Rehabilitation of intervertebral disc disease (IVDD)

Conservative management of intervertebral disc disease (IVDD)

There are many dogs diagnosed with intervertebral disc disease that do not require surgery. These dogs can be effectively managed with rehabilitation. Early intervention and support is vital, as is a thorough assessment and implementation of a staged rehabilitation treatment plan.

Physiotherapy aims

In the initial stage following diagnosis of IVDD the aims of physiotherapy will be to:

• Reduce inflammation
• Reduce pain and spasm
• Maintain soft tissues flexibility
• Improve core strength
• Stimulate sensory input
• Re-train postural responses

These above aims continue and progress with time depending on your dog’s progress. Aims will ultimately develop to include the following:

• Further strengthen core stability
• Facilitate effective gait
• Increase exercise tolerance and overall cardiovascular fitness
• Return to normal function

Physiotherapy options

Many different physiotherapeutic modalities can be employed when rehabilitating a dog undergoing conservative management of IVDD. Possible options might include – laser, or and cold therapy, massage, range of motion exercises and stretches, muscle stimulation, hydrotherapy, home exercise programme and advice re: injury prevention.

The following table is an example of a rehabilitation programme our chartered physiotherapists may use with your dog:* 

Timescale	Physiotherapy aims	Physiotherapy treatment options
0-4 weeks	Reduce inflammation	Electrotherapy – laser
	Reduce muscular guarding	Electrotherapy – laser Soft tissue massage Heat therapy
	Improve core stability	Home exercise programme
	Increase strength	Home exercise programme Neuromuscular electrical stimulation Hydrotherapy Underwater treadmill
	Increase sensation and awareness of body position	Home exercise programme
	Maintain soft tissue length and flexibility	Home exercise programme – passive movements and stretches
	Management at home	Exercise restriction Advice regarding flooring, Advice regarding walking with a mobility aid e.g. harness and sling if required
4-6 weeks	Continue as above	Progression of home exercise programme to challenge balance, body awareness and strength
		Advice on maintaining restricted exercise when dog is feeling better
6 – 12 weeks	Increase exercise tolerance	Increase exercise level
	Continue to increase core stability	Home exercise programme
12 weeks +	Return to full function	Progress to off-lead exercise and previous exercise level

Postoperative management of IVDD

Rehabilitation has a very important role to play during the recovery of a patient following surgery for intervertebral disc disease. Early intervention is crucial. The aims and treatment approach will vary depending on the level of disability your dog has and also the timescale following surgery. The key aims and treatment options are listed below. Your dog’s chartered physiotherapist will constantly re-evaluate progress and adjust the programme accordingly.

Physiotherapy aims

Initial phase postop:

• Reduce inflammation
• Reduce muscle spasm
• Maintain soft tissue flexibility
• Increase sensory awareness
• Increase strength
• Advise owners of home care management requirements

Weeks 4-6:

• Activate core muscles
• Progress with the above aim
• Improve balance and coordination
• Enhance gait patterns

Week 6 ongoing:

• Increase exercise tolerance and cardiovascular fitness
• Increase core stability and strength
• Return to normal function

Physiotherapy options

Similar physiotherapeutic modalities to conservative management of IVDD can be employed when rehabilitating a dog following surgery. Possible options might include – laser, hot and cold therapy, massage, range of motion exercises and stretches, muscle stimulation, hydrotherapy, home exercise programme and advice about injury prevention. The following table is an example of a rehabilitation programme our chartered physiotherapists may use with your dog.*

Timescale	Physiotherapy aims	Physiotherapy treatment options
1-2 weeks	Reduce inflammation	Electrotherapy – laser Ice massage
	Reduce muscular guarding	Electrotherapy – laser Soft tissue massage Heat therapy
	Maintain soft tissue length and flexibility	Exercise programme – passive movements, stretches, joint mobilisations
	Prevent bed sores (decubital ulcers) if recumbent	Regular position changes
	Increase sensation and awareness of body position	Exercise programme – proprioceptive stimulation
	Increase strength	Exercise programme Neuromuscular electrical stimulation Hydrotherapy Underwater treadmill
	Improve independence with postural sets	Exercise programme – lying, sitting, standing with support if required
	Improve core stability	Exercise programme – balance challenges, baited stretches
	Assist owner with management at home	A discharge appointment with a chartered physiotherapist will be arranged to explain about keeping your dog confined, assisting to walk and to demonstrate exercises to continue at home
2-4 weeks	Progress strengthening	Exercise programme Hydrotherapy Underwater treadmill
	Improve balance and co-ordination	Exercise programme – balance challenges, baited stretches
	Ensure correct movement patterning	Exercises to address any movement compensations
	Maintain full passive range of movement at all joints and soft tissue flexibility	Exercises and stretches
	Improve mobility	Gait re-education
4-6 weeks	Continue as above
6-12 weeks	Increase exercise tolerance	Exercise programme Circles Hills Hydrotherapy Underwater treadmill
12 weeks +	Return to previous exercise level	Advice re: progression of exercise aiming to off-lead advance strengthening and proprioceptive training specific to dog’s functional needs

*Please note that rehabilitation plans should only be followed under the guidance of a qualified rehabilitation professional, who will be able to provide a tailored plan based on the individual patient’s rehabilitation needs.

Hydrotherapy options

Hydrotherapy is invaluable when rehabilitating patients following surgery. The buoyancy of the water supports the patient against gravity and allows effective exercise to take place. The warmth of the water provides a source of relief for any discomfort present and the hydrostatic pressure assists in swelling reduction.