Should my Dog Still be Limping After ACL/CCL (knee ligament) Surgery? (Info could apply to any orthopedic surgery)

Should my Dog Still be Limping After ACL (CCL) Surgery?

This is a common question, and the most common answers I give are as follows, based on what I find in my practice:

If your pet is limping your pet has about a 98% chance of being pain.

The most recent version of this topic may be found in my book for Kindle on Amazon. I have edited the topic for the books to be concise and easier to read than what is contained here on the website, however I have left some of the following info on this page for now because this topic receives thousands of hits on this site. Evidently it’s a big problem around the world! The link to my book using Amazon.com is:

www.amazon.com/dp/B00EY3D03S

and the book is not expensive :)

Also, the book contains, for $7.99 USD, instructions regarding how to protect your dog at home and how to get them walking well again without pushing them into a pain state. Check it out for more info than is on this site! Thanks-

Your dog is not limping solely “because he/she had surgery”; the dog is limping because he/she is painful after surgery. This situation is also not really an issue of having to retrain the dog to use the leg…again, they are very most likely not using the leg because it is painful, and there are usually very good helps available for your pet, both pharmaceutical and non-pharmaceutical. This point is one I spend a lot of time going over with people, even on many occasions when their veterinarian hasn’t been quite convinced that there is pain. The vet not recognizing that the pet is in pain could be due to many reasons. Pretty much all I do daily is determine the level of pain in my clients based on multiple factors, including the animals response to daily activity and exercise programs I have outlined. I then determine whether more veterinary intervention is needed and also the next best course of functional rehab.

After working with athletes and other animals for over 30 years, as well as dealing with quite a bit of pain personally, I am well-versed in dealing with determining pain and working to eradicate it. Dogs usually aren’t quite acting themselves in the clinic when they see the vet, and most veterinarians I know, with whom I’ve had lengthy conversations, will admit to having been trained to look at the quality of the surgery and not necessarily add pain in as a factor. Often your pets regular veterinarian will give up any post-surgical medication intervention to the surgeon, and when the meds that the surgeon scripted run out, the limping begins. I find that vets with whom I work often are finding the benefit of dosing adequate medications so that the pet will use their leg in my rehab programs, and the pets do, every time we get the combo of pain relief correct (and when there’s nothing additional going on, as I cover below). Veterinary medicine, on the whole, wasn’t teaching that animals felt pain, in so many words, until the late 1980’s. Another point is that in human medicine, we don’t have pain management down to an exact science, by far, and that is for people who are able to speak or convey in language and signs we are accustomed to understanding better.

1) The pain could be due to the dog being too active.

2) The pain could be due to the dog not having enough pain meds that they are actually taking.

3) The pain could be due to the knee having an infection.

Those are the three most common situations I encounter after the surgery site has been checked by the veterinarian and has been deemed stable to the best of their knowledge. Follow your vet’s discharge instructions regarding restricting and controlling the activity of your pet, and I also have beneficial instructions regarding this on my homework pages on this site. Depending on the type of surgery performed, many things can go wrong with the items used to stabilize the knee, but that situation is not the most frequent culprit I find in my practice and experience. I cite infection as another culprit, and that can come from outside, i.e. licking the incision site, or that can come from suture or implants, etc…on some occasions. You will often be able to narrow down the issue to infection if moderate to high amounts of at least two analgesics are used and the dog is still limping until you try antibiotics. If your pet stops limping 1-3 days after the introduction of antibiotics, then it is likely that you have some form of infection. The “usual” pain medications don’t “usually” get rid of infection pain.

The fourth issue that I occasionally find is a torn meniscus. In older dogs that I’ve worked with for non-surgical help after a torn cruciate ligament, it has been beneficial in my area to combine Tramadol, Gabapentin, and an anti-inflammatory to get them through the additional pain of torn meniscus and on to better weight-bearing and therefore better muscle improvement. Other drugs may be used more prevalently in other countries. These drugs are great to help with the scientifically-proven exercise choice of gravity-based, weight-bearing drills, which is the most productive way to build bone, bone strength, and supportive tissue strength, including muscles. The increased thigh muscle will help support the joint and in most of my cases has served to stabilize the joint very well. This work will often also help your pet get past the acute phase of torn meniscus. I have had many of these meniscal tear cases work out with sufficient pain relief over time, however, if you have access to surgery procedure to have the meniscus scoped out (two small slit incisions will be made), then that can be a moderate remedy, too. I say moderate remedy because scoping is less invasive than opening the whole knee for full cruciate repair surgery, if you are wanting to avoid surgery. I have had cases that resolved and were strong after the non-surgical work for torn ligament and that have gone on to have the meniscus scoped out without fully opening the knee as would be done in the ligament repair surgery.

Elsewhere on this site, under “Research”, I have posted data from human sports medicine research citing that both torn meniscus and torn ACL can do very well without surgical intervention. These good outcomes involve exercise and physical therapy. Surgery for a torn or ruptured ACL/CCL and/or torn meniscus is optional and making the decision for this surgery is not a “life or death” decision. Those papers are here if you would like to know more about the studies for non-surgical remedy :):

http://rehabilitationandconditioningforanimals.wordpress.com/2013/03/28/physical-therapy-as-effective-as-surgery-for-torn-meniscus-and-arthritis-of-the-knee-human-study-suggests/

http://rehabilitationandconditioningforanimals.wordpress.com/2013/03/09/more-than-half-of-all-acl-reconstructions-could-be-avoided/

If limping and pain are your pets issues, stop them from doing too much activity & read my recommendations on my homework page, which may be found here:

http://rehabilitationandconditioningforanimals.wordpress.com/2011/04/28/post-cruciate-aclcclrepair-homework/

If your dog does not have an anti-inflammatory and an additional analgesic, like Tramadol and/or Gabapentin, for the first few weeks after surgery, then I recommend you ask your vet to consider supplying those. Use rest, restriction, and even ice during the time your pet does not have other pain relievers. Fish oil, fish containing Omega 3’s (or other animal dietary sources), joint supplements (Like Xymogen DJD, Glycoflex III, Cosequin DS) are beneficial, as are natural anti-inflammatories, like turmeric/curcumin, ginger, rosemary, etc…I like a product called Xyflamend by New Chapter for this. (No, I don’t receive any compensation for mentioning any of these online or in verbal discussion ;))

If your dog is on moderate-to-high amounts of those analgesics and is being restricted as recommended yet remains lame after a couple of days of renewed restriction and medications, then it is highly possible that your dog has an infection. An infection can be present and will cause pain, even if there is no known swelling or seepage. Anti-inflammatories and the other pain relievers will not relieve infection pain. In my area the vets will often prescribe Cephalexin for a two week course, and the limping usually ceases within the first 24 hrs. of taking the antibiotics.

