More Than Half of All ACL Reconstructions Could Be Avoided, Five-Year Follow-Up Study Shows

Another Human-Based Study, and I’ve Been Proving This in Canine Cases For Over 10 Years-

From RehabDeb: This report is from human medical research, however Colorado State University has since conducted some animal studies. I would love to conduct studies with advanced exercise physiology protocol that I have been using for over 20 years even with my own pets before doing “official” vet med work. I look forward to when I have resources to do those studies.

When I began independent practice in 2007, I used my accumulated research studies, experience, and knowledge begun decades before my work in veterinary medicine in order to create some simple functional exercise and drill protocol. These programs benefited hundreds of my pet patients whose people opted to not pursue surgery. I have used these programs for both cats and dogs.

In every case where people follow my protocol (and where there are no extenuating circumstances), the pets have stabilized the knee or other joint with muscle growth and strength and with proper scar tissue (sometimes we want some scar tissue).

These pets have also functioned very well after rehabilitation. You may do all this work in the home environment with no dependence on specialized equipment in a clinic. There is no need for specialized equipment when we are drawing from centuries of known exercise physiology.

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. This means that clients and veterinarians do the work and get good results. You can too, if you want to do the work 🙂

Jan. 30, 2013 — In the summer of 2010, researchers from Lund University in Sweden reported that 60 per cent of all anterior cruciate ligament (ACL) reconstructions could be avoided in favour of rehabilitation. The results made waves around the world, and were met with concerns that the results would not hold up in the long term. Now the researchers have published a follow-up study that confirms the results from 2010 and also show that the risk of osteoarthritis and meniscal surgery is no higher for those treated with physiotherapy alone.

“We have continued with our study and for the first time are able to present a five-year follow-up on the need for and results of ACL surgery as compared with physiotherapy. The British Medical Journal published the findings and they are basically unchanged from 2010.

This will no doubt surprise many people, as we have not seen any difference in the incidence of osteoarthritis,” says Richard Frobell, one of the researchers behind the study, who is an associate professor at Lund University and a clinician at the orthopaedic department, Helsingborg Hospital.

Richard Frobell explains that the research group’s results from 2010, which were published in the New England Journal of Medicine, caused a stir and questions were raised as to whether it was possible to say that an operation would not be needed in the long term.

Half of the patients who were randomly assigned not to undergo reconstructive surgery have had an operation in the five years since, after they experienced symptoms of instability.

“In this study, there was no increased risk of osteoarthritis or meniscal surgery for ACL injury treated with physiotherapy alone compared to treated with surgery. Neither was there any difference in patients’ experiences of function, activity level, quality of life, pain, symptoms or general health,” says Richard Frobell.

“The new report shows that there was no difference in any outcome between those who had operations straight away, those who had operations later, and those who did not have an operation at all.

“The message to the medical experts who are treating young, active patients with ACL injuries is that it may be better to start by considering rehabilitation rather than operating straight away.

In Sweden, over 5000 people every year suffer an anterior cruciate ligament injury, mainly young people involved in sport. There are different schools of treatment and Sweden stands out with treatment that is in line with the results of the study.

“On an international front, almost all of those with ACL injuries have operations. In Sweden, just over half have surgery, but in southern Sweden we have been working for many years to use advanced rehabilitation training as the first method of treatment. Our research so far has confirmed that we are right in not choosing to operate on these injuries immediately. Longer-term follow-up is important to look more closely at the development of osteoarthritis in particular,” says Richard Frobell.

KANON, Knee ACL NON-operative versus operative treatment is the name of the research group. They are now moving on to the next stage. This year, the third part of the study will begin, following up the patients ten years after acl injury.

Richard Frobell has also entered into a collaboration with researchers at the School of Economics and Management at Lund University. He is evaluating the health economics aspects of different treatment methods for ACL injury.

Journal References

  • R. B. Frobell, H. P. Roos, E. M. Roos, F. W. Roemer, J. Ranstam, L. S. Lohmander. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ, 2013; 346 (jan24 1): f232 DOI:10.1136/bmj.f232
  • Richard B. Frobell, Ewa M. Roos, Harald P. Roos, Jonas Ranstam, L. Stefan Lohmander. A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears.New England Journal of Medicine, 2010; 363 (4): 331 DOI:10.1056/NEJMoa0907797

From ScienceDaily

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests

Just One of Many Studies Published on This Topic-

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. So, this means that clients and veterinarians do the work and get good results.

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –

“Surgery may not always be the best first course of action.

A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. To reinforce that, this study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.

“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.

