What does rehab for a CCL injury look like?
How do we approach rehabilitating dogs after an injury to the cranial cruciate ligament (CCL)? Whether the dog has had surgery to address the CCL injury or is being managed conservatively without surgery, whether they need a stifle brace or not, whether they are young or old, rehab is a critical part of the treatment plan for optimal healing and return to function. Though treatments and timelines will vary if a dog is managed surgically or conservatively, rehabilitation after any injury promotes healing within normal movement patterns rather than allowing unhealthy compensatory patterns to develop. This may help speed the recovery process and reduce the risk of further injury.
Getting a History
Before we can create an effective rehab treatment plan, we must do a thorough in-person evaluation. One of the first and most important pieces of the evaluation is gaining an understanding of the dog’s individual background. We ask questions like: What was their level of function before the injury? What activities do they enjoy doing? How much exercise did they typically get prior to the injury? Is there a history of any other injuries or health issues that we need to know about? What is the home setup like? Do they have to climb stairs every day? Are there other pets in the home?
We also ask clients what their goals are for their dog, as these can be wide-ranging and may greatly determine how we create a plan of care moving forward. Is the goal to be able to eventually return to competing in high-level agility, or is it simply to live a quiet, pain-free life?
Getting a robust history of each dog’s health, lifestyle, and hobbies allows us to start shaping an individualized treatment plan that will help a dog reach its goals. This is one of the reasons why general “plug and chug” rehab protocols, which dictate exactly which treatments to provide in each phase of recovery, are not a replacement for seeing a rehab professional directly. Veterinarians and physical therapists trained in canine rehabilitation use clinical reasoning and expertise to devise treatments that work for your dog’s unique needs and goals.
Observe, observe, observe!
The next thing we do (and something we never stop doing), is observe how the dog moves. Rehab professionals are considered “movement experts”, trained to have a keen eye to detect alterations in movement that may indicate pain or dysfunction somewhere that could be detrimental to the dog’s health. We observe the dog walking, trotting, and running (if applicable and appropriate). We observe their posture, how they stand, and where their weight is shifted when in standing. We observe how well they are able to transition from a stand to sit, a sit to down and a down to stand. We observe how they move up and down stairs or over uneven surfaces. And we observe their body language when performing different movements. Do they appear comfortable and carefree, or are they nervous and hesitant? Are they clearly experiencing pain? Are there more subtle indications that they may be in pain but just trying to push through? Are they avoiding certain activities that they have learned over time to be painful?
After speaking with the owner and watching the dog move, we already have A LOT of very valuable information! There are likely already conclusions we can make about where the dog has discomfort and recommendations we can provide to make the dog’s life easier. But before we do any of that, the next step in our evaluation is the hands-on assessment.
During the hands-on portion of our evaluation, we examine a number of important factors that can indicate to us where the dog has impairments that are creating pain or dysfunction. We assess the range of motion of all major joints and the flexibility of important muscles. Is there a limitation somewhere that is restricting motion? We check muscle strength, muscle mass, and measure muscle circumference. Though muscle mass is not directly indicative of strength, we do know that muscle atrophies (shrinks) when it is not being used. We palpate for muscle tension, swelling, or abnormal warmth that may indicate local inflammation. We also palpate along bony prominences and tendons for any areas of pain. Is the dog tender when a particular area is touched?
After performing our hands-on assessment, we compile all of the new information we have acquired. The dog’s individual health and background, goals, how they stand, how they move, and what impairments they have in strength, range of motion, flexibility, and more — all of this data put together helps us make a treatment plan that is individualized to your dog and help them return to a life they love.
Once we have completed our initial evaluation and have determined where the dog has impairments, asymmetries, or deviations from normal, we devise appropriate treatments to help the dog reach its long-term goals. As rehabilitation professionals, we also create short-term goals related to the dog’s impairments, which helps us track the dog’s progress over time. For example, if a dog is currently lacking 30 degrees of stifle flexion, we may create a goal to get 15 degrees of motion back in the next 3 weeks.
One of our first goals with any new or recently exacerbated CCL injury is to reduce pain and inflammation first if present. To do this we can use strategies like icing, low-level laser therapy, massage, and hydrotherapy. The next thing we try to address is any range of motion deficits. We must improve range of motion first before addressing areas of weakness, otherwise we’ll end up strengthening through only part of normal motion, creating bad movement habits!
Throughout this time we also use manual therapy, or hands-on treatment, to improve joint mobility and promote proper muscle tone and length.
As range of motion begins to improve, we build strength in weakened muscles through appropriate, individualized therapeutic exercises (don’t be fooled by one size fits all exercises!) and teach you how to lure the dog with treats to perform the exercises correctly and with proper form. If the dog has any maladaptive movement patterns, we also provide exercises that will help normalize these patterns.
One fantastic way to help normalize optimal movement patterns during walking is done using hydrotherapy. Hydrotherapy, or “water therapy” is performed either in a pool or in an underwater treadmill and can include walking, swimming, strengthening, floating, and massage. In dogs with CCL injuries, we typically use hydrotherapy for gait training (re-learning how to walk with appropriate mechanics). The water provides a gravity-minimized environment to allow dogs to have extra support and reduced weight-bearing as they heal from injury.
We also discuss ways to adapt the home for a more optimal healing environment. For example, dogs may have difficulty getting traction on hardwood or tile floors and may slip and re-injure themselves. One solution we often recommend is placing rugs or yoga mats in high-trafficked areas to prevent the dog from slipping. We also may provide recommendations for adaptive equipment, which can help the dog (and you!) move through the world with better form and less strain on the body. A few common assistive devices we often recommend are “help ‘em up harnesses”, boots, ramps, or stairs into a car.
If you scrolled all the way to the bottom for the TL;DR, the biggest takeaway is this: Any rehab program for any injury should be individualized to your dog, should take into account the dog’s WHOLE body (not just the joint or limb that is injured!), and should consider your dog’s own unique goals and hobbies. If you’ve got a treatment program like this for your dog, then you’re both well on your way to living a life with less pain, better mobility, and more joy!
To health and mobility,
Cassie Swafford, PT, DPT