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Hello
I was going to attach a video of a 3yo mongrel with bilat THR (indiscriminate breeding now means we have severe HD in our local mongrel population). R THR was Mar 2015 and had fabulous rehab. L THR was Sept 2016 and the owner's thought they could manage, dog became o'weight and while restriction and slow into to full exercise was done the focused exercises were not.
This dog looks like he as a hip pivot on LHL at walk (slow mo video NOT attached- sorry- system won't allow). With what looks like a inwards rotation at end of hip extension. Assuming implants are all ok and as we often see this early post op- what are your favourite exercises to help?
thanks Jane

Hi Jane!

So the simple answer is Glutes, Glutes, Glutes, and some Abs.

At this point, you will likely see the greatest results by using e-stim on the glutes and doing a 3-leg stand (stim the standing leg, and watch the timing). Tons of this to build not only the muscle bulk, but the motor control and timing. (See the video on Motor Control & timing - it talks about Abdominals - which you should check for and do as well - but the concept applies to the glutes as well.) You could get the owners doing this but by tapping on the glutes before doing the 3-leg stand... but the e-stim will make more of a difference!
Home Exercises: Hills, Sit to stands facing up hill/up a plank/with front feet up on a step, and for 'fun', some tug of war.

To progress the 3-leg stands, you could then do them up on two blocks, slowly shifting them further apart, and then doing the 3-leg stands (thus mimicking the end range extension, and the need for the glutes to work at that range.)

Best of luck! Get the glutes and you'll get what you want to see!

Laurie

Thank you for the info. I love the techniques!
I did find very weak glutes which responded super well to stim during 3-legged, BUT that was on the RHL- the original THR. The LHL was super strong, no drop. If we go back a little in history, after the RHL THR, the dog was using the RHL immediate post surg (because it was such a relief). The RHL rehabed well and quickly. My last muscle mass measurements 3mth post 2nd THR (on the LHL) were X on RHL and X-1cm on LHL (as expected). Now they have reversed to X on LHL and X-1cm on RHL. So...... now using the LHL more and we can determine the glutes are the weak point on the RHL- working on it. And iliopsoas is painful- also working on it. In this case, is the recent pivot in the LHL due to the R side only? or could I be missing something else?
I also used the theraband around the belly. During my visit, I could see improvement but owner sent me videos which really don't show much difference. I'm going to send these to you on email in case I am talking &*%$#.
thanks again
Jane


well done me! I just added videos to youtube:
no band: http://www.youtube.com/watch?v=LpWpxnNJkGY
with theraband: http://www.youtube.com/watch?v=UDIfz7OBcJY

Hi Jane,

Thanks for the update on this dog. Very interesting indeed. I think there must be some weakness on the LHL as well... maybe more when the hip is extended out a bit further, and or when the foot is in first contact with the ground.

I'd continue with strengthening, but try things where the hip has to be in a bit more extension. Hill walking or stair walking would be great for this dog. Progressing to trotting up hill if able.

What we know in human medicine is that THR complications / failures, etc that occur 'later' post-op are either due to muscle weakness or shortening. So check the status of the TFL, glutes, iliopsoas.
For TFL, look at flexibility and/or trigger points. To stretch TFL, you adduct the limb caudal to the contralateral limb (but of course, you need to use caution b/c this is a THR... so maybe just assess tone and MFTrPs).

I'd also try attaching a loop of theraband around the whole back end of the dog - attach it to the abdominal loop - to see if you get better coordinated movement.

My overall gut feeling is that you need to continue to strengthen glutes and get the dog to 'buy into' extending the hips back as he walks / moves. I think the iliopsoas tenderness is due to 'holding' the limb in position and avoiding full extension. So upward (hills or stair) activity could help with this (active iliopsoas stretching AND glute building all in one.)

Best of luck!

Laurie

Further update
I am not winning here.
I have incorporated all ideas. Except the theraband around back legs.... how to keep it on?

RHL weakness has improved somewhat and iliopsoas is no longer uncomfortable. However, when going up stairs, he will use LHL largely to protect the RHL from full single leg weight bearing.
He is easy to fatigue and the LHL hip pivot looks worse on incline. Both HLs show limited extension at walk (weakness at extension phase), but on ROM in standing, are very good.
I spoke w surgeon who will check implants shortly for cup loosening (which she says may occur to cause a pivot later after initial recovery).
But I still have a weak RHL which was stronger and had more muscle mass after the LHL's THR and I want to know why.

thanks Laurie
Jane
More videos:
https://www.youtube.com/watch?v=zih3aaL ... load_owner (incline)
https://www.youtube.com/watch?v=v-j8Y8P ... load_owner (stairs)

Thanks for the videos, they help.

Since strengthening isn't working, and this is what the dog is looking like... I too think that the surgeon needs to evaluate the dog for implant loosening.
Can you find pain anywhere or with any movement?

When the dog goes to weight bear on the RH, there is definitely a giving way, which, if you / they have been working on strengthening, should be improving.

So, I'm going to say, this isn't a 'you' problem!

Laurie