Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories
Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012
How to Recover from Muscle Soreness Caused by Intense Exercise
Muscle soreness should be part of every exercise program. If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.
You must damage your muscles to make them grow and become stronger. When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.
DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear. Your body
treats these tears in the same way that it treats all injuries, by a process called inflammation. Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.
The most beneficial intense exercise program is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.
ACTIVE, NOT PASSIVE, RECOVERY: When athletes feel soreness in their muscles, they rarely take days off. Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days. Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.
TIMING MEALS TO RECOVER FASTER: You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin. Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate. This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours. The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids. The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle. Waiting to eat for more than an hour after finishing an intense workout delays recovery.
WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt. You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating
virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables. If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.
BODY MASSAGE: Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational
Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.
NSAIDS DELAY DOMS RECOVERY: Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.
HOT BATHS: Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006) (RehabDeb’s comment: On the other hand, Epsom Salts Soak/Bath works well for humans and the dogs and cats I’ve encouraged toward that therapy. Of course, this is more than “just” a hot bath…)
COLD OR ICE BATHS: A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths. They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.
My Dog is Just Old…
Quite frequently I hear this comment from clients and even from people active in the practice of animal health and science. I provide a mobile rehabilitation and conditioning service to encourage better recovery after surgery or otherwise improve quality of life through functional rehabilitation. Roughly 80% of my client base is elderly dogs, usually with orthopedic and/or neuro issues. Following are some short comments on beneficial treatments for aging pets:….Any fitness/rehabilitation/conditioning/bodywork program should be collaborated with your pets regular veterinarian, i.e., they should be in the loop. This may be accomplished by having your veterinarian refer you to me or by my contacting the vet after you have contacted me should you desire to work hands-on with me as a rehabilitation and conditioning specialist. Dachshunds flying off couches is not the same as plyometrics training, and many owners may not know the risks or benefits to either activity! So make sure to include your primary care veterinarian in your plans to have additional therapies practiced on your pets…..
In addition to #1, pain control, and #2, functional (possibly assisted) exercise protocol:
Massage is a common therapy that almost anyone can use beneficially to encourage circulation and subsequently possibly encourage healing. Many owners may take a stab at performing massage, but instruction from me is always best to start. Different massage techniques accomplish different results, and hands-on massage is not even recommended in some cases! Otherwise, I have found great benefit in using the little AAA battery-operated massagers produced by the Homedics company. My favorite ones cost $5.99, have four balled feet, and the spread of the feet is usually just right to straddle the spine of different animals. These little massagers have a great vibration frequency and anecdotal evidence proves that their use is extremely beneficial. I ran across them in a store about 5 yrs. ago, and based on reading years of research regarding vibrations and circulation, etc…I decided to give it a try. At the least, this massager will increase circulation and the animal will hopefully enjoy it. Cat owners are using it too!
I recommend beginning by slowly using the massager from neck to tail without it turned on, travelling the spine one direction, again, slowly. After a couple of passes, turn on the massager and do the same movement as when it was off. I like to divide the body into 5 minute sections, beginning with the department giving the most discomfort, i.e. mid-spine to tail base, then neck to mid-spine, right thigh, right shoulder, left thigh, left shoulder. If your pet has hip problems, start with the thighs then do the spine then the shoulders, etc…The idea is that doing this form of massage on the whole dog could take 30 min. in one sitting, but if you only have time for 10 minutes’ worth, then do the most important parts first. It is all complimentary and helpful; an animal with hip problems is taking more stress on his front end, and one with elbow problems is straining the neck, spine, and other parts of the body in compensation, so hopefully you get the idea.
Passive range of motion (PROM) should usually be performed and instructed to owners by an experienced practitioner. Some owners I have counseled have come away from surgery discharge having been told to perform massage or PROM, yet the owner actually does not know what this means or how to perform it so that the animal is not injured. A referral to a rehab practitioner to judge protocol and beneficial movements would be great for owners in these cases. Joint mobilization should only be performed by an experienced practitioner. PROM is not usually necessary if the pet is moving on their own, and other physical activities will be a better use of owners time. If your dog is moving and flexing & extending his knee after surgery, very likely his joints are staying mobile and you need not bug him by making him endure your “bicycling” his knee. Other drills and exercises will bring about improved use and recovery of the knee, and you subsequently have less opportunity to hurt him (or you) if you are not trying to manipulate him. Animals do not have the same hesitancy to use their offended joints as humans do, and the PROM is largely unnecessary unless the animal has nerve damage and cannot move the limbs, THEN PROM is indicated.
