By Sandra J Platt VMD
It seems all-too-often a patient sits in my office who has torn a cranial cruciate ligament. The cranial cruciate ligament (or CCL) is probably the most common major musculoskeletal disorder seen in general practice in the adult dog. The tear often occurs due to a rotational stress on the knee joint – and the injury is typically a great surprise to both the patient and the client.
Until recently, it was thought that the only means of dealing with a rupture was surgical. Surgical correction is still the gold-standard, but it is strongly recommended that patients also undergo rehabilitation to ensure the best outcome for their way to recovery. Some patients are not good candidates for surgical correction due to age, health conditions, or finances. In these cases, rehabilitation therapy has shown to be remarkably effective in returning patients to full function, even in the absence of surgical correction. Academic journals have written about the benefits of rehabilitation therapy to bolster healing in addition to or in place of surgery when necessary.
When a rehabilitation program begins, expect for your pet to undergo a set of measurements called goniometry and muscle mass measurements which will gauge how much flexibility and muscle are present in each of the joints of the limb. Once the process is completed and the veterinarian understand the needs of your pet and your goals, a therapeutic plan will be designed and put in place. This plan can include therapies for pain reduction, minimization of swelling, increasing of range of movement, bolstering muscle strength, and building proprioception and balance. Likely, this will include exercises and restrictions for you to carry on at home. Restrictions will include how often and how long to walk your pet, what kind of leash or harness to use, whether to let your pet walk up and down steps, jump up on the furniture, and/or what kind of pet bed to use. Exercises can include walk length – with increase at carefully-regulated intervals, jogging, climbing steps, passive range of motion exercises, sit-to-stand exercises, walking/swimming in the bathtub or pool, and/or applying cold or heat packs to the affected areas at certain times relating to exercises. Often, the speed of recovery will depend heavily on these home exercises and treatment plans can move faster than anticipated. Always do home exercises only under the supervision of a veterinarian, as any setbacks will slow down the course of progress.
During the course of treatment, expect routine updates of muscle mass measurements and goniometry. Your pets balance, strength, proprioception, and – most importantly – discomfort will be routinely assessed. Special exercises will be done in the office such as laser therapy, ultrasound, massage, cavaletti rails, balance boards, giant balls (everybody’s favorite to watch!), and even special surfaces for walking, hopping, and wheelbarrowing.