Torn Knee (and Other) Ligaments – Overview of Injury and Recovery

Ligament Structure, Injury, and Recovery –

Former title: Stifle (Knee) Ligament Ruptures (Torn ACL, CCL) Information Overview and Ligament Injury Recovery.

Prologue –

This is a piece I wrote as an overview of torn knee ligament originally in 2007 for a client of Dr. Dennis Sundbeck, DVM, owner and practitioner at Round Rock Animal Hospital for 35 years.

Dr. Sundbeck retired in 2014 and passed away April 15, 2018. Our community remembers him fondly as we celebrate his life and contributions to many aspects of Central Texas.

I remember Dr. Sundbeck specifically and warmly because he was possibly the first established, old school, veterinarian in my area to refer a case to me for non-surgical recovery of a torn knee ligament in a dog. I do not think he and I had been able to talk prior to the referral, however he must have read the materials I dropped off at RRAH when I began my business in January, 2007. Evidently my methodologies made common and scientific sense to him.

I have always held that situation deep in my heart as a beacon to support my work to switch veterinary medicine off of the all-too-quick referrals to surgeons for injuries like torn ligament, torn meniscus, and “bad hips”. RRAH continued to support my rehabilitation practice over the years and often supplied my recovery booklets for their clients.

 

Overview –

This post has information about ligaments, ligament injury, surgery, and some guidelines for rehabilitation. The homework protocol I have written for use after surgery or instead of surgery and which has been used successfully for years is now available in book form, and here are the links: rehab books on Amazon.

What Are Ligaments?

A torn ligament is not a life or death situation in and of itself.

Ligaments are dense connective tissue structures consisting of fibroblasts, water, collagen, proteoglycans, fibronectin, and elastin that connect two or more bones (1, 2).

What Happens When My Dog or Cat Tears a Ligament?

Within hours of injury, the defect (injury) is filled with an organized hematoma and the surrounding tissue becomes edematous (swollen with fluid) from perivascular leakage of fluid.  Monocytes and macrophages are found in the wound by 24 hours and respond by cleaning up the site and transitioning to the next phase.

Does My Dog’s Torn Ligament Heal?

At this writing, a great deal of information remains unanswered regarding timing of ligamentous healing in canines, especially with respect to postoperative mobilization techniques (graft, suture, TPLO, TTA, CBLO, etc…).  This is because ligaments heal differently depending on the location.

For example, the healing potential of the medial collateral ligament of the stifle is very good, but the cranial cruciate ligament, which has received the most investigation, demonstrates virtually no healing response following injury (2).

What Will My Pet’s Veterinarian Do?

Your veterinarian will most likely watch your pet walk, manipulate the injured limb and joint, and take an x-ray, radiograph (rads), of the knee or other injured area. Please do not protest the x-ray.

You are correct if you already know that we cannot see a torn ligament, per se, via rads. What we can see, however, is cloudiness where the swelling I mentioned above is happening. We may also see whether there is what I call a 1% issue in the knee or surrounding area. Sometimes there are hairline fractures at the tibia or growths that are irritating the leg or joint that we are able to see on rads.

I have seen a lot of what I call 1% cases in my practice, and I won’t take time to cover that here. Get the x-ray to see if your vet sees what they think they’ll see if they recommend an x-ray. Clients ask me to explain the need for the x-ray *all* the time.

It is at this point that most veterinarians will recommend an anti-inflammatory drug for your pet and a consult to a veterinary surgeon. If you are referred to a surgeon, there is a possibility that the surgeon will want to take their own rads. They usually do that if the originals did not come out as well as the surgeon would like to see and if they think there is something worth seeing. I have been with surgeons in the room at the time of consult, and sometimes they say that “there’s no need for x-rays because you cannot see a torn ligament on x-rays”, and sometimes they want an x-ray.

Some veterinarians will know of my programs and will refer people to them. If you want to see a few of the testimonials for my programs, from vets and clients, click here.

Booklet for sale with rehab program for right after injury

Some veterinarians will have clients keep their pet restricted, with or without medications and without referring to surgery. There are many, many ways medical practitioners deal with injuries, and there is not one set method. Above are the top three situations I meet. Here are the first three steps I recommend after injury.

In newer news, many studies have linked non-steroidal anti-inflammatories (nsaids) to delayed healing of injuries. I have followed the research and I promote healing methods without nsaid use for both my human and veterinary clients.

