Canine rehabilitation: Getting orthopedic patients back on their feet - Firstline
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Canine rehabilitation: Getting orthopedic patients back on their feet
Cranial cruciate ligament tears and ruptures are common conditions that can lead to debilitating osteoarthritis. Consider a veterinary team approach to canine rehabilitation to improve every patient's quality of life.



Osteoarthritis, otherwise called degenerative joint disease (DJD) in dogs, is typically secondary to a primary condition. Radiographic signs of osteoarthritis indicate the joint has reacted to an acute or chronic event, such as a ligament tear or strain, infection, or other disease process. Osteoarthritis in dogs typically begins more rapidly than in humans. Some dogs may begin to show signs of osteoarthritis as early as just days after injury, depending on the injury.

Managing osteoarthritis in dogs is similar to nonsurgical management of a CCL injury. Physical rehabilitation, NSAIDs, chondroprotectives, weight loss, and lifestyle changes all help when managing an arthritic patient, no matter its age. It's important to know that every patient will respond differently to treatment and that there is not always a correlation between clinical function and severity of radiographic signs.

Radiographs give us insight into the progression of the disease and allow us to more easily explain to clients why their dogs may be lame in the morning or after rough play. But, just as in humans, there is no cure for osteoarthritis in dogs, and the goal of treatment is to slow the process down and alleviate the patient's pain.

It's also important to recognize that too little activity is just as bad for osteoarthritis as too much. Put this in perspective for clients with simple framing, such as, "Do you know how you feel when you lie in the same position for too long and feel stiff? The same thing is happening to your pet." Most people have experienced a twist, a sprain, or a break, and explaining that similar processes are happening to their dogs—only at a much quicker rate—will help them understand the importance of keeping their dogs lean and paying attention to their pets' exercise routines.

Physical rehabilitation

Physical rehabilitation is a specialty with both veterinary professionals and human physical therapists working toward the overall improved care of pets, working or sporting dogs, and our feline and equine patients.

Figure 1. Cody, a patient with femoral head and neck excision, undergoes low-level laser therapy. This modality can be used on nearly every condition, from wound healing to osteoarthritis.
Some of the different modalities for treatment include therapeutic ultrasound, cold or low-level laser therapy, electrical stimulation, therapeutic exercises such as wobble boards, massage, and the underwater and land treadmills (Figures 1-5). Not every rehabilitation facility or veterinary hospital is going to offer all of the different modalities and equipment on the market. The most important piece of equipment is a pair of experienced hands. Then you let your ingenuity take over. (See "Physical rehabilitation at your hospital".)

Figure 2. A gel pack can be used for heating and icing. To demonstrate the therapy in the photo above, there is no barrier used between the skin and pack.
Since you cannot talk to your canine patients and politely ask them to put their legs on the ground or to stand with one leg in the air, you have to learn how to do it for them and engage their muscles and even their minds. Dogs want to do what's easy. And sometimes what's easy is running on three legs, hopping up the stairs, or keeping their head down low when walking. All of these issues can have some simple corrections that will make a huge difference in their recovery and overall daily living. It can be challenging to change the way a patient walks after they've been doing it for 10 years—or even just eight weeks after recovering from surgery—but the difference can benefit them for the remainder of their lives.

Figure 3. A wobble board helps strengthen core muscles by working on balance and helps improve the ability to shift weight to different limbs.
And remember, you are not just changing how the patient moves, you are also asking owners to change their day-to-day routines. You must keep that in mind when discussing any changes back at the pet's home. For example, some owners may have never had their dogs on a leash, let alone taken them for walks. So asking them to spend time two to three times a day walking them may be difficult in the beginning.

Figure 4. Bear undergoes passive range-of-motion therapy.
The rehabilitation practitioner will perform a complete orthopedic evaluation, gait analysis, and neurologic examination as the first step in assessing a patient. Then, with that information and a history and lifestyle discussion with the owner, the practitioner can determine the best plan for that patient. A Certified Canine Rehabilitation Practitioner (CCRP) will also offer home exercise plans and nutritional counseling.



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