Deborah Carroll's Blog, page 13

LouDog FHO Almost a Year Ago – Still Lame

Ryan

Submitted on 2014/02/13 at 8:23 pm

My dog had FHO almost a year ago. He was slow to gain muscle tone but everything looks good now. The doctor said to make sure he wasn’t rough housing and not to run for a specified amount of time. On our walks I would go back and forth across the street so he would get a good distribution of inclines (not much is flat near me).

My worry is that the leg he had the surgery on has a slight rotation outward, sometimes as much as a 30 degrees outward. And it makes me cringe when he rotates on it. My question is, is it normal for that to happen, and if not how could I correct it?

Thank you!

P.S. His name is Lou Dog and he is a border collie/lab mix

2/20/14

Hey Ryan

From what you describe, your dog is still compensating for pain by rotating his knee laterally, outward. I suspect he hasn’t yet built up muscle equal to the other thigh either…? If he isn’t using the leg consistently and building up from a very basic plan, only increasing slow walk time by 5 minutes, up to 30 min, (so that would take several weeks), then working on more muscle-building exercise, he won’t be able to build muscle progressively and well and use the leg with less pain.

That may make total sense, or it may seem like a vague answer…depends on how you understand exercise physiology, I think.

Typically we all try to push things faster than they are naturally designed to comply…and people really push the animals because our pets, especially dogs, are eager to make us happy and get about “normal” lives.

So, they end up ahead of themselves with lingering injuries and pain.

It sounds like you did well with basic recovery parameters…when you feel the thighs, are they equal in size? Get behind him and cup your hands loosely over the femur/quads and slide them up and down, from flank to knee. Also, stand and cup your hands, thumbs down, over the hams and slide your hands up and down. Usually the quads develop faster and more equally than the hams.

It really sounds like LouDog could use some pain meds or you could start with ice and vibrational massage prior to each walk to see if that’s enough pain help. Then start back at 2-4×10 min super slow walks daily with no additional running around. To alleviate the pain rotation or the functional deficits, I suggest you start back closer to the beginning so he may achieve success and THEN if/when he gets to a sticking point, a point wherein he is rotating again, you will know what to address…

Hope that makes sense-

POSTED BY REHABDEB | FEBRUARY 20, 2014, 1:14 PM | EDIT

Filed under: Q&A (Make Sure You Click Link to Older Posts Too) Tagged: dog FHO, dog hip surgery lame, dog lame FHO surgery, FHO

Hips – 1 Post

Home-based exercise program improves recovery following rehabilitation for hip fracture

Date:  February 18, 2014Hi

Source:  The JAMA Network Journals (ScienceDaily post)

Summary:

Among patients who had completed standard rehabilitation after hip fracture, the use of a home exercise program that included exercises such as standing from a chair or climbing a step resulted in improved physical function, according to a study. More than 250,000 people in the United States fracture their hip each year, with many experiencing severe long-term consequences. Many of these patients are no longer able to independently complete basic functional tasks that they could perform prior to the fracture, such as walking 1 block or climbing 5 steps 2 years after a fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. This new study addresses this type of cost-effective program.

More than 250,000 people in the United States fracture their hip each year, with many experiencing severe long-term consequences. “Two years after a hip fracture, more than half of men and 39 percent of women are dead or living in a long-term care facility. Many of these patients are no longer able to independently complete basic functional tasks that they could perform prior to the fracture, such as walking 1 block or climbing 5 steps 2 years after a fracture,” according to background information in the article. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established.

Nancy K. Latham, Ph.D., P.T., of Boston University, and colleagues randomized 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture to a home exercise hip rehabilitation program comprising functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months (n = 120); or in-home and telephone-based cardiovascular nutrition education (n = 112).

Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed improvement relative to the control group (n=95) in functional mobility on various measures. In addition, balance significantly improved in the intervention group compared with the control group at 6 months.

“The traditional approach to rehabilitation for hip fracture leaves many patients with long-term functional limitations that could be reduced with extended rehabilitation. However, it is unlikely that additional months of highly supervised rehabilitation can be provided to patients with hip fracture,” the authors write.

“Exercise programs are challenging for people to perform on their own without clear feedback about whether they are performing the exercises accurately and safely and without guidance as to how to change the exercises over time. The findings from our study suggest that [the approach used in this study] could be introduced to patients after completion of traditional physical therapy following hip fracture and may provide a more effective way for these patients to continue to exercise in their own homes. However, future research is needed to explore whether the interventions in this trial can be disseminated in a cost-effective manner in real clinical environments.”

Story Source:

The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.

Journal Reference:

Nancy K. Latham, Bette Ann Harris, Jonathan F. Bean, Timothy Heeren, Christine Goodyear, Stacey Zawacki, Diane M. Heislein, Jabed Mustafa, Poonam Pardasaney, Marie Giorgetti, Nicole Holt, Lori Goehring, Alan M. Jette. Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture. JAMA, 2014; 311 (7): 700 DOI: 10.1001/jama.2014.469

Filed under: RESEARCH CITATIONS (MAKE SURE YOU FOLLOW THE LINK TO "OLDER POSTS" TOO) Tagged: animal therapy hip surgery, dog rehabilitation after hip surgery, hip surgery, rehabilitation after hip surgery

9 yo Lab Mix with CCL Tear, Possibly Both Knees-

Hi Deborah,

First, thank you so much for creating this site – it is so helpful and full of great information — I only wish I lived near you to have the benefit of a visit, but this will do for now! I have ordered your book (treating without surgery) and am eagerly awaiting its arrival so I can read it and implement your plan. In the meantime, I have two questions about Metacam and also depression.

My 9 year old Lab mix, Oso, has been diagnosed on 1/21/14 with a CCL tear on the left stifle (the worst side) and potentially one on the right as well. I do not plan on surgery for the injury as I would prefer to use holistic methods to help him heal. I would like to know your thoughts on Metacam. Since the evening we went to the vet for xRays, Oso has been on 2 50mg Tramadol 2x day and one dose, by weight, of Metacam which I give him after his dinner. He also is taking the high dose of Dasuquin with MSM for large dogs, as well as several Standard Process compounds. My goal is to eliminate pain and swelling as much as I can without putting him in a daze. He is 88 pounds. I keep reading bad things about Metacam side affects…but don’t want to remove it since it is an anti-inflammatory. Our vet agrees and has not set any end-dates to this regimen. I would love your thoughts on the long term use of this drug — and potential alternates that I can discuss with the vet.