How Long Does The Injury Last?

The acute injury phase lasts about 48-72 hours (2). The knee will swell, sometimes only a little, inside the joint. This makes the bony parts thicker or expanded due to fluid accumulation inside the joint. This is called effusion, and it is part of the healing process. Sometimes the knee (stifle) swells a lot inside the joint. Other times there is swelling in the soft tissue as well.

Should I Use Ice on the Injury?

Practitioners often recommend ice during the acute phase of injury. The standard recommendation is 1-6 times per day, for 20 minutes each application, on average. The duration of application depends on fur density on the pet and type of ice used.

In the meantime, I have also been recovering a variety of human and pet injuries without the use of ice. Ice, too, delays recovery. The physician who developed the sports medicine standard, RICE (rest, ice, compression, elevation) has reversed his stance. Many of us in recovery work have followed suit.

I have a separate paper with icing recommendations on this site if you really feel that you need to use it. The method of delivery most recommended by others yet one of the least effective is frozen veggies, so check out the other options noted in my post. 

More research in recent years shows that stopping the inflammatory process is not a good idea much of the time for this type of injury. The body may heal faster If we allow it to go through the natural inflammatory process. It also helps if there are pain medications like Tramadol or Gabapentin available. Ice and nsaids work against inflammation, and therefore also work against healing.

Should I Use Heat on the Injury?

This question is often in debate. Here is a link to a recent paper on the subject. I recommend that you NOT use heat on your or your pet’s injury unless you have read the recent science. In my experience, people want to use heat when they should be using ice. They usually don’t know how and when to use heat to help with healing. Check out the above link for more info.

Laser Therapy and Acupuncture –

Throughout the healing process using low-level laser therapy is a good idea if it is available to you. I use a class IIIb laser in my practice, and I have attended two national and world conferences on laser therapy. See these sites for more info: WALT and  NAALT .

I haven’t yet posted much on acupuncture, so here is a random PubMed search link to papers on acupuncture for healing. I use laser therapy over acupuncture if only one option is possible. This is because of the added benefits laser therapy provides over acupuncture. USA law says if anyone is going to acupuncture your pets, it has to be a licensed veterinarian.

Acupuncture and laser therapy both work in manners that most people don’t necessarily understand. Acupuncture can be very effective for short-term pain relief. I rarely come across a human account of pain relief from acupuncture lasting more than a day. Acupuncture is also a great treatment for other conditions.

Laser therapy (LLLT) is effective for short and long-term pain relief. LLLT also stimulates cellular growth and production and it also breaks down scar tissue. Short story. Check out the websites I linked above for more information.

The main idea after injury is to lower the level of pain and to encourage healing, so use the best tools and information you have available. To that end, I believe forced specific range of motion exercises are unnecessary in a companion animal that is functional, one that is able to move their limbs on their own.

Supplements & Vitamins –

Follow my guidelines here, and consider using these supplements for healing after injury or surgery.

I do not recommend throwing the kitchen sink of vitamins and supplements at any injury, illness, or chronic condition. I recommend using specific, limited ingredient, supplements for specific conditions and expected results.

Ligament Support, Arthritis, and Instability –

In many cases, loss of ligamentous support invariably leads to progressive osteoarthritis, such as in cranial cruciate ligament (ACL) ruptures. Osteoarthritis will continue, even if you choose to have surgery. Another interesting paper from the “human side”, because the research on athletes and other humans is better than what we have available for advanced recovery protocol in veterinary medicine.

Most veterinarians are trained to believe that the pet is not using their injured limb for psychological reasons. I believe the greatest reason that humans and pets are not using a body part is due to pain. I discuss this more in this post. Instability also plays a small part in leg disuse.

Surgery Does Not Stop Arthritis –

Please understand that the arthritic process began when the first injuries occurred in the joint, when damage first occurred and then when tearing began.  It is most likely that you know nothing about when the arthritis actually began to develop. A ligament usually will tear for some amount of time before total rupture. Sometimes people use my programs at first notice of injury, prior to a full ligament rupture. Most of those pets do not go on to fully rupture their injured ligament.

So What Does Surgery Do?

Clients tell me that veterinarians and others tell them that surgery will stop the arthritis. This statement is related to the truth but it is not altogether true. Surgery immediately stabilizes the joint. The stabilization is supposed to keep the knee from moving incorrectly, and that helps keep the joint from further damage.

