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FHO case study; a journey using hydrotherapy and gait pattern retraining

11/27/2023

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The first time I ever heard about FHO surgery I was shocked to learn of the high success rates for doggo patients who have made the decision to undertake this somewhat radical approach to solving an all too common problem. As a hydrotherapist, planning a recovery program for a dog who has recently completed FHO surgery at first appeared daunting but when you have amazing patients and doggo owners who follow the plan step-by-step, what once appeared as daunting suddenly becomes one of the most rewarding rehabilitation cycles of my career. In this blog, we will dive into FHO surgery, what it entails and the plan towards a successful recovery using both hydrotherapy and physiotherapy as the main focal points on the journey to success.

What is FHO?

Canine femoral head and neck excision (FHO) surgery is a procedure that addresses hip joint issues in dogs, providing relief and improved mobility.

FHO is commonly performed to alleviate pain and discomfort associated with hip dysplasia, fractures, arthritis, or other conditions affecting the hip joint. It involves the removal of the femoral head and neck, allowing the formation of a "false joint" with surrounding muscles and tissues.

During FHO surgery, the surgery removes the femoral head (the ball part of the ball-and-socket joint) and sometimes the neck of the femur. This eliminates the bone-on-bone contact that causes pain, and the body adapts by forming a pseudo-joint, utilising surrounding muscles for stability.

The Road to Recovery

Every journey starts out best with a proper plan or road map in place so that all parties involved are aware of the recovery process and what steps to take next to ensure the best recovery and rehabilitation possible.

After FHO surgery, dogs will need rest and restricted activity. Pain medications and the beginning of some rehabilitation therapy will also be prescribed to manage discomfort and aid in the recovery process. Controlled exercise is crucial during the recovery phase. Short, on-leash/guided walks can help prevent muscle atrophy and promote joint mobility. Avoiding activities that place excessive strain on the hind legs, such as running or jumping is of the most importance at this early stage.

Most Vets will ask patients to seek a physiotherapist post-surgery to aid and assist in the recovery process. Joint mobilisation exercises, massage and the use of laser therapy will all go a long way to promote strength and flexibility to aid in the recovery process as this is also a crucial time to be aware of potential complications that could quickly derail the road to recovery. These complications, such as infection or persistent lameness, need to be addressed as soon as they are noted and the safest option if there is ever any doubt would be to return to the vet for further review.

As each patient progresses in recovery, the vet may gradually allow increased activity. However, it's essential to remain cautious and avoid pushing your dog too quickly, ensuring a steady and safe return to normal activities. This is the perfect time to add hydrotherapy to your recovery plan to not only continue in aiding the road to recovery but to also help build and manage muscles in the hind limbs and lower back.


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X ray taken pre-FHO

Hydrotherapy Case Study

The recent FHO case we worked with in the clinic belonged to a patient who was hit by a minivan and left in a state that can only be described as life-threatening. The patient was a standard breed Chihuahua and he arrived in our care approximately 2 weeks after his FHO surgery. He was, as you can probably expect, cautious of anyone moving or touching his injured leg and due to the nature of his injury, his other hind leg had also been fractured in the accident. A slow and steady initial consultation in the clinic allowed him to gain the trust of not only me as his hydrotherapist, but also allowed him to feel safe and secure in the clinic space. The initial gate assessment and palpation were different to a normal review because again, understandably, the cautious and pain alarm/reaction within this little fighter was well and truly ringing for all to hear.

With some careful placement of his family and the lure of some of our very own hydrotherapy treats, we were able to fit him with a Help ‘Em Up Harness to better control him in the tank space and from there, the trust between the patient and myself as the hydrotherapist began to grow. Prior to the filling of the tank, his LHL was held up in flexion and his balance was poor due to all of the weight being distributed through his other HL. Once the water level reached his mid-thigh, he began to shift his weight laterally onto the operated side and began toe touching. The session began with a slow roll of the treadmill and I allowed him to feel the belt moving under him prior to engaging a cycling of the LHL. At first, again, he was unsure of what was happening. Still, within a matter of 20 seconds, he relaxed his LHL fully and allowed me to cycle further than previous which also included a technique whereby I placed my index fingers to the planter side of his paws and shortened each step by allowing my fingertips to make contact to the belt. From there, the balance of the 2-minute set was spent slowly cycling his legs and for the first time in 2 weeks, he was actually back to walking with an altered gate using all four limbs.

