VN April 2021

Vetnuus | April 2021 26 Weeks 5 – 8 Early Strength Training 1. Encourage full ROM. 2. Enhance normal gait and weight bearing. Add obstacles to the walking sessions or develop specific obstacle course session where the dog must walk around and over various obstacles. Add uphill walking and diagonals on the slope. 3. Increase motor control (neuromuscular training) and strength. This phase of rehabilitation is during the remodelling and strengthening phase of tissue repair so the aim is to minimise scarring, improve flexibility, relearn fine proprioception and build strength at a stretch. Weeks 9 – 12 Intense Strengthening Increase strength and motor control. Continue the exercises that are the most challenging. Introduce trotting on the level and recall running between two people. Increase time and duration of exercises as the dog is able. Many rehabilitation programs stop at this level and in some cases before this stage. The decision to stop will be based on the client’s goals and the work (or not) the dog must perform. Pain management is non-negotiable. Use medications and modalities in a multi-modal approach until healing is complete. These can be decreased when the dog is accomplished in the exercises. The land-based program with weight bearing is functional rehabilitation. This program builds bone and soft tissue strength. Increased thigh muscle mass supports the stifle and improves function. Exercise promotes the strengthening of correct and appropriate scar tissue to stabilise the joint yet maintain flexibility. Other considerations Other considerations in the conservative management of CCL deficiency are the use of orthotics/braces, platelet rich plasma (PRP) or prolotherapy. The use of custom-made orthotics can assist the affected limb following injury (or surgery) and the brace may be temporary or permanent. The custom-made assistive devices are hinged and made from a mould of each individual patient. Custom stifle braces can be used in dogs with bilateral CCLD to support the non-surgical limb, on juveniles whilewaiting for surgery or in cases wheremoney needs to be saved. These braces can be used post-CCL surgery but also have a role to play in management of non-surgical candidates. The benefits of custom orthopaedic braces include: • Enhanced sense of joint position/proprioception • The injured limb can relax and fatigue in that limb is reduced • Provides a small measure of mechanical protection against impact • Allows muscles time to react and control following the injury Cranial Cruciate Ligament Disease – Non-Surgical Management Part 2 Tanya Grantham