Also, what to do about doggie depression? Oso loves to chase birds and squirrels and he has been completely restricted from running by using a temporary fence in the backyard. The last several days I see what I would call depression behavior. Any thoughts on how to avoid that without allowing him to run and play?

Oh and if you prefer to answer these questions via phone, just email me with your rates and possible schedule — I am in Seattle so we have a bit of a time difference.

Thank you again for an awesome resource site!

Marla B

(Deborah’s note: we moved to email to discuss phone consult possibilities)

I realize I didn’t answer one question in the emails we exchanged, and that was about depression.

Yes, I do find that there is what seems to be an element of depression accompanying injury in our companion animals. It’s actually frequently a big issue in human athletes. Two factors effect this status:

Pets read off of the caretaker’s mood, so I spend a bit of time explaining that to clients and encouraging them to not feel and project anything about “poor puppy” to their dog while they are in recovery process. This really does make a difference, and I don’t have more time to give examples right now

Just continually encourage them that they are ok and that you are ok with them the way they are. REally.

The second factor is the way I have designed the workout regimen. The regimen is compliant with the best recovery information available as well as attentive to species differences between humans and companion animals. The sessions are multiple at first, yet short, and they allow for bonding and giving importance to the pet while being productive. I find that caretakers and pets welcome the structure as well as feel like they are doing something beneficial several times a day, and that makes a lot of physical and attitude difference!

Blessings- Deborah

Hi Deborah, 

I read most of the book today and if it was not absolutely pouring rain, we would be going out for a 5 minute walk tonight! 

(Rehabdeb: Keep in mind that most pets and homes will accommodate an indoor 5 and 10 min slow walk for purposes of rehab. I recommend using the harness and making it “official” so they get the idea. Obviously no stopping and sniffing or peeing indoors during these walks, either  )

Are you writing a “long version”?  You mention that several times in this edition.  

(Rehabdeb: No, there aren’t additional weeks written yet, mostly because I’m swamped, because I have several more intro injury booklets to get out first, and because there are some variables I haven’t quite figured out how to overcome and I probably won’t be able to overcome…but I’m working on it. Those variables include people taking animals off of pain meds far too soon, the pet being lame and painful, yet the people press on with the hills or stairs or complicated routines, because they just don’t know and understand the injury and process. I see clients locally after they have read the booklet, and they are “on week 4″, but they haven’t followed most of the instructions, so they really should be fastidiously making sure week 1 is accomplished in all of it’s simplicity. Simply, if the pet isn’t using the leg, and all the caveats to that I cover in the book, it’s not time to progress to week 2 It’s kinda a mystery to me, but I get it, because I didn’t get to know as much as I do without cutting corners and suffering consequences ;) So, I’m still doing remote consults using video viewing and phone for now.)

I feel very good about the process you have outlined and I actually have seen how a bit of exercise (as in 5 minutes) made Oso feel better, mentally and physically. 

That’s great news!

We had snow on Sunday, his favorite thing and he was so bummed already (the depression I mentioned) so I put on his harness and we went out in the snow.  He actually put down his leg for the first time since Jan 20th and tried to use it.  We did that twice and what a wonder – he has been trying more and more to use the leg, or at a minimum, toe touch when eating or drinking water.  And not nearly as bummed out.  So I know your plan will work as we tried it without even knowing the plan (before I read the book).

Great! 

So long story long,  I would like to do the plan as the book describes it and see if that brings up questions as I am guessing it will.  Do you do any morning sessions (since I get up early for work anyway and we have the time difference to work with)?  That way I could take a couple of weeks and let you know when I need a pow-wow and we could schedule a morning.  Or worst comes to worst, sheesh, I can come home early for once!

Yes, we may schedule a morning phone consult  

And yes, if I could help clone you so you could come here, believe me, I would.  I am in no man’s land for holistic pet care.  North of me and east of me, there are more practitioners but around my area, nada!  Our vet is great though – he does acupuncture and Lomi Lomi – Oso has had both.  

Thank you!

Marla B

Keep up the good work!

Filed under: Q&A (Make Sure You Click Link to Older Posts)

11 Month Old Havanese With Grade 3 Luxating Patellas

I have an 11 month old havanese who had surgery to fix a grade 3 luxating patella about 12 days ago. Her recovery has been going well, she’s on rymadyl and clavamox. She began putting weight on the leg immediately when we brought her home. I have followed strict crate rest and pottied her on lead only. Unfortunately she slipped out of her collar last night and ran like a wild child until I could catch her, seemed like forever, probably about 2 minutes. She did not limp then, and is not limping this morning. I am terrified that I ruined the whole surgery. I am being even more careful now, and she has a follow up with the surgeon in 3 days. If she’s not limping, painful or swollen do you think she might be okay?

POSTED BY PAM | JULY 9, 2013, 11:10 AM | 

Hi, Pam-

So sorry it took me so long to reply…I was at a conference and several other things have overwhelmed my time  By now you have (hopefully) gotten one or two rechecks done with the surgeon, and I hope that she is recovering well!

If you are local (Austin, TX area), then I highly recommend we schedule an appointment so I can work with y’all and help you pursue her best recovery. If not, I do strongly recommend you watch the massage video on this site (under videos) and watch it twice in case you miss something…begin doing that method daily for the next 4 weeks.

Also, begin the homework I have posted here: http://rehabilitationandconditioningforanimals.wordpress.com/2011/04/29/patella-luxation-homework-after-surgery-or-instead-of-surgery/

and also read the few notes I’ve written on pain. Here is a link to one:

http://rehabilitationandconditioningforanimals.wordpress.com/2012/02/12/should-my-dog-still-be-limping-after-acl-ccl-surgery/

I believe these bits should help you, and please update me/us here if you’d like!

