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These exercises can be carefully extended to involve the dog walking alongside a low kerb and with gentle encouragement to step slowly sideways onto the raised surface. This must only be attempted when the dog is confident about stepping over poles laid on the ground.

Stretching

There is much discussion and literature about canine remedial stretching exercises. This is an area that needs careful and precise knowledge, and should not be performed in the general physical therapy arena. Some of the stretches used, in the hands of the untrained, are potentially hazardous to the dog’s health. This is because it is possible to manipulate a dog’s joint beyond its natural range or mobility, unlike that of a person or horse, whose personal strength and reflex reaction will outmanoeuvre those of the stretcher. This is not to say that stretching is not an important part of physical therapy and massage; it is, and the uses within remedial care are manifold. But it should only be performed by someone with excellent anatomical and physiological knowledge, and it should have correct directional application.

Passive movement

Passive movement is different from a stretch because it is a movement that is taken up to its natural ‘end feel’. If the joint is compromised in some way, the same applies. Passive movement is a highly influential technique and one that is not discussed as much as stretching, possibly because of the simple reason that the name does not conjure up a meaning symbolic of dramatic change as that of a ‘stretch’. To integrate passive movement exercise will assist with mobilization from a physical and neurological perspective:

•Physical benefit: passive movement involves managing the balance of muscle and scar tissue. Scar tissue can

be the most effective method

of maintaining mobility, especially in the case of femoral head and neck excision, where the femur is secured in place by the post-operative scar tissue. This has to be managed so that it can facilitate as close to full range of the limb as possible, and yet maintains stability. During this process, the hip flexor and/or extensors will develop areas of tension within normal muscle tissue; therefore, these two must be balanced and treated accordingly.

•Neurological benefit: it can also assist the re-establishment of neural pathways and influence the Golgi tendon receptors (see Chapter 2) to accept an improved range of movement by relaxing the antagonist; this also reduces the pain cycle.

For the recumbent dog, or one with limited mobility, it is best to perform passive movement with the dog lying on its side. This is important, as if it were standing, to lift one leg of its already unbalanced body could cause it to fall. Flexion and extension movements are the same as in Chapter 6, but with the dog on its side (122, 123).

•Passive movement must not be executed by an open wound, on a freshly injured site, on any swollen joint, or to a locked joint.

•The dog must be comfortable and stable – either standing or lying.

•All the moving limbs must be supported above and below the joints.

•It is very important that the joints and tissues have been sufficiently prewarmed by effleurage.

•Passive movement involves taking the joint through its natural anatomical range of movement – it is not a stretch.

•The passive movement should be conducted slowly so that all the tissues involved have time to adjust without any sudden or erratic

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122 Extension of the thoracic limb.

movement; if a joint is moved quickly, damage to the muscle and joint can be inflicted.

•The joint should be held in position (flexed or extended) for at least

15 seconds.

•After every movement, the limb is taken back to a neutral point and held there before the next one.

•Usually three passive moves for each joint are sufficient.

•After passive movement exercises, effleurage or light exercise is used to re-adjust joints and tissues.

Passive movement can also be applied to the neck region. Muscular neck problems in dogs can go unnoticed and, as previously mentioned, a good indicator of a problem can be that of a dry nose. Before any neck movement is attempted, there must be utmost care to ensure that there are no underlying serious neck conditions, such as any spinal damage or disease. This must be checked by a veterinary surgeon.

Extension and flexion of the neck can aid mobility and gently assist the

123 Extension of the pelvic limb.

realignment of muscles if it is done along with deep tissue treatments. When performing these exercises be aware that even though they appear to be specific for the neck, they also engage the shoulders and back. Thus, if a dog has back or shoulder problems, these ‘neck’ exercises can potentially impact on these areas. For this reason, these exercises must be performed sympathetically and with recognition that any restriction could mean a further issue distal to the neck. If at any time a dog is highly resistant to these exercises the dog should be referred for veterinary investigation. Any exercise that involves neck movement must be performed with the greatest care and attention to the individual dog’s limits.

An effective neck exercise involves the dog sitting facing the handler, with the neck and head in a forward position in line with the dog’s horizontal plane. (This must be especially encouraged in small breeds as the dog is inclined to look up at the handler, drawing the neck into the shoulders.)

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•The handler takes approximately four steps backwards with the dog continuing to sit and look directly at the handler. The dog should be sitting as squarely as possible, with their tail directly behind them (124).

•The handler then walks in an arc clockwise, from ‘half past’ to ‘twenty to’, holding the dog’s gaze for 10–15 seconds (125). If the dog cannot hold the gaze, or shuffles its feet, the handler moves back to where the dog can comfortably hold the position and resumes timing.

•The handler then returns to the starting position in front of the dog, again encouraging the dog to extend the neck forwards away from the shoulders.

•The exercise is then repeated, but walking to the ‘twenty past’ position, and is conducted as before (126).

The dog’s head should be moving on the horizontal the first time; the exercise can then be repeated with the dog slightly angling its head up and down, but should always be encouraged to extend the neck. In this way, different muscles of the neck and shoulder will be mobilized and softly stretched by the dog.This exercise is highly effective for any dog with neck issues and for general maintenance of range and function. As it involves no intervention from the handler, the dog will only take the extension or flexion to their own range.

To encourage good extension, hyperextension and flexion exercises (head moving up and down) the following exercise should be conducted, starting with the dog in the same position as in the previous exercise.

•The handler stands approximately two strides back from the dog.

•Holding their hand on the horizontal to dog’s head, the handler encourages the dog to elongate their neck and hold this position for 10–15 seconds.

124–126 Flexion and extension of the neck. With kind permission of Galen Natural Progression ©.

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•The dog is then allowed to relax, but still encouraging a gentle elongation the handler starts moving their hand in the shape of an arc or through a clock face dimension, starting at ‘quarter past’ (in line with the dog’s nose), slowly lifting their hand upwards and forwards towards ‘12 o’clock’ but stopping just before (‘five minutes to the hour’).

•The position is held for 10–15 seconds if the dog is comfortable and not shuffling or tilting his head to one side or the other.

•The handler’s hand is drawn down encouraging the dog to watch, and stops at ‘quarter past’ (the start point), again encouraging the dog to elongate their neck.

•The handler’s hand moves down towards the floor, again following the line of an arc or clock face, stopping just before’ half past’.

•This position is held for 10–15 seconds – remember this will encourage a deep stretch through the caudal border of the shoulders and into the thoracic region.

•The exercise finishes by resuming the start position.

This soft exercise could be repeated once a day in acute and chronic cases. If the dog shuffles his feet, licks his lips, or starts to look away, it could be the handler is asking too much movement for the dog’s comfort, so the exercise should demand less movement.

Balance cushion

This form of exercise can be extremely beneficial if applied correctly, after the appropriate therapy. However, the author does not promote the use of many other types of balance apparatus intended for human use, e.g. the Swiss ball. This balance cushion (127) allows the dog to demonstrate discomfort easily, giving clear indications of pain that would contraindicate its continued use. The use

of the balance cushion for conditions involving pelvic and shoulder instability is highly effective, if used at the correct time. For optimum gain, the dog should only receive treatment which is appropriate to the cushion. Conditions like hip dysplasia can respond positively to this, but only in conjunction with professional therapy.

The aim of this form of therapy is the stimulation of the deep postural muscles of the pelvic or shoulder region. These muscles, in the course of normal movement, may not be neurologically stimulated and, therefore, not involved within movement patterns. To stimulate these using a balance cushion can help to develop good core and postural balance.

127 A dog standing with the pelvic limbs on a balance cushion.