Infections can occur for many reasons, and an infection is not necessarily someone’s “fault”. I see many patients that are licking at their incision, even if ever so slightly or infrequently (according to owners), and I am telling you that even a small amount of licking can cause a raging infection. Most often, though, I see infections that aren’t seeping or causing additional signs of there being an issue. We are confirmed in our suspicions when the antibiotics have great effect and the limping/lameness/pain is relieved. My own dog incurred infection in a very clean surgery hospital, however she had a weak immune system, and also due to other circumstances was open much longer on the table as she would otherwise have been. Lots of things can cause infection.

I do recommend remaining on additional pain relievers in order to begin my exercise protocol, primarily because your pet has been dealing with a lot of pain and has not been using the leg very well, if at all. Even when the infection is dealt with, your pet will likely need additional pain relief to help them use their leg as best possible while following the restrictions and the recommended exercises.

Those are the basics.

Limping does NOT mean that the dog needs to be taken to a water treadmill to induce usage of the affected leg. Limping means that there is a problem that needs be rooted out and dealt with. See my suggestions at the beginning of this post for the most likely culprits :)

I have taken over the rehab of many dogs that were previously forced to walk in the water treadmill, didn’t have sufficient pain control, and often have had infection or breaks, which was easily rooted out after process of elimination. Some of these dogs have ended up having additional injury that was also discovered after appropriate pain meds were given yet expected relief was not achieved. Some of them incurred injury by being forced to work in the water treadmill, with the practitioner suspecting they were ‘just not using the leg’ as if it were psychological.

In my experience, if we deal with the root problem, which is pain, and we find the source of the pain, which can be as simple as “I just had surgery”, and we deal with it appropriately, then the walking will happen, leg use will occur. Animals aren’t sitting around plotting disuse of their leg and overthinking the issue. They also aren’t holding out so you will give them more drugs. It’s rarely, if ever, “just psychological” with limb disuse. It wasn’t psychological when they were first injured, before surgery…

I use massage with the small Homedics unit featured in my massage video:       http://rehabilitationandconditioningforanimals.wordpress.com/2011/11/27/simple-massage-video-uploaded-to-youtube/

I sometimes use ice, and sometimes laser therapy on the knees with infections or lots of effusion (joint swelling). I also recommend that my clients do not work the animals until the pain is relieved substantially. “Relieved substantially” means that they are only slightly favoring the leg. My exercise programs are designed to work in conjunction with adequate pharmaceutical pain relievers, where those are needed.

I have utilized many non-pharmaceutical methods of pain relief, however after surgery it seems that pharmaceutical pain relief (pills) gives the most benefit. Those pain relievers may be reduced over time as the muscles are built, the joint heals, and appropriate, slow, progressive, reintroduction to activity is accomplished. Please know that most post-surgical and some post-injury-non-surgical pets need to be on pain meds for 4-8 weeks, with 8-12 weeks usually being more productive. During this time, it is important to gauge their activity levels and utilize appropriate return-to-function exercise programs, only increasing activity slowly while gaining good pain control and only reducing pain control meds as more activity is able to be achieved without added discomfort (lameness, etc…). Use my homework for the exercise plan.

This means, stop going from total restriction to “return to normal activity”. Humans cannot go from a two-month layoff back to winning one of the top five marathons in the world, even if they are world-class…progressive reintroduction has to occur, regardless of what level you, as an athlete, or your pet were at prior to injury/surgery.

Oh, and, yes, there is always the possibility that your animal has destroyed the surgery in some manner. But the top three reasons for lameness & limping that I already cited are really the most prevalent causes. I have had a few clients who have simply not restricted the animal (dog, cat, horse, llama…) and have allowed far too much activity and have blown up the surgery. A typical example is a dog that is allowed to run up and down stairs and bounce all over the place. They usually blow out knee surgeries and have to have re-dos. Only speaking of knee surgeries here, four more biggies come to mind, and none of these have had to do with the owner allowing too much activity, although in two of them the surgeon tried to blame the owner and/or rehab, but infection was the ultimate culprit. Often I am not called onto a case until extra damage is done, so I am accustomed to rooting out these things, and hopefully this little bit of info is helpful to you.

Just speaking of knees, and just off the top of my head, one of those additional blowup cases was a tiny dog that had both cruciate ligaments and both patellas (kneecaps) operated on all at once. The practice of doing all that surgery at once is more common than you might think. The owner was very compliant, doing things the “right” way, and she had me come each weekday for a month to do the exercise and therapy work at least once daily, so she would “know” it was done correctly. I suspected infection right away in one knee because of the abnormal amount of swelling just a day or so after surgery. I reported to the surgeon excessive joint swelling (effusion) and other signs that accompanied this situation and that increased my belief that we had an infection compromising the repair. I could feel the pin in the problem knee working its way out. This would be a common side effect of infection. The short story is that the pin was removed many weeks later, and there was infection that would have most likely happened within several hours of surgery, given when I noticed the swelling.

Another case is mentioned elsewhere on this blog, that of the Great Pyranees that had knee surgery and ended up blowing out his opposing hip during recovery at a veterinary surgery center. By the time I saw him, I determined he definitely did not have adequate pain meds on board, for either the knee alone and much less for the addition of the FHO hip surgery as well. It is my guess that he was far, far too painful during recovery after the knee surgery and could not support himself well on the operated, atrophied leg. He had a series of very great complications, and the biggest battle, after we saved his life from gastro & infection-related near-death, was getting adequate pain relief for this very heavy and slightly lazy dog. Eventually so much time went by that his dysfunction (physical and psychological, in this case) complicated his recovery.