These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Furthermore, patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. In this situation, thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”

Story Source:

The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408

Pet Injury – 3 Steps

Pepper, a medium-sized black dog doing rehabilitation walks after rupturing her calcanean or Achilles tendon
Pepper Ruptured Calcanean Tendon

 Pet Injury Follow Steps –

Short notes with instructions for you to follow after your dog has been injured. I do also work on lots of cats as well as a variety of other animals. If you want to know more about cat specifics right now (because I haven’t finished developing the cat pages), please search for cat in the search box 🙂

These recommendations also work if your pet isn’t moving as well as they used to because of arthritis or advanced age, for instance, and you would like to help them.

Please have your pet evaluated by a veterinarian if you have not already, so that we may all work to be on the right track for your pet’s recovery. It is very likely that your veterinarian does not know about this style of rehabilitation, because it is home-based, so feel free to share this site with them. I am available to discuss with your vet and provide teaching seminars for clinics, too!

For more specific info on a particular injury or diagnosis, please see the menu at the top bar or use the search box on this site. For more info on why I don’t have ever injury and recovery ever posted on my site yet, see this page or this page 🙂

1) Get the right book with a successful plan for you to use at home

Books:

Most pet (and often human) orthopedic and soft tissue injuries may be recovered without surgery when there are no broken bones, and some injuries with broken bones recover well without surgery, too! Your veterinarian should be able to help you decide if surgery is necessary for your pet’s broken bones. More on this later-

The information in this booklet my booklet with 4 weeks of foundational recovery instructions also contains a GREAT foundation-building, functional recovery base for older pets that have lost muscle mass & strength and have lost some proprioceptive abilities, lost the ability to maintain balance and know where they are physically in relation to their environment. The 4-week foundational program in the bookmy booklet with 4 weeks of foundational recovery instructions is often what is needed to help older dogs that are slipping on the floor or having trouble rising or are tripping over the doggie door threshold.

More strengthening and drills should be added after this program. A full 12-week, progressively difficult, program designed by me or a practitioner with a lot of experience and training in exercise physiology program design and functional recovery is what I’m about! For most people and pets, even a little bit of improvement makes everyone happy and makes a big difference in quality of life.

You have to start with a specific foundationmy booklet with 4 weeks of foundational recovery instructions, though, at the beginning, to make sure your pet has a solid foundation to help offset additional injury.

Please also pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction regarding your pet’s 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 appropriate to recovery and should not be causing any harm. Still, no running or jumping or playing! You may, however, incorporate the directions I give to you for allowable activity. Otherwise, your injured pet should be restricted!

Right now I only have one book published with information about helping your pet build a foundational base through four progressive weeks of work after injury. This is the book, then, to get you started and the one to order if your pet has lost any degree of function, especially in their hind end.

This book is specifically addressing torn knee ligaments, yet until I am able to publish the books I am working on that deal with hip issues, other knee issues, elbows, old age/arthritis, and spinal issues, the book below will be helpful to you for those situations, too. This book contains the restrictions and advice I would give to get you started after almost any orthopedic injury or diminished functional condition.

Note that your pet’s veterinarian really needs to evaluate most injuries sooner than later, even if you think you know exactly what the problem is. Unless you have a full range of personal experience with diagnostic knowledge and an x-ray machine, you might miss something very important! And even veterinarians can run into orthopedic or neurological problems they aren’t sure how to treat, so joining with a specialist like me builds your pet’s recovery team!

Please do not involve additional work until you have passed the 4-week foundation with gold stars! Please follow all the instructions for the best outcome 🙂 Please do not (again, I say it, because you’d be surprised at how many people think adding other work to this intro recovery system is a great idea) don’t add swimming (no swimming yet), stairs (no stairs yet), hill repeats (no hill repeats yet), poles (no poles yet), cavalettis (no cavalettis yet), or other dynamic activity.

Your pet may seem to be doing great and may seem to you like she/he is healed, especially if they have good pain medication, but I can assure you that biologically the minimum amount of time for soft tissue recovery is on average 8-12 weeks. Some situations take up to a year to heal well (nerve damage, torn muscles, etc…), so please don’t be fooled by appearances or by programs that don’t understand biological recovery science. Best way I know to say it ^^ and I’ve seen complications from hundreds of cases where a proper foundation wasn’t followed 🙂

Being able to walk a mile or around the block a day doesn’t matter if your pet has function problems elsewhere in their life, so get this info, follow it, and establish a solid base. If your pet can walk a mile but can’t get up off the floor, this plan is for them. The book explains more about this approach.

