Water Treadmill is Not Necessary for Your Pet’s Rehabilitation
Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of these dogs with ruptured ligaments that are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery after initial veterinarian assessment for surgical repair after the torn ligament, there are relatively very few rehab clinics in the world and fewer still with water treadmills…as compared to the number of these dogs with ligament tears, etc…
Dogs of the world do relatively “ok” in all areas of the rehabilitation treatment spectrum after torn knee ligament and/or meniscus and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery performed on their dog, regardless of the size of dog (even), the dog would have to be euthanized. Just wanted to clear up that bit of misinformation (much to your delight, I hope).
That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation in 2004 with approximately 25 years experience in human sport science, functional program design, and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.
I became more aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within small animal veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.
I also believe the introduction and overuse of the water treadmill in small animal medicine is due to a misunderstanding of the science that exists regarding functional physical recovery and a misapplication of “human” based machines and protocol from physical therapy models. Also, the use of the wtm was brought over into small animal veterinary rehab I presume because it has been such a great tool in equine medicine and has been for decades.
Quite simply put, horses and other very heavy animals often struggle with pain after injury/surgery, and the pain control medicines and protocol that exist for (especially) horses do not often alleviate pain as much as we’d like to see. That, coupled with the sheer weight of these large animals, can really do additional damage to a healing body. The water treadmill for an animal that weighs a ton or so is a godsend, I’d think. In those cases the water displaces just enough weight so as to encourage appropriate exercise protocol while building recovery and assisting with pain control (because all the weight isn’t on the damaged limbs).
Water treadmill for horses or other very heavy animals is extremely helpful for recovery. Water treadmill for smaller animals is not necessary, often a trauma to the pet, often an unnecessary additional cost to the pet caretaker, and definitely overused. After a week of easy recovery post-surgery the pet should have enough analgesic available (and dosed) and should definitely have ability to walk on dry land and should be pursuing a controlled plan daily in the home environment.
Unfortunately, I found that what is not taught within this same model of small animal veterinary rehab is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.
What does this mean to you and your pet (primarily dogs…)?
The chief complaint I hear from people who contact me is that they were referred to a veterinary rehab clinic or three (no, not all clinics are the same) for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other cookie-cutter things, the pet is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious.
Their pet isn’t where the owner thought they would be after surgery.
When I was in a clinic setting and working on utilizing the wtm we had and I helped design, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realized by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.
Overall, over time, and according to decades of research, however, the most benefit is realized by work on dry land, where possible, using gravity to strengthen bones, connective tissue, and muscle. I began developing protocol for just that for small animal rehab since I did not find any published when I arrived on the scene in 2004.
Your pet will use their leg to some extent and will use it increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds and hundreds of cases, some having had surgery and some going the conservative route. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the pet and the owner.
If your pet is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to
1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol, however I find more benefit and big-picture-science backing the combo use of Gabapentin and Tramadol);
2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or
3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.
The homework protocol I generically recommend is found here. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.
This info about pet limping and pain could apply to almost any orthopedic surgery… and some of it applies to almost all injuries as well!
Pet limping after injury or surgery is overwhelmingly due to pain. The pain is caused by one or more of the situations I introduce in this post. Continued pain is so common that this post on my website has been the most visited post for over a decade. The most common answers I give to questions about limping are as follows, based on what I have found true in my practice:
If your pet is limping, your pet is very likely in pain.
Many clients say they don’t think their limping pet is in pain and/or their vet said their pet isn’t in pain. Trust me, limping is usually because of pain.
If your pet has on a bulky bandage, as Jake does in the photo, and your pet is limping, it is likely because of the bandage or cast, that they are bulky…and there may also be pain.
Eating, Drinking, Happy –
Eating, drinking, running, tail-wagging… if your pet is doing some of these things, it doesn’t mean they are not in pain. (Hint: Most pets shouldn’t be running anyway after surgery)
In contrast, if your pet is NOT doing these things (wagging, eating, drinking, seeming happy), that could indicate pain.
There will be general pain on average for about 2 weeks after surgery, because…surgery. Plus, sometimes the surgery doesn’t go well or complications occur with surgery methods. In those cases, the pain will last a lot longer.
