Hydrotherapy for Surgical Recovery

Underwater treadmills are changing the way physical therapy gets done for dogs.

By Erika Gebhard, DVM, CVA,
Certified Canine Rehabilitation Therapist (CCRT)

A 6-year-old Labrador Retriever had bilateral cranial cruciate ligament complete ruptures within 2 weeks. He was overweight and very high-energy personality making activity restriction and home recovery difficult. Using manual therapy, low-level laser, behavior modification, home exercises and hydrotherapy in underwater treadmill he was able to recover quickly, lose weight and return to full activity level with no visible lameness.

PRESENTATION

Luke a 6 yo male neutered black labrador presented to the NorCal Physical Rehabilitation service 2 weeks after right TPLO surgery. He had come to our surgery service with acute onset RPL lameness and was diagnosed, at that time, with right sided acute on chronic complete cranial cruciate ligament rupture along with a left sided partial cranial cruciate ligament rupture and lumbosacral pain. In addition he was 15% overweight at 45kg and was very high energy.

His left cruciate fully ruptured requiring the second TPLO before formal rehabilitation therapy was started.

EXAMINATION

The challenge Luke brought with him was that he is a very large dog with very high energy and had bilateral stifle surgery. We needed to restrict activity at both of his stifles while keeping him from developing cage rest associated behavior problems or hurting himself. At 100lbs he could not be carried by the owners. In addition he was a behavioral challenge in that he was anxious during any type of handling and would bite when his paws or legs were touched.

TREATMENT

Immediately after the first surgery, on-site rehabilitation started with icing and passive range-of-motion and sling or harness supported walks out to eliminate. At home Luke’s owners continued daily range-of-motion and sling supported walks.

At 2 wks post bilateral TPLO surgeries the surgery sites were healing well and Luke started underwater treadmill therapy. He had bilateral and asymmetrical pelvic limb muscle atrophy and was very reluctant to have his legs touched. In the underwater treadmill he was able to walk with more independence and showed improved active range of motion with normal stepping motion. He returned home tired and was more calm during home activity restriction.

Luke had low-level laser therapy to reduce post-operative pain and relax tight muscles and acupuncture to reduce pain. Manual therapy was used to maintain and improve joint range-of-motion and, along with behavior modification techniques, to desensitize and counter condition him to required handling. Hydrotherapy twice a week in the underwater treadmill was critical for early activity, improving range of motion (1) and strengthening. In water at a depth where weight is taken off the joints(2) we walked him to tire him out, burn calories and build muscle mass in his hind legs. At 100lbs he could not be carried by the owners so a Help-Em-Up Harness was used allowing the owners to walk Luke while supporting both hind legs.

At home the owners started training Luke with hind limb sparing exercises for fitness and mental stimulation. Behavioral modification techniques desensitization and counter-conditioning to handling was initiated immediately and continued throughout his rehabilitation. Exercises progressed from range-of-motion and stretching to weight shifting, strengthening and then gait, posture and transition re-training. As he returned to normal function we worked with Luke on maintaining endurance, overall fitness and body conditioning.

RESULTS

At Luke’s 8 week surgical recheck he had normal joint range-of-motion and correct posture and alignment. He gained symmetrical hind leg musculature, maintained correct sit posture. He has no lameness at any gait and is walking up and down stairs normally. In addition he is comfortable and relaxed during handling and manual therapy.

Using a targeted and personalized approach to physical rehabilitation my goals are efficient return to optimal function while maintaining overall health, reducing stress for owners and avoiding complications. To achieve these goals I use hydrotherapy, low-level laser, e-stim and acupuncture to start targeted strengthening, expend energy, resolve and prevent compensatory problems. Transforming post-operative activity restriction into an opportunity to work on behavior modification, concurrent mobility restrictions and training engages owners in the recovery process.

DISCUSSION:

Our physical rehabilitation service continues to develop and improve our case management. In the past year we have instituted behavioral modification and physical rehabilitation techniques much earlier in the injury-recovery process and ideally techniques are started prior to surgery if possible.

REFERENCES:
1. Monk ML, Preston CA, McGowan CM. 2006, Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res. 67 (3): 529-536
2. Zink CM, Van Dyke JB. Canine Sports Medicine and Rehabilitation. 2013

NOTE: Photos are not of “Luke.”