Rehabilitation therapy for orthopedic conditions (Proceedings)

Apr 01, 2010

There are numerous studies indicating the positive benefits of rehabilitation therapy following CCL surgery. In summary, rehabilitation therapy has been shown to improve muscle mass and attenuate muscle atrophy that occurs in the post-operative period, increase stifle joint ROM, especially extension, improve weight-bearing as measured by force plate analysis, and reduce the progression of osteoarthritis.

Rehabilitation guidelines following stifle surgery are structured to direct the clinician in returning dogs to pre-injury activity levels as quickly and safely as possible. Criterion-based protocols eliminate subjective progression through rehabilitation by dictating the milestones that must be reached in order to progress to the next phase. The rate of progression can differ between dogs and is dependent on the individual rate of healing and the demands of the dog's activity level. Also, clinicians should prescribe therapeutic interventions within each phase that are tailored to the patient's needs. Prescribing therapeutic interventions in a 'cookbook' fashion for each particular diagnosis is committing a disservice to the patient.

Table 1. Three phases of rehabilitation
Three phases of rehabilitation are included for recovery in dogs: the acute phase, advanced phase, and return-to-play phase (Table 1).

Acute phase

Table 2. Rehabilitation days 14-30
In the acute phase of rehabilitation, strategies are focused on controlling the effects of inflammation (pain, effusion, loss of motion, and muscle atrophy). The goal of the acute phase is to revise full range of motion, reduce effusion, retard muscle atrophy, and ambulate without assistance (Table 2). Cryotherapy, Laser therapy, NMES, TENS, passive range of motion, and compression of the affected limb can assist in counteracting the effects of inflammation and edema. A combination of low-load sustained stretching, joint mobilizations of the patella and tibiofemoral joints, and modalities to control pain and resultant muscle spasm are commonly performed following CCL surgery.


Cryotherapy (Ice compresses) following CCL surgery provides an excellent method to help control pain and inflammation in the immediate postoperative period. Not only is cryotherapy beneficial in the acute phase of tissue injury and inflammation, it is also advantageous after exercise and throughout rehabilitation when inflammation occurs. The effects of cryotherapy include vasoconstriction, decreased blood flow, reduced cellular metabolism and permeability, attention of traumatic or exercise-induced edema, and decreased muscle spasm. Another primary effect of cryotherapy is analgesia, which is thought to be a result of decreased sensory and motor nerve conduction velocity that occurs when nerve fibers are cooled.

Table 3. Rahabilitation days 30-60
Cryotherapy following CCL surgery can be accomplished with a variety of methods. The simplest way is by placing crushed ice in a sealed plastic bag and than wrapping the bag in a thin towel. Alternatively, you can prepare a mixture consisting of two parts water and one part alcohol in a double-sealed plastic bag and place it in a freezer. The resulting pack should be frozen slush that conforms to any surface. Apply the cold pack to the stifle for 15 to 20 minutes immediately after surgery while the patient is still recovering from anesthesia. Be careful when applying cold packs to patients that are already hypothermic postoperatively. Following CCL surgery cryotherapy is used for the first three or four days to help minimize inflammation, swelling, and pain from surgery. Apply the cold compress for 15 to 30 minutes three or four times a day. Monitor the patient for discomfort, and assess the tissues periodically for signs of adverse effects such as white or pale areas. Do not use cryotherapy in patients with poor or absent pain sensation. Cryotherapy will be a valuable part of the home rehabilitation program once the patient is discharged (Tables 1-3).