A third incident involved a dog that had a bone-modifying knee stabilization surgery (CBLO) and was damaged while in recovery at the specialty hospital where he had surgery, best we are able to determine from pre-and-post surgery xrays. The client was familiar with my work, and she called me to evaluate her dog when he was still exceedingly lame a little over a week out of surgery. He had been to work in a water treadmill already at a facility. When I first saw him, he was lame beyond what I would expect, based on my experience and based on the lack of swelling of any sort, however he also did not have enough pain control on board, based on established protocol and based on his lameness. He was set to go for another water treadmill session within the next week, and I drove home to the owner that she really, really needed to alleviate his pain and have the surgeon take another look at him. He was only being given an nsaid (non-steroidal anti-inflammatory)(Rimadyl, Vetprofen, Metacam, etc…). I pushed her to get Tramadol from either her regular vet or the surgeon. Weekend coming up, regular vet deferred to the surgeon, surgeon not responsive, associate vet finally gave script over the weekend. Yay! The pet went to his second, pre-scheduled, water treadmill session, and I saw him the following day. I told the owner to make an appointment with the surgeon and not do any more activity until they got an x-ray. The dog was far too lame for having the nsaid plus the new moderate doses of Tramadol on board. He had been on antibiotics for the surgery, if I recall correctly, so we didn’t think it was infection, plus, there wasn’t a large amount of effusion (knee joint swelling). It turned out that she got the x-ray and his fibula was broken and the screws and plates were pulled out from where the bone was cut. Eventually we were able to go back and compare post-op rx-rays and find that it seems the fibula was broken in recovery just after the surgery or ? We don’t know. What mattered was moving on and doing the best for the pup. It has been a little over a year and he is doing great! He had some re-dos and a long period of multiple pain reliever drugs being juggled. He was not on any meds at about a year out from the incidents. He did, however, need to take the pain relief drugs for many months. The point to these short stories is to give some brief recounting of post-surgical abnormal knee incidents so you may be informed and move forward with your pet. I am not going into full case studies here.

The fourth incident that comes to mind actually involves two small dogs with the same issue: both had suture repair of torn CCL/ACL and one was encouraged to run up and down the flight of stairs in the home soon after surgery because the owner thought it would help strengthen the dog. The pet had adequate pain meds, so the owner thought he was healed and encouraged this running. He blew out the surgery. The owner did receive instruction from the vet telling him of restrictions, etc…but restriction is not what happened, and often people are confused even if they receive adequate instructions. The restrictions are very important. The other case was also a small dog, and the owners felt sorry for her and allowed bouncing and running all over the house. She blew out two surgeries in one knee and about a year later had the same surgery on the other knee, this time with many restrictions heeded. :)

The first incident I told several paragraphs ago could happen to any pet, however in the many cases I’ve treated, even it is unique. The second and third are ones I see in large dogs once in a while because of complications in recovery. I’m convinced they should be recovered in the hospitals like a horse would be, in a supported sling, instead of on the floor! So, cover your bases regarding the first three reasons your dog may be limping/lame and pursue vet care based on this information.

In my area, we also have many vets that practice acupuncture and a few that do chiropractic work, so I often direct my patients to their services for the additional pain relief benefits. I know, based on how many I know of in this area that have had complications, as well as from feedback I receive from around the world, that very many of you out there have dealt with complications. Realize, though, that most issues I see before *major* complications set in are resolved by following the three guidelines at the beginning of this blog.

My own dog, Grace, had OCD (osteochondritis dissecans) in her knee(s), and before I knew more, before I got into this vocation and began putting together what I already knew from sports medicine and exercise physiology, I chose a TPLO surgery for her when she tore her first knee ligament, in the genetically malformed knee. She had about a half softball calcification at the medial aspect of the operated stifle, and a previous surgery performed to hopefully stimulate correct bone growth was unsuccessful. The TPLO cut was a non-union, meaning the bone did not grow back together after surgery. It wouldn’t have grown back, presumably, given that the bone was damaged inherently as it was, but I guess it was thought at the time to be worth a try, or that being able to move the position of the head of the tibia and have the plate in place to stabilize it was a positive step, given the other issues. I wouldn’t do it for that same dog and that same set of circumstances again today, but I know a lot more than I did those many years ago. That genetically bad knee turned out to be her better one over time, as the other knee eventually became destroyed. She tore the second CCL in about a years time, and I chose a TPLO for that knee as well. She seemed to have a compromised immune system, so we had a habit of starting her on Cephalexin some days prior to any surgery. Due to some circumstances, she ended up with a resistant pseudomonas infection seemingly immediately after surgery, complete with need for drains for the green slime over several weeks while I administered powerful, injectable antibiotics for weeks. It was clear within about two years that the infection had really eaten up her knee. She had two more scopes (arthroscopic surgeries) to clean out debris. She eventually became bone-on-bone in both knees, the infection knee being the worst, and she eventually tore all three ligaments (diagnosed via signs, x-rays, palpation, and common sense, collaborated by vets) in the worst, infection knee, and signs of more ligament tears existed in the original “bad” one. She was amazing nonetheless, and a pioneer for me regarding non-surgical helps for knee damage, since nothing more could be done given her dynamics and dramatic damage. With her immune system and other medical history, she probably would not have been a candidate for the knee replacement studies that were going on at the time.

