Category: Quality of Life

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Yorkie Infection Pain After Knee Surgery – Issues in Rehab

Yorkie Infection Pain After Surgery –

This post actually applies to any pet after surgery and not just to Yorkie infection pain after surgery.

In a perfect world…

I would have already published a good-sized booklet about  common rehab problems I encounter and the solutions we work towards, for everyone’s knowledge, about what helped and what didn’t.

I haven’t done that yet, as of this writing.

Below is a bit of info about one case involving a Yorkie (Yorkshire Terrier) that had concurrent (at the same time) bilateral (both sides, in this case, both knees) torn knee ligament surgery and luxating patella surgery.

infection pain after knee surgery
Not the Yorkie knee, but a knee that is possibly infected.

Two Surgical Fixes on Each Knee?

I have frequently seen cases where veterinary surgeons performed these two surgeries at the same time, on both knees, so a quadruple whammy. On the one hand, reasoning for doing so includes such thoughts as, “You only have to put your pet (usually a dog) through anesthesia and surgery one time”, and “You *only* have to go through recovery once”, and “We might as well do both surgeries once we open the knee”.

On the other hand, neither of these surgeries absolutely has to be performed on a Yorkie, much less one that is receiving a solid, exercise-science-based rehab plan. We have lots of complete functional remedies in advanced exercise science. This surgery is not life-saving, while the expense and trauma are usually unnecessary for anyone willing to follow strict yet progressive and helpful recovery methods.

Regardless, two surgeries on each knee done at the same time is a huge recovery commitment. Whether you have one knee surgery done at a time or more, here is my “just got home” recovery advice and first four weeks recovery booklet. At least in this case I had the “good” knee to compare to the “bad” one.

Some Case Details –

For now, I will tell you basic functional details of this case without the additional info I’d report in a formally published case study for a journal. I’ll put all the additional info into my booklet when I write it.

Feel free to ask questions.

This particular client found me after her dog’s surgery, having been referred to me by a groomer. The client, like most, was at a loss as to how to handle what was a very fragile situation with her best buddy.

Within the first 2 days of working with this little cutie I noticed tissue swelling, redness, and heat in one knee. The other leg was limping along in a fairly average recovery yet also not seemingly infected.

I typed reports, including extensive details about the signs and symptoms of a possible infection in one knee post-surgically, and I faxed them (years ago when we used fax more) to the hospital for the surgeon after my first visit with the dog.

The surgeon didn’t respond to me regarding my observations so I guided the client in solid restriction protocol, including how to help her dog potty, while she waited for her recheck appointment. I also thoroughly explained to the client the discussion she should have with the surgeon or her regular veterinarian to get the knee re-evaluated for possible infection  asap and/or rule out other post-surgical complications.

Infection or Activity Level?

At the time of the appointment, instead of recognizing infection, the surgeon offhandedly blamed the owner and rehab for doing too much, saying that was why the knee was red and swollen. I assure you, Dear Reader, that neither the client nor the 1st week of rehab recovery was the problem…not at all! I emphasize this so that if you feel strongly about your or your pet’s health, you don’t feel intimidated when you pursue answers for healing. Politely speak up for yourself and for others. Try to build a bridge while not settling for any answer that belittles you or your thinking, if possible.

Recovery Protocol –

The client had gone above and beyond regarding securing the best recovery she could for her little dog. She frequently worked from home, a multi-level home, and she purchased baby playpens as good recovery pens for her fuzzy kid and put them on each level and in at least one room on each level. The dog was confined to the pens or to a crate.

The client originally hired me to come daily and strictly perform my very basic first week recovery plan just so “it would be done right”. I assured her that the plan was so simple for the first four weeks that she would not mess it up and that she could do it herself, but she really wanted me there daily.

The client was incredibly attentive to *doing everything right* and wanted me to do all the work except for potty breaks and other relevant work I couldn’t perform because I didn’t live with the dog. That turned out to be beneficial for the dog, since I caught signs of infection early.

Outcomes and Results –

The surgeon did not return my communications regarding the signs I noted that pointed to a problem that was likely infection in one knee.  He also made the client to feel inadequate when she most very likely had nothing to do with the onset of the infection (based on preventative measures & type of infection),  and she did return to have the surgeon address the issue, as anyone should.

