Successful Rehab Without Water Treadmill

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.

Thank you!

Jicky E-Collar

CAVALETTI (OBSTACLE) VIDEOS

Dog Cat Cavaletti Obstacle Drill Basic Methods and Videos –

Kacey Cat Does Cavaletti Work

Kacey has neurological problems in her hind end. I have been performing laser therapy on her and working on finding exercises that will benefit her quality of life. Her “mom” and I discovered during one visit that she would walk one direction across a particular section of the bar top to get to some place her kitty brain holds special…so special that she will repeat this action many times.

I placed 5-6 remotes across the bar top, and Kacey is to make 5-6 passes over all of them, every other day, doing it all at one time.

She has improved much around the home, and we made some other exercises work for her too.

She is working on losing some of her “extra” girth, too.

Popi Working on Cavaletti Drill Form

 

Watch with CC enabled to see my comments during the vid.

Popi does cavaletti drills AFTER doing my foundation-building drills. He is doing a great job, although he goes a little too fast.

Great improvement since he would not use his surgerized hind leg a few weeks earlier. He had a hip surgery, FHO, and there were problems with the surgery. Popi did NOT begin with his cavalettis this high; he built up to this height for best success.

See elsewhere on this website for more instructions on cavaletti work. Yes, the video needs work. I am a one-person show with tons of demand on my time. You can watch this and get info you may need without the vid being perfect. Keep calm and carry on…

Introducing Cavalettis –

a short vid with verbal pointers about introducing your dog to cavalettis-

Over time, I hope to improve all my videos. This one was filmed in 2015, and it usually takes a while for me to add vids to this site. Regardless of the quality, you will find some helpful pointers in this demo.

Maya has already finished base-building work to recover from torn knee ligament and from hip dysplasia. She was my client for many years, off and on, when she wasn’t racing around her back yard and playing dog tackle.

Maya is a pro, as you will see in the video. Yes, you may try this at home. It will not make sense to try this exercise though before building a foundational leg use base. Please follow my program(s) to get the best results.

The internet is full of “good ideas” from people who don’t have experience with fixing major injuries across many species and over many decades. I frequently help clients who first tried good ideas from the internet or from friends or rehab practitioners who don’t have much broad experience. Unfortunately they destroyed a surgery or complicated an injury. I know it’s really hard to decide whom to believe when peeps give advice. Start slowly and advance thoughtfully. There is a science to the wonder of the universe.

Blessings-

Rehabdeb

For photos of a few different ways clients have designed cavalettis, click here!

Original Published November 8, 2014. Updated March 27, 2018. I Also Decided to Start Using Vimeo Instead of YouTube & Maya’s Vid is the First One I Posted 😉

Elderly Sheepdog With Neurological Problems – Homework Review

Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.

To Abby’s Caretakers:

Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I re-evaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains. As always, I am available to do this work and especially if you need assistance because it is hard on your own body or even just to make sure it gets done so that Abby may recover well! 🙂

I can’t emphasize enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:

http://wp.me/p1wSDA-kp

And do it as best possible without cutting corners. You will get the best outcome if you follow the video instructions, and I’d really like it done daily to better encourage healing on several levels. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realized from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.

For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. I chose 15 minutes because you said she has already accomplished doing 10 min walks for a week, 3-4 times per day. Before that, she laid a foundation with 3-4 five minute walks daily for a week. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.

For the week following the twice daily 15 min walks, please walk her 2×20 minutes in the same manner, and only if the 15 minute walks are completed well for a week. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. That’s because we spent time building the base. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not wanting complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt to and accomplish.

I really would like her to wear two supportive hard braces during these walks, and I realize you have only one. She hyper-extends both her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and deficits in this case, and that has been a problem since I began giving you instruction for her over a year ago.

After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my Facebook rehab page that depict several home-based cavaletti designs. Please be sure to read the descriptions below the pictures, because not every type of cavaletti is for every pet 🙂

Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.

After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.

During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month-I’ve had good outcomes from doing this with similar cases.

I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading for the past many months…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.

Thanks!

Blessings-

Deborah January, 2013

Degenerative Myelopathy and Neurological Conditions

Question from the International Veterinary Academy of Pain Management, 2012:

“Does anyone have any recommendations regarding treatments for a 14 year old Husky with Degenerative Myelopathy? So far, the only thought I have is a cart. Also, my understanding is these animals are not in significant pain – is this true? Thanks for any info.”