And Grace’s situation is likely not the complication your dog/animal will encounter. I welcome stories of problem and resolution. I am only relaying these few stories to allow for the fact that other things do happen outside of the first three most common incidents I outlined, however the reason for lameness/limping after surgery is usually one (hopefully one) of the more simple-to-resolve first three situations I cited. ! :)

The most updated version of this post is now available from Amazon.com, under

Rehabilitation and Conditioning for Animals

Guidelines for Home Rehabilitation of Your Dog

After Surgery for Torn Knee Ligament,

First Four Weeks, Basic Edition

Blessings-

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About rehabdeb

I'm a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association, member NSCA Certified Canine Rehabilitation Practitioner (CCRP) through the program at the University of Tennessee Member American College of Sports Medicine Member International Veterinary Academy of Pain Management Certified CPR/First Aid/AED through the Red Cross I love low-level (class IIIb) laser therapy for healing and have been to two laser conferences, absorbing like a sponge. I have been a student of holistic nutrition, healing nutrition and nutrition for sports training since the mid-1970's. I love working on functional rehabilitation for animals and have worked in similar capacity with humans, including world-class athletes and medically-complex cases, off and on for over 25 years. (a large variety of things make up my life, however the above are pertinent to my current occupation and pioneering efforts in functional animal rehab and conditioning.) :)
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29 Responses to Should my Dog Still be Limping After ACL/CCL (knee ligament) Surgery? (Info could apply to any orthopedic surgery)

  1. jenniffer says:

    my am staff had her knee done and they gave her nothing for pain it was her right acl

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  2. Kathleen Campbell says:

    My female boxer, 5 yrs old, had knee surgery in Sept, 2012. She was doing fine, therapy, no activity, etc, gaining muscle tone. In the middle of November she was limbing and would not use that leg for balance, etc.
    Today, December 12, 2012, she is limping worse than when she had the surgery. Our veterinian feels she either has a infection in the knee joint or the implant was infected. The Xrays show that everything is in place and the surgery went well. The vet will be doing more blood tests on her this weekend. My poor dog is in pain. And going through all of these tests is really waring her down, (me, too). I feel bad that we had the surgery done.Does this happen often?

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    • rehabdeb says:

      Hi!
      Yes, what I call a latent, low-grade, infection, happens quite frequently, evidently, and it sounds like your vet is on the right track, in my opinion. Your Boxer’s infection may be more obvious than some, however most of the ones I’ve run across that are a couple of months out from surgery don’t have an opening in the skin, and there isn’t notable joint swelling or tissue swelling. Our main indicator, usually, is lameness that is not resolved with very good pain control, meaning at least two analgesics at near the top end of dosing parameters. Usually I find that the post-surgery animal doesn’t have enough pain med on board, so that’s the first thing to resolve after the vet has checked the repair as best possible. Sometimes there is substantial effusion, swelling in the joint, and that expands the joint so that we can’t tell if the surgery is in-tact or not. I usually tell the clients to rest their pet for one to two days, begin appropriate analgesics if they haven’t already, and then begin my intro walks if lameness is better resolved in about two days. The Tramadol, anti-inflammatories, and often Gabapentin are fast acting. I see results in Gabapentin dosing alone within hours of first dose, if it is helping with the type of pain we are addressing. If there is infection, these pain relievers really won’t deal with the infection pain, and then the vet can see the results of pain med dosing then move on to prescribing an antibiotic. In all of the cases I’ve seen and suspected this action, it has been true, there has evidently been an infection, and the lameness has resolved substantially within 2-3 days of antibiotic dosing. When I see an animal that is more than 1/4 lame, not bearing much weight, notably limping, holding up leg, even if they do it indoors and not outdoors, then I know we have pain that is not being addressed. Begin to address the pain and the reason for the pain will reveal itself or be more easily deduced. Helping to resolve these issues is a huge part of my practice, and I’ve seen a lot of interesting cases with this issue, some over a year out from surgery.
      Blessings-
      Deborah

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      • Pat says:

        My 8 month old goldendoodle had ocd shoulder surgery 10 weeks ago. It was not arthroscopic, but open surgery. He was still limping 4 weeks later, so he was opened up again for a second surgery on the same shoulder. It has been five weeks. He has been given the series of 8 adequan shots, which he just finished, and he limps as bad or worse that he did at the beginning. What can we do? I am heartbroken. My vet says he has ocd in the other shoulder as well, but I’m not about to do anything about it, until we can get our dog out of pain from his first shoulder.

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      • rehabdeb says:

        hi! I just finished my last appointment and I’m on my phone right now voice texting you via email.
        are you near me in Austin, Texas?
        my first thought is this takes quite a while to heal and your dog needs more pain medication.
        what meds is your dog on right now?
        also, since this takes a while to heal, she should be doing specific short controlled walks and no extra activity around the house.
        let me know what’s going on with these things-
        Deborah

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      • Chris says:

        Hi, we have the same problem as above. Our boxer is not putting any weight on the leg though she did beforehand. The leg was swollen but now the swelling has gone down almost completely and the incision site looks well.She was seen by the vet yesterday and was given some antibiotics called Noroclav. I was just wondering if these antibiotics are effective against the kind of infection you were mentioning above?
        Thank you very much for your help
        Chris

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      • rehabdeb says:

        Sounds like your vet is working on addressing the issue, so, good!
        That antibiotic is sold in the states under the name Clavamox for vet med, and it is a broad spectrum antibiotic, intended to hit a variety of bugs. Even in my area, veterinarians have a variety of antibiotics they like to use, including that one, so stay in communication with your vet regarding the results. Loosely speaking, on about the third day after beginning dosing, you should see more weight-bearing as the pain from infection is removed and if that pain is the main pain, and if that antibiotic is working for your Boxer’s infection.
        I recommend you always give antibiotics after a meal, not just a snack, and contact your vet if there is vomiting or diarrhea. Also contact your vet if there is no change in swelling or lameness after about 5 days.
        I cover more info on pain in my booklet, and it’s available also on Amazon.uk. I have only the Kindle version for now dealing with post-surgical rehab and issues, but the paperback booklet should be available in the near future. The pain discussion in the post-surgical booklet is slightly different from the discussion in the non-surgical booklet.
        Blessings-

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  3. kat says:

    my dog had ccl surgery 11 weeks ago..we had a lot of snow and she’s favoring her leg again…i believe too much activity too soon. she’s on pain meds (tramodal) …..i’m worried she’s blown her surgery….i’m hoping for not that…any advise?

