PHYSICAL THERAPY REGIME

This is an expert of the physical therapy booklet for Harley's rehab, that I was sent home with. It's published by TopDog Home Therapy Program.

HOMECOMING
THE HOUSE
It is important to have a plan on how and where you are going to restrict or confine your dog during this crucial post-operative period. Quality rest is as important as having a good therapy plan. Many owners incorporate one of the following:
Dog Crate
Gated off Area
Room confinement

NO JUMPING
It is EXTREMELY important not to allow your dog to jump, AT ALL! Over extension of the stifle could compromise the repair
NO JUMPING on/off bed/couch/on you!

NO STAIRS
Stairs, like jumping will overstress the joint and inhibit repair. In the beginning stages, right after surgery, it is imperative that you do what you can to prevent your pet from going up or down stairs.

NO HORSING AROUND
As much as you would like top lay with your dog this is not a good idea.

WALKING SURFACES
Wood floors, tile, linoleum etc can all be very slippery t your pet. Consider putting down some throw rugs with rubber backing to make things easier on your dog.


HOME THERAPY PROGRAM
WEEK BY WEEK PROTOCOL
The following weekly protocol has many benefits. It’s important to follow these guidelines as closely as possible in order to:
Speed recovery
Decrease pain and enhance healing
Prevent further disuse muscle atrophy
Restore normal range of motion
Decrease possibility of further compensatory problems

During all times outside of therapy, STRICT CONFINEMENT IS MANDATORY. It is extremely important to follow this protocol as closely as possible to ensure recovery. Any form of rambunctious activity is PROHIBITED during this critical recovery period.

PERFORM ALL THERAPIES IN THE ORDER DESCRIBED


WEEK 1
1. MASSAGE (5-10 min) (3-4 times a day)
This is best done with your pet lying on his or her side. Start by gently rubbing the affected limb from toes up the leg. If you pet is reluctant to have this done, try using less pressure or try again later.
2. PASSIVE RANGE OF MOTION (PROM) (10 repetitions)( 3-4 times a day)
The goal of PROM is to manually simulate the normal motions of each joint. This is best done after massage and with your pet laying on his side. Starting with the hip, gently extend and flex. Continue on to the knee and ankle. Be sure to support the leg carefully with your other hand while performing these movements. Do not force PROM. If your pet seems uncomfortable, stop and try again later.
3. SHORT AND CONTROLLED LEASH WALKS (5 Min)(3-4 times/day)
These walks should really be for elimination purposes only at first. The slower your dog walks, the more likely they will place the repaired leg down while walking. If needed, use a support harness or towel under the belly to support your dogs hind end.
4. ICE THERAPY (10-15 min, after exercise)
following the above therapy exercises, it is important to apply cold therapy to the affected knee. You can use commercial gel ice packs or even frozen vegetables. For most ice packs, wrap them in a towel or bad before applying.

3 days after surgery you can begin applying MOIST HEAT prior to your therapy session with your dog. DO NOT do this prior to 3 days post op if the swelling around the joint is still significant.


WEEK 2

1. MOIST HEAT (10 Min Prior to exercise)
For this therapy, a commercial moist heat product is advised. Moist heat has been shown to penetrate tissue better then dry heat. Types of moist heat are available in most drug stores. Another way to provide moist heat is to take a wash cloth and wet it with hot water. The heat should be warm enough to touch, but not so hot that it burns you when you are applying it to your dogs joint.
2. MASSAGE (10 MIN)(3-4 TIMES/DAY)
3. PROM (15 REPS)(3-4 TIMES/DAY)
4. SHORT AND CONTROLLED LEASH WALKS (5-10MIN)(3-4 TIMES/DAY)


WEEK 3

1. MOIST HEAT (10 Min Prior to exercise)
2. MASSAGE (10 MIN)(2-3 TIMES/DAY)
3. PROM (AS NEEDED)
4. SHORT AND CONTROLLED LEASH WALKS (15-20MIN)(3-4 TIMES/DAY)
5. SIT TO STAND EXERCISES (5-7 REPS) (3-4 TIMES/DAY)
We call these puppy squats. Basically, you want to get your dog to sit down and immediately stand back up. This encourages extension/flexion of all joints in the rear legs and also works the muscles surrounding his stifle. Do this at a time when your dog is most likely to oblige, like when it is feeding time. If you have to use treats to get your dog to do this, make sure they are low fat.
6. DISCONTINUE POST THERAPY ICING as long as there is no apparent discomfort.

WEEK 4

1. MOIST HEAT (10 Min Prior to exercise) This does not need to be done 3-4 times/day anymore. If your dog seems to enjoy the heat, go ahead and apply it 1-2 times/day.
2. MASSAGE as needed
3. PROM (AS NEEDED)
4. SHORT AND CONTROLLED LEASH WALKS (20+MIN)(3-4 TIMES/DAY)
5. SIT TO STAND EXERCISES (10 REPS) (3-4 TIMES/DAY)
6. Figure 8’s (10 Reps) (3-4 times/day)
To perform figure 8’s, simply walk as if you are following an imaginary 8 drawn onto the ground. The top of the 8 is one circle and the bottom of the 8 is another circle that intersects in the middle. Each top and bottom portion of the 8 should be equal to about a 10 meter circle. If your dog has difficulty balancing this 8, make it bigger. The purpose of the Figure *’s is to increase muscle strength and encourage balance.

