Canine rehabilitation: Getting orthopedic patients back on their feet

Being familiar with the anatomy of the stifle joint will make it easier to understand what happens to the body after a CCL tear, so let's briefly review the ligaments. The joint is stabilized by the medial and lateral collateral ligaments and the cranial and caudal cruciate ligaments. The collateral ligaments limit the varus and valgus (side-to-side) movement of the stifle. The cruciate ligaments prevent cranial and caudal drawer motion, hyperextension, and internal rotation, and they also help limit varus and valgus motion. Although it's possible to injure any of these ligaments, CCL injury is most common. Some pet owners may opt for nonsurgical management of their dogs' CCL tears. Although this is not the most ideal recommendation for canine patients, it's still an option. However, it's important to discuss realistic goals at length with the owner. These patients may never recover to the same capacity as those that have had surgery, and osteoarthritis within the joint is more likely to progress at an increased rate than it would in patients that have surgery. There is also about a 36 percent chance of a meniscal tear without surgery.1 How much rehabilitation is necessary? There is no cookie-cutter protocol for any condition. Although there may be similarities in how a patient with an acute CCL tear is rehabilitated compared with a patient with chronic osteoarthritis, each patient and owner needs an individualized plan. Many variables, including the owner's schedule and financial means and the patient's degree of lameness, come into play when deciding on a pet's home exercise program, in-house or at-home therapy, and which modalities would be the best fit for the condition. Physical rehabilitation can only be performed correctly once the veterinarian provides a proper diagnosis of the conditions. Registered veterinary technicians must perform any physical rehabilitation under a veterinarian's direct or indirect supervision. Please refer to your state's law to determine what applies to you and your practice. Also, you should always get permission from the attending veterinarian to begin any type of rehabilitation, as there may be underlying circumstances that would prohibit any of the following exercises to be performed.