You, Human Reader, should have your concerns addressed without your being made to feel inferior by the surgeon. Just so you know that’s a potential great outcome from the encounter, should you have one.

Soon thereafter, the pin the surgeon had placed in one knee as part of the patellar luxation surgery began to remove itself from the knee due to the infection and swelling. The pin notably moved out of where it was placed during surgery to a place that was easy for anyone to feel it poking out.

The client and her regular veterinarian were both timid with regard to “going over the head of the surgeon” and didn’t want to “step on toes” by addressing the now fairly obvious infection. This does happen fairly frequently in some communities.

Activity and Pain –

The Yorkie was in so much pain that he wasn’t trying to bounce around or get out of his confinement(s). I’ve never seen a dog that received this quad-whammy surgery bounce and try to play soon after surgery. They are usually very subdued by the pain of the surgeries. Also, bouncing and playing on a post-op leg usually produces a different type of swelling than infection swelling.

It is my opinion that we need better pain control for our pets . We do for humans, too, and you may already know that. Help for pain, especially nerve pain, has been a fave topic of mine for decades.

Is it an Infection?

I have also found that it is often hard to determine whether or not infection is present. We (client & care team) discover sort of anecdotally most of the post-surgical infections I see in cases. These infection areas are not hot and do not cause tissue swelling.  These infections are causing pain in the joint. This pain doesn’t go away with combos of the right amounts of the right pain medications.

Dealing With the Infection –

When I suspect infection in a post-op orthopedic case, I recommend the client and vet discuss trying an antibiotic. I base this recommendation on something I learned in about 2006 from a surgeon. I always tell them that it was the surgeon’s idea, not mine. If the limping stops around three days after beginning abx, it is likely that we’ve found infection causing the pain.

I can’t legally diagnose infection, however I may share information about infection and potential treatments to inform the client. I also easily have many conversations with veterinarians to share what other vets might have done in a particular situation. That is collaborative work.

Of course antibiotics are considered only after ruling out the other usual pain scenarios (not enough pain medications, destroyed surgery, etc…) and/or medical reasons the pet cannot take antibiotics. Often this abx (antibiotics) dosing is the cure for continued limping if all else seems okay. I have shared the info from this surgeon with many veterinarians in my area. It has helped a lot of pets.

Usually I also tell the pet’s regular veterinarian about the many situations I’ve encountered where antibiotic treatment has produced the pain relief we hope for. In these cases it has eliminated an infection that wasn’t even suspected. I cannot legally diagnose any medical issues, but I don’t hesitate to relay my findings and experience to veterinarians. By doing that, sometimes we all get to learn and collaborate.

Whose Fault?

This infection was not the fault of rehab nor of the client and possibly not the fault of the surgeon. Infections like this are actually a common occurrence. I cannot say whether or not this infection could have been avoided. In my experience it seems very difficult to avoid infection under certain circumstances. Let’s just recognize it and deal with it medically on our ends, because we are working after the fact.

If there is swelling in your pet’s knee (or other body area) or if it is hot and red after surgery or injury, please go to your veterinarian or veterinary specialist and have it evaluated sooner than later.

…and the Pin?

This Yorkie’s infection advanced quickly. The surgeon removed the pin from the infected knee after the dog finished a course of antibiotics. In the meantime, the infection did its damage. This Yorkie never gained as full a use of the infected leg as he did in the other leg.

“That’s What I Thought!”

If you feel like your pet has a problem that the surgeon or veterinarian is ignoring, then please go ahead and get a second opinion from another licensed veterinarian. I post information about cases like this because I receive many, many emails from all sorts of people about their pet’s cases, which are similar to what I frequently encounter in my practice. I want to give strength to your voice if you are trying to get to the bottom of a problem with your pet and aren’t sure to trust your gut.

What Else Helps With Infection and Infection Pain?

Ice will not do much to help infection swelling and pain, in my experience and according to research. Usually other time-consuming therapies don’t get rid of the infection, and therefore the pain, either, and waiting for them to help with pain allows the infection to cause additional joint and tissue damage. Bacteria are causing the pain in the case of infection pain and have to be killed for the pain resolution.