There may be other pain, on top of general pain, due to overuse of the body part that had surgery and…
There may be pain due to an obvious or a hidden infection. This one happens A LOT.
Lesson is: your pet can be in a lot of pain and could still be wagging their tail, eating well, and chasing prey!
That’s the short answer section.
Your pet is not limping “just because he/she had surgery”
I put part of that sentence in quotes because many times I’ve heard people (clients, veterinarians, clinic staff, etc…) say the pet is limping because of surgery or injury as if surgery and injury are somewhat abstract and causing the pain. Surgery is painful, and torn ligaments and other soft tissue damage are painful, too. Your pet is usually limping because they are in pain.
I try to bring people around to understanding factors other than a good surgery or injury can cause the limping. Pain is the #1 reason for limping. Additionally, injury is painful, surgery is painful, infection is painful, bandages are awkward and may cause a feeling of instability, torn connective tissue may lead to a feeling of instability, and all these factors can contribute to limping.
When we work out a cause for the pain/limping/lameness, then we may work on more correct solutions to the problem.
Your pet is limping because he/she is painful after surgery (or injury) in almost every case.
Your pet should not be limping more than a couple of days after surgery if
1) they have enough of the right pain medications,
2) don’t have an infection,
3) the right procedures were followed in surgery,
4) your pet didn’t destroy the surgery by chewing or with too much incorrect activity.
I have worked with many pets that have limped or been lame more than a full year after surgery. In some cases the lameness has been going on for a few years. Some of these limping cases are because there are problems with the surgery.
All of my cases have improved when we have done the right work as best possible for the true problem causing the lameness. This may mean getting x-rays to check the surgery if there was surgery. This may mean getting another opinion if necessary about post-surgical limping. You may need to try out antibiotics if the other factors I’ve mentioned are all eliminated. You may also need to get better pain management drugs plus use them to the best benefit to go with rehabilitation work.
An exception to the “limping due to pain” rule would be as in Jake’s case (above photo), because if your pet’s surgeon is using a bandage on your pet after surgery, the bandage or cast will be a little awkward. The awkwardness will make your pet walk funny. Your pet will probably act a little weird with the bandage in place. They may not want to walk in the bandage, they may be a drama queen, they may take exaggerated movement strides, etc…
Most surgeons have discontinued bandaging after knee surgery.
Don’t worry that your pet does or does not have a bandage after surgery. Without bandage is proved to be best in general.
Whether they have a bandage or not, most pets will do best with the e-collar around their neck until 2-3 days after stitches or staples are removed if they have had surgery.
The post-surgical or post-injury pet limping is not an abstract limp caused by mystery forces.
The limp and lameness have overwhelmingly turned out to be because of pain, in my experience with hundreds of cases.
With right amounts of pain medications for your pet’s particular situation, body chemistry, and processing ability, the severe lameness almost always stops. Sometimes “right amounts” of pain medications for your pets particular situation” includes antibiotics. The “particular situation” may be a sneaky little persistent infection. Medications for pain usually do not help very much in combating infection pain; usually only antibiotics will stop infection pain.
Next step is often to try a course of broad-spectrum antibiotics. Infections are not always hot, not always swelling tissue and joints, and they do hurt! At the same time, your veterinary team should be checking out the surgery area to see if it is in tact from what they can feel. They will likely want to do another x-ray to see what is going on inside your pet. This is a good idea in most cases; an x-ray shows random surgery failures as well as cloudiness from swelling in the area, among other things.
If the pet limping does not stop after thoughtful application of treatments I have mentioned in this post, then other factors may yet need to be discovered. Again, your pet should not continue limping more than a day or two after surgery if the above factors are met. The same goes for pets that have had re-do surgeries; if they are limping, there are other problems. The main problem in these cases is usually not enough of the right pain medications.
There is probably some “odd” discomfort and/or feeling of instability after surgery or after those injuries that involve tearing or rupturing of supportive connective tissue, and…
Maybe things feel a little “different” or unstable to your pet. Usually you will notice pets being reluctant to walk on slick floors or are using more caution over tricky surfaces when they feel unstable. I have torn connective tissue in my shoulders, hips, and knees, and I find that I guard my body while doing certain movements. Sometimes I subconsciously tend to be suspicious of my joint’s dependability in some situations. I have been active in body science for many decades, and I know my body well.
