Home programs are an essential part of rehabilitation. Simply put, what happens ‘in clinic’ during a session is just a part of the benefit that rehab provides. What happens all of the rest of the days of the week hold equal importance. So, what should your home program include?
Naturally, exercises are an important part of the home program. It’s important to pick exercises that provide the best use of time and give you the ‘biggest bang for your buck’. Targeted exercises are likely more useful than just walking. Not to say that walking is of no use, but just that targeted exercises might help a dog get better faster.
Stretching also makes complete sense to add to a home program. So long as you are ensuring that the dog and owner are both in ‘agreement’ to the activity, then it’s a good thing to prescribe. In other words, if the dog is willing to be passively stretched, and the owner feels confident to do the stretching, then, great! However, if you are requesting that the owner has to pin their dog down in order to do the stretch, then perhaps come up with an activity that will accomplish the same thing.
What else? It’s important to provide do’s and don’ts for managing the dog around the home. In other words, what will keep the dog safe and reduce the chance of harm. Block off the stairs. Do not allow off-leash activity. Do not allow jumping off the bed. Do encourage walking around the yard. (etc.)
What about hands on therapies? Well, this is where I think you must be very careful about what you do or don’t prescribe.
One of the safer things to allow an owner to would include joint compressions. These can be beneficial for post-operative cases or osteoarthritis cases, and there is very little that can go wrong in giving these out to owners. The caveat of course, is that you SHOW the owner how you want them to perform the technique and you have them demonstrate it to you before you authorize it to be part of the home program.
Some massage and myofascial techniques might also be of benefit. Effleurage could be useful. Acupressure could be prescribed. Skin rolling could help. All with proper instruction, and being mindful of the patient and the owners. Will the dog tolerate what you are advising the owner to do? Is the owner competent and confident enough to do what you are asking them to do?
Should you prescribe mobilization therapies? Here is an area where I am far more cautious.
I will teach owners how to do various tractions. If there is a pinched nerve or disc herniation, then doing traction daily, more than once a day, will resolve the issue sooner than later. So, I feel that this is an important technique to prescribe despite being a technique that requires a higher skill level. So, teaching an owner how to do traction properly is imperative. If YOU don’t know how to perform tractions well, then you shouldn’t prescribe it to the client.
As a general rule, I never prescribe mobilizations to owners. Having taught mobilizations to physiotherapists and non-physiotherapists alike, I have found that these skills take a good deal of practice and refinement to get right. It’s an advanced skill. There are very few exception to this rule. I have prescribed Chest Lifts to owners. To me, these are safe. And for sporting dogs with medial shoulder hypermobility syndrome, I have prescribed shoulder ‘wobbles’. Some I have even taught how to get a ‘click’ out of the shoulder. My reasoning for doing so, is that there have been more than a few times where some of these patients come up lame just before a competition, and the owners can’t get their dogs in to see me. Knowing how to mobilize the shoulder and/or get an auto-manipulation is practical knowledge for a sporting dog owner (i.e. put the shoulder into a position and then movement that will cause the shoulder to click if there is a pressure build up in the joint… but NOT a high velocity low amplitude thrust. Sort of like pulling on a finger that clicks). Again, if you don’t know how to do this yourself, then you can’t adequately teach it. As well, the owners need to be instructed well (and often repeatedly) to get it right. Even the most highly competent owners can be intimidated by this technique, so it’s not one I give out frequently.
Other than these scenarios, I don’t tend to give out very many manual therapies. I tend to stick to exercises and home management strategies.
But, I’d love to hear from you? What do you like to prescribe for your home programs? I’ve created a survey to be able to hear back from all of you and be able to share the trends that others are using in practice.
Here’s the link to the survey: https://www.surveymonkey.com/r/TK8P3DQ
On that note, until next time…