After the base is built, then always there are additional strengthening and proprioceptive drills to be done in order to return your pet to a better quality of movement and lifestyle!

Conservative treatment after torn knee ligament, instead of surgery:

my booklet with 4 week base-building recovery plan
Amazon for USA, CA, DE, ES, FR, IT, & UKlinks to buy the booklet in different countries, including the USA
Amazon in other countries
Books are also available on Barnes and Noble and you should be able to order from any bookseller (available on Kindle and in paperback).

Also, if the injury you are concerned about is a torn knee ligament in your dog, then please click here to read more info (then return to the instructions on this page!).

2) In addition to thoroughly reading any of that ^^ info, 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 buzzy massager.

There are also 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:

there is additional information about where you might purchase this particular massager in the written instructions under the video. I am often asked if this massager or that massager will work, and the answer is, “no, not as well”. There are “we love science” reasons for my choice.

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.

If you would like advanced or personalized 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 pet.

Blessings-
Rehabdeb

 

(Updated January 25, 2018. First posted on this site April, 2015)

How Do I Find Help for My Pet on This Site?

There is a lot of information on this site!

I have posted a lot of information about rehabilitation for pets on this site. You should find directions that are very helpful to you and your pet’s situation, even if I don’t directly answer your specific question yet on this site.

  • In the menu section you should see a few question-based topics. If you see what you want, click on the topic.
  • There are detailed choices under each topic. You should see cascading menus with many choices.
  • If you don’t want to read all the available choices (I’ve tried to condense them), then just skip to the search box and try searching a couple of your ideas.
cat with neurological problems in a harness and cart I built to help teach her to walk again
Tiny the Cat in Her Mobility Mover

More Tools-

I have also made posts for you to see some of the products I use to work on healing and recovery with your pet. I will be adding to the helpful tools section as time allows and when I find products that truly work in the field.

A lot of tools and ideas marketed to people for pet rehabilitation are a waste of time and money. I want to help you to streamline your rehab work and use tools that really work to help your pet!

Check out the list of the top five posts people read on this site. This list is to the right of posts on a desktop/tv and at the very bottom of the page on phones or tablets.

I will be adding to the choices of conditions on my injury and surgery pages. I have explained more on those pages about how to use the rehab steps to help you with your pets orthopedic or neurological problem diagnosis.

Saint Bernard in a cart to help support her while she walks

The Website and My Work-

I write all of my own posts, design all rehab programs for clients, perform most of the IT work on this site, oversee IT messes & posts on all my other social media, manage client communications, and perform *all* the other work associated with running a business. It’s very time-consuming, as you may know, and I don’t have administrative help/support. I don’t update this site as much or fast as I’d like to. There are lots of IT errors and there are lots of topics I have yet to cover! Now I’m working on streamlining this site as fast as I am able while I play catch-up 🙂 Thanks for your patience! If you would like to contact me, please go to this page.

Rehabdeb

Updated June 28, 2018

Supplements & Vitamins

Links to Some of the Supplements & Vitamins I Recommend for Pets –

Anti-Inflammatories – Natural Formulas:

For Cats or Dogs –   

For People or Pets –

photo of a bottle of Xyflamend you may purchase through clicking on photo

Joint Helpers: 

Also see anti-inflammatories, above.

I prefer supplements and vitamins that have the least amount of added flavoring, coloring, and other additives that aren’t specific for healing.

Below are a few brands I have chosen to help a cat or dog with painful joints. Each product links to Amazon, but you may buy them anywhere you like, of course.

This page is specifically for links to products I recommend and for which I have received positive results feedback. You may find more info about each product by clicking on the photo link. I also have some information about the use of these supplements  in other posts on this website and in my books.

For Cats –

Bottle of Nutramax brand Cosequin capsules for cat painful joints that links to Amazon for purchasebottle of Duralactin Feline immuno-nutritional aid for managing inflammatory conditions in cats and cat painful joints that links to Amazon for purchase

“Duralactin Feline is an immuno-nutritional aid for managing inflammatory conditions, such as soft tissue injury or arthritis in cats. Managing cat arthritis symptoms with Duralactin Feline can be especially beneficial in many ways. Duralactin Feline is affordable and can be used as a long-term solution in conjunction with other medications and treatments. Duralactin Feline is a dried milk protein concentrate derived from hyper-immunized cows. It is a non-prescription supplement that is available in liquid or capsule form. Duralactin Feline can be administered directly, with or without food. The main ingredients are MicroLactin, a dried milk protein and omega fatty acids.”

