Here are two news articles that discuss some important aspects of physical activity: 1) The public’s sedentary trends and how physicians and health care providers are combating this behavior by prescribing exercise (http://on.msnbc.com/w43DC9), and 2) Even though you may participate in some form of regular exercise/physical activity program, be aware of how your body is responding and make sure that you are staying within a safe range (http://on.msnbc.com/zv5jNX)

With adept application, many human interventions may be crossed over to non-human animal functional rehab

Yesterday morning it was pouring rain in this area, and I braved the interstate highway to drive about an hour away to see a friend of mine from Boston, a human cardiologist, who was presenting concepts from her heart health program to a large room full of interested persons. She gave me a copy of her new book, smart at HEART, a holistic 10-step approach to preventing and healing heart disease for women. I read the intro last evening and it looks really promising! She and I have a lot in common, and from what I can tell, she is promoting (like the title says) a well-rounded, holistic approach to health and wellness. Reminds me of Dr. David Servan-Schrieber and the book he wrote detailing his different, changing views as he went through cancer diagnosis and treatment (Anti-cancer: a New Way of Life). I highly recommend looking at his book, too.

On my way back to Austin, I stopped at a veterinary clinic to discuss some ideas they have for expansion and inclusion of rehab facilities. We agreed to move forward on a variety of ideas, and I’ll be consulting with them to hopefully bring about very functional approaches to rehab that considers the clinics abilities and needs in conjunction with those of their clients and the community.

I stopped at another clinic to discuss a client I recently saw, some of the postings in this blog (of which the vet was very supportive), and how to incorporate my non-surgical ideas with his propensity toward surgery, or his liking certain surgeries and his being very good at them. It all works well together, because combining our approaches and knowledge gives clients more options for their pets. We may draw from a larger knowledge base and outcome base and are able to, together, offer more ideas, more possibilities.

And that was the end of the day, aside from meeting a friend for dinner and taking care of basic home duties.

Today I am hoping to begin catching up on basic reports to vets regarding program design for animals I saw last week. I already called or otherwise gave reports after seeing animals that seemed to have immediate need for recheck with the vet. I will also be hoping to better prepare a presentation I will be giving in a couple of weeks to the pre-vet group at the university. I have other projects to attend to, and this afternoon I look forward to an indoor rowing competition with my cohorts on Team Survivor. We get to train and row for free, year-round, due to the generosity of Sara-Mai Conway, Flywheel Fitness, and the Austin Rowing Club. And due to the nature of Team Survivor, which offers free fitness, wellness, and workout programs for any woman at any stage of any cancer diagnosis. That second thank you is a thank you to the community and to everyone who has donated to Team Survivor- through the Mamma Jamma Ride, at our annual fundraiser, or in any other way.  I know exercise and movement are medicine and wellness, and so I go…and I try to coerce as many others as I am able!

Carpe momentum…

…and here are some links:

Team Survivor- http://teamsurvivoraustin.org/

Flywheel Fitness- http://flywheelfit.com/

Malissa Wood, M.D.- drmalissawood.blogspot.com

Here is the first answer I sent you via Facebook-

Hi-
Here is my FB rehab page, and you may already be a fan, since we have at least one friend in common, but there is no easy way for me to search and sort who follows this page
I will get to answer your post on my website as soon as I can. Otherwise, I do know the answers to all of your questions are on one or both of my sites…it just takes a lot of reading ! So while you wait for me to be able to answer, check out the homework and other related posts if you haven’t already.
Sam does need pain meds of some sort and he does not need to rush into surgery based on what you have told me. X rays won’t show torn ligaments, however they will show clouding in the joint which just tells us what we already know, that there is joint disruption and damage.
See the post I just made on the wordpress blog regarding Clark, the hip dog.
Blessings-

And here are more answers now that I have some time:

I will always do a paid phone consult, so if you are interested, let me know and we will set that up.

I do not know of anyone else that practices the way I do, with standard therapy interventions and certification within veterinary medicine (CCRP) yet using the tried and true, long-standing principles of athletic training and strength training protocol. There are a few people in the U.S. that I know of who also carry the strength and conditioning certification that I do, the CSCS.

