Laurie's Blogs.

From:  https://mikereinold.com/shoulder-dislocations-from-weightlifting-restoring-chronic-weakness-unsafe-pt-treatments/ 

This ‘blog’ is actually a video-cast where Mike Reinold and his team answer questions.  It’s usually quite good.  One question that came in on a broadcast I watched was: 

“What do you do with a patient with CHRONIC weakness?  What are the best ways to get the patient strongest fastest?”

They interviewed the panel / group of experts and came up with the following answers:

1. If you want to be a great artist, you do you craft hours a day.  So, if you want a muscle to fire / build / work / recruit, then it needs to fire and be used multiple times a day.  So, as much firing as it can do a day, the better!  
2. What we know in people is that even THINKING about firing a muscle will cause muscle activation.
3. Be careful about pain – reduce pain, b/c pain causes muscle inhibition.  Especially in the early stages (post op / post injury), make sure pain is adequately addressed!
4. Then… concentric, eccentric… fast contractions, slow contractions.  
5. You may need double and triple the time to BUILD a muscle as how long it was atrophied for!  (For example, if a muscle was atrophied for 6 months, then it might take a year or 18 months to build it back up!!)
6. Focus on high frequency, lots of exercise.  Linear loading and building of exercises.  Then once they plateau on that, then try different loading systems (more eccentric, high velocity concentric, plyometrics… etc.)

What’s our CANINE SCENARIO / APPLICATION?

All of us in this area of practice will have seen the severely deconditioned / chronically weak patient.  And, it’s interesting to me to take apply the answers above to our canine patients.  Whether the scenario be a chronic cruciate injury, a deconditioned older dog, a recovering neurologic patient, the hip dysplasia case, etc, we too are faced with the question of ‘What to recommend?’

So, to apply the suggestions above to our patients, let’s start with #1.  Advise LOTS of short bouts of activity (and trickery) to start. Maybe that means putting the food bowl in a farther location or on a different level of the house.  Perhaps it means playing hide and seek or other games in the house.  Maybe pieces of kibble get thrown in the yard, leading to an extended session of ‘find the yard treats!’ As well as lots of short walks, naturally.  WE have to be creative in our suggestions to allow dog owners to become creative in coming up with solutions that would work for them in order to facilitate multiple muscle contractions per day!

Number 2.  How can we get a dog to THINK about muscle contractions?  I suggest letting dogs WATCH other dogs play.  Especially in a case where a dog is severely debilitated, compromised, or in pain.  An owner can put their dog in a little red wagon and wheel him/her down to the dog park to watch play.  OR, if the dog has a love/hate relationship with the neighbourhood squirrels, birds, or cats, then set him/her up in front of a window or on the deck to watch the action in the yard or on the street.

Address pain.  Yes, that makes sense, and not just from a pharmaceutical perspective, but also from a nutraceutical perspective AND by use of modalities prior to exercise.  As an example, it is protocol at my clinic to use the laser BEFORE a dog goes into the underwater treadmill.  I have always thought that there might be an added benefit to the exercise session, when pain (whatever there might be) is minimized at the beginning of the session.

Number 4 is just a reminder that ANY muscle contraction is a good muscle contraction for a chronically weak muscle.  Don’t over think or over complicate things too early in the recovery process.  Just get the muscle working again, in any way you can get it to work.

Number 5 was discussed quite a bit during the video broadcast.  It was a PT who presented the concept, and he had taken note of many of his patients, and felt it was accurate.  I would agree to some extent, especially if the case happen to have a sudden onset of immobility / reduced use or activity. However, I’m going to have to pay better attention to my canine patients to see what I think of this as a ‘rule’.   (Do the same and let me know what you think!)

The last comment – build gradually, and when they plateau, get fancier with your exercise prescription – I like quite a bit!  To me, this can happen in rehab practice, where the practitioner is scared to prescribe anything complex and/or doesn’t have the knowledge or tools to advance an exercise program by means of specific plyometric, eccentric, high velocity, etc. exercise.  However, when a patient plateaus, that’s when you have to change it up.  Lock that tidbit away for later, when you need it!

So, there you have it.  Simple, straightforward advice for a relatively common problem.

Until next time… Cheers!

Laurie