By Mandi Blackwelder, DVM CCRP
What is electrostimulation?
Electrostimulation is using an electrical impulse to a nerve within a muscle to help decrease pain, increase muscle strength, or both.
Hang on a minute…..I’m picturing Frankenstein stuff…..
When delivered appropriately and with proper training, electrostimulation should be ONLY a positive experience, particularly in our pets who can’t understand why we would do something painful even if it was helpful. Stimulation devices all have multiple properties which can be adjusted to get the desired effect without discomfort.
Types of electrostimulation:
- Neuromuscular Electrostimulation (NMES)
- Transcutaneous Electrical Nerve Stimulation (TENS)
Neuromuscular Electrostimulation (NMES):
Who? Patients needing help with muscle contractions, usually with nerve damage. Examples are dogs with back fractures, slipped discs or nerve damage in a forelimb
What happens? Electrodes (which are the little gel stick pads that you think of for a heart monitor) are attached to the skin. The hair must be shaved or the contact is incomplete and then it hurts. The pads are applied over motor points. A motor point is the area inside the muscle where the nerve triggers the muscles to contract. The machine is set and turned on. It is then adjusted to assure there is no discomfort and so that the muscles contracts (the leg moves) for a short period of time and then releases for rest. As the patient improves, longer periods can be used so the muscle gets stronger.
Why? Since the patients cannot use the muscle by themselves due to paralysis or nerve damage, we are creating muscle contractions for them. It is not the exactly same muscle use as weight bearing, but when the dog or cat is able to get back on their paws, they have some muscles to use and are not standing on jello. Ultimately, progress to function is much faster.
Transcutaneous Electrical Nerve Stimulation (TENS)
Who? Patients with painful muscle spasms or tightly contracted muscles from compensating for another injury.
Here the hair is shaved and electrodes attached as in NMES. In TENS however, the electrode is placed over a trigger point. A trigger point is a point in a muscle that hurts when it is touched. These are the points we instinctively rub on ourselves when we have an ache. The machine is set and turned on, then adjusted for comfort. Generally a gentle pulsing is most comfortable for the pet.
Trigger points are tight balls of muscle fibers that due to pain, cannot let the contraction go completely. We usually say “I have a ‘knot’ in my neck.” The pulsing confuses the pain nerves which allows the muscle point to release, creating pain relief. This modality is not commonly used in pets, as trigger points can be painful until they release. These patients must be chosen carefully and their discomfort respected.
Who? Patients with musculoskeletal disease, neurological damage or pain.
What happens? Acupuncture needles are placed at appropriate points (learn more). Then electrode clips are attached to the needles. My clients often call these “jumper cables” as that is what they look like. The machine is turned on and slowly increased in intensity until the pet licks his lips or turns his head. This means he feels it. Then they are watched closely for comfort and turned down if they are panting or otherwise uncomfortable.
Why? The needles are a copper conductor that allows the electrical signal to penetrate better into the acupuncture point. Paralyzed patients and dogs with neuromuscular disorders seem to respond nicely to this technique. Electroacupuncture leaves a longer lasting or more complete effect than acupuncture alone for most patients. However, it should be used with caution. Some animals are sensitive to acupuncture in general, can appear quite relaxed at the treatment, but then are “wiped out” then next day or two.
Overall, electrical modalities are used to help the “boost” the nervous system’s conduction of signals for the betterment pain management or muscle strengthening.
Improve Your Sport, Protect Your Dog
By Mandi Blackwelder, DVM CCRP
For canine athletes, whether agility, fly ball, disc dog, earth dog, dock diving, sled dog racing or any other canine sport, rehabilitation techniques and equipment can improve your dog’s longevity and performance in its sport. Plus, it gives you new ways to train your dog to keep you both entertained and out of a training rut. Teaching your dog new ways to exercise expands the range of the muscles and nerves, which is vital to protection from injuries.
Helpful equipment for canine conditioning:
• Underwater treadmill
• Balance and wobble board
• Obstacle course
• Cavaletti poles
There are 3 main goals in conditioning an athlete:
1. Improving strength
2. Improving endurance
3. Preventing injury
Improving strength: All athletes need muscles. The better your dog’s muscles are honed to your sport, they better they will perform. Conditioning techniques can improve muscles specific to your sport. For example, an agility dog pushing a physioball focuses muscle work on the hamstring to improve its jumping strength. A fly ball dog working an obstacle course of multiple physioballs and disks alternating with firm surfaces works the muscles on the inside and outside of the legs creating better turns.
