Rehabilitation for the cruciate patient includes conservative management and postoperative rehabilitation. The exact rehabilitation programme will vary between individuals, intended outcome (functional intention) and owners' ability/participation.
Following this talk you should be able to provide your clients with an outline of rehabilitation options in addition to lead exercises. This talk will cover the principles of rehabilitation, basic exercises that can be taught to clients and more complex programmes for later stage rehabilitation.
Postoperative Rehabilitation
Early stage rehabilitation: in the early stage of rehabilitation the focus is on helping reduce inflammation, maintaining muscle integrity without stressing the surgical site and ensuring safe function. This will include appropriate electrotherapy, ice, muscle stimulation and advice to owners.
Muscle stimulators can be used in the early post-operative period. These machines are relatively cheap to purchase and easy to use. They can help reduce inflammation, increase muscle circulation and muscle activity without placing any stress on the joint/surgical repair. There is a study that suggests that there may be increased incidence of meniscal damage after using muscle stimulator but this was only carried out on a study of 12 dogs. Subjectively, this effect has not been noted in physiotherapy practice.
As postoperative period stabilises, rehabilitation can progress to include proprioceptive exercises - these can vary in complexity from very basic compression of the stifle to high level balance exercises. It is important to include these in a rehabilitation programme to help support the joint, encourage muscle activation and reduce long-term lameness and further injury.
As lead walking exercise is increased the rehabilitation programme can include range of movement exercises, these can be hands-on stretches, food stretches and more functional exercises as the joint become more stable. Wherever possible, functional based rehabilitation exercises should be included in the client's programme. These exercises are based on normal movement activities and incorporate range of movement, proprioception and strengthening in movement patterns helping to tap into muscle memory. The functional approach also takes away the owner needing to be responsible to "increasing" range of movement which can be difficult for owners to fully understand and the dog may become resentful of this hands-on approach.
Dogs in general are willing/active participants in rehabilitation programmes and can be challenged using a number of treatment exercises. Exercises that can help with increasing strength include sit to stand exercises, walking backwards and "squats."
Exercises that can help increase range of movement include walking over ladders, fan exercises and figure of 8 exercises.
Mid to later stage rehabilitation can also include use of a water treadmill and swimming. The treadmill provides a controlled means of rehabilitation supported in the water and can begin once the sutures have been removed. The depth of the water can be varied to reduce weight bearing and support the limb. If using swimming this should be included later as it is not as controlled. There can be increased stresses on the cruciate and the dog may use a rotational movement which can aggravate stifle inflammation. It is also difficult to ensure that with swimming the dog actively uses the affected limb.
Owners should be provided with clear information on managing the post-operative period and activities that they can do and when these can be included. Information of activities that the dog should be refrained from doing should also be outlined (jumping in out of cars, onto beds, toilet on lead etc.). Many owners will think they are "being kind" to the dog to allow them to jump onto the sofa/bed or "5 minutes play with another dog."
There are a number of studies that show that early physiotherapy intervention may be beneficial post operatively with reduced lameness, increased range of movement and reduced secondary complications. However the numbers of dogs included in these studies are relatively small.
Case studies will be used in this presentation to clarify types of exercises that can be used for cranial cruciate rehabilitation and effect of a rehabilitation programme.
One of the biggest factors in the rehabilitation programme is the owner's participation and understanding. It is important to determine how they are managing with any exercises that have been recommended and getting them to demonstrate what they are doing.
Provide owners with clear precise information and in a written form - handouts can be a useful option with areas showing the exercises that can be included and when. It is important to monitor the dog to ensure that progression of the exercises is appropriate and that the dog is using the limb appropriately for that stage of its recovery.