The second set saw a similar result to the first and I made the decision that for his third set I would fill the tank further and allow him to independently swim, whilst being managed using the Help ‘Em Up Harness, to better feel how his operated leg was functioning. Without any hesitation, he freely paddled both FL’s and HL’s together and as the set and session closed, he was well and truly sold on the magic in the water that is hydrotherapy.

We would see this patient twice a week for further sessions and also included laser modalities and home weight-transferring exercises as prescribed by Jo, our physiotherapy guru. This dual approach saw the road map to recovery become all that much clearer for our patient as with each session and week that went by, his gate consistency and strength grew to a point where he was able to freely walk using all 4 limbs with little to no issue. Our session structure began to change approximately 6 weeks after our initial meeting with the focus moving towards gate pattern retraining and also further strengthening to his HL and back by adjusting each session's set time and speed. Utilising a fixed FL stand, we were also able to directly target only the HL in each 2nd set of each session which again helped our patient to grow not only in strength but also in confidence with each visit. We managed him further by spacing out his treatments to weekly, and as of today, he is still on the road to recovery but is a lot further down the track than when we first met. His owner’s initial goal was to have him back to full function, and with this continued hydrotherapy approach, he just might come back better than he ever was before.

Where to from here?


It's impressive to see the positive progress in the Chihuahua's recovery through hydrotherapy after such a traumatic incident. The careful approach, use of the Help 'Em Up Harness, and the gradual introduction of exercises seem to have played a crucial role in building trust and improving mobility. The collaboration with the physiotherapy plan and the integration of laser modalities highlight a comprehensive approach to rehabilitation.

To conclude, canine femoral head and neck excision surgery can significantly improve the quality of life for dogs suffering from hip joint issues. A thoughtful approach to post-surgery care, including rest, controlled exercise, and proper veterinary guidance, is key to a successful recovery. By understanding the procedure and actively participating in your dog's rehabilitation, you can help them regain mobility and enjoy a more comfortable, active life. As always consult with your Vet and canine specialist therapist to tailor the best plan forward to aid in the full recovery of your beloved four-legged doggo!

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canine bone healing time frames & the 7 factors that can influence healing

11/13/2023

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Hey everybody! If you're interested in veterinary medicine or canine bone health, you've come to the right place. In this blog post, we'll be looking into the subject of canine bone healing and discussing some of the time frames that are relevant to it.
As a canine physiotherapist,  I’ve had the privilege of helping doggos (and their owners) navigate their way through fracture management and it really all comes down to some set time frames that we must be aware of when progressing through the rehabilitation process. 
Let's take a closer look at the subtle process of bone healing and why these time frames are important in the rehabilitation process. 
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Dogs have approximately 321 bones in their body
Understanding Canine Bone Healing:
Our doggos  share a strong skeletal system, comparable to ours,  which is capable of recovering from fractures, breaks, and other various bone-related injuries. Following a bone injury, a complex series of events takes place in the body, aimed at repairing the damage and restoring the bone's strength. The healing process can be broadly divided into three phases, each with its unique characteristics Inflammatory 

1) The inflammatory Phase: 
The first phase, known as the inflammatory phase, typically lasts from one to seven days. During this phase, the body responds to the injury by initiating a rapid and intense inflammatory response. The injured area becomes swollen, painful, and tender to the touch as the body's immune cells rush to the site to remove debris and start the healing process. Blood vessels dilate, increasing blood flow to the area and allowing immune cells to reach the site more quickly. 


2) The reparative phase: 
The second phase, called the reparative phase, typically lasts from one week to several weeks. During this phase, the body begins to form a soft callus, consisting of cartilage and fibrous tissue, around the injured bone. Over time, the callus transforms into hard bone tissue, gradually restoring the bone's strength. The reparative phase is a critical stage in the healing process, and proper care and rehabilitation during this time can significantly improve the chances of a full recovery. 

