Laurie's Blogs.

Hi Laurie

I have a question about a dog I saw today (actually I saw three at various stages in the same day!) who require hobbles for MSI.

In all three cases, (and different rDVM orthopedic specialists) the owners are avoiding surgery and/or had been advised it is not necessary (yeah!), and have been recommended to get Dogleggs for MSI.

My question, is that in all 3 cases, they have been advised to wear the hobbles 24/7 for 6-8 months.  They have all been told also to do rehab. (swimming, which I don't agree with, to easy to get medial shoulder movement!)  I am wondering what your thoughts are on rehab.  

My thought process is that we need to use the hobbles for walks, and to avoid any type of movement laterally when not supervised, but not 24/7.  

Would I be correct in thinking, use 24/7 will prevent proper range of motion (flexion / extension) and thus muscle wasting, and will inhibit proper return to function after the 6-8 month period.  

What is a safe way to utilize hobbles?  Do we use it when doing strengthening? My thinking is that we use the hobbles during the acute phase (1-2 months) and then gradual increase time without, and during this time increase demands of the surrounding muscles using fit paws, land exercises, UWTM, and of course, shock wavve, and laser...and over the 6-8 month period, gently introduce lateral movement in a controlled fashion, increasing proprioception and strengthening.  

Your help would be greatly appreciated.

Thanks,

-T.

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Okay... getting to this question now...

So, I believe that the prescription for wearing the Hobbles 24/7 stems a bit more from the post-op mind set.  But even if post op, I'd think that if resting / crated overnight, it would be so much more comfortable to have them off.

I would agree with you about using them acutely for 1 - 2 months and then graduating to something else.  I really like my tensor bandage (ace bandage) wrap for this (in fact, I've only ever ordered the Hobbles once - for a geriatric dog with other issues and minimal regenerative capabilities in regards to strengthening).  All others I've worked with using the tensor / ace bandage.  What I like about the stretchy tensor / ace bandage is that is is more proprioceptive, and provides support while allowing some motion to occur... which in my head is important for minimizing atrophy and muscle relearning.  (I'd only have the bandage on when supervised however... we don't want a foreign body... otherwise the dog should be crated if not in Hobbles.

So for daily walks, I would advise that the owners use the Hobbles (or bandage), and when in clinic, I think you would get better effect with bandage on.  I agree that I don't think that swimming would be best, but I do think that UWT could be advantageous as it is controlled and a straight line.  This could be done without anything on the dog or with the bandage.  To do any kind of manual therapy -  stretching, ROM, massage, mobilizations - the Hobbles would have to come off.  Otherwise, what' s the point?  I would also use shock wave and laser, and incorporate treatment of acupoints (maybe with the use of TENS).  Functional exercises could start with weight shifting, progress to 3-leg stands (lifting the unaffected limb), progress to this same but with a mildly wobbly surface, then increasing the wobbly surface, then try a using theraband around the 'standing' leg and pull on the leg from an outward direction and/or some pulls that angle outwards and cranially or outwards and caudally.  Eventually you will get to diagonal leg standing, starting on an even flat surface and progressing to an unstable surface.  Late stage rehab?  I find that these dogs have lost their active end range shoulder extension (and / or willingness to go into end range extension) and for this I find that walking backwards on a treadmill is fabulous (either all 4 on or back feet off on a platform and only the front feet moving.  Try it different ways.) Ohh... and tug of war!  And end stage rehab?  Don't forget to train bursts of lateral movement (i.e. keep away game or short retrieves).

I've never had them take 6 - 8 months to recover.  I'd aim for 3 - 4!

Good luck!  I hope this helps!

Cheers,

Laurie

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Thanks so much, you said exactly what i thought and have so far recommended.  With all but one of the 4 dogs i have right now, the lameness is not perceivable during gait analysis of each session...My biggest concern you addressed, was...limiting ROM would encourage muscle loss, and not something we want...my goal is to ensure there is no explosive lateral movement to aggravate the medial ligament...

I am doing shock wave, Laser, joint mobs, PROM, and very static weight shifting on fit paws balance disc ensuring that the dogs don't move the forelimbs while doing movements.  the Plan is to gradually over the next few months increase the 'load' of the joint..much like you say...then work up to doing more active movements using land treadmill, fitpaws etc...

Thanks so much, I know you are overwhelmed...

-T

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Good thinking in all of your plans!

Good luck! 

Laurie