Learn & Go With Dr. Laurie
How to Prevent a Cranial Cruciate Ligament (CCL) Rupture
This is the first part of preventing Cranial Cruciate Ligament (CCL) rupture, and I’m showing you the first two signs that a dogs CCL is in danger of rupturing. Both in regards to inflammation.
Let’s discuss two key indicators that may suggest risk that a dog's Cranial Cruciate Ligament (CCL) will rupture; joint fluid thinning and increased volume of fluid in the joint. In our video, I will show you how to test for each of these indicators.
Cranial cruciate repair is so common now that 50-85% of all canine orthopedic surgeries performed each year are to repair ruptured CCLs, making it the most common orthopedic surgery done by orthopedic veterinary surgeons.
When I graduated from veterinary school in 1992, CCL tears were typically believed to be caused by trauma. However, today, we see that breakdown of the ligament, secondary to inflammation, is more frequently to blame.
Following that train of thought, if we can minimize or eliminate inflammation in the stifle, we can reduce the likelihood of a dog sustaining this painful injury and requiring surgery.
The first indication of inflammation, joint fluid thinning, is similar to a car's oil that does not perform optimally when it thins out. Joint fluid's primary role is to cushion the joint. It is thick and viscous and allows cartilage surfaces to glide next to each other smoothly as the joint flexes and extends under pressure.
When this cushion of joint fluid thins, the cartilage surfaces grind against each other. This results in the wear and tear of healthy cartilage and the release of chemicals that cause even more inflammation and further thinning of the joint fluid.
These chemicals that are released cause continuing breakdown of the CCL, allowing fibers to rupture bit by bit, until a partial or full CCL rupture has occurred.
Additionally, as cartilage wears away, an inferior cartilage matrix may develop to fill the gap, which is more prone to damage, and so the cycle continues.
Ideally, we want to find and stop this cycle of degeneration and inflammation as soon as possible. The test I show you in the video is the perfect way to identify the problem so we can break the cycle early.
They can be performed by veterinarians and pet parents, alike, so be sure to watch as I explain exactly what to look for.
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Consider Cavaletti Jacks for Great At-Home Strengthening and practice
How to Prevent The #1 Cranial Cruciate Ligament (CCL) Complication
There is an often overlooked CCL injury and/or surgery complication. Because most people don’t know about it , it goes untreated and increases the chance that the dog will tear their other CCL 12-18 months after they tore the first.
We’ve been talking about issues related to and how to prevent cranial cruciate ligament (CCL) tears. Today, we’re continuing the CCL discussion, but I want to introduce the number one complication related to CCL surgery that is overlooked.
If I were to ask you to list the most common surgical complications, you’d likely come up with infection, hemorrhage, shock, blood clots. These are common and problematic. But when we talk about cranial cruciate injury or surgery, there is something we must specifically look for because unless we do something to stop it, every dog that has a cranial cruciate injury or surgery has this happen. And when it does, it increases the chances that the other cranial cruciate ligament will be injured.
The #1 cranial cruciate injury or surgery Complication is Range of Motion Loss
The most common things we see with CCL injury or surgery is loss of flexion of the hock and extension of the stifle. This may not seem like a big issue, but it can lead to something much worse. It can be a factor in the tearing of the opposite CCL. Remember, 25-50% of dogs that tear one cruciate will tear the other in the next 16 months.
It makes sense, every time a dog sits, they flex their hock. When they flex the hock, the tibia is pushed forward, straining the cranial cruciate ligament fibers. If some of the fibers are torn, it puts added stress on the remaining fibers, causing pain. If the whole ligament is torn, it puts abnormal stress on the joint capsule as the tibia slides forward, also causing pain.
To prevent the pain, dogs will decrease the amount they are willing to flex their hock. To keep the hock at 90 degrees instead of 30-45 degrees of flexion, they will hold the limb forward as seen by the tip of the toes being ahead of the other side. They will hold the leg out to the side, and they may externally rotate the leg with their toes pointing out. They then shift their weight off of the leg which had the cruciate injury onto the other side. The healthier leg is held medially, or toward midline when standing, has added weight on it when they are sitting and laying down, and has added stress at the joint when they rise into a stand. This puts added stress on the knee on the good side, causing inflammation. It is the inflammation that causes stress to the cruciate ligament that can then cause the sprain or tear on the good side.
