There are some lecturers who challenge our thinking far beyond the norm – who ask questions and share observations that challenge the very foundation of what we do and how we think.
Lowri Davies is one such lecturer.
In a lecture presented to the Onlinepethealth Hydro Membership, Lowri questions when, where and how hydrotherapy should be applied to best serve our patients.
Here are some of the thoughts I walked away with after watching the video.
Buoyancy, Viscosity, Hydrostatic Pressure
Hands up if you have watched many hours of continuing education on canine hydrotherapy 🙋🏻♀️
It’s not uncommon for a lecturer to start their lecture discussing the properties of water, and so when Lowri started this way my heart sank just a little, and my eyes glazed over. It wasn’t long, however, before her words shook me out of my reverie, and I decided to rewind to catch what I had just missed.
The interplay
When it comes to the moving, living, breathing individual in front of us, we need to consider the interplay of factors working on the whole individual, not just one component. Yes, buoyancy means that we can decrease the amount of load on a distal joint by increasing the water depth. However, when we add motion to the equation, together with abnormal muscle recruitment patterns and compensatory postures – we may well be increasing the load on distal joints.
How does that work?
It’s not all about weight – the amount of force acting on a joint is also subject to the acceleration and deceleration of that limb segment, as well as the force of muscle contraction acting on that joint. When we have a higher water level, the limb segment needs to move through much greater resistance. This results in higher muscle contraction forces.
Because moving through higher water levels demands much more work from the muscular system, compensatory muscle recruitment patterns and postural adaptations will likely be heightened or worsened in higher water levels.
As Lowri says, “Practice makes permanent, not perfect!” If an animal is constantly using muscles incorrectly in response to pain, more exercise (and pressure on the joint) will not help – and may well make the condition worse.
Asking the Hard Questions
In her lecture, Lowri asks the hard questions about hydrotherapy:
- Does it answer the need for motor learning?
- Is the skill transferable?
- Does it correct postural adaptations, or does it entrench them?
- Does it meet the need for stress and repair?
Instead of creating ‘rules’ and ‘guidelines’ for treating specific conditions, we need to be treating the patient in front of us. Postural evaluation needs to form an integral part of our initial assessment and treatment planning, both statically and dynamically.
The fact that adaptations in posture occur in response to pain is a sure indicator that we need to start by identifying and understanding changes in the muscle recruitment and activation patterns of the individual patient. This information will guide our plan for retraining those muscles and reconfiguring those patterns. We need to be breaking down movements into their simplest components to correct neuromotor control, muscle tone and activation through land-based exercise.
Muscle activity needs to be the major focus in rehabilitation, according to Lowri. Without focusing on muscle activity within movement chains, we cannot support stability and mobility in motion. Without both stability and mobility, our patients are at a disadvantage in their environments, both in terms of how they act and react to stimuli.
Lack of stability and mobility not only reduces the dog’s ability to heal and recover from injury, it also dramatically increases the chances of injury or re-injury.
Looking at the Evidence
When we look at the evidence available within canine hydrotherapy, we become aware that an overwhelming amount of information is still missing. The quality of evidence is generally poor, and based on small sample sizes, poor study designs and a lack of a representative sample of patients. Add to that a lack of congruency in methods, and it begins to seem very strange that many of our clinical decisions – including treatment protocols – are based on the available research.
I am a huge proponent of research and being evidence-based in our practices, in hydrotherapy as in everything else we do. However, I have felt for a long time that the evidence available in canine hydrotherapy does not provide us with the information we are claiming it does, and does not support the clinical decisions we are using that evidence to justify.
In her lecture, Lowri casts the lens wider than the few articles we have on canines, and looks at the relationships that have been established in human hydrotherapy practice. She discusses many of these findings and their relevance to us in her lecture, which I found to be incredibly eye opening.
Sometimes, finding an article that contradicts our patterned and normal way of thinking can be enough to jolt us back to reality. Contradictory evidence should encourage us to open our eyes to the individual in front of us and their physical response to the modality we are using. Specifically, from Lowri’s lecture, I learned how crucial it is to be aware of the way our patients’ movements adapt at different water levels, and to consider that in some circumstances, the increased pressure of water depth and speed of movement may be detracting from healing, rather than promoting it. Just something to consider.
Continue Learning
Are you ready to take your continuing education up a few levels? Then I’d recommend watching these webinars presented by Lowri Davies in the Onlinepethealth Memberships.
0 Comments