The top 5 tips to help you and your pet get back to doing more of the things you like to do together:
1) Do only controlled exercise in a sequential and methodical manner and otherwise restrict your pet as much as possible.
The exercise programs I have developed and that I and others have applied to thousands of cases work extremely well. I consider them to be like Goldilocks’ porridge…not too much and not too little. Resist the urge to jump ahead into advanced drills or harder work if you haven’t put in the time to build a solid foundation. Please do not only keep your pet crated, and, more importantly, do not allow any loose activity outdoors or indoors during recovery! Crates are great, and I want them to be used. I also want you to use them or other tight restrictions along with a competent exercise recovery program!
2) Give all medications as your pet’s veterinarian has prescribed them, especially antibiotics…especially pain meds…especially all medications 🙂
My booklets and other posts on this site explain this in more detail. I have written a lot about pain in this post: Pain & Limping . I included info about pain and infection in that post. Pain is the top reason people contact me after a pet is injured or has had surgery. I know some medications are hard to dose, so I have posted some links to products that can help without using unhealthy options (unhealthy=Cheeze Whiz, marshmallows, most dairy, etc…you probably already know) on my Resources & Tools page. Pain=limping=pain. Surgery also = pain…so either way, surgery or no surgery, your pet most likely needs pain medications.
3) Use the e-collar after surgery.
The Elizabethan collar (e-collar) is the best and fastest way to allow healing and stop pets from licking their injury or surgery site. Based on my extensive experience fixing messed-up stuff after surgery, I can tell you there aren’t any other great options available that work as consistently well as the e-collar.
Some pets will pull it off if you don’t tighten it down to 2 fingers placed flat under the neck tie. If your pet pulls it off, that is usually due to operator error (yours or mine or vet clinic staff). The e-collar is very important.
I’ve dealt with the resulting problems when people don’t use the e-collar. There are many reasons people don’t use the collar. Maybe it’s because the pet crashes it into everything around the house, or the people say “he doesn’t like it”. The problems I deal with when the collar isn’t used are ruined surgeries, dogs licking an area on their bodies down to the bone, cats fussing with the staples or sutures and pulling them out, extensive infections that sometimes cause loss of life, etc.
I recommend people keep the e-collar on the pet until about 2 days after suture removal. Have you had stitches? Surgery? The sutures can cause itching when removed, as you may remember if you’ve had them. Often nerve reactivation to the surgery area can cause the area to “feel weird”. Keep the collar on your pet. More often than not this move will save you and your pet a LOT of trouble!
4) Use a good harness with a very short leash to control and protect your pet if you are walking them.
I discuss this at length in my books and videos. Harness and leashes I recommend are here. Use a harness and not the collar when you are working on rehab with your pet. Use a super short leash, keeping your pet close by your side so they don’t hurt themselves.
5) Don’t cut corners.
Unless you have extensive experience with physical recovery science applications in a variety of settings, don’t change the rehab plans I recommend. You and your veterinarian most likely won’t know when you can shorten a program without doing damage to your pet. If you cut corners, you also run the risk of not getting the same positive results following the plan brings. It’s easy for me to help clients to see where their omission or addition of parts of the plan turned the recovery plan the wrong direction. Since I don’t get to work one-on-one with most of you in person, I return to recommending that you find a well-described plan and follow the plan and not add to it and not cut corners 🙂
My list of recommendations could go on and on, yet these are the top 5. I made this list based on problems from many cases over many years. Like so many things in life, pet rehab can be very easy, yet it’s our wrong thinking about solving the problems that often stands in the way of following a good program well. Feel free to write and email using the contact form if you have had a learning experience with any of the recommendations I listed above. If I think it’s helpful to others, I will publish it under this post!
When and Why to Perform Range of Motion Drills for Pets
If you are going to do range of motion drills on your pets, you should have an experienced practitioner demonstrate them to you, preferably on your own pet.