Early warning signs of trouble in the “good” knee
Thinning synovial fluid and then effusion. In this series we will discuss how anyone can check for effusion and the most sensitive way to assess for thin joint fluid. Watch for that post.
How to Assess and Treat Range of Motion IssueS
Assessing a dog’s range of motion is easy with a Goniometer. With some specific manual therapy and/or some passive range of motion exercises, we can keep available motion in the normal range or return it to normal quickly when it is lost. I touch on this briefly in this video, but will go more in depth in a couple weeks.
How to perform passive range of motion correctly
It is super important to work on flexion and extension of each joint independently to prevent putting excessive strain on some of the joints without benefiting the restricted joints. Some joints may be hypermobile (having too much motion) and they can actually become even more hypermobile or overstretched, to compensate for the hypomobile joint (a joint that has restricted motion) when several joints are motioned at the same time. This can lead to an injury at the hypermobile joint and not change the range of motion of the restricted joint. We never want to stretch a joint in the direction of its hypermobility. We do want to perform passive range of motion if there is restricted motion, to normalize it.
We always want to work within the dog’s comfort level.
There are rare instances that we want to increase tarsal extension. If this is done indiscriminately, we can cause irreversible damage.
The 90 Second Rule
To increase flexibility (muscle related) or range of motion (joint related), we stick to the 90-second rule. That means flex or extend the joint that has lost flexion or extension in either two sets of 45 seconds, three sets of 30 seconds, or my favorite, 10 sets of 10 seconds. I know this adds up to 100, but it’s easy to remember and works really well.
If you aren’t a subscriber, be sure to sign up now HERE so you get the latest updates straight to your inbox, and always feel free to pass along to anyone who might benefit from this info!
Consider Cavaletti Jacks for Great At-Home Strengthening and practice
Dr. Laurie Featured on the Petability Podcast
This week, Dr. Laurie was featured on the PetAbility Podcast with Cathy Symons CVT, CCRP, and Chris Cranston MPT, CCRP.
How to Improve your Geriatric Dog's Healthspan & Lifespan – with Dr. Laurie McCauley
This week, Dr. Laurie was featured on the PetAbility Podcast with Cathy Symons CVT, CCRP, and Chris Cranston MPT, CCRP, to talk about geriatric dogs and using an exercise program to extend their optimum life.
She answered the questions
When is my dog geriatric?
What happens to my dog's body and brain with aging?
How can I positively prevent or reverse some of the natural effects of aging?
How to perform Rhythmic Stabilization, one of Dr. McCauley's Top 5 Exercises for Geriatric Dogs.
Signs to look for before, during , and after exercise
How to create an exercise program for your dog?
What is Myos and how can this supplement help build muscle?
The Top Starter Exercise for Athletes
Learn the best exercise to start with athletic dogs. Understand how to perform it correctly, decrease the chance of injury, and help make Your dog, and your patients, stronger, faster, and smarter.
Do you have a canine athlete? Or do you work with canine athletes? If you answered yes to either of these questions, you are going to want to watch this video.
This is one of the first exercises I teach to all of my clients who have athletic dogs. And I guarantee you would be amazed at how many athletes can't do this exercise or can't do it correctly.
With the help of a peanut ball this single exercise strengthens the rear limbs, the core, and the front limbs. It also stimulates the brain in a way that very few exercises can.
In this video, I'll teach you how to choose the correct size ball, I explain the importance of the dog’s and your positioning, and I give viewers a sneak peek of what this exercise could lead to – the ninja dog.
Learn to perform this exercise correctly, decrease the chance of injury, and help make your dog, and patients, stronger, faster, and smarter.
If you have ever done ball work with a dog, you will find that dogs learn how to cheat. If you've never done ball work, then you likely don't know what to look for, giving your dog more room to "cheat" and maybe even setting them up to fail.
When done correctly, this exercise can strengthen a dog's whole body and engage the brain.
By strengthening the rear limbs in this manner, we are targeting the muscles for propulsion, power, jumping, and speed.
When done correctly, this exercise strengthens the muscles that support the carpal joints/wrists, elbows, and shoulders while putting less stress on the joints than if the dog were walking on the ground.
