Acupuncture

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Acupuncture is the insertion of very fine needles at specific points in the body to create a physiological change.  Acupuncture has been used in human medicine for over 5,000 years, and in animals for over 3,000 years.  In the 1970's it was  brought to the United States where Americans quickly tried to disprove its' theories.  What they found surprised them...that acupuncture was a viable medical option for many medical conditions.  Among their findings was data that demonstrated that individual acupuncture points had thinner skin, a change in electrical resistance, increased mast cells (which release histamine and other chemicals), blood vessels and nerve endings directly under the points.  

When an acupuncture needle is inserted, there is a cascade of reactions in the body.  Some of the chemicals released caused muscle contraction (as if the muscle is "grabbing" the needle) directly around the needle.  If a needle is placed in a non-acupuncture point, no muscle contraction takes place.  The reaction in the body can be altered by the time that the needles are left in the body (the cascade of events is interrupted at different points).  Acupuncture in rehabilitation is used to relieve pain and muscle spasms, and to increase nerve regeneration and circulation.  The different types of acupuncture used at TOPS Vet Rehab include: 1) dry needle acupuncture ("normal" acupuncture); 2) aqua-puncture (injection of Vitamin B12 into the acupuncture points); 3) electro-acupuncture (a micro-current connected from one needle to another); 4) laser-acupuncture (for animals that cannot tolerate the needles); and 5) moxa-acupuncture (the burning of a Chinese Herb over the needles to heat the acupuncture point).  

Animal Chiropractic

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Animal chiropractic is a modality based on the biomechanics of the spine and nervous system, which is used to relieve chiropractic subluxations.  The characteristics of a chiropractic subluxation include:

• Loss of motion in the joints between the vertebrae

• Pain on pressure of the vertebrae
• Increased or decreased tone of the muscles surrounding the vertebrae
• May include changes in temperature, swelling or scar tissue

The goal of animal chiropractic is to restore normal joint motion with an "adjustment", and to aid in neurologic reprogramming.  Neurologic reprogramming can be thought of as an improvement of the message that one nerve sends to another.  A chiropractic adjustment involves a controlled, high velocity thrust over a specific joint, most commonly involving the joints between the vertebrae (backbones).   Depending upon the duration and severity of the subluxation pattern, a series of adjustments allows gradual restoration of the biomechanic and neurologic function.  Animal chiropractic is commonly thought of for back and neck pain, but is often quite useful for animals with an abnormal gait, which can be caused by a limb injury or pain (ie arthritis).  

At TOPS, we also may provide the chiropractic adjustments in the warm water of our therapy pool, which allows an adjustment to be made with decreased thrust and results in a more relaxed patient. 

Aquatic Bioelectric Therapy

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Aquatic Bioelectric Therapy is a new form of treatment combining the benefits of whirlpool therapy with the pain management benefits of electromedical horizontal therapy.  This represents an exciting new avenue for providing pain relief for a variety of conditions.  Since incorporating aquatic bioelectric therapy into our regimen, we've seen dramatic results as early as the first treatment. 

Good candidates for aquatic bioelectric therapy are those patients that:

   - Have an acute injury (sprains, strains)

   - Are recovering from orthopedic surgery (knees, hips, elbows, shoulders, etc.)

   - Osteoarthritis and rheumatoid arthritis

   - Any type of chronic pain

For more information on this therapy, check out the following websites:

    VetSystems, manufacturer of the WhirlpoolTx

    Hako-Med, manufacturer of the Hako-Med horizontal therapy delivery system

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Cryo and heat therapy is the use of cold and/or heat over an injured or healing area of the body. Following an injury there are two phases of inflammation:  1) phase 1 inflammation, the breakdown period, which usually lasts 48 - 72 hours;  and 2 ) phase 2 inflammation, the healing period.

Cryotherapy, the use of a moldable cool pack or a bag of cold peas:

• Decreases nerve conduction velocity (which decreases pain perception)
• Decreases the rate of cytokine release (which decreases inflammation)
• Causes vasoconstriction (decreased blood flow) followed by a rebound vasodilation (increased blood flow) 
• When used immediately after surgery or an injury, decreases bleeding at the surface and deep in the tissue.

Overall, cryotherapy is used to decrease pain and inflammation and speed healing. Cryotherapy is typically applied for 10 minutes, removed for 10 minutes, and then applied for 10 minutes for the first 72 hours post-surgery or injury (phase 1 inflammation).  

