Blue presented to the SMART Veterinary Clinic for physiotherapy and rehabilitation of her left pelvic limb in August of this year. Historically Blue has been an active dog. She unfortunately suffered an acute non-weight bearing lameness of the left pelvic limb and was diagnosed with cruciate injury with her first opinion veterinary practice and was referred for surgical stabilisation with Bristol Veterinary Specialists. A left tibial plateau levelling osteotomy (TPLO) surgery was performed and Blue’s recovery was unremarkable. She was referred to ourselves to help improve her mobility on the affected limb and to help protect the functionality of the opposing pelvic limb. In post-cruciate injury cases, it is very important to establish even weight bearing in all four limbs to help prevent injury on the opposing limb as well as to help to encourage appropriate neuromotor activation quality in the surgical limb which ensures the best possible outcome of recovery from surgery.
On Blue’s initial assessment with ourselves (three weeks following her surgery with BVS) she demonstrated a Grade 1/6 lameness in the left pelvic limb but was confident in her weight bearing (no toe touching). With challenge, she would fatigue quite quickly and trended towards a cranial focus in her centre of gravity and a kyphotic spinal posture to compensate for ongoing weakness/fatigue in the surgical limb. On physical examination, her surgical site had healed quite nicely and there was no discomfort over her implant. There was appreciable diminishment of the left pelvic limb muscle groups (particularly over her quadriceps and hamstrings). Blue visited our clinic weekly to fortnightly for hourly appointments which included acupuncture, soft tissue massage, laser therapy and gait training in the treadmill. Each appointment evaluated her progress in her pain scores, lameness, and muscle development globally which helped us to adjust her recommended home exercise and walking routine accordingly to her progress. Initially Blue responded quite quickly to her treatment plan (with resolution of lameness); however, she began to plateau in her ability to maintain strength in the affected limb with prolongation/increase of challenge of exercise. To help address this, Blue began to attend her visits as an inpatient with ourselves to focus more intensely in her gait training aspect of her treatment program. Inpatient appointments afford us time through the day to introduce multiple opportunities for gait training in the treadmill, as well as additional input from our physiotherapy team to work on a patient’s exercises throughout the day.
Blue has responded quite well to this adjustment, overcoming her plateau, and enjoying increased levels of exercise without losing her achievements in movement quality, posture and low pain scores. Blue is well on her way to her graduation! She is being re-evaluated this week coming to be officially signed off from regular treatment sessions and will enter into a maintenance phase of her treatment to help Blue maintain her previous achievements to hopefully decrease future risk of cranial cruciate injury of the opposing limb. Each of these additional inputs will help Blue to enjoy an active and pain free lifestyle as well as to be protective of her other stifle joint. Blue was a really good example of excellent compliance and dedication of her humans in her home exercise program in addition to the adjustments made in her in clinic treatment which has led to a very positive outcome of recovery.