This body guarding happens in pets, too, and overcoming this disuse is a big part of my work on them and with their humans to achieve better overall function.
I do in-person and phone consults to help people help their pets to solve pain issues. I will write more on topics that are introduced in this post. In the meantime, please search the words “infection” or “pain” in the search box. Please look over the Q&A and some case stories on this site. I have hundreds more stories than I’ve had time to post, and I’d like to post them to help you. I will as time allows 🙂
It is often a LOT of work to get to the bottom of continued limping problems. In my opinion getting to the bottom of limping diagnosis takes so much time because
1) people do not know that their pet should not be limping after a few days in most cases.
3) veterinarians are hesitant to override the medications the surgeon has given.
Sometimes they are not well-versed in multi-modal pain moderation. Most doctors are not taught a lot about pain evaluation and pain control in school. What your vet learns about pain control is mostly from drug reps, journals, through word of mouth from colleagues, from conferences, and personal experience working with hundreds of cases. I have also learned this way over the decades. Personal experience with hundreds of cases is the best long-term teacher if the learner is open to making changes and solving puzzles.
If you can get your veterinarian to work with you on the steps I mentioned while you are following strict restrictions anda program like mine, then you will be able to solve the limping issues much sooner. I have a local “team” of veterinarians who have come to understand working on pain in a more focused manner. Some are members of IVAPM and have worked on discovering more about animal pain. Some of them also perform acupuncture as therapy for pain, and often the client and I bring one of them onto the evaluation and treatment team. More on this later or elsewhere on this site…check Q&A for now.
These are some basic bits of information for your thought. I mostly deal with continued pain cases, surgery complications, non-surgical interventions, and neurological cases. Daily I work with people and pets to help them pursue avenues to in order to get to the bottom of things and reduce or eliminate pain.
If you would like advanced or personalized exercises, then please contact me for a consult. There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
Blessings – Deborah
(Revised January 27, 2018. Originally posted 2007)
Femoral Head Ostectomy/Removing the Ball off the Femur at the Hip Joint
First and foremost: pay attention to the discharge instructions your veterinarian has given you. During this surgery, there was cutting of muscle and other tissue that will require care and time to heal. You do not need to wrestle with your dog in order to apply ice to the surgery site; I no longer recommend icing nor prolonged use of anti-inflammatory medications after most surgeries or injuries in keeping with the advanced research findings over the past 5+ years.
While other tissues are also disrupted during a FHO, muscle requires a little over six weeks to achieve a normal collagen ratio and will take longer to heal more fully. This should be considered when you think your dog is ready to chase squirrels at two weeks after surgery. Don’t let them if you hope for the best outcome from the surgery. On the other hand, the bone that was cut does not require the same care that a fracture repair or a TPLO would; there is no need to be concerned that you will cause further damage to the bone with exercise.
In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery by promoting hip flexion and extension through therapeutic exercises that stimulate leg use, leading to muscle strengthening and avoiding chronic disuse of the operated limb. Since the dog will move as they are comfortable and are made more comfortable with the right amount of the right pain medicines, I DO NOT recommend pet owners try to do range of motion.
After about five days, and especially if your dog is not using the leg much, then I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your dog. Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine along with the right kind of exercise at the right time helps achieve this, and it seems the medications are needed for an average of eight weeks for dogs after this surgery, if not more. No, as popular as it might be, your dog does not need a water treadmill workout to start walking again!
In light of this information, I believe the best outcome from surgery will be realized with a rehab consult from me to give instruction and homework specific to your pet. In-person consultation will always be better than the generic homework given over the internet. Otherwise, until I publish the booklet for specific post-op instructions after this hip surgery, please follow the first four weeks of work outlined in this book:
All of these exercises should be done very slowly so as to encourage more weight-bearing. When the dog goes too fast, he/she can “cheat” and not use the repaired leg much or well. Too fast could also prolong the inflammation and pain as well as create additional damage to the area of the muscle at the end of the femur hip and upper thigh muscles. Too fast and too much activity will elevate blood pressure and likely cause the blood vessels to open up inside…keep calm and allow the vessels at least two weeks to heal.