Improving endurance: Think of the marathon runner. To increase endurance she can run MORE miles OR she can make those miles harder. This allows her body to work more efficiently and endure more speed during the marathon. The underwater treadmill makes the “miles” harder for our sporting dogs. The water creates resistance. The incline creates resistance too. So a lure coursing dog that has been running the length of the course in the treadmill, now has more endurance for greater speed for that same distance on land.
Preventing injury: Dogs injure themselves not on the perfect run or dive or turn, but on the one that is off just a bit – a divot in the grass, too tight of a turn coming out of the tunnel, a slight distraction changes the dog’s head position as he runs. The ability to correct and recover without injury are entirely dependent training the nerves and muscles for this purpose. Physio work like the physioball or physiodisk simulates uneven footing and weight shifting. We do these exercises at a variety of heights and head positions. For our “blast off sports” like dock diving working turns is essential for them to adjust footing if they hit the dock at the wrong speed. For disc dogs, “straight line” work is needed, such as the land treadmill to maintain the tendons and muscles mass in appropriate alignment.
Working to condition your dog with a rehabilitation specialist is like having a personal trainer for yourself. You know how to lift weights, but your trainer makes the work more efficient. You get bored with your routine, your trainer can suggest new exercises to help keep it interesting. And if you have an injury, your trainer can make sure you are exercising appropriately to protect the injury while maintaining endurance. Working with a veterinary rehabilitation specialist is like a personal trainer for your dog – you are still the coach for the big game but your rehab specialist is a valuable member of the team.
By that same token, you wouldn’t want a personal trainer who is just a guy who’s in shape. Without appropriate training he may not know how other health factors affect your ability to exercise, he may not understand the way joints load weight for different body types, and he may not understand how you are motivated. A CCRP (Certified Canine Rehabilitation Practitioner) or CCRT (Certified Canine Rehabilitation Therapist) has taken over 100 hours of course work, completed 40 hours of internships, presented cases for review and passed an examination in addition to being a veterinarian or veterinary technician. Only someone certified has the flexibility to work across sports, understands options and risks for injuries and can adjust exercises for different breeds and temperaments.
by Dr. Mandi Blackwelder
Isn’t ultrasound a way to look inside the body? How is it therapeutic?
It’s both. Ultrasound, by definition, is a oscillating sound wave that is above the range the we can hear. For diagnosis (i.e. looking inside the body) – the machine is measuring what comes back to it after that sound wave bounces off things inside the body and makes a picture based on the distance of the bounce. For therapy, those waves are used to warm the tissues for a healing effect.
Isn’t a heating pad going to do the same thing?
Only on the surface. The beauty of ultrasound therapy is that we can target a specific tissue at a specific depth. By coning that energy into a small space, we can get maximal therapeutic effect. A heating pad, while it feels good, can only heat the surface and cools very quickly.
How does ultrasound help an injury?
- Increased blood flow. Think about how your skin turns pink when you’ve been in a warm shower. That’s because blood flow has increased at the skin. Now think about concentrating that heat to an injury. The increased blood flow will bring all the blood components in to heal the wound faster.
- Reduction of swelling. Think about a sprained ankle. The more swelling that is here, the less motion you have, and the more likely you are to have permanent decreased range of motion. Ultrasound helps remove that swelling to increase motion early, tendons don’t freeze up to create scar tissue.
- Pain relief.The movement of the ultrasound, coupled with the heat, serves as massage for the affected area. This reduces pain, helps remove toxins, and helps medication reach where they need to go.
- Increasing motion in old injuries. We all know that “stuck” things work better when warm. This is why we run a stuck jar under warm water to open it. This is why we don’t keep Vasoline in the refrigerator. The same concept applies to tendons and ligaments that have been “frozen” from injury. Heating and increasing blood flow allows it to soften, bring in more blood flow and break up scar tissue, resulting in better movement.
Does it hurt?
No. Therapeutic ultrasound should feel like the benefits described above….warm massage. Often we will stretch the limb or affected area while doing ultrasound, but again it should not be to the point of pain, only to the point of stretch.
What specific conditions warrant ultrasound?
- Tendon injuries
- Ligament injuries
- Scar tissue problems
- Preventing post operative scar formation
- Any acute swelling
- Muscle injuries
- Slow healing wounds