Continued Physical Rehabilitation at Home for Post-Cranial Cruciate Ligament Repair

By Amy Straut, DVM, CCRT
angell.org/rehab
781-902-8400

During the initial phases of rehabilitation for canine cranial cruciate ligament repair surgery, the primary goal, especially for osteotomy procedures, is healthy bone healing. Now that the dog has completed his initial course of physical rehabilitation and e is healing well after surgery, what happens next?

Your client owner is most likely very eager to know when their dog can get back to his normal level of exercise and play. The answer is NOW, but the truth is that his rehabilitation isn’t over, and the back-to-normal exercise protocol is a SLOW, CONTROLLED process! It is important that owners understand that they will need to continue physical rehabilitation at home for continued proper healing.

Progression from the initial phase of physical rehabilitation to the return to normal exercise will vary from patient to patient. Although each dog is unique, it is imperative to ensure that, at minimum, the return to normal exercise phase includes the following:

1. Radiographic proof of bone healing (TPLO, TTA)
2. Proof of normal stifle range of motion
3. Return of appropriate muscle mass at the surgical limb

Bone repair is typically radiographically present between eight and 12 weeks, and confirmation of appropriate bone healing is recommended before moderate impact exercises are performed.

Normal stifle range of motion¹:

Flexion               30-45 degrees
Extension          155-170 degrees

A dog working through a formal physical rehabilitation process will typically regain appropriate muscle mass at the thigh of his surgical limb at six weeks after surgical repair.² The goal for quadriceps muscle mass gain at eight weeks post-surgery is equal to 80% of the girth of the contralateral limb.³

The most important part of transitioning a dog from his initial rehabilitation program to his normal exercise routine is to communicate the SLOW BACK-TO-NORMAL EXERCISE ROUTINE with the dog’s owner. Setting realistic goals is imperative to the continued success of physical rehabilitation! You must take into consideration the dog’s personality, his job, his home environment, and the level of at-home participation that the owner is able to offer.

Help Em Up™ Dog Harness

Based on your discussion with the dog’s owner about continuing the dog’s rehabilitation at home, it is best to provide a written list of attainable exercises, demonstrate the proper exercise format, and talk through the feasibility of each exercise with the resources that the owner has at home. In human medicine, we follow the SAID (Specific Adaptations to Imposed Demands) Principle. This concept is based on the notion that the body will respond to exercises targeted to build specific muscles required to meet the demand of the activities for return to normal function. Therefore, think about the dog’s job at home and assign exercises accordingly.

Remind the owner that they will most likely have to advocate for their dog to make sure that he does not overdo physical movement, which could result in high-level pain, lameness, and possible injury. Just like going to the gym after a two- to three-month break, it makes sense to GO SLOW!

Examples:

Once bone healing is confirmed

• Increase controlled leash walking to 20-30 minutes two or three times per day.
• Integrate hill walking (slow, gradual inclines).
• Assist dog with proper navigation up/down stairs once or twice per day (use harness support and proper four-beat gait).
• Assuming you do not observe any lameness, increase the walk time by five minutes per week and stair work by doubling the volume weekly.

Once dog appears confident and nonpainful with multiple leash walks, hills, and stairs

• Begin short periods of off-leash activity.
  • Off-leash activity should be in a tightly controlled and supervised environment such as a small, fenced-in, flat-surfaced yard with no other dogs present.
• Start with very short periods of time, depending on the dog’s normal energy output (one to five minutes). If the dog has high energy off-leash, then one minute may be enough, whereas if the dog typically meanders around to sniff the flowers, five minutes may work well.
• Slowly increase off-leash time over a period of two to three weeks until the dog appears confident in his movements.
• Once the dog appears confident, and if he enjoyed playing with other dogs in the past, introduce another, familiar dog into the controlled environment. Scale this new play time back to one to five minutes, based on your dog’s energy with play. Always maintain control over both dogs to assure no rough play.

Once dog appears comfortable with 15 minutes of off-leash play with another dog in a controlled setting

• Continue the same concept with play at the park.
  • Try to find quieter times at the park (early morning) when there are fewer other animals present, and begin with five minutes of off-leash play. Slowly increase this type of play until both the owner and the dog are confident in his movements.

Remind owners that keeping their dog’s weight at a proper level is imperative to keeping his joints healthy by reducing joint load. It is also recommended that you instruct owners to avoid highly explosive and impact side-to-side “cutting” activities such as fetch, as these types of activities place a very high level of stress on the stifle joints. Swimming is an excellent low-impact exercise that owners may offer their dog as an alternative form of exercise.

If, at any time during this back to normal exercise process, the dog becomes slightly lame or painful (increased limping), have the dog rest for a few days and return to the previous level of rehabilitation. There are no strict numbers on how much activity is adequate for your dog; the most important part is to avoid multiple setbacks.

References

1. Millis, D.L., Levine, S. et al. Canine rehabilitation & physical therapy. Saunders 2004, p 226.
2. Monk, M.L. (2006), Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67:529-36.
3. Canapp, S.O. The Canine Stifle. Clin Tech Small Anim Pract 2007; 22;195-205.