Controlled, specific swimming in warm water can be beneficial for the improvement of muscle tone, fitness and strength, especially if an animal is too sore in their joints to walk well for just basic fitness. Swimming for conditioning or therapy should be done in a controlled manner with the use of a dog life jacket and in short, steady bouts while better fitness is achieved. Just because a 15-year-old dog “likes to swim” does not mean he/she should go at it for 15 minutes straight the first or even the fifth time. I carry a full set of life jackets in my mobile practice should an owner possess facilities for swimming at home. In some environments, a regular harness may be used instead of a life jacket. Small dogs with short legs, like Dachshunds, may be swum in many home tubs. ….I find that outside the home environment, elderly animals (and many of other ages as well) are usually not happy to be in a swim tank in a foreign environment. I worked with a water tank/treadmill during the first years of my practice and determined that I would not miss it one bit in mobile practice. Elderly animals are often slightly confused and seem to want to do things in the comfort of their accustomed environment. In addition to incalculable fear levels when trying to use a facility-based water tank for therapy, this fear often induces nervous diarrhea in the water and the fear is potential cause for new injury. Travel to and from a facility can produce unnecessary stresses on both owner and animal. Therefore, I have come up with a variety of exercises and slings to assist elderly animals while they learn to return to better function on land…..
Epsom salt baths have been very beneficial for my elderly patients whose owners have tried them. Your pet may have health conditions making these baths prohibitive, so check with me or your veterinarian. Make sure to rinse off all the residue after the bath, otherwise when your pet licks off the residue, diarrhea will likely ensue…(magnesium).
Many machine modalities may be used in the practice of rehabilitation. I consider low-level laser therapy to be the most complementary and productive machine modality I utilize in my practice. Laser therapy has immense benefits which I will not attempt to cover here. A wonderful website to peruse is Thorlaser.com, and much information regarding laser therapy may be found there.
Ultrasound therapy on arthritic or sore joints and muscles has been proven to be beneficial. I also utilize this therapy in my practice and have had very positive owner feedback with regard to improved function in their animals. Much research information, including evidence-based research, is available on the web regarding these modalities…..People often ask me about using heating pads on their dogs; the use of heat depends on the nature of the injury or disease process. A combination of ice/heat/ice is often more therapeutic or the use of moist heat or brown rice in a sock heated in the microwave are usually preferential heat application options, but moist is good for some things while dry heat is for others. When in doubt, use ice. Instructions for the use of ice and heat may be found on my websites.
Chiropractic interventions are the choice of some and in my opinion should be combined with other therapies, especially massage, and should be administered by vets who have studied chiropractic or by chiropractors who have studied animal chiropractic—especially with regard to spinal issues—and are working in conjunction with the vet.
Acupuncture intervention has been proved to be beneficial as well and especially for pain control. There are several vets in the Austin area who practice acupuncture.
Diet: There are commonly-recommended neutraceuticals for elderly and injured dogs as well as for young dogs that have genetic or early-onset of disease process in their joints. Younger sporting dogs should benefit from these as well. Animals, like people, are not always being fed an optimal diet, so the receipt of quality nutrition from feeding varies, and the supplementation of neutraceuticals is often warranted. It is my preference, based on 30+ years’ experience, well-performed and founded research, and successful nutritional healing protocol, to encourage my patients toward a grain-free diet. The research is out there, and I will not attempt to summarize is here. Among commonly-used and readily-available supplements in this catagory are Glucosamine Hydrochloride with Chondroitin Sulfate (synergistic benefit), MSM (additional synergistic benefit), SAMe (joint, liver, tissue, brain, pain), and Omega 3 fatty acids, preferably in the form of fish oil. Oil-based supplements included in animal food are chemically altered during the production process to the point of diminishing their efficacy and/or they soon become rancid when the bag is opened. Omega 3 fatty acid chains are very fragile and research shows use of the capsule form is best. Additional options are digestive enzymes, probiotics, vitamin C, B vitamins & L-Glutamine, to name a few.