Blessings-

Deborah

POSTED BY REHABDEB | JULY 28, 2013, 5:52 PM | 

Filed under: Q&A (Make Sure You Click Link to Older Posts) Tagged: dog ruined surgery, Havanese, luxating patella surgery dog

18 Month-Old Lab/Weimer With Dysplasia, Luxating Patellas, Torn CCL/ACL

From Leslie T:

We have an 18 month old lab/weimer shelter rescue. We found out around Thanksgiving that he has hip dysplasia, luxating patellas and on Jan 2, he tore his ACL in his right leg. We’ve been restricting his activity, he’s on meloxicam daily, dasuquin, and I give him Exclusive senior dog food that is very high in glucosamine and chondroitin. We had taken him to a chiropractic vet to check his hips after the initial diagnosis of dysplasia and he agreed with our regular vet that FHO surgery is in Jack’s future, but nothing we need to do right now.(Double hip replacement isn’t in our budget) My question is, is your rehab protocol something that I can do with Jack considering he’s such an ‘orthopedic train wreck’ as my vet described him? We have noticed that Jack’s front left leg is starting to turn in, almost like being pigeon toed, since he tore his ACL. Is this because of the additional strain he’s putting on that leg now? I’ve been impressed with what I’ve found on your website, but I don’t want to do something that could further injure Jack. He’s tentatively scheduled for surgery on 2/17, but we can always reschedule. I hadn’t scheduled it until this week because we were trying to put it off to see if we could work with him at home without surgery. It was going GREAT until he took off in the backyard after a bird. He limps on his back leg and when he’s standing and eating, he will put his tip-toe down. Before he took after the bird, he was beginning to put a little more weight on that leg. He still is very happy-go-lucky and wants to try and run. Other than the limping, he doesn’t appear to be uncomfortable most of the time. We do have tramadol if he seems to be uncomfortable and we have had to give it to him a couple of times. One problem we are running into is that he absolutely REFUSES to go to the bathroom while on a leash. What we had been doing is walking him on his leash out into the backyard and then letting him off. Since his leg was starting to feel better, as soon as we unleashed him, he would run. I don’t know how to stop this. There really isn’t a way to confine him in our yard. We have a pool and when it warms up, I do plan on getting him in the pool. Right now, it’s just WAY too cold for this Texas gal!

Submitted on 2014/02/03 at 5:48 pm | In reply to Leslie T.

Hi!

I’m going to move this conversation to the Q&A section after this response, so go ahead and find it there to respond more

Let’s see…My first thought it that you’re so close to Austin, we should work on getting together! I will come to your vet’s clinic in Houston if we can get together a couple of rehab clients and maybe do a lunch-n-learn with the clinic…but you’d have to set up all that I would charge you for a consult but not for mileage ;O

Ok, some quick answers, and I apologize for taking a while to respond…just busy over here-

*Restricting like you have been doing is great.

*I have over 30 years experience in nutrition and supplements, for performance and for wellness and for chronic disease…and everything in-between. It is my preference that even when feeding a great food people supplement with specific amounts of additional fish oil (specific to EPA and DHA) and a glucosamine/msm/chondroitin/green lipped mussel supplement that is of the higher pharmaceutical quality available.

*I deal mostly with multiple-issue pets, train wrecks :), and very definitely the beginning course for everything you have listed is to start at the very beginning of one of the books I have out. The first four weeks are very much the same for all the issues you have named. The specifics come in the future and depending on lagging parts. Almost everyone thinks they don’t have to start at the very beginning, mostly because they have in mind what they have been already doing with their pet. Almost everyone really does need to start at week one of my protocol. Fact is that most of these pets are not taking enough pain relief for their complicated and compiled issues, and most of them have NOT been made to go very slowly on their sore parts. Slow is essential to get all parts back into the game. Pain meds are essential to help all those sore parts as we get them back on board.

*I will tell you I have successfully rehabbed dogs with the “worst” hips I’ve seen (and I do this a LOT, rehab bad hips, see bad hips) using exercise physiology and progressive sport training program design. These dogs are able to build muscle, pull the femur away from the cup, and not need surgery so long as whatever is needed to maintain their physical improvements is pursued.

*You are correct about the front leg (based on what you said and my experience with the same), and pain meds will help that discomfort and the altered carriage.

*Thank you for the kudos about the website!

*Most conservative recommendations, even those from vets who aren’t as familiar with exercise physiology return-to-function like I am, say to give the dog 6 weeks (as does Slatter’s Veterinary Surgery text) of time, and that without a specific program! In your case, if you get the post-op book, because it has the most info right now, then you’ll be ahead of the game, and if you follow it as exactly as possible, not cutting corners and not assuming that parts don’t pertain to you (start at the beginning, get 2-3 analgesics on board, restrict, do the massages, etc…), then you will be surprised (maybe…hopefully) at the outcome, and you’ll be ready for weeks 5-8. Then maybe we can figure out how to consult together.

*Give him the Tramadol 2-3 times per day (hopefully that’s the script your vet wrote), and if he can stand it, for now also give the nsaid. If he cannot take anti-inflammatory, then see if your vet will script Gabapentin to go with the Tramadol; that’s what we use in Austin to get weight-bearing accomplished if need be. Within a couple of days, I can work with a vet to get the right meds and along with home and leash restriction, take a dog that is 4/4 lame (not using injured leg) and get them to 1-2/4 lame…WITH the RIGHT amount of medication and restriction. THEN we can work on the best productive exercise to build the strength of the muscle and connective tissue.

*So, obviously no more bird chasing and no more off leash in the back yard. I’d say that about 1/3 of my client patients purportedly won’t go potty on the leash…but really I see all but less that 1% of those come around when they aren’t given a choice. They eventually figure out they aren’t going to outlast you, and they will go…it almost always works if you have patience, and in this case, Jack would be much worse off after surgery if you don’t get on top of this behavior, you know? You definitely cannot let him off leash to do whatever he says he wants to do while he’s tricking you if he has surgery. He will also (from the sound of personality) HAVE to wear an E-collar after surgery…I’ve seen some dogs do minimal licking, once or twice, and end up with a raging infection…MUCH worse to deal with than the E-collar

*And definitely don’t use the pool for his conditions until after 12 weeks of my rehab…longer for other protocol. Dogs don’t generally use their hind legs when swimming, and when they do, it’s at an odd angle that adds to the problems in the knee (simple answer). It doesn’t build the muscle we need to stabilize and support the knees and hips. So, the best exercise for Jack will be progressive, land-based, weight-bearing exercise

I think that answers all your questions for now. If you’d like more info, we should email and set up a paid phone consult that I put on the books at a specific appointment time in order to give you better attention for Jack!

