For Referring Vets and Physiotherapists
The following topics will provide vets and other animal professionals with information relating to Canine Hydrotherapy. The information will assist in all aspects of Canine Hydrotherapy but if you feel there is something missing then please do let NARCH know.
Referral for hydrotherapy
Registered Canine Hydrotherapists (RCHs) are required to obtain either a letter of referral, or a signed form giving permission to treat with hydrotherapy, from the animal's veterinary surgeon. No dog will receive hydrotherapy treatment without this.
Clients may contact hydrotherapy centres direct but in every case, even for a 'fitness' swim, they will be informed that their vet will be contacted for background information and to obtain permission for hydrotherapy treatment.
In cases where there are first opinion and referral vet(s) and/or physiotherapists involved in the animal's care, all parties will be contacted for clinical histories and reports. This is to ensure that the hydrotherapist has a complete picture of the animal's condition, behaviour, clinical history and any cautions or contraindications for hydrotherapy.
It will often be the veterinary physiotherapist who has referred for hydrotherapy and they will normally provide a summary report and plan for the hydrotherapist, listing cautions and the aims of treatment.
Why refer to a Registered Canine Hydrotherapist?
A Registered Canine Hydrotherapist (RCH) has fulfilled the NARCH training requirements for registration and must keep up to date by completing a further 20 hours of Continued Professional Development training each year.
RCHs are required to abide by the guidelines and rules set out in the 'Guide to Professional Conduct for Registered Canine Hydrotherapists' and must hold public liability and professional indemnity insurance.
An RCH will maintain client and professional confidentiality.
RCHs are listed on the NARCH website; it is possible to check their registration is valid and see their level of training and areas of competence or expertise.
NARCH has the highest training requirements for registration in the UK.
If a hydrotherapy centre is listed on this website you can be assured that all hydrotherapy treatment will be carried out or supervised (in the case of a trainee) by an RCH.
Benefits of hydrotherapy
Pain relief and improved function/ROM
- Decreased pain perception
- Relaxation of muscle tension and/or muscle spasm
- Reduction of oedema - either because of hydrostatic pressure or with increased limb movement in water
- Decreased inflammation
- Patient may be more compliant with 'hands on' treatment and PROM in water
- Possible feeling of well being due to release of endorphins and this may result in better mobility and a reduced medication requirement
Non or partial weight bearing exercise
- Non weight bearing environment in hydrotherapy pool
- Controlled weight bearing in underwater treadmill
- Potentially earlier return to normal function
- Support for weakened or spinal injury dogs in neutral spinal position - increased core stability gained with swimming, walking in underwater treadmill and dynamic standing exercises
Improved muscle mass and function
- Increased active range of motion - choice of hydrotherapy pool or underwater treadmill depending on which joints require increased flexion or extension
- Improved muscle patterning and recruitment
- Increased muscle bulk, strength and tone
- Prevention or reduction of muscle atrophy
Proprioception and gait retraining
- Increased sensory perception - from action of water and hands on with hydrotherapists
- Animal can be supported in standing by the buoyancy of water and the hydrotherapist - helping to gain confidence and enough time to make corrections without falling
- Dogs with neurological deficits benefit from hands on gait retraining - particularly in the underwater treadmill
Other benefits
- Reduction of frustration for dogs on cage rest or reduced/lead only exercise - less likely to be 'uncontrollable' on land
- Slowing of progression of degenerative disease processes - particularly useful for maintaining fitness and strength in Degenerative Myelopathy cases
- Improved quality of life for dogs with reduced mobility
- Prevention of secondary complications such as atrophy and contracture
- Improved cardiovascular fitness
- Reduction in obesity as part of a weight control plan
Conditions treated with hydrotherapy
- Orthopaedic
- Neurological
- Soft tissue injuries
- Degenerative and medical conditions
- Conditions related to age - developmental or geriatric
- Long term disability
These conditions can include but are not limited to:
- Osteoarthritis
- Hyperextension injuries
- Fractures
- Luxations and sub luxations
- Spinal injuries including recovery after surgery
- Neurological and proprioceptive deficits
- Spondylitis
- Spondylosis
Hind limb
- Hip dysplasia - lifelong management, pre and post operative total hip replacement
- Legge Calve Perthes disease - pre and post operative FHO, FHNE, etc
- Cruciate ligament rupture -conservative management
- Cruciate ligament rupture - post operative recovery hydrotherapy programs dependent on type of surgical repair
- Patella luxation - either conservative management or post operative
Forelimb
- Elbow dysplasia - management or post operative
- Shoulder injuries
Contraindications and cautions for hydrotherapy
It is important that you inform the hydrotherapist of any medical condition that may affect hydrotherapy treatment. Some medical conditions contraindicate hydrotherapy and others mean that hydrotherapy treatment should only be carried out with caution. However there may be some situations where the benefits of hydrotherapy can outweigh possible concerns.