Bed: Bedding DOES make a difference. If your old dog/cat is still trying to jump onto your bed, I recommend you either stop them and provide an eggcrate bed nearby or get them started using stairs or a ramp up to the bed (and into the car, too…). Infrared bedding is nice (expensive), and solid research proves benefits. I have a Great Dane, and she has the chaise end of a couch, a Papasan Chair cushion, and two egg crate foam beds (in different rooms).
Elevate Food and Water: this reduces strain on elbows and neck. I put my Great Dane’s kibble in a Rubbermaid container that stands about 18″ high. Many varieties of elevated stands are available from stores and many homemade ideas about on the net. Definitely makes a beneficial difference.
There are definitely more ideas to be shared, and you are welcome to make note of some in the comments section. Pain control and exercise are key to keep your pet moving and healthy. I have a 10.5 year old Great Dane, Grace, as of this writing (Aug. 4, 2011), and she has had many severe orthopedic and some neurological issues, as well as several systemic internal issues. She appears as though she is 3 years old to most people. She does okay…:)
Water Treadmill is Not Necessary for Rehabilitation
Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of said dogs with ruptured ligaments who are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery for structural remedy, there are relatively very few rehab clinics in the world and fewer still water treadmills.
Dogs of the world do relatively “ok” on all areas of the treatment spectrum and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery, the dog would have to go. Just wanted to clear up that situation.
That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation with approximately 25 years experience in human sport science and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.
I became aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.
Unfortunately, I found that what is not taught within this same model is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.
What does this mean to you and your pet (primarily dogs…)?
The chief complaint I hear from people who contact me is that they were referred to this clinic or that one for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other things, the dog is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious. They aren’t where the owner thought they would be after surgery. When I was in a clinic setting and working on utilising the wtm we had, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realised by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.
HOWEVER, I also find that after very many years of reading many, many reports in sport science and regarding functional return to activity, the best benefit is realised via gravity-based, slow, structured exercise protocol, and I began developing that for small animal rehab since I did not find any published when I arrived on the scene.
Your dog will use their leg to some extent and increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds of cases. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the dog and the owner.
If your dog is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to 1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol); 2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or 3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.
The homework protocol I generically recommend is contained elsewhere in this blog. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.
ICE (CRYO) THERAPY
Ice therapy is used to decrease pain and inflammation and to increase healing. Ice may be effectively applied 2-4 times per day, with 4 being optimal within the first week after injury/surgery. Ice may be used in several forms, some of which are as follows:
*Frozen vegetables make a tidy ice pack, although not as cold as other options. These should be left on the treatment area for approximately 20-30 minutes without a towel and on bare skin. Frozen veggies are not cold enough, nor do they retain cold well long enough, so that is why extended application times are recommended.
*Slush ice in two zip lock-type baggies. This turns out to be very cold and is made with one part water to two parts rubbing alcohol. If the mixture is too watery, add more water to make it icier. If the mixture is too hard, add more alcohol to make it slushier. This ice pack should only be left in place for ten minutes at a time without a towel or twenty minutes on a medium-to-large dog with full fur. Fur is no more a barrier to icing than a towel on a human would be, especially if “colder” icing options are used (pupsicle, slush packs, etc…) and ice is applied for adequate time, i.e., 20 min. Smaller animals with less dense hair coats will still only need a 10 min. ice application, so try to use good judgment. Dish soap in double sliding zip-locked baggies and frozen works like the slush pack mentioned above.
*Pupsicle ice is a cup, either paper or Styrofoam, that has been filled ¾ with water
and then frozen. This ice is especially effective and may also accomplish some surface
tissue massage at the same time as the cryotherapy. The ice melts into puddles, so grab a towel. You should rub this ice over the affected area for approximately ten minutes at a time using circular or stroking motions, as in massage.
Ice, not heat, should be used for at least the first 72 hours post-surgery or injury, and there is generally no need for heat at all. This phase is often referred to as phase one inflammation-breakdown or phase one post-trauma. Pupsicle and slush ice may be left on 10 min, taken off 10 min, and then reapplied 10 min. during phase one inflammation.
I am often asked if ice may be used any time, and the answer is yes. If back muscle spasm episodes occur, if there seems to be pain or inflammation, or even if a new incident of disc rupture occurs, ice may be used even while on the way to the vet. In these instances, always use ice and not heat.
