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Physical Therapy After CCL Repair

Physical Therapy After CCL RepairEach veterinarian seems to have their own theories regarding how soon physical therapy should be started after ccl surgery and what techniques work best. Other veterinary surgeons will write off physical therapy all together, preferring for the dog to remain quiet for the first 6-8 weeks after the repair, gradually returning to exercise. While it is always best to go along with the instructions of your vet, I do want to point out that studies done by the American College of Veterinary Surgeons have shown that dogs beginning rehabilitative therapy within 48 hours of the procedure tend to heal faster and have greater range of motion than dogs without any physical therapy.

The best way to assure your dog is on the right track after his cranial cruciate ligament repair surgery is to incorporate a varied regimen of passive range of motion, balance exercises, and slow, controlled, leash walks. Range of motion exercises, also referred to as “ROMs”, should be demonstrated to you by a professional before you undertake them on your own, as you can do damage to the healing tissues in the knee with the wrong technique. There are canine physical therapists skilled in ROMs, and if you are unsure of your skills it is best to seek the help of a professional to ensure the safety of your dog. Balance exercises can also be tricky for unskilled owners, and it is best that a qualified veterinary physical therapist perform balances exercises with your dog; think placing your dog’s belly on a ball while helping him to bear weight and flex the knee.

Swimming is an excellent non-weight bearing activity, but only after the incision site itself has had time to heal. All therapies should always be cleared through your veterinary surgeon, prior to their implementation. If you have access to a pool and a dog that loves to swim, this can be a great way to help them regain lost muscle mass while working on ROM exercises in a zero resistance environment (decreasing the likelihood of injury).

Some owners have also chosen to go a more holistic route with their dog’s post operative therapy, seeking out the assistance of a professional skilled in acupuncture.  The use of animal acupuncture, and similarly acupressure, in a dog recovering from ccl repair surgery may help alleviate post op discomfort, which can help your dog to heal more quickly from surgery.  A growing number of veterinary clinics are now integrating western techniques such as acupuncture and massage into their practices, with many offering these services on site.  Acupuncture and acupressure can be used in conjunction with ROM exercises and hydrotherapy under the supervision of your veterinarian.

The long term prognosis for animals undergoing surgical CCL repair is good, with clinical reports of improvement in 85-90% of the cases. Unfortunately, degenerative joint disease or osteoarthritis progresses regardless of treatment. Long term outcome includes a decrease in activity over time, an increasing level of disability, an adverse response to cold weather, and stiffness after inactivity related to progressive degenerative joint. Weight loss, an exercise regime of daily moderate activity, and the use of joint supporting supplements like glucosamine and chondroitin can help to improve these adverse clinical symptoms.

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18 Responses to Physical Therapy After CCL Repair

  1. inconspicuous June 7, 2008 at 8:10 am #

    Thanks for the comment! Our dog had CCL repair just over a year ago now, and she is doing great. She’s dropped 1/3 of her body weight (per the vets request) and acts like a puppy again and she’s almost 7. The surgery worked great, though it was tough for the first few months.

  2. Yvonne Scott November 18, 2008 at 10:12 am #

    Hi there. My 4 year, 4 month old German Shepherd just had her CCL surgery 5 days ago. What is the best advice anyone can give me. We are just coming in to winter and the weather is already below freezing. She loves to just sit outside. Will the cold affect her inscision and her leg? What is recommended? I appreciate any shared stories I can read. thank you.

  3. sonia December 25, 2008 at 12:53 pm #

    After the surgery its better that U keep the dog warm & inside.Maybe cover him with a blanket.
    The cold may cause more stiffness Or infection being outside.
    Its very important that he rests for 1-2 months so the bone heals………
    Follow the docs advice.
    Also,make sure he doesn’t run Or slip after the Surgery Or he may damage the knee.
    Please let him rest & follow instructions strictly.
    Hope he recovers soon.
    Thanks.

  4. Gary C December 29, 2008 at 8:13 am #

    My 7 year old Border Collie tore her CCL mid-November. Our vet suggested waiting a couple of weeks before surgery and sugery was performed on December 3rd. We left her in the care of the vet for 1 week so that he could check to make sure all had gone well.

    After a week, we borught her home and did as instructed: kennel with bed (memory foam), no excessive movement, carrying her in and out of the house (2 steps), lifting her into and out of the car for vet visits, etc. Unfotunately, the vet removed the bandages that she had been wearing even though we protested. I left alone in her kennel for 1 hour, she removed the bandage that he had applied and chewed out the stitches. Back to the vet and he used staples to close the wound and more bandages plus halo collar.

    Since she has a large neck and small head, the halo collar was meaningless. Regardless of how it was attached, she could remove it. Every night for 10 days she would remove the bandages and staples. Everyday we would go back to the vet to have more staples to close the wound.