Blessings-

Deborah

Filed under: Q&A (Make Sure You Click Link to Older Posts) Tagged: dog ACL surgery, dog CCL surgery, dog torn acl, dog torn CCL, hip dysplasia, luxating patellas, swimming dog

Exercise – 5 Posts

(Also See Research Citations)


Goals of Therapeutic Exercise


Enable ambulation


Release contracted muscles, tendons, and fascia


Mobilize joints


Improve circulation


Improve respiratory capacity


Improve coordination


Reduce rigidity


Improve balance


Promote relaxation


Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC)


Improve exercise performance and functional capacity (endurance)

The last 2 goals mirror an individual’s overall physical fitness, a state characterized by good muscle strength combined with good endurance. No matter which types of exercise may be needed initially and are applied to remedy a patient’s specific condition, the final goal of rehabilitation is to achieve, whenever possible, an optimal level of physical fitness by the end of the treatment regimen.

(taken from Medscape)

Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories
Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, vets seem to be interested in the information when it is presented to them.

Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine

May 6, 2012

How to Recover from Muscle Soreness Caused by Intense Exercise

Muscle soreness should be part of every exercise program.  If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.

You must damage your muscles to make them grow and become stronger.  When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning.  Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.

DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear.  Your body

treats these tears in the same way that it treats all injuries, by a process called inflammation.  Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.

The most beneficial  intense exercise program  is:

* severe enough to cause muscle pain on the next day, and

* usually allows you to recover almost completely within 48 hours.

ACTIVE, NOT PASSIVE, RECOVERY:  When athletes feel soreness in their muscles, they rarely take days off.  Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days.  Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.

TIMING MEALS TO RECOVER FASTER:  You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin.  Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate.  This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours.  The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short  time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids.  The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle.  Waiting to eat for more than an hour after finishing an intense workout delays recovery.

WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt.  You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating

virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables.  If you prefer animal tissue, you can get your protein from fish, poultry,or meat.   Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.

BODY MASSAGE:  Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational

Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.

NSAIDS DELAY DOMS RECOVERY:  Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.

HOT BATHS:  Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006) (RehabDeb’s comment: On the other hand, Epsom Salts Soak/Bath works well for humans and the dogs and cats I’ve encouraged toward that therapy. Of course, this is more than “just” a hot bath…)

COLD OR ICE BATHS:  A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths.  They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.

Water Treadmill is Not Necessary for Rehabilitation

Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of said dogs with ruptured ligaments who are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery for structural remedy, there are relatively very few rehab clinics in the world and fewer still water treadmills.

Dogs of the world do relatively “ok” on all areas of the treatment spectrum and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery, the dog would have to go. Just wanted to clear up that situation.

That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation with approximately 25 years experience in human sport science and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.

I became aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.

Unfortunately, I found that what is not taught within this same model is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.

What does this mean to you and your pet (primarily dogs…)?

The chief complaint I hear from people who contact me is that they were referred to this clinic or that one for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other things, the dog is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious. They aren’t where the owner thought they would be after surgery. When I was in a clinic setting and working on utilising the wtm we had, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realised by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.

HOWEVER, I also find that after very many years of reading many, many reports in sport science and regarding functional return to activity, the best benefit is realised via gravity-based, slow, structured exercise protocol, and I began developing that for small animal rehab since I did not find any published when I arrived on the scene.

Your dog will use their leg to some extent and increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds of cases. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the dog and the owner.

If your dog is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to 1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol); 2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or 3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.

The homework protocol I generically recommend is contained elsewhere in this blog. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.

Thank you!

The Exercise Cure

How can we motivate people to take a free, safe, magic pill?

By Jordan D. Metzl

“Lack of fitness is the public health epidemic of our time,” says Bob Sallis, past president of the American College of Sports Medicine.

If there were a drug that treated and prevented the chronic diseases that afflict Americans and we didn’t give it to everyone, we’d be withholding a magic pill. If this drug was free, in a country that spends more than $350 billion annually on prescription drugs, where the average 80-year-old takes eight medications, we’d be foolish not to encourage this cheaper and safer alternative as first-line treatment. If every doctor in every country around the world didn’t prescribe this drug for every patient, it might almost be considered medical malpractice.

We have that drug today, and it’s safe, free, and readily available.

Exercise has benefits for every body system; it is effective both as a treatment and for prevention of disease. It can improve memory and concentration, lessen sleep disorders, aid heart disease by lowering cholesterol and reducing blood pressure, help sexual problems such as erectile dysfunction, and raise low libido. Exercise does it all. Even with cancer, particularly colon and recurrent breast cancer, the data show clearly that exercise is a deterrent. Newer studies on a glycoprotein called Interleukin 6 suggests that general body inflammation, a factor in almost every chronic disease, is reduced by regular exercise.

Even the most challenging cases of obesity can be helped with the right incentives.

The United States currently spends more than $2.7 trillion, roughly 17 percent of GDP, on a health care system that is financially incentivized to treat disease. The more tests that are run on patients, the more medicines that are dispensed, the more procedures that are performed, the greater the financial burden for us all. Despite far outspending any country in health care, the United States is currently ranked 28th in life expectancy. Our current system does very little to encourage preventive health care. We are mortgaging our country’s financial future to pay for increasingly expensive treatments for the same diseases we could effectively delay or prevent.

Professionally and personally, I have made dispensing the drug of exercise a large part of my life. I treat limping and hobbled athletes of all ages in my sports medicine practice at the Hospital for Special Surgery in New York City. My waiting room is filled with 8-year-old gymnasts to 80-year-old marathoners, all wanting one thing: movement. My job is to fix their aches and pains and to keep them going. Before and after work, I am one of them, an avid athlete who has run 30 marathons and 11 Ironman triathlons. I’m what you might call an exercise fanatic.

