Friday, March 26, 2010

Hip dysplasia and physical therapy for dogs

Hip dysplais is very common in dogs, in particular in large breeds such as golden retrievers, mastiffs, rotweillers, saint bernards, and labrador retrievers.  Canine hip dysplasia is an orthopedic malformation of the hip joint, which leads to looseness in the joint. This laxity in joints can cause pain  (particularly with hip extension, which is when the dog stretches the leg back hehind him/her and with increased weightbearing, such as when going upstairs).  The laxity often causes increased wear and tear on the joint, which can result in cartilage damage over time.  Arthritis often sets in, and when it does, it can become very painful and result in extreme limping.  A dog may choose to lie around, not want to play fetch as much, and may choose to not go upstairs anymore.  If very severe, the dog may choose to not even use the leg. 

If you see any of these signs, your dog might have hip dysplasia:  decreased activity; difficulty rising after lying down for a while; hind limb lameness or limping; reluctance to use stairs, particularly to go up; reluctance to jump or stand on hind limbs; bunny-hopping gait; a waddling gait; or pain if you try to move the hip/leg back behind in the dog into the motion that is called hip extension. 

If your dog has hip dysplasia, there are a few different surgical options.  But, I have found that physical therapy can make a massive difference in these dogs and in many cases, surgery can be avoided.  When I say "physical therapy" in this case, I am referring primarily to a specific exercise program tailored to your individual dog's needs.  Typically, the exercise program is followed daily or every other day.  But, it really is based on the dog's tolerance - how he/she responds to the exercise type and amount.  If implemented very thoughtfully and carefully by an experienced canine physical therapist, this type of program can be extremely effective. 

The exercise program involves choosing the best type(s) of exercise and slowly increasing the amount, all while "listening" to the dog about how it feels to the hips (both during and after the exercise session).  It also involves regular exercise sessions as opposed to the "weekend warrior" mentality of doing nothing during the week and then a lot on the weekend.  The exercise program, in many cases, can be as simple as starting with a short walk on a leash.  This might be a one minute walk for a very deconditioned, obese, or painful dog.  Or it might be 5-10 minutes for another dog.  It's all dependent on previous activity level, the current conditioning level of the dog, how he/she responds to it, and other factors.  The surface the dog walks on is relevant too.  And almost always, part of the program is to eliminate all of the irritating activities the dog is currently doing that result in pain and inflammation.  Your dog's physical therapist can explain these irritating factors in detail. 

In a nutshell, the pain-inflammation-pain cycle needs to be broken, while also increasing the exercise to strengthen the muscles around the hips.  If we can strengthen those muscles around the hips, that adds stability to the joints and can often be enough to prevent the need for surgery.  But, the muscles need to gain strength via increased exercise and it is necessary to maintain that strength with a maintenance exercise program for life.  The trick is to break the cycle of irritation and find an exercise that works for your dog (without causing further irritation).  Many - I would say, most - dogs can do this by leash walking.  But, for some dogs, the weightbearing is just too painful and causes too much irritation for the joints.  Swimming is an excellent type of exercise for dogs who really need a non-weightbearing form of exercise.  Swimming is actually great for almost all hip dysplasia dogs.  But, my point is that swimming is not always necessary.  Many people do not have access to a place to swim their dogs.  So, just know that in most cases, it is do-able to implement an effective exercise program for dogs with hip dysplasia with walking as the primary form of exercise. 

I often use massage and icing with these dogs too.  Massage because it simply feels good and relaxes the muscles.  And I use ice when the dog shows an increased pain level, which can happen if we do too much exercise too quickly, if the dog gets off leash and runs after that squirrel, if the dog tweaks the hip somehow, etc.  Sometimes when pain and inflammation flare up, we have to begin icing and back off the exercise and then once better, reassess the situation and readjust the type and amount of exercise.  It's definitely a trial and error type of situation - but in my experience, with a commitment to figure it out and follow through with the exercise prescriptions, most dog owners end up happy and so do their dogs! 

I have to say though that dogs tend to do really well with the FHO (femoral head osteotomy) if the pain is just too great and surgery is necessary.  From my experience, extreme care needs to be taken when considering a total hip replacement for your dog.  Different surgeons have different techniques and varying success rates.  So, do your research!  I would just suggest trying the physical therapy/formal exercise program first.  And if it doesn't work out, surgery can be a good second choice.  My 12-year-old golden, Tucker, is still truckin' along and he was diagnosed as a puppy with an extremely severe case of hip dysplasia.  Being an avid tennis ball fetcher made his hips really strong and prevented the need for surgery!  This is actually a good example for us.  He built up to about 10 minutes of running after balls.  That was usually his limit.  If we did more, he got sore.  So, for years, we did 5-10 minutes of running after balls, twice per day.  That is what worked well for him.  But, remember that every dog is different!  A slow 30 minute walk each day may be what works for your dog.  You just don't know until we try different approaches and find something that works.  But, with a great dog owner who is committed to figuring it out and keeping a log to track the exercise and dog's tolerance level, it can usually work out well with just one initial visit, regular contact via phone or email with your physical therapist to make adjustments to the program as needed, and occasional checkups (perhaps weekly for the first month and then less often once a good program is established).  So, it is also a very affordable approach in comparison to surgery!

This is a topic that I could write endlessly about - there really are so many factors to go into the mix, which is why I recommend an experienced canine physical therapist to help you achieve success with your dog! 

Best of luck!  Post comments if you have questions or comments.  Thanks!

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