“Knees love being operated on,” said her vet.
Today, knowing what I know now, I have to agree with that.
Making the decision of putting your dog through surgery is never easy. And you still have to decide which of the available techniques to go with.
Regardless of which surgery you choose, however, the post-operative care and physical therapy are paramount to the successful outcome.
Make no mistake, this is where the real work begins. I cannot stress this enough. What you do after the surgery is what makes or breaks the recovery.
That is why I’m very disturbed by the fact that so many people I talk to have not been told this and have not received any instructions in this regard.
I remember seeing this Yellow Lab in the park, who was visibly favoring his rear left leg. When asked, the owner told me that he had a TPLO. He had the surgery a year ago and was still favoring the leg. A year after surgery, there is no such thing as still recovering. It could well be that the surgery didn’t go as well as hoped, but I think it is much more likely that the poor recovery was a result of a poor (or non-existing) post-operative rehabilitation.
If your dog is having knee surgery, do make sure your surgeon, or vet, gives you detailed post-op rehabilitation and physical therapy plan!
To give you an idea what such a plan should look like, here is the plan we got after Jasmine’s knee surgery.
Cruciate Ligament Surgery Post-Operative Care: Introduction
- Absolutely NO OFF LEASH exercise for 20weeks. Your dog should be ON A LEASH at all times when outside, even if only in the backyard. The in-house activity should be kept to a minimum.
- See your veterinarian in 14 days for suture removal.
- Follow the physical therapy instructions, given to you by your veterinarian.
- See your veterinarian in 4 weeks so he/she can check the healing progress. You can expect your dog to still be lame but weight bearing at this point. If your veterinarian feels that the healing process is advancing as expected, then be sure to continue with the physical therapy
- See your veterinarian 8 weeks after surgery for a final re-evaluation of the knee. If your veterinarian feels that the healing process has not been completely achieved, then he/she will call. If all is well, be sure to continue to follow the physical therapy instructions. It may
take up to 6 months before your dog is as good as he/she will be on that limb.
- Cruciate ligaments can tear in any type of animal, because of a misstep. However, in the large breed dogs(Labradors, Golden Retrievers, Rottweilers, Akita’s, Mastiffs) the cruciate ligaments may simply degenerate(deteriorate). 30% of these dogs will have the same problem with the other knee. Therefore monitor your dog especially during the healing process because of the extra weight carried by the other leg (ask your veterinarian about “towel walking” ). These dogs are also more likely to develop arthritis. Arthritis may or may not cause problems later in life but it is a good idea to keep your dog as lean as possible because obesity will greatly accentuate the arthritic pain.
Cruciate Ligament Surgery Post-Operative Care: Physical Therapy
The first 10 days after surgery:
- Apply a cold compress to the knee, 3-4 times per day for 15 minutes for the first 3 days. Apply 2-3 times per day for 15 minutes for the next 7 days. This will help decrease inflammation.
- Passive Range Of Motion(PROM): This activity involves moving all the joints of the limbs through a comfortable range of motion. This will promote cartilage and joint health, prevent contraction of the muscles and stimulate blood and lymphatic flow. Do be careful as this may cause discomfort in the early stages. You may wish to place a muzzle on your pet to protect yourself and to get the work done efficiently and safely. Your pet should lie on his/her side with the affected limb up. Gently and slowly extend and flex each joint (ankle, knee, and hip) 10 times 2-3 times per day. If you are unsure, ask your veterinarian to demonstrate.
- Massage the quadriceps and hamstring muscles (large muscle groups at the front and back of the thigh respectively). Best to massage for 2-3 minutes before and after PROM. Massaging will help stimulate blood and lymphatic flow and break down scar tissue within the muscles. Start by applying light pressure and gradually increase it over the course of the massage. Try to keep a steady rhythm. Start close to the knee and move up the muscle toward the hip.
- Assist your dog over slippery surfaces by placing a towel under the belly and supporting your dog (commonly referred to as towel walking).
