Front Matter

400 Canine Sports Medicine and Rehabilitation

Stifle joint biology and biomechanics are key
contributors to CCL disease and should be
addressed in rehabilitation. Specifically, joint
biology is addressed with modalities to decrease
pain, promote tissue healing, and reduce inflam-
mation and swelling. Laser, TENS, and grade
I–II joint compressions are effective tools for
achieving these goals. Biomechanical concerns
regarding joint stability are addressed with ther-
apeutic exercises to strengthen the dynamic sta-
bilizers of the stifle and the core stabilizers.
Retraining the proprioceptive feedback loop is
essential after disruption of a ligament.
Treatment goals for surgical and nonsurgical
CCL rehabilitation are generally quite similar
with the exception of important differences
during the early stages of rehabilitation. With
osteotomies, early treatment must allow for
proper bone healing by promoting weight bear-
ing in the sagittal plane, and promoting healing
with the use of modalities and activity restric-
tion. Early rehabilitation of the nonsurgical case
will depend on the acuity of the injury.
Therapeutic exercise can be accelerated so long
as pain and inflammation are not increased.

Nonsurgical rehabilitation

Common findings on physical therapist’s
evaluation

● Positive cranial drawer and/or cranial tibial
thrust test
● NWB to PWB gait
● Abnormal sitting posture (hip abducted
and stifle partially extended)
● Swelling
● ROM limited and painful at end range stifle
flexion and extension
● Compensatory tightness of gastrocnemius,
hamstrings, sartorius, and iliopsoas
● Disuse atrophy throughout the involved
pelvic limb.

Treatment goals

● Decrease pain and inflammation
● Normalize ROM
● Normalize flexibility
● Enhance proprioceptive awareness
● Achieve FWB gait
● Strengthen quadriceps, hamstrings, and
gluteals

● Promote core stabilization

● Develop HEP.

Treatment rationale

A nonsurgical, partially torn CCL warrants par-

ticular attention to reflexive training of the

hamstrings with advanced proprioceptive

work. In so doing, the hamstrings can help to

substitute for the dysfunctional CCL.

Treatment by goal

Decrease pain and  inflammation. Use ice, laser,

NMES, TENS, joint compressions, and STM.

Normalize ROM. Grade III stifle joint dis-

traction, grade III–IV caudal glide of the

talus, PROM (emphasis on stifle flexion and

extension and tarsal flexion), walking over

high cavaletti poles performed at mid-tibial

height

Normalize flexibility. Muscle stretching with

simultaneous STM of the muscle being

stretched (hamstrings, gastrocnemius, sarto-

rius, iliopsoas).

Achieve FWB gait. Examples of progressive

exercises are:

● Joint compressions (NWB and weight-bear-

ing positions)

● Weight-shifting exercises

● Low cavaletti walking

● Slow walking with head elevated

● Circle walking (involved leg to the inside)

● Three-leg stands; lifting the uninvolved pel-

vic limb; head must be elevated

● Balance activities such as placing thoracic

limbs on a wobble board.

Muscle strengthening. Initial use of NMES

for muscle re-education of the quadriceps,

gluteals, and hamstrings performed in

NWB  or weight-bearing positions. Example

exercises:

● Gluteals, quadriceps, and hamstring muscles:

sit-to-stand transfers while facing uphill,

backward walking up an incline, and unilat-

eral step-ups onto a block