Passive Range of Motion (PROM) really only needs be performed on animals limbs that the animal is not able to move on their own. PROM is the passive version, and describes range of motion drills when your pet is passive and unable to move their limb.
Range of motion exercises (ROM) are exercises that we may do for others, yet those others are also capable of moving on their own.
ROM drills are often recommended in veterinary medicine. I disagree with doing ROM on the majority of pets, and I do not recommend it for my veterinary rehab patients after hip or knee injury or surgery.
This recommendation, to do ROM, comes from the “human side”, like a lot of good information for pet recovery does, however pets operate differently with respect to their damaged bodies than humans do. Making blanket recommendations to pet peeps to do ROM is not the best approach.
I do not recommend doing ROM if the pet is able to move on their own, even if they are not moving a lot after surgery or injury.
Some pet caretakers I have counseled have left the vet’s office with surgery discharge instructions that tell them to do massage or ROM exercises. Most of the time the animal caretaker/pet owner does not truly know what this means or how to do it so that the pet is not injured or so that the person is not wasting time.
People are sometimes injured accidentally by their pet if they push ROM drills. Correct range of motion drills that make a difference are likely to cause pain in a pet that has neuromuscular function and feeling. If the limb is not paralyzed, the pet can most likely feel. Sometimes a pet that appears paralyzed is able to feel pain, too. The pet doesn’t understand and they might nip at people when they cause pain with ROM drills.
Comfortable Joints –
If pets are comfortable with joint use after injury or surgery, they will use their joints. As pets recover, their joints will be less swollen and more normal use will increase naturally. This is especially true if the pet is doing a good rehabilitation program.
People also usually do not know when to stop pushing a joint and where to start working with ROM drills. This leads to non-compliance on an exercise the clinic recommended, and usually this drill is an unnecessary expense of time if the pet is able to move their limb on their own.
A referral to a strength and conditioning rehab practitioner or a neurological recovery specialist to judge protocol and beneficial movements is a great idea for pet caretakers in these cases.
Joint Stops –
I have consulted on several cases wherein people were really trying and forcing range of motion drills with no improvement in their pet’s natural joint movement. Most of them had been back to the surgeon or regular veterinarian at least once to have the practitioner check the case. In these particular cases I found that there was a “stop” in the joint that should not have been pushed. The people didn’t know that, and in some cases the veterinarian and surgeon did not know, either.
The “stops” I mentioned above are due to different circumstances in different cases. One cat had a pin in her knee that was part of a fracture repair, and the pin was stopping the joint from opening more fully. A surgeon needed to remove the pin. The client had been to the surgeon and to the surgeon’s rehabilitation practitioner. Both of those practitioners kept telling the client to push ROM on the cat. The CCRP rehab person had forced the knee joint during many visits. Of course, it wouldn’t open further, and any perceived gains were likely due to the pin digging into the opposing bone.
The cat was mad and in pain, as you can imagine, and was hiding under the bed when I arrived for my consult. My advice, after finally getting to gently examine the cat, was that the client pursue a second opinion from a different surgeon in a different practice. It’s probably obvious to you that this cat didn’t need more range of motion exercises; she needed surgical intervention to correct the pin.
Then Why Did my Veterinarian or Surgeon Recommend These Drills?
Most of the time, I believe the veterinarian is trying their best to catch up with some of the rehabilitation protocol promoted at conferences and seminars. Veterinarians and veterinary rehabilitation practitioners are doing what they have been told to do when they recommend ROM. I think they are really trying to do a good job. There is just so much to know that they may not have experienced some of the “bad” situations I mention in this post and therefore they haven’t had opportunity to come up with other solutions to the problems or think differently about the solutions.
ROM, water treadmill and balance board use are some hot topics in rehab practice. As hot as they may be, they are not the best unique approach to home or clinic-based rehabilitation. If they are to be used, they should be used in a planned order along with other work to compliment strength-building and recovery.
Alone, the types of drills I mention above only put a small piece, usually out of place, into the puzzle of recovery. Clumped together, these drills and others like them are often not in an order that compliments the science we know of exercise physiology and recovery.
