Front Matter

Chapter 15 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Pelvic Limb 401

● Core stabilization: diagonal leg lifts with
and without perturbations, side sit-ups, and
weave pole walking
● Reflexive hamstring training: perturbations
with the involved limb on a fit disc with the
thoracic limbs elevated, and backward
walking on a foam mattress
● Advanced proprioceptive training: walk-
ing backwards over a ladder, side stepping
over cavaletti poles, and standing on a
physioball.

Home exercise program:

● Per stage of recovery
● Weight management
● Modified activity.

Surgical rehabilitation

The initial stages of postoperative rehabilitation
will focus on controlling swelling, encouraging
ROM, promoting weight bearing, initiating
muscle re-education, and educating the client
regarding activity modification. Protec ting the
joint for proper bone healing must be empha-
sized with osteotomies. Preventing falls or
slips is important and can be avoided with
the use of non-skid throw rugs or mats for
stable footing. Crate confinement when unsu-
pervised is suggested.

Common findings on physical therapist’s
evaluation

● NWB to PWB gait
● Sitting with 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.

Treatment rationale

This depends on the type of surgery performed.
For example, a primary concern post osteotomy
is activity modification that ensures good bone
healing. Human research supports the use of
NMES in the early stages of rehabilitation as a
means of preventing muscle atrophy and

weakness (Hasegawa et al., 2011). The early use

of eccentric muscle contractions (as compared

to a standard strengthening protocol) was

shown to increase quadriceps and gluteus

maximus muscle mass and function over a

1-year period of time (Gerber et al., 2009).

Additionally, the use of perturbation exercises

has been shown to enhance recovery by improv-

ing coordinated muscle activity (Chmielewski

et al., 2005; Risberg et al., 2007).

Treatment goals

These are the same as those of nonsurgical

rehabilitation:

● Decrease pain and inflammation

● Normalize ROM

● Normalize flexibility

● Achieve FWB

● Strengthen thigh, gluteal, and core

musculature

● Develop HEP.

Treatment by goal

These are the same as the nonsurgical goals with

the exception of greater activity restrictions for

bone healing.

Gastrocnemius avulsion/calcaneal

tendon injury

A gastrocnemius avulsion is often the result of

an acute event; however, chronic degenerative

calcaneal tendinopathy is common. The classi-

fication of calcaneal tendon lesions according to

Meutstege (1993) is shown in Table 15.4.

Common findings on physical therapist’s

evaluation

Partial rupture

● Standing posture reveals tarsal hyperflexion

● PWB/antalgic gait with shortened stance

phase

● Tenderness to palpation of the calcaneal

tendon

● Thickened calcaneal tendon

● Pain with stretch of the gastrocnemius.