Laser therapy (ie, photobiomodulation therapy [PBMT]) exposes tissue to electromagnetic radiation in a certain spectrum of light, leading to changes in electron and proton transfer that have biologic effects.15,16 These effects may include activation and production of growth factors, stimulation of cell growth and stem cell differentiation, promotion of vasodilation, angiogenesis, fibroblast proliferation, and epithelialization, with an overall acceleration in tissue healing.16,17 There is no standard dose or frequency recommended in veterinary medicine for PBMT. Doses using class 3B or class 4 lasers from 4 to 6 J/cm2 to 8 to 10 J/cm2 have been recommended by practitioners with experience in this field.15,18 In the acute postoperative period, daily administration of PBMT may be recommended with a greater interval between treatments as healing progresses.15,18
Massage has mechanical and physiologic effects that can aid in tissue healing during the postoperative period.19,20 Massage creates pressure differentials in which high-pressure areas increase venous and lymphatic outflow and low-pressure areas have an influx of new fluid. This flushing effect may enhance circulation, nutrient delivery, and waste removal and may decrease inflammation, pain, swelling, and edema.13,21 Deposition of scar tissue can also be minimized, as massage loosens muscles and tendons and enhances movement between tissue layers.20 A massage may be started immediately postoperation, with initial sessions performed with greater frequency and shorter duration. Several massage techniques exist, and there are many specialists certified in veterinary rehabilitation or massage.
Protected weight-bearing in the early stages after orthopedic surgery is an essential component of rehabilitation. In human medicine, no other technique has been shown to aid in the proper healing of injured bone, fibrous tissue, and muscle more than controlled physical activities.22 When a force or load is applied to connective tissue early after surgery, it causes increases in circulation and matrix synthesis that result in repair and remodeling of that tissue.22,23 Without the application of early controlled loading, the tissue would, at best, heal in a disorganized manner and, at worst, not heal at all.22-24 Dogs can be taken on a slow, controlled outdoor leash walk, with or without a sling or harness, or led to walk on an underwater treadmill. Cats can be encouraged to walk by placing trails of kibble on the floor, dividing meals into 3 to 4 separate food bowls placed around a room, or dragging a feather wand slowly across the floor. As tissue healing progresses and the patient improves clinically, the duration, frequency, and speed of walks or activity can be increased.24 It is generally safe to increase the amount of activity by 10% to 15% per week if the patient remains comfortable and the surgery site is not compromised.24