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A Tibial Plateau Levelling Osteotomy (TPLO) is one of the most common surgeries I see in Physiotherapy clinic, so if your dog is due to have or has had a TPLO please do not panic! This blog is targeted at owners so you can learn about why a TPLO is needed and the role of Physiotherapy. I strongly feel owners need to feel educated and informed about their dog’s next steps so the right decisions can be made. So, let’s start from the beginning!

Why would my dog need a TPLO?

A TPLO is a type of surgery used to treat either a partial or fully ruptured Cranial Cruciate Ligament (CCL). When thinking about this in humans, a CCL is the same as an Anterior Cruciate Ligament (ACL) which works exactly the same. The CCL (or ACL) helps to stabilise the knee by preventing forward movement of the tibia on the femur (the shin bone and the thigh bone).

When you read about the cause of a CCL rupture you will see the term ‘degenerative changes’. Now I tend to dislike that phrase and something I refrain from using in my human practice, mainly because the wording can have negative or worrying connotations for patients. It sounds so much worse than what it means. I tend to use the analogy, ‘it’s like when your hair goes grey’ because it’s a ‘natural ageing process within the body’, so overtime the ligament can weaken. This process can also be accelerated by other factors, such as weight, breed, or conformation so in some cases dogs can be quite young and have this injury. Another added cause to a CCL injury is how the dog is anatomically made. In standing a dog will stand with roughly 110degrees of knee bend (on average), which means the CCL is always under strain. When there is strain or tension, intrinsic stress can occur in the joint and the risk of injury is higher, hence why younger dogs can sustain this injury.

What are the symptoms of a CCL rupture?

The symptoms overall are obvious to owners because your dog just won’t be their normal self. I have written the most obvious symptoms below.

• Inability to put their full weight through the leg – pain and inflammation are common drivers to this because of the excessive movement of the tibia on the femur.
• Stiffness on rising, getting out of bed, after walks or at the start and end of the day – this is usually due to the level of swelling within the joint but also the muscles around the joint becoming inactive and tight.  
• Aggression to other dogs or sometimes people due to the level of pain.
• Reluctance to go upstairs, jump in and out of the car or the sofa.

What is a TPLO?

A TPLO is one type of surgery used for this injury, it is widely performed and first described in 1993. It involves cutting into the bone called the tibial plateau (top of the tibia) and rotating it, meaning the tibia cannot slide anymore. It ultimately stabilises the knee immediately and reduces the risk of further complications, such as osteoarthritis. A plate is then put in place to secure the rotated bone and promote healing. Despite the surgery sounding quite intense it is very routine. There are some useful images here https://www.ndsr.co.uk/specialist-referral-service/pet-health-information/orthopaedic-surgery/tplo-surgery.

So where does Physiotherapy come in?

A human would have Physiotherapy after an ACL injury and so should your dog.

There are various things Physiotherapy can do after a TPLO with the focus of reducing pain, promoting tissue healing and reducing compensatory strategies. When these three aspects align, flexibility, strength, balance, and confidence will return, and your dog will be back to their usual tricks again within no time. Some patients require weekly sessions after a TPLO, whereas others need more of an observational approach and this is because every dog is different and every rehabilitation journey is different, so it must be tailored to you and your dog’s needs!

An assessment will always be conducted first where the physiotherapist will assess your dog’s gait, the wound, range of motion, muscle bulk, motor control, posture, and neurology. One other large aspect of physiotherapy is to prevent the risk of injury in other areas whilst they are recovering, for example after a TPLO the dog will naturally offload the limb and quite cleverly move their centre of mass forward. The risk of forelimb and shoulder pathologies can increase if this posture is maintained so this is usually targeted early in the rehabilitation programme.

As time and healing progresses so does the Physiotherapy. This might include the introduction of a strengthening programme starting from static and ranging from plyometrics and fitness rehabilitation. Everything is tailored to your dog and their lifestyle.

I hope this has been beneficial and if I had more time I could keep writing and talking, so if you have any questions please do contact us, even if its just to say hello!

See you soon!!