For Dogs –

bottle of Nutramax brand Cosequin DS capsules for dog or cat with painful joints that links to Amazon for purchase

For Dogs or People –

If you are taking a proven, high-quality glucosamine & chondroitin (sometimes with more ingredients) supplement, then you may usually share it with your dog. Check the labels on one of the products I have listed here in order to find out dosing suggestions for your dog. Then you may compare the pet dosing to the info on your own supplement. Try to get close to the same amount the veterinary version suggests. In this case it’s better that you give a little bit more rather than a lot less than the recommended amount.

bottle of Nutramax brand Cosamin Joint Health Capsules that may be used for human cat or dog painful joints that links to Amazon for purchase

Check the ingredients of yours to make sure there isn’t a sweetener in it. Don’t give xylitol to your pets. I don’t like to give any formulas that contain aspartame or sucralose, either. That cuts out many of the flavored dog versions.

Liver Helpers:

Cats & Dogs, Per Weight –

Cats & Small Dogs –

For Small-Medium Dogs –

For Medium & Large Dogs –


click on this photo of box to purchase

Nerve Helper:

SAMe also can have beneficial effect on nerves. See above ^^

click on this photo bo buy Now brand liquid Vitamin b complex

Omega 3’s:

Omega 3’s are pretty easy to find in lower doses, for cats and dogs under 50#, however many of my clients have difficulty finding the 1-capsule, high dose versions. Your veterinarian may carry a good Omega 3. If you cannot find them from your veterinarian or in a store near you, here are a few suggestions:

For Cats & Small Dogs –

Each capsule of this Omega 3 contains 180 mg EPA & 120 mg DHA.

For Medium & Large Dogs –

   This one contains 400 mg EPA & 200 mg DHA per capsule.

…and this one contains 500 mg EPA & 250 mg DHA per capsule

For Very Large Dogs or People or Other Pets –

click on this picture of Omega 3 fatty acids to buy them  This one contains 600 mg EPA & 300 mg DHA per capsule.

Probiotics:

I recommend getting a pharmaceutical-grade probiotic, where available, and getting one with at least 5 bacterial strains in it.

I also recommend switching the brand or some of the varieties of bacterial strains every time you buy a new bottle/box.

Check the amount of live cultures contained in the probiotic you have been giving and try to do a comparative amount when you begin a new type. If you look below, for instance, you will see a bottle with 1 billion units in a serving and you will see a bottle with 3.4 billion units in a serving. Make sure you check labels for amounts.

There is a LOT of info on the web about probiotics and some of it is good, true, solid info.  Much of the info is not correct, especially if it’s on an opinion site instead of in a research paper. Some info is “different from what we thought” as new research is accomplished. Here’s a link to some related research. Look up probiotic research for yourself on a fairly reliable source, like PubMed.

I have listed below only a few capsule and powder varieties of probiotics and there are a lot of options out there. Pets don’t have to take probiotics marketed solely to pets. I prefer to use the powder without added flavorings.

Yes, you may open a capsule and sprinkle the powder on the food if you didn’t buy the powdered form not in capsules. You may also use these methods to give capsules or pills.

Your veterinarian may also carry a probiotic that doesn’t have flavorings and colorings in it.  Flavorings and colorings, including “natural” flavorings, can cause allergic reactions, like itchy paws and ears.

Multi-Strain Capsules For Peeps or Pets –

You may open up the capsules and sprinkle them onto your pet’s food or give them straight to the pet (if they’ll eat it), or use one of my helpful dosing methods.

Cats or Dogs –

The next probiotic (below) is for advanced medical cases and cases of stress, like those encountered daily by many athletes. I do not recommend giving this high a dose of probiotics until you have taken a little time to slowly increase your or your pet’s daily amounts.

If you or your pet have been taking 1 billion units daily, then increase that to 3 billion or not more than 5 billion for about five days. Then increase again by a bit for several days, then increase again. You will find that advanced use of probiotics in high doses for certain situations is common practice among functional wellness practitioners.

Increase probiotic amounts gradually so you will hopefully avoid a full and immediate coup of the gut. A full coup with high doses of “good” bacteria may subsequently result in a full day in the bathroom…

bottle of sound probiotics click to buy

I’ve used the following probiotic for many years while on the road, and many athletes and pets I know use it, too! This one is shelf stable, but don’t leave it in a 100-degree F automobile! Otherwise, EPS doesn’t need refrigeration. Please read the instructions on the box about how to store these. Also, don’t open up this capsule and dump it on the food.

Shelf-stable, for People or Pets –

box of Jarrow EPS 5 billion unit probiotics