The right exercise protocol after injury ALSO helps keep the knee (or whichever joint is damaged) from moving incorrectly. Moreover, the right exercise protocol strengthens the muscles of the leg with the damaged joint and keeps the other limbs from overloading and becoming injured, too.

By the same token, braces are not a more permanent fix for torn knee ligaments. They are no substitute for good recovery drills and exercise to gain long-term quality of life. I am asked about braces *all* the time. Here is my braces post.

Active Recovery –

Your pet still needs an appropriate active recovery program and not only surgery. If your pet does not do an active recovery program, their muscles will not develop to help stabilize the joint. Use my or a program designed by someone who has experience with exercise physiology and veterinary rehabilitation.

Moreover, your pet is likely to tear the ligament in the opposite leg if they’ve already torn one. My strong belief is that the opinion about the high likelihood of a dog tearing the knee ligament in the other leg after tearing the first ligament is based on poor recovery techniques. One day, I hope to run a study proving this.

Excessive exercise during periods of acute joint inflammation may be harmful to articular cartilage. (4)  Greater stresses that are placed on the joint in the presence of ligament damage will cause joint damage. NO running, jumping, playing, etc…

My Vet Said My Dog Had to Have Surgery –

A ligament rupture is not a matter of life and death.

Many people come to me saying that they have felt forced toward surgery for this condition in their dog. In contrast, I had one client, who is a human medical doctor with a different opinion. She said, “I wish we could get people off of the surgery idea! We don’t even rush every human athlete into surgery, much less every person in general.”

Slatter’s Textbook of Small Animal Surgery  Slatter's Textbook of Small Animal Surgery click to purchase on Amazon
states that small dogs often do well without surgical intervention, and that based on particular studies, “it is prudent to wait for at least 6 to 8 weeks before recommending surgery for small dogs.  These dogs are older at diagnosis and are often obese with concurrent medical problems.  Small dogs that are lame for 6 weeks after diagnosis and show no improvement often have meniscal tears and are operated on for meniscectomy and joint stabilization.” (pg.1832)

Meniscal Tear, Too?

Your veterinarian may help you check whether or not your dog has a meniscal tear. If I am working with you and your pet, I  can point out sounds and other signs that may indicate a torn meniscus. If we find s&s, you should follow up on that with your veterinarian.

It is also not necessary to have surgery for a meniscal tear. My programs for dogs with torn knee ligaments work for meniscal tears, too. I had an MRI of one of my knees several years ago to find out what was going on in it. It turns out I had already non-surgically worked through a very old meniscal tear of my own!

Keep in mind that the recommendations I cited from Dr. Slatter’s textbook do not include a return to function plan. Slatter’s instructions are most likely based on the fact that many dogs have improved over time without any specific intervention. If a thoughtful and proven program is performed, the dog or other pet should recover all the better!

No Surgery –

If you decide to not pursue surgery on your pet, then you will find great introductory recovery instructions here.  Even if you opt for surgery, the recovery time and exercise protocol are virtually the same.

You may do all recovery for torn knee ligament or meniscus injury or surgery in your home environment.  You may also enlist the help of technicians and vets at your standard clinic if you are using my programs.

What About Giant Dogs?

Additionally, I have used the same basic and advanced functional rehab protocol for large dogs. That is because successful programs are based on principles of athletic training and recovery. These will best address joint instability and muscle atrophy that occur along with knee damage in giant breed dogs.

My Great Dane, Grace, was the most orthopedically-challenged pet I have known. Without my rehab, she probably would have passed on at half her life of 11.5 amazing years.

My own soulmate pet, RIP Grace, xox. She had two TPLO’s, which I would never do again, and both were extremely problematic. She ended up with all three ligaments torn in her right knee and 2 torn in the left. Her story is long. She received both drugs and supplements most of her life.

 

Some positive feedback from veterinarians and owners is cited on this website, Amazon, Goodreads, and in separate blog posts regarding this exercise protocol.

Muscle Atrophy After Injury –

After loss of support and inflammation of ligament and joint, muscle atrophy is another complication I address.

Muscle atrophy almost always occurs with or without surgery because the injury hurts and may feel unstable to the pet. This usually leads to their not using the injured leg as much. Rehab interventions are proven to aid in gaining strength and muscle tone in the affected limb

Muscle atrophy usually occurs during the whole time the pet has been injured, prior to intervention. This is because the injury will have usually produced pain and instability, even if mild at first. Pain and instability encourage disuse and, therefore, muscle atrophy.