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    • rehabdeb says:

      Hi!
      My best advice is to take her back to the vet who did the surgery and have them check it for stability.
      After that, and until you do that, I recommend keeping her on the pain meds and starting my rehab homework with the 5 min walks, done like the homework says to, so long as she is using her leg on the walks and not limping a lot. If she hasn’t had a full rest day with only potty breaks since her ‘using it too much’ time, then I recommend a full rest day or two as soon as possible. Primary goal is to protect the joint while assisting her with mobility.
      Thanks!
      Deborah

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  4. Doris Ruckoldt says:

    Hi Deborah,
    I just ran across this site & would like to ask a question. March 2012 my Casey had TPLO surgery. Months later she started to limp. Took her back to the Vet Specialists here in Anchorage, AK & the vet said everything healed good & the surgery looked great. She seemed to be having problems with the plate so in April 2013 I had them remove the plate & screws. While the vet was in there he noticed her meniscus was shot so he removed it. I was told to give it a good 3-4 months so scar tissue could build up & that would help with her limping. Well, its 3 months now & she still favors the leg & limps pretty bad at times. I’ve been given Rimydahl, which I don’t really like to give her but I do, and we have Tramadol. The vet is puzzled & just doesn’t know why she’s still limping. He said there isn’t anything else he can do & that she may be in the small percentage that just will limp. Sounds a bit hoaky to me but I don’t know what else to do. We’ve tried water treadmill, laser & swimming & things are still the same. How do I tell if she has a continued infection? She’s only 6 years old. She’s a Golden mix. Any advice?
    Thank you,
    Doris R.
    Palmer, AK

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    • rehabdeb says:

      Ok, but also, one of the easiest ways to see if infection is affecting the situation is to have the vet throw her on a course of broad-spectrum antibiotics. Your regular vet may do that in lieu of the specialist, however often the reg vets seem to feel like they’re stepping on the toes of the specialist, and they’re timid to do something that bothers how they perceive their relationship and dependence on particular specialists. On the other hand, some specialists and reg vets would totally “get” this course of action, and there would be no conflict of ego or interest…shouldn’t be, and it’s not a big deal to toss in some abx. I’d give Casey a LOT of probiotics to go along with the abx, if she were my dog. :)

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    • rehabdeb says:

      Hi, again!
      Did you get my other two responses? Let me know what’s going on now, if you’d like-
      Deborah

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    • rehabdeb says:

      I just realized this reply I sent the same day didn’t end up going to you, I don’t think…don’t know.
      Here’s a cut-n-paste version, again:
      Ok, but also, one of the easiest ways to see if infection is affecting the situation is to have the vet throw her on a course of broad-spectrum antibiotics. Your regular vet may do that in lieu of the specialist, however often the reg vets seem to feel like they’re stepping on the toes of the specialist, and they’re timid to do something that bothers how they perceive their relationship and dependence on particular specialists. On the other hand, some specialists and reg vets would totally “get” this course of action, and there would be no conflict of ego or interest…shouldn’t be, and it’s not a big deal to toss in some abx. I’d give Casey a LOT of probiotics to go along with the abx, if she were my dog.

      Blessings-

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  5. Doris Ruckoldt says:

    Hi Deborah,
    I did get your email & am now just reading your reply. I don’t think my vet would think that since the specialist said there’s nothing more he can do for Casey. I’ll run that by my vet about the broad spectrum antibiotics. Thank you. Where would I get probiotics for Casey & how would they help her? One more question, is abx short for antibiotics?
    Thanks again.
    Doris

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  6. Lindsay says:

    Great article! Thank you for sharing! I would really like to share what me and my Newfoundland dog, Hyzer, have been enduring the past year.
    Hyzer blew his ACL and had TPLO surgery and a few short weeks later the vet diagnosed him with a luxating patella.(apparently rare in large breeds) So I took him for another surgery. The surgeon stated that when he went to fix the luxating patella, the ACL was torn too so he fixed both issues. A year later I noticed hyzer limping again so I took him back. After X-rays it showed the knee cap on the leg that had the firtst TPLO now had a luxating patella. And so back for more surgery.
    At this point in the story I should add that I live in a rural Ontario border town. I take Hyzer to our local vet for diagnosis and x rays, but due to his size i have been taking him into the USA to have his surgeries done by a specialist. The same specialist performed all the surgeries.
    So the third surgery on the luxating patella (over the first TPLO ) was supposed to be done on his left hind leg. Unfortunately, this surgery was performed on the right hind leg. (A leg that had been diagnosed as just a luxating patella, but in surgery needed TPLO) this means this leg got 2 luxating patella surgeries and the leg with just the tplo (which needed the luxating patella fixed) had not gotten the surgery it needed. *big huge sigh* confused?
    I contacted all the vets, got hyzer the proper surgery (4 now in total). He is now recovering from 2 surgeries. It seemed as if he was recovering beautifully, but there was some major swelling and seeping. But the seeping was clear, and appeared to not be infected. I took him back to have it drained and the vet said everything was fine… No infection. That was last week. This week, the staples are out, swelling down…but hyzer is not putting any pressure on his left leg. I’ve been restricting his movements, but I had to get him into the vehicle to go to the vet. He also is unstable on my kitchen floor and he may have slipped despite my best efforts to keep him off it. His meds are finished as well. What do you think I should do? How do I know if he had blown his surgery?

