Dr Sue Ramoo BVSc (hons) MANZCVS (internal medicine)
Bio: Dr Montana Mays - B.V.Sc, CCRP, MANZCVS (Veterinary Sports Medicine & Rehabilitation - Canine), PgCert (VBM)
Dr. Montana grew up in rural NSW and knew from the age of 4 that she wanted to be a vet. She graduated from the University of Sydney in 2015 and worked in general practice for a few years before moving to the UK to locum. After completing further studies in veterinary rehabilitation (Certified Canine Rehabilitation Practitioner through the University of Tennessee), she returned to Australia and opened her own veterinary rehabilitation clinic, Animal Wellness & Performance.
Pawsitive Progress: Exploring Canine Rehabilitation with Dr. Montana Mays
What inspired you to specialise in dog rehabilitation, and how has your journey in veterinary science evolved over the years?
I worked in general mixed practice for several years - both in Aus and the UK - however, outside of work, my hobby was competing in canine agility with my dogs. I did a lot of fitness and conditioning work with them and wanted a way to tie my job in with what I loved doing. So I then studied my CCRP through the University of Tennessee and moved home to bring rehabilitation back to the Australian vet industry - it was much bigger in the UK & US at that stage than in Australia.
Could you explain the fundamental principles behind canine rehabilitation and how it differs from traditional veterinary care and osteopathy?
Canine Rehabilitation is the general term that covers all aspects of therapy related to an animal’s mobility. This includes physical therapies such as massage & osteopathy, equipment-based therapies (laser, shockwave, ultrasound, TENS, underwater treadmill), and exercise prescription (e.g., balance exercises, strength exercises, proprioception, etc.). It’s about a holistic approach to improving our animal’s quality of life and returning their musculoskeletal (or neurological) system to optimal function. We are essentially physiotherapists for animals.
What are some common conditions or procedures that are seen in general practice that may benefit from rehabilitation therapy, and why is early intervention important?
- Post-orthopaedic surgery - TPLO, MLP, hemilaminectomy, fracture repair
- Non surgical management of hereditary conditions - e.g., elbow & hip dysplasia
- Soft tissue injury recovery and prevention
- Neurological conditions - intervertebral disc disease, geriatric vestibular disease, degenerative myelopathy
- Old dog management - arthritis
The list goes on. Early intervention is crucial as maintaining as much function as possible gives a much better outcome than trying to completely reteach a movement after it is completely lost. When it comes to early intervention, it’s hard to give an exact time because of the range of conditions we treat, but if you apply the approach as soon as possible, then you’re off to a great start. For a hereditary condition, it should be referred as soon as it is diagnosed. For a surgical case, the rehab can start within a few hours in the form of icing, pain management, and passive range of motion exercises. So if you refer an animal at the earliest notice, you are always improving the outcome, even if it just starts with client education and then start the physical therapy aspects a few weeks later.
What are the top 5 cases most commonly referred for canine rehabilitation? What should a GP vet expect when cases are referred?
- TPLO (or other cruciate repair surgeries)
- Hip dysplasia
- IVDD
- Arthritis
- Obesity
Typically, a patient’s regular vet will refer them to us. We perform an initial assessment and treatment plan, and a copy of this is sent back to the vet. Often we then manage the treatment plan as the therapies are quite specific; however, if the regular vet is equipped to manage the case at their clinic once we have done the assessment then the GP may also be responsible for managing the treatment. It really depends on the case. Rehabilitation cases are normally long-term, so we provide updates to their regular vet at appropriate intervals.
Can you discuss some common techniques that GP clinics can implement for canine rehabilitation?
Basic rehabilitation therapies such as cryotherapy, laser therapy, massage and balance/proprioceptive exercises can all be performed in GP clinics. There are plenty of courses available in these fields and most rehab practitioners in Australia are happy to provide guidance on these. There have been various studies into the benefits of rehabilitation and some recent ones include:
- Cryotherapy decreases signs of pain, swelling and lameness and increases stifle joint range of motion in dogs during the first 24 hours after TPLO (1)
- NMES has been shown to improve cross-sectional morphology of muscle fibres throughout 90 days of immobilisation as well as 30 days after the removal of the immobilisation (2)
- TENS has also been investigated for treatment of osteoarthritic stifle pain and was shown to improve ground reaction forces in treated dogs (3).
Can you explain the importance of client education in the success of canine rehabilitation programs, and how do you empower owners to actively participate in their pet's recovery?
Client education and involvement are hugely important to rehab success. We recommend them home exercises to do with their pets, as well as provide guidance on home management (e.g., crate confinement, sling walking, restricted off-lead exercise, etc.). These aspects are almost more important than what we do in consultation with their pet, so a big portion of time is allocated to making sure pet owners understand. We then send them home with handouts so they have information on hand all the time.
How do you assess the progress of a dog undergoing rehabilitation, and what benchmarks do you use to measure success?
It really depends on the case as we treat such a wide range of conditions. The overall goal of rehabilitation is to gain optimal functionality. This may not mean ‘normal’ mobility as the end goal (as for some conditions that simply isn’t possible) but we want the pets to be able to use their bodies optimally and in the most pain-free way possible. We have various measurements that we can take to quantify this progress as well as tests like gait analysis that we perform throughout their recovery.
What advice do you have for GP clinics who may be interested in incorporating rehabilitation techniques into their practice?
The basics of rehab are really easy to implement without any major investments needed. Things like icing a dog’s leg post-TPLO are easy to do without any cost whatsoever. Also the client education aspect is straight-forward with a few handouts and follow-up appointments. There are various canine massage courses available within Australia and there is an online course available from the University of Tennessee, so it is easy to study in your own time.
Looking ahead, what do you see as the future trends or developments in canine rehabilitation, and how do you envision its role evolving within the veterinary field?
Veterinary rehabilitation and sports medicine are huge in the UK and the USA and Australia is just catching up. This means really exciting times ahead in Australia as the industry continues to grow and as general practice vets / specialist surgeons begin to see, first-hand, the benefits of structured rehabilitation programs. It’s all about education and those of us qualified in the field are always happy to help anyone interested in investigating our field further.
References:
Drygas KA, McClure SR, Goring RL, et al. Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc. 2011;238:1284–1291.
Pelizzari C, Mazzanti A, Raiser AG, et al. Medium frequency neuromuscular electrical stimulation (Russian) in dogs with induced muscle atrophy. Ciênc Rural. 2008;38:736–742.
Johnston KD, Levine D, Price MN, et al. The effect of tens on osteoarthritic pain in the stifle of dogs. Proc 2nd International Symposium on Physical Therapy and Rehabilitation in Veterinary Medicine; 2002; Knoxville, TN.
