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I have a patient who is about 5 weeks post-op TPLO.  He was doing pretty wells for the initial 2-3 weeks but then he started holding up the leg again.  On exam he had no warmth or swelling of the stifle, good range of motion with no pain on PROM and no meniscal click or creptius.  He does have some significant trigger points over his quads, sartorial and along his iliopsoas.  He was definitely painful on direct palpation of the psoas.  He is a golden who gets VERY excited to see his dad and when he first sees me (he really likes peanut butter cups and Frosty paws :-)  We did laser, massage, and gentle stretching to treat his psoas strain and he did improve.  Last week he came in for a follow up and he is better but still pretty uncomfortable in the psoas and quads.  The owner is very keen on getting him through rehab ASAP because they take him running/hiking here, but now I have 2 problems and feel like I need to back off and get the psoas healed.  

So, my question is this…how aggressive can I be with rehabbing his TPLO leg without aggravating the psoas that seems strained on the same side.  What exercises are safe for the psoas that are good for post-op TPLO?  He was doing sit to stands, loving on the stairs, and 3 leg stands.  I haven’t been much more aggressive because of the psoas.  We are doing laser twice a week as well.  I have a doc here who is acupuncture certified…would that help or just stick with laser?

I warned the owner that the psoas could take a while to heal and will slow our ability to rehab his TPLO.  Suggestions?

Thanks - H

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Ack... how frustrating.

So, the one thing in regards to discord in therapy between TPLO & iliopsoas rehab that I have found is UWT.  The iliopsoas patients do not do well with UWT.  At minimum, it does not help, at it's worst, I've seen it irritate the iliopsoas injury.

Beyond that, you should be okay to follow a course of progressive exercise.

I would immediately add hill walking - forward AND backwards (and slow on leash walking DOWN stairs).

I think you can get these better at the same time... so long as there are no slip / falls / nut-bar zoomie-runs!  Sounds like a good time (and good rationale) for Dad to work on behaviour & obedience!

I'd not worry about acupuncture at this point - stick with your laser, stretching & exercise routine.  Maybe add some manual techniques for releasing MFTPs along the quads, & sartorius & some slow progressive deep pressures to the iliopsoas... (I think I put these in the last - or second last MFTP Mini Course video).

So all in all, to answer your question directly... you can rehab the TPLO - minus UWT - as if you don't know there's an iliopsoas strain, but just add some specific targeted therapy to the iliopsoas because you do know it's there!

How's that?  

(And btw... I love this question... It would make a great Q & A blog post!!)

Cheers,

Laurie