    Like

    • rehabdeb says:

      Wow…
      I know that’s a lot to deal with, and while I really dislike seeing bilateral knee surgeries performed, I dislike even more seeing the quadruple! I do see it occasionally, though, and the bigger they are, the harder the recovery seems to be. I think this is due in very large part to there being a reluctance to dose high enough amounts of three different analgesics. The large and the old do not seem to recover as well or fast with only two, much less one (anti-inflammatory). The big three used in this area and in most of the USA for multi-modal approach are an anti-inflammatory (which carried with it issues of potential gastric distress and also stifles healing-see research on that), Tramadol/Ultram, and Gabapentin/Neurontin. But maybe you have this conquered! I also use laser therapy, the massage I have recorded on this site, and often grab a mobile acupuncture vet to come see the big ones…littler ones may more easily be schlepped into a clinic for acupuncture.
      I cannot emphasise enough that he definitely needs more pain meds and for probably at least 12 weeks, and if you were here, we’d work with the vet to see that accomplished.
      For now, I’m going to refer you to doing a search on pain in my search engine, and then look at the “older posts” section. I have a paper about limping and pain…the one you have already read, and if you have the patience, review it again. I do see a LOT of cases wherein infection is not suspected at first, and the pain notes I’ve written covers some of the methodology to sniff out underlying issues causing pain.
      Laptop is dying, so take this for now, and keep me posted if you can!
      Blessings-
      Deborah

      Like

  7. julianne says:

    Hi I’m not sure if you are answering questions, but I’m trying anyway :)

    I have a complicated case on my hands with my dog. I am a vet tech at a general practice and my doctors performed the lateral suture stabilization technique. He is 7 wks post-op and still barely toe-touching and holding the leg up a lot. I must say, before the surgery he was using the leg but had a very odd, exaggerated limp for 8 weeks, like nothing I’ve seen a typical cruciate dog do. Also, when they operated on him they said it was “not normal” in his joint. They said his ligament was not even torn but there was fibrosis all inside from chronic irritation (he had an injury 2 yrs prior with just conservative treatment.) They went ahead and cleaned out the joint and his cruciate ligament because it was fibrosed. He has been on tramadol, rimadyl and gabapentin. He is almost 12 yrs old. My doctors have consulted with an orthopedic specialist and she recommended the gabapentin and re-xraying the stifle, along with some rehab exercises. I think the gabapentin may be helping a little bit, but I am afraid to give him all the medication at once, so right now he’s getting rimadyl and gabapentin.

    Long story short, my dog will not fully extend his limb or use the bottom of his paw to push off. When he does use the leg, he toe touches and has the same exaggerated limp as before the surgery. I can fully extend the leg but he does not like it. I know there are other things I could be doing but everything I’ve been told has not worked. I am at my wits end and wishing someone could give me some hope. I am hoping with more time, because he is older, he will be back to normal. Any thoughts?

    Thank you in advance..

    Like

    • rehabdeb says:

      Hey!
      Sorry for your pup to be having so much trouble!
      …and for you :)
      Where are you located, where is the practice?
      He’s 12…what breed? What size?
      Has anyone said he may have had osteochondritis dissecans (OCD)?
      The first thing I thought when I read your post yesterday was that he had previously undx OCD. The second thing I thought was the same as the first…and that I have questions about the previous injury.
      If he had sx with the previous, which I don’t think he did because you said “conservative”, then my thoughts go to infection.
      I have seen a damaged joint, unopened, entertain an infection that came from elsewhere in the body, and occasionally I’ve seen this eat up a joint.
      I’m wondering if there is OCD which has led to the various subsequent injuries.
      Regardless, I have a lot to write up on my own Great Dane, Grace, who passed 2 yrs ago and was the most complicated case I’ve ever dealt with…and I get some doozies.
      She had, among other things, OCD, worse in L stifle, had sx to stimulate the cartilage, ended up with a half-softball-sized medial buttress, eventually tore the CCL, had a TPLO and non-union of the cut tibia, since it was a bad knee in the first place. The drilling didn’t work to stimulate the bone, etc…
      She tore the R CCL within a year, most likely because I wasn’t doing this work yet and didn’t yet know basic points to compare from the sports science and exercise physiology I’d been practicing for over 20 years at the time. I hadn’t yet really implemented my functional rehab exercise protocol like I would have with a human athlete and I wasn’t yet working in this venue, however her case was the impetus for the surgeon to ask me to start their rehab clinic.
      Shortening the story from here…the R leg ended up with raging infection, removed plate, knee scoped 2-3 times, all 3 ligaments torn, and bone-on-bone for the last 3 years of her illustrious and happy life.
      I pushed for better pain management and pushed the drugs to be used in addition to laser tx, massage, ice at times, and many other things at my disposal. She was on a nsaid beginning 2 yrs after a splenectomy to correct IM Thrombocytopaenia when nothing else worked. Never had another problem, btw, with nsaids. Was also on highest doses of Gabapentin along with highest of Tramadol. Adequan didn’t work for her, and neither did Amantadine.
      I began pushing the dosing for her, knowing quite a bit about it from other aspects of my life and even having heard more advanced vet presentations than were being practiced in my area at the time.
      So, that trying-to-be-short story is to give a little more info about pain meds while I wait for some of your other answers.
      As you can imagine, the Grace had a strange, pivoting walk, especially in the R hind. She also never achieved great extension again, and I didn’t push a lot of particular mechanics with her, especially as she aged and as I was able to really note what was necessary and what just wasn’t necessary for her quality of life. There is a lot of emphasis from certain circles placed on making the mechanics better, and that is good; however it is not practical and even possible in every case.
      She did use both hind feet independently, however she had modified their position to where the funny, long pad hairs grew out, looking like small sea creatures…you probably know what I mean.

      All that to say, he sounds like he’s in pain.
      Keep working on getting to a more therapeutic level of pain meds AND high/therapeutic doses of Omega 3’s (only, not 6,9,12,etc…) (start 20mg/kg of EPA daily if he tolerates that much…or start lower and build up to at least that much), and I like Xymogen DJD for joints. No chemicals, no additives, sold to human market, specialty pharmacy sourced usually. That’s just the basics.
      Don’t worry much about the mechanics right now. Sounds like the knee is close to trashed, so as you ramp up the different remedies, using all at your disposal and noting the benefits/differences, you will hopefully find the place where the pain is much relieved and you get as good a mechanics as possible at the time.

      That’s a lot of stabbing in the dark, not knowing what else is going on, and I don’t mind answering, but my time on the PC is really limited most days, so don’t be discouraged if you don’t hear back quickly :)
      I have taken some cases like this and scheduled paid phone consults for people who really want to have timely ongoing discourse, so let me know if that’s an option you’d like to pursue.