There probably is such a thing as too much exercise, but I’m much more worried about inactivity. As my colleague Bob Sallis, past president of the American College of Sports Medicine, says, “Lack of fitness is the public health epidemic of our time.”

Seventy percent of Americans are overweight, 30 percent are obese, and only a very small fraction exercise for the 150 minutes per week recommended by the American Heart Association. What can we do to motivate them?

In a recent study, Kevin Volpp from the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania took 56 morbidly obese, middle-aged, male participants and studied systems to incentivize weight loss. In the world of obesity, morbidly obese men are tough customers; it’s very difficult to get them to change their behavior patterns. Obesity and related conditions and diseases, including high blood pressure, diabetes, and high cholesterol, account for more than 50 percent of annual health costs in the United States. Solving the obesity epidemic is the key to reducing health care costs.

Volpp randomly divided subjects into three groups: a control group and two financially incentivized groups, in a study in which the goal was to achieve a 16-pound weight loss over 16 weeks. The control group was weighed at regular weekly intervals with no financial reward. One financially incentivized group was given a fixed sum of money weekly that they could win if they hit their target weight-loss goal per week, and the other group was enrolled in a lottery system in which they had the chance of winning smaller or larger amounts of money but could qualify for payment only if they hit their weekly weight goals. Subjects from all three groups were educated on the role of exercise and nutrition for weight loss at the beginning of the study. After 16 weeks, both the fixed payment and lottery system subjects had lost more than 16 pounds while the control group had not. The financial incentive was relatively small, averaging $350 in total payments over 16 weeks. This isn’t a long-term solution: Four months after the study’s completion, most subjects had returned to their prestudy weight. But it shows that even the most challenging cases of obesity can be helped with the right incentives.

In the United States, we routinely incentivize behaviors deemed conducive to a highly functioning society. Financial incentives encourage marriage, having children, owning property, even accruing debt. As much as we believe we are free to choose, Big Brother’s tax code is pulling our strings from above. I’m not arguing that this is poor policy. On the contrary, encouraging favorable behavior for the greater good helps keep the fabric of our society together and the wheels of our economy turning.

When I began writing The Exercise Cure, my thought was to provide a guidebook to encourage healthy behavior. Having investigated the correlation between disease and fitness, I now believe that we can save billions of health care dollars by incentivizing movement. Rather than mortgage our financial future on a bloated health care system that isn’t doing a very good job of making us healthy, we’d be much better served by incentivizing people to get off the couch. Ideas to make this happen include lowering health care premiums based on activity levels: The more steps you take per month or year, the less you pay. This doesn’t have to be large amounts of money—even a little bit of incentive goes a long way. We also should encourage the use of a fitness vital sign for annual medical checkups where the amount of physical activity that someone is doing per week is monitored in the same way heart rate and blood pressure are. These methods will help encourage movement and health and will reduce disease prevalence.

I can’t promise you that if you work out daily you won’t get sick. I’m also not suggesting that exercise cures all ills. Genetics, chance, socio-economic, and other factors clearly play significant roles in affecting health profiles. What is becoming increasingly apparent, however, is that the drug called exercise can help prevent, alleviate, or treat almost every disease state. I hope my book inspires you to take it for yourself.

Jordan D. Metzl, MD, is a sports medicine physician at the Hospital for Special Surgery in New York. His newest book is The Exercise Cure. Follow him on Twitter.

Anecdotal Progress

Exercise is thought to have beneficial effects on Parkinson’s disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.

“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”

The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.

I am one person working alone, however I have over 30 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are a few others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.

I don’t have money to drive clinical research, and while I have ideas of those whom I could approach to get involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.

It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.

In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.

Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.

Blessings-

Filed under: HOMEWORK SUGGESTIONS FOR FUNCTIONAL REHAB, QUALITY OF LIFE Tagged: exercise homework for animal rehab, exercise is healing, quality of life, water treadmill animal rehab

Neurological and Paralysis – 9 Posts

FCE Rehab for Yiqqyir the Shepherd Mix

“Y” had an FCE (fibrocartilaginous embolism) and has regained almost “normal” function in her left hind leg while her right is dragging and lagging This is our first meeting, and Y is doing much better than it sounded like she might be doing when we were exchanging emails! She was not knuckling (bending over her paw and dragging or walking on the top) during our visit when she was made to go very slowly. I began her on a basic endurance and foundation strength-building walking program. Some of our discussion is in the video, and hopefully it begins to answer some questions you may have.

Update: Y’s caretaker emailed this to me shortly after our visit:

“Have been working out with Yiqqiyr as directed. She is doing FABULOUSLY!”

“Friday after I went home from seeing you, we did a walk and two massage sessions. Saturday we walked 3×15 min and did 3 massage sessions. Sunday was the same. Monday I was off work at the office for the holiday, so we were able to keep the same schedule.”

By the way, my videographer has a dog that had similar problems after back surgery years ago, and he has done great! His rehab went well, family followed instructions, including restrictions, and years later he is going strong and able to play rugby with his kray-kray sister dog

There are MANY conditions that can lead to an animal dragging the hind feet, and the number one cause I see is protruding disks. If your pet is not paralyzed, you DO need to see a vet and work on getting a diagnosis. The treatments are different for the different causes of nerve damage. If your pet IS paralyzed, the sooner you get to the vet, the better. In my area complete lack of limb use gets you an appointment with a surgery specialist. Mild to moderate nerve issues may be dealt with using appropriate drugs and restrictions, depending on the diagnosis.

Blessings-

Degenerative Myelopathy and Neuro Conditions

Question from the vet pain assn. board:

Does anyone have any recommendations regarding treatments for a 14 year old Husky with Degenerative Myelopathy? So far, the only thought I have is a cart. Also, my understanding is these animals are not in significant pain – is this true? Thanks for any info.

My Response:

Hi!

I apologize for taking so long to reply. I have a 30-yr. background in human sport science and nutrition, worked two years in a veterinary specialty hospital designing and building the rehab dept., and since 2007 have had a mobile practice wherein I serve a huge number of “mystery-ortho-neuro” cases, many of which are presumed to be D.M.