Ice increases blood flow by cooling and slowing blood while constricting the blood vessels, after which the body reacts by sending more blood to the cold area to warm it and thus increase the flow of body fluids through the area. This is actually beneficial in reducing swelling. Heat increases blood flow by opening up blood vessels. The opening of the blood vessels by heat early in post-injury phases could cause unwanted swelling and inflammation, so even though heat may seem to feel good, it is not what should be done to help healing at this time.
Rehabilitation and Conditioning for Animals
Deborah Carroll, CCRP, CSCS
Hip Dysplasia Referral
We were referred to you by Dr. Matthews (KAH). He believes you can help us with Bella, our 5 year old blonde lab who was diagnosed with Hip Dysplasia 2 years ago. Since then, she has consistently been on Rimadyl. We visited Dr. X (a vet surgeon) and discussed surgery options. At that time we opted for the routine and consistent Rimadyl therapy and to consider other options (hip replacement) for the future.
We were very intrigued and encouraged to receive your information from Dr. Matthews as would very much like to pursue alternative forms of therapy and conditioning to improve Bella’s current and future quality of life.
We would be most pleased if you could contact us at your earliest convenience to schedule a consultation to discuss our options.
Art and Caryl
parents of Bella (Lab), Dakota (German Short-Haired Pointer), Raja (cat) and newest addition, Tucker (horse)
Even though I left you guys with a written note card of things I wanted you to follow for Bella, here is also the aforementioned bullet point email summing up our discussion during our visit pertaining to Bella last Tuesday.
I am also sending a copy to Dr. Matthews so he may be in our loop.
Thank you for inviting me to help with Bella’s quality of life, and I hope you find the protocol easy to manage. Text, call, or mail if you have any questions after having worked on the protocol the past couple of days.
1) Consider switching Bella to Wellness Core or another grain-free food. WC is available at Petco (and not Petsmart, to my knowledge) as well as at some of the specialty dog boutique stores. Bella is currently on a JD formulation that was given her by another veterinarian, and my research over the years has shown grains to be a major culprit in joint disorders and auto-immune disease (short story). All the dogs (and humans) I have dealt with have thrived when fed grain-free and a substantial diet using other nutrients. You indicated that Dr. Matthews would be open to this suggestion.
2) Begin giving Bella ~500 mg EPA (and concurrent DHA) in fish oil, using capsules, daily. I am not a fan of bottled oil due to potential for rancidity and potential for breaking up the fatty acid chains with shaking. Long-term research evaluation has led me to understand that there are too many complications (rancidity, fragile fatty acid chain, heating of oil changes composition, etc…) when fish oil/omega 3’s are added to processed food sources. As well, I find fault with the research promoted by predominant dog food manufacturers, in that the therapeutic dosing for a dog Bella’s size may be found in 1-4 capsules of easily-obtainable fish oil, as opposed to the much higher number reported in the food company’s statements, either from a vet or from a “human” brand source. There are other major questions and loopholes regarding the research promoted by the dog food companies, and if the animal is to have the best opportunity to “fight” arthritis and thrive in other ways, then the choice of going grain free eradicates some of the popular food brands containing fish oil at the outset. The addition of fish oil and the elimination of grains has been proved in research over the years to be of much assistance to a variety of mammalian corporeal systems.
3) Add a glucosamine/chondroitin/msm supplement to Bella’s daily routine…check with Dr. Matthews to see if they carry one of the vet formulations. I recommend obtaining this from your vet or from a “human” brand source. You may check ConsumerLab.com if you are wary of some of the human brands or look for some of the brands I recommended that are available locally. I do not recommend a “dog” version other than the ones you may find available from your vet.
4) Continue Rimadyl and any other pain meds as scripted.
5) Using my FHO homework, start Bella at week 2, 2-4 10 min walks daily, very, very slowly. Please read all the guidelines cited on the homework. 🙂
6) Go to my WordPress blog or YouTube and find my dog massage video under RehabDeb. Please watch it and follow the instructions, massaging Bella daily for 2 weeks.
7) We will recheck in 2 weeks to evaluate her homework performance and upgrade her homework and drills (hopefully).
Thank you, again!
Should my Dog Still be Limping After ACL (CCL) Surgery?
This is a common question, and the most common answers I give are as follows, based on what I find in my practice:
If your pet is limping your pet has about a 98% chance of being pain.
