Dr Van Dyke is an accomplished surgeon. But, she is cutting less these days. Why is that? Dr Van Dyke is revolutionising the way we examine and treat our patients, both in the acute injury phase and over the longer term through the burgeoning field of Canine Rehabilitation. By dipping your toe into the field of canine rehabilitation, you too can offer your patients so much more than just rest and NSAIDs. We are certain that you will learn from her advice and experience and are excited to share our interview with Dr Van Dyke from the Canine Rehabilitation Institute with you today.
How do you define canine rehabilitation?
Canine rehabilitation is defined by the American Association of Rehabilitation Veterinarians (www.rehabvets.org) as the treatment of injury or illness to decrease pain and restore function. I personally define it as the application of the art and science of human physical therapy applied to our canine patients.
What are the core modalities involved?
Manual therapy and manual diagnostic techniques are really the core skills that allow the physio to diagnose and treat soft tissue impairments often missed by the practicing veterinarian (or human orthopedic surgeon for that matter!).
Do you have a favourite?
Joint mobilizations, addressing the arthorkinematics of each joint, are my favorite as they clearly show the attention that the physio pays to the minute details of anatomy while problem solving for the patient.
How did you come to be involved in this field?
I did surgery for a number of years and had several clients who were physios. When I would discharge my patients to these owners, I would give them the standard ‘post-operative care’ instructions. The physios would often ask me why vets didn’t use other techniques. So, I started to query them on what they would do if this were a child recovering from the same surgery. This lead to my changing my post-operative guidelines, then to changing my actual surgical approaches, then to adding pre-hab for my planned surgeries. I learned more each year, and started to attend human physio CPD courses so that I could become more skilled. Finally, I realized that my colleagues should learn the same, so I gathered the best possible faculty to help me to provide a great training program.
What do you love about your role?
I love seeing my colleagues: veterinarians, veterinary nurses, and physics, light up when they gain a new skill and can demonstrate it to our faculty. Recognizing that they can now help patients who in the past might be treated with just NSAID’s and rest, that they can offer their clients better options! This is a wonderful moment to witness and we get to witness it month after month after month!
How has the field changed over time?
Canine rehabilitation is a relatively new field globally. Equine rehabilitation started in the 1960’s, but canine was slow to follow. The primary growth of the field started ~2000. We have watched a change from the early days when the veterinary market was told that the key to success was in buying equipment, especially lasers and underwater treadmill. As more physios have become involved with veterinary rehabilitation, the emphasis has moved more toward manual therapy, realizing that the physical modalities, such as laser and e-stim, can still be quite beneficial, but not until a proper physiotherapeutic diagnosis has been reached and a valid treatment plan put into place. Increasingly in the U.S. and Europe we see the move toward collaboration between veterinary and physiotherapy professionals…working together to maximize the benefits for our patients.
What are some common misconceptions about canine rehabilitation out there in the profession?
Many practice owners believe that if they purchase equipment and advertise rehabilitation services, they can put a veterinary nurse in charge of this service and be successful. Unfortunately, 90% of the benefit of rehabilitation comes from a proper soft tissue impairment assessment, something that only a trained vet or physio can (and should) do. Once the proper assessment is completed, the same trained vet or physio must create a plan of care. This is when the vet nurse, trained in canine rehabilitation, is brought in to do the time-consuming hands-on work with the patients, freeing up the vet and the physio to see more patients.
Vets are often taught, ‘a chance to cut is a chance to cure’. Do you agree?
No! My training and experience in canine rehabilitation convinced me that we could provide much better care for our patients by thoughtfully addressing their problems, especially their soft tissue (joint capsule, muscle, tendon, ligament and fascia) concerns. By pinpointing the actual issues confronting the patient, arriving at a diagnosis that addresses all of the issues (not just the bone and joint), and creating a problem-solving approach to the plan of care, we can reduce much of our surgical pathology and result in stronger, healthier, happier patients (and clients).
In light of this, as a highly trained and skilled surgeon, who also pioneers the canine rehabilitation field, do you find that you are now ‘cutting’ less? If so, why is that?
We can offer far better diagnostics, come up with more comprehensive diagnoses, address the specific impairments, and often offer less aggressive surgical techniques. By then doing post-operative rehabilitation, we can have patients who are stronger and more capable of returning to peak performance. This results in far greater client satisfaction, which is good for the practice’s bottom line.
What do vets need to learn that we haven’t been taught?
We need to help our veterinary professionals see the importance of reviewing soft tissue anatomy, especially muscle origins, insertions and actions. So often, these get ignored, focusing instead on what we can see clearly on radiographs. So many lamenesses are the result of soft tissue impairments that are difficult or impossible to see on radiographs. By having a well-trained set of hands that can better palpate these patients, the veterinarian can tease out the source of the lameness and treat the specific problem rather than resorting to rest and NSAID’s.
What should be doing for patients that are on NSAIDs indefinitely?
NSAID’s are not the ‘bad guys’ unless used indiscriminately. We have many rehabilitation patients who continue to use NSAID’s, however, we can generally reduce the dose and frequency of delivery by using rehabilitation techniques to address both pain and weakness that leads to pain.
What about before and after surgical intervention?
The use of ‘Pre-Hab’ before surgery is commonplace in human orthopedic practice, and we are increasingly using this for our veterinary patients. This allows us to better control swelling, pain, and weakness prior to the procedure and creates a less fearful situation for the post-operative canine patient as they are now familiar with the rehabilitation setting and equipment. Patients actually look forward to visiting with their therapists as they know offer cookies for doing the right thing!
What advice would you have for vets who are interested in working in the field of canine rehabilitation?
There are many opportunities for veterinary professionals to become trained in canine rehabilitation. VetPrac offers courses provided by the Canine Rehabilitation Institute from the U.S. These courses include some distance learning (online video presentations) as well as classroom sessions in which students are given ample opportunity to practice new skills on live volunteer dogs. Class sizes are limited so that each student has sufficient time with multiple instructors to gain all of the requisite skills. The textbook, Canine Sports Medicine and Rehabilitation (Zink and Van Dyke, eds.) is available through Wiley Publishers. Many national and international conferences include lecture and lab tracks on canine sports medicine and rehabilitation. No excuses! ☺
For more information about VetPrac’s collaboration with Dr Van Dyke and the Canine Rehabilitation Institute, click here.