• Passive range of motion (PROM) — Perform this slow, controlled movement with slight overpressure at the end range on each joint of the forelimb two to three
• Joint mobilization — Perform these slow manipulations to improve joint play on the carpus, elbow and shoulder to increase circulation, proprioception
and healing while decreasing inflammation.
• Massage and stretching — Soft tissue massage or mobilization and stretching of the surgical forelimb, nonsurgical forelimb, cervical spine and hindlimbs
minimize the effects of compensations that occur prior to or secondary to surgery.
Leash walking may be initiated after surgery. Start with five to 10 minutes three times daily, increasing the duration to
20 minutes as tolerated by the end of the acute phase. Weight-bearing exercises are then gradually introduced and performed
on a daily basis:
• Three-leg standing — Lift the nonsurgical forelimb, and shift the weight onto surgical limb (Photo 4).
Photo 4: The three-leg standing technique.
• Down to stand — Ask patient to lie down and then stand.
Rocking on all fours — While the dog stands on all four limbs, gently rock the dog from side to side and diagonally with 3-cm perturbations in
each direction, promoting weight bearing and proprioception to the affected limb.
• Ladder — Using Cavaletti rails or an extension ladder on a level floor, walk the dog slowly through the ladder rungs or rails to
ensure individual weight bearing on all limbs.
• Wheelbarrow exercises — Hold both rear legs and have the dog walk on its forelimbs only. Begin with a short distance, and increase it as tolerated.
• Hydrotherapy — Have the dog swim or walk on an underwater treadmill (Photo 5). Before initiating hydrotherapy, full range of motion of
the elbow should be present, and there should be no palpable tenderness or inflammation of the elbow or shoulder. Perform
the hydrotherapy sessions two to three times a week, and start slowly at five minutes, increasing one to two minutes per session,
Photo 5: A dog undergoing hydrotherapy with an underwater treadmill.
• Wobble board, BOSU or therapeutic ball — Implement these exercises to improve coordination, balance and strength (Photo 6).
Photo 6: A dog balancing on a wobble board.
This series on elbow disease in dogs will conclude with Part 3 next month and discuss medical management.
Dr. Canapp is an ACVS board-certified surgeon who practices orthopedic surgery and sports medicine at the Veterinary Orthopedic & Sports
Medicine Group in Annapolis Junction, Md.
http://dvm360.com/surgery to access hundreds of articles on veterinary surgery.