The degree of quadriceps muscle atrophy present before surgery for cranial cruciate ligament (CCL) rupture seems to correlate significantly with the degree of cartilage fibrillation, indicating a relationship with the severity of the condition.  I refer you back to my info on pain and instability.

In studies, muscle mass improved 7 and 13 months after surgery, but significant residual muscle atrophy remained in many dogs even after 1 year. I usually see muscle atrophy reversed in much less time when owners have followed my recommended protocol. I have also worked with many patients that have not regained muscle mass after injury or surgery prior to our work. We have been able to correct the imbalance in most instances.

dog rear end with good muscle tone after rehab for ligament injury recovery

How Will Rehabilitation Help Ligament Injury Recovery?

Outside the scope of this writing is the argument as to whether a natural course of events follows evolution or deterioration without intervention; either way it is the primary purpose of rehabilitation interventions to improve upon what natural abilities would theoretically otherwise be realized.

A specific exercise program with frequent changes in protocol will indeed build muscle. It will also usually cause hypertrophy better than surgical repair alone or pain medication alone. I realized this first based on my observations in practice. There is also a lot of substantiating research on the topic(s). Try the National Strength and Conditioning Association for foundations in strength training if you have further interest in this specialty.

Whether or not an animal will do well on its own without intervention is inconsequential when the overwhelming benefits of rehabilitation intervention are considered. In light of this, rehabilitation treatment is indicated whether or not ligament repair surgery is performed.

So Now What Do I Do?

For non-surgical and surgical patients, rehab treatment may consist of conservative exercise that increases in difficulty as healing progresses. Both should receive therapies such as I have mentioned plus weight control plans.

For non-surgical patients, building muscle and supporting tissue will be important toward stabilizing the nearby joint(s).  We also want to keep up protective interventions for affected joints. Use the therapies mentioned above and keep up dosing supplements and pharmaceuticals proven to aid with function and recovery.  Nutrition supplement support includes glucosamine/chondroitin/MSM, Arnica Montana 30, and fish oil, among others.

Rehabilitation Practitioners –

A qualified rehabilitation practitioner should be able to design a basic appropriate plan of action. They and your pet’s vet can collaborate to meet your pet’s needs for recovery in the home environment.  It is within the scope of this paper to briefly give information regarding ligament damage. I also inform more specifically on basics of rehabilitation recovery.

There were no written protocol that I could find that addressed specific exercise protocol and return to function for small animal veterinary medicine when I began professionally practicing in veterinary rehabilitation in 2004.  This was especially true for ligament injury recovery. I subsequently began writing protocol based on how similar human injuries are managed and treated for athletes. This method has been very successful and very helpful to large numbers of people and pets.

References –

1.  Fowler D:  Principles of wound healing.  In Harari J, editor:   Surgical complications and wound healing in the small animal practice, Philadelphia, 1993, WB Saunders.

2.  Frank C et al:  Normal ligament:  structure, function, and composition.  In Woo S, Buckwalter J, editors: Injury and repair of the musculoskeletal soft tissues, Park Ridge, Illinois, 1991, American Academy of Orthopedic Surgeons Symposium.

3.  Moore KW, Read RA:  Rupture of the cranial cruciate ligament in dogs.  II. Diagnosis and management, Compendium of Continuing Education Pract Vet 18:381391, 405, 1996

4. Agudelo CA, Schumacher HR, Phelps P:  Effect of exercise on urate crystal-induced inflammation in canine joints, Arthritis Rheum 15:609-616, 1972

By the way, that case? From my prologue? Was a 2 yo in-tact male Chocolate Labrador hunting dog with extreme crate anxiety and parent-clients who both worked long hours in science-based jobs. I remain forever grateful for that referral.

And I continue to receive support from RRAH and Dr. Sharon Waters, most specifically, as they work to provide the best care for their patients.

(Copyright 2007, Deborah Carroll, Updated April 18, 2018)

What is Rehabilitation and Conditioning for Animals? (Rehabdeb, RehabRevolution)

Animal Rehabilitation, Pet Rehab, & Canine Sport Conditioning

Rehabilitation and Conditioning for Animals provides science-based functional rehabilitation, wellness conditioning, nutrition counseling, and athletic training for all ages and stages of companion animals in collaboration with veterinarians while also engaging community and worldwide participation in programs that benefit the human-pet experience.