    We used a muzzle but everytime she was left unattended for even the shortest period of time she would remove the bandages and remove the staples. In several cases, this only took 15 minutes.

    While leash walking her 2 weeks after her surgery, she tore the CCL on her good leg. Now we have to wait until the first leg heals before surgery on her other leg.

    We had no idea that a torn CCL could be so exhaustive. For those considering CCL surgery for your dog, please be forwarned. It is a long, long and trying recovery. Good luck and God bless our dogs!

  5. Haley January 28, 2009 at 6:17 pm #

    Our Golden had Extracapsular suture technique done 8 days ago. She’s still holding her leg up pretty high and is not using it at all to walk or balance. When can I expect her to begin to use the leg? Is canine Physical Therapy worth the time, drive and money? Any suggestions? Follow up appointment is 6 days out.

  6. anne hall January 29, 2009 at 7:18 am #

    Hello!! Just read everyones comments, the therapy is key to the surgery, your buddy will be grateful.

  7. Katy February 7, 2009 at 11:26 am #

    Hello. Our almost 2 year old lab just had ccl repair surgery. I would NOT recommend this. SHe is miserable. We have three other dogs and she hates begining in the crate when they are outside. She weights 65lbs and I have to carry her back legs in a sling per the vets request which is very hard. I have to do this for the next 6 weeks!!! She also has a halo collar on that she cannot keep from hitting the sides of the crate with. I had NO IDEA what we were walking into with this surgery. I wish we had just kept her on glucosamine tablets to help with the arthritis (sp?) and let the leg out. This looks like torture to her.I am so overwhelled with her care and the long road to recovery we were told 6 month after she had the surgery. This is awful.

  8. nmlhats February 23, 2009 at 9:30 am #

    Katy,

    Don’t be discouraged. We had the right CCL on our 45-lb mutt done two years ago and two weeks ago the other one blew out so we have just started the surgery, recovery and rehab all over again. He came home on the 10th day with stitches removed and no E-collar, and promptly started chewing at the wound. I cleaned up an old E-collar from the garage and put that on him for a few more days to protect the incision.

    I would definitely recommend to anyone that you board your dog at the vet for at least a week post-surgery, if not two. The first time we did two full weeks and this time ten days, but I wish we had left him the two full weeks again. This is important especially if you have other pets and you want to be sure he remains calm.

    If I remember correctly, it was a good six weeks of very limited activity with some therapy (the “dancing” and also the “bicycle” movement with the leg). Then at the 3-month point he was allowed to go faster but still we had to avoid any forceful springing starts or jumps. At six months it was almost normal but it was not till about nine months that he really seemed to be close to 100% normal again.

    Now he’s 12 yrs old and I expect recovery to be slower this time. He’s very active for his age and we do have other pets that want to engage him in play. He also has keen hearing and he rises very quickly to check out any stray noise he hears. It is hard to keep him in slow-motion!

    The bottom line is that it will be a slow and careful recovery and rehab BUT it will be worth it, especially considering that your dog is so young. I guess because she is a larger dog you are having to assist his movement with the sling.

    Do be aware that 35 to 50% of dogs who have torn one will eventually tear the other, so be careful. But even then, it can still happen due to some genetic tendencies regarding the ligaments themselves.

  9. Sarah March 2, 2009 at 3:31 pm #

    Our 4 year old Sheppherd/Rotti cross had his second knee done about 10 weeks ago, the first 2 years ago. Unfortunately, after 8 weeks he got out of our gated yard for only 90 seconds and came back hopping on three legs! Then a few days ago, even though he was on a leash he jump onto a high step… he just appeared up there. Now he’s walking on 3 legs again or putting very little weight on it. It’s so frustrating and I feel so sad for him. My husband has now taken him to the vet who has suggested limited walking yet again and hopefully he hasn’t re torn the ligament. Not sure if we can get it done again! ALthough, he’s so young would his quality of life be better having it done for the second time? I don’t know.

    Anyway, the moral to the story is, keep your dog on a tight leash and really restrict their exercise for a good 3 months. Swimming wil be great once the weather warms up but they do feel better and think they can run or jump…but they can’t, don’t let them.

  10. Tiffany April 10, 2009 at 10:56 am #

    My 8 year old lab mix had the wire CCL repair on her right knee a month ago. So far, so good, but as lot of people on this site have mentioned, this kind of surgery involves a lot of post care. My mom and I have split her care which has been a big help. If you can make the time, I really think the physical therapy can be done at home as opposed to a professional facility which I hear can get really expensive.

    This is how her care has progressed and hopefully my diary will help others here:

    Vet provided a Fentanyl patch for pain directly after the surgery which made initial pain management a lot easier on my end.

    I fed her 4 small meals a day at first to evenly stagger her antibiotic and Vetprofen dosages.