The protocol I have developed over time, and which has been successful at improving function to varying, but notable, degrees is derived predominately from my long-time experience in sport science program design. A body at rest stays at rest and only changes with dynamic interference…

Pain management discussion aside (and I DO agree that while D.M. may not produce pain in and of itself, it is highly likely that an animal with any neuro condition has self-induced pain by nature of the fact that they are compensating, stressing tissues, and possibly pinching nerves, akin to when our sciatica or sub-scapular, etc…get impinged and cause us pain), I introduce a system of simple, vibration-based, massage with a $4.99 Homedics unit (see the video elsewhere in this blog), Low-Level Laser Therapy (MUCH research exists regarding nerve conduction, regeneration, re-invigoration), and a plan of return to whatever level of function is possible via primarily-animal-induced movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. Strength and endurance/conditioning drills I concoct depending on each animals status are implemented. I begin with laser twice a week for a month and review exercise protocol that the owner is charged with doing if they are capable and which I do if the owner prefers. I use a front harness designed for riding in the car that has fleece and the best stitching I have found and only costs $30 shipped from Petsmart. This is the Travelin’ Dog harness. I turn it around, and it is “perfect” for hind end support (legs through arm holes, tail through neck hole) while relieving owner back stress, if used properly. It is much better designed for the body than the blue neoprene sling, less pressure on the abdomen than a belly sling, and less problematic than a Bottoms-Up sling. No one pays me to promote these items; I have just found that they are simply the best and cheap, and in my years of experience I deem that they work better than a lot of what is out there. I have pics of neuro dogs wearing these harnesses around this blog.

There are many more things that may be done, however getting the owner started on helping the animal around the home in a manner that hurts neither owner nor animal, and in a manner that is most productive time-wise, is one of the major components of my mobile practice. I tend to not involve owners in activities that, again, would potentially cause more harm than good or waste more time than be productive.

I also utilise Ruff Wear boots, usually sometime along the way, for dogs, depending on function-ability, to encourage hind limb use and stability in the home on tile and wood floors. I have contacted the company twice to positively discuss their product and have never heard back from them, nonetheless, they have a product that provides great traction and encourages increased mobility.

OH! And on several elderly canine patients I have used epsom salts baths to great benefit.  Owners HAVE to ensure they rinse off all the salt residue after the bath, otherwise if the dog licks it, which they usually will, diarrhea will likely ensue.

I am in a hurry to get to a dog event today and have been intending to respond to this mail and to the mail regarding laser therapy for quite some time. Only have time for this right now, and while it is definitely not all-inclusive, I trust it is a help.

Blessings to All, and I much enjoy and forward many of the informative posts to vet and pharmacist friends. I have been through surgeries and injuries and I am also a patient advocate and navigator for humans, especially for cancer, so I have paid much attention to pain management for many years. Thank you, thank you for your progressive and beneficial attitudes and approaches!

Deborah Carroll

(from a note posted to the IVAPM, veterinary pain management forum)

My Dog is Just Old…

Quite frequently I hear this comment from clients and even from people active in the practice of animal health and science.  I provide a mobile rehabilitation and conditioning service to encourage better recovery after surgery or otherwise improve quality of life through functional rehabilitation. Roughly 80% of my client base is elderly dogs, usually with orthopedic and/or neuro issues.  Following are some short comments on beneficial treatments for aging pets:….Any fitness/rehabilitation/conditioning/bodywork program should be collaborated with your pets regular veterinarian, i.e., they should be in the loop. This may be accomplished by having your veterinarian refer you to me or by my contacting the vet after you have contacted me should you desire to work hands-on with me as a rehabilitation and conditioning specialist.  Dachshunds flying off couches is not the same as plyometrics training, and many owners may not know the risks or benefits to either activity!  So make sure to include your primary care veterinarian in your plans to have additional therapies practiced on your pets…..

In addition to #1, pain control, and #2, functional (possibly assisted) exercise protocol:

Massage is a common therapy that almost anyone can use beneficially to encourage circulation and subsequently possibly encourage healing.  Many owners may take a stab at performing massage, but instruction from me is always best to start.  Different massage techniques accomplish different results, and hands-on massage is not even recommended in some cases! Otherwise, I have found great benefit in using the little AAA battery-operated massagers produced by the Homedics company.  My favorite ones cost $5.99, have four balled feet, and the spread of the feet is usually just right to straddle the spine of different animals.  These little massagers have a great vibration frequency and anecdotal evidence proves that their use is extremely beneficial. I ran across them in a store about 5 yrs. ago, and based on reading years of research regarding vibrations and circulation, etc…I decided to give it a try. At the least, this massager will increase circulation and the animal will hopefully enjoy it. Cat owners are using it too!

I recommend beginning by slowly using the massager from neck to tail without it turned on, travelling the spine one direction, again, slowly.  After a couple of passes, turn on the massager and do the same movement as when it was off.  I like to divide the body into 5 minute sections, beginning with the department giving the most discomfort, i.e. mid-spine to tail base, then neck to mid-spine, right thigh, right shoulder, left thigh, left shoulder.  If your pet has hip problems, start with the thighs then do the spine then the shoulders, etc…The idea is that doing this form of massage on the whole dog could take 30 min. in one sitting, but if you only have time for 10 minutes’ worth, then do the most important parts first.  It is all complimentary and helpful; an animal with hip problems is taking more stress on his front end, and one with elbow problems is straining the neck, spine, and other parts of the body in compensation, so hopefully you get the idea. 

Passive range of motion (PROM) should usually be performed and instructed to owners by an experienced practitioner.  Some owners I have counseled have come away from surgery discharge having been told to perform massage or PROM, yet the owner actually does not know what this means or how to perform it so that the animal is not injured.  A referral to a rehab practitioner to judge protocol and beneficial movements would be great for owners in these cases.  Joint mobilization should only be performed by an experienced practitioner.  PROM is not usually necessary if the pet is moving on their own, and other physical activities will be a better use of owners time.  If your dog is moving and flexing & extending his knee after surgery, very likely his joints are staying mobile and you need not bug him by making him endure your “bicycling” his knee.  Other drills and exercises will bring about improved use and recovery of the knee, and you subsequently have less opportunity to hurt him (or you) if you are not trying to manipulate him. Animals do not have the same hesitancy to use their offended joints as humans do, and the PROM is largely unnecessary unless the animal has nerve damage and cannot move the limbs, THEN PROM is indicated.

