Common Conditions for Dog Physiotherapy
A brief summary of some common, and even some not-so common conditions affecting your dogs. How these diseases or injuries may happen, some veterinary treatment and some rehabilitation information is included. We highly recommend contacting us to make the most out of your dog's rehabilitation and physiotherapy process.
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Arthritis
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Arthritis is the broad term referring to “inflammation of the joints”. Not only the joint surface is affected, but tendons, ligaments and muscles surrounding the inflamed joints struggle as they try to compensate for the discomfort in the joints. The cause of this inflammation can be generalised as a result of age and “wear and tear” of joints, or it can occur secondary to injury, disease and biomechanical abmormalities.
Veterinary Treatments
Pain is a major factor with this chronic and degenerative condition, but it is important to note that acute flare-ups occur along the chronic road. Veterinary involvement can take several forms to help these different pains.
Pain relief in the form of NSAIDs can help with ongoing and flare up management. Joint injections themselves can take different forms, with different active components being used to target the inflammation within the joint capsule, reducing the pain at the source, introducing “healing” components to protect what is left of joint capsule linings/
Rehabilitation advice
Joint inflammation affects all parts of a joint capsule, which means more than just the bones and cartilage that make up the focal part of the joint. The ligaments, tendons, muscles and cells within and associated with these joints are also affected. The pain and disuse caused by the inflammation can cause these tissues to seize up.
Strong muscles and bodies make for stronger and healthier joints and soft tissues. Unfortunately, pain from chronic arthritis or acute flare-ups will heavily affect the body’s ability to perform these exercises and to strengthen. Rehabilitation for these cases requires a balance of pain relief modalities alongside targeted and measured strengthening efforts.
Laser therapy – a powerful modality to aid pain relief and support the body’s own healing systems. Can be used directly on painful joints, or on secondary soft tissue pain.
Heat therapy – painful joints create stiffness in the soft tissues around them. Adding warmth as a therapy for pain relief and as a preparation for exercise or movement can greatly improve comfort levels for your dog. Care should be taken for this not to be too hot, and not to be applied for too long (15 minutes maximum).
Cold therapy – an effective and easy pain relief tool, which can address direct heat and painful joints during flare-ups or post-exercise as needed. Care should be taken for freezing items not to be applied directly to the skin to avoid freezer burn, as well as not to be applied for too long (15 minutes max)
Massage & Manual therapies – comforting therapy for stiffened soft tissues due to acute or chronic arthritic pain. This can help to lymphatic circulation and drainage, improving the biochemical conditions of tissues, as well as provide soothing relief to your pet.
Exercise programme – targeted exercises can be a powerful addition to the daily management of arthritis. Due to the often whole body nature of this disease, it is highly recommended you seek professional advice for the exercises which may be suitable for your dog.
Elbow Dysplasia
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Trauma, genetic, or developmental problems with the elbow joint lead to painful degeneration. This hinge joint becomes unable to articulate comfortably with each other, and as the majority of 4-legged animal’s weight is carried by the front end, the pain implications of this disease are high. Veterinary intervention is possible, but working alongside a physio who can guide you through the exercises and manual treatments that would maintain the muscles and ligaments in as healthy a way as possible is highly recommended.
Veterinary Treatments
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Rehabilitation advice
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Hip Dysplasia
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Trauma, genetic or developmental problems with hips leads to the hip joint degenerating. The “ball” of the hip no longer effectively sits in the “socket” of the pelvis, and as such instability in the hind end happens. This can be very painful, with loss of muscle and function of the hind end occurring over time, sometimes quite quickly. Many surgical options are available to treat this problem, but all require management of the body to reduce risk of re-injury and gentle re-introduction of exercise to control the pain and re-educate the body to move properly again. Physiotherapy is vital to the success of a lot of these cases.
Veterinary Treatments
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Rehabilitation advice
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Intervertebral Disc Disease
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Some dogs are highly pre-disposed to this painful and damaging disease. The squishy material that sits in between the vertebrae of their backs can become damaged in multiple ways. Usually, neurological damage and loss of hindlimb function to varying degrees occurs. Options for treatment include surgery to stabilise the problem. Following this, or if conservative management is chosen, movement re-education and owner education on how to support their dog for the first 6-8 weeks post-op, which are often crucial is advised. LASER therapy can help nerve regeneration and growth, which aims to have your dog feeling their bodies and moving more comfortably again.