    She wanted to chew on her incision so I ended up getting this type of cone (http://www.allfourpaws.com) and it was great compared to those giant plastic ones.

    First two weeks she was kept in a cage most of the time. Only went out for bathroom breaks. Iced the joint followed by range of motion exercises twice a day.

    In the 2-4 week range she’s been kept in the house to restrict her movement but no longer needs the cage or cone. Stopped icing and started hot compresses (hot wet rag wrapped around the knee) followed by the ROM exercises twice a day.

    She wants to put some weight on the leg now, unlike prior to surgery, and the knee doesn’t seem to be too stiff.

    One problem is because of her decreased exercise, she’s been gaining too much weight so I’ve had to cut back her food.

    The other big problem is her boredom! She was getting listless alternating with anxious energy after being cooped up so much. Been trying to take her out into the yard to sniff/dig gopher holes and rub her back on the grass. No real walking just yet though.

    This weekend I plan on starting her with some real exercise. Just 15 min up and down the street slowly on a leash and some time in the pool.

    Her thigh muscle is in pretty skinny from disuse and I’m hoping the workout will eventually help regain her muscle mass.

    The vet suggested after 2 months to get her to walk on uneven surfaces like deep pillows, big gravel, and stairs to help get her balance back as well.

    I have to admit she’s been pretty miserable at times, especially with that cone around her face. But so far it seems to have been the right decision, seeing her want to stand on her leg again. I went into this never expecting her to fully recover to her old self but to the point where she can run to some extent again. I was also concern over the increased stress from scrambling around on 3 legs may prove to been too much for the remaining good joints and she’d end up with other problems.

    I’ll follow with another update as she progresses.

    Good luck to everyone out there!

  11. Natasha August 24, 2009 at 10:43 am #

    My soon to be 8 year old lab mix had TTA surgery two and a half weeks ago. She is 50 lbs. She did an overnight for the surgery at the hospital.

    The vet told me if she is not accustomed to being crated not to do so because it may stress her. I kept the e-collar on her the first week while I was not supervising, until the stitches were removed. She is doing great!

    The first week I only walked her to releave herself which is half a city block. For the past week, I have been taking her for short, slow, walks (about 2 blocks, or 20 minutes). She has a slight limp, and has not put weight on the foot. She is not allowed to play with other dogs, they do sniff each other, but I usually take her away before she gets too playful.

    It’s hard keeping her home for the summer, since what I enjoyed most was our long walks together. But I keep in mind, as many have told me, next summer she will be healthy and happy, and we will be able to go on our long walks.

    To all who have opted to have the surgery (which ever one you chose) good luck with your love ones and be patient, by next year they will be back to their old selves!

  12. Erin Neill September 9, 2009 at 8:03 am #

    How long does significant swelling remain s/p an ACL repair? My 2 year old English Bulldog had TTA surgery 5 weeks ago on his hind right leg and the swelling is still significant. It looks like he has a nerf football attached to his knee. He has a slight limp and only has toe touch weight bearing ability. I understand that the reahab of the ACL tear is long, but my concern is the swelling. Any thoughts on what I should expect with this? The incision looks great, it’s not warm/hot or red…..thanks…..

  13. Monika February 23, 2010 at 3:28 pm #

    My 74lb lab/ shepherd mix completely tore her CCL (ACL in human terms) on 2/10/10. She had a partial tear diagnosed in September and was scheduled for an elective repair on 2/22. With the complete tear (happened in the snow), she yelped and suddenly was unable to weight bear on her left hind leg. I immediately called the vet and they moved her surgery date up to 2/11/10. I opted for the TTA repair. If you can afford it, it is the best route to go for a dog over 50 lbs. The recovery time is less than for the suture technique (not great for larger dogs) or the TPLO, which is much more invasive. She spent two nights in the hospital, which I recommend for pain control and comfort. She came home on post op day number two on Keflex (antibiotics) for 7 days, Deramaxx for 21 days, Tramadal every 12 hours as needed for pain, and a Fentanyl patch that was to be removed 5 days after coming home. On her third day home, she began to act very strange. She was up, walking around, whimpering, crying, and constantly trying to get my attention. It got progressively worse during the course of the day. Eventually, my dog was so anxiety ridden, she looked like a dog on “crack”. It was 8pm– I called my vet and he determined that the Fentanyl patch was causing an adverse effect. I immediately pulled the patch off. Two hours later, she was still crazy… I felt so badly and was very concerned that something else was wrong. I took the advice of my vet and gave my dog 75mg of Benadryl… within a half hour, she finally calmed down and went to sleep. During the entire time of this anxiety attack, she did not eat or drink. She woke up the next am a new dog. Please be aware of the adverse effects that multiple analgesics, especially the Fentanyl patch, can have on dogs. I wish my dog’s surgeon would have forewarned me. We are now on post op day number 12– she toe touches in her gated area while walking/ moving but when I walk her (using a sling as an assist), she walks remarkably well. No toe touching and she fully weight bears, squats to urinate and deficate with no difficulty. She was closed subcuticularly, so she has no staples or sutures to remove. Will see the surgeon for the first time on post op day # 14. It is very difficult for both the dog and me, as it is very boring to just sit in a small gated area with walks 3-4 times a day about 10-15 minutes. To all you moms and dads who are considering surgery for your dog… please consider the TTA approach, if applicable to your dog. It is 16 weeks of hell, but well worth it in the end for all involved. As the old saying goes, “no pain, no gain”. Good luck to all of us doggy moms and dads!