Controlled, specific swimming in warm water can be beneficial for the improvement of muscle tone, fitness and strength, especially if an animal is too sore in their joints to walk well for just basic fitness.  Swimming for conditioning or therapy should be done in a controlled manner with the use of a dog life jacket and in short, steady bouts while better fitness is achieved.  Just because a 15-year-old dog “likes to swim” does not mean he/she should go at it for 15 minutes straight the first or even the fifth time.  I carry a full set of life jackets in my mobile practice should an owner possess facilities for swimming at home.  In some environments, a regular harness may be used instead of a life jacket. Small dogs with short legs, like Dachshunds, may be swum in many home tubs.  ….I find that outside the home environment, elderly animals (and many of other ages as well) are usually not happy to be in a swim tank in a foreign environment.  I worked with a water tank/treadmill during the first years of my practice and determined that I would not miss it one bit in mobile practice.  Elderly animals are often slightly confused and seem to want to do things in the comfort of their accustomed environment.  In addition to incalculable fear levels when trying to use a facility-based water tank for therapy, this fear often induces nervous diarrhea in the water and the fear is potential cause for new injury.  Travel to and from a facility can produce unnecessary stresses on both owner and animal.  Therefore, I have come up with a variety of exercises and slings to assist elderly animals while they learn to return to better function on land…..

Epsom salt baths have been very beneficial for my elderly patients whose owners have tried them.  Your pet may have health conditions making these baths prohibitive, so check with me or your veterinarian.  Make sure to rinse off all the residue after the bath, otherwise when your pet licks off the residue, diarrhea will likely ensue…(magnesium).

Many machine modalities may be used in the practice of rehabilitation.  I consider low-level laser therapy to be the most complementary and productive machine modality I utilize in my practice.  Laser therapy has immense benefits which I will not attempt to cover here.  A wonderful website to peruse is Thorlaser.com, and much information regarding laser therapy may be found there.

Ultrasound therapy on arthritic or sore joints and muscles has been proven to be beneficial.  I also utilize this therapy in my practice and have had very positive owner feedback with regard to improved function in their animals.  Much research information, including evidence-based research, is available on the web regarding these modalities…..People often ask me about using heating pads on their dogs; the use of heat depends on the nature of the injury or disease process.  A combination of ice/heat/ice is often more therapeutic or the use of moist heat or brown rice in a sock heated in the microwave are usually preferential heat application options, but moist is good for some things while dry heat is for others.  When in doubt, use ice.  Instructions for the use of ice and heat may be found on my websites.

Chiropractic interventions are the choice of some and in my opinion should be combined with other therapies, especially massage, and should be administered by vets who have studied chiropractic or by chiropractors who have studied animal chiropractic—especially with regard to spinal issues—and are working in conjunction with the vet.

Acupuncture intervention has been proved to be beneficial as well and especially for pain control.  There are several vets in the Austin area who practice acupuncture.

Diet:  There are commonly-recommended neutraceuticals for elderly and injured dogs as well as for young dogs that have genetic or early-onset of disease process in their joints.  Younger sporting dogs should benefit from these as well.  Animals, like people, are not always being fed an optimal diet, so the receipt of quality nutrition from feeding varies, and the supplementation of neutraceuticals is often warranted.  It is my preference, based on 30+ years’ experience, well-performed and founded research, and successful nutritional healing protocol, to encourage my patients toward a grain-free diet.  The research is out there, and I will not attempt to summarize is here.  Among commonly-used and readily-available supplements in this catagory are Glucosamine Hydrochloride with Chondroitin Sulfate (synergistic benefit), MSM (additional synergistic benefit), SAMe (joint, liver, tissue, brain, pain), and Omega 3 fatty acids, preferably in the form of fish oil.  Oil-based supplements included in animal food are chemically altered during the production process to the point of diminishing their efficacy and/or they soon become rancid when the bag is opened.  Omega 3 fatty acid chains are very fragile and research shows use of the capsule form is best. Additional options are digestive enzymes, probiotics, vitamin C, B vitamins & L-Glutamine, to name a few.

Bed: Bedding DOES make a difference. If your old dog/cat is still trying to jump onto your bed, I recommend you either stop them and provide an eggcrate bed nearby or get them started using stairs or a ramp up to the bed (and into the car, too…). Infrared bedding is nice (expensive), and solid research proves benefits. I have a Great Dane, and she has the chaise end of a couch, a Papasan Chair cushion, and two egg crate foam beds (in different rooms).

Elevate Food and Water: this reduces strain on elbows and neck. I put my Great Dane’s kibble in a Rubbermaid container that stands about 18″ high. Many varieties of elevated stands are available from stores and many homemade ideas about on the net. Definitely makes a beneficial difference.

There are definitely more ideas to be shared, and you are welcome to make note of some in the comments section. Pain control and exercise are key to keep your pet moving and healthy. I have a 10.5 year old Great Dane, Grace, as of this writing (Aug. 4, 2011), and she has had many severe orthopedic and some neurological issues, as well as several systemic internal issues. She appears as though she is 3 years old to most people. She does okay…:)

Homework Exercise Review for Elderly Sheepdog with Hind-End Neurological Problems

Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.

Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I reevaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains.

I can’t emphasise enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:
http://rehabilitationandconditioningforanimals.wordpress.com/category/videos/
And do it as best possible without cutting corners. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realised from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.

For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.

For the following week, please walk her 2×20 minutes in the same manner, if the 15 minute walks are completed well. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not after complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt and accomplish.

I really would like her to wear two supportive hard braces during these walks, and I realise you have only one. She hyper-extends her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. (Orthovet Splint) Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and defecits.

After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my rehab FB site that depict a trained sporting dog doing cavalettis using an extension ladder. I have a video on this site of a cat with neuro problems using a lineup of remote controls across a bar top. I have a pic on my FB site of another older dog using obstacles in the back yard. When time allows, I will attach some of those pictures to this post.

Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.

After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.

During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month.

I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.

