Moist heatis typically used for more chronic cases of osteoarthritis; it reduces muscle spasms and increases the metabolic rate in and circulation to the region. It may be applied in the form of a moist hot pack, warm baths, warm towels, or hydrocollators. Typically, temperature increases about 3° C at the superficial level and 1° C approximately 3 cm below the skin. Applications last about 15 to 20 minutes, and the skin integrity must be continuously monitored. Heat is applied directly over the involved joint or joints (Figure 1). Any stretching or range-of-motion exercises should be performed during or directly after the application.
Electrical stimulation may be used for pain control, neuromuscular stimulation, edema control, and functional return. For osteoarthritis, electrical stimulation is most often applied to control pain and assist in the reeducation of muscles. Electrical stimulation, or TENS (transcutaneous electrical nerve stimulation), is used to treat the area of pain. Electrodes are placed directly over the area of pain, nerve root distribution, acupressure points, or areas of referral (the areas should be shaved). Treatments are comfortable and generally last for 20 to 30 minutes; the patient should be continuously monitored for the duration of treatment.
Neuromuscular electrical stimulation is used over weak muscles or muscle groups to stimulate contraction. One electrode is placed over the motor point of the muscle and another along the muscle belly. Cocontractions can be elicited (eg, on the quadriceps and hamstrings), or electrically stimulated contractions may be timed with volitional contractions for function.
Range of motion is often impaired in patients with osteoarthritis. Exercises to help restore range of motion are frequently part of the treatment plan for many patients.
Aquatic therapy may also be performed in an underwater treadmill: The dog walks into a chamber, and the chamber is then filled with water to the desired height, depending on the amount of weight and energy expenditure the dog can tolerate. For example, filling the chamber with water to the level of the greater trochanter decreases the dog's body weight by more than half. Once the water level is determined, the treadmill is initiated at the appropriate speed-usually between 0.5 and 5 mph (Figure 4). Any type of aquatic therapy is strenuous so the dog's physiologic status must be monitored during sessions.
Cost and Frequency
Cost of rehabilitation varies throughout the U.S. Initial evaluations may range in price from $75 to $200, and individual treatments may range from $35 to $100. Many centers offer package deals to help reduce the costs.