Did you know that the most common orthopaedic disease in dogs is cruciate ligament disease of the stifle joint, the dog equivalent of the knee? The knee joint in dogs (and people) contain a pair of ligaments that form an “X” (hence “cruciate”, or “cross-like”) which act to stabilize the joint by firmly strapping the thigh bone to the shin bone. Cruciate disease results when one of the ligaments weakens or snaps completely. It is estimated that about 1 in 200 dogs in the UK will be affected by this debilitating and painful condition. Rottweilers, Westies, Golden Retrievers, and Staffies are at particular risk.
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Surgery to stabilize the knee joint is recommended for large breed dogs. As for small breed dogs, the jury is out whether surgery is better than old-fashioned exercise restriction and pain relief. But certainly, it looks like surgery will reduce the recovery period for the little guys. There is a lot of information to take in when deciding to put your dog forward for cruciate surgery. So you probably won’t be thinking much beyond the day of the surgery itself. Most vets, however, will recommend that your dog has some rehabilitation or physiotherapy in the days and weeks after surgery. So what does this entail? And is it worth the extra time, effort, and cost?
Why is rehabilitation recommended after a cruciate operation?
The goal of cruciate surgery is for the dog to regain the knee joint’s normal, pain-free function. All surgeries have inherent risks. A recognized risk for cruciate surgery of all types (for there are many), is persistently poor function of the affected leg 4 – 8 weeks after surgery. This can increase the risk of long-term problems such as shrinking of the leg muscles and stiffening of the joints.
Rehabilitation is thought to help recovery from cruciate surgery through pain reduction, improving muscle strength and joint mobility, and maintain cardiovascular fitness. It can sometimes be confused with alternative medicine (like acupuncture or homoeopathy). Still, almost all vets now consider it a conventional therapy based on established medical science. It is recommended to reduce the chance of poor limb function after cruciate surgery.
Post-operative instructions for cruciate surgery traditionally involved an initial period of strict rest, usually for 10-14 days, to allow initial healing. All being well at this point, the vet would prescribe a strictly controlled lead exercise program. This would gradually build up over the following weeks until the dog was back to normal. This traditional approach could be considered the simplest form of rehabilitation. But, having borrowed from techniques used in human physiotherapy, veterinary rehabilitation has become much more sophisticated in recent years.
The nitty gritty of veterinary rehabilitation
So, if you sign up your dog for post-operative rehab, what can you expect? In the first instance, your vet may prescribe some exercises for you to start straight after your pet’s surgery. Cold compresses (“cold therapy”) for the first 2-3 days, which reduces inflammation and pain. Then gentle range-of-motion and stretching exercises when your dog will allow it, usually by 4-5 days. Applying a warm compress (“heat therapy”) beforehand helps warm up the muscles, tendons and ligaments, much as an athlete would warm-up before competing. You must follow the precise instructions your vet provides very carefully to avoid any unintentional discomfort or injury to your dog.
Another form of rehabilitation you may wish to opt for is hydrotherapy. The basis for this is that water takes the dog’s body weight off the sore leg and makes it easier for the dog to build up muscle. Some vets may have hydrotherapy facilities onsite, although most will have to refer you to a specialist centre. There are fundamentally two types of hydrotherapy: the swimming pool and the water treadmill. The treadmill is theoretically the better option because it works more muscle groups. All hydrotherapy sessions should be overseen by qualified personnel. That means that “DIY” hydrotherapy, such as the bath at home or the local lake, is not recommended. For most patients, hydrotherapy can be started as soon as the surgical wound is fully healed, usually 10-14 days after surgery.
Finally, the Full Monty of doggy rehabilitation is a referral to a qualified veterinary physiotherapist. Not only will they have a wide range of advanced techniques in their toolbox which many vets will never have heard of (sustained natural apophyseal guides, anyone?), but they will also be able to create a rehabilitation program tailored to your pet’s specific needs.
Sounds impressive (and expensive!). Be honest, is it worth it?
Despite the solid science that underpins the concept of physical rehabilitation, there is not much evidence that shows it improves recovery after cruciate surgery in dogs, especially in the long term. Current recommendations for its use in pets is currently based on sound evidence from studies in people. However, a Canadian study has shown that dogs that had received physiotherapy after cruciate surgery were more likely to use their leg normally after two months. Importantly, this study found no evidence that rehabilitation causes any harm.
The bottom line is that some dogs will have an excellent recovery from cruciate surgery; rehabilitation will not make much difference to them. On the other hand, there will be cases where physical rehabilitation will make a real difference to the quality of their recovery. The difficulty for vets and owners is identifying those dogs that will benefit most from rehabilitation. For dogs with a delay of several weeks between cruciate injury and surgery, where muscle wastage and joint stiffness have already developed, then post-operative rehabilitation would be strongly recommended.