Veterinary Treatments
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Rehabilitation advice
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Cruciate Ligament Injury
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
The cranial cruciate ligament in the dog is highly prone to injury, especially in thosewith straighter limb conformation. Some activities, sadly those like chasing a ball, can also trigger rupture of this ligament, which is not dissimilar to ACL injury in humans. Several surgical interventions are possible, as is conservative management. Because of the complex structure of the knee joint that this injury affects, lifelong compensations can present following injury. Client education and guidance through the rehabilitation process can increase the likelihood of return to former work, as well as monitor pain levels throughout the rehabilitation process. Both are crucial components to monitor during rehabilitation processes.
The Cranial Cruciate ligament is literally a crucial ligament which sits in the middle of the knee/stifle joint in dogs (and cats). It is responsible for stabilising this joint through jumps, landing, twists and turns. This also means that any of these forces applied with too much power or at a fragile angle, can lead to significant damage to this ligament. Acute, or sudden, onset of damage – aka sudden partial or complete tear to the ligament is possible, as is chronic, or long-term degenerative damage able to cause pain and problem to this structure.
Veterinary Treatments
Generally veterinary treatment takes place in the form of surgical intervention with these injuries. These surgeries generally address, in one way or another, altering the strain placed on the CCL. Usually, the surgery alters the joint to reduce the cranial (forwards) thrust of the femur on to the tibia. This can also result in the quadriceps muscles and patellar ligaments recruited to reduce and even remove pressure on the CCL, and to stabilise the limb.
Tibial Plateau Levelling Osteotomy – Changing the angle of the knee by repositioning where the top of the tibia (lower hindlimb bone) meets the bottom of the femur (upper hindlimb bone). A portion of the tibia is cut out to re-level the top of this bone, which recruits the patellar ligaments and relieves the angle and pressure on the CCL.
Tibial Tuberosity Advancement – Similar principle to a TPLO, carried out in a slightly different way. The end results of this surgery is equally to relieve any strain on the CCL, by recruiting the Quadriceps and patellar ligaments to create stability in the knee joint. Altering the angle of the patellar ligament against the joint surface achieves this.
Rehabilitation advice
These cases require a balance of rest and recovery from significant surgery alongside a careful re-introduction to exercise and eventual strengthening programme. Managing compensation, secondary pain and risk of secondary injury is crucial. Many dogs with one cruciate ligament injury sadly commonly suffer the second within 12 months of injury.
A significant word of warning with rehabilitating these cases: the surgeries involved are, to some extent, changing the angle of the joint and the biomechanics. These changes will take time for your dog to adjust to, and so monitoring their condition on a whole-body basis is important to maintain their comfort and welfare!
Quadriceps activation and strengthening – with the slightly altered and additional role given to these muscles, strengthening and maintaining healthy condition of this muscle group is vital. Activities to engage and mobilise the knee joint to encourage optimal range of motion and quadriceps activity are crucial to maintain health and strength in the injured knee, as well as to condition and maintain the uninjured but at risk knee. Many of these exercises have a “globally” strengthening benefit to dogs, which is also where experienced animal therapists are highly recommended; in order to assess the suitability and efficacy of the exercises.
Poles – lifting limbs up over a range of pole designs, heights and repetitions targets repetitive activation and conditioning of the hindlimbs. Core strength and forelimb health also benefits from these exercises, increasing the overall strength of the patient.
Hillwork – Hindlimb flexion and control is targeted when walking up and down hills. The addition of gradient to the surface dogs are walking on alters the loading and coordination demands on the limbs, thereby increasing the conditioning and strengthening of the tissues in each limb and the body on the whole. Due to the nature of most CCL surgeries, which have likely changed the angle of the joint surface, this exercise should be introduced cautiously, in a controlled manner, so as not to damage the healing process.
Sit to stands – Squats for your dog. Gentle, controlled activation of the hindlimbs with minimal concussive forces on the hindlimbs are a great tool for CCL rehabilitation. Posture, form and fatigue must be monitored to ensure these are being done effectively and more importantly safely.