  14. Cristina July 16, 2010 at 7:45 pm #

    I have really appreciated all of your stories. It helps a ton to hear what you have experienced (compared to the “suggestions” & “feedback” I have been dreading from people who have not experienced this.

    My Pitbull King will be 4 in October…he tore his CCL about 3 weeks ago & we have been debating the surgery. From what I am reading I am leaning towards YES!! He loves to run around & play & swim. I can relate to those of you who are in as much pain as their doggy…he is my partner & this has ruined our summer. He is miserable being kept in the bedroom while the other dogs are outside playing & it is killing me.

    Anyway, one of my main concerns (of course besides the HUGE financial stress that the surgery will put on us) is will he be able to walk & run around again post surgery (after what seems like from the comments about a 6 month recovery) & from what you are saying…yes he will…although he is most likely going to tear the other leg at some point.

    I would be grateful for any feedback on the TTA or the TPLO or CM! Thanks & good luck!!

  15. Deborah November 12, 2010 at 5:24 pm #

    Hey-
    I’ve been in functional rehab, human sport science and therapeutic nutrition for 30 years and I have a few papers posted on my animal rehab website regarding post op rehab care and conservative management care. Many of these have been copied and reposted to popular sites on the web. Please have a look and pursue some of these interventions for your animals.
    Blessings-
    Deborah Carroll
    Also on Facebook

  16. Amber April 23, 2011 at 4:49 pm #

    My golden retriever/chow mix, Teddy, had a traditional repair done almost three months ago. He has also lost almost 20 pounds to help him get back to a healthier weight! Everything has been going wonderfully until last night he got away from me and took off to chase whatever the other dog was running towards . . . It was dark and I never saw what happened but when I went to retrieve him and his leash he was dragging behind him, he was laid out and couldn’t walk without me forcing and dragging him back into the house. His pain is definitely coming from the “good” nonsurgical knee!!! I can’t believe it. He is back to square 1 or maybe worse. His vet will see him Tuesday. I am scared to hear his options. Teddy isn’t completely recovered from his first surgery. How can we keep him from having a re-injury on that leg if he has to have the other leg fixed??? I’m just sick for him.

    • Monika May 2, 2011 at 1:23 pm #

      Dear Amber,

      I have experienced an CCL tear in my 75 lb lab/shepherd mix last year anlong with my dad’s golden retriever tearing CCL #1 and having the ‘tight rope’ technique done only to tear CCL #2 two weeks after the surgery to CCL #1. So, in all of this (and my career being in medicine), I would like to offer the following advice to you…

      Teddy has a ‘healing’ knee on one side and an injured knee on the other. My dog had a TTA repair done on her knee and my dad’s dog had the tightrope done on knee #1 and the TTA repair on the other about 6 weeks later. The TTA is your best option for Teddy because the TTA approach will allow Teddy to weight bear immediately after surgery. The tight rope is not a good choice for larger (especially active) dogs as the CCL is never repaired and the healing process depends solely on scar tissue build up to support the knee. TPLO recuperation time is really long, and dogs can’t weight bear on the affected leg for quite a while. There have also been reportings of bone cancer from the steel they use during TPLO surgery. TTA uses titanium. My dog is doing well a year plus later and my dad’s dog is doing well 3+ months after his TTA surgery on the other leg (both dogs are 9). So, my advice is for Teddy to have the TTA surgery on the other leg ASAP to protect the already surgically repaired leg and to prevent further damage in the knee that is now injured. Good luck. It is a costly operation and a tough recovery, but so worth it in the end. — Monika

  17. Deborah Carroll April 25, 2011 at 2:10 pm #

    Hey Amber,
    The reply I wrote above, to Cristina, is good for you, too, at the outset.
    One damaged joint or two, all the more reason to go back to restrictions, use ice, use anti-inflammatories AND Tramadol/Gabapentin/Amantadine (pref. Tramadol, but depends on your vet), and read my protocol for conservative treatment and for post-surgical treatment…homework, as it were.
    If Teddy were my dog, from what I know from what you posted, I would not have surgery on that other knee right now, if ever. You have time to let the joint heal. The joint will heal on its own, in time, with or without surgery, if allowed to convalesce.
    Blessings-

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