Thanks!
Blessings-
Deborah


Fighting Foot Drop

From Advance Journal for Human Physical Therapy

My (RehabDeb) Comment:

“Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.”

Employing these techniques in animal-other-than-human rehab is what I do and is highly successful here, as well–proprioceptive training that can also build nerve strength . For dogs and cats, I utilize Orthovet footbed splints and Thera-Paws Dorsi-Flex Assist boots on a case-by-case basis.

The Foot Drop Fight

Early treatment and compliance with a home exercise program are essential.

By Rebecca Mayer Knutsen

Posted on: December 20, 2012

Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.

A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.

Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.

Gaining Control

The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.

“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.

Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.

“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?”

Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. “If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared.

According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.

“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”

“We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.”

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Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.

“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.

The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.

Enter the AFO

If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.

The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.

“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”

Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.

The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”

In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.

Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.

The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.

Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.

“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”

The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements. “If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and a passive AFO system will have to be used,” Thomas shared.

If the patient’s spinal cord has been interrupted in any way, then retraining the muscles would be a very difficult-and maybe even impossible-endeavor.

An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments that interfere with operation of a foot drop system.

Complying at Home

For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, however, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”

Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and I go through the exercises the first day and then send them home with illustrations. I say I will quiz them during the beginning of the next session and will ask them to demonstrate the exercises I assigned.”

With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”

When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”

Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier. “There was a lot less I could do for her compared with what I could have done right after her stroke,” he said. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”

Rebecca Mayer Knutsen is senior regional editor of ADVANCE and can be reached atrmayer@advanceweb.com.

Simple Massage Video Uploaded to YouTube

Water Treadmill is Not Necessary for Rehabilitation

Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of said dogs with ruptured ligaments who are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery for structural remedy, there are relatively very few rehab clinics in the world and fewer still water treadmills.

Dogs of the world do relatively “ok” on all areas of the treatment spectrum and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery, the dog would have to go. Just wanted to clear up that situation.

That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation with approximately 25 years experience in human sport science and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.

I became aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.

Unfortunately, I found that what is not taught within this same model is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.

What does this mean to you and your pet (primarily dogs…)?

The chief complaint I hear from people who contact me is that they were referred to this clinic or that one for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other things, the dog is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious. They aren’t where the owner thought they would be after surgery. When I was in a clinic setting and working on utilising the wtm we had, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realised by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.

HOWEVER, I also find that after very many years of reading many, many reports in sport science and regarding functional return to activity, the best benefit is realised via gravity-based, slow, structured exercise protocol, and I began developing that for small animal rehab since I did not find any published when I arrived on the scene.

Your dog will use their leg to some extent and increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds of cases. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the dog and the owner.

If your dog is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to 1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol); 2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or 3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.

The homework protocol I generically recommend is contained elsewhere in this blog. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.

Thank you!

Kacey Cat Does Cavaletti Work

http://youtu.be/IqwFemytxzs       (CLICK HERE)

Kacey has neurological problems in her hind end. I have been performing laser therapy on her and working on finding exercises that will benefit her quality of life. The owner and I discovered during one visit that she would walk one direction across a particular section of bar top to get to some place her kitty brain holds special…so special that she will repeat this action many times.

I placed 5-6 remotes across the bar top, and Kacey is to make 5-6 passes over all of them, every other day, doing it all at one time.

She has improved much around the home, and we made some other exercises work for her too.

She is working on losing some of her “extra”.

Click on the link above to view the video.

Anecdotal Progress

Exercise is thought to have beneficial effects on Parkinson’s disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.

“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”

The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.

I am one person working alone, however I have over 30 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are a few others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.

I don’t have money to drive clinical research, and while I have ideas of those whom I could approach to get involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.

It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.

In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.

Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.

Blessings-

Filed under: HOMEWORK SUGGESTIONS FOR FUNCTIONAL REHAB Tagged: ankles, dog muscle building, dog rehab, hind end weakness, hips, hyperextended tarsal joint, neuro-muscular strength, neuro-muscular weakness, neurological, spine, weak legs

FCE Rehab for Yiqqyir the Shepherd Mix

 

“Y” had an FCE (fibrocartilaginous embolism) and has regained almost “normal” function in her left hind leg while her right is dragging and lagging This is our first meeting, and Y is doing much better than it sounded like she might be doing when we were exchanging emails! She was not knuckling (bending over her paw and dragging or walking on the top) during our visit when she was made to go very slowly. I began her on a basic endurance and foundation strength-building walking program. Some of our discussion is in the video, and hopefully it begins to answer some questions you may have.

Update: Y’s caretaker emailed this to me shortly after our visit:

“Have been working out with Yiqqiyr as directed. She is doing FABULOUSLY!”

“Friday after I went home from seeing you, we did a walk and two massage sessions. Saturday we walked 3×15 min and did 3 massage sessions. Sunday was the same. Monday I was off work at the office for the holiday, so we were able to keep the same schedule.”

By the way, my videographer has a dog that had similar problems after back surgery years ago, and he has done great! His rehab went well, family followed instructions, including restrictions, and years later he is going strong and able to play rugby with his kray-kray sister dog

There are MANY conditions that can lead to an animal dragging the hind feet, and the number one cause I see is protruding disks. If your pet is not paralyzed, you DO need to see a vet and work on getting a diagnosis. The treatments are different for the different causes of nerve damage. If your pet IS paralyzed, the sooner you get to the vet, the better. In my area complete lack of limb use gets you an appointment with a surgery specialist. Mild to moderate nerve issues may be dealt with using appropriate drugs and restrictions, depending on the diagnosis.

Blessings-

Filed under: VIDEOS Tagged: animal rehab neuro conditions, dog dragging leg, FCE dog rehabilitation, fibrocartilaginous embolism, nerve damage, rehabilitation therapy for dog nerve damage

Gracey Goldendoodle Torn CCL / ACL

Here is the link to my booklet, Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament

Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition (Volume 1): Deborah Carroll CCRP CSCS: 9780615900476: Amazon.com: Books

Simple Massage Video Uploaded to YouTube

Simple Massage Video Uploaded to YouTube

Filed under: VIDEOS Tagged: circulation, massage, massage for my dog, my dog hurt his back, my dog is injured