The most recent version of this topic may be found in my book for Kindle on Amazon. I have edited the topic for the books to be concise and easier to read than what is contained here on the website, however I have left some of the following info on this page for now because this topic receives thousands of hits on this site. Evidently it’s a big problem around the world! The link to my book using Amazon.com is:
and the book is not expensive 🙂
Also, the book contains, for $7.99 USD, instructions regarding how to protect your dog at home and how to get them walking well again without pushing them into a pain state. Check it out for more info than is on this site! Thanks-
Your dog is not limping solely “because he/she had surgery”; the dog is limping because he/she is painful after surgery. This situation is also not really an issue of having to retrain the dog to use the leg…again, they are very most likely not using the leg because it is painful, and there are usually very good helps available for your pet, both pharmaceutical and non-pharmaceutical. This point is one I spend a lot of time going over with people, even on many occasions when their veterinarian hasn’t been quite convinced that there is pain. The vet not recognizing that the pet is in pain could be due to many reasons. Pretty much all I do daily is determine the level of pain in my clients based on multiple factors, including the animals response to daily activity and exercise programs I have outlined. I then determine whether more veterinary intervention is needed and also the next best course of functional rehab.
After working with athletes and other animals for over 30 years, as well as dealing with quite a bit of pain personally, I am well-versed in dealing with determining pain and working to eradicate it. Dogs usually aren’t quite acting themselves in the clinic when they see the vet, and most veterinarians I know, with whom I’ve had lengthy conversations, will admit to having been trained to look at the quality of the surgery and not necessarily add pain in as a factor. Often your pets regular veterinarian will give up any post-surgical medication intervention to the surgeon, and when the meds that the surgeon scripted run out, the limping begins. I find that vets with whom I work often are finding the benefit of dosing adequate medications so that the pet will use their leg in my rehab programs, and the pets do, every time we get the combo of pain relief correct (and when there’s nothing additional going on, as I cover below). Veterinary medicine, on the whole, wasn’t teaching that animals felt pain, in so many words, until the late 1980’s. Another point is that in human medicine, we don’t have pain management down to an exact science, by far, and that is for people who are able to speak or convey in language and signs we are accustomed to understanding better.
1) The pain could be due to the dog being too active.
2) The pain could be due to the dog not having enough pain meds that they are actually taking.
3) The pain could be due to the knee having an infection.
Those are the three most common situations I encounter after the surgery site has been checked by the veterinarian and has been deemed stable to the best of their knowledge. Follow your vet’s discharge instructions regarding restricting and controlling the activity of your pet, and I also have beneficial instructions regarding this on my homework pages on this site. Depending on the type of surgery performed, many things can go wrong with the items used to stabilize the knee, but that situation is not the most frequent culprit I find in my practice and experience. I cite infection as another culprit, and that can come from outside, i.e. licking the incision site, or that can come from suture or implants, etc…on some occasions. You will often be able to narrow down the issue to infection if moderate to high amounts of at least two analgesics are used and the dog is still limping until you try antibiotics. If your pet stops limping 1-3 days after the introduction of antibiotics, then it is likely that you have some form of infection. The “usual” pain medications don’t “usually” get rid of infection pain.
The fourth issue that I occasionally find is a torn meniscus. In older dogs that I’ve worked with for non-surgical help after a torn cruciate ligament, it has been beneficial in my area to combine Tramadol, Gabapentin, and an anti-inflammatory to get them through the additional pain of torn meniscus and on to better weight-bearing and therefore better muscle improvement. Other drugs may be used more prevalently in other countries. These drugs are great to help with the scientifically-proven exercise choice of gravity-based, weight-bearing drills, which is the most productive way to build bone, bone strength, and supportive tissue strength, including muscles. The increased thigh muscle will help support the joint and in most of my cases has served to stabilize the joint very well. This work will often also help your pet get past the acute phase of torn meniscus. I have had many of these meniscal tear cases work out with sufficient pain relief over time, however, if you have access to surgery procedure to have the meniscus scoped out (two small slit incisions will be made), then that can be a moderate remedy, too. I say moderate remedy because scoping is less invasive than opening the whole knee for full cruciate repair surgery, if you are wanting to avoid surgery. I have had cases that resolved and were strong after the non-surgical work for torn ligament and that have gone on to have the meniscus scoped out without fully opening the knee as would be done in the ligament repair surgery.