Also, most of the time, veterinarians, medical doctors, and surgeons do not have extensive experience in functional rehabilitation. That is why there is a need for many types of recovery specialists in human medicine and why rehabilitation is a specialty in veterinary medicine as well. None of us has time to know everything about even our own specialties, much less all other specialties of interest.
I don’t do everything perfectly in my practice. I have, however, had a lot of experience in a broad variety of conditions and situations, and on this website I give to you more ways to think about solving problems.
Back to ROM –
ROM drills are not usually necessary if the pet is moving on their own! Other physical activities will be a better use of rehabilitation activity time than ROM. Other work will do a better job of encouraging overall limb and body use. Start with this foundation if you want to do some work yourself.
My Pet Already Moves Their Leg –
If your dog or cat or other pet is moving and flexing & extending their knee or other joint after surgery, very likely their joints are staying mobile enough for beginning recovery. They are as mobile as they are comfortable with moving.
Often better movement is dependent on better pain control. You may achieve better pain control in the short-term the most effectively with medications prescribed by your pet’s veterinarian. Supplements are usually helpful with long-term pain control. I have taken supplements for over 40 years and using the effective ones in my pet patients for over 25, if you count my own pets as patients! Unfortunately there is not a supplement at the time of this writing that will do the job that focused and thoughtfully applied pharmaceutical medications will do. At this time you cannot overcome big pain with supplements.
You don’t need to bug (and probably cause pain to) your pet by making them endure “bicycling” of their leg(s). Other drills and exercises will bring about better recovery and use of the joints. You subsequently have less opportunity to hurt your pet (or you) if you are not trying to forcefully manipulate them. Please start with and complete this foundation if you want to do some work yourself.
Pain? Or “Just” Needs More ROM?
If your pet is able to move on their own yet is choosing to hold a limb in flexion, bent at the joint, and isn’t using the limb much, then the problem is most likely pain. Usually the issue is NOT that the pet needs to be forced to extend/unbend and flex/bend with painful drills we make them do by our own hand. Please see my posts on pain for more info.
Animals do not have the same hesitancy to use their damaged joints in the same way that humans are reluctant to do. This means that if a dog sees a cat it wants to chase, then most of those dogs will chase now and endure the consequences later!
Movement and Reasoning –
In fact, even though I could make an argument for animals demonstrating reasoning ability, I have seen plenty of “act now, consequences later” results! In humans we call this impulsive. Sometimes I also have impulse control issues. You probably do, too. More on that another day.
We humans are usually going to stop moving. We usually think hard about how much pain we think the movement will cause. Our pets seem to do the same thing when they are in pain, but they don’t always restrict themselves.
In those cases humans need excessive coercion, like the ROM machine after knee surgery. Or sometimes we just need the best basic exercise drills for our situation. My dad has shoulders that freeze up due to old injuries. He gets physical therapy once in a while and he can afterward move better. Slowly over time, he forgets to do his exercises. Then his shoulders freeze and are very painful. Then I remind him to start with the simple exercises. The pattern continues today because he forgets. He needs to continue the best drills for his situation. So does your pet, until there is better function.
Conclusion on Forced Range of Motion –
Forced ROM is largely unnecessary for our pets unless the animal has nerve damage and cannot move their limbs; THEN you should do PROM.
The only time it is necessary to use ROM drills is when the pet is unable to move their limbs. Then you must incorporate several sessions of range of motion drills daily. Do this so that the muscles don’t contract and the joints don’t freeze.
Later I might post about proper range of motion for a pet that cannot move its limb. There are already videos galore on the webbage that show a lot about ROM and PROM. I don’t need to duplicate those. Most of the time those vids are encouraging you to do ROM on pets that don’t need it. I’m not necessarily talking about the models for the videos not needing ROM; I can’t comment on all those vids and whether those pets need ROM. I’m talking about necessity of ROM or PROM regarding the content of this post.