3) The remodelling phase: 
The final phase, known as the remodelling phase, can last several weeks to months, depending on the severity of the injury. During this phase, the bone remodels and reshapes itself to regain its original form and strength. This ongoing process involves the removal of old bone tissue and the formation of new bone tissue, refining the bone's structure over months. The remodelling phase is a gradual process, and it may take several months for the bone to return to its pre-injury strength.

Factors Influencing Healing Time:
When it comes to a dog's bone healing process, various factors can significantly impact the duration it takes for the bone to heal. Understanding these variables is important to that the doggo receives appropriate care and treatment from the veterinarian or canine therapist and also for the pet owner to understand and  adhere to continued care at home.


Type and location of the injury: 
One of the primary factors that affect the healing process is the type and location of the injury. If the fracture or injury is complex, the healing time may vary. Moreover, the location of the injury, whether in a weight-bearing bone or not, can significantly affect the healing process. 


The age and health of the dog:  Diet, nutrition
Another critical factor that can affect the healing time is the age and health of the dog. Younger dogs generally experience quicker healing due to their active metabolism and robust bone-forming capabilities. On the other hand, older dogs may require a longer time to heal due to their reduced metabolism and decreased bone density. Moreover, the overall health, nutrition, and the presence of underlying medical conditions can influence the speed of healing. 
A dog with a balanced diet and excellent health condition will heal faster than a malnourished or an unhealthy dog. 
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Chosen treatment approach:
Finally, the chosen treatment approach can play a pivotal role in determining the healing time. The treatment method, whether surgical intervention or conservative management, can significantly affect the healing process. The veterinarian will assess the severity of the injury and determine the most suitable treatment. For instance, surgical intervention may be necessary for complicated fractures, while conservative management may be appropriate for less severe injuries.

While it's important to understand the intricate phases of bone healing, there are several proactive steps doggo owners  can take to aid in recovery from a bone injury. 

Follow the veterinarian's recommendations:
First and foremost, it's crucial to follow the veterinarian's recommendations regarding treatment, medication, and follow-up care. This will ensure that any dog is receiving the appropriate care for their specific injury or condition.

Create a comfortable home environment: 
In addition to following veterinary advice, creating a comfortable environment at home to rest and recover is also essential. Reinforcing a safe and comfortable space, minimising stress and unnecessary movement.

Maintain a balanced diet: 
Maintaining a balanced diet is also key to supporting bone health which is a nutritionally balanced diet rich in essential nutrients, supporting overall health and bone strength. Consult with a veterinarian or canine nutritionist to determine the best diet for the best advice in regards to diet. 

Rehabilitation and Physiotherapy: 
Collaborating with a skilled canine physiotherapist can also aid in recovery. Developing a tailored rehabilitation plan that incorporates targeted exercises can aid in muscle strengthening and joint flexibility. Physiotherapy and rehabilitation can play a crucial role in optimising recovery, so consider working with a professional to create a comprehensive plan.
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Physiotherapy and rehabilitation can play a crucial role in optimising bone healing
Brain stimulation and support: 
Finally, it's important to recognise that the healing process takes time and patience is a virtue, particularly for a very active dog. Consider other ways to keep doggos engaged with treat games and love and affection. 

​In order to promote the healing of bones, it's important to have a thorough understanding of the different factors that contribute to the bone healing process. Furthermore, having a clear understanding of the timeline of this process is crucial in facilitating bone healing.

If you want to learn more tricks and tips and be involved in a community of like minded individuals, join our facebook group at : 
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Benefits of Hydrotherapy for Senior Dogs

11/13/2023

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Hydrotherapy for senior canines is a rapidly expanding field that has gained popularity for its numerous benefits in promoting the well-being of our doggo friends. As dogs age, they often face various health challenges, including arthritis, muscle atrophy, and joint stiffness. Hydrotherapy, which involves exercising in water, has proven to be a valuable therapeutic option for senior dogs. Below we will explore the benefits of hydrotherapy for senior canines and why it is becoming a preferred choice for many pet owners.