Elsewhere on this site, under “Research”, I have posted data from human sports medicine research citing that both torn meniscus and torn ACL can do very well without surgical intervention. These good outcomes involve exercise and physical therapy. Surgery for a torn or ruptured ACL/CCL and/or torn meniscus is optional and making the decision for this surgery is not a “life or death” decision. Those papers are here if you would like to know more about the studies for non-surgical remedy :):
If limping and pain are your pets issues, stop them from doing too much activity & read my recommendations on my homework page, which may be found here:
If your dog does not have an anti-inflammatory and an additional analgesic, like Tramadol and/or Gabapentin, for the first few weeks after surgery, then I recommend you ask your vet to consider supplying those. Use rest, restriction, and even ice during the time your pet does not have other pain relievers. Fish oil, fish containing Omega 3’s (or other animal dietary sources), joint supplements (Like Xymogen DJD, Glycoflex III, Cosequin DS) are beneficial, as are natural anti-inflammatories, like turmeric/curcumin, ginger, rosemary, etc…I like a product called Xyflamend by New Chapter for this. (No, I don’t receive any compensation for mentioning any of these online or in verbal discussion ;))
If your dog is on moderate-to-high amounts of those analgesics and is being restricted as recommended yet remains lame after a couple of days of renewed restriction and medications, then it is highly possible that your dog has an infection. An infection can be present and will cause pain, even if there is no known swelling or seepage. Anti-inflammatories and the other pain relievers will not relieve infection pain. In my area the vets will often prescribe Cephalexin for a two week course, and the limping usually ceases within the first 24 hrs. of taking the antibiotics.
Infections can occur for many reasons, and an infection is not necessarily someone’s “fault”. I see many patients that are licking at their incision, even if ever so slightly or infrequently (according to owners), and I am telling you that even a small amount of licking can cause a raging infection. Most often, though, I see infections that aren’t seeping or causing additional signs of there being an issue. We are confirmed in our suspicions when the antibiotics have great effect and the limping/lameness/pain is relieved. My own dog incurred infection in a very clean surgery hospital, however she had a weak immune system, and also due to other circumstances was open much longer on the table as she would otherwise have been. Lots of things can cause infection.
I do recommend remaining on additional pain relievers in order to begin my exercise protocol, primarily because your pet has been dealing with a lot of pain and has not been using the leg very well, if at all. Even when the infection is dealt with, your pet will likely need additional pain relief to help them use their leg as best possible while following the restrictions and the recommended exercises.
Those are the basics.
Limping does NOT mean that the dog (or other animal) needs to be taken to a water treadmill to induce usage of the affected leg. Limping means that there is a problem that needs be rooted out and dealt with. See my suggestions at the beginning of this post for the most likely culprits 🙂 I have taken over the rehab of many dogs that were forced to walk in the water treadmill, didn’t have sufficient pain control, and often have had infection, which was easily rooted out after process of elimination. Some of these dogs, however, have ended up having additional injury that was also discovered after appropriate pain meds were given yet expected relief was not achieved. Some of them incurred injury by being forced to work in the water treadmill, with the practitioner suspecting they were ‘just not using the leg’ as if it were psychological. In my experience, if we deal with the root problem, which is pain, and we find the source of the pain, which can be as simple as “I just had surgery”, then the walking will happen, leg use will occur. Animals aren’t sitting around plotting disuse of their leg and overthinking the issue. They also aren’t holding out so you will give them more drugs. It’s rarely, if ever, “just psychological” with limb disuse. It wasn’t psychological when they were first injured, before surgery…
I use massage with the small Homedics unit featured in my massage video: http://rehabilitationandconditioningforanimals.wordpress.com/2011/11/27/simple-massage-video-uploaded-to-youtube/
I sometimes use ice, and sometimes laser therapy on the knees with infections or lots of effusion (joint swelling). I also recommend that my clients do not work the animals until the pain is relieved substantially. “Relieved substantially” means that they are only slightly favoring the leg. My exercise programs are designed to work in conjunction with adequate pharmaceutical pain relievers, where those are needed.
I have utilized many non-pharmaceutical methods of pain relief, however after surgery it seems that pharmaceutical pain relief (pills) gives the most benefit. Those pain relievers may be reduced over time as the muscles are built, the joint heals, and appropriate, slow, progressive, reintroduction to activity is accomplished. Please know that most post-surgical and some post-injury-non-surgical pets need to be on pain meds for 4-8 weeks, with 8-12 weeks usually being more productive. During this time, it is important to gauge their activity levels and utilize appropriate return-to-function exercise programs, only increasing activity slowly while gaining good pain control and only reducing pain control meds as more activity is able to be achieved without added discomfort (lameness, etc…). Use my homework for the exercise plan.