Part of the Physiotherapist’s assessment is to observe the conformation of your horse, meaning their build, shape and structure. Assessing conformation allows the clinician to identify potential risk factors for injury, and part of the assessment includes looking at the Hoof Pastern Axis (HPA). Physiotherapists have a range of skills but working with your Farrier is key when it comes to hoof balance alongside working with your Vet – it’s all about that team approach!

So, the HPA describes the relationship between the pastern and the hoof. It’s important to note it does not show phalangeal alignment because an x-ray is needed to know this. HPA is assessed externally, as shown below. A line is drawn from the middle of the pastern down to the start of the hoof wall. A line is then drawn through the middle of the external hoof wall with the angle in between being the HPA.

The HPA can either be described as broken forward, straight or broken backward. The diagram below (left) shows how the HPA is assessed in relation to the bones in the lower leg and hoof. This diagram is not drawn to scale so it isn’t exact but it gives you an idea of how the HPA is observed from looking at the horse from the outside in. The photo on the right shows an example of when the HPA is broken forwards, but very mildly. Again this is to show you the idea compared to the left picture so measurements are not exact. But you can see the angle between the pastern and the hoof wall is slightly smaller, meaning the angle is pointing forward and therefore shows a broken forwards HPA.

So what does this all mean?

Understanding the effects of the HPA can help your Vet, Farrier and Physiotherapist understand what might be causing lameness or behaviour changes, and the most appropriate management choice.

In a broken forward HPA the strain is placed on to the extensor tendons (at the front of the lower leg). This does not directly affect the horse much, but it can result in tissue injury of the hoof capsule and could affect the integrity of the hoof wall itself. The lack of load on the heels creates contraction and an atrophied frog also. The muscles of the flexors (at the back of the leg) may start to shorten, which can affect the stance of your horse. It’s important to note effects are all different and dependent on the severity of the HPA (Logie, 2017).

In a broken backward HPA (opposite to the picture above – the horse will have a longer toe) the force is placed on the flexor tendons (tendons in the back of the lower leg) which is transmitted as pressure into the navicular region. The horse may try to alleviate this pressure by changing its stance. The hoof capsule can then be overloaded. (Logie, 2017).

If the hoof is broken forward or backward the theory is that it induces rotation of the bone in the hoof (DIP joint). With the pastern and the hoof aligned, it allows for an equilibrium of forces therefore reducing tendon and joint overload.

So what is the ideal?

Every horse is different and effects of the HPA are dependent on what you use your horse for and the degree of the HPA. Below is a diagram showing the ideal (if there ever was one!). But the idea is if the shoulder angle and HPA is the same, therefore optimal loading will occur from to top to bottom and vice versa. This helping to maintain hoof health and reduce concussion forces through the forelimb.

But the moral of the story is your Vet, Farrier and Physiotherapist will all have an awareness of the effects of the HPA and management strategies for it, if needed. For Physio’s it helps us understand what biomechanical and physiological effects might be happening on the surrounding soft tissue and bones. The farrier is able to manage these conditions with a range of specialist skills and they are a wealth of knowledge for us physios when it comes to keeping your horse’s limb alignment in optimal condition, ultimately so you can enjoy your partners in crime. If you want more information or you want to share your stories you might have experienced with your own horse ,please get in contact.

Sharing knowledge and experience is how we all keep learning!

The Bow and String theory was identified initially in 1946 and it explains the kinematic relationship between the horses’ spine and their legs.  The amount of movement at the spine will affect the amount of movement of the limbs.

It’s important to understand what the Bow and String theory is because horses have multiple functions. From being wild animals, they are now domesticated, this means their function can be ridden, jumping, racing, grazing or breeding and so the demands on their musculoskeletal system fluctuates.

So this diagram (Van Weeran, 2004) helps to explain all about the mechanics of the bow and string theory.

The bow = The spine, pelvis and ribs (top line)

The String = The Abdominals (bottom line)

The bow is held in place by the tension from the string. So, when abdominals are contracted the bow is put under more tension. Functionally this means;

• If we protract the forelimb of the horse (limb goes forwards) and retract the hindlimb (limb goes backwards), we flatten or ‘extend’ the bow.  If we want the bow to be better able to support both the horses own weight and that of a rider, it needs to be capable of flexion.