In addition to physical benefits, hydrotherapy fosters a strong bond between dogs and their human companions. The supportive and encouraging environment created during hydrotherapy sessions enhances the relationship, making it a positive experience for both the canine and the owner. This is particularly valuable for senior dogs who may be dealing with the challenges of aging, as the emotional connection plays a crucial role in their overall well-being.

With all of that being said, below are my 7 recommendations as to why introducing hydrotherapy to the routine of a senior canine is so important to not only their lives but also to their position in your family unit.

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Senior Canine Hydrotherapy
1. Low-Impact Exercise:
One of the primary advantages of hydrotherapy for senior canines is that it provides a low-impact form of exercise. Aging dogs, much like aging humans, may struggle with joint pain and arthritis. Traditional forms of exercise can exacerbate these conditions. Hydrotherapy, however, allows dogs to move their joints and muscles without putting excessive pressure on them. The buoyancy of the water reduces the impact on their limbs, making it an ideal option for senior dogs to maintain mobility.
2. Pain Management:
Hydrotherapy is an effective way to manage pain in senior canines. The warm water used in hydrotherapy sessions helps to soothe achy joints and muscles, providing relief from discomfort. The water's buoyancy also reduces the gravitational force on the dog's body, minimising pain associated with movement. For senior dogs with conditions like osteoarthritis, hydrotherapy can be a valuable component of a comprehensive pain management plan.
3. Improved Range of Motion:
As dogs age, they may experience a decrease in their range of motion. Hydrotherapy encourages a full range of joint movements, helping to improve flexibility and overall mobility. The resistance of the water ensures that dogs engage in various muscle groups during their exercises, leading to enhanced joint flexibility. This increased range of motion can contribute to a better quality of life for senior canines.
4. Muscle Strengthening:
Muscle atrophy is a common issue in aging dogs due to reduced activity levels. Hydrotherapy provides a controlled environment for dogs to exercise their muscles, promoting strength and endurance. The resistance offered by the water requires more effort from the muscles, contributing to the development of lean muscle mass. This can be particularly beneficial for senior canines who may be experiencing weakness or muscle loss.
5. Weight Management:
Maintaining a healthy weight is crucial for the overall well-being of senior dogs. Excess weight can exacerbate joint issues and contribute to a decline in mobility. Hydrotherapy offers a weightless environment, allowing senior canines to engage in physical activity without putting undue stress on their joints. Regular hydrotherapy sessions can assist in weight management and help senior dogs maintain a healthy body condition.
6. Enhanced Circulation:
Hydrotherapy promotes improved blood circulation, which is essential for the health of senior canines. The warm water causes blood vessels to dilate, facilitating better blood flow to muscles and joints. This enhanced circulation can accelerate the healing process, reduce inflammation, and contribute to the overall vitality of aging dogs.
7. Stress Reduction:
The calming effect of water can help alleviate stress and anxiety in senior canines. Hydrotherapy sessions provide a soothing and enjoyable experience, creating a positive association with physical activity. This is especially beneficial for dogs dealing with age-related anxiety or those who may be hesitant to engage in traditional forms of exercise.
It's essential to note that hydrotherapy should be approached with caution and under the guidance of a qualified professional. A certified canine hydrotherapist can tailor the hydrotherapy program to address the specific needs and health conditions of senior dogs. Individualised sessions ensure that the intensity and duration of exercises are suitable for the dog's age, fitness level, and health status.
Hydrotherapy is proving to be a valuable tool in caring for the health and well-being of senior canines. Its low-impact nature, coupled with a range of physical and psychological benefits, makes it a preferred choice for many pet owners seeking holistic approaches to senior dog care. As we continue to prioritise the health and happiness of our doggos, hydrotherapy stands out as a therapeutic and enjoyable option for senior dogs in their golden years.
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Understanding Carpal Hyperextension in Dogs: A Canine Physiotherapist's Insight

11/6/2023

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As a canine physiotherapist, I see many injuries and pathologies in dogs ranging from spinal disease to hip dysplasia to ACL injuries. One injury that tends to alarm doggo owners more so than others is a condition called carpal hyperextension. 
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What is Carpal Hyperextension?
Carpal hyperextension, also known as "dropped wrist" or "down pastern," is a condition that affects a dog's front legs. This occurs when the carpus, which is the equivalent of the human wrist in dogs, extends beyond its normal range, causing instability and discomfort. In simple terms, it's like a dog's wrist bending backward more than it should and the supporting ligaments can become lengthened and stretched.  A normal wrist has straight upright legs while a hyperextended wrist is flatfooted in appearance. 

