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The quicker the dog starts to use their limb, the easier the recovery. The underwater treadmill may be started at suture removal or earlier, depending again on the integrity of the incision and the comfort level. The level of the water may be brought up to above the stifle to decrease the stress on the limb. Progressions of therapy will include balance and proprioceptive exercises, range of motion, theraball work, cavaletti rails, walking on a land treadmill, figure eights, controlled jogging and ball playing and a restoration of activities. Total hip replacements will follow a similar protocol but a strong respect for the prosthetic implant needs to be adhered to and this will depend upon the type of procedure. Many of the dogs that come in for rehabilitation have not had surgery – and are being treated conservatively. Pain management is again key and should be adhered to with a multimodal approach. Modalities such as laser therapy, moist heat, and electrical stimulation will assist with the pain control. The lumbar spine, stifles and thoracolumbar area should be examined for compensations due to the decreased movement in the hips. And the forelimbs should also be examined for compensations. Once the pain is under control, balance and proprioceptive exercises are very important. Simple weight shifting may be performed initially to assist with the weight bearing motions. It may then be progressed to balance equipment. Range of motion and stretching exercises should be performed, and maintained in the pain free range. Joint mobilization is very helpful in restoring range of motion and assisting with pain free range of motion and function. Walking in the underwater treadmill, swimming, and possibly land treadmill are beneficial in assisting with the maintenance and increase in strength.
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