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5

The Rehabilitation Examination

Sasha Foster

James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO, USA

5.1 Introduction

Canine rehabilitation modifies human physical therapy evaluation and treatment techniques
into the canine model with the goal of improving functional outcomes for patients. Mobility
depends on the health and quality of many tissues, from the deepest part of the joint, the articu-
lar cartilage, to the superficial muscles, fascia, and skin. When tissues are injured, these attrib -
utes deteriorate which may produce painful and abnormal function. For example, if cartilage is
no longer smooth and pliable, joint surface movement becomes restricted; this in turn may
shorten the joint capsule, leading to secondary tightening of muscles, which may then cause
weakness and atrophy. What rehabilitation brings to the lameness exam is the ability to clini-
cally differentiate which tissues (e.g. joint, muscle, ligament, and fascia), based on their normal
and abnormal attributes, may be contributing to lameness. The evaluation techniques used to
clinically differentiate these tissues are subjective, manual evaluation techniques consisting of
(i) passive range of motion (PROM), (ii) joint play, (iii) flexibility testing, (iv) strength testing,
and (v) special tests (Box 5.1). The latter entail specific maneuvers that evaluate a specific condi-
tion (such as cranial drawer for cruciate ligament instability). This chapter will focus on the first
four components of the rehabilitation exam (please refer Chapters 12–22 for special tests regard-
ing individual regions).
When completing manual therapy evaluations, the available scientific evidence needs to be con-
sidered before determining a diagnosis and establishing a treatment plan. Only few canine studies
exist to support the use of manual evaluation techniques, such as PROM and limb circumference
evaluation (Millis and Ciuperca 2015). Even studies in people (who have the capacity to communi-
cate pain to an evaluator) show that the reliability of manual evaluation techniques is variable
(May et al. 2010). Yet, results of manual therapy evaluation can be useful to the evaluator to develop
and further define a differential diagnosis list, particularly regarding muscle injuries. Nonetheless,
the systematic application of established diagnostics such as radiographs, ultrasound, CT, and MRI

Canine Lameness, First Edition. Edited by Felix Michael Duerr.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/duerr/lameness