From: A Veterinarian in the U.S.A.

RehabDeb Response:

Hi!
I apologize for taking so long to reply. I have a 30-yr. background in human sport science and nutrition, worked two years in a veterinary specialty hospital designing and building the rehab dept., and since 2007 have had a mobile practice wherein I serve a huge number of “mystery-ortho-neuro” cases, many of which are presumed to be D.M. (Degenerative Myelopathy) (or, as of 11/2014, may have been tested using protocol at Missouri).

The functional rehabilitation protocol I have developed over time, and which has been successful at improving function to varying, yet notable, degrees is derived predominately from my experience in sport science program design coupled with principles of neuroscience. A body at rest stays at rest and only changes with dynamic interference…
(original RehabDeb quote :))

I DO agree that while D.M. may not produce pain in and of itself, it is highly likely that an animal with any neuro condition has self-induced pain by nature of the fact that they are compensating, stressing tissues, and possibly pinching nerves, akin to when our sciatica or sub-scapular, etc…get impinged and cause us pain.

Pain management discussion aside, for my own patients I introduce a system of simple, vibration-based, massage with a less-than-ten-dollars Homedics unit (see the video elsewhere in this blog), Low-Level Laser Therapy (MUCH research exists regarding nerve conduction, regeneration, re-invigoration), and a plan of return to whatever level of function is possible via primarily-human-induced and animal-activated movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. I prefer to use dry land and gravity, and I work with clients on methods to help them get this work done. Strength and endurance/conditioning drills I concoct depending on each animals status are implemented.

I begin with laser twice a week for a month and review exercise protocol that the owner is charged with doing if they are capable and which I do if the owner prefers. I use a front harness designed for riding in the car that has fleece and the best stitching I have found and only costs $30 shipped from Petsmart (no longer available-2014). This is the Travelin’ Dog harness. I turn it around, and it is “perfect” for hind end support (legs through arm holes, tail through neck hole) while relieving owner back stress, if used properly. It is much better designed for the body than the blue neoprene sling, less pressure on the abdomen than a belly sling, and less problematic than a Bottoms-Up sling. No one pays me to promote these items; I have just found that they are simply the best and cheap, and in my years of experience I deem that they work better than a lot of what is out there. I have pics around this blog of neuro dogs wearing these harnesses.

There are many more things that may be done, however getting the owner started on helping the animal around the home in a manner that hurts neither owner nor animal, and in a manner that is most productive time-wise, is one of the major components of my mobile practice. I tend to not involve owners in activities that, again, would potentially cause more harm than good or waste more time than be productive.

I also utilize a brand of boots with excellent traction, usually sometime along the way but not usually right away. Depending on function-ability I will introduce the boots when I believe they will not encumber the pet and will be more help than hindrance. The right boots always seem to encourage hind limb use when there already is function and they give stability in the home on tile and wood floors. I also often have pet owners stop using boots if they have begun using them before the pet is functionally ready.

On several elderly canine patients I have also used Epsom salts baths to great benefit.  Owners HAVE to ensure they rinse off all the salt residue after the bath, otherwise if the dog licks it, which they usually will, diarrhea will likely ensue.

These are some of the basics, and I will be glad to discuss the topic further if you’d contact me.

Blessings-

Deborah Carroll

 

Cavaletti (Obstacle) Photos

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.

First…

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.

Cavalettis Original Design 2-27-14I 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.

Cavalettis 3 Cavalettis 4

Later, her person caretaker raised the bar by raising the bar and building a more elaborate brick-scapade across the back yard!

Second –

10-11-14 Cavalettis

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 –

Cavalettis 2-27-14

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.

Cavs 2 7-11-14Cavs 7-11-14 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.

BJ Cavs 1 8-8-14

BJ Cavs 8-8-14

Yes, these ARE speaker stands inserted into milk crates. Only in Austin, TX (and maybe Nashville…)

Cavalettis

I DO work with many cats. This one is Kacey, and there’s a vid on this site of her doing cavaletti repeats…

Chile R 6-26-13 Cavs Happy

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)