Walking on Water: Veterinary Rehabilitation and the Underwater Treadmill

by Barbara Royal, DVM (2007)

Recently there have been exciting and promising improvements in treatments for patients needing veterinary rehabilitation.  These advances, especially the underwater treadmill (UWT) have been extremely useful for the greyhound.

While physical therapy  -acupuncture, chiropractic, electrostimulation, therapeutic ultrasound,massage, underwater treadmill, range-of motion, therapeutic and stretching exercises and thermal modalities -is  not a new concept, equipment and accessibility has opened up new possibilities.   I recommend all these therapies and have personally had great success using them.

I started using the UWT in 2001 at the Veterinary Specialty Center in Buffalo Grove.  I have come to rely on it so much that I installed one in my own clinic, The Royal Treatment Veterinary Spa in Chicago. I know that many owners believe that their pets walk on water, but at these facilities, they truly do.  Even animals unused to or disliking water do well in our pool.

The UWT chamber is the size of a wide single bed.  Dogs, cats, rabbits, ferrets or any animal walk into a dry chamber with the technician.  After the door is closed, the pool is then filled to the desired level.  Buoyancy is increased by raising the water level.  With increased buoyancy there is decreased weight-bearing load.  The water stabilizes the animal and, along with the technician, provides resistance to avoid falling.   Once the desired level is reached, the treadmill is slowly started.  Technicians and doctors work together to monitor progress and plan treatments.

Changing water levels, increasing or decreasing treadmill speed are basic to UWT therapy.  While in the pool, we help animals return to normal gait by physically moving the joints in the water and providing other physical therapy aids, like massage.  Owners stand by, with treats, actively encouraging the treatments. Most pets can’t wait to get into the pool the next time.

Due to the nature of racing, and the musculoskeletal configuration of our lanky friends, greyhounds require physical therapy to recover from injury, trauma or arthritis pains.  Often we are treating animals with serious or debilitating impairment who need help to regain essential motor functions. In addition, some animals must increase their fitness to prevent future injury.

The goals of physical therapy include: improving muscle strength and retarding atrophy, decreasing pain and inflammation, increasing rate of healing, remodelling scar tissue and stabilizing arthritic joints. We work closely with orthopaedic specialists, the regular veterinarian, and the owner  to develop treatment plans for pre- and post-operative patients, or patients trying to avoid surgery. Where surgical intervention is an option,  the post-operative rehabilitation can include UWT.   We  also use the UWT to help patients avoid surgeries. When surgery is not an option at all, veterinary physical therapy may be the best treatment.

Because of their sensitive constitution, greyhounds are often referred to my clinic for alternative treatments. They have a tendency toward specific musculoskeletal problems. Due to their history as racers and their physical configuration – an arched topline,  thin, long legs, deep chests and very little body fat, – greyhounds have a higher incidence of musculoskeletal injuries than most breeds. I treat many chronic conditions:   lamenesses, weakness (especially in rears), stumbling or mis-steps, shortened strides and difficulty in getting up. Decreasing their pain is a priority. Often they are not improving with medication, or medication is not tolerated well.  If further diagnostic, medical or surgical intervention is not warranted, we proceed with physical therapy.

Along with using UWT on our sporty but fragile greyhounds, it is best to incorporate a discussion about nutrition, supplements and herbal remedies in the rehabilitation plan. We even devise special harnessing or therapeutic clothing. With any problem, especially joint-related, an accurate diagnosis by a veterinarian is essential to rule out systemic illnesses that can also cause joint pain and weakness in a greyhound.  These can include tick-borne diseases, hypothyroid conditions, and bone cancers.  Once other causes are ruled out, treatment options can be properly assessed.

Bred for speed, the greyhound’s spine has terrific flexibility and permits them to tuck their rear leg and cover longer distances with each stride.   This can predispose them for spinal arthritis.  The geriatric greyhound may develop some degree of spinal inflammation or pain. There may be no obvious signs until something precipitates a stress on their back and spinal arthritis or a disk problem is diagnosed.  UWT  therapy can decrease pain and increase flexibility in many of these animals.

Sadly, many retired racers have traumatic injuries to their joints.  While some are subclinical injuries from the concussive forces of racing, others are more dramatic, and can be the reason for the career change from racing star to couch potato.   Although we often think of these injuries as racing-related, they can also happen to the retired racer just running around the yard.

Common injuries include:  accessory carpal fractures (wrist), metacarpal (metatarsal) fractures (long bone of foot), calcaneous/talus fractures (hock/ankle), central tarsal fractures (hock /ankle), 4th tarsal fractures (hock/ankle), P1-P2 instability (toes), P2-P3 instability (toes), P1, P2, or P3 fractures (more toes!)

We also see radial and/or ulnar fractures (forelimb) and sesamoid fractures (small bones of the feet) as well as sprains, avulsions, tendon and ligament tears in the greyhound.  With any of these injuries, even if they are healed, there can be arthritis, pain, or decreased function of the affected joint. They can all be ameliorated by physical rehabilitation and work in the UWT.

