Physiotherapy and Hydrotherapy Management of Fibrocartilaginous Embolism (FCE)

FCE presents as a sudden onset spinal cord injury caused by a blockage in a blood vessel supplying the spinal cord, typically by a piece of cartilage from an intervertebral disc. This can lead to paralysis or weakness, especially in the hind limbs, and commonly seen large and giant breeds. FCE is a non-surgical disease of the spinal cord. 

Rehabilitation has a huge role to play in managing dogs diagnosed with FCE. Maintenance of physical function and prevention of secondary compensatory changes is vital to your dog making good progress throughout the rehabilitation process. The level to which a patient is affected by the FCE will vary from dog to dog. Ongoing re-evaluation is essential to allow an effective and appropriate treatment course that is adapted to the individual patient..

Physiotherapy aims

In the initial stage following diagnosis, the aims are as follows:

• Maintain soft tissue flexibility

• Prevent muscle spasm

• Provide sensory stimulation

• Provide supported means of mobility

Depending on your dog’s progress, the aims might then progress to:

• Improving core stability

• Improving body awareness and coordination

• Providing home care management advice

6 weeks on from diagnosis your chartered physiotherapist would aim to:

• Strengthen core stability

• Improve gait pattern

• Increase cardiovascular fitness

• Return to normal functional activities

Physiotherapy options

Correct positioning, massage and stretches can be implemented in the early days. Laser, heat and sensory stimulation techniques complement the healing at this stage. Muscle stimulation is invaluable to maintain “at risk” muscle groups whilst your dog might be recumbent. As your dog improves, an appropriate and progressive exercise plan can be used to assist in gait re-education, core stability, strengthening and promote balance. Once your dog is recovering muscle mass and general cardiovascular fitness will continue to be improved to original levels as able. Advice regarding assisting with everyday activities will be given for injury prevention.

The following table gives an example of a rehabilitation plan for a dog recovering from an FCE:*

Timescale	Physiotherapy aims	Treatment options
0-2 weeks	Reduce potential risk of soft tissue trauma Reduce muscular guarding Increase sensory input and motor activity Possibly gait re-education according to deficits Improve core stability Increase sensation and awareness of body position	Correct positioning Soft tissue massage and stretches. Laser therapy Neuromuscular stimulation Sensory techniques e.g. brushing, tapping Hydrotherapy treadmill Home exercise programme Neuromuscular electrical stimulation Proprioceptive exercises
2-4 weeks	Maintain soft tissue length and flexibility Management at home	Home exercise programme Passive movements and stretches Exercise restriction Advice regarding flooring Advice regarding assisted walking with harness and sling if required Advice regarding cavaletti pole work, gradients, steps and different surfaces
4-6 weeks	Continue and progress as above	Progression of home exercise programme to challenge balance, body awareness and strength Advice on maintaining controlled exercise when dog is feeling better
6-12 weeks	Increase exercise tolerance Improve function	Increase exercise level Hydrotherapy treadmill Core stability and strength
12 weeks +	Return to full function or establish deficits and advise regarding long-term management.	Progress to off-lead exercise and previous exercise level if appropriate

*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 options

Our underwater treadmill is a useful tool for assisting with gait re-education. The warm water provides support to the patient and allows effective gait training. For longer term management, the hydrotherapy treadmill is used to restore muscle strength and cardiovascular fitness.