What You ‘ll Find on This Site –

  • programs for pets for after surgery and conservative treatment programs to use instead of surgery
  • programs that you may do at home, in a standard clinic, or elsewhere
  • a lot of work for you to do with your pet
  • first-hand details about programs I have developed and used as well as information about results
  • pros and cons of rehabilitation I have discovered in my years of practice in veterinary rehab (see clients I’ve helped)
  •  programs designed by a professional certified in several disciplines related to conditioning, recovery, and strength (this is important because there is a lot of bad information on the web about how to rehab a pet, even though most of it is well-intended)
  •  pet rehab = principles of exercise science + neuroscience + clinical medicine

How Are These Programs Different?

My programs are based on over four decades of my having participated in, worked in, and created programs in human sport science, nutrition, and medical recovery. They are also based on my experiences working hands-on with veterinary specialists, and sitting in on medical, neurological, and surgical specialty evaluations of patients.

I design these programs so that almost anyone may use them at home or in a standard veterinary clinic. You may do all rehabilitation on pets in the home environment in most cases.

Why Did You Create Different Programs?

I professionally began small animal veterinary pet rehab in 2004. At that time there were no standard, concise, systematic, and progressively oriented rehabilitation programs available on the web or that I could find in publications.

I had hoped to find programs based on exercise physiology and recovery principles like those I already had experience using for athletes. I wanted them to exist already so that I could follow-up on specifics that also interest me. I’d like to investigate breed recovery differences and give more complementary rehab care for veterinary cancer patients.

Over the years, I have ended up developing and using the types of programs I thought would already exist for small animal medicine and recovery. I figured they already existed, in part because I was used to systematic programs from human exercise physiology science and in equine science.  

May Anyone Use These Programs?

These programs mean a lot of work for you. Your work should be successful if you follow the recommendations I give. 

I have shared my rehabilitation protocol with many pet healing groups, veterinary clinics, trainers, boarding facilities, and specialty hospitals. I have shared rehab programs in person, on the phone, and on many internet platforms over the years (remember MySpace?).

You Don’t Need to Have a Certification to do Successful Rehabilitation on Your Own Pet!

There are a couple of standard courses of pet rehabilitation in use in veterinary medicine. None of these teaches practitioners foundations in exercise science and exercise physiology-based recovery.

My programs use a combination of a small amount of clinic-type rehab and a large dose of recovery science. I’ve pulled over athlete recovery methods from the “human” side and successfully applied them to the veterinary side of rehab.

My rehab work is designed to teach you how to work with your pet and gain success in recovery

In addition, I have certifications in pet massage, canine rehabilitation, human strength and conditioning, and wilderness medicine, to name a few. I use information from a wide variety of experiences to help pets recover or to improve sporting conditioningMore here…

 

Nside Texas MD Rehabilitation and Conditioning for Animals Article by Heather Daniels

Other “Official” Information –

Check out my semi-updated profile on  LinkedIn

We discuss lots of issues on this site, so I recommend you look through the Q&A. Please use the search box to find specific topics. More info about how to get the most out of this site is on this page, How Do I Find Help For My Pet on This Site?.

Rehabilitation and Conditioning for Animals is subject to guidelines overseen by the Texas Board of Veterinary Medical Examiners (TBVME).  Therefore, I do require that your pet has recently gone to their veterinarian for acute issues. Additionally I require that your pet’s veterinarian has evaluated your pet within the past year for any chronic issues. I also need to be able to communicate with your pet’s regular veterinarian about the issues I will be addressing.

I do not need a referral from a veterinarian to begin rehabilitation work with you and your pet. The TBVME does not require a referral for me to work with your pet on sport training and conditioning.

After my consults, I direct clients to be in communication with their regular vet to discuss medications, signs & symptoms, and collaborative treatments. Your pet does need to go to their veterinarian if they have a new medical issue the vet hasn’t seen.

Thank you for visiting and I believe you will find useful information for you and your pet!

Rehabdeb

Originally Published February, 2015 and Updated April 14, 2018

4 Month Old Pup Too Active After Spay

Q & A –

Is your spayed pup active? Your newly altered pup bouncing off the walls?

The following question came from a long-time client who occasionally texts to me. My response was given while I was on the road, voice texting concise answers back to her.

After our text exchange, below, I’ll give a few extra thoughts, and here are some more pointers!

