Fighting Foot Drop in Humans Translates to Pets, Too!

Fighting Foot Drop in Pets

This Post:

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

RehabDeb Comment:

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

Boots and Splints –

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

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

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

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

Making Braces at Home –

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

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

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

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

From “Advance Journal for Human Physical Therapy”

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

Originally Posted on: December 20, 2012

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

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

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

Gaining Control –

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

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

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

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

After Diagnosis –

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

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

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

Focus Work –

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

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

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

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

Enter the AFO –

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

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

Goals –

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

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

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

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

FES, Another Option –

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

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

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

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

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

AFO or FES?

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

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

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

Complying at Home –

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

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

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

Therapy When?

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

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

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

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

(Updated February 23, 2018)

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 😉

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)

Warm Up More Productive Than Stretching to Avoid Injuries

Warm up More Productive Than Stretching-

I’ve read studies on the topic of stretching for several decades and the consistent evidence is as Dr. Mirkin presents it (below).

Every opportunity I get to work with competitive dogs is an opportunity to reeducate the human clients about sport training and competition. People in the pet competition world often promote ball stretching as an acceptable form of pre-competition warm up or exercise.

Ball stretching before an event is more destructive than helpful. Coming out of a crate and trotting around just a short bit is not enough of a warm up prior to competition. Dogs should do better in events with at least a quarter-mile slow jog warm up and then a few sprints. This would also be beneficial prior to training drills as well. Just the basics…

The article below comes from Dr. Gabe Mirkin’s Fitness and Health e-Zine
April 7, 2013

Stretching Before Exercising Provides Only Flexibility

Whenever I see someone stretching before running, cycling, tennis, swimming, or any other sport, I worry that the person doesn’t know much about training.

Exercise First and Then Stretch

Stretching Before Exercise Only Weakens Muscles:

Two recent studies show that stretching before competition and training weakens muscles. Stretching prevents you from lifting your heaviest weights or running your fastest miles. It limits how high you can jump, and how fast you can run (The Journal of Strength and Conditioning Research. April, 2013; The Scandinavian Journal of Medicine and Science in Sports, April, 2013).

Stretching weakens muscles by almost 5.5 percent. The longer you hold the stretch, the more strength you lose. Holding a stretch for more than 90 seconds markedly reduces strength in that muscle. Stretching reduces power: how hard you can hit a baseball or tennis ball, how fast you can swim, run or pedal, Stretching also does not prevent next-day muscle soreness, and it does not prevent injuries. On the other hand, warming up helps to prevent injuries and helps you to run faster and lift heavier.

Rudi Stretching Naturally After Exercise
Rudi the Brittany Spaniel in Rehab After Hip Surgery, FHO, Femoral Head Osteotomy. He’s Doing Natural Stretching AFTER exercise, and NOT Doing Forced Range of Motion Work by His Mom Owner

 

How Muscles Move Your Body:

Every muscle in your body is made up of thousands of individual fibers. Each fiber is composed of sarcomeres, repeated similar blocks, lined end-to-end to form the rope-like fibers. Each sarcomere touches the sarcomere next to it at the Z line. Muscles move your body by contracting, a shortening of each muscle fiber. Muscles do not shorten (contract) equally throughout their lengths. Muscles contract only at each of thousands of Z lines. It is the cumulative shortening of thousands of Z lines that shorten fibers to make muscles contract and move your body.

How Stretching Saps Strength:

When you stretch a muscle, you pull on the muscle fibers and stretch apart each fiber at the thousands of Z lines. This damage occurs only at the Z lines throughout the length of the muscle fiber, to weaken the entire muscle.

Prolonged Stretching Limits the Ability of Muscles to Store Energy:

Muscles are like rubber bands. They stretch and contract with each muscle movement. This constant stretching and contracting stores energy. For example, when you run, you land on your foot and the muscle stops contracting suddenly.

The force of your foot striking the ground is stored in your muscles and tendons and this energy is released immediately to drive you forward. Your foot hits the ground with a force equal to three times your body weight when you run at a pace of six minutes per mile. Up to 70 percent of the force of your foot strike is stored in your Achilles and other tendons. This energy is released by your muscles and tendons to drive you forward for your next step.

Stretching decreases the amount of energy you can store in muscles and tendons and therefore weakens you and you have less stored energy to drive you forward, so you have to slow down.

Stretching Saps Speed and Endurance:

Elite college sprinters were timed in 20 meter sprints, with and without prior multiple 30-second stretches of their leg muscles. Both active and passive stretching slowed them down (Journal of Sports Science, May 2005).

Stretching Does Not Prevent Next Day Muscle Soreness:

A review of 12 studies published over the last 25 years shows that stretching does not prevent muscle soreness that occurs 8 to 24 hours after you exercise vigorously (The British Journal of Sports Medicine, December 2011; 45:15 1249-1250). Researchers in Australia reviewed five studies, involving 77 subjects, to show that stretching does not prevent next-day muscle soreness. (British Medical Journal. December 2007; 325:468-70 and 451-2).