Heat therapy, the use of a moldable heat pack or warm, moist towels:

• Increases the collagen's (healing tissue) ability to stretch
• Increases blood flow
• Decreases pain 
• Increases enzyme activity (which speeds healing).
• Increases muscle contractility and stretching capability

Like cryotherapy, heat therapy overall is used to decrease pain and inflammation and speed healing.  The difference is that cryotherapy is used by itself during phase 1 inflammation, and heat therapy is typically used along with cryotherapy during phase 2 inflammation.  Heat therapy should be used no earlier than 72 hours post-surgery or injury.  When cryotherapy and heat therapy are applied together, they are typically done as follows:  cryotherapy for 10 minutes; heat therapy for 10 minutes; cryotherapy for 10 minutes.  This sequence is repeated up to 3 times daily.

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Electromedical Horizontal Therapy is described as being the cutting edge of pain management.  The electromedical horizontal therapy is delivered by a machine called the Hako-Med.  The Hako-Med delivery system can either be used as a standalone form of treatment or in conjunction with the Whirlpool TX.  For injuries affecting a small number of joints needing directed treatment to those joints, the Hako-Med is most effective used in a standalone fashion.  For generalized conditions, such as pain throughout the body, the Hako-Med is used as the delivery agent to the Whirlpool Tx to provide a therapy called aquatic bioelectric therapy.  Just like the aquatic bioelectric therapy, the Hako-Med therapy is used to treat:

   - Acute injuries (sprains, strains)

   - Joints post-surgically (knees, hips, elbows, shoulders, etc.)

   - Osteoarthritis and rheumatoid arthritis

   - Any type of chronic pain that is localized rather than generalized

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At TOPS Vet Rehab, exercises are an important part of the rehabilitation services we provide.  An exercise may be as simple as doing passive-range-of-motion (PROM) to improve or maintain a joint's flexibility, to ambulation exercises to retrain an animal to walk. Exercises are often devised specifically for each individual patient, so it is difficult to explain all the exercises we may prescribe for a patient. Here are some general types of exercise that we perform at TOPS:

• Passive range of motion (PROM) exercises increase nutrition availability at the joint cartilage, stimulate new cartilage production, and is used to increase range of motion at the joint.
• Stretching exercises increase circulation and muscle flexibility.
• Proprioceptive exercises are exercises used to help the animal know where their feet are in space.
• Strengthening exercises (stairs, land treadmill, hydro-treadmill, sit/stands, etc.) are used to strengthen individual muscles or muscle groups.
• Weight shifting exercises are exercises used to help the animal shift their weight to the affected limb or side to make the animal walk more balanced.
• Ambulation exercises are exercises used to reeducate a paretic animal (severe loss of function of  their limbs) how to walk.  

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Hydro-treadmill therapy in veterinary rehabilitation is the use of an underwater treadmill for strengthening and re-education of the dog's limbs.  Hydro-treadmill therapy was originally developed for rehabilitating race horses in the 1970's.  Until the mid-80's, this treatment option was limited to horses.  In the mid-80's the hydro-treadmill became available for human patients.  In 1998, TOPS Vet Rehab introduced the world to the use of the hydro-treadmill for canine rehabilitation, thus providing a new rehabilitation tool for canine patients.  Hydro-treadmill therapy provides the ability to strengthen the patient's muscles in an environment of little to no pressure on the joints, due to the buoyancy of the water. When placed in a warm water environment, it also increases flexibility, mobility, and contractility of the muscles, as well as circulation.  The benefits of the hydro-treadmill include:  

• Earlier return to exercise post-surgically
• Strengthening of the muscles surrounding painful joints in arthritic patients
• Weight-loss.  

Importantly, it is frequently observed that an animal not using a limb on land will use it in the water.  When the patient walks on the hydro-treadmill, they tend to move their limbs using an exaggerated range of motion, providing additional therapeutic benefits.  An important additional benefit of this treatment method versus traditional hydrotherapy, is that the variables (speed, resistance, and depth) can be controlled which allows for a consistently progressive therapy plan.  It also allows the therapists to introduce the patient to the water in a slow, controlled manner, alleviating fear which helps the patient relax, and consequently improves the results of the therapy session.   Finally, the hydro-treadmill allows us to combine other rehabilitation therapies (ie passive range of motion, massage, chiropractic) with the therapeutic benefits of the water.  At TOPS Vet Rehab, our hydro-treadmill is submerged in a pool, which allows us to add whirlpool jets, which provide resistance during exercise and massage following exercise.  

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Like our hydro-treadmill therapy, we also use a specially developed canine land treadmill to increase strength, balance and coordination.  This form of therapy, while used less often than our hydro-treadmill therapy, has advantages in some situations:

• Stimulation of bone growth and strengthening
• Ability to vary rate of incline and decline, thereby concentrating the effort to specific muscle groups
• More beneficial at certain stages of post-joint surgery rehabilitation (ie cruciates, hips, elbows)

One of the limitations of the land treadmill is that there is no ability to reduce pressure on the joints as there is with the hydro-treadmill therapy. Therefore, hydro-treadmill therapy is used primarily for patients with joint pain, whereas land treadmill therapy is used primarily for strengthening in the absence of pain, or reeducation of balance.   

