The typical protocol is to put the dog on a nonsteroidal anti-inflammatory (NSAID), and recommend rest for the dog; known as "R&R": Rimadyl and Rest. If they can do surgery, they do surgery. "R&R" might fix the problem, but often not permanently; it might just mask the problem.  Sometimes there is a chronic waxing and waning of the problem after using the R&R approach. Well, if it's a strain of the teres major (a scapulohumeral muscle) or medial shoulder instability, until it's treated appropriately, it's never going to get better!

Another classic scenario is when a dog has a little pain in his hind end, so he stops using it efficiently, and puts more weight on the front end. Then he becomes weaker and can't get stronger because of the pain and fatigue due to muscle atrophy. You've seen them - old Labrador Retrievers with huge shoulders and skinny butts. Unless we're proactive about strengthening the hind end, the dog is never going to come out of the spiral.

But now we have rehab vets and practitioners. Ideally, when a veterinarian sees that the dog has a soft tissue injury, she'll send him to a rehab specialist, realizing that the dog needs to see a musculoskeletal specialist. The bottom line is that the field is becoming a lot more like human medicine, in terms of specialization. There is just too much to know to expect one veterinarian to be able to do it all - and it's odd that we didn't realize it sooner.

Because a good portion of what is going on during rehab is working on building strength, flexibility, proprioception, and range of motion, the means of addressing those issues will vary depending on who is administering treatment.

For example, some practitioners frequently use acupuncture and chiropractic. Other practitioners use those modalities and/or laser, ultrasound, electrical stimulation, hydrotherapy (underwater treadmill and/or swimming), massage, physio balls, wobble boards, land treadmills, cavaletti, weights, Thera-Bands, Chinese herbs, homeopathy, and nutrition. And that's not an exhaustive list!

Ideally, find someone who has trained at one of two schools in the U.S. The Canine Rehabilitation Institute (with locations in Florida, Maryland, and at CRCG's Broomfield location) awards the certificate of Canine Rehabilitation Therapist (CCRT) to veterinarians; the University of Tennessee University Outreach and Continuing Education Department, in conjunction with Northeast Seminars, offers a Certified Canine Rehabilitation Practitioner (CCRP) certificate.

But you might also find someone who has been practicing in the discipline for a long time. Maybe they don't have one of the certifications, but perhaps they've spent a lot of time learning on their own, working with physical therapists, and getting invaluable practical experience. As with any specialist, you've got to ask them! A good rehab practitioner also usually has another modality such as acupuncture or chiropractic in her toolbox. Those kinds of tools allow the practitioner to get a lot more done, including the ability to deal with both the condition and pain relief.

What are the typical goals of rehab and what are some examples of injuries or conditions we might see treated?

With hip dysplasia, we can use rehab to help with strength and flexibility. We find that we're able to put off using pain medication and surgery to the extent that we're seeing a lot of cases that would have needed surgery, now don't need it.

If you know your dog has hip dysplasia early on, and you manage her, you can begin work early to prevent the hind end from becoming weak, and keep the pain at bay - pain that we often see in the low back and the muscles around the hips. Rehab can keep those areas loose, flexible, and strong.

After anterior cruciate ligament (ACL) surgery, we used to see protocols that called for the dog to start walking for five minutes one week, then 10 minutes the next, and so on. There wasn't anything else, and particularly nothing to address stretching and strengthening.  Now we can prescribe passive range-of-motion exercises to do at home; light weight-bearing exercises to practice early on; and starting hydrotherapy anywhere from two to eight weeks post-op. And sometimes we see the use of lasers, electrical stimulation, or ultrasound to help with tissue healing. With rehab, animals get better a whole lot faster; they return not just to functionality, but to the condition in which they were in, pre-injury.

Any time you have an animal that needs to work on increased strength, proprioception, and/or flexibility. And pain management is huge - it's a big part of rehab. Rehab and pain management go hand in hand. It's important to realize that you need both to get anywhere when dealing with pain. We can throw drugs at it, but if the animal is in significant pain, we need to be doing other things as well. For example, if a dog is stiff and painful, even doing things as simple as stretching and massage can be a big part of pain management.

Sometimes a conventional veterinary approach leaves the client wanting; there is a lack of knowledge about the other tools that are available to us. Take intervertebral disc disease, for example. You might have a dog that is partially paralyzed or weak in the hind end because a disc is pressing on the spinal cord. Often, we can avoid surgery through acupuncture and rehab, by waking up nerves and bringing the dog back to function.