Stretching Does Not Prevent Injuries:

A review of the scientific literature shows that there is no good evidence that stretching prevents sports injuries (Clinical Journal of Sports Medicine. March 2005). Muscles and tendons tear when the force applied to them is greater than their inherent strength, so anything that makes a muscle stronger helps to prevent injuries. Strengthening muscles helps prevent muscle and tendon tears, but stretching does not make muscles stronger. This review showed that stretching does not prevent shin splints, bone stress fractures, sprains, strains or other arm and leg injuries.

 

Original Post August 3, 2014. Updated February 19, 2018

Range of Motion Drills for Your Pet

When and Why to Perform Range of Motion Drills for Pets

If you are going to do range of motion drills on your pets, you should have an experienced practitioner demonstrate them to you, preferably on your own pet.

Anatolian Shepherd standing with one hind paw turned under, knuckling
Parker was partially paralyzed and once he could walk again, he couldn’t plant his hind paw on his own at first. Parker needed flexion and extension drills for his toes and foot to keep them from locking in place over time.

Passive Range of Motion (PROM) really only needs be performed on animals limbs that the animal is not able to move on their own. PROM is the passive version, and describes range of motion drills when your pet is passive and unable to move their limb.

Range of motion exercises (ROM) are exercises that we may do for others, yet those others are also capable of moving on their own.

ROM drills are often recommended in veterinary medicine. I disagree with doing ROM on the majority of pets, and I do not recommend it for my veterinary rehab patients after hip or knee injury or surgery. 

This recommendation, to do ROM, comes from the “human side”, like a lot of good information for pet recovery does, however pets operate differently with respect to their damaged bodies than humans do. Making blanket recommendations to pet peeps to do ROM is not the best approach.

After Surgery?

BJ cavaletti work in harness with short leash, doing her own range of motion drills after doing the foundation program.

I do not recommend doing ROM if the pet is able to move on their own, even if they are not moving a lot after surgery or injury.  

Some pet caretakers I have counseled have left the vet’s office with surgery discharge instructions that tell them to do massage or ROM exercises. Most of the time the animal caretaker/pet owner does not truly know what this means or how to do it so that the pet is not injured or so that the person is not wasting time.

People are sometimes injured accidentally by their pet if they push ROM drills. Correct range of motion drills that make a difference are likely to cause pain in a pet that has neuromuscular function and feeling. If the limb is not paralyzed, the pet can most likely feel. Sometimes a pet that appears paralyzed is able to feel pain, too. The pet doesn’t understand and they might nip at people when they cause pain with ROM drills.

Comfortable Joints –

If pets are comfortable with joint use after injury or surgery, they will use their joints. As pets recover, their joints will be less swollen and more normal use will increase naturally. This is especially true if the pet is doing a good rehabilitation program.

Rudi the Spaniel using a steep hill incline to stretch naturally after exercise
Rudi the Brittany Spaniel in Rehab After Hip Surgery, FHO, Femoral Head Osteotomy. He’s Doing Natural Stretching at the Right Time, and NOT Being Forced with Range of Motion Work by His Mom Owner. His original surgery was not entirely successful, because too much of the femur head was left during surgery. I did extensive rehab with him to increase muscle mass and avoid a second surgery.

People also usually do not know when to stop pushing a joint and where to start working with ROM drills. This leads to non-compliance on an exercise the clinic recommended, and usually this drill is an unnecessary expense of time if the pet is able to move their limb on their own.

A referral to a strength and conditioning rehab practitioner or a neurological recovery specialist to judge protocol and beneficial movements is a great idea for pet caretakers in these cases.

Joint Stops –

I have consulted on several cases wherein people were really trying and forcing range of motion drills with no improvement in their pet’s natural joint movement. Most of them had been back to the surgeon or regular veterinarian at least once to have the practitioner check the case. In these particular cases I found that there was a “stop” in the joint that should not have been pushed. The people didn’t know that, and in some cases the veterinarian and surgeon did not know, either.

The “stops” I mentioned above are due to different circumstances in different cases. One cat had a pin in her knee that was part of a fracture repair, and the pin was stopping the joint from opening more fully. A surgeon needed to remove the pin. The client had been to the surgeon and to the surgeon’s rehabilitation practitioner. Both of those practitioners kept telling the client to push ROM on the cat. The CCRP rehab person had forced the knee joint during many visits. Of course, it wouldn’t open further, and any perceived gains were likely due to the pin digging into the opposing bone.

The cat was mad and in pain, as you can imagine, and was hiding under the bed when I arrived for my consult. My advice, after finally getting to gently examine the cat, was that the client pursue a second opinion from a different surgeon in a different practice.  It’s probably obvious to you that this cat didn’t need more range of motion exercises; she needed surgical intervention to correct the pin.

Then Why Did my Veterinarian or Surgeon Recommend These Drills?