Question –

“Hey, I have a friend with a 4 mo old pup who just got spayed. She keeps jumping around and opening the wound. Any ideas to get her tired?” 

Dog caught by the belly in the window blinds
Didn’t Mean to Get Caught in the Blinds. This is NOT the dog mentioned in this post, btw!

Answer –

“:-) Hey! Is she using a harness only and keeping her restricted in a crate or a penned area or restricted with the harness?

All walks should be in a harness with a snug leash, no leeway, restricted always, & also potty on tight leash, 5-10 min out (then back in), & follow the recovery for first four weeks after surgery. Do not walk more, not longer & not dozens of times.

Capillaries need to heal and they won’t do that if she keeps getting her blood pressure up (playing). Splitting the stitches or staples is a secondary problem cuz the stitches are in place so that the tissue can heal, and all the activity is going to tear the healing tissue and open up the healing capillaries.”

Her Response –

Response to my response: “She’s keeping her in a crate. She has a donut (e-collar), but I don’t think she’s keeping her on a leash in the house.”

Further Discussion –

This is a question based on a situation I encounter *all* the time. Pets very often tear out stitches and staples, in many ways and for many reasons.

If a pet you know that has had surgery has torn out their stitches, staples, butterfly bandages, etc, then that pet will need to have the wound(s) and incision(s) inspected and may need to have the stitches replaced. That advice is the smartest I can easily give on this website.

There are many different issues a medical practitioner will be looking at depending on the type of surgery the pet had. This means you should probably just go to the vet and not take a poll of your friend’s and family’s opinions first. If your veterinarian told you at the last visit that you didn’t need to return if the pet tore out the stitches again, then perhaps you don’t need to go. However, if you were told that you didn’t need to return yet you see blood coming from any area, I recommend you have the area evaluated medically.

The pet caretaker mentioned in this Q&A text was returning to the vet for care, to my knowledge. So, the question that they came up with was how to tire the pup so she quit busting her stitches.

Pets can get very excited –

small white plastic open top pen for pets
Small Crate for Bedroom

This is why my simple post-surgical instructions work. I recommend the harness, etc, as I did in my answer, above. Use restrictions. Follow the four-week post-op plan in my booklet. All of this helps keep your pet from damaging their healing areas and encourages healing.

I recommend, in addition to what I’ve already said, to give all pain medications as the veterinarian prescribed them. Please double-check the medication labels. I do that for people when I am in-person at an appointment. You might be surprised at how often people are making mistakes with the medications. Make a chart or record that details when you give the medications.

Positive Vibes –

Follow the restrictions with a good attitude toward them and pass along a “positive vibe” to your pet. Animals pick up on our emotions. I often need to discuss with clients that their feeling sorry for their pet is rubbing off and they need to switch to praise and encouragement with a “normal” tone and voice. More of a “move along, nothing to see here…” attitude, with empathy instead of pity.

Pets feel the worry and pity that their people feel toward them. Often the pet will worry about their people. That usually makes the pet seem “worse”, and the people worry about the pet worrying about the people. In my experience, dogs and people do this cycle more than cats and people do.

I explain more in my booklets about the positive benefits of restriction plus the right kinds of exercise for recovery. “The right kinds of exercise” includes progressive work that is relative to healing and includes many restrictions. I have found that if people restrict themselves or their pets as I urge them to do plus take their pet on specific outings, for potty or rehab work, the people end up doing a lot more attention-giving activities with the pet. This helps the pet to stop being so crazy or anxious in the house during recovery.

I intend to write more on the psychology of how we humans mess with our pets in other posts.

Bottom line –

In this case, the dog doesn’t need exercises to tire her out. In fact, as I’ve said, that will open healing capillaries. Too much exercise obviously caused other problems, too.

This pup and others like her need to start with a structured recovery plan which includes a lot of restrictions.

Rehabilitation is available for every condition known to mess up our bodies. Every injury and surgery should have a rehabilitation plan. No one needs the water treadmill for most surgeries or injuries, and we don’t want or need to put a newly spayed pup into a water treadmill. What’s can you do? Recovery in a fairly controlled atmosphere and a thoughtfully crafted work program.

Cheers!

Rehabdeb, April 7, 2018

 

Rehab for Pet Surgery – 3 Steps

Spaniel dog with plastic Elizabethan collar on her
Jicky the Spaniel in the E-Collar after FHO

A quick bit of info for you after your pet has had surgery.