So many working dogs, especially agility dogs, have acute or chronic repetitive stress injuries of the carpal, elbow, and shoulder joints. This exercise allows us to strengthen the tendons and ligaments that support these joints without any of the stress seen with so many other exercises.
Can laser help CBD work better?
Can laser and CBD work together to help more?
When I was speaking at the Veterinary Encouragement Conference earlier this year on Therapeutic Exercises and Laser Therapy, I got a great question: Can laser help CBD work better because of the upregulation of the receptors? I’ll be honest, I didn't know the answer right off the bat but I did some digging.
And it looks like laser therapy can possibly increase the effects of CBD. Laser therapy works at the cellular level by affecting mitochondria, which, at lower doses, leads to an increase in ATP production, which then controls cAMP levels (cAMP is a secondary messenger that is essential for many biological processes).
One receptor that CBD acts on is CB1, which is highly concentrated in CNS cells. Agonists of these receptors are often linked to analgesic properties as pain pathways in the CNS have many CB1 receptors present on them. These receptors and their signaling appear to be dependent on cAMP regulating the inhibition of calcium channels and activation of potassium channels.
Putting it all together, as ATP in the CNS increases, there is a rise in cAMP, and with that, a secondary effect on CB1 receptors enhancing the analgesic effect of CBD on the CB1 receptors when it is present.
Have you ever used CBD with laser treatment? I would love to hear about it. Tell me about your experience in the comments below.
Sources:
Greineisen WE, Turner H. Immunoactive effects of cannabinoids: considerations for the therapeutic use of cannabinoid receptor agonists and antagonists. Int Immunopharmacol. 2010 May;10(5):547-55. doi: 10.1016/j.intimp.2010.02.012. Epub 2010 Feb 25. PMID: 20219697; PMCID: PMC3804300.
Farivar S, Malekshahabi T, Shiari R. Biological effects of low level laser therapy. J Lasers Med Sci. 2014 Spring;5(2):58-62. PMID: 25653800; PMCID: PMC4291815.
Chung, H., Dai, T., Sharma, S.K. et al. The Nuts and Bolts of Low-level Laser (Light) Therapy. Ann Biomed Eng 40, 516–533 (2012). https://doi-org.vmed-ezproxy.lsu.edu/10.1007/s10439-011-0454-7
Sebastian Mejia, Felix Michael Duerr, Gregg Griffenhagen, Stephanie McGrath; Evaluation of the Effect of Cannabidiol on Naturally Occurring Osteoarthritis-Associated Pain: A Pilot Study in Dogs. J Am Anim Hosp Assoc 1 March 2021; 57 (2): 81–90. doi: https://doi.org/10.5326/JAAHA-MS-7119
Wilson RI, Nicoll RA. Endocannabinoid signaling in the brain. Science. 2002 Apr 26;296(5568):678-82. doi: 10.1126/science.1063545. PMID: 11976437.
Gamble L-J, Boesch JM, Frye CW, Schwark WS, Mann S, Wolfe L, Brown H, Berthelsen ES and Wakshlag JJ (2018) Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs. Front. Vet. Sci. 5:165. doi: 10.3389/fvets.2018.00165
Choosing the correct cavaletti height for different goals
We reviewed cavaletti spacing, but what about the height? It’s just as important to achieve our goals.
In a previous post, we reviewed the spacing of cavalettis, but what about the height? The height is just as important as spacing to ensure our pets and patients are set up to achieve our goals in as little time as possible.
If the cavalettis are too high, the pet will knock them or tick them with their nails. Their stride will also shorten to accommodate the height and it can be discouraging. But if the cavalettis are too low, we may not be able to achieve our goals.
As a reminder, we can use cavalettis to:
Strengthen the trunk and limb muscles
Increase balance in puppies, adults, athletes, geriatric, neurological patients
Improve proprioception for puppies, adults, athletes, geriatric, neurological patients
Increase reach and drive for confirmation dogs and athletes
Improve equal-limb weight bearing post surgery or injury
Eliminate pacing for confirmation dogs and athletes
Reduce the risk of contralateral cruciate injury
Reduce the risk of patella luxation
Be sure to watch the video above – we discuss the importance of starting low, teaching dogs the rules of the game, and then changing the height to achieve our goal in the least amount of time needed.
