Is It Time to Put ‘Rest’ to Bed?
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It is becoming increasingly apparent that while extended crate or stable rest protocols for musculoskeletal injuries or post-operative recovery are still widely recommended, the standard of care has shifted away from extended immobilisation towards early mobilisation and weight bearing. It can, however, be very challenging to change the perspective and recommendations of Veterinary professionals from rest to early mobilisation.?
During several lectures in 2021, the detrimental effects of extended rest and immobilisation were highlighted. Here we discuss taking a more active approach with earlier mobilisation and loading of healing tissues from an evidence-based perspective.
If you have been looking for the evidence behind the earlier mobilisation protocols and theories, we are happy to share a few below.
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Healing phases and timelines
During the Vet Rehab Summit 2021, Dr Sheila Schils shared that we are revising our understanding of the?tissue healing timelines?and how we interact with them. The healing timelines may be up to 50% faster than we initially thought in the 90s.
In the same lecture, Dr Lowri highlighted that the timeline is also not static – tissues will cycle through the inflammatory, reparation and maturation phases many times through the course of healing, and this is something that we can strongly influence with our rehabilitation protocols. Inflammation is not the enemy of healing, but rather allows the body to continue to break down tissue that is incorrectly aligned or that causes scarring and restrictions in motion, and replace it with functionally appropriate collagen fibrils.
Dr Lowri follows a three-day protocol to guide tendon and ligament healing, where on day 1 (not day 1 post-injury, but rather day 1 of the rehabilitation protocol) she will use overload and cause microdamage to the tissue, putting the tissue into a negative balance; on day 2 the tissue will again reach a neutral point, on day 3 there will be adaptative collagen deposits before the 3-day cycle repeats.
?Read the full article here: https://onlinepethealth.com/is-it-time-to-put-rest-to-bed/
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References?
Amiel, D., Gelberman, R, Harwood, R., Harwood F. (1991). Fibronectin in healing flexor tendons subjected to immobilization or early controlled passive motion.?Scandinavian Journal of Medicine & Science in Sports?11 (3): 184-189
Bakti N., Antonios, T., Phadke,??A. & Singh, B. (2019). Early versus delayed mobilization following rotator cuff repair.?J of Clin Ortho and Trauma.
Bring, C., Reno, P., Renstrom, P., Salo, D., Hart, P. & Ackermann.P.?(2007). Prolonged immobilization compromises up-regulation of repair genes after tendon rupture in a rat model.?Scan J. Med Sci Sports, 20 (3): 411-417.
Canapp, S.O., Canapp, D.A., Carr,B.J., Cox, C. & Barrett, J.G. (2016). Supraspinatus tendinopathy in 327 dogs: A retrospective study.?Veterinary Evidence?Vol 1 No 3
Gimbel, J.A., Van Kleunen, J.P., Williams, G.R., Thomopoulos, S. & Soslowsky, l.J. (2007). Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site.??Journal of Biomechanical Engineering, 129(3):400-4Jung H.J., Fisher M.B. & Woo, S.L.Y. (2009). Role of biomechanics in the understanding of normal, injured and healing ligaments and tendons.?Sports Medicine, Arthroscopy, Rehabilitation Therapy & Technology,?1 (9): 1758-2555.
Kannus, P. (2000). Immobilization or early mobilization after an acute soft-tissue injury??Physician and Sportsmedicine, 28 (3): 55-63.
Schils, S.J. (2017). The development of training programs to reduce injury and of specific rehabilitation protocols when inury occurs. 13th Annual Promoting Excellence Symposium (2017). Florida Association of Equine Practitioners, Proceedings October 19-22, Naples, Florida.
Stoffelen D. & Broos P. (1998) Minimally displaced distal radius fractures: Do they need plaster treatment??J Trauma,?44 (3): 503-505.
this article was first published on www.onlinepethealth.com