Anti-inflammatories and narcotics don’t usually help against infection pain and they don’t kill the infection bugs, either. I never recommend heat compresses or dry heat in general right after surgery or injury. I base that idea on decades of published research that practitioners still argue about. Sometimes heat and/or ice are the best idea, but only in specific cases and not across the board. Sometimes moist heat is great for certain infection cases AFTER infection diagnosis.

Ultimately, there is no “blame” here, especially since that isn’t productive in this case; what there is, however, is discovery and learning through experience. Ultimately the pets health (or yours) needs you to be the best advocate you can be. Trust yourself if things don’t seem right, and push to find a practitioner who listens and collaborates.

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.

RehabDeb July, 2019

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Resistance Training and the Older Adult

Resistance Training and the Older Adult

From the American College of Sports Medicine, Comments and Position Statements

This article has some plain English and some sciencey stuff. Give it a try if you don’t usually like the longer, data-filled articles. The bits in quotes are directly from the article, written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM. I have included a few of my own comments in parentheses. Italics and bold type are also my additions. And, yes, I have used most of the ideas outlined here and adapted them for old pet rehabilitation–RehabDeb.

Great Dane, Miss Moneypenny, Taking a Break From Old Pet Rehabilitation
Great Dane, Miss Moneypenny, Taking a Break After Exercise Program

Benefits of Resistance Training in Older Adults –

“The health benefits of appropriately prescribed long-term (more than 12 weeks) resistance training in older adults–ages 65 and older–are well known. They include improvements in muscle strength and endurance; other possible health benefits include increase in muscle mass, which translates into improvements in functional capacity. In addition, increased weight bearing with resistance training is considered beneficial in improving bone density and combating the effects of osteoporosis.”

(Rehabdeb note: the above is basically true for other mammals as well.)

Appropriate Programs for Function –

“Achieving appropriate levels of function is very important for older adults so they are able to carry out most of the daily living skills necessary to lead independent lives. Due to the fact that muscle wasting (sarcopenia) and weakness, exacerbated by physical inactivity, is prevalent in the aging population, more emphasis has been placed on developing resistance-training programs for older adults. When developing resistance-training programs for this group, important components to consider are the various training-related variables: frequency, duration, exercises, sets, intensity, repetitions, and progression.”

Orthopedic Issues and Resistance Training –

“Older adults often have orthopedic issues that contraindicate resistance training of the affected joint(s). Older adults are also at a higher risk of cardiovascular disease, and in many cases have even been diagnosed with it. Therefore, it is critical that the older adult receive prior approval from their physician before participating in resistance training.

It should be noted that proper supervision of the individual’s resistance-training program, including any testing procedures, by an appropriately trained exercise professional, is highly recommended. It should also be noted that performing maximum strength testing in many older adults is not recommended. Therefore, when strength testing is appropriate, sub-maximum testing protocols for estimating maximum strength are recommended.”

Frequency –  

“Exercise may be categorized as either multi-joint, meaning more than one joint is dynamically involved to perform the exercise (e.g., bench press, shoulder press, leg press), or uni-joint, meaning only one joint is dynamically involved (e.g., bicep curls, triceps extensions, leg extensions). In the older adult, the resistance-training program should focus primarily on multi-joint exercises. Uni-joint exercises are not discouraged entirely but should not make up the majority of exercises within the training program.

If a person is performing both multi-joint and uni-joint exercises for a particular muscle group, it is recommended that the multi-joint exercise(s) be performed before the uni-joint exercise. Additionally, within each resistance-training workout, larger muscle groups (i.e., legs, back, and chest) should be worked before smaller muscle groups (i.e., arms and shoulders).”

Equipment for Humans –

Additionally, machines are recommended over free weights (i.e., barbells and dumbbells) due to skill-related and safety factors. As the individual progresses, they can use free-weight exercises appropriate for their level of skill, training status and functional capacity.

(Rehabdeb note: I design some programs using weights for pets. Otherwise, we don’t have weight machines, per se, in veterinary rehabilitation. There are some standard tools and equipment recommended in veterinary rehabilitation programs. Most practitioners use those tools before building a good foundation. They are also often troublesome for a client to use successfully at home. Veterinary rehab clinicians often use a water treadmill when other work would be more effective. It really helps a practitioner to know functional recovery at the professional human sports level.)

