What is Rehabilitation and Conditioning for Animals? (Rehabdeb, RehabRevolution)

Animal Rehabilitation, Pet Rehab, & Canine Sport Conditioning

Rehabilitation and Conditioning for Animals provides science-based functional rehabilitation, wellness conditioning, nutrition counseling, and athletic training for all ages and stages of companion animals in collaboration with veterinarians while also engaging community and worldwide participation in programs that benefit the human-pet experience.

What You ‘ll Find on This Site –

  • programs for pets for after surgery and conservative treatment programs to use instead of surgery
  • programs that you may do at home, in a standard clinic, or elsewhere
  • a lot of work for you to do with your pet
  • first-hand details about programs I have developed and used as well as information about results
  • pros and cons of rehabilitation I have discovered in my years of practice in veterinary rehab (see clients I’ve helped)
  •  programs designed by a professional certified in several disciplines related to conditioning, recovery, and strength (this is important because there is a lot of bad information on the web about how to rehab a pet, even though most of it is well-intended)
  •  pet rehab = principles of exercise science + neuroscience + clinical medicine

How Are These Programs Different?

My programs are based on over four decades of my having participated in, worked in, and created programs in human sport science, nutrition, and medical recovery. They are also based on my experiences working hands-on with veterinary specialists, and sitting in on medical, neurological, and surgical specialty evaluations of patients.

I design these programs so that almost anyone may use them at home or in a standard veterinary clinic. You may do all rehabilitation on pets in the home environment in most cases.

Why Did You Create Different Programs?

I professionally began small animal veterinary pet rehab in 2004. At that time there were no standard, concise, systematic, and progressively oriented rehabilitation programs available on the web or that I could find in publications.

I had hoped to find programs based on exercise physiology and recovery principles like those I already had experience using for athletes. I wanted them to exist already so that I could follow-up on specifics that also interest me. I’d like to investigate breed recovery differences and give more complementary rehab care for veterinary cancer patients.

Over the years, I have ended up developing and using the types of programs I thought would already exist for small animal medicine and recovery. I figured they already existed, in part because I was used to systematic programs from human exercise physiology science and in equine science.  

May Anyone Use These Programs?

These programs mean a lot of work for you. Your work should be successful if you follow the recommendations I give. 

I have shared my rehabilitation protocol with many pet healing groups, veterinary clinics, trainers, boarding facilities, and specialty hospitals. I have shared rehab programs in person, on the phone, and on many internet platforms over the years (remember MySpace?).

You Don’t Need to Have a Certification to do Successful Rehabilitation on Your Own Pet!

There are a couple of standard courses of pet rehabilitation in use in veterinary medicine. None of these teaches practitioners foundations in exercise science and exercise physiology-based recovery.

My programs use a combination of a small amount of clinic-type rehab and a large dose of recovery science. I’ve pulled over athlete recovery methods from the “human” side and successfully applied them to the veterinary side of rehab.

My rehab work is designed to teach you how to work with your pet and gain success in recovery

In addition, I have certifications in pet massage, canine rehabilitation, human strength and conditioning, and wilderness medicine, to name a few. I use information from a wide variety of experiences to help pets recover or to improve sporting conditioningMore here…

 

Nside Texas MD Rehabilitation and Conditioning for Animals Article by Heather Daniels

Other “Official” Information –

Check out my semi-updated profile on  LinkedIn

We discuss lots of issues on this site, so I recommend you look through the Q&A. Please use the search box to find specific topics. More info about how to get the most out of this site is on this page, How Do I Find Help For My Pet on This Site?.

Rehabilitation and Conditioning for Animals is subject to guidelines overseen by the Texas Board of Veterinary Medical Examiners (TBVME).  Therefore, I do require that your pet has recently gone to their veterinarian for acute issues. Additionally I require that your pet’s veterinarian has evaluated your pet within the past year for any chronic issues. I also need to be able to communicate with your pet’s regular veterinarian about the issues I will be addressing.

I do not need a referral from a veterinarian to begin rehabilitation work with you and your pet. The TBVME does not require a referral for me to work with your pet on sport training and conditioning.

After my consults, I direct clients to be in communication with their regular vet to discuss medications, signs & symptoms, and collaborative treatments. Your pet does need to go to their veterinarian if they have a new medical issue the vet hasn’t seen.

Thank you for visiting and I believe you will find useful information for you and your pet!

Rehabdeb

Originally Published February, 2015 and Updated April 14, 2018

4 Month Old Pup Too Active After Spay

Q & A –

Is your spayed pup active? Your newly altered pup bouncing off the walls?