So the more we strengthen our horses core, the greater range and strength we achieve in the back. If we achieve the flexion in the back (the bending) this allows for greater pelvic motion and allows the hind limbs to protract forwards underneath them.

The best way to imagine the opposite of what we’re trying to achieve is in a brood mare. When the abdominals are stretched with lack of muscle tension. In turn this causes the spine to enter a degree of extension and therefore look sunken.

What happens if there is back pain?

As you’ve probably guessed, back pain will change the amount of limb movement available. This is because when in pain spinal movement is limited often due to the muscles fixing the spine into extension, usually in a protective manner. This then limits hindlimb protraction, the hindquarters cannot ‘engage’, weight cannot be shifted back, and the forelimbs are overloaded.

Whether you start off with backpain and/or hindlimb lameness; left untreated, forelimb lameness is more likely if the hindlimb cannot function effectively. One sided lameness brings about changes in protraction/retraction of the limbs and consequently asymmetric torques about the longitudinal axis.

So, if all riders or horse owners reading this, take one message away – the bow and string theory is an important component to your horses’ function and performance. The back will affect the legs, so whether its back or limb lameness its key horses are treated as a whole and not just on one body part. This is where the role of physiotherapy is so important. We are trained in treating the musculoskeletal system so we can help with prevention and treatment of such injuries and keep you and your horse in tip top shape.

If you want any more information or would like free advice, don’t hesitate to contact us.

We all know how beneficial physiotherapy is in humans and animals. Specifically, when treating Degenerative Myelopathy (DM) in dogs, physiotherapy has proven to increase life expectancy by an average of 255 days (Kathmann et al. 2006).

Degenerative Myelopathy in Dogs

DM is a progressive condition involving gradual paralysis of the hind limbs. It usually occurs between the ages of 8 and 14 and can over time can be fatal. But it’s important to know it is not a painful condition.

The cause

The reason as to why some dogs might suffer with DM is unknown but it’s thought a gene mutation might be the cause. It is known as a ‘large breed;’ condition commonly affecting German Shepherds however in recent years, its become more evident it can also affect terriers, pugs, poodles and other smaller breeds.

Symptoms

It usually begins with a lack of co-ordination in the hindlimbs which can range from minor to severe. Owners might see their dogs standing with their hind limbs wider apart than usual to help counteract their lack of balance. Others might drag their feet, scuff their nails or knuckle their paws when trying to walk. Over time its progressive nature does mean the limbs become weaker therefore standing can be difficult.

Its progression rate can be anything from 6months to 1 year. Over time incontinence can become a symptom alongside difficulty eating and swallowing.

Management

DM unfortunately is not curable therefore management is based on managing symptoms through anti-inflammatories or corticosteroids and Physiotherapy.

What can Physiotherapy do?

1. Maintain strength and tone whilst encouraging correct use of the limbs.
2. Core strengthening
3. Maintain flexibility and prevent joint stiffness
4. Enhance circulation and nourish joints
5. Enhances proprioception and balance
6. Reduces pain caused by muscle tension, particularly in the forelimbs due to compensation
7. Posture correction
8. Maintain cardiovascular fitness
9. Advice on paw protection and environment changes.

‘A fine balancing act‘

The key with managing this type of condition is to not push your animal into fatigue. If you suffer with an inflammatory condition yourself, you will understand the concept of ‘good’ and ‘bad’ days. This principle is extremely important for dogs with DM. The balance is about ensuring your dog has a good quality of life but is not being pushed into fatigue which consequently causes a ‘bad’ day. Now we know DM is not curable so its understandable there will naturally be ‘bad’ days, but the aim of physiotherapy is to have more good, than bad days.

An example might be;

Your dog wakes in the morning and gets out of bed with no stiffness, tail wagging and hungry for food. As an owner you might think he is having a ‘good’ day today, so you decide to add on an extra 20 minutes on to the walk. As the evening draws in you might notice he is tired but not noticing anything abnormal, however the next day he struggles to get out of the bed and you decide to not take him out that day.