WARNING: If you notice any signs of lameness or discomfort while increasing any of the mentioned exercises, revert to the previous week’s level of activity. For example, during week three you notice that your dog becomes very tired after walking for 20 minutes, then return to walking for only 10-15 minutes, until your dog is able to tolerate this level of activity for a few days, then slowly increase time.

WEEKS 5-8

1. DISCONTINUE MOIST HEAT; PROM AND MASSAGE, as long as your dog is consistently using his limb.
2. CONTROLLED LEASH WALKS WITH HILL WORK (20-30 min with 5-10 min hill)(3-4 times/day with hills 1-2 times/day)
Find an incline that is suitable for your dog to walk up and down. While on your daily walks, slowly walk your dog up and down this incline. Begin with about 5 minutes of hill work and slowly increase to 10 minutes after a few days. Hills are great for the quads and hamstrings, which help support the knee.
3. SIT TO STAND EXERCISES (10-15 REPS) (3-4 TIMES/DAY)
4. Figure 8’s (10-20 Reps) (3-4 times/day)
5. CURB WORK (10-20 feet)(3-4 times/day on walks)
Curb work is basically stepping up and off a length of curb while on your walk with your dog. The curb should be appropriate for your dogs height. Any surface that has some height can be used for this purpose. It does not have to be a curb, but you do need a length of about 20 feet. While on your walk, simply step up and off the curb for a length of 10-20 feet, making an “S” pattern, as you walk on and off the curb. Curb work is great to increase muscle strength, girth, and balance, as well as improve flexion and extension. Go at a pace that is comfortable for your pet. If your dog seems to have any difficulty with this exercise, do not perform it at this time.


WEEKS 8-12
NOTE You are now nearing the end of total recovery, these next few weeks are the strengthening period. These exercises can be used a guideline for your to challenge your dog in a variety of ways, while regaining lost strength and muscle.

1. STAIR WORK(5-7 steps in a row)(1-3 times/day)
At this stage, you can begin to incorporate stairs as a form if exercise. Start with your dog on a leash and if needed, a towel under the belly to support him. Walk slowly up about 3 stairs to start and then slowly back down. Increase the number of stairs and the frequency of the stairs each week. DO NOT give your dog free access to stairs yet, it is still too early.
2. SUPERVISED, OFF LEASH OR LONG LEASH WALKS
3. CONTROLLED LEASH WALKS WITH HILL WORK (30 MIN TOTAL, WITH 1O MIN ON HILLS)(3-4 TIMES/DAY)
4. SIT TO STAND EXERCISES (10-15 REPS) (3-4 TIMES/DAY)
5. Figure 8’s (20 Reps) (3-4 times/day)
6. CURB WORK (20 feet)(3-4 times/day on walks)
7. JOGGING (intervals of 20 feet)(3-4 times/day)
If possible, while on walks, get your dog to jog for a length of only 20 feet and then stop. Jogging increases muscle strength and girth.
8. SWIMMING (5-10 min)(1-2 times/week)
Swimming can be performed as long as your vet approves. It is best done in a controlled environment, preferably in a pool and under direct supervision. Your dog should be lifted into and out of the body of water and held in place or allowed to swim with assistance for about 2-5 minutes. Your dog should not be allowed to jump into or out of the water to swim. Swimming is great for increasing muscle and range of motion. Your local canine rehab facility is a great place to perform this exercise.


CRYOTHERAPY=ICING
Cryotherapy, the use of cold in healing, is the most underutilized therapy in vet medicine today. If you were to have knee surgery, you would leave the OR with your leg immobilized in an inflatable icing unit and then you would undergo aggressive icing thereafter. It should not be any different for your dog. Cryotherapy is extremely important for the 1st 72 hours after surgery. It is almost important after an acute injury or strenuous exercise. It works by stimulating constriction of the blood vessels, thereby slowing circulation to the injured are and preventing many of the bad inflammatory mediators from harming tissue. The cold also slows nerve conduction velocity as well, decreasing localized swelling.


HOW TO’S:
Any of the following can be used: commercial cold gel packs, ice wrapped in cloth, or a bag of frozen peas. When icing, it is best to perform while your dog is lying on it’s side, relaxed. Place the cold source directly over or around the affected area. If your dog reacts to the direct application, try laying a towel between the cold source and the skin. Each icing session should lat 10 minutes.


MOIST HEAT THERAPY
WARNING: Before applying heat to your dog, test the surface temperature of the heating unit to your own skin and hold for 20 seconds. If it does not burn you, it should not burn your dog.

Moist heating is the 2nd most underutilized therapeutic modality in vet medicine. Moist heat is recommended versus dry heat due to the fact that the moisture allows the heat to penetrate deeper into tissue. Heat therapy is NOT to be used until at least 72 hours post surgery. It is contraindicated during any acute inflammatory process, over open woulds, edema or cancerous tissues.

HOW TO’S:It is best to utilize moist heating prior to performing PROM, stretching and exercise to ensure full benefits. There are a number of commercial heating packs available. Like cold therapy, it is easiest to perform the heat therapy while your dog is lying down and relaxing.