This means, stop going from total restriction to “return to normal activity”. Humans cannot go from a two-month layoff back to winning one of the top five marathons in the world, even if they are world-class…progressive reintroduction has to occur, regardless of what level you, as an athlete, or your pet were at prior to injury/surgery.
Oh, and, yes, there is always the possibility that your animal has destroyed the surgery in some manner. But the top three reasons for lameness & limping that I already cited are really the most prevalent causes. I have had a few clients who have simply not restricted the animal (dog, cat, horse, llama…) and have allowed far too much activity and have blown up the surgery. A typical example is a dog that is allowed to run up and down stairs and bounce all over the place. They usually blow out knee surgeries and have to have re-dos. Only speaking of knee surgeries here, four more biggies come to mind, and none of these have had to do with the owner allowing too much activity, although in two of them the surgeon tried to blame the owner and/or rehab, but infection was the ultimate culprit. Often I am not called onto a case until extra damage is done, so I am accustomed to rooting out these things, and hopefully this little bit of info is helpful to you.
Just speaking of knees, and just off the top of my head, one of those additional blowup cases was a tiny dog that had both cruciate ligaments and both patellas (kneecaps) operated on all at once. The practice of doing all that surgery at once is more common than you might think. The owner was very compliant, doing things the “right” way, and she had me come each weekday for a month to do the exercise and therapy work at least once daily, so she would “know” it was done correctly. I suspected infection right away in one knee because of the abnormal amount of swelling just a day or so after surgery. I reported to the surgeon excessive joint swelling (effusion) and other signs that accompanied this situation and that increased my belief that we had an infection compromising the repair. I could feel the pin in the problem knee working its way out. This would be a common side effect of infection. The short story is that the pin was removed many weeks later, and there was infection that would have most likely happened within several hours of surgery, given when I noticed the swelling.
Another case is mentioned elsewhere on this blog, that of the Great Pyranees that had knee surgery and ended up blowing out his opposing hip during recovery at a veterinary surgery center. By the time I saw him, I determined he definitely did not have adequate pain meds on board, for either the knee alone and much less for the addition of the FHO hip surgery as well. It is my guess that he was far, far too painful during recovery after the knee surgery and could not support himself well on the operated, atrophied leg. He had a series of very great complications, and the biggest battle, after we saved his life from gastro & infection-related near-death, was getting adequate pain relief for this very heavy and slightly lazy dog. Eventually so much time went by that his dysfunction (physical and psychological, in this case) complicated his recovery.
A third incident involved a dog that had a bone-modifying knee stabilization surgery (CBLO) and was damaged while in recovery at the specialty hospital where he had surgery, best we are able to determine from pre-and-post surgery xrays. The client was familiar with my work, and she called me to evaluate her dog when he was still exceedingly lame a little over a week out of surgery. He had been to work in a water treadmill already at a facility. When I first saw him, he was lame beyond what I would expect, based on my experience and based on the lack of swelling of any sort, however he also did not have enough pain control on board, based on established protocol and based on his lameness. He was set to go for another water treadmill session within the next week, and I drove home to the owner that she really, really needed to alleviate his pain and have the surgeon take another look at him. He was only being given an nsaid (non-steroidal anti-inflammatory)(Rimadyl, Vetprofen, Metacam, etc…). I pushed her to get Tramadol from either her regular vet or the surgeon. Weekend coming up, regular vet deferred to the surgeon, surgeon not responsive, associate vet finally gave script over the weekend. Yay! The pet went to his second, pre-scheduled, water treadmill session, and I saw him the following day. I told the owner to make an appointment with the surgeon and not do any more activity until they got an x-ray. The dog was far too lame for having the nsaid plus the new moderate doses of Tramadol on board. He had been on antibiotics for the surgery, if I recall correctly, so we didn’t think it was infection, plus, there wasn’t a large amount of effusion (knee joint swelling). It turned out that she got the x-ray and his fibula was broken and the screws and plates were pulled out from where the bone was cut. Eventually we were able to go back and compare post-op rx-rays and find that it seems the fibula was broken in recovery just after the surgery or ? We don’t know. What mattered was moving on and doing the best for the pup. It has been a little over a year and he is doing great! He had some re-dos and a long period of multiple pain reliever drugs being juggled. He was not on any meds at about a year out from the incidents. He did, however, need to take the pain relief drugs for many months. The point to these short stories is to give some brief recounting of post-surgical abnormal knee incidents so you may be informed and move forward with your pet. I am not going into full case studies here.