Shortcut on Cavaletti Heights
General heights are carpus or below, carpus to midway up to the elbow, and the highest chosen height is close to the elbow. If we set the cavaletti poles above elbow height the chest gets in the way and we don’t want them jumping over the bars so they do not hit their chest. We want them to have fun and succeed; work hard and play hard.
CAVALETTI EXERCISES ARE GREAT FOR:
Body awareness, balance, and proprioception (knowing where their body is in space)
Strength
Enhancing cognitive ability
Increasing reach and drive
Picking up, rather than sliding their feet while walking
Increasing flexion of the limb joints (think marching)
WHAT KIND OF DOG CAN BENEFIT FROM CAVALETTI EXERCISES? EVERY KIND.
Puppies – they can all benefit from exposure to proprioception exercises
Geriatric dogs or others that have weakness
Dogs that have had surgery and are less weight bearing on one or more limbs that is a habit (pain is controlled)
Working dogs that need better proprioception
Athletes that require intense foot-eye coordination
Dogs with patella luxation
Show dogs that need more reach and drive
Dogs that need neurological stimulation to stop or slow down cognitive decline
Dogs that slide their feet
Dogs with neurological disease or ataxia
A good exercise program teaches you a lot of simple activities, allowing you to tie them together into an exercise that is tailored to the specific needs of a dog. Ideally you want exercises that challenge every area of the body and enhance balance, proprioception, and cognitive function.
THE MOST VERSATILE CAVALETTIS ON THE MARKET – OPV CAVALETTI JACKS
Strengthening your dog’s iliopsoas muscle
Injuring the psoas muscle is so common nowadays, both in athletes and pets. It can happen during a simple slip on the floor, which is why strengthening is so important.
Injuring the iliopsoas muscle is a common injury nowadays, in both athletes and pets, but we can reduce the chance of injury dramatically with strategic strengthening.
Muscles are much more likely to get injured when they are in a stretched position
Muscles are much more likely to get injured when they are in a stretched position, especially if there is an explosive motion that puts that muscle into that stretched position.
In the video below, I explain how to position your dog to create an iliopsoas stretch, putting the muscle in a "long" position.
iliopsoas muscle's anatomy and function
Let's start by discussing the iliopsoas muscle's anatomy and function.
The iliopsoas muscle has two muscle bellies – the psoas major and the iliacus. The psoas major muscle originates on the lumbar vertebrae and the iliacus originates on the wing of the ilium. They come together to insert on the lesser trochanter of the femur.
The main function of the iliopsoas muscle is to flex and externally rotate the hip, it also functions to help stabilize the lumbar spine. This is important because if the iliopsoas muscle is injured, it may show up as pain on hip extension, especially if the lumbar spine is in extension when the hip is extended.
An acute injury can happen when a dog splays their rear limbs behind them or by falling off the A-frame or dog walk when one leg tries to hold on as the rest of the body is falling off. It can also happen from a chronic repetitive motion or during explosive activity with a muscle that is not warmed up and strong enough to keep the lumbar and hip joints stabilized, such as a dog running full out.
Spotting an iliopsoas muscle injury
A person with a trained eye may see an agility dog limping or having a rear limb that’s lower than the other as the dog travels over a jump. But the injury can show up as a slight slowing down too, as the all-out explosive motion is uncomfortable because it puts strain or stress on the iliopsoas muscle.
Sometimes, however, there are no signs at all until on exam we find resistance to hip extension or extension with abduction or possibly just pain on palpation of the musculotendinous junction.
Why do we tell you all this? So you can start to look for these signs, understand what they mean, and catch iliopsoas injuries when they are minor rather than waiting until the dog is limping because every step hurts. But perhaps more importantly, I tell you all of this because we want you to be able to prevent these injuries in your pets and patients.
Preventing iliopsoas muscle injury
Strengthening the illopsoas muscle is the best way to prevent injury; however, the key to strengthening it is doing it in a "long", or stretched, position.
If we only strengthen the iliopsoas in a short position, the dog is more likely to injure it when they return to a long or stretched out position as in cantering or galloping, especially if they get to this position with explosive activity.