That being said, I do know of a friend who is a vet and who opened a rehab center in Mobile, called Ark Animal Clinic and Rehabilitation Center. She knows of my practice and even came to Austin to ride around with me prior to opening her practice, however I do not know that she knows of and embraces non-surgical treatment for torn cruciate ligaments. She has a website and a Facebook page for her practice.

The protocol for dealing with this situation did not exist that I could find when I first came into companion animal practice, in 2004-05. I began writing simple programs based on my background and experience. These have been refined and honed and proved to be beneficial.

Additionally I was blessed with a Great Dane companion for 10.5 years who was bone-on-bone in both knees, had all three ligaments torn in the right knee and two torn in the left. She had a genetic bone disorder called OCD (for short), and had two TPLO’s that didn’t work out, or, the end result was not what we would have aimed to accomplish. I am not anti-surgery and not because of her situation. It is through her situation that I learned even more about improving function non-surgically or in the face of very complicated circumstances.

At the least, I have substantiated with some vets in this area and around about (who have inquired and followed my simple homework) the beneficial effect of slow, weight-bearing, pain-controlled return to function after surgery. I built my Grace’s thigh muscles to better support her joints, and I had plenty of opportunity to see the benefits of increased muscle mass in her case. I have also appreciated the benefits in other cases.

I hope that you have found many of the other answers you were seeking elsewhere in this blog.  I suggest pretending like it all just happened and start at the beginning of my homework suggestions (under “homework”) and I strongly suggest, as I said previously, that you obtain an anti-inflammatory if Sam’s system will support it (your vet will do blood work to substantiate this), and if not an nsaid, then use Tramadol or Gabapentin. There are lots of options for pain control (see my Q&A post regarding limping after surgery), and if you just pretend like it happened recently and really start again at the beginning, building up from there, I really think you will realise great benefit for Sam.

Adequan seems to work really well on relatively few dogs (animals). I tried it a lot in my Grace, and I was working with a surgeon friend, so we tried it three different ways (IM, IA, SQ)on three different trials, to no effect for her. Some of my clients say it has helped their dogs substantially. A surgeon on the East Coast told me in 2005 that he didn’t think it would work for my Grace and that they had stopped using it in horses due to little effect. It’s expensive, yes, and it’s great if it works on your dog.

In the meantime use fish oil and a glucosamine/chondroitin/msm combo for joint health. Your vet may carry these products. I have info posted elsewhere regarding these supplements. If Sam takes off running and injures the joint, then make him rest for the remainder of the day and he has to go back to slow leash walks until he is no longer lame. You may also use ice, right on his knee, 20 min, when he has a limping/lameness episode. Hopefully you will be able to have a veterinary relationship where more pain medicines are utilised for greater overall benefit. Check out www.ivapm.org for more pain management info. I’m with you in that he is probably uncomfortable at night. Pain meds will help this, and the other options I gave you will help it some.

If he were my dog, I would definitely follow my homework and the supplement advice, the pain med advice, and I’d recheck with me when the first four weeks of homework are completed. I would not have surgery on him right now based on what you have told me, however I also have seen older dogs do well in surgery…so it’s not the surgery that is offputting; it’s just that I think he can thrive, based on what you have told me, without surgery. You have opportunity to find out if you get strict with the restrictions and homework again. He will have difficulty every time he spazzes out until he builds more thigh muscle. Then the joint should suffer less impact. At the least, if you follow this simple homework, it could serve as pre-hab, and if you decide on surgery, he will be in better shape and presumably recover better after surgery.

That is all I have time for right now.

Our next consult should be a paid phone consult if you’d like to go further. Thanks for presenting Sam to us-

Blessings-

Deborah

If your dog is limping your dog is in pain. Your dog is not limping just “because he/she had surgery”; the dog is limping because he/she is painful after surgery.

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

The pain could be due to the dog not having enough pain meds.

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

These are the three most common situations I encounter.

Stop the dog from doing too much activity & read my recommendations on my homework page.

If your dog does not have an anti-inflammatory and an additional analgesic, like Tramadol or Gabapentin, for the first few weeks after surgery, then I recommend you ask your vet to consider supplying those.

If your dog is on those analgesics and is being restricted as recommended, 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 additional 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 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. We are confirmed in our suspicions when the antibiotics have great effect and the limping/lameness/pain is relieved.

Those are the basics.