I do work on lots of cats and a variety of other animals. If you want to know more about cat specifics now (because I haven’t finished developing the cat pages), please search for cat in the search box 🙂

For more specific info on a particular surgery or diagnosis, please refer to the menu (and drop-downs) at the top of the page. If you do not see what you are looking for, please use the search box on each page.

If the injury is a torn knee ligament in your dog, and you have been told surgery is necessary but you have not yet taken your dog to surgery, then please click here to read more info about that condition. After that, please go to the instructions on this page!

 

“My pet just had surgery…
…and now that I’ve gotten them home, I realize I’m not really sure what to do!!”

First and foremost:  pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction about an injury.  Please pay special attention to the part about no running, jumping, or playing. If you follow my booklet instructions, you and your pet will be doing work proper for recovery and should not be causing any harm.

If your veterinarian did not say so, please note there should not be any flying over couches, no galloping on stairs, no jumping into or out of cars and trucks,  no jumping onto couches or your bed, no jumping off of couches or beds, no twisting very fast in tight circles, no sliding on ice or slippery floors, and no freedom in and out of doggie doors.  No owner jumping out from behind things to scare the dog into running crazy funny around the house like you sometimes like to do.

No running really means no running…

…to the door when the doorbell rings, no running away from Halloween costumes, no running from one end of the house to the kitchen every time the fridge or a plastic bag is opened, no running to you when you yell to ask the dog if it wants to go outside, no kitty running from anything right after surgery, and no running inside after the ball, which is very similar to no running outside after the ball. No, no swimming until at least 8 weeks after surgery and then only if no lameness is present at a slow walk.

DO work on the protocol below and the info contained in the instruction booklet.

1) Here are guidelines to follow for the first four weeks after surgery:

Right now I only have one book published with information about helping your pet through four progressive weeks of functional therapy and recovery after any surgery. Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

This book is specifically addressing surgery after a torn knee ligament, yet until I am able to publish the books I am working on that deal with hip issues, other knee issues, elbows, spinal issues and more, this book will be very helpful to you for the first four weeks of recovery if your dog has had one of these other surgeries.

This book has the information, restrictions and advice I would give after almost any orthopedic surgery, so if you follow the restrictions and the practical applications in the booklet, your pet should do well and recover progressively if there are no additional issues.  These restrictions will match a lot of what your vet surgeon gave you to follow after surgery.

Additionally, these instructions incorporate information for functional recovery, my specialty, so there is a LOT more structured and guided info in the book. The links to the book I made for this page will take you to Amazon U.S. and if you would like the links to Amazon in other countries, read below the picture of the book.

I also have info elsewhere on this site about cats and surgery. Cats aren’t small dogs. Unless your cat will walk on a leash, which some do very well, I recommend looking at this page for now.

So, the following book will help you calmly and methodically approach the recovery of your pet’s surgery, and the book will guide you about establishing a functional base of activity. After the base is built, then there are more strengthening programs and other drills to be done to return your pet to a rambunctious lifestyle.

A good recovery plan helps guard against future or further injury, especially in the opposite limb! I am very happy to report that people and dogs that follow both this and the non-surgical program for 12 weeks do not end up with the other knee ligament tearing. It’s all a matter of balancing the work, my experience with exercise physiology recovery principles, and people being connected to their pets!


Amazon for USA, CA, DE, ES, FR, IT, & UKMy booklet with instructions to follow after dog knee or any orthopedic surgery
Amazon in other countries 

Books are also available on Barnes and Noble and you should be able to order them from any bookseller, especially if you use the ISBN.

Instructions for first four weeks for dogs after FHO (hip surgery where the ball of the femur is cut off):

Instructions for first four weeks after surgery for luxating patellas (flopping kneecaps):

and there are a few more homework pages to be found by following the links in the menu at the top of the page or by using the search feature.

2) In addition to thoroughly reading any of that info (some of which now includes exercises available in book form), please watch > this video < twice, and begin to do this massage daily for a month:

Please watch the video to see my recommendations on method of use for massager unit AND so you will hopefully have success introducing the massager.

There are written instructions under the video on the linked page.
Here is what the massager looks like, and if you click on the picture, you may buy it on Amazon if you choose:

Homedics brand hand-held massage unit with four feet

3) If your pet is still limping 5-7 days or more after surgery, please read this > pain post < all the way through!