We hope to create a slightly and increasingly calloused area in the muscle tissue at the end of the modified/cut femur. This will make the tissue feel the end of the bone less and less and will create a cushion of sorts. You can do this with the moderate & slowly increased exercise I begin to outline in the book…slowly increased exercise…not randomly increased because you think he’s better and able each day…slowly according to the plan I’ve written or one similar that allows for adjustment and healing in the body. I write these words having worked hundreds of cases that were allowed to do too much too soon, and it’s much harder to heal under those conditions 🙂
Running & rambunctious play during this time will upset the scar tissue I want you to help your pet create. On the other hand, not enough exercise, which is usually the problem after this surgery, results in too much scar tissue all around the hip, and your pet will experience decreased mobility and more continuous pain, especially when she is technically at a point that she may play and be wild. I often see these dogs months after surgery and they are still not using the surgery leg well.
If your pet is not using the operated leg after week 1, then I recommend calling your veterinarian or me for rehab intervention and to get them started on beneficial exercise. Range of motion is not an exercise that will be most beneficial at this time. With proper pain control, with good pain medication, your pet should use the leg for the exercises I outline in the book and in the future.Water treadmill is also not necessary for recovery from this surgery. If you follow the exercise prescription well and after week 4 of work would like advanced exercises, then a rehab consult is necessary.
I have some separate recommendations for cat FHO’s .
If you would like advanced or personalized exercises, then please contact me for a consult. There is a contact form atthe bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
Some Examples of Cavaletti Equipment my Clients Have Used in their Home Environments –
Since my practice is mobile, I look around the client’s home or workout environment to find cavaletti equipment or tools to get the (obstacle) work done. These drills are for proprioceptive benefit as well as range of motion and isometric strength building.
Cavalettis should technically and scientifically be done only after establishing a base with this program.
I look around the home environment to help people with ideas that are inexpensive and easy to set up the right size and spacing of cavalettis for their pet. Finding options for the right kind of obstacles in the home environment makes it easier for the people and the pets to be compliant with the work. Less time demand and easier access makes for greater compliance. Even if people have to buy stuff to use for these drills, sometimes pool noodles or something from the home supply store, these tools are inexpensive.
I lined up these bricks along a house to make range of motion and isometric drills for a mid-sized herding dog with non-surgical rehab of torn cruciate ligament.
Later, her person caretaker raised the bar by raising the bar and building a more elaborate brick-scapade across the back yard!
This was the cavaletti path for a large Pit/Lab X doing non-surgical rehab for torn cruciate ligament and torn meniscus. She also had a tarsal (ankle) injury that I discovered at the same time!
This client was unable to work her large, happy, strong dog outside with much success. She had great success doing all the advanced drills inside the home.
She also didn’t have the right size and type of items for the drills lying around the home, so she spent a little bit of money on wood. After doing the introductory drills at this height, the client then placed flat 2×4 blocks under the ends of the boards to raise them.
After several successful sessions at an introductory level, pets need to continue the drill at increasingly higher bar levels. For videos of cavaletti instructions, click here!
This client bought wood, nails, and pvc –
This was level 2 cavaletti height for a Goldendoodle doing non-surgical rehab for torn meniscus and torn cruciate ligament. She also had hip pain issues that after muscle atrophy from the knee injury. This resolved after she started my program for muscle-building and received the proper pain medications from her veterinarian.
The next level for her was to put 2 x 4 blocks under the pvc. You already see that in the picture.
These were from the woodpile out front at this mid-sized dogs home. I set them up to help her recover from her neurological event, an FCE (fibrocartilaginous embolism). I directed them to begin this work only after completing my base work of fitness and muscle strength.
Yes, these ARE speaker stands inserted into milk crates. Only in Austin, TX (and maybe Nashville…)
I DO work with many cats. This one is Kacey, and there’s a vid on this siteof her doing cavaletti repeats…
And this guy is getting a start using his own standard cavaletti equipment he usually uses for agility training. Recovery cavaletti drills are much different than agility training work with jumps. There is no jumping in recovery cavaletti drills. He was working on this drill to help with his disk disease and degenerative myelopathy.
(Original Post November 3, 2014. Updated March 27, 2018)
Homework Suggestions After Cat FHO, Femoral Head Ostectomy (Removing the Ball off the Femur at the Hip Joint)
First and Foremost –
Pay attention to the discharge instructions your veterinarian has given you. Really try to follow them.