Muscle Groups –

“Traditionally, muscle groups are classified as the following: 1) chest, 2) shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest group contains the pectoral muscles, the shoulder group contains the deltoid, rotator cuff, scapular stabilizers and trapezius muscles, the arm group contains the biceps, triceps, and forearm muscles, the back group contains the latissimus dorsi of the upper back and the erector muscles of the lower back, the abdomen group contains the rectus abdominis, oblique, and intercostals muscles, and the leg group contains the hip (gluteals), thigh (quadriceps), and hamstring muscles.

In the older adult, it is important to attempt to incorporate all six of these muscle groups into the comprehensive resistance-training program.”

(Rehabdeb note: same for other animals ^^. A practitioner with enough experience in program design and implementation can design programs for you. You may use my programs at home with your pet to meet the goals in this statement paper.)

How Much Exercise for Benefits?

“It has been recommended that one to two exercises per muscle group is normally adequate. Noteworthy here is to understand that by employing primarily multi-joint exercises in the resistance training program one may actually exercise more than one muscle group or specific muscle per exercise.

For example, in performing the leg press exercise the quadriceps, hamstrings, and gluteal muscles are all involved and, in many cases, this could eliminate the need to perform any uni-joint exercises for those particular muscles.

Studies have shown improvements in muscle strength employing ranges of one to three sets of each exercise during the training program.”

Some Human-Based Guidelines –

“Based on current guidelines, it would be recommended that the individual start with one set of each exercise and, depending on individual need, possibly progress up to no more than three sets when the fitness professional deems it appropriate. It should be noted, however, that an average of two sets of each exercise would be beneficial for most individuals. To avoid excess fatigue, a two-to-three minute rest period between sets and exercises is recommended.”

(Rehabdeb note: I have based my basic programs and my advanced pet rehab work on principles of sport science recovery. I also incorporate advanced human surgical recovery plans and exercise science program design.  Often I need to merge elements of neuroscience and neurology. Veterinary medicine plays the part of diagnosis, prescribing medication, and oversight of cases in collaboration with a professional rehabilitation specialist. I design programs taking into account the busy status of most people’s lives. I plan for practical application of physical recovery principles, and timing of work for best recovery.)

Intensity of Work –

“Intensity refers to the amount of weight being lifted, and is a critical component of the resistance-training program, considered by many fitness professionals to be the most important training-related variable for inducing improvements in muscle strength and function.

In other words, the more weight lifted, the more strength gained. Even though this may not always be the case, the importance of intensity in facilitating strength improvements is well documented.

Intensity is often expressed as a percentage of the maximum amount of weight that can be lifted for a given exercise (1RM). For example, if someone who has a maximum effort of 100 pounds on the bench press exercise performs a set with 80 pounds, they would be training at 1RM of 80%. Studies have suggested that older individuals are able to tolerate higher intensities of exercise, up to 85%.

However, research has also shown intensities ranging from 65%-75% of maximum to significantly increase muscle strength. Therefore, in order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies higher intensities of resistance training, a low-intensity to moderate-intensity range of 65%-75% is recommended.”

(Rehabdeb note: So, for example, this is why I don’t recommend hill repeats for your knee or hip injury pet only 2 weeks into a foundation program. I have seen this recommendation on discharge instructions. If a person doesn’t have experience with program design and lots of implementation, they often push too much too fast.)

Repetitions –

“Repetitions (reps) refer to the number of times an individual performs a complete movement of a given exercise. There is an inverse relationship between intensity and repetitions, indicating that as the intensity increases the repetitions should decrease.

Based on previous research, a rep continuum has been established that demonstrates the number of repetitions possible at a given relative intensity. For example, an intensity of 60% relates to 16-20 reps, 65% = 14-15 reps, 70% = 12-13 reps, 75% = 10-11 reps, 80% = 8-9 reps, 85% = 6-7 reps, 90% = 4-5 reps, 95% = 2-3 reps, and 100% = 1 rep.”

(Rehabdeb note: it might be obvious that this recommendation is specifically for humans. This information is based in large part on specific observation of and verbal feedback from human subjects. The research is based on many other measurements, though, as well. I’d love to do the work on determining rep protocol for pets, specific for breeds and species. Nonetheless, the information should be helpful to you if you are an exercise scientist.)

