9 1/2 yo Lab Mix Torn ACL/CCL no Surgery

Cathy
(originally submitted under comment section of “Anecdotal Progress” post)
Submitted on 2012/12/17 at 8:15 pm
I agree that exercise can help heal. My 9 1/2 yr old lab mix tore her ACL in September and we chose not to have surgery for many reasons. I found your site and we began the SLOW short walks 3 weeks after the injury. Other than that she was restricted to my bedroom and potty breaks outside. We began with 5 minute walks twice a day. It has been over 3 months now and we have progressively increased the duration of her walks. Today she walks about 20 minutes at a reserved pace twice a day. Her limp is barely noticeable. In the house we only restrict her (with a baby gate) to my carpeted bedroom when no one is home to prevent her from chasing the cat or freaking out at the doorbell, etc. and we bought cheap runners to put on the hardwoods to create no-slip paths for her. She takes Glucosamin/Chondroitin and Green Lipped Mussel supplements daily, and we cut her food back somewhat so she stays “skinny”—-no extra weight on the knee. She is on a no grain dry food mixed with canned. She was on Rimadyl for a month after the injury and Tramadol for 2 months. I took her off both now. I know she may never go back to unrestricted running and chasing the insane Papillion dog next door—- but she is getting better without surgery or drugs for now.
Here is my question: How can I find a vet who is supportive? My vet sent me to a surgeon and they weren’t positive about options or alternatives. I would also like to know if you recommend water therapy?

rehabdeb
Submitted on 2012/12/19 at 9:05 am | In reply to Cathy.
Hi, Cathy!

Thank you so much for your feedback, and commendations to you for being fastidious with the program 🙂
According to what I saw in my email feed from your post, you may be in North Carolina? I do know vets, specialists, and rehab practitioners in N.C., specifically Raleigh, however I will say you will likely, at this point, gain more support from a horse trainer and the horse racing community.
When I came into animal rehab at the end of 2004, I came from a varied and dynamic background in human sport science, to put it succinctly. I came to animal rehab expecting to find program protocol, functional program design based on dynamic neuro-muscular principles, and info of that nature. There wasn’t any I could find published on the web. I found some wonderful articles by Dr. Jan Steiss, Auburn, one of the first vocal practitioners of DVM-based animal rehab, but nothing along the lines of the very intense sport science journals I’d been reading and the coaching practices I knew. In the following months and years I began writing easy, land- and home-based programs, so that patients I was seeing even in a hospital clinic setting could benefit from applied and thoughtful homework. I now realize I have a lot more broad background in body wellness and functional program design than many people in veterinary medicine and veterinary rehab, and while it’s awesome to see info I take from centuries, really, of practice that began in human sport science and repair (long before I came on the scene…:)), being so very simply beneficial to the animals I work with, it’s complicated to gain an ear at times. Keep in mind that no professional can know everything, and since in a broad view, so many disciplines are and can be linked, it just takes time for mass acceptance. I have no staff, and until I take time to write and publish more of my anecdotal findings more formally, there will be nothing for others to note or contest. I hope that makes sense. It’s been like swimming up a waterfall, because I’ve been aware of a lot of the principles I use for muscle strengthening, bone strengthening, recovery from injury, etc…since the late 1970′s. I have seen that even if papers are published, the majority will remain hesitant, and that seems to be the way it is with so many things. I think that most often we/they/anyone has to have a dynamic personal experience to hop our thought and process over the ridge of the rut to begin traversing a different path. I can remember some of my light-bulb moments over time and my astonishment that what I now “knew” wasn’t broadly taught or widely accepted…several times this has happened over the past 30 years or so, in a variety of venues.
So, I don’t recommend water therapy for your case, based on what you have said in your note. I don’t see overall beneficial reason for it in over 95% of my cases. This is because a thoughtful, progressive, controlled, land-based, gravity-based, exercise protocol will do more to provide return to overall function, repair of hard and soft tissue, and be less expensive for the people while less disruptive to the animals. And the land-based protocol only work well in the environment of appropriate, lameness-duration-based pain management. I have come to the conclusion that so many animals are over-worked in the water treadmill without appropriate pain control and they are returning to function, slowly, painfully, and it’s not a miracle or even an awesome tool, in these cases. What is an awesome tool is appropriate pharmaceutical pain management coupled with the controlled, super slow, walking and then beyond-the-basics, return-to-function program.
The quick answer as to why/what works about the programs I’ve written is that it is slow and therefore not further concussive on the joint. Slow also means more equality in weight-bearing on all limbs…no cheating, which happens when they go faster. Slow means it will be more painful because we are asking for the injured or surgery limb to be used, but if we control it (use a harness, too!!), then we are not inducing damage…we are just asking for use. Pain meds take away the painful part and we get better use. Better use means muscle and supportive tissue builds. Surrounding soft tissue and supportive structures will, in turn, support the joint. Over time, many of my patients have rehabbed torn CCL knees without surgery to the point that their vets could no longer get drawer motion nor could they really differentiate between knees. None of the properly rehabbed ones have gone on to tear the opposite knee ligament. This is huge.
Lack of adequate pain control is a thorn in my practice, and I’m trusted by the vets in this area who use me frequently, so they understand when I send an animal back for review of meds. I cover pain issues in a Q&A post I think I entitled “Should my Dog Still be Limping…”. There are three main reasons I see pain and lameness, so check out that note, too, if you’d like.
I also think I have posted a note elsewhere on this site regarding water treadmill, and I go into more depth about it therein.
I’ve got to run to appointments.
I hope this is helpful, and I really appreciate your taking time to write!!
Blessings-
Deborah

rehabdeb
Submitted on 2012/12/19 at 9:10 am

…also, if you’re on Facebook, check out my FB rehab page:

https//www.facebook.com/animalrehabconditioning

and it sounds like you could use a phone consult from me, if you’d like. You could use a little more direction for the next steps, and I have dogs returning to agility competition, hunting, etc…without surgery, so more can usually be achieved than where you might be now.
ciao-

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 )