Quadriceps Contracture in Companion Animals - Physical Therapy

Abstract

Background: Quadriceps muscle contracture (QC) that develops because of orthopedic interventions in the distal femur, proximal tibia or knee joint is a difficult process and may require a new series of orthopedic surgeries. However, despite everything, the prognosis is considered poor. The use of various physical therapy methods in musculoskeletal system and pain control is becoming more common in veterinary practice. This study aimed to investigate the effectiveness of transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TU) and low-level laser therapy (LLLT) applications in the treatment of QC in 1 cat and 6 dogs. 

Materials, Methods & Results: The study was conducted on 6 dogs and 1 cat diagnosed with QC. All animals had undergone previous surgery. TENS+TU+LLLT was applied to the animals in the study for physical therapy for 3 or 4 weeks. The findings of the study were found to be extremely satisfactory, in terms of opening the muscle contracture and regaining the use of the leg. After each case was examined clinically, the relevant extremity was evaluated orthopedically. The hip-knee joint, femur, tibia and surrounding soft tissues were examined. Quadriceps femoris muscle (QFM) tension, knee and knee joint range of motion, QFM atrophy, pain, hip joint function, abduction and adduction ranges were examined. In addition, the patient's history and the development of the disease were noted to determine the etiology. Additionally, craniocaudal and mediolateral X-ray images of the extremity were taken. The diagnosis of quadriceps contracture was made based on clinical examination findings. Physical therapy was then planned with TENS, TU and LLLT sequences. When the cases were evaluated, it was understood that some of them were caused by faulty/insufficient and malpractice practices (4 cases), while some (3 cases) developed QC due to the patient's inability to use their extremities. In all cases, the knee joint was stiff, and it was very difficult to move the joint. The quadriceps muscles were stiff and atrophied. No problems or difficulties were experienced in the implementation of physical therapy procedures. In the animals that the owner showed interest, it was noticed that the knee joint gap and contracture started to decrease after the 2nd session and the recommended passive movements were performed at home. In the other patients, there was a significant relief at the end of the 1st week. At the end of the 3rd week, the animal was able to use its extremities clinically and the owner was satisfied. No case required surgical treatment for QC.

Discussion: Treatment options for QC, which often develops after incorrect or poor/insufficient orthopedic interventions, are limited even today. The patient remains in a situation that can lead to amputation of the relevant extremity. In addition, it is known that strain or hyperflexion movements during physical therapy will cause ruptures or fractures at the point where the muscle attaches to the tibia. In our study, different physical therapy applications such as TENS, TU and LLLT were used in combination without applying any force or pressure to the region. Of course, different doses and durations than the ones we chose could have been chosen, but the patient owner constantly stated that the patient's pain was relieved in our applications. In addition, it was clearly seen that the muscle contraction began to resolve significantly at the end of the 1st week of treatment and the knee joint range of motion began to increase. As a result, it should be known that in cases where QC develops, with effective physical therapy in the early period, the patient can regain his/her former health and surgery will not be necessary. 

Keywords: cats, dogs, low level laser therapy, LLLT, transcutaneous electrical nerve stimulation, TENS, therapeutic ultrasound, TU.