“In view of the previously mentioned recommendations for an intensity of 65%-75% of maximum, this would suggest that for each training exercise the individual perform an adequate amount of weight that would allow for 10-15 reps. In the event that no initial strength testing was performed, simply through trial-and-error an individual could determine appropriate training loads that would allow them to perform only 10-15 reps. They could then be sure of training at 65%-75% of maximum effort.”

(Rehabdeb note: I have designed my broad foundation-building program, as well as my specific programs, to allow for info like that above.)

Continued Improvement Needs Work –

“In order to continually enjoy improvements in strength and functional capacity, it is important to consistently incorporate progression and variation into the resistance-training program.

Progressing and varying one’s program commonly involves incorporating the overload principle.

The overload principle involves making adjustments to the training variables of the resistance-training program such as frequency, duration, exercises for each muscle group, number of exercise for each muscle group, sets and repetitions.

In terms of adjustment, normally the overload principle involves making increases to these variables. For example, making progressive increases in intensity has been shown to be important in increasing muscle strength. In terms of the rate of progression, one should consider attempting to progress their resistance-training program on a monthly basis. However, it should be noted that increasing the intensity in some older adults may be contraindicated due to orthopedic and/or other medical limitations. As a result, making adjustments in other training variables would be recommended.”

(Rehabdeb note: I work to change the nature of veterinary rehabilitation to better instruct practitioners. It is important to incorporate principles specifically noted in the last section, above, into a veterinary physical rehabilitation program.)

Thanks for reading and for looking for solid help for your pet-

Deborah

Paper published August, 2009 and originally posted on my website around that time. My comments updated May 16, 2018

 

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Rehab for Pet Surgery – 3 Steps

 

Spaniel dog with plastic Elizabethan collar on her

Jicky the Spaniel in the E-Collar after FHO

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

I do work on lots of cats and a variety of other animals. If you want to know more about cat specifics now, please search for cat in the search box. I’m still working on developing the cat information pages.

For more specific info on a particular condition, please refer to the menus at the top of the page. If you do not see what you are looking for, please use the search box on any  page.

If the injury is a torn knee ligament, then please click here to read more info about that condition. After that, please go to the instructions on this page!

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

First and foremost:  pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction about an injury.  Please pay special attention to the part about no running, jumping, or playing. You and your pet will be doing good work for recovery if you exactly follow my booklet instructions.

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

No running really means no running…

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

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

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

I currently have published one book to help your pet through four progressive weeks of recovery after any surgery.

Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

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

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

My recommendations are based on decades of information we have in human sports medicine recovery. These methods matches up very well how your pet thinks and moves and behaves. This program matches up scientifically with how the body recovers.

These instructions incorporate steps  for functional recovery, so there is a LOT more structured and guided info in the book. The links to the book I made for this page will take you to Amazon. You may order the book from any bookstore using the ISBN.

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

So, the following book will help you calmly and methodically approach recovery from your pet’s surgery. The book will guide you to establish a functional base of activity.  You have to build a good base to help recovery and to of avoid additional injury. This is only the base. I have more strengthening programs and other drills for you to do to return your pet to a rambunctious lifestyle.

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


Amazon

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

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

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

Find a few more homework info pages by following the links in the menu at the top of the page.  Also use the search feature.

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

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

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

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 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-
Rehabdeb

(Original Post March 17, 2015. Updated July 29, 2019)

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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)

Posted on

Should My Dog (or Cat) Still be Limping After ( Knee ) Surgery?

Pain, pain, and also pain –

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!

Chocolate Lab lying on floor with bandage on leg after surgery

 

 

 

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:

Limping –

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.

Bandage –

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.

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.

2) people have not followed a solid recovery base program like this for injuries or this for surgeries,

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.

4) In some cases the surgery has failed.

Surgery failure happens most often because the pet is too active, the pet’s body rejects some of the surgery technique, or the surgery technique wasn’t complete. The last event happens frequently in FHO surgeries, in my experience. I have created successful non-surgical programs for recovery from all hip and knee issues without surgery. I have recovered lots of pets that had too much bone remaining on the femur after FHO and the client didn’t want another surgery. In those cases, we followed deep pain control protocol and my foundation-building programs as well as my advanced drill programs.

If you can get your veterinarian to work with you on the steps I mentioned while you are following strict restrictions and a 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.

me giving laser therapy treatment for pain control and nerve regeneration on Magnolia the Weimaraner after spinal surgery

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)

 

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