These instructions usually include keeping your cat as subdued, quiet, and inactive as possible for at least two weeks, preferably with only controlled activity for 8-12 weeks.
I highly recommend that you do not allow your cat to play; no cat rugby, no toys to pounce, no “I’m still the bossiest kitty” smack-downs from the surgery kitty to the other kitties, no smack downs from other kitties to the “wounded” kitty, etc…and definitely no jumping onto things for 8-12 weeks.
Escape Artists –
Given the opportunity, it is highly likely your cat will escape from you upon arriving home from the hospital. It will probably immediately occur to your cat to promptly and speedily dash to some hiding place. The best hiding place is one where you cannot reach them. You know.
It is better to keep your cat in their crate, and when you arrive home from the clinic, keep kitty in a place of your choosing to oversee them during this time of healing. I’m pretty sure controlled restriction from the beginning will work out best versus pulling your cat by the armpits or hind feet out from under the bed.
I do recommend that you shut the doors to the bedroom, closet, and bathroom, if your cat does escape. That way when they do come out from under the bed, you will have a better chance of collecting them and getting them back into a crate.
Surgical Cuts and Recovery –
During this surgery, there was cutting of muscle and other body parts that will need care and time to heal.
The muscle that was cut into during the FHO requires a little over six (6) weeks to make a normal collagen ratio and will take even more time to heal fully. You should consider that info when you think your cat is ready to jump onto high places at two (2) weeks after surgery. Don’t let them if you hope for the best results from the surgery.
Use the E-Collar –
A hard e-collar will almost always work the best.
A soft e-collar will not work if the pet can get around it to lick their surgery site.
Scar Tissue –
Just as in recovery from canine FHO, we count on the right amount of the right kind of scar tissue to help stabilize the joint after surgery. This scar tissue only forms correctly under the right circumstances and over a couple of months of doing the right activities.
Too little of the correct activity allows the scar tissue to bind and tighten tissue in the hip area. Too much activity, especially dynamic or rambunctious activity, tears the scar tissue that is forming and causes extra bulky scarring.
Sometimes scar tissue bulking is removed in over-active dogs. I do not personally know of anyone who has paid for a 2nd surgery to de-bulk their cat’s hip scar tissue. I do meet cats with lots of problems moving their leg after FHO due to excessive scar tissue. There are other reasons why they may have trouble moving the operated leg, too.
On the other hand, the bone that was cut, the femur, does not need the same care that a fracture repair would; the head of the femur was cut off completely. There is no bone healing from bone to bone, as there is after a fracture.
You do not need to wrestle with your cat to apply ice to the surgery site; I no longer recommend icingacross the board after most surgeries or injuries. Advanced research findings over the past 10+ years support this. I do recommend using ice if your cat is in pain and therefore probably isn’t getting enough of the right kinds of pain medications. There are many reasons for pain after surgery, and dosing the right medicine(s) for your pet should encourage body use, whatever the problem. I have more info on icing if youclick here.
In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery. The false joint is the pocket area of proper scar tissue that forms by slow, repetitive weight-bearing movement. The best way is to promote hip flexion (bending) and extension (stretching out) through natural therapeutic exercises that stimulate leg use, not range of motionexercises. Natural leg use drills lead to muscle strengthening and avoid chronic lack of use of the operated limb.
Range of Motion? NO.
Since the cat will move on their own when they are comfortable and become even more comfortable with the right amount of the right pain medicines and restrictions, I DO NOT recommend pet owners try to dorange of motion (ROM). I have a paper discussing thathere.
I know it is popular for veterinarians to recommend ROM after surgery or injury. Please read the papers I referenced ^^. And thank you 🙂
So What Do I Do?
For comfortable and progressive results after surgery, I recommend working on some of the rehab activities noted below:
Some cats like going on leash walks with their peeps, and if your cat is one of them, then you may follow the standard foundation-building homework I write for canines. You may want to try to carry out that homework even if you have not previously “walked” your cat on a leash, either inside or outside. Please use a harness to introduce this walking activity. If your cat is one of those “paralyzed” cats in a harness, then perhaps regular walking won’t work as soon as I’d like it to. It’s up to you; play around with it, but again, don’t get into a wrestling match with your post-surgical cat.