Causes of Carpal Hyperextension
  1. Genetics: Some breeds are more prone to carpal hyperextension due to their genetic predisposition. Breeds like Great Danes, Doberman Pinschers, and Basset Hounds are more commonly affected.
  2. Developmental Abnormality: Carpal hyperextension in young dogs is caused as a result of weakened ligaments. It is often seen in large breed puppies such as Great Danes and causes can range from inadequate nutrition to rapid growth however, sometimes no underlying cause is identified. 
  3. Trauma or Injury: Accidents, falls, or repetitive stress on the front legs can lead to carpal hyperextension where the ligaments get stretched or torn and is a common cause of carpal hyperextension in dogs. 
  4. Overuse: Working dogs or those involved in strenuous activities might develop this condition over time.
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Carpal Hyperextenson
Signs and Symptoms
Identifying carpal hyperextension in doggos is the first step towards addressing the issue. Keep an eye out for the following signs:
  1. Lameness: Dogs with carpal hyperextension may exhibit a subtle or pronounced limp on one or both front legs depending on the severity of the hyperextension. 
  2. Swelling: The affected area can become swollen, warm to the touch, or painful, particularly if acute trauma has caused the instability. 
  3. Stiffness: dogs might appear stiff and reluctant to bear weight on the affected leg.
  4. Abnormal gait: Dogs may walk with an abnormal walking pattern. Often owners are alarmed at how the carpus 'looks'  and many people describe it as looking ' deformed.' 

Treatment Options
As a canine physiotherapist, my primary goal is to help doggos regain their mobility and comfort. Treatment depends on the severity of the condition but here are some treatment options for carpal hyperextension:
  1. Physiotherapy/ non-surgical: Customised physiotherapy exercises and stretches can improve joint stability and muscle strength, helping doggos regain proper carpal alignment.
  2. Supportive Bracing: In some cases, specially designed braces can be used to provide additional support to the carpal joint and can be fitted through a veterinarian or canine physiotherapist.  The brace helps support the carpal joint and restores normal function to the stretched ligaments. 
  3. Medications: Anti-inflammatory drugs may be prescribed by the treating veterinarian to reduce pain and inflammation.
  4. Lifestyle Adjustments: Ensuring that your dog avoids strenuous activities and maintains a healthy weight can aid in their recovery. Avoiding tasks that place undue stress on the carpal joint line jumping down from height and chasing balls repetitively can help to alleviate symptoms. 
  5. Surgical Intervention: In severe cases, surgery may be recommended to correct the carpal hyperextension which typically involves fusing the entire carpus (arthrodesis.)

Preventing Carpal Hyperextension
Prevention is always better than cure. To minimise the risk of carpal hyperextension in doggos, consider the following:
  1. Regular exercise: Maintain a balanced exercise routine to keep doggos muscles strong and joints healthy. Excessive exercise like chasing and running for balls can place extra stress on the carpal joint and will need to be kept in moderation with all other forms of exercise. 
  2. Protect against injuries: Keep an eye on your dog during physical activities and minimise any potential hazards. Check the home for any tripping hazards such as slippery floors, particularly when jumping off surfaces like the couch onto them and if needed,  put an anti-slip mat down. 
  3. Weight management: Ensure your dog maintains a healthy weight to reduce excess strain on their joints.
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Protecting the wrist joint (carpus) from over use or acute injuries such as jumping or repetitive chasing will help to prevent carpal hyperextension

​Carpal hyperextension can be a challenging condition, but with the right guidance, it's possible to manage and let dogs go on to lead a full and happy life. Remember, early detection and proper treatment can make a world of difference. If you suspect your dog is suffering from carpal hyperextension, don't hesitate to reach out to a canine physiotherapist or veterinarian for assistance.

If you want to learn more tricks and tips and be involved in a community of like minded individuals,  join our facebook group below:​
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    Joanna Whitehead

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