One of the reasons I still see patients, is that they provide me great learning opportunities and opportunities to tell stories!
So, here we go. The blog about Proper Dosing of Therapies, was about more than just exercise. (Manual therapies, education, modalities, etc.) However, this blog is ALL about exercise and highlights a case where the owner was overdosing her dog’s exercise program.
So, the patient in question had an extracapsular repair for cruciate deficiency. The owners has been through this before. She has equipment at home. She came for her initial assessment and then started into the underwater treadmill, but didn’t come back to ME for a follow up consult for 6 weeks.
I had seen her in the Underwater Treadmill just before she had returned to me. Our hydrotherapy staff member asked me how I thought she looked. I said, “She looks 2 – 3 weeks behind schedule.”
So, in the appointment with me I learned that the dog was doing 40+ minutes of daily leash walking, and that the surgeon was very happy with the knee and said, “You can let her do off leash now.”
I looked at the dog. Yes, she had full range of motion. Yes, there was no pain at the stifle. However, she was toe touch weight bearing, was choosing to sit or lie whenever given the opportunity, and upon measurement, the difference in thigh circumference was 8.5cm. (I didn’t do the weight bearing measure, as I knew it would be a waste of time given what I was seeing. When I had seen her after the surgery, she was 7% weight bearing on the surgical leg. Today, she looked to be less than that!)
That’s when I started to ask more questions about what they were doing for exercise at home. All of the targeted exercises had been stopped, and she was only getting the long leash walks.
So, the treatment consisted of coming up with the new exercise plan. It consisted of exercises from the second stage of healing, and reducing leash walking times. Essentially, this dog was experiencing an overdosing of one kind of exercise, and an underdosing of other kinds of exercise, and subsequently wasn’t using the leg like she should be at her stage of recovery.
Treatment that day was not only appropriate exercise prescription, but lots of education about ‘how much is too much’, ‘when not to push’, ‘why we are backing up the program’, and ‘what I think went wrong’.
What do I think went wrong? Essentially, I think this dog learned to compensate too well. I don’t think she was MADE to use the leg. I think, while she might have started off a walk looking good, and using the leg properly, that at some point she crossed a threshold where she learned to avoid using the leg.
Essentially, we had to change the exercise dosage, and change the kind of exercises. I had to provide a great dose of education. We’ll see how it goes!
Let me know your thoughts!
Until next time, Cheers! Laurie
(PS I saw this dog again just this past Saturday, and we're on the right trajectory now!)