Most of the time, I believe the veterinarian is trying their best to catch up with some of the rehabilitation protocol promoted at conferences and seminars. Veterinarians and veterinary rehabilitation practitioners are doing what they have been told to do when they recommend ROM. I think they are really trying to do a good job. There is just so much to know that they may not have experienced some of the “bad” situations I mention in this post and therefore they haven’t had opportunity to come up with other solutions to the problems or think differently about the solutions.

ROM, water treadmill and balance board use are some hot topics in rehab practice. As hot as they may be, they are not the best unique approach to home or clinic-based rehabilitation. If they are to be used, they should be used in a planned order along with other work to compliment strength-building and recovery.

Alone, the types of drills I mention above only put a small piece, usually out of place, into the puzzle of recovery. Clumped together, these drills and others like them are often not in an order that compliments the science we know of exercise physiology and recovery.

Also, most of the time, veterinarians, medical doctors, and surgeons do not have extensive experience in functional rehabilitation. That is why there is a need for many types of recovery specialists in human medicine and why rehabilitation is a specialty in veterinary medicine as well. None of us has time to know everything about even our own specialties, much less all other specialties of interest.

I don’t do everything perfectly in my practice. I have, however, had a lot of experience in a broad variety of conditions and situations, and on this website I give to you more ways to think about solving problems.

Back to ROM –

ROM drills are not usually necessary if the pet is moving on their own! Other physical activities will be a better use of rehabilitation activity time than ROM. Other work will do a better job of encouraging overall limb and body use. Start with this foundation if you want to do some work yourself.

My Pet Already Moves Their Leg –

If your dog or cat or other pet is moving and flexing & extending their knee or other joint after surgery, very likely their joints are staying mobile enough for beginning recovery. They are as mobile as they are comfortable with moving.

Often better movement is dependent on better pain control. You may achieve better pain control in the short-term the most effectively with medications prescribed by your pet’s veterinarian. Supplements are usually helpful with long-term pain control. I have taken supplements for over 40 years and using the effective ones in my pet patients for over 25, if you count my own pets as patients! Unfortunately there is not a supplement at the time of this writing that will do the job that focused and thoughtfully applied pharmaceutical medications will do. At this time you cannot overcome big pain with supplements.

My own soulmate pet, RIP Grace Dane, xox. She had two TPLO’s, which I would never do again and did before I developed my rehab practice. Both surgeries were extremely problematic. She ended up with all three ligaments torn in her right knee and two torn in the left. Bone-on-bone in both knees. Her story is long. She received both drugs and supplements most of her life. I drove and pushed for the right drugs for her situation. They helped a lot, in context.

You don’t need to bug (and probably cause pain to) your pet by making them endure “bicycling” of their leg(s).  Other drills and exercises will bring about better recovery and use of the joints. You subsequently have less opportunity to hurt your pet (or you) if you are not trying to forcefully manipulate them. Please start with and complete this foundation if you want to do some work yourself.

Pain? Or “Just” Needs More ROM?

If your pet is able to move on their own yet is choosing to hold a limb in flexion, bent at the joint, and isn’t using the limb much, then the problem is most likely pain. Usually the issue is NOT that the pet needs to be forced to extend/unbend and flex/bend with painful drills we make them do by our own hand. Please see my posts on pain for more info.

Animals do not have the same hesitancy to use their damaged joints in the same way that humans are reluctant to do. This means that if a dog sees a cat it wants to chase, then most of those dogs will chase now and endure the consequences later!

Movement and Reasoning –

In fact, even though I could make an argument for animals demonstrating reasoning ability, I have seen plenty of “act now, consequences later” results! In humans we call this impulsive. Sometimes I also have impulse control issues. You probably do, too. More on that another day.

We humans are usually going to stop moving. We usually think hard about how much pain we think the movement will cause. Our pets seem to do the same thing when they are in pain, but they don’t always restrict themselves.

In those cases humans need excessive coercion, like the ROM machine after knee surgery. Or sometimes we just need the best basic exercise drills for our situation. My dad has shoulders that freeze up due to old injuries. He gets physical therapy once in a while and he can afterward move better. Slowly over time, he forgets to do his exercises. Then his shoulders freeze and are very painful. Then I remind him to start with the simple exercises. The pattern continues today because he forgets. He needs to continue the best drills for his situation. So does your pet, until there is better function.

Conclusion on Forced Range of Motion –

Forced ROM is largely unnecessary for our pets unless the animal has nerve damage and cannot move their limbs; THEN you should do PROM.

The only time it is necessary to use ROM drills is when the pet is unable to move their limbs. Then you must incorporate several sessions of range of motion drills daily. Do this so that the muscles don’t contract and the joints don’t freeze.

Later I might post about proper range of motion for a pet that cannot move its limb. There are already videos galore on the webbage that show a lot about ROM and PROM. I don’t need to duplicate those. Most of the time those vids are encouraging you to do ROM on pets that don’t need it. I’m not necessarily talking about the models for the videos not needing ROM; I can’t comment on all those vids and whether those pets need ROM. I’m talking about necessity of ROM or PROM regarding the content of this post.

Thank you!

Rehabdeb

(Published August 3, 2014. Updated April 6, 2018)