The issue here is adding on too much to the walk on a good day which has triggered a flare in symptoms. Physiotherapy can guide owners through diary management and walking tolerance to help re-correct the balance so more good days are seen than bad. This might be adding on a percentage of time onto a walk whilst ensuring on a ‘bad’ day the dog is still able to do something instead of nothing.

It is all about a fine balance of doing something, but not overdoing it.

You can contact us for more information if you would like free advice for your own dog.

The Sacroiliac joint (SIJ) can be a relatively common area of pain in sport horses and an even more common reason for poor performance.  

The reason the SIJ is susceptible to injury is because of the amount of force travelling through it. Whether it is taking off for a jump, transitioning through different gaits or galloping, the risk of injury to the SIJ increases.

Two reasons your horse might have SIJ pain;

1. Age related changes – such as Osteophytes and cortical buttressing which results in Osteoarthritis
2. Trauma – related to high levels of loading through the joint resulting in swelling/inflammation

However diagnosing SIJ pain can be difficult because most commonly it doesn’t act alone. Literature has found 25% of SIJ pain can cause hindlimb or forelimb lameness with another 25% having age related changes elsewhere in the spine. So usually there are other factors going on contributing to the dysfunction, but its chicken and the egg with which causes which! (Frustrating I know!)

How do I know if my horse has SIJ pain?

There are many indicators to look out for, so I’ve written the most common ones;

• Behavioural changes in canter (Bucking/rearing). So canter involves a suspension phase which means there are times where all four limbs are off the ground. What this means is there’s a short period of time where one hind limb is taking all the weight – so canter usually is the most pain producing movement for them.
• Behavioural changes on the circle – so again you’re looking for bucking/rearing but also head position – is their head/neck straight or are they looking out during one rein? Are they bringing their inside hind limb underneath them or are they struggling with hoof placement?
• Not tracking up on their lame limb. This can be because as they protract their hind limb forward they have to lengthen the spine and back muscles, but if there is stiffness, tightness or pain the horse will avoid a symmetrical stride when comparing the non-lame limb and the lame limb.
• Lack of muscle bulk and apparent muscle tightness along their back is very common. Usually due to pain inhibition and gradual disuse of this muscle group they weaken gradually. Muscle tightness can also be due to splinting because of pain.

There are many more things to be looking out for but by this point you will need your Vet to review the horse where a diagnostic and management plan will be devised.  

Is my horse at risk?

The most group of horses susceptible to injury to this area are Show jumpers, Dressage horses

Warmbloods and taller/heavier horses. One key aspect for prevention is cross training, ensuring you do not overjump or over train your horse is important!

How can a physiotherapist help?

Depending if the injury is new or a reoccurring injury, a physiotherapist can offer a variety of treatments.

If a period of box rest is advised by your vet, physiotherapy can provide specific stable based exercises such as isometrics, traction, weight shifts and core contractions.

If the condition is chronic an exercise programme can begin. This is a gradual approach to ensure strengthening, hind limb range of motion, core activation and pelvic motion is built but without causing irritation to the area.

What can the owner do?

The actions of the owner will depict the length and severity of the condition. Its extremely common to think behavioural changes in the horse are due to them misbehaving, but in fact most of the time its down to pain. So, its always worth reminding yourself of this and to not fall into the trap where a condition which could be treated quickly, ends up being a chronic issue.

• CROSS TRAINING, CROSS TRAINING, CROSS TRAINING! Don’t over train in the same activity. Alternate flat work, hacks in the field and cavaletti to avoid repetitive stress on the joint.

• If you notice any of the above signs you, they will need a period of rest from aggravating factors such as jumping, tight turns, circles, abrupt transitions, galloping – give them rest.

• Turn out your horse as much as possible, moving around freely will help them maintain flexibility and reduce SIJ stiffness

• Its extremely useful if the owner can keep a diary to be able to work out when to progress or regress their rehabilitation.

If you have any questions about the above information or would like to discuss a referral to physiotherapy for your horse, please contact Rochelle.