There is more on the topic of pain within the books-

Check out other resources under the “Rehab Resources & Tools” link in the menu under the website title at the top or by clicking here

 

Blessings-
Rehabdeb

(Original Post March 17, 2015. Updated March 3, 2018)

Fighting Foot Drop in Humans Translates to Pets, Too!

Fighting Foot Drop in Pets

This Post:

  1. Helps you understand why the foot doesn’t go flat on the floor
  2. Gives you suggestions to fix that condition
  3. Helps you see how human rehabilitation can be helpful for pets

RehabDeb Comment:

Employing these techniques for foot drop in pets is what I do and is highly successful. You may also build neuromuscular strength in pets by doing proprioceptive training.

Boots and Splints –

I use foot-bed hard splints and  dorsi-flex assist soft boots on a case-by-case basis for foot drop in pets. Both of these helpful tools serve a different purpose; they are not necessarily interchangeable in use!

People sometimes order a soft boot with toe flexion help when they actually need a hard splint and vice-versa. Please confer with an experienced rehabilitation specialist who has used both of these products. They should have experience with a large variety of cases so that you don’t waste resources or damage your pet.

I also urge you to listen to your common sense in the matter of braces or splints. Sometimes staff at brace or splint companies have suggested to mutual clients equipment that is too generic.

The course of action with assistance tools should be based on a broad problem-solving thought process. Each client will do best with a solution unique to them. I have had discussions with physical therapists at brace and orthotic companies to point out functional and physics errors in their designs for some few cases. I love that orthotics for pets are available! Getting the wrong fit leads to unnecessary expenses, possible pet injuries, and not as much help with recovery. Plus you have to spend lots of time on the phone working out the problem. Meh.

Making Braces at Home –

See the end of this post for a brace I made for Anatolian Shepherd Parker with hind limb dysfunction and partial paralysis. I purchased the materials at local stores for less than half the cost of commercial boots. This method was less expensive, however the client had also paid for a commercial boot I measured and ordered.

We needed the boot right away and the boot we ordered was going to take almost two weeks to arrive. I wanted to give the caretakers proper tools for the situation and use those tools to avoid paw dragging and new sores on the top of the paw. The commercial boot works better, in general, than my temporary boot. If I spend more time on my creation boot, then it works as well as the commercial boot. Regardless, we had mine to help in the meantime while we waited for the other one.

I create many helpful tools for pet rehab on a case-by-case basis. I know what results I am hoping to achieve and have a lot of MacGyver-type experience. If you try this at home, I recommend you get a veterinarian or a human physical therapist to help you with design. These professionals should have the most experience with neurological problems and help your pet get the best results.

The standard education for most veterinarians and veterinary rehabilitation specialists does not train them in advanced neurological problem drills. I am not slighting them; I am guiding you so that you may have more options for helpful tools. That is why I suggest a human physical therapist, hopefully one with lots of neuro experience. Your veterinarian will usually tell you if they have a lot of advanced experience with diagnosing and recovering neurological cases. Many veterinarians do not have this experience because of the advent of great veterinary specialty education. Board-certified veterinary neurologists are a thing.

From “Advance Journal for Human Physical Therapy”

The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen

Originally Posted on: December 20, 2012

Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.

A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.

Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.

Gaining Control –

The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.

“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.

Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.

“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?

After Diagnosis –

Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared. (Flaccid limbs or muscles in pets are the ones that need range of motion drills, NOT limbs that the pet moves moderately well on it’s own – Deb).

According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.

“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”

Focus Work –

We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.” (I focus on these principles with my patients that have neurological problems-Deb).

Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.

“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.

The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.

Enter the AFO –

If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.

The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.

Goals –

“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”

Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.

The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”

In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.

FES, Another Option –

Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.

The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.

Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.

“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”

The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements.

AFO or FES?

“If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and [you will have to use] a passive AFO system,” Thomas shared.

If disease or injury interrups the patient’s spinal cord in any way, then retraining the muscles is often very difficult.

An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments. Those conditions will all interfere with operation of a foot drop system.

Complying at Home –

For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”

Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and go through the exercises the first day and send them home with illustrations. During a quiz at the beginning of the next session I will ask them to demonstrate the exercises I assigned.”

With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”

Therapy When?

When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”

Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier.

“There was a lot less I could do for her compared with what I could do right after her stroke”. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”

Rebecca Mayer Knutsen is senior regional editor of ADVANCE and you may reach her at atrmayer@advanceweb.com.

(Updated February 23, 2018)