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The  Medlight device uses LED lights to generate infrared energy in the form of low level, narrow band light.   We know it sounds complicated, but the bottom line is that we use the Medlight for pain management and wound healing.  This former NASA technology was recently released for public use, and is gaining wide acceptance in the medical community as an alternative / supplement to other pain management and wound healing techniques.  At TOPS, we can either deliver the treatment right at the clinic, or you can lease the equipment from us and deliver the treatment in the comfort of your home. 

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The type of massage we perform at TOPS would most commonly be described as therapeutic massage.  The benefits of therapeutic massage for our patients mirrors those benefits people receive: 

• Improved circulation
• Reduction in muscle knots and spasms
• Reduction in anxiety and stress
• Improved relaxation and sleep
• Reduction of pain

By doing each of the above, the patients are put in a position to gain the most from the other forms of therapy they are receiving.  For example, if the patient needs improved range of motion in a joint through passive range of motion exercises, the relaxation, reduction in pain, and reduction in anxiety will enhance the effect of the exercises.  For this reason, massage is usually used in conjunction with other therapies we perform at TOPS.  To further improve the benefits of the massage for those patients receiving hydro-treadmill therapy, the massage is performed in our therapy pool, aided by the warm water and massage jets. 

Neuromuscular Electrical Stimulation

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Neuromuscular electrical stimulation (NMES) is the application of a low level electrical current which results in a muscle contraction.   This is achieved by placing electrodes at the beginning and end of the muscle.  These muscle contractions can be used to mimic strength training for animals that are non-weight bearing or have limited use of a muscle or muscle group.  NMES is used to prevent atrophy post surgery or injury, or to increase strength for muscles that have been chronically underutilized.  NMES is commonly used in paretic dogs or dogs post surgically before they are weight bearing and during reeducation of ambulation.

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One of the unique treatment options we provide at TOPS Vet Rehab is Pulsed Signal Therapy (PST).  Pulsed Signal therapy is a new therapy that has been used extensively in Europe for the treatment of osteoarthritis, rheumatoid arthritis, tendon and ligament injuries, etc.  This treatment has been used in Europe for over 20 years with over 100,000 patients.  The manufacturer of the Pulsed Signal Therapy machine, BioMagnetics Therapy Systems (www.pstvet.com), is currently pursuing FDA approval for human use, and as such, current use is limited to animals.  

The PST treatment requires 9 consecutive treatments, which can be administered once or twice per day.  TOPS has two PST options:  1) stationary unit located at TOPS; and 2) portable unit for take home use.  There are only small differences between both units.  Most importantly, both provide the same clinical efficacy.  The stationary unit is somewhat easier to administer for the client, while the portable unit is slightly more difficult to use but comes with the benefits of being able to administer the 9 treatments from home.

For background on the principles of PST, it is believed that there is an electrical field around each joint that plays an important part in the continual regeneration of cartilage and connective tissue. If osteoarthritis or inflammatory joint disorders are present, there is a disturbance in this electrical field.  PST allows reconstruction of the disturbed electrical field, which returns the natural regeneration capabilities and reactivates the cartilage and connective tissue to increase production of proteoglycans and collagen (the building blocks of cartilage) to aid in repairing the cartilage defects.  PST does this by pulsing an electro magnetic field  to the treatment area.  To get technical, this will simulate pressure on the joints, which will pull hydrogen atoms out of the cartilage surface, stimulating cartilage regeneration and cartilage cell reproduction.  This phenomenon is known as streaming.  

In human clinical trials there was a significant improvement of pain and "performing" activities of daily living" in greater than 85% of treated patients.   There are also currently double-blind studies in the US which have recently been completed in canine patients and are in the process of being tabulated.  TOPS Vet Rehab is currently conducting a clinical trial for BMTS to explore additional treatment options beyond medications and traditional treatment options for arthritis, cruciate injuries, tendonitis, etc.  

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Therapeutic ultrasound is the use of sound waves which are passed through tissue creating certain physiological effects.  Though the handheld probe looks similar to a diagnostic ultrasound probe (ie the ones doctors use to see a fetus) this unit operates at a different frequency and does not receive information back like the diagnostic ultrasound.   Therapeutic ultrasound used together with medication is termed phonophoresis.  Phonophoresis delivers the medication through the skin, which allows the delivery at the local level, reducing side affects related to oral or injectable delivery.  The uses of therapeutic ultrasound include:

• Increasing circulation
• Increasing contractility of muscle fibers (to increase range of motion)
• Decreasing scar tissue 
• Decreasing pain and muscle spasm
• Decreasing inflammation
• Accelerating wound healing

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