As we know from prior discussions, cruciate injuries are extremely common in our canine friends. A complete cruciate tear causes instability in the affected stifle (knee.) What you see as an owner is that your dog doesn’t  want to put full weight, or in some cases, any weight on the leg with injury. In people, we know that this instability leaves them with a“giving way” sensation, creating a lack of trust that the knee will support them. This is likely true for your dog with the injured stifle, too. We know that there are many receptors in joints that provide information to your brain about where your body is in space. We call this body awareness or proprioception. Injuries to a joint create swelling, inflammation and this alters this body awareness. Longterm fibrosis or  scar tissue affects it too. This altered awareness can increase the risk of  additional injury.

One of our goals in physical rehabilitation is to improve this body awareness and proprioception when there is an injury to a joint, as in an ACL tear, to help prevent further injury. We want to enhance balance and improve body awareness. One of the best ways to do this is to provide sensory input in a controlled, but unstable, environment. Think balance disc here. BOSU ball. Peanut ball. Wobbleboard. Exercises that provide an element of instability are fabulous choices to enhance body awareness. The trick is doing these therapeutic exercises in a carefully controlled manner with supervision. Like anything new, your dog must learn what  we want him to do and then his body must learn how to do it. Some dogs are more aware than others. I think we have all seen those dogs that are like the proverbial "bull in a china shop." My first dog, Major, was like that. If I had  known then what I know now, I would have worked with him to improve that.Every dog has the ability to improve to maximize their potential.

Ultimately, working on proprioception is about safety. The exercise must be done safely, watching your dog's form and watching for signs of muscle fatigue,(which is when your dog is at increased risk for injury.) We want to safely increase body awareness to reduce your dog's level of risk for further injury.

Sometimes in my rehab practice, I am asked about a dog with a prior cruciate tear. These are frequently dogs that tore an ACL more than a year ago, and in some cases, many years ago. The dog may still be favoring the leg on occasion and the owner wonders if physical rehabilitation would help at this point in time.

The adage “old tear, no repair” is sometimes applied to these old injuries. What we mean by that, is that if the stifle is stable, then surgical repair is often not recommended. Remember the goal of surgery is to stabilize the knee to prevent “tibial thrust” or the movement of the tibia forward during movement or weight bearing. If there is no tibial thrust or instability to prevent, then surgery isn’t needed. In this case, your dog’s body has placed scar tissue, often large amounts of it, there to stabilize the knee. This occurs over time after an injury and when surgery was not performed.

But do these dogs need physical rehabilitation? Depends. If there is persistent muscle weakness then, yes, physical rehab will help. If there is osteoarthritis in the joint as a result of an old injury, then yes, physical rehab can help. If your dog still favors the leg, then yes, physical rehab can help. If your dog has not yet torn the other ACL, then yes, rehab can help. If your dog as just torn the other ACL, then yes, rehab can help. If your dog has no limping, no other issues, no pain and no apparent arthritis, then your dog probably doesn’t rehab for it. Your dog would benefit from a fitness program though. All of us benefit from a well designed fitness program. Physical rehabilitation can help prepare your dog for a fitness program too. There really is something for everyone!

I've mentioned before how cruciate ligament injuries are the most common injury to occur to a dog's stifle ("knee" for people.) A significant portion of my rehab practice is composed of rehabbing cruciate tears. Cruciate tears come in different forms, complete or partial, and partial tears come in different severities. Today, let's talk about partial tears.

First, how can you tell if a tear is partial or complete? The short answer is for your veterinarian or rehab therapist to feel the degree of instability in your dog's stifle. Sometimes your dog needs to be sedated for this, to overcome tight and tense muscles as your dog protects and guards an injured area. Veterinarians will usually recommend x-rays too. This is not to see the torn ligament, but to check for any small fractures or signs of bone infections. Joint swelling can be seen on an x-ray too (and usually can be felt in the joint if you know where to look for it.) So if the x-ray shows no other problems, and the stifle joint feels "loose" in a particular manner (called cranial drawer movement) the diagnosis is an ACL tear. A partial tear only shows this particular movement when the stifle is held in certain positions. Partial tears may be quite painful. Partal tears come in 3 varieties too: grade 1,2, and 3 depending on severity. All can benefit from physical therapy to some degree.

So how do you rehab your dog's partially torn ACL? Every patient is different, of course, and so your dog's rehab plan should be tailored to his or her needs and condition. However, there are some basic principles that apply to all. One, activity restriction. Your dog with a partial ACL tear should not be allowed to run, jump, wrestle, or otherwise play for the next 2-3 months. Yes, I said 2-3 months. And yes, I know its hard to restrict it but if you want your dog to get better, not worse (i.e. go from a partial tear to a full tear!) then you must figure out a way to do this. Two, your vet/therapist should use modalities such as laser therapy to increase the blood flow to the ligament to aid healing. Three, the adjacent muscles should be strengthened. Okay guys, this MUST be done in a controlled manner under the guidance of a vet or therapist trained in physical rehab. Doing the wrong exercise, or doing it at the wrong time, or doing it with the wrong form can lead to increased risk of injury. Four, work on balance and coordination. The same warning applies as for strengthening. Five, provide adequate nutrition for healing and strengthening. This is usually done in the form of supplements, including glucosamine, MSM and omega 3 fatty acids. However, again, your dog is an individual and your dog's individual needs should be evaluated.

Every dog is unique. Every rehab program is unique. The results vary for every situation. A partial ACL tear offers a good opportunity to try a conservative approach of physical therapy, though.

ACL tears, or cruciate ligament ruptures, are the most common cause of limping on a rear leg in dogs. There are 2 cruciate ligaments in each stifle (knee for people) but its the cranial or anterior one that usually tears. While not a life-threatening injury, for the sake of the dog's quality of life it must be addressed.Treatment for complete cruciate ligament rupture, or full tears, is usually surgery to stabilize the knee. There are several different surgical procedures.

But what if surgery is not an option? What if the anesthesia is too risky because the dog has another condition, like heart disease? Or what if the owners are not able to afford to have the surgery done? Repairing a ruptured cruciate ligament is a major orthopedic procedure, ranging from $1000-$3000 depending on what surgery is done and who does it. Or what if the owners, for other reasons, have decided that they are not going to do surgery? Can we still help their dog, or is it condemned to a lifetime of pain and suffering?

The short answer is that I can help them all to some degree. Those dogs with meniscal injuries as well as an ACL tear should still have surgery, but partial tears and even full tears, surgical or not, can benefit from physical rehabilitation. We can help improve their function, their strength, and maintain the joint's range of motion in many cases. We can help prevent partial tears from becoming full tears. Without surgery, rehab is really the only chance to help these dogs.  And if a dog has had surgery then post-op therapy is still recommended for both the injured leg and the good leg ,as most dogs will tear the ligament in the other knee within 2 years. Rehab should definitely be part of the treatment plan for any dog with a torn ACL. I will discuss cruciate disease in more detail is weeks to come.