The following question came from a long-time client who occasionally texts to me. My response was given while I was on the road, voice texting concise answers back to her.

After our text exchange, below, I’ll give a few extra thoughts, and here are some more pointers!

Question –

“Hey, I have a friend with a 4 mo old pup who just got spayed. She keeps jumping around and opening the wound. Any ideas to get her tired?” 

Dog caught by the belly in the window blinds
Didn’t Mean to Get Caught in the Blinds. This is NOT the dog mentioned in this post, btw!

Answer –

“:-) Hey! Is she using a harness only and keeping her restricted in a crate or a penned area or restricted with the harness?

All walks should be in a harness with a snug leash, no leeway, restricted always, & also potty on tight leash, 5-10 min out (then back in), & follow the recovery for first four weeks after surgery. Do not walk more, not longer & not dozens of times.

Capillaries need to heal and they won’t do that if she keeps getting her blood pressure up (playing). Splitting the stitches or staples is a secondary problem cuz the stitches are in place so that the tissue can heal, and all the activity is going to tear the healing tissue and open up the healing capillaries.”

Her Response –

Response to my response: “She’s keeping her in a crate. She has a donut (e-collar), but I don’t think she’s keeping her on a leash in the house.”

Further Discussion –

This is a question based on a situation I encounter *all* the time. Pets very often tear out stitches and staples, in many ways and for many reasons.

If a pet you know that has had surgery has torn out their stitches, staples, butterfly bandages, etc, then that pet will need to have the wound(s) and incision(s) inspected and may need to have the stitches replaced. That advice is the smartest I can easily give on this website.

There are many different issues a medical practitioner will be looking at depending on the type of surgery the pet had. This means you should probably just go to the vet and not take a poll of your friend’s and family’s opinions first. If your veterinarian told you at the last visit that you didn’t need to return if the pet tore out the stitches again, then perhaps you don’t need to go. However, if you were told that you didn’t need to return yet you see blood coming from any area, I recommend you have the area evaluated medically.

The pet caretaker mentioned in this Q&A text was returning to the vet for care, to my knowledge. So, the question that they came up with was how to tire the pup so she quit busting her stitches.

Pets can get very excited –

small white plastic open top pen for pets
Small Crate for Bedroom

This is why my simple post-surgical instructions work. I recommend the harness, etc, as I did in my answer, above. Use restrictions. Follow the four-week post-op plan in my booklet. All of this helps keep your pet from damaging their healing areas and encourages healing.

I recommend, in addition to what I’ve already said, to give all pain medications as the veterinarian prescribed them. Please double-check the medication labels. I do that for people when I am in-person at an appointment. You might be surprised at how often people are making mistakes with the medications. Make a chart or record that details when you give the medications.

Positive Vibes –

Follow the restrictions with a good attitude toward them and pass along a “positive vibe” to your pet. Animals pick up on our emotions. I often need to discuss with clients that their feeling sorry for their pet is rubbing off and they need to switch to praise and encouragement with a “normal” tone and voice. More of a “move along, nothing to see here…” attitude, with empathy instead of pity.

Pets feel the worry and pity that their people feel toward them. Often the pet will worry about their people. That usually makes the pet seem “worse”, and the people worry about the pet worrying about the people. In my experience, dogs and people do this cycle more than cats and people do.

I explain more in my booklets about the positive benefits of restriction plus the right kinds of exercise for recovery. “The right kinds of exercise” includes progressive work that is relative to healing and includes many restrictions. I have found that if people restrict themselves or their pets as I urge them to do plus take their pet on specific outings, for potty or rehab work, the people end up doing a lot more attention-giving activities with the pet. This helps the pet to stop being so crazy or anxious in the house during recovery.

I intend to write more on the psychology of how we humans mess with our pets in other posts.

Bottom line –

In this case, the dog doesn’t need exercises to tire her out. In fact, as I’ve said, that will open healing capillaries. Too much exercise obviously caused other problems, too.

This pup and others like her need to start with a structured recovery plan which includes a lot of restrictions.

Rehabilitation is available for every condition known to mess up our bodies. Every injury and surgery should have a rehabilitation plan. No one needs the water treadmill for most surgeries or injuries, and we don’t want or need to put a newly spayed pup into a water treadmill. What’s can you do? Recovery in a fairly controlled atmosphere and a thoughtfully crafted work program.

Cheers!

Rehabdeb, April 7, 2018

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.

 

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:

Homedics brand hand-held massage unit with four feet

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)

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Journal References

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

From ScienceDaily