THR questions
Posted: Sun Sep 11, 2022 7:15 pm
Hi Laurie,
I have a couple of patient groups that I have been reflecting over case management with in order to improve my practice. I would really appreciate your thoughts/wisdom/suggestions here.
THJR - I have seen a few patients with complications following this procedure. For some of these patients it is a surgical issue, such as infection or implant failure. Those that fall into the category of physiotherapy management are: a) Sciatic nerve compromise, B) neurodynamic issues?, C) patients with muscle atrophy and weakness, or just slow to develop muscle mass (especially biceps femoris, vastus lateralis).
Strategies that I have been adopting for sciatic nerve compromise include:
* toe-up splint if affected hindpaw is knuckling
* sensory activation strategies: massage/stroking or flicking the skin surface to activate muscles and sensory receptors/touching the limb with different materials of varying sensations - to both the affected limb and paw
* proprioception activation strategies - electric toothbrush to affected paw as vibration to activate proprioceptors, walking over cavaletti to encourage joint proprioceptors, gentle hip joint compressions
* Laser: I have a SpectraVet laser Class 3B with both multi-probe and deep tissue probe. I have been applying laser at several points along the sciatic nerve tract in these patients and would be interested in your thoughts here in terms of points that you would choose, frequency of treatment. Often these patients are not referred to me until minimum 2 - 4 weeks post-operatively.
* Sciatic nerve excursion: I have been using sciatic nerve stretching where indicated (where hip flexion and combined stifle extension ROM is limited or resented). Normally I would recommend 5 - 10 reps pending on patient tolerance 2 x per day.
Patients with poor muscle activation, atrophy and weakness:
* NMES - often this is to biceps femoris and middle gluteals
* Kinesio-taping to activate muscles - although I do find this does not stay on so well with dogs
* Isometric contraction exercises
I am also wondering if there is a pain component that I am missing, and whether TENS would be a useful adjunct to some of those patients who appear to be poorly controlled with pain despite being on gabapentin +/- meloxicam.
Please advise if there is anything that I am missing.
Kindest Regards,
KG
I have a couple of patient groups that I have been reflecting over case management with in order to improve my practice. I would really appreciate your thoughts/wisdom/suggestions here.
THJR - I have seen a few patients with complications following this procedure. For some of these patients it is a surgical issue, such as infection or implant failure. Those that fall into the category of physiotherapy management are: a) Sciatic nerve compromise, B) neurodynamic issues?, C) patients with muscle atrophy and weakness, or just slow to develop muscle mass (especially biceps femoris, vastus lateralis).
Strategies that I have been adopting for sciatic nerve compromise include:
* toe-up splint if affected hindpaw is knuckling
* sensory activation strategies: massage/stroking or flicking the skin surface to activate muscles and sensory receptors/touching the limb with different materials of varying sensations - to both the affected limb and paw
* proprioception activation strategies - electric toothbrush to affected paw as vibration to activate proprioceptors, walking over cavaletti to encourage joint proprioceptors, gentle hip joint compressions
* Laser: I have a SpectraVet laser Class 3B with both multi-probe and deep tissue probe. I have been applying laser at several points along the sciatic nerve tract in these patients and would be interested in your thoughts here in terms of points that you would choose, frequency of treatment. Often these patients are not referred to me until minimum 2 - 4 weeks post-operatively.
* Sciatic nerve excursion: I have been using sciatic nerve stretching where indicated (where hip flexion and combined stifle extension ROM is limited or resented). Normally I would recommend 5 - 10 reps pending on patient tolerance 2 x per day.
Patients with poor muscle activation, atrophy and weakness:
* NMES - often this is to biceps femoris and middle gluteals
* Kinesio-taping to activate muscles - although I do find this does not stay on so well with dogs
* Isometric contraction exercises
I am also wondering if there is a pain component that I am missing, and whether TENS would be a useful adjunct to some of those patients who appear to be poorly controlled with pain despite being on gabapentin +/- meloxicam.
Please advise if there is anything that I am missing.
Kindest Regards,
KG