      Blessings-

      Like

      • rehabdeb says:

        Also!
        Watch my “Simple Massage Video” in the Video section, and start using that type of massage, paying specific attention to the hip and thigh of the most affected leg, but do the whole system, too. I tell people to watch it twice because they usually miss stuff the first time.
        Thanks-

        Like

  8. julianne says:

    Hi Deborah! Thanks for answering. I feel like there is so much more to my dog’s story that I left out. My dog is an Australian Shepherd and about 47 lbs. I’d prefer not to say where I work (just for privacy sake of this being posted in a public forum.) I have not had anyone tell me he had OCD, we had the ortho specialist look at the xrays and that was never brought up (do these even show up on rads? not sure), nor did my doctors say anything about that when they opened up the joint for sx.

    I saw his first injury happen. He was playing frisbee. Unfortunately we were playing on a very lumpy, soft yard (my bad) and he ran full speed, “tripped”, yelped and was dragging his leg. I never did any diagnostics at this point and the Doc said he was too tense to do the drawer test. He was better within a few weeks on Rimadyl and Tramadol but his leg has never been the same. He has always had a slight limp at a walk. I started him on Dasuquin after this happened and it seems to help a lot. He is now on Dasuquin with MSM. Not sure if the MSM helps or not, but I want to do everything possible!

    It’s been 8 wks now since sx and he’s made very little improvement. Since last I posted, I started him on the lower dose (as per ortho vet) of Gabapentin and he’s been on a low dose of Rimadyl continuously, plus Tramadol mixed in there occasionally. None of it seems to work that well. I can increase the dose of Gabapentin, and will probably try soon. I also started him on a lower end dose of Baytril in case of infection. He’s been on it for 6 days and it’s hard to say if that is helping or not. I probably should have gone with a higher dose, not sure. He has been using the leg about the same but now he lets it hang and touch the floor (still toe-touch) a little more. I have gotten some Flexadin Advanced, an omega 3, vit E and UC-II supplement (http://www.vetoquinolusa.com/AdditionalProducts/JointSupport/JointSupport.html), and will start that when he is done with the Baytril. I hate having him on so many things, but I probably am over-sensitive about this, admittedly. He hasn’t had any side effects as far as I can tell.

    There is definitely a clicking when I straighten his knee all the way but it doesn’t click when he does use it. It also popped loudly a couple times on manipulation a couple weeks ago, but hasn’t since. I am hoping the clicking will resolve and wonder if this is what causes his pain? I sure hope it’s not a meniscus problem, as my Docs said they cleaned that up and did not see any tear at the time of sx.

    I feel like I’m leaving more stuff out, but that’s all I can think of for now. I sure appreciate the info you’ve given me thus far and can understand why you’d want to be paid for your expertise! I just thought I’d give you a little more info.

    Like

    • julianne says:

      I mainly want him to be able to use his leg more so I can walk him. His muscle is G O N E. It’s so sad to see on such an athletic, energetic dog (even at almost 12 yrs old!) I suppose hydro-therapy may be a good choice here, but I have been putting that off, admittedly. I also forgot to mention that we have tried Adequan, with little results as well.

      Thanks again for your time!

      Like

  9. rehabdeb says:

    Ok…keeping it simple now…
    I’m repeating this paragraph so it will stand out…and I recommend you read my pain postings, as well as get the book I’ve written with guidelines for post op rehab.

    All that to say, he sounds like he’s in pain.
    Keep working on getting to a more therapeutic level of pain meds AND high/therapeutic doses of Omega 3′s (only, not 6,9,12,etc…) (start 20mg/kg of EPA daily if he tolerates that much…or start lower and build up to at least that much), and I like Xymogen DJD for joints. No chemicals, no additives, sold to human market, specialty pharmacy sourced usually. That’s just the basics.
    Don’t worry much about the mechanics right now. Sounds like the knee is close to trashed, so as you ramp up the different remedies, using all at your disposal and noting the benefits/differences, you will hopefully find the place where the pain is much relieved and you get as good a mechanics as possible at the time.

    Since I sent an email to you, you have my address, so write and let me know privately where you are, in case I do know someone in your area who could help.

    I cannot emphasize enough that if you haven’t read my guidelines and followed them exactly, just starting now, even though you have all this complicated history, then you may just have the key yet in store for you.

    Here is the link to the book and the guidelines:

    Right now, this one is only available in Kindle version, and it’s only $7.99. You can read it on your smartphone, pc, apple, etc…by downloading the free Kindle app. I am working on the paper copy.

    I can only encourage you to trust me and to follow the process exactly as I’ve outlined it, not second-guessing and do start from scratch. I have used this similar protocol over and over and over, successfully.

    The key is enough pain control, and you probably need to max out what you’re doing at this point…you probably need to get as ahead of the pain as possible at this point, and that will be hard, since it got ramped up after surgery.

    If you get the book, follow the instructions, including massage and pain control, then I will almost guarantee you will see improvement. There may yet be a meniscal tear, but I have dealt with those, too…same basic protocol to start, plus max doses for the older animals of nsaid, Tramadol, and Gabapentin in most cases. Some don’t tolerate one or the other drug, so we find another. I have two papers on this website from the human side that validate physical therapy without surgery for torn meniscus and torn ACL. Lots more validation exists…just thought I’d draw your attention to them if you didn’t yet read them.

    From my perspective, I have seen hundreds of cases improve and recover. I have also seen many, many humans -athletes and otherwise- recover from injury and surgery. Working with high-end athletes takes a practical, exercise physiology-based, return to function program such as what I have written and use for our pets as well.

