After 10 years in the business and practice of small animal physical rehabilitation, one of the most prevalent diseases our facility treats is canine hip dysplasia (CHD). The hip dysplasia patient can be post-op, older and arthritic or under 12 months of age and in pain.
The most common surgical CHD patient is one that has undergone a femoral head and neck excision arthroplasty. The patients that come through our doors within 2 weeks of the surgery (or for prehabilitation) recover the fastest although return to full function can still be challenging. Those that present for rehabilitation when there is severe atrophy of the pelvic limb musculature follow a longer course of therapy. The dogs undergoing a total hip replacement usually undergo 3 - 4 months of physical therapy, which only begins about 6 weeks after the surgery.
Those dogs with severe degenerative changes of the coxofemoral joint are managed differently. Whilst development of the muscles of the hind limb is important for the support of the joint, much of the therapy focuses on management of chronic pain. This is a multimodal approach and photobiomodulation (in the form of low level laser therapy), therapeutic massage, acupuncture and hydrotherapy play a large role and are applied in conjunction with NSAIDs and analgesics. These modalities are important when managing the pain associated with secondary compensatory changes. The active exercise used to strengthen the muscles is more successful when the pain is under control. With less pain the focus can move to repatterning a more normal gait pattern.
The juvenile dog with CHD is becoming more prevalent. Aside from management of pain, it is important to focus on the development of those muscles which support the hip joint. These are primarily the gluteal group. However, due to poor extension of the pelvic limb the hamstring group is also underdeveloped and shows poor tone. Goniometric measurements are taken at the initial assessment, as well as bilateral thigh circumference at different levels. These are used to objectively assess progress. The client is often reluctant to have surgery performed on their young dog. A physical rehabilitation program can aid in preventing surgery but, in the event that the pain is not managed, the dog will have had the benefit of a program prior to surgery. With an increased muscle mass, the recovery is quicker. The client has been afforded time to grow accustomed to the idea of surgery. Should the dog respond well to therapy then the referring veterinarian is considered in a very favourable light.
The final factor to mention regarding juvenile CHD is that the sooner the disease is diagnosed (or even suspected) the more of an impact can be made using physical rehabilitation techniques. The long term positive effects are far reaching. Appropriate therapy will strengthen the supporting muscles and aid in their development. The knock-on effect is a more stable joint and slower development of DJD. The dog is happier (that’s our business as vets) and so the client is satisfied, and more likely to continue to use your services.