I use massage with the small Homedics unit featured in my massage video, ice, and sometimes laser therapy on the knees with infections. I also recommend that my clients do not work the dogs until the pain is relieved. My programs are designed to work in conjunction with adequate pharmaceutical pain relievers. I have utilised many non-pharmaceutical methods of pain relief, however after surgery it seems that pharmaceutical pain relief gives the most benefit. Those pain relievers may be reduced over time as the muscles are build and healing occurs.

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. Two that come to mind were small dogs that were allowed to run up and down stairs and bounce all over the place. They blew out knee surgeries and had to have re-dos. Only speaking of knee surgeries here, four more biggies come to mind, and none of these had to do with the owner, although in two of them the surgeon tried to blame the owner and/or rehab. Often I am not called onto a case until extra damage is done.

Just knees, and just off the top of my head, one blowup case was a tiny dog that had both cruciate ligaments and both patellas surgerized all at once. The owner was very compliant, and she had me come each weekday for a month to do the work at least once, so she would “know” it was done correctly. I suspected infection right away in one knee. I reported excessive effusion and other signs that accompanied this situation and increased my belief. I could feel the pin in the problem knee working its way out. The short story is that the pin was removed many weeks later, and the owner gained no voice in the meantime with the surgeon. The surgeon did not return my many communications regarding the signs I noted that pointed to a problem. The owner and her regular vet were both timid with regard to going over the head of the surgeon and didn’t want to “step on toes”. This is a complicated scenario, and I see it play out all the time in human medicine and veterinary medicine. I have come to believe that finding our voice in peace and confidence is a part of all our journeys.

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 the vet school 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 surgerized, atrophied leg (yes, I think surgerized is a slang word that some of us have made up…). He had a series of very great complications, and the biggest battle, after we saved his life from gastro & infection-related death, was getting adequate pain relief for this very heavy dog. Eventually so much time went by that his dysfunction (physical and psychological) complicated his recovery. He is very happy today, and his owners, who live in another town, have worked out a lifestyle that works for all of them.

The first incident could happen to your dog, however in the many cases I’ve treated, even it is unique. So, cover your bases regarding the first three reasons your dog may be limping/lame. The second incident is far less likely to repeat itself in your dog. I know, based on how many I know of in this area that have had complications, that very many of you out there have dealt with complications. Realize, though, that most issues I see before *major* complications are resolved by following the three guidelines at the beginning of this blog.

A third dog had a CBLO and was damaged at the specialty hospital where he had surgery, best we are able to determine. I had previously worked with the owner on another dog of hers, and when her current dog tore his CCL, she just didn’t think to call me. That happens. She called me to evaluate when he was still very lame a little over a week out of surgery. He had been to work in a water treadmill already as part of the surgery package. When I first saw him, he was lame beyond what I would expect, based on my experience. He was set to go for another wtm session within the next week, and I drove home to the owner that she really, really needed to alleviate his pain. He was only being given an nsaid (Rimadyl, Deramaxx, 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! He went to his second wtm session, and I saw him within a day or so. 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. It turned out that she got the x-ray and his fibula was broken and the screws and plates were pulled out. Eventually we were able to go back and compare post-op rads and find that it seems the fibula was broken in recovery 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! The point to these short stories is to give some brief recounting of post-surgical abnormal knee incidents. I am not going into full case studies here.

The fourth case that came to mind is actually two 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 because the owner thought it would help strengthen the dog. He 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 that is not what happened. The restrictions. The other was also a small dog (as was the first one in this paragraph), 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.

My own dog, whom I forgot to count in my original quickie thought process, had OCD and before I knew more, before I got into this vocation and began putting together what I already knew from sports medicine, I chose a TPLO for her. She had about a half softball calcification at the medial aspect of the operated stifle, and the first 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 it was cut and the plate put in place. It wouldn’t have grown back, presumably, given that the bone was damaged inherently as it was. That genetically bad knee turned out to be her better one over time, as the other one eventually became destroyed. She tore the opposing 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. Nonetheless, there was a problem with the saw blade in surgery, and we had to wait for a new blade to be flash sterilized. I believe she was just open too long for her system on the table while waiting. She gained a resistant pseudomonas infection seemingly immediately, complete with need for drains over several weeks while I administered injectable, powerful antibiotics for weeks. It was clear within about two years that the infection had really eaten up her knee. She had two more scopes 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). She was amazing.

