The Pet PT Pit Stop: “All or None, or Partial?” (Part 2 of 3-part series on Cruciate Ligament Tears)

by Susan E. Davis, PT “pull in for a helpful refuel!”

It’s all about guiding and empowering you to help your dog avoid injury, provide practical solutions and achieve rapid restoration of health and function!

Last month I covered the prevention of cruciate ligament tears, a topic of prime concern with any canine species at-risk.

In some cases, despite efforts to prevent tears, they still occur.

To review the mechanism of injury, I remind the reader that the cruciate ligament tends to tear gradually in dogs, compared to human beings.

As humans are bipedal, upright walkers, the knee’s anterior cruciate ligament is situated horizontally in relation to the ground and is less affected by gravital force. Therefore human ACL tears occur acutely, suddenly and fully, usually due to trauma.

In canines, tears are typically slow and occur with gradual degradation, followed by complete rupture.

Well, usually followed by complete rupture, but not always.

If diagnosed and treated early, many pre-tears and partial tears can be prevented from becoming full, complete tears. Obviously this can help the dog greatly with their function and save the owner major financial expense.

Diagnosis of CCL tears is made through observation, the performance of a drawer test, and with the help of radiographs and MRI.

The drawer test is performed by a therapist or veterinarian, using their hands.

The test becomes positive if the tibia slides too far forward, such as a drawer being pulled out from a chest or cabinet. Grades 0-5 are assigned, according to the amount of excessive tibial movement demonstrated in the test, in millimeters. A score of 0 means no tear; score 1-2 indicates a partial tear, and 3 is a partial to nearly-full, 4-5 indicates full tears.

Can a physical therapist make this assessment?

Yes, an experienced one can, but they will likely ask you to see the veterinarian for confirmation especially if they find a score of 3-5. If the dog has a score of 1-2, indicating a slight or partial tear, non-surgical treatment in indicated. Initial rest, use of medications prescribed by your vet (for pain, inflammation), physical therapy treatment, and braces or wraps can be used.

The use of laser therapy is very beneficial to facilitate healing at the tear site, and relieve pain and inflammation.

I must clarify that laser therapy will not regenerate new ligament tissue nor help the torn part of the CCL to reattach. Rather, cold laser helps strengthen and firmly bind the residual part still intact. It also helps form good scar tissue over the torn portion, giving tensile stability to the joint.

I have treated many dogs having partial tears with an initial drawer test of Grade 2-3, become reduced to Grade 1 or even 0 after several sessions of PT.

Most all of the cases I see with partial tears, that are rapidly diagnosed and treated early, are successful. In very rare instances have these cases go on to become full tears.

A typical example of physical therapy treatment for partial CCL tears consists of:

Laser therapy over all sides of the stifle joint
Ultrasound, and/or shock wave therapy, but cold laser is by far the most effective.
Electrical stimulation in various formats: functional stim (FES) or NMES, over the thigh musculature if there is loss of tone and bulk (also called atrophy). Transcutaneous electrical stimulation (TENS) is effective for the reduction of acute pain.
Manual techniques to increase blood flow to the injury such as massage and Reiki.
Range of motion exercises to maintain mobility of the stifle and to prevent tightness.
Strengthening to the hip and thigh musculature through sit to stand exercises, weight shifting, limb lifts, controlled leash walks on level and inclined surfaces, controlled weight bearing with the dog placed over a physio roll, resisted exercises by a therapist using cuff weights, weighted sleds or therabands.

Activity restriction must occur during the initial stages of healing as instructed by your veterinarian and therapist.

This may include temporarily keeping toe dog off wood floors and placing carpet runners, restricting access to staircases, blocking furniture which the dog would normally jump on or off of. If there are other pets in the house it may be necessary to separate them for a week or so to avoid heavy playing and contact interaction. As the stifle joint regains tensile strength, assessed by your therapist repeating the drawer test, you can gradually increase to full activity.

In addition to therapy, products such as Dr. Buzby’s Toe Grips, stifle braces and soft stifle supports can help eliminate stress on the healing ligament.

Similar treatment options are used for dogs with complete or full ligament tears that cannot undergo surgery due to advanced age, seizure disorders, or medical conditions which pose a high risk for anesthesia.

***

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program. She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ. Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”. For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.

Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.