During the first two weeks especially, we want your cat to walk and stretch and use their operated leg in a natural, yet controlled way and with moderate to slow movements. Any walking is fine, i.e., to the litter box, to food and water, but avoid pouncing, jumping and dashing altogether or as much as possible.
Structured Walks and Movement Drills –
If your cat is using the leg pretty well a day or two after surgery, then I urge you to slowly increase the time of consistent leg use and otherwise start some structured walking at five days after surgery.
If your cat will not go for structured walks with you, as outlined and as described above, then another possibility is to use a favorite treat to coax them to walk slowly across the floor. You could hold up the treat at head height and crawl along with your cat to get them to walk along in a continual gait pattern as best possible, trying to get to the treat. Two to five minutes of this walking a couple of times a day for the first week will be beneficial for the cat and possibly hard on you. Because…crawling on the floor.
You may also use this same treat method while another person holds the cat on a leash and a harness to introduce the concept of leash walking. If you can accomplish the leash walks, the kitty rehab work should be easier on you.
Some cats will follow a string or feather, etc…pulled slowly across the floor, and you may only use this method if your cat will walk sluggishly. Again, slow, progressive, tissue-building exercise…no pouncing now. Many cats will wait for distance between themselves and the item and then pounce on the string or feather, so use your knowledge of your cat to make good choices. No pouncing until after six weeks or more, depending on rate of recovery. Never less time.
The Goal –
The goal is to encourage enough continual, weight-bearing leg use to create a callous of scar tissue within the compartment where the top of the femur bone now rides. This is very much like the callous that forms on your own sit bones as you become accustomed to riding a bicycle or sitting in a horse’s saddle. Get the idea?
I tell people that the tissue we want is very much like what you get when you ride a bike a lot. If you have not ridden in a while and you go out for a longer ride, the bones at your seat will likely feel like they hurt the next day when you sit in a hard chair. People who frequently ride have scar tissue that operates as padding between bone and tissue. After a couple of riding sessions, the appropriate scar tissue forms and it is no longer painful to sit. The same applies to how much your seat hurts after riding a donkey to the bottom of the Grand Canyon for the first time ever. I’ve not done that, but I hear stories…
This is very similar to the type of tissue I want to see your cat form after an FHO; they need a slow build-up of scar tissue to cushion between the cut femur and the muscle, and while scar tissue is forming due to friction from consistent and proper leg use, I don’t want to tear it or otherwise disrupt it with harsh movements. Excessive movement and subsequent tearing could lead to formation of more bulky scar tissue which makes it harder for the leg to move and sometimes causes nerve pain.
Similarly, we don’t want to allow the animal to not use the leg, because scar tissue will form that will bind the leg into a place of reduced function and it will always then hurt to do some favorite activities in the future.
Not too much, not too little.
Too much activity and/or abrupt, jumping movements could tear up the scar tissue we want to form and instead create more “bad” scarring from the new damage. Eventually, with too much activity, there could be a bulk of scar tissue and increased pain from that.
Bulking doesn’t seem to happen as often in cats as it does in dogs, primarily because they may not weigh as much, and therefore do not put as much pressure on the surgery leg when doing the wrong activities. Cats are also in theory easier for people to control after surgery, in contrast to the large Labrador that has an FHO and caretakers that let it run amok.
That extra, harsh, impact pressure is what can cause the top of the cut femur to tear into the healing area where instead we’d like to have a callous of scar tissue form. Slow, steady, easy exercise encourages the best healing in most cases.
Deeper Problems –
After about five (5) days, and especially if your cat is not using the leg much by then, I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your cat.
Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine helps achieve this, as do other pain “helps”. In my experience the medications are needed for an average of four (4) weeks for cats after this surgery, if not more.
No, as amusing as it might be, your cat does not need a water treadmill workout to start walking again!
Too Much Femur Remaining –
Another common problem after FHO is that not enough of the femur head was removed during surgery. This could mean that the remaining bone is too tall and continually cutting into surrounding tissue. This could also mean that one piece of the femur is jutting out into the surrounding tissue and cutting it. I have seen this occur many times in dogs.