And her 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 lameness/limping after surgery is usually one (hopefully one) of the more simple-to-resolve first three I cited. !

Over time, and when I am able to allocate time, I will hopefully relay more case studies and stories of problem/resolution.

Blessings-

We were referred to you by Dr. Matthews (KAH).  He believes you can help us with Bella, our 5 year old blonde lab who was diagnosed with Hip Dysplasia 2 years ago.  Since then, she has consistently been on Rimadyl. We visited Dr. X (a vet surgeon) and discussed surgery options.  At that time we opted for the routine and consistent Rimadyl therapy and to consider other options (hip replacement) for the future.

We were very intrigued and encouraged to receive your information from Dr. Matthews as would very much like to pursue alternative forms of therapy and conditioning to improve Bella’s current and future quality of life.

We would be most pleased if you could contact us at your earliest convenience to schedule a consultation to discuss our options.

Kindest Regards,
Art and Caryl
parents of Bella (Lab), Dakota (German Short-Haired Pointer), Raja (cat) and newest addition, Tucker (horse)

5) Using my FHO homework, start Bella at week 2, 2-4 10 min walks daily, very, very slowly. Please read all the guidelines cited on the homework.

We finally got her to tolerate some Deramaxx and using heat, massage, and alternative remedies (herbs, acupuncture, laser), she is using the leg pretty normally now and is feeling MUCH better the last 2 weeks or so. She is up to 2-3 ten to fifteen minute walks a day. Time to try building up some muscle to even out her legs and hips. Any suggestions? Our rehab specialist here says we can start small slopes and cavalettis. Since you know Zoe well, what can you tell me about helping her build her strength and conditioning back up?

Thanks, and we miss you!!!

My Replies:

I know her and I know you guys, so I don’t mind being a little more specific on here for you…but I do wish I were there I really am beginning to think about a trip…I know we have exchanged some texts and emails about her in the past few months…

Did you guys ever find my FHO homework and start on that fairly strictly, beginning at week one? I see that you are taking her on 2-3×15 min walks daily…how slowly? Wedding march is the speed I want to see, with consistent walking (no piddle & sniff) and consistent weight bearing. You may be doing that, in which case, I need to know if she seems more lame, lame at all, or not lame after those walks.

If she is not lame at all, then my preference is to advance to 2 weeks of 2×20 min walks before adding in hills. Let me know where you are on that. The most prevalent difference I find between what I say vs what people are having their dogs do is in the speed of the walk. The pain meds help encourage leg use and the slow speed forces individual limb use. Two different things, in a way, and I’m sure you can see that. So, no sense moving on to hills if we cannot get 20 min of persistent, consistent leg use on the flats. Let me know about that and then we will talk about type and frequency of hills. Thanks for the great post!

From the client:

You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.

Me:

I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell )
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
) Blessings-

Me:

After our first evaluation, my bullet point recommendations were to

1) restrict and crate when not at home for the next 2 weeks.

2) Begin exercise protocol noted on my FHO homework sheet, beginning with week 2, 2-4×10 min walks daily, very slowly (wedding march).

3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 pm walks. Give 2 hrs. rest period in-between walks (as per homework sheet).

4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm.

Client:

(after having some problems with Clark, a rescue, and other dogs adjusting)

Hi!

We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.

Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)

I will keep you posted on progress…just might be a little longer than 4 weeks.

Have a wonderful week!

Me:

Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.

In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.

Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation.
Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes?

I don’t think you are in that catagory.

You guys represent the “norm” (knowing there is no normal) in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This norm is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work.
I know you get that

And of course my perspective is a little more broad, because I have seen a lot of what happens to animals in a wide variety of circumstances.

The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).

More than that is the additional stress and pain for the animal.

I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.

You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.

And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems. I came into vet rehab after 25 years experience in human sport science and nutrition protocol covering the gamut. These principles were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for animals for pre-hab, re-hab, and instead-of-surgery in many cases. No, you can’t just copy a program from Muscle and Fitness magazine…but you can pay attention and learn what actions produce what results. That will take time. The paying attention and learning…

There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue.

I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics.

Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.

Other beneficial things will happen as well, as always do with exercise of the right type for a particular entity. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say, and that is what the literature says. Vet surgeons in other parts of the U.S. will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.

So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.

That’s all I have time for right now, and I think this will help you guys.

Blessings-