Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Hi Deborah!

I’ve enjoyed following the stories you post on FB about the dogs you heal, and who’d’ve thunk I might one day need your services?

My dog, K, has been gimpy for about a month or so (back right leg)… took her to our vet a couple of weeks ago. By poking and prodding, they figured it’s her knee. Gave us some anti-inflammatories and said to keep her from running, going up stairs, etc. It showed improvement during the first week, but then we let her back on the stairs and it’s back to the same.

My former vet friend, P, looked at it a couple of days ago… She strongly suspected an ACL tear.

I poked around a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought I’d ping you and ask you a few questions:

– What would our next step be? (we haven’t had x-rays or the “drawer-test” that Pam described to me)

– If we wanted to do any rehab through you, how would that work and what would the fees be?

K seems very happy and it doesn’t really slow her down too much (unfortunately! She wants to continue being the family dog that she is, around us all the time). Yesterday, we decided to confine her (like crate rest), but the problem is, the gimpiness seems worse after she’s been lying down for a while, then it seems to warm up and work itself out once she walks around a bit. So by keeping her confined, she’s lying on it a lot more and not moving as much, so it actually seems worse. (making me wonder if the confinement is the right thing to do…)

Thanks!!
T

My Answer Today:
Hey Gurl…
Goody…I happen to be home and able to give you a better answer via the pc keyboard!
The best option, imho, is to have me come out and do a consult regarding how you should proceed. It usually takes an hour for something like this. I prefer to see animals for the first visit in the home environment so I may discuss potential pitfalls and see home items we may use for drills, among other reasons. I am also able to do phone consults at $1/minute, but I prefer to see the pet in person…

The second best option is for you to go onto my rehab site and look under notes for the homework for post cruciate ligament rupture rehab.
I also have a video posted on YouTube and my WordPress site regarding a massage technique that is beneficial. The Pittie featured in the video is 3 years out from a cruciate ligament tear and never had surgery. He is doing great because the owner did the homework as I recommended. The YouTube link is on my WordPress and is under RehabDeb if you search it.

I do not think I would ever have surgery on one of my own dogs for this issue again. My little Grace had two TPLO’s, the major surgery where the bone is cut and replaced at a different angle, and both didn’t work out. One wouldn’t have worked out because she had a congenital joint disorder on that knee and the surgery wasn’t ever going to be solid, and on the other knee she ended up getting a raging infection at the time of surgery that eventually ate up the whole joint. The Grace had a poor immune system, and she was open too long on the table, due to unforeseen circumstances, among other things.

She was bone on bone in both knees for the last 3 years of her life, yet she was definitely full of life! She ended up tearing all three ligaments in the second knee, so far as I/we can tell, and it was muscle support of the joint that enabled her to function as well as she did. None of the available braces were of a good enough design for her, and I’m not a fan of what is currently available for most dogs, especially not without working on my walking and exercise drill protocol first.
I deal with many dogs whose owners don’t want surgery for a variety of reasons, and the feedback I receive is that they have done great without surgery.
Of course, I also do rehab with many pets that have had surgery also, from both boarded surgeons and regular vets, using all types of modifications.
I’d be glad to discuss the differences.

We don’t do surgery on every human athlete, much less every human, yet most of the dogs are immediately referred to surgery as if there isn’t another answer the vet knows to suggest. This is because the vets are trained to react in that manner, and they usually don’t have any foundation in muscle-building and joint support protocol. Most of the reasons I’ve heard given in favor of surgery aren’t necessarily scientifically correct, according to available research and anecdotal evidence. I’m trying to make my functional rehab protocol using principles of exercise physiology more readily available.

My background in sport science definitely gives me a huge edge in developing protocol for recovery, and it is just taking slow time, getting the word out and getting people to think more wholly about the situation, and to see/know therapies that exist in other areas of physical science and apply them here. The angle of a dog’s knee, or any quad-ped knee, is definitely different than that of a human/bi-ped, however many principles of physiology and of the relationship between soft and hard body tissue apply and are useful to improve function and quality of life.

Blessings!!

