Post-FHO Homework Suggestions for Dogs (Hip Surgery)

Femoral Head Ostectomy/Removing the Ball off the Femur at the Hip Joint

First and foremost: pay attention to the discharge instructions your veterinarian has given you. During this surgery, there was cutting of muscle and other tissue that will require care and time to heal. You do not need to wrestle with your dog in order to apply ice to the surgery site; I no longer recommend icing  nor prolonged use of anti-inflammatory medications after most surgeries or injuries in keeping with the advanced research findings over the past 5+ years.

While other tissues are also disrupted during a FHO, muscle requires a little over six weeks to achieve a normal collagen ratio and will take longer to heal more fully. This should be considered when you think your dog is ready to chase squirrels at two weeks after surgery. Don’t let them if you hope for the best outcome from the surgery. On the other hand, the bone that was cut does not require the same care that a fracture repair or a TPLO would; there is no need to be concerned that you will cause further damage to the bone with exercise.

In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery by promoting hip flexion and extension through therapeutic exercises that stimulate leg use, leading to muscle strengthening and avoiding chronic disuse of the operated limb. Since the dog will move as they are comfortable and are made more comfortable with the right amount of the right pain medicines, I DO NOT recommend pet owners try to do range of motion.

After about five days, and especially if your dog is not using the leg much, then I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your dog. Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine along with the right kind of exercise at the right time helps achieve this, and it seems the medications are needed for an average of eight weeks for dogs after this surgery, if not more. No, as popular as it might be, your dog does not need a water treadmill workout to start walking again!

In light of this information, I believe the best outcome from surgery will be realized with a rehab consult from me to give instruction and homework specific to your pet. In-person consultation will always be better than the generic homework given over the internet. Otherwise, until I publish the booklet for specific post-op instructions after this hip surgery, please follow the first four weeks of work outlined in this book:


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All of these exercises should be done very slowly so as to encourage more weight-bearing. When the dog goes too fast, he/she can “cheat” and not use the repaired leg much or well. Too fast could also prolong the inflammation and pain as well as create additional damage to the area of the muscle at the end of the femur hip and upper thigh muscles. Too fast and too much activity will elevate blood pressure and likely cause the blood vessels to open up inside…keep calm and allow the vessels at least two weeks to heal.

We hope to create a slightly and increasingly calloused area in the muscle tissue at the end of the modified/cut femur. This will make the tissue feel the end of the bone less and less and will create a cushion of sorts. You can do this with the moderate & slowly increased exercise I begin to outline in the book…slowly increased exercise…not randomly increased because you think he’s better and able each day…slowly according to the plan I’ve written or one similar that allows for adjustment and healing in the body. I write these words having worked hundreds of cases that were allowed to do too much too soon, and it’s much harder to heal under those conditions 🙂

Running & rambunctious play during this time will upset the scar tissue I want you to help your pet create. On the other hand, not enough exercise, which is usually the problem after this surgery, results in too much scar tissue all around the hip, and your pet will experience decreased mobility and more continuous pain, especially when she is technically at a point that she may play and be wild. I often see these dogs months after surgery and they are still not using the surgery leg well.

If your pet is not using the operated leg after week 1, then I recommend calling your veterinarian or me for rehab intervention and to get them started on beneficial exercise. Range of motion is not an exercise that will be most beneficial at this time. With proper pain control, with good pain medication, your pet should use the leg for the exercises I outline in the book and in the future. Water treadmill is also not necessary for recovery from this surgery. If you follow the exercise prescription well and after week 4 of work would like advanced exercises, then a rehab consult is necessary.

I have some separate recommendations for cat FHO’s .

© 2007  Deborah Carroll

Reviewed 4/2015

Rehabilitation and Conditioning for Animals

Clark, 14 Month Old Shepherd Mix With “Bad” Hips, Questions About Surgery

From the client:

You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.

Me:

I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell ;))
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
:)) Blessings-

Me, After Eval:

After our first evaluation, my bullet point recommendations were to

1) restrict and crate when caretakers not at home during the next 2 weeks.

2) Begin exercise protocol noted on my FHO homework, beginning with week 2, 2-4 x 10 min walks daily, very slowly (wedding march or “wagons ho” pace).

3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 evening walks. Give 2 hrs. rest period in-between walks (as per homework sheet).

4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm. These are all proved anti-inflammatory measures.

Client:

(after having some problems with Clark, a rescue, and other dogs adjusting)

Hi!

We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.

Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)

I will keep you posted on progress…just might be a little longer than 4 weeks.

Have a wonderful week!

Me:

Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.

In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.

Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation. Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes? 

I don’t think you are in that catagory.

You guys represent a lot of families I see in my practice, in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This family model is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. You don’t have to load up Clark to go into a clinic in order to gain the best functional rehab for him in this case. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work. 
I know you know that .

And of course my perspective is a little more broad than that of some practitioners, because I have seen a lot of what happens to a lot of animals in a wide variety of circumstances.

The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).

More than that is the additional stress and pain for the animal after surgery.

I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.

You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.

And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems, based on what I find is known and not known about standard principles of exercise physiology and return-to-function program design. I came into vet rehab at the end of 2004, after 25 years experience in human sport science and nutrition protocol. These principles I utilize and design programs around were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for other animals for pre-hab, re-hab, and instead-of-surgery in many cases.

There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue and more.

I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics, or so it seems.

Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. The same exercises will also improve muscle hypertrophy, which will, in turn, displace the femur away from the acetabulum and therefore reduce the pain element so often accompanying “bad” hips. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.

Other beneficial things will happen as well, as always do with exercise of the right type for a particular body and situation. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say whom I’ve heard, and that is what the literature says. Vet surgeons in other parts of the U.S. (other than where we are) often will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.

So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.

That’s all I have time for right now, and I think this will help you guys.

Blessings-