PHYSICAL THERAPY HOME CARE INSTRUCTION
It is recommended that you muzzle your pet before performing any physical therapy exercises, particularly if he/she seems painful.
The patient’s activities are gradually increased in order to stretch the surgery scar tissue and rebuild the muscles. The degree of activity should progress with the patient remaining comfortable. Since increasing duration, not intensity is the goal, explosive activities, such as running, jumping or playing, are not allowed during the rehabilitation period.
Throughout the rehabilitation process, the dog is allowed to go as far as he/she is able while remaining comfortable. To judge the dog’s comfort, watch the dog when he/she gets up following exercise and rest. If invigorated at excited about more activity, the dog is comfortable. If the dog gets up with stiffness and complaint, then the amount of activity should be reduced.
The first few weeks of activity are comprised of progressively longer walks with the animal on a short lead. Begin with short walks of one block, or equivalent, and see how the dog responds. Continue at this distance for a few days. If the dog remains comfortable, double the distance of the walk. Continue doubling the distance of the walks every few days as the dogs’ comfort level permits. If the animal appears to be uncomfortable with the increased distance, cut the length of the walk back to the last distance at which the animal was comfortable. Your pet will benefit more from several short walks in one day rather than a single long walk.
Administer anti-inflammatory medication 30 to 60 minutes prior to the first session of the day.
Begin the session by performing passive range of motion/stretching exercises. Place the dog on its side. Have somebody help restrain the dog, especially the head. Begin by slowly flexing the joint until the first signs of discomfort are noted. These may include tensing the limb, moving the other leg, trying to lift the head, or other reactions indicating discomfort. Hold for a 10 count. Repeat these exercises for 10-20 repetitions.
Follow the stretching exercises with very slow leash walks to encourage the dog to bear weight on the limb. While walking slowly, you may gently try to shift the weight of the dog to encourage touching of the limb to the ground.
Follow this activity by applying cold towels or ice packs to reduce swelling. These activities may be performed three to four times daily. When the dog begins to toe-touch, step 2 exercises should begin.
At this point, the main goal should be to continue stretching exercises to try and achieve normal range of motion and weight bearing.
Continue any medication that has been dispensed. Provide slow leash walks three to five times per day, concentrating on going at a slow speed to encourage weight bearing. If a home treadmill is available, you may wish to try encouraging your pet to work on a treadmill. Consult the doctor before beginning this activity. The affected area may receive cold packs following therapy to reduce swelling. These activities should be continued until the dog is consistently bearing some weight on the limb at a walk. If this is the case, it is time to proceed to step 3.
The goal of step 3 is to improve weight bearing at a walk and begin to bear weight while trotting.
If complete flexion and extension have not been achieved, continue stretching activities. Also continue if the dog seems stiff or unwilling to fully extend the knee during walking and trotting. A warm-up activity of leash walking at a moderate pace may be offered for five minutes. Walking up inclines or hills should follow this.
When the dog is comfortable going up an inclined surface, the dog may be walked up a flight of steps. Care should be taken to go slowly and encourage full weight bearing and pushing off with the affected limb. Stair climbing may be alternated with sit-to-stand exercises. The goal of this exercise is to encourage the dog to sit squarely, and then arise from the sitting position by using the affected limb to push off. Initially, 5-10 repetitions should be performed, and your dog may work up to 20 repetitions. It may be helpful to offer a small, low-calorie treat to encourage and train your dog to perform these exercises. This activity should be performed two times daily.
During one session per day, the dog may jog slowly for 2 to 5 minutes. If available, swimming in a pool, lake, or pond for 2 to 5 minutes daily or every other day will be beneficial. When the dog is bearing significant weight on the affected limb at a trot, step 4 should begin.
During this time period, the walks are continued with the animal on a long lead. This allows the dog the freedom to trot back and forth, increasing its usage of the leg. As distances are more difficult to judge at this point, it is important to monitor the dog’s comfort level closely during this stage of rehabilitation.
The goal of step 4 is to add strength and speed to the gait, while further reducing any lameness.
At this point, the dog should be using the limb consistently at a trot. Trotting activities should be encouraged for 5-10 minute sessions, three times daily. At least part of this time should be spent jogging up hills. Stair climbing and sit-to-stand exercises should continue. If possible, swimming should be offered several times per week, for 10-20 minutes depending on the fitness of the dog. Controlled playing with a ball at a fast trot or slow lope may be encouraged several times per week for 5-10 minutes. Step 4 should be continued until the dog willingly trots quickly and with minimal or no lameness. At this point you may proceed to step 5.
AFTER RADOGRAPHS DOCUMENT BONE HEALING
Before proceeding beyond step 4, please contact Dr. Fallon to ensure that this is appropriate for your pet.
At this time the dog is allowed very mild activity off lead. The area should have no other animals or distractions around. The dog should remain under the voice control of the owner. Avoid any activities where the dog’s full concentration is thrown into the activity without regard for his/her body.
The goal of step 5 is to continue strength training at relatively high performance levels.
Dogs may run up and down hills, inclines and trot up steps. Swimming may continue for 15-20 minute exercise periods. Ball playing may be encouraged with the dog running near top speed. Dogs may jog for prolonged distances.
During all of the five steps, particular attention should be paid to any deterioration in the dog’s progress. Specifically, attention should be focused on lameness or stiffness following activity. If the dog appears to have stiffness or increased lameness at any time after a therapy session, the level of activity should be decreased and a slower rate of progression should be instituted. It is very important that dogs be comfortable and pain free during the rehabilitation period.
It is important to realize that your dog may not be totally normal even with intensive physical rehabilitation. Depending on your dog’s condition prior to surgery, there may be arthritic changes, which would preclude return to normal function. However, rehabilitation is the key in obtaining and maintaining as much function as possible. Also, it is extremely important that if your dog is overweight, he or she go on a diet during rehabilitation to minimize the stress on the joints and to reduce the possibility of arthritic changes progressing. If your dog does not appear to be making progress, has any complications, or you have any questions, please contact me at (202) 288-5518 7:30 A.M.-5:30 P.M. Monday through Friday.