(10-17-13 and now you may purchase the guide book for rehab of this condition at http://wp.me/p1wSDA-cU )

Sully’s Story: Great Dane with Lick Granuloma, Spinal Infection (probable), Paralysis, Ulcer, Pneumonia

I first met Sully March 4, 2011, and you have seen him if you have followed some of my posts about him on Facebook and Twitter. I was first called to see him by a mobile vet and the owner stated as her main concern for Sully at the time, “loss of use of hind legs”. The owner, a woman living alone and not able to easily cope with this just-under-200 pounds-dog who couldn’t move on his own, contacted me on Feb. 28, 2011, and our schedules did not match up until the fourth of March…and by that time he had ceased to be mobile and had been stuck, lying on one side, for several days.

The short story for those of you with attention span issues is that Sully couldn’t walk, had a lick granuloma that was about 2 yrs. old, had likely incurred spinal infection from the infected granuloma site, had several urine burn ulcers, developed pneumonia, was treated for pneumonia, which, in turn, developed into long-term treatment for possible spinal infection, was treated for pain, was pushed daily to move in increasing amounts, and is now walking down the street with no assistance.

A case outcome like this is relatively rare, primarily because the owner has stuck with treatment (it works if you work on it and give it time…), and usually a case like this would have been euthanized because he is huge, the owner did not have additional help in the home, he is aggressive, and the owner was not going to have him hospitalized for any reason-not for pneumonia, not for machine-based diagnostics, not for urinary incontinence, not…period.

Sully definitely had some dark moments, yet everything that has happened with Sully has been “do-able”, maybe not optimal by  some of today’s standards, yet definitely “do-able”. I have pushed Sully, the vets, the owner, and any other caretaker every inch of the way to drive us all to give Sully the best treatment we all could…it has definitely been a collaborative effort, and I knew from my background and experience that experiences like ours with Sully were/are very novel to the majority.

Silly Sully

Thank you for your attention thus far, and blessings…please take any of the following info and use it to heal in your corner of the world.

Two block-and-tackles, a belly sling, a saddle girth, some caribiners, and a hind end sling…gets the day going!

April 7, 2012

Today is Sully’s 10th birthday! I have been working with him for one year and one month. A year ago, he couldn’t stand on his own and was sporting a urinary catheter. Last week he tried to run down the street with me! We love us some Sully!

Fat and Fat Reduction – 3 Articles

Fat is Pro-Inflammatory! Weight Loss Helps Relieve Pain From Arthritis (among other things!)

Copied from a recent post on the IVAPM*:

“…I would be looking for some of the non-pharmacologic strategies. You have already mentioned an important one, getting the weight off. Adipose tissue is the body’s largest endocrine organ, and it secretes, especially when in excess, a slew of nasty cytokines that essentially bathes the body – including the synovia and joints – in a soup of pro-inflammatory mediators. We have increasingly strong evidence in dogs that nothing more than weight loss will improve comfort and mobility in this species, including excellent one this year where the authors conclude “results indicate that body weight reduction causes a significant decrease in lameness from a weight loss of 6.10% onwards. Kinetic gait analysis supported the results from a body weight reduction of 8.85% onwards. These results confirm that weight loss should be presented as an important treatment modality to owners of obese dogs with OA and that noticeable improvement may be seen after modest weight loss in the region of 6.10 – 8.85% body weight”.”

Weight loss. There is no substitute. • Lago R, Gomez R, et al A new player in cartilage homeostasis: adiponectin induces nitric oxide synthase type II and pro-inflammatory cytokines in chondrocytes. Osteoarthritis Cartilage. 2008 Sep;16(9):1101-9. • Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. JAVMA 2000 Apr 1;216(7):1089-91 • Burkholder, 2001 • Mlacnik E, Bockstahler BA, Muller M, et al. Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc. 2006 Dec 1;229(11):1756-60. • Marshall WG, Hazewinkel, HA, Mullen D, et al. Vet Res Commun. The effect of weight loss on lameness in obese dogs with osteoarthritis. 2010 Mar;34(3):241-53

*International Veterinary Association of Pain Management

Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones.

J Bone Miner Res.  2011; 26(12):2851-9 (ISSN: 1523-4681)

Shah K; Armamento-Villareal R; Parimi N; Chode S; Sinacore DR; Hilton TN; Napoli N; Qualls C; Villareal DT
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO, USA.

Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30  kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p  <  0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p  <  0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p  <  0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p  =  0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p  =  0.001). Multivariate analyses revealed that changes in lean body mass (β  =  0.33), serum osteocalcin (β  = -0.24), and one-repetition maximum (1-RM) strength (β  =  0.23) were independent predictors of changes in hip BMD (all p  <  0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.

 

Fast Walking and Jogging Halve Development of Heart Disease and Stroke Risk Factors, Research Indicates

The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.
This has been proved in different studies in different ways for different reasons, mostly related to sport science and training, for many years. Don’t think you don’t have enough time to exercise 🙂

Keep in mind, though, that it’s very slow walks that bring about the benefits at the beginning of rehab, as per my homework instructions!

ScienceDaily (Oct. 8, 2012) — Daily activities, such as fast walking and jogging, can curb the development of risk factors for heart disease and stroke by as much as 50 per cent, whereas an hour’s daily walk makes little difference, indicates research published in the online journal BMJ Open.

The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.

Genes, diet, and lack of exercise are thought to be implicated in the development of the syndrome, which is conducive to inflammation and blood thickening.

The authors base their findings on more than 10,000 Danish adults, between the ages of 21 and 98, who were initially assessed in 1991-94 and then monitored for up to 10 years. All the participants were quizzed on the amount of physical activity they did, which was categorised according to intensity and duration.

At the initial assessment, around one in five (20.7%) women and just over one in four (27.3%) men had metabolic syndrome. Prevalence was closely linked to physical activity level.

Among the women, almost one in three of those who had a sedentary lifestyle had the syndrome whereas only one in 10 of those who were very physically active had it. Among men, the equivalent proportions were just under 37% and just under 14%

Of the remaining 6,088 participants without metabolic syndrome, just under two thirds (3,992) completed the fourth and final survey and assessment, by which point one in seven (15.4%; 585) had developed it.

Again, the prevalence was higher among those leading a sedentary lifestyle, with almost one in five (19.4%) affected compared with around one in nine (11.8%) of those who were very physically active.

It was not only the amount of exercise, but also the intensity which helped curb the likelihood of developing the syndrome.

After taking account of factors likely to influence the results, fast walking speed halved the risk, while jogging cut the risk by 40 per cent. But going for an hour’s walk every day made no difference.

“Our results confirm the role of physical activity in reducing [metabolic syndrome] risk and suggest that intensity rather than volume of physical activity is important,” conclude the authors.

Walk Slow or Walk Fast?

Q&A –

Should your pet be walking slowly or walking faster after injury or surgery? Science says slow and steady –

Question –

“Dr. *Surgeon* did X-rays and said she is totally healed. He said sometimes the implant can be irritating for her and he can remove that since the bone has healed…could be the reason for some of her discomfort. He also said slow walking is more painful for her and she should go at a faster pace. What do you think???”

Answer –

Yes, walking slower is more painful because she is having to use the injured limb more.

She has to use the injured limb more for good recovery.

It is also painful when the pet is not receiving enough pain medication to go along with a proper home rehabilitation plan.

She needs to use her leg for full healing.

If your pet is going fast, they are usually skipping over using the injured body part, whether you think you see them doing that or not. If they don’t use the painful body part, they won’t grow bone & muscle as well or much at all, and they won’t heal as well. They cheat on leg use when they go fast after injury or surgery and if they are in pain, which they most often are in my experience.

Pets don’t use the affected muscles & limbs like they should for better development and recovery when they are in pain. Proper dosing of pain medicine goes a long way toward encouraging healing and making the system work better.

I do not agree that she should walk faster; it defies sports medicine principles and the principles of functional recovery and rehabilitation to have her walk faster now. A slow return to positive function will most likely insure against added injury.

Here is a booklet to help after surgery or with most basic recovery for the first four weeks. Real rehab should be progressive and will last at least 12 weeks on average. Persistent problem cases may take up to a year or more to heal more fully. This is the same as in human medicine. 

 

Published August 13, 2011. Updated May 3, 2018

My Dog is Just Old…Old Pet Tricks

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…:)