The same is true for rehabilitation of an iliopsoas muscle injury. If the muscle is only strengthened in a short position, when the dog returns to explosive motion, which is stretching the iliopsoas muscle, they are much more likely to reinjured it.
An underwater treadmill is a great tool overall (of course I believe this, I designed the first one for dogs) and it is especially great for strengthening the iliopsoas muscle in a shortened position, as it uses water to increase resistance for hip flexion. But, it is important to recognize that it can’t be the only exercise used for dogs as they do not have full hip extension while walking or trotting in the water; they tend to stay in a more hip flexed position with less drive than we will see on land.
Land exercises must be incorporated with the underwater treadmill for the best rehab plan to build strength in both a long and short position.
So, how do we strengthen the iliopsoas in a long or stretched position? Watch the video for images and videos for great examples.
The down and dirty to strengthening the iliopsoas muscle
The first thing to think about is that the goal is to end up with the dog’s lumbar spine and the hips in extension.
To reach this goal we have the dog stand with their front feet on a raised surface. This may be starting with the front feet raised only a few inches on a step or a block. If the dog is recovering from an iliopsoas injury, we definitely raise their front feet in small increments.Start by holding this position for 5-30 seconds depending on the ability and comfort level of the dog.
Using a muscle without changing the length of the muscle fibers is an isometric exercise. It is the safest form of exercise and can be great for strengthening when used for longer periods of time. Think of holding a plank for 1-5 minutes.The thoracolumbar spine should be straight – not kyphotic/roachy or lordotic/swayback. Both of these positions can put stress on the spine.
Slowly, over time, increase the height of the front feet.
The higher the front feet, the more the hips are in extension and the more the iliopsoas stretches
Over time, you will want to work up to longer iliopsoas stretch positions, but make sure the dog’s back always remains straight.
When should you stop? How high should the front feet be raised?
This position can actually be held for several minutes or several repetitions of one minute. This allows us to build individual muscle endurance. We will explore that concept in another Learn & Go, so stay tuned.
You do not want the front feet higher than the shoulders in the standing on two leg position.
You also want to make sure the dog’s front feet are resting on a surface.
If the dog is leaning forward while on only their rear limbs, it can put stress on the epaxial muscles of the lumbar spine. These are the muscles that balance the iliopsoas muscles as they sit dorsal to the transverse processes on the spine. They are the same muscles that we rub after leaning over and stressing our backs.
Let's keep all the muscles healthy and strong.
How to Space Cavalettis for Multiple Outcomes
Are you sure you are spacing your Cavalettis correctly? Have you wanted to use Cavalettis but didn’t because you weren’t sure how to space them?
Are you sure you are spacing your Cavalettis correctly?
Cavalettis are an amazing tool that can be used with dogs (or pigs) of all ages and abilities – from young pups and geriatric dogs to competitive athletes.
But to get the best results, you need to ensure that they are spaced appropriately.
In this Learn & Go video, I talk through different goals depending on they type of dog you're working with and how to set up your Cavalettis to achieve them.
Cavaletti exercises are great for:
Body awareness, balance, and proprioception (knowing where their body is in space)
Strength
Enhancing cognitive ability
Increasing reach and drive
Picking up, rather than sliding their feet while walking
Increasing flexion of the limb joints (think marching)
What kind of dog can benefit from Cavaletti exercises? Every kind.
Puppies – they can all benefit from exposure to proprioception exercises
Geriatric dogs or others that have weakness
Dogs that have had surgery and are less weight bearing on one or more limbs that is a habit (pain is controlled)
Working dogs that need better proprioception
Athletes that require intense foot-eye coordination
Dogs with patella luxation
Show dogs that need more reach and drive
Dogs that need neurological stimulation to stop or slow down cognitive decline
Dogs that slide their feet
Dogs with neurological disease or ataxia
A good exercise program teaches you a lot of simple activities, allowing you to tie them together into an exercise that is tailored to the specific needs of a dog. Ideally you want exercises that challenge every area of the body and enhance balance, proprioception, and cognitive function.
The most versatile Cavalettis on the market – OPV Cavaletti Jacks
The importance and versatility of a Foundation Exerise
Here’s a foundational exercise that is easy for dogs to learn and sets up a great foundation for them to use later in life.