If I am asked to review a case and I suspect that there is too much femur head remaining, I ask the client to get a post-surgical x-ray from their veterinarian, preferably the veterinarian who did the surgery. This can help confirm the situation I described above. It is standard procedure to take an x-ray after the surgery, so it shouldn’t cost you additional money to get that x-ray for your records.
Not Another Surgery!?
Many times people do not want to put their pet through another surgery. I have helped pets recover from the “too much femur” condition many times. The recovery in these cases (and in the cases I help recover without surgery) occurs by building out the thigh muscles, and that occurs with a lot of the right kinds of exercise drills. You will also need a lot of pain medicine.
Water treadmill work can take the place of pain medicine in some rehabilitation cases, but on the whole, rehab practitioners spend too much time on the same work volume when they rely on the water treadmill. It is also not very practical to work most animals at a clinic in a water treadmill, especially when you have these programs available to use at home and if you have dealt properly with causes of pain.
I frequently take over rehab cases wherein the pet has been working on the treadmill three times per week for months and hasn’t improved past a very basic point. More on water treadmill.
If you are going to “fix” the extra femur piece problem without surgery, you will have to invest in a structured pain control protocol with your veterinarian. You also need exercise drills designed by a strength and conditioning specialist who understands sports medicine rehabilitation. I am definitely available for in-person or phone consults regarding this situation.
Or, get the second surgery.
Timing Medications & Drills –
You should also time medication dosing so that the pain medications are helping with the exercises. I recommend doing the drills or walks or other exercises between 45 minutes after giving the medications and up to 4 hours after dosing. Follow the recovery time I recommend in-between drills. If you have more questions about this, please see this book and these instructions for now.
Extending and Stretching the Surgery Leg –
There are a variety of easy and healing ways to get your cat to stretch out that operated hind leg. Any may be utilized as long as the end result is not further injury. I find that with careful restrictions and exercise, along with proper pain medication, cats will usually come around to using their leg as well as ever, if not better, without anyone stretching it or forcing movement.
If I meet a cat patient more than six weeks after surgery they should be using their leg well. If they aren’t using the surgery leg in extension, I will check to determine if there is crunchiness in the hip area. Crepitus at the hip after FHO often indicates that there is a piece of femur sticking out into the tissue. This is usually causing pain. See discussion about that several paragraphs above this one.
I check for crepitus or issues with the incision area, discussing with the veterinarian if need be, and clear the cat from other medical issues, so far as we are able. I then work on exercises and drills that encourage the cat to stretch their surgery leg on their own.
Continuing Work –
Sometimes I get a cat to extend from the floor to a couch, slowly, for a treat or toy. They leave their back paws on the floor and slowly reach up with the front. Then I draw them back to the floor again. During the first four weeks this method only works best if the cat does not end up jumping onto furniture. A stretching drill like this should be done 2-4 times per day with 10 repetitions each time. Please allow your cat to rest and recover at least two hours between exercise sessions.
After three weeks of base-building exercise then you may begin more structured play. This work should encourage stretching, leg use, and muscle strengthening. You can use a feather in the air that your cat will rise onto their hind legs and bat. Two to three minutes of this type of play or twenty repetitions at this time, twice per day is beneficial.
At four weeks, if your cat will walk with you up and down stairs without bounding, start stair walking. Some cats will follow the owner for continual repetitions. Other cats will need a leash and harness. Some cats will walk away. Do what you can, and keep in mind that several easy repetitions of continuous movement are needed to encourage recovery. Sporadic activity will not build the base your cat needs to flourish.
After Building a Base –
Where and when possible, a set of 5 x 8-10 stairs once every other day could be a good workout. Any slow climbing is better than none, only after building a base first. More repetitions in a row are better for the muscles than only one or two stairs here and there.
By three to four weeks, your cat will be wanting to run around more. They will function as if they are ready for all the “usual” household activities. I recommend you avoid harsh movements during healing. This is so your cat doesn’t tear the good scar tissue that has already formed from following these instructions. Capillaries also need time to heal after any surgery.
If your pet is not using the operated leg after week one, then I recommend calling your vet for recheck and pain medications. You may also contact me for rehab intervention and to get them started on beneficial exercise. Of course you may show this plan to your veterinarian.
If you follow this exercise prescription well and would like advanced exercises, then contact me for a consult. There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your cat.