The fourth incident that comes to mind actually involves two small dogs with the same issue: both had suture repair of torn CCL/ACL and one was encouraged to run up and down the flight of stairs in the home soon after surgery because the owner thought it would help strengthen the dog. The pet had adequate pain meds, so the owner thought he was healed and encouraged this running. He blew out the surgery. The owner did receive instruction from the vet telling him of restrictions, etc…but restriction is not what happened, and often people are confused even if they receive adequate instructions. The restrictions are very important. The other case was also a small dog, and the owners felt sorry for her and allowed bouncing and running all over the house. She blew out two surgeries in one knee and about a year later had the same surgery on the other knee, this time with many restrictions heeded. 🙂
The first incident I told several paragraphs ago could happen to any pet, however in the many cases I’ve treated, even it is unique. The second and third are ones I see in large dogs once in a while because of complications in recovery. I’m convinced they should be recovered in the hospitals like a horse would be, in a supported sling, instead of on the floor! So, cover your bases regarding the first three reasons your dog may be limping/lame and pursue vet care based on this information.
In my area, we also have many vets that practice acupuncture and a few that do chiropractic work, so I often direct my patients to their services for the additional pain relief benefits. I know, based on how many I know of in this area that have had complications, as well as from feedback I receive from around the world, that very many of you out there have dealt with complications. Realize, though, that most issues I see before *major* complications set in are resolved by following the three guidelines at the beginning of this blog.
My own dog, Grace, had OCD (osteochondritis dissecans) in her knee(s), and before I knew more, before I got into this vocation and began putting together what I already knew from sports medicine and exercise physiology, I chose a TPLO surgery for her when she tore her first knee ligament, in the genetically malformed knee. She had about a half softball calcification at the medial aspect of the operated stifle, and a previous surgery performed to hopefully stimulate correct bone growth was unsuccessful. The TPLO cut was a non-union, meaning the bone did not grow back together after surgery. It wouldn’t have grown back, presumably, given that the bone was damaged inherently as it was, but I guess it was thought at the time to be worth a try, or that being able to move the position of the head of the tibia and have the plate in place to stabilize it was a positive step, given the other issues. I wouldn’t do it for that same dog and that same set of circumstances again today, but I know a lot more than I did those many years ago. That genetically bad knee turned out to be her better one over time, as the other knee eventually became destroyed. She tore the second CCL in about a years time, and I chose a TPLO for that knee as well. She seemed to have a compromised immune system, so we had a habit of starting her on Cephalexin some days prior to any surgery. Due to some circumstances, she ended up with a resistant pseudomonas infection seemingly immediately after surgery, complete with need for drains for the green slime over several weeks while I administered powerful, injectable antibiotics for weeks. It was clear within about two years that the infection had really eaten up her knee. She had two more scopes (arthroscopic surgeries) to clean out debris. She eventually became bone-on-bone in both knees, the infection knee being the worst, and she eventually tore all three ligaments (diagnosed via signs, x-rays, palpation, and common sense, collaborated by vets) in the worst, infection knee, and signs of more ligament tears existed in the original “bad” one. She was amazing nonetheless, and a pioneer for me regarding non-surgical helps for knee damage, since nothing more could be done given her dynamics and dramatic damage. With her immune system and other medical history, she probably would not have been a candidate for the knee replacement studies that were going on at the time.
And Grace’s situation is likely not the complication your dog/animal will encounter. I welcome stories of problem and resolution. I am only relaying these few stories to allow for the fact that other things do happen outside of the first three most common incidents I outlined, however the reason for lameness/limping after surgery is usually one (hopefully one) of the more simple-to-resolve first three situations I cited. ! 🙂
The most updated version of this post is now available from Amazon.com, under
Rehabilitation and Conditioning for Animals
Guidelines for Home Rehabilitation of Your Dog
After Surgery for Torn Knee Ligament,
First Four Weeks, Basic Edition