The lists below are not exhaustive but are a useful guide.
Hydrotherapy Contraindications
- Open wounds
- Surface infections
- Contagious diseases
- Cardiac and respiratory dysfunctions
- Severe peripheral vascular disease
- Epilepsy - one or more fits in week preceding hydrotherapy
- Water phobia causing extreme panic reactions
- Vestibular syndrome
Hydrotherapy Cautions
- Incontinence
- Obesity
- Breeds with elongated soft palate
- Brachycephalic breeds
- Laryngeal paralysis and tie backs
- Decreased exercise tolerance
- Cushings/Addisons disease
- Diabetes
- Epilepsy
- Heart murmur or heart disease
- Spinal injury
- Extreme laxity of joints - hyperextension injuries
- Undiagnosed forelimb lameness - risk of worsening any cervical spine problem due to extension of neck
Pre-operative hydrotherapy
If surgery is planned, pre-operative hydrotherapy can provide a number of benefits.
- The dog has time to become familiar with, and confident in, a hydrotherapy situation before it undergoes the surgery. This is particularly important for dogs that have never swum or who may be fearful - learning to swim immediately post operatively is not ideal.
- RCHs have an opportunity to build up a positive relationship with client and dog so that the client feels confident of the care the dog will receive following surgery.
- Some veterinary surgeons use pre-operative hydrotherapy to improve strength and fitness to condition prior to surgery, helping to reduce recovery times post operatively.
Training for hydrotherapists
Hydrotherapy Principles
It is important to understand the basic principles and effects of immersion and movement in water. This gives a greater insight into how hydrotherapy treatment can be so effective for patients. The following is an extract from a 2002 document written by Christelle van Wyk, BSc Physiotherapy, PGDip Veterinary Physiotherapy and edited by Angela Griffiths CCRP, RCH.
Open document
Hydrotherapy Theory
- Relative Density (RD)
The RD of an object is the ratio of the weight of the object to the weight of an equal body of water. The density of various substances is defined by a pure number value called Specific Gravity (SG).
Implication: The RD and SG will determine how well an object (dog or cat) will float.
If the ratio of an object's SG to that of H2O is greater than 1 = object will sink
If the ration of an object's SG to that of H2O is less than 1 = object will float- Specific Gravity of H2O = 1
- Lean person SG = 1.10
- Obese person SG = 0.93
- Human body with air in lungs = 0.974 and 1.1 without air
- Fat lowers SG
- Dense bones increases SG
- Buoyancy and Gravity
There are 2 forces affecting a body immersed in water
a) Gravity
b) Buoyancy - upward thrust of water acting on body that creates and apparent decrease in body weight while submersed.
An immersed body with RD less than water will be assisted to the surface by buoyant forces.
Implication:- Buoyancy aids in the rehabilitation of weak muscles and painful joints.
- Joints can be unloaded as a result of the buoyant properties of water.
- Buoyancy counteracts weight, allowing ambulation when weight bearing is contraindicated.
- Water level can be adjusted to decrease weightlessness
- Can use floatation devises to increase resistance
- Hydrostatic Pressure (HP)
- Pressure is exerted by water on a immersed body
- The pressure is equal on all surfaces at rest at a given depth
- Greater depth = greater pressure
- Hydrostatic Pressure I = constant
- HP can be beneficial for swollen joints and oedematous tissue
- HP opposes the tendency of blood and oedema to pool in lower parts of the body (deeper depth = higher pressure)
- HP can aid in circulatory problems
- Patients with respiratory problems or heart conditions can be affected
Implication
The decrease in pain perception will allow the animal/human to perform a variety of movements with less pain. - Viscosity
Frictional resistance caused by cohesive forces between molecules of a liquid- H2O provides resistance that may strengthen K9 muscles and improve cardiovascular fitness
- Possible increase in sensory awareness
- Assist in stabilising an unstable joint/s
- Buoyancy and Viscosity prevents falling by increasing the time span for animal to react... more willing to move in water (especially spinal patients)
- Anti-swim jets/turbulence
- Resistance
To increase resistance- Increase velocity (encourage dog to swim faster)
- Increase surface area (Add floatation/ boot)
- Increase lever arm
- Surface Tension
Resistance to movement is slightly greater on the surface
Implication:
Therapeutically if the patient is weak movements may be performed more easily just beneath the water surface. Miniature breeds will be more affected by surface tension.
