Thursday, January 7, 2016

The Pet PT Pit Stop: Preventing CCL (ACL) Tears (Part 1 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!   

Happy New Year! Do you set resolutions for your pets? May I suggest focusing on health and prevention of injuries as a priority for 2016!

CCL Tears, Cranial Cruciate Ligament Tears, ACL Tears in Dogs

Among the most frequent injuries and causes of hind limb lameness in dogs are cranial cruciate ligament (CCL) tears, also referred to as ruptures.

These occur in the hind limb, at the knee (stifle joint).

I am frequently contacted to provide consultation services and treatment for CCL tears, both partial and full. The topic is expansive, so I’ll address it in 3 parts, starting here with prevention, and continue in February and March, first with partial and then full cruciate tears.

The CCL, correlating to the ACL in humans, tears most often from repeated movements and excessive stress on the stifle joints. 

These tears are usually slow and gradual, where the ligament starts to degrade and eventually, if not treated, ruptures completely. Once the stability of the CCL becomes compromised, the stifle joint is lax and knee cartilage can also tear or degenerate. 

The first outward sign is decreased weight bearing/lameness on the affected limb. 

Inflammation, painful motion, loss of strength and functional decline follow next. Some purebred dogs are more prone to cruciate injury, such as Labrador and Golden Retrievers, GSDs, Newfoundlands and Rottweilers.

It is prudent to identify which breeds are at risk and follow preventative practices.

Breeders can play a big role in prevention, by tracking the incidence of CCL tears in their offspring lines and using responsible techniques to ensure the health of future generations. While breeders essentially hold control of genetic lines, there are ways the average pet owner can help prevent the likelihood CCL tears.

Here are my top tips:

Achieve and maintain proper body weight

Avoid having your dog jump on and off furniture or out of trucks or SUVs

Keep in mind that jumping down/landing holds a higher risk for ligament rupture than climbing up.

Consider proactive laser treatments for breeds at high risk for CCL tear

Avoid having your dog run on wet grass, ice, or other slippery surfaces such as backyard decks with composite floors

Wooden deck floors are less slippery, unless they become dirty or covered with mold. It is important to understand that slippage on these surfaces causes horizontal translatory shearing force which the cruciate is very susceptible to, because of the anatomical angle at which it attaches to the tibia and femur in quadruped animals.

Before letting your ‘at risk’ dog leap and play on safe surfaces, have them warm-up just like an athlete 

A warm-up example:  slow controlled leash walks with gradual increasing speed, inserting mini intervals of ‘burst’ movement, ending with moderate walking speed, total duration of 6-12 minutes (multiples of three work well).

Keep the buttock and hamstring muscles strong

Such as via tunneling (dog walking through a round tunnel, under a table or low ceiling causing the hip and knee joints to bend during the movement); retro steps (holding a treat under the dog’s chin and walking toward the dog, encouraging them to step backwards); sit to stand exercises: starting position with the dog’s rump backed into a corner.

De-load the hind limb joints

You can do that by placing the dog over a physio ball (have a physical therapist advise you of the correct size) or over a stack of pillows or blankets.  This can be performed several times per week, for 2-3 minutes duration.

Reduce the use of stairs if possible, and minimize slippage on stairs by use of carpet or anti-skid pads

Avoid repetitive ‘twist and turn’ activity

If your at-risk dog loves it, allow them to navigate cones or low hurdles in a controlled manner, using a lead attached to a chest harness.

Be aware of the escape artist and prevent this dog from getting loose, running and chasing.
Prime and lubricate the joints with prophylactic range of motion exercises

Flexion and extension of the stifles, instructed by your veterinarian or physical therapist. The job of ligaments is to control motion at the joint and provide stability. Thus, keeping the articulating joint surfaces healthy reduces workload on the cruciate ligament.

Finally, if one CCL tears can the other side be prevented from tearing as well? 

Statistics are quite high in regards to ‘other side’ tears, but with increased access to canine physical therapy and rehabilitation, I hope to see those figures reduce in a few years.

One of the best ways to avoid a tear in the sound limb is early post-op rehab treatment in the torn side. This will reduce pain, promote motion and encourage early weight bearing on the operated side and reduce overuse of the sound side. Timing is critical, so plan to start PT early.


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 , 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.

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery 
Physical Therapy Tip Of The Month: Ideas to Chew on - Can Physical Therapy Help with my Dog’s Digestive Problems?
Wrap It Up: Using Soft Supports For Your Dog
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part I) 
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part II) 
Physical Therapy Tip Of The Month: Safe Summer Boating Tips for your Dog 
Physical Therapy Tip Of The Month: Hip Dysplasia - What’s a Dawg Mama to Do?
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part I)
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part II)
Staying in the Loop with Targeted Pulsed Electromagnetic Field Therapy
Addressing Frailty Syndrome in Geriatric Dogs 
The Pet PT Pit Stop: "Where's The Evidence?"
Physical Therapy is Great, Except When It Isn’t 
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part I)
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part II) 
What's in a Dog's Gait? 
A Practical Method to manage your Dog’s Care Plan 
Wound Care 101 (Part I The Basics) 
Wound Care 101 (Part II Wound Management)
Prevention and Management of Hip Dysplasia in Puppies: Attention all Breeders!
Support and Braces
Vaccinosis - A Vexing Conundrum 
The Pet PT Pit Stop: Blame it on the Weather, Really!
Relief for Laryngeal Paralysis using Physical Therapy 
Is the Treatment Necessary? Is It Working? 

Related articles:
How The Oddysey Started: Jasmine's ACL Injury 
Talk To Me About ACL Injuries
ACL Injuries in Dogs: Non-Surgical Alternatives?
ACL Injuries in Dogs and Stem Cell Regenerative Therapy
Newest Surgery For Ruptured ACL In Dogs
Preventing ACL Injuries In Dogs
ACL Injuries In Dogs: Xena's Story 
ACL Injury Conservative Management: Sandy's Story
Surviving The Post-Op: After Your Dog's ACL Surgery
Talk to Me About Arthritis
Don't Forget the Physical Therapy 
My Love Is Sleeping At My Feet: ACL Surgery Complications 
Coco's TPLO Post-Op Diary 
Small Breeds Can Hurt Their ACL Too: Star's Naughty Knee 
One Thing Leads To Another: Why The Second ACL Often Goes Too 
Dog Knee Injuries: Should You Say Yes To Pain Management?

No comments

Post a Comment