterinary supervision; all cases
eventually require muscle stimulation and rehabilitation.
• The ‘problem back’ is the one producing some signs of discomfort and
reduction in performance ability, but without obvious clinical findings.
• These types of back are almost certainly a result of ligament strain and
associated muscle problems.
• Soreness and discomfort in the back have occurred as a result of a problem
in a limb causing the horse to work out of balance, the uneven stresses
falling on the back.
• The answer is to find and cure the limb problem, and then the back will
recover.
• The cause of back pain can be;
• incorrectly fitting or poorly maintained saddle
• pain elsewhere, causing the horse to alter its
action, so putting abnormal stresses on the
back
• falling, slipping up
• twisting, turning abruptly https://i.pinimg.com/originals/4c/a0/78/4ca07847c3877c92bfc9000cfa609dac.jpg

• jumping awkwardly

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• Treatment for back pain in horses include a multimodal approach
• Rest is essential, ranging from weeks to months.
• More specific treatment will depend on the diagnosis and includes:
• painkiller,
• physiotherapy, eg heat, ultrasound, electrotherapy, manual therapy (massage),
PEMFT,
• infiltration into area of pain, eg. anti-inflammatories
• surgery in cases of painful “kissing spines” and some fractures
• controlled exercise
• acupuncture
• If there is an exact back problem, reduce the pain, stimulate the appropriate muscle
groups, re-educate the movement pattern, check the saddle fit and find the cause.