Problems can occur when a minor lameness causes a weight shift off the affected limb.  With decreased usage, muscles will start to atrophy, the spine can shift out of alignment to compensate for the change in gait and problems intensify.  Because of buoyancy in the water, exercise on the UWT can provide relief from the concussive force of gravity.  This allows a more complete range of motion for the joints/limbs involved. Better motion means increasing neuromuscular stimulation, better muscling, enhanced circulation, improved joint fluids, greater flexibility and strength and a return to normal function.

Although not born swimmers, greyhounds do surprisingly well on the UWT. Because they are deep-chested, they maximize bouyancy with pool depth. This is key to providing exercise while decreasing impact force on the joints. Their lack of fur makes evaluating and measuring gait easier and muscle atrophy and redevelopment more obvious. Their statuesque physiques show noticeable changes and treatment protocols can be tailored and tweaked as they recover.  Because their bodies are  honed for physical activity, greyhounds enjoy the challenge presented by the water and, naturally, the treats provided by our staff.

Rehabilitating a greyhound on land can be difficult.  If they do fall or knuckle over it is a long-leggy way down. Their skin, which has little padding, tears easily. They tend to prefer a quick sprint to the slow workouts needed for recovery. UWT provides a consistent and therapeutic workout without over- or under-taxing the patient, and, obviously, falling is not an option in the water-filled chamber.  Since greyhounds are exquisitely sensitive to temperature extremes – both cold and hot, we keep the temperature of the water between 85-90 degrees Fahrenheit for their comfort and safety.

The gentle cardiovascular workout on the UWT is great for greyhounds in most conditions. Studies have shown that subjects can walk at slower speeds in water while expending the same amount of energy (measured by oxygen consumption).  Blood pressures while exercising underwater remains lower while the heart rates increase so that the safety and efficacy of the aerobic exercise is improved.

One of my greyhound patients, a 14 year old sweetie named Amber, initially made me think twice about using the UWT . I had started treating her with acupuncture.  Her  chronic arthritis and muscle weakness was an issue.  But my chief concern was her history of laryngeal surgery. If she breathed in any water, it was a straight shot into her lungs. To make matters worse, when she walked she held her head down low.  Her weakness, opened larynx, and delicate age were all against her. But after conversations with her family, we decided pursue UWT.

We discovered  that if we pushed a bucket under the water in front of her head – holding just air in it – she could put her head into it. We were able to raise the  water level enough to give her proper buoyancy without her breathing it in. With gentle reminders not to tuck her rear legs under herself and float, she walked with the rears on the treadmill.  So we kept her head in the bucket, distracted enough to walk normally and buoyant enough to get a better range of motion on her painful joints. The treatment ended up requiring both her parents, my technician and me to make it work, but she was quite thrilled with the attention.

The results of UWT have been terrific.  Amber is  mobile and comfortable. She plays and uses stairs better and is noticeably stronger.  Her owners say she is doing activities that she hasn’t done in a long time.  Amber reminds me how willing the body is to heal itself if provided a conducive atmosphere and proper stimulation.

While advanced techniques and modern equipment  are tremendously effective, they are only a part of the process. There are many simple and effective things owners can do at home, or, ideally, start doing even before they get to a physical therapy facility.

Here are a few tips:

  • If arthritis is causing stumbling, gently squeeze the feet (firm handshake pressure) a few times a day.  This gives the neuromuscular network reminders about the location of the feet to help proper placement and mobility (conscious proprioception).
  • If muscles are weak, plan some short figure-8 patterns during walks. This will strengthen underused muscles.
  • If your pet is overweight, decrease their food and treats immediately.  Try to decrease on carbohydrates also.  Usually “diet” foods and treats aren’t necessary if you can just get them to eat less.  Try canned (low salt) green beans as treats.
  • Beware of dry sand which can be a bad hazard, especially for knees.  Unstable motions on sand can cause strains or tears of ligaments or tendons (especially cruciate ligaments).
  • Gentle, frequent, low impact exercise is best for arthritis.  Becoming more sedentary with arthritis causes a dangerous downward spiral.  Healthy joints need motion and proper weight bearing to remain healthy.
  • Arthritic joints may feel like they don’t want to move, but without movement, they will deteriorate, stabilizing muscles will atrophy, and function will be lost.
  • Although warmth may be helpful for arthritic patients, care must be taken not to overheat the greyhound. A warm washcloth in a plastic bag placed over an affected area can give some relief.
  • Heating pads and microwave heated compresses are not recommended because they can cause severe burns to delicate greyhound skin.

We  teach owners to provide specialized restorative exercises, massage, elecrostimulation, and diet changes for their pets.  Owners learn about the supplements and proper diet needed for their animal.  I strongly believe that diet is a very individual thing.  In order to decrease the weight on affected joints, don’t let them get overweight.  Supplements for healthy joint fluid and antioxidants are often essential, as are certain vitamins and herbs.

The modalities that I use for veterinary rehabilitation can provide a huge service for greyhound owners.  They can stay fit, recover from debilitating impairments and regain mobility using fewer medications.  We can help decrease the need for surgical intervention or help in post-operative recoveries.  Greyhounds are an amazing and wonderful breed that survive many set-backs. Greyhound owners tend to be among the most dedicated; they provide the extraordinary effort that has made the difference in these animals lives.  It is gratifying to be able join forces to give them a better chance at a long, active, happy and healthy life.

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