Sources & Further Reading
Luxating Patellae
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Luxating patellae becomes a chronic degenerative condition if not addressed early or effectively. The kneecap, or patella, sits in a ridge on the top part of the femur, as part of your dog’s knee joint. When functioning correctly, the patella will move smoothly within the confines of this ridge. When this structure becomes undermined, the patella no longer sits consistently in the ridge, and can start to “slip” or “luxate” out of the ridge. Several tendons, muscles and ligaments play a role in keeping the patella in this ridge however several factors can affect their effectiveness.
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Conformation – Dogs with “bowed” knees, such eas bulldogs, pugs, staffies, jack russels etc are all more susceptible to developing luxating patellae. The angle of the joint predisposes the patella to being able to “slide” out of its ridge, thereby luxating.
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Genetic predisposition – possibly overlapping with the conformational elements, as these dogs
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Injury and/or inactivity – Often, injury requires a period of inactivity or “cage rest” as it is known in the veterinary industry. Injury to the hindlimb can result in direct trauma to the patella or associated structures, leading to compromised function and eventual luxations which may increase over time. Secondly, this inactivity is likely to result in reduced strength, function and effect of the quadriceps muscles (and other structures) which associate with the patella. The atrophy of these structures reduces the strength and stability of the patella to be held in place in its ridge, and so increases the possibility of future luxations.
Once luxations begin, the degeneration begins. These luxations are graded on their severity – 1 being the lowest with very rare occasions of slip, 4 being the highest with almost permanent luxation seen/felt. Continual luxations are likely to flatten the ridge that the patella sits in, starting a downward spiral where more luxations brings more likelihood of luxations.
Veterinary Treatments
Orthopaedic surgeries targeting the severe cases are considered by your vets on a case-by-case basis. I am not a vet, these surgeries are listed purely for educational purposes, as examples of options available to treat this condition. The decision is ultimately at the discretion of your veterinary surgeon to assess.
https://www.fitzpatrickreferrals.co.uk/orthopaedics/patellar-luxation/
Recession Sulcoplasty aka Ridge deepening – effectively artificially re-cutting the ridge in which the patella sits.
Tibial tuberosity transposition aka altering the top part of the tibia, which is where the ridge the patella sits in is found – the location of the ridge is altered entirely to anchor the patella and reduce ineffective quadriceps tension, to reduce slip. This surgery can also be used in the case of cruciate ligament injury, as it creates increased stability within the knee joint.
Pain relief and ongoing management – ensuring sufficient pain relief is prescribed to your pet is crucial for rehabilitation. Painful limbs are not used effectively and so can result in compensations, which can lead to secondary pain and potentially even injury. Regular reviews in the early days of acute pain, and ongoing reviews to manage their ongoing well-being is highly recommended.
Rehabilitation advice
The real MVP for these cases is strength training. Strengthening your pet’s quadriceps should create greater tension acting on the patella, and greater stability in the patella to stay central in its ridge. Whilst an initial period of cage rest is highly likely, an approximate benchmark of 6 weeks is usually set for these surgeries, strength training and targeted activity are crucial to maintain longevity of their comfort.
Sit to stands – squats for your dog. Flexion and extension of the stifle joint activates the quadriceps muscles, stimulating and strengthening them, with the goal of stabilising the patella in its ridge, over time.
Cavaletti – encourage knee flexion and coordination to further strengthen your dogs Quadriceps muscles. Carefully and effectively done, the whole body workout that these exercises offer maintains and even improves range of motion in your dog’s joints (not just their knees) and strengthens globally, which reduces the risk of secondary and compensatory pain and potential injuries.
Balance exercises – low force exercises with great benefit to the stability and activation of the hindlimbs particularly but muscles globally. Small, consistent efforts to stabilise on increasingly unstable surfaces offers improved balance, control and patellar stability.
Fractures
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
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Veterinary Treatments
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Rehabilitation advice
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Neurological Deficit
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Under construction
Veterinary Treatments
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Rehabilitation advice
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Conformation problems & Joint deformities
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Under construction
Veterinary Treatments
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Rehabilitation advice
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Amputations
What is it? How might it treated by a vet? How might it treated by a dog physio?
Pathophysiology/how it happens
Under construction
Veterinary Treatments
Under construction
Rehabilitation advice
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