- Multiple short, slow, controlled, short leashed (NO FLEXI-LEADS PLEASE!) walks. Start with 5 – 10 minute walks 2-3 times per day. After 7 days, increase the frequency and length of walks gradually so that you are eventually walking for 15-20 minutes 3 times per day by day 28. Monitor your pet’s performance; do not exceed his/her limit.
- Continue with the massages and PROM (Before and after the walks).
- Use warm compress for 5 minutes before walking and use cool compress after the walk. To save time, apply the compress to the joint while you are massaging the muscles.
- See your veterinarian around Day 28. You can assess your dog’s progress by measuring the circumference of the thigh muscles ( it should increase with exercise) or simply compare it to the muscling on the non-operated leg. Your veterinarian will assess the knee for swelling, pain, stability and the position of the kneecap.
- Use a foam mat or pad 4,5, 6, 8 ft long, thin (¼ to ½ inch) then thicker as legs get stronger to encourage a higher footfall and increased joint use. Just have them walk back and forth on it.
Weeks 5 to 8
- Continue with the slow, controlled, short leash walks. Gradually increase to 20-30 minutes 3 times per day.
- Add functional strengthening exercises. Walk your dog in a figure 8 pattern to the left and the right ( this will help with neuromuscular re-education as well). Start with a large figure 8, and walk the pattern 4-5 times in one direction before switching to the other direction. As your pet improves and becomes stronger gradually (over 3-4 weeks) tighten the figure 8 (no sharp turns) and switch directions more frequently. Do “sit-to-stand” exercises: Ask your dog to sit and then ask your dog to stand several seconds later (this is not an exercise in speed). Start with 3 to 4 repetitions, 2-3 times per day. Gradually increase (over 3-4 weeks) the frequency (to 10 times 2-3 times per week) and difficulty by asking your dog to sit with the operated leg along the wall and then with his/her hind end in a corner and the operated leg along the wall and then with his/her hind end in a corner and the operated leg against the wall ( by making the space smaller, you are asking your pet for finer control over how he/she maneuvers that limb).
- Massages, PROM, and warm/cool compresses will still be useful and appreciated at this stage.
- See your veterinarian for the 8-week recheck. Your veterinarian will reevaluate the healing progress and make sure that the knee’s stability and range of motion are as they should be.
Over the next two months
- Continue to increase the muscling by using the figure 8 technique and sit-to-stand exercise. Do figure 8 at a slow trot (no sharp turns).
- Uphill walks (slowly) will be very helpful as well as walking through deep snow, sand or water. Gradually increase the incline of the slopes and depth of the water/sand/snow.
- Ascend and descend stairs slowly ( a flight of 5-10 steps) 2-3 times per day.
- Set up a line of cones (use your creativity) and zig-zag through the line at a walk and gradually move up to a slow trot.
- Dancing: Hold your dog’s front paws, allowing your dog to stand only on the back limbs. Encourage your dog to take a few small steps in this position.
- Incorporate balance activities: have your dog walk over couch cushions (on the floor), walk across a wide board place over a low fulcrum (acts as a teeter-totter when walked over).
- Use leg weights. Wrap the weights around both ankles (both limbs even if only one is problematic). Velcro can be purchased from any fabric store and hardware (such as nuts or bolts) can be attached to the velcro. Be imaginative! If using weights, only use 2-3 minutes at a time, and only every second or third day. Do not overdo it.
During the second month
Allow short periods of off-leash activity (2-4 times per week). Do not encourage rapid stops or turns (i.e do not throw a ball, frisbee, stick…)
We followed this plan religiously.
No, it’s not fun. But it is really important. If your dog is having knee surgery (or any other surgery for that matter), do make sure that your surgeon/vet gives you a comprehensive, detailed post-op plan. Then, stick to it!
As much as it might seem to be taking forever, at the end of it your dog can return to the life they love, with legs they can rely on.
Disclaimer: This is an example post-op care plan. Your dog may not be able to follow this schedule. Have your surgeon provide a post-op plan tailored to your dog’s case.