Physiotherapy and Hydrotherapy for intervertebral disc disease (IVDD)

Intervertebral discs are fibrocartilaginous cushions between the that allow movement, are supportive and act as shock absorbers. They consist of a fibrous outer rim, the annulus fibrosis, and a jelly like centre, the nucleus pulposus. Intervertebral disc degeneration results in reduced shock-absorption, and can ultimately lead to disc herniation and spinal cord compression.  

What causes intervertebral disc disease and are there certain breeds at risk?

Intervertebral disc disease (IVDD) is an age-related, degenerative condition but some breeds can suffer disc problems from when they are young adult dogs. Disc degeneration is thought to occur because of loss of the disc to “hold water” becoming dehydrated. Discs can also herniate through trauma to the spine. 

Conservative management of IVDD

Not every dog that is diagnosed with intervertebral disc disease will require surgery. These dogs can be effectively managed with rehabilitation. Early intervention and support is important, as is a thorough assessment and implementation of a staged rehabilitation treatment plan.

Physiotherapy aims

In the initial stage following diagnosis of IVDD the aims of physiotherapy will be to:

• Reduce inflammation

• Reduce pain and spasm

• Maintain soft tissues flexibility

• Improve core strength

• Stimulate sensory input

• Re-train postural responses

These above aims continue and progress with time depending on your dog’s progress. Aims will ultimately develop to include the following:

• Further strengthen core stability

• Facilitate effective gait

• Increase exercise tolerance and overall cardiovascular fitness

• Return to normal function

Physiotherapy options

Physiotherapy treatment may include laser, cold therapy, myofascial release, range of motion exercises and stretches, muscle stimulation, hydrotherapy and the vital home exercise programme and advice.

The following table is an example of a rehabilitation programme for IVDD 

Timescale	Physiotherapy aims	Physiotherapy treatment
0-4 weeks	Reduce inflammation Reduce muscle guarding Core activation and stability Muscle tone modulation Improve body awareness and sensation Maintain soft tissue length and joint mobility	Ice therapy Laser Heat therapy Myofascial release Whole body vibration Neuromuscular electrical stimulation Neuromuscular facilitation exercises Home exercise programme Hydrotherapy  Advice for home care and using assistive devices Advice on careful supported handling techniques Passive assisted movements
4-6 weeks	Core strengthen Increase motor control Improve body awareness and proprioception	Continue as above with appropriate progressions Home exercise program Hydrotherapy Controlled exercise
6-12 weeks	Continue as above	Continue as above with appropriate progressions Cavaletti Balance cushions Assisted walking Home exercise program hydrotherapy
12-20 + weeks	Increase exercise tolerance Improve gait pattern Improve higher function running, circles	Continue as above with appropriate progressions Home exercise program hydrotherapy

Physiotherapy and Hydrotherapy for surgical management of IVDD

Rehabilitation is vital following surgery for intervertebral disc disease. Early intervention is crucial. The aims and treatment approach will vary depending on the level of disability your dog has and also the timescale following surgery. The key aims and treatment options are listed below. The chartered physiotherapist will constantly re-evaluate progress and adjust the programme accordingly.

Physiotherapy aims

Initial phase postop:

• Reduce inflammation

• Reduce muscle spasm

• Maintain soft tissue flexibility

• Increase sensory awareness

• Increase strength

• Advise owners of home care management requirements

Weeks 4-6:

• Activate core muscles

• Progress with the above aim

• Improve balance and coordination

• Enhance gait patterns

Week 6 ongoing:

• Increase exercise tolerance and cardiovascular fitness

• Increase core stability and strength

• Return to normal function

Physiotherapy and hydrotherapy options

Possible options might include – laser, hot and cold therapy, massage, range of motion exercises and stretches, muscle stimulation, hydrotherapy, home exercise programme and advice about injury prevention. The following table is an example of a rehabilitation programme our chartered physiotherapists may use with your dog.*

Timescale	Physiotherapy aims	treatment options
1-6 weeks	Reduce inflammation Reduce muscular guarding Maintain soft tissue length and flexibility  Prevent bed sores (decubital ulcers) if recumbent  Increase sensation and awareness of body position Increase strength Improve independence with postural sets Improve core stability Assist owner with management at home	Electrotherapy – laser Ice Therapy Soft tissue massage Joint mobilisations Exercise programme, lying, sitting, supported Proprioceptive exercises Neuromuscular electrical stimulation Regular position changes Whole body vivbration
6-16 weeks	Muscle strength Core stability Functional gait re-education Sensory stimulation Modulation of muscle tone Improve body awareness	Hydrotherapy treadmill Baited stretches Stimulation brushing Supported standing Assisted stepping Standing weight shifts
16 weeks- 6 months	Co-ordination Continue to progress strength, balance Correct functional movement Core strength and stability Improve mobility	Cavaletti Figure 8 and circle walking Sensory stimulation Balance cushion and wobble board exercises Hysrotherapy treadmill
6-8 months	Increase exercise tolerance	Hills Gradual increase of exercises as above
12 months+	Return to normal activity	Off lead exercise

*Please note that rehabilitation plans should only be followed under the guidance of a qualified rehabilitation professional, who will be able to provide a tailored plan based on the individual patient’s rehabilitation needs.

Hydrotherapy for IVDD dogs

Hydrotherapy is invaluable when rehabilitating dog patients following IVDD surgery. The buoyancy of the water supports the patient against gravity and allows effective exercise to take place. The warmth of the water provides a source of relief for any discomfort present and the hydrostatic pressure assists in swelling reduction.