    Get back with me once you’ve gotten the book, read it twice, watched the massage video, and begun the work as well as increased meds. That will be the solid foundation and “same page” we may work off of to get your kiddo in better function.
    Blessings-

    Like

  10. Maureen Slattery says:

    My 5 yr old dog had ACL surgery along with scraping out of torn meniscus etc. The vet said it was a real mess. He is still favoring his leg, and holds it up alot, but will bare wait on it probably 50 percent of the time. Shouldn’t he be using it 100 percent by now? It has been 2 and a half months since surgery and is a picture of health aside from his leg. Also, his leg is noticeably smaller compared to his other leg. Please advise.
    Thanks so much.
    Maureen

    t

    Like

    • rehabdeb says:

      Hi, Maureen-
      If you are local, consider setting up an appointment with me, and I will more easily pinpoint the things holding back your dog’s recovery :)
      The biggest reason I see for lack of use is that the pet has had continual pain and has not been given a really good, structured, return-to-function program.
      If he’s holding up the leg, not using it, I’d guess there’s over 90% chance it’s due to pain.
      The leg is smaller because he is not using it, therefore the muscle is smaller.
      Another option for you is to get my book and begin at week 1 as if he just had surgery. I have been able to see hundreds of pets through this situation by getting caretakers (pet owners) to do exactly as my booklet says. That means no cutting corners on any of the things I recommend. The book is cheap and the solutions for you to follow should be relatively easy.

      This should help!
      Deborah

      Like

  11. julianne says:

    My dog ended up having a patellar ligament rupture.. very uncommon. His limp was strange from the start, I knew it wasn’t “just a CCL tear”.. it is amazing watching a truly gifted surgeon diagnose something so quickly when others were just scratching their heads. Anyway, he’s having surgery soon and hopefully will regain strength in that leg. Unfortunately, the surgeon said he couldn’t give me a prognosis, too much is unknown from what’s going on in there to the recovery/healing/rehab.

    Like

    • rehabdeb says:

      Great! Thank you so much, Julianne, for taking time to answer…finding out about those 1% things is helpful for me and for others in practice, as well.
      In my own practice, I’ve encountered in person a handful of 1% conditions (nerve sheath tumor, pelvic mass, etc…) that confound standard practice, and when we suspect something else and have tried prudent and practical measures, it really pays to keep after the answer. If you don’t mind telling us, who is the surgeon you found who was able to diagnose? And did they use MRI to diagnose or exploratory?
      My own Greatest Dane eventually tore all 3 knee stabilizing ligaments, and there really wasn’t anyone in this portion of the US who could help her, plus she wasn’t a candidate for knee replacement (they’re still arguing about those here, too), so I had to rely on all my powers of strength, wellness, and conditioning…she wasn’t a brace candidate, either, although I spent time trying to develop one that would work for her :) She had a great life and could dance with squirrels.
      Patellar tendon repair is something we deal with in human sports rehab, and the restrictions PLUS beneficial, slowly progressing exercise on a simple program is key in the first few weeks (and throughout, really).
      If you’d like to investigate a very good human postsurgical rehab guideline text that covers the issue, check out Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician from the Hospital for Special Surgery Dept. of Rehabilitation. It’s a great reference.
      Blessings-

      Like

  12. Connie says:

    Hi Deborah, My 8 year old Golden Retriever torn her ACL after she fell in a woodchuck hole. She had lateral suture stabilization technique 9 weeks ago, and has done great until now. She has stared limping and holding up her leg more than she did with the initial injury. The vet took x-rays today and said everything looks fine. She was given pain meds, and told to continue with her therapy. Why is she regressing after doing so well? I’m feeling guilty that maybe I am allowing her to do too much. We have lots of stairs in our house that the vet said is good therapy for her. She was also cleared to be off-lead in our fenced in yard. My instinct is telling me to take her back to square one.. I’m going to order your book today. What do you think?
    Thanks in advance, Connie :)

    Like

    • rehabdeb says:

      Hi!
      Glad you wrote, and I take it you are not in my area, not in Texas? :)
      For now, I do agree with you…with extreme limping, use good judgment and go back to square one in this case.
      Yes, get the book, and the first four weeks lays a foundation. After that, I like to review a case and then recommend increased intensity drills, however stairs are not recommended until much later, after an active recovery foundation is laid.
      The thing is, surgical body invasion of any sort is painful, and some of us also have plenty of pain even in parts that aren’t “invaded” :)
      Keep the meds on board, really review the pain chapter in my book, and be aware of changes in your Golden.
      There are possible issues that won’t necessarily be seen on an x-ray, like an infection or torn meniscus. Both of those may be ruled out or in along the way, and both are able to be rectified without additional surgery in most cases. Cloudiness may be seen on an x-ray, which indicates joint anger, so to speak, but there aren’t always easy-to-see issues using x-ray.
      The best way through, regardless at this point, if no small fractures or growths were seen and the surgery seems stable to your vet, is to go to the beginning and work through methodically.
      I will say that if you only started easy stairs recently, the timing was perhaps not bad, however having a methodical program and taking it slow and easy is the only way to avoid injury or additional pain. Many dogs I encounter are being asked to do very hard work at 6-8 weeks without pain meds and without laying a foundation of recovery, so I work to get that foundation going for everyone.
      Let me know if you have more questions after getting the book. I am available for phone consults for long-distance cases, and I use PayPal for billing.
      What is your dog’s name?
      Blessings-
      Deborah

      Like

  13. Connie says:

    Dear Deborah, Thank you so so much for responding :) My vet (I’m in Pa) did say that stairs were fine right from the get-go…so she has been using them in our tri-level home pretty much right after surgery . Although, I will say she is a very calm but vibrant 8 yo Golden. This is day 10 of severe limping since doing so well the first 8 weeks. She has been given a new pain pill Gabapentin after seeing no difference with the Tramodol. It’s just disheartening that Ellen has regressed so much since her June 26th surgery. Now they want her to go to physical therapy in a few days…is this wise? Other than holding her leg up she seems happy and eating well. I just wish that I had a definite picture of what was going on. Like I said they did do digital x-rays and said everything looked fine. Would they be able to tell if the suture had elongated or even snapped? I’m a professional dog groomer and my Golden’s go to work with me everyday so I’m very in-tuned to them…I feel in my heart something is wrong :( I hope I’m not right. Thanks Deborah for all you do for pet lovers everywhere!

    Like

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