Do you know what a Foundation Exercise is?
It’s an exercise that is reasonable easy to teach and for dogs to learn. And it establishes a set of behaviors and skills that the dog will use now and later in life. It will help them in other situations, allowing them to do much harder things. Even better, a Foundation Exercise can be used with puppies, geriatrics, and elite athletes.
One such Foundation Exercise is Cookie Dance.
The rules are simple – feet stay square, nose follows the cookie.
The Goals of Cookie Dance
Enhanced balance and proprioception
From puppies and geriatric dogs to athletes, Cookie Dance enhances body awareness decreasing the chance of injury
In patients with neurological challenges, Cookie Dance helps reset the nervous system to bring back optimum quality of life
Strengthening stabilization muscles
Beneficial for all dogs, Cookie Dance strengthens the muscles that stabilize the joints in all four limbs as well as strengthening the core
Weight shifting
Cookie Dance can be used post injury or surgery to create more even weight distribution
Watch the video below to see how Cookie Dance is performed and difficulty is increased with a 12-year-old Mastiff and a 4-year-old ninja athlete.
Want to make it a littler harder?
Changing the surface the dog is working on immediately increases or decreases the difficulty.
Flat stable surfaces - easiest
Mildly unstable surfaces
Difficult unstable surfaces
Stabilized movable surfaces
Non-stabilized movable surfaces - most difficult
A good exercise program teaches you a lot of simple activities, allowing you to tie them together into an exercise that is tailored to the specific needs of a dog. Ideally you want exercises that challenge every area of the body and enhance balance, proprioception, and cognitive function. Cookie Dance is one of the simple foundational exercises needed to create such an exercise.
Join us in learning more about exercises in our up coming course Optimum Geriatric Exercises for Veterinary Professionals as a debut to more in-depth education. Sign up now to get on our waitlist for the course. When we launch there will only be 30 Gold Level spots, and our waitlist members will have first access to these spots. Currently we have over 80 people signed up! Join them and sign up for this exciting course.
The best starting exercise for geriatric patients (and other dogs)
Did you know that dogs lose up to 25% of their type II muscle fibers just by aging but type I muscle fibers don’t deteriorate?
Did you know that we can convert type II muscle fibers to type I muscle fibers by performing certain types of exercises?
Sarcopenia is a normal aging in which type II muscle fibers turn into fat and then into fibrous tissue. Certain exercises can slow this progression down.
Exercises that target type II muscle fibers are great for aging patients because these tissues are lost when not used. But these can also be quite beneficial for puppies, patients with neurological ailments, dogs that have had surgery, and athletes to help prevent injuries.
When animals start to have sarcopenia, the circumference of their muscles does not change as the muscle fibers turn to fat, but they do lose strength. However, as sarcopenia progresses, the circumference of the tissue diminishes as well as strength.
Type I muscle fibers are not affected by aging. These fibers make up the majority of muscles that control posture and joint stability. They are slow twitch, slow to fatigue, and use fat to create ATP. Helping these muscles to fire over a period of time can work to alleviate obesity, better stabilize joints, and enhance endurance.
It’s so important to keep our dogs moving, as these muscle fibers are lost from disuse atrophy. That’s why geriatric dogs, dogs that have had surgery, and dogs that have neurological issues are especially at risk.
However, we can keep these muscles strong in a safe manner with simple exercises. Watch this video to see the best starting exercise and learn how to modify it for different patients.
This exercise, when done correctly, targets the type I muscle fibers in the whole body.
Type II muscle fibers are also important, as they are the ones that give muscles their power. These fibers are found in higher numbers in muscles that create motion. They are quick to fatigue and are important for athletes that need speed and the ability to jump. These fibers hypertrophy to create thicker muscle bellies. We are not targeting these fibers with this exercise, but I will show you how to target them in the future.
When done properly, this exercise can be done with every dog, from two-day old puppies to athletes as a foundational exercise. As with every exercise there are nuances, be sure to watch the video to understand how to modify for each of the follow:
Puppies
Adult Dogs
Post-Surgical Patients
Dogs with Neurological Ailments
Geriatric Dogs
Athletes