188 Canine Sports Medicine and Rehabilitation
Except for the stretching routine, patients
start with three to four repetitions of each exer
cise if they are able, with the goal of working up
to 10 quality repetitions. Once the patient can
complete 10 repetitions with ease, the exercise
is made more difficult. Strength exercises are
undertaken 3 to 5 days per week. For the 3‐day
program, training is done every other day. For
the 5‐day program, the two days off should not
be consecutive. Proprioception work, weight
shift exercises (isometrics), balance work, and
stretching can be performed daily. Endurance
and cardiopulmonary work, when indicated,
are generally done every other day, alternating
with strength work. The high‐end athlete can
do some endurance work daily, but cross train
ing is suggested.
When to progress
A decision whether to advance the therapeutic
exercise program should made at each assess
ment of the patient. The frequency of assess
ments depends upon the individual patient.
Neurorehabilitation patients might make daily
progress while in the hospital, and then be reas
sessed at each return visit. The postoperative
orthopedic patient will generally be reassessed
every 2 to 4 weeks (Connell, 2010). The high‐
end athlete might take months to move to the
next level.
When it is clear that the current level of work
is not difficult for the patient, the exercise
should be made more demanding. The patient
may be tired when he gets done, but if he is
ready to play 30 minutes later, the therapist can
likely increase his activities. If the patient seems
tired during the rest of the day, the current level
of work should be maintained or slightly
decreased. If the patient is stiff or sore the next
day, or hesitant to work, the intensity of the
exercise should be halved and then slowly
advanced. Immediately after an exercise, the
patient’s posture and transitions should be the
same or better than they were before the exer
cise. If performing the exercise creates a decline
in posture, ability, or transitions, the repetitions
or frequency of the exercise should be reduced
or a less challenging exercise prescribed.Case Study 8.1 Cranial cruciate ligament insufficiencySignalment: 3 y.o. M/I Pitbull. Presented 4 days post
TTA, right.Clinical findings: Significant swelling with heat/inflam-
mation and restricted flexion, stifle; restricted flexion,
tarsus; 2 cm discrepancy in muscle mass with right
thigh smaller; feather weight‐bearing stance, right.Goals: Eliminate swelling, normal ROM stifle and tarsus,
even muscle mass, full weight‐bearing right pelvic limb.Therapy: Cryotherapy and PROM used to attain first
two goals. Therapeutic exercises used to attain last
two goals. Changes in status are noted.Week 1—leash walks in yard to eliminate q.i.d.
Week 2—Toe touch weight bearing; 3–5‐minute
walks b.i.d to q.i.d. with leashed activity in yard to
eliminate.
Week 3—Increased weight bearing; added 1–2 sit‐to‐
stand exercises to each leash walk, diagonal leg
left weight‐shifting exercises, and rocker board: 3
sets of 30 seconds b.i.d.Week 4—Walks of 0.2 to 0.3 miles, with a sit-to-stand
every tenth of a mile; three sets of 45 seconds on
rocker board.
Week 5—Walks of 0.4 miles, with 2 sit-to-stand
exercises every tenth of a mile, continued rocker
board, added cavaletti pole exercises (2 × 2′′
planks).
Week 6—Walks of 20 minutes b.i.d., with 3 sit-to-stand
exercises every tenth of a mile, cavaletti poles (2 × 4′′
planks), and weave poles 30′′ apart.
Week 8—Walks of 30 minutes b.i.d.; front feet on
chair, rear feet on cushion (with perturbations)
4 reps of 1 minute, 5 sit‐to‐stand exercises each
side of the street, weave poles 24′′ apart, con-
tinue cavaletti poles, add 3 feet on wobble board
and right rear stabilizing balance (3 reps of
45 seconds).
Week 10—Continue walks, weaves, sit‐to‐stands,
wobble board, and cavaletti poles; front feet on
ball controlling ball position 3 reps of 1 minute.
Week 12—Normal range of motion, even muscle
girth, no visible lameness, normal postures and
transitions. Discharged from rehabilitation.