348 Medical Management of Cruciate Ligament Rupture
therapeutic exercises are not possible. Massage,
passive range of motion, and stretching are
used to decrease edema and promote motion
between tissue planes to improve and main-
tain mobility. Therapeutic exercises are per-
formed under controlled conditions with ther-
apeutic purpose. Purposes of exercises include
promoting limb use, strengthening, improving
joint and soft tissue mobility, promoting core
strength, promoting proprioception and bal-
ance, and eliminating weight shifts. Exercises
are adapted to the stage of recovery. During
the early postoperative period, exercises may
include static exercises (isometrics), slow walk-
ing, or exercise in water where loads placed on
joints are decreased.
During the subacute and chronic recovery
period, the intensity of exercises increases.
Exercises performed without difficulty are
often replaced by new exercises that offer
reachable challenges. Leash walking is the most
universal exercise. Leash walks can be adapted
during recovery by changing the support and
constraint, the position of the handler, the
intensity (speed), duration, and frequency.
Other exercises are similarly adapted to the
stage of recovery and to the patient (Fig-
ure 42.6). Exercises are often introduced in a
rehabilitation environment and, once the dog
is familiar with them and once the owner is
taught to exercise their dog, they evolve into
home-based exercises. Aquatic exercises in an
underwater treadmill offer unique advantages
over land-based exercises that make them par-
ticularly suited for dogs with limited mobility.
Underwater treadmill therapy can provide
the most comfortable ambulation assistance,
decrease loads resisted by joints, and assist
with a gradual transition to normal weight
distribution when standing and walking.
Swimming is sometimes used in for reha-
bilitation of dogs with CR, but the intensity
of swimming varies greatly among dogs. Dur-
ing the early postoperative period, swimming
with high intensity could negatively impact
a surgical repair or create soft tissue inflam-
mation, such as patellar tendonitis. Because
of its unpredictable intensity and variation in
mechanics, swimming is best used during the
subacute and chronic phases of rehabilitation,
and is not recommended in the early postop-
erative period or initial healing period in dogs
managed without surgery. Some dogs use all
Figure 42.6 A Belgian Malinois that underwent a left
tibial plateau leveling osteotomy is standing with thoracic
limbs on an exercise ball and pelvic limbs on a balance
board. The exercise promotes symmetrical pelvic limb
weight-bearing, promotes hip and stifle joint extension,
challenges proprioception, and activates core muscles.four limbs when swimming, while others pri-
marily use their thoracic limbs, keeping their
pelvic limbs flexed. Stifle extension is limited
during swimming. In one study, the mean sti-
fle extension observed while swimming in dogs
recovering from CR stabilization surgery (∼ 95 ◦)
was outside the range of motion used by these
dogs while walking (∼100–135◦)(Marsolaiset al.
2003). This suggests that swimming is a logi-
cal strategy if extension during exercise is not
desirable because of pain, but is unlikely to be
an effective strategy to regain stifle joint exten-
sion and increase quadriceps strength after CR
surgery. The intensity of the swimming activity
and use of the pelvic limbs should be controlled
by the therapist, and unsupervised swimming
should be avoided.
Ambulation assistance is part of the over-
sight provided by rehabilitation. Dogs that
have difficulty standing or walking during the
recovery phase benefit from wearing a support
harness (Help’Em Up; Blue Dog Designs, Den-
ver, CO, USA) or the use of a chest harness and