Cranial Cruciate Ligament Injury - Prehab, Rehab and Potential Environmental changes.
23.02.2025 Dheep Kalsi
So your dog has a cranial cruciate ligament injury – what are your options? In our last blog we discussed what a ruptured cranial cruciate ligament is and one of the main surgical techniques used to treat this injury. Depending on the severity of the injury, it is possible to manage a cranial cruciate ligament injury with conservative management (non – surgical techniques) such as Physiotherapy.
Once an injury occurs to the cranial cruciate ligament, initial Physiotherapy aims to control any inflammation and compensation in the surrounding muscles around the stifle joint. We then encourage the affected limb to be used and help to prevent / slow down any muscle wastage. As the rehabilitation programme progresses, the aims change to help strengthen the affected limb, improve the weight loaded onto the limb, regain normal movement patterns and return to full function of the limb.
Generally the first twelve weeks following a cranial cruciate ligament injury is where most of the rehabilitation occurs, such as red light therapy, soft tissue massage, myofascial release and gradually progressive exercise programmes. We try to regain full function of the limb as soon as possible, ideally by the 12 week mark post injury. However, it can take longer to regain the strength and exercise level that your dog was carrying out prior to the injury depending on what point Physiotherapy starts, any setbacks in rehab etc. Most of the research into when to start Physiotherapy is all around early intervention, if we can see your dog within a week or two of injury we can prevent compensatory patterns and muscle wastage. However, even if we are 6 months post injury Physiotherapy can be beneficial but may take longer to recover due to more compensations likely to have taken place over this time we then need to address.
If the rupture is too great or your dog is over a certain weight then surgery may be needed with Physiotherapy being used to help support your dog before and after the surgery occurs. Prehab is when Physiotherapy starts before a surgery; this is useful for patients who will have limited mobility and reduced weight bearing on limbs. Prehab helps to strengthen muscles and reduce compensatory issues that may occur. It has a positive effect on recovery times as the tissues in the body are stronger going into the surgery and complications post surgery are less likely to occur as the body is already learning how to return to its normal movement patterns and surrounding muscles become stronger. Therefore, the joint is more supported throughout its recovery.
Below are some of the most common things to think about to help you support your dog through a cranial cruciate ligament injury.
Will my dog still be able to go for walks?
Yes – however walks will be restricted and slowly built up over time as your dogs’ Physiotherapy programme advances. Ball chasing and off lead walks are not recommended for the first 12 weeks following surgery or the initial injury (if using conservative management). We usually recommend harnesses to be used on walks rather than a collar. If your dog pulls we need to prevent this to encourage increased use of their hindlimbs. We can teach you how to use a harness and lead to prevent pulling. More sniffy walks are encouraged rather than longer distances. With less walks, it can be hard to tire your dog out and keep them stimulated so the more sniffs they have, the more mentally stimulated they will be, the more they will be tired and relax/rest when they are home.
Focus on enrichment for your dog during this time; items such as snuffle and lick mats, kongs, and scent games such as finding treats in grass / towels are great to keep your dog entertained whilst they are on restricted exercise.
Do I need to get a crate?
Crates can be helpful during recovery for a cruciate ligament injury as they can prevent your dog from jumping on and off of furniture and give them a space to go to to rest / recover. However, they are not entirely necessary. If your dog is able to be kept calm in one space and will not jump on and off of furniture then you may not need a crate. Crates can provide peace of mind if you are unable to watch your dog at all times (especially during the night). If your dog is not used to crates then you may need to start to crate train them – we can help you with this and guide you with resources as to how to get your dog to love their crate. Alternatively using a pen can also help to restrict your dog but still provide them with enough space for freedom.
How long before my dog can go off lead or chase balls?
We usually recommend off lead walks to begin after 12 weeks depending on how your dog is recovering however, some dogs will need a bit more time before introducing this. Like the lead walks, the time off lead will be built up over the weeks and we usually recommend building up distance and recall by using a long line so that you still have control over your dog. Your dog may forever be restricted from chasing balls or frisbees as this could cause damage to the cruciate ligament or potentially cause the opposite hindlimb to have an issue with the ligament. We will discuss the pros and cons with you for these as they are more risky activities.
I have slippery floors – will my dog be okay on them?
Slippery floors are not ideal for a dog with cranial cruciate ligament injury – they can cause further issues due to the lack of grip that your dog will have which causes more strain on the ligament. Don’t panic – you do not need to get carpet for your house but maybe think of laying down rugs or mats to help cover areas that are slippery. There are many cheap alternatives to protect your dog from slippy floors, this is something we can discuss with you. Think about where your dog spends most of their time – food is usually given to dogs in the kitchen which tends to be tiled, so a mat for your dog to stand on and eat is helpful. As Physiotherapists we can help guide you as to where to put down rugs or mats during your sessions.
My dog sleeps in my bed, will they still manage to do that?
We would recommend that your dog sleep somewhere that they do not have to jump on and off so ideally a crate or a flat dog bed would be better. In the first 12 weeks, we recommend that your dog does not go up and down stairs, therefore thinking about where your dog’s bed is placed is another factor to consider. If your dog sleeps in a dog bed upstairs, then think about if you are able to carry your dog up and down the stairs in a safe manner for you and them – if not think about where this can be moved to or investing in a crate to keep them safe overnight. Human beds are usually high and dogs have tendencies to jump on and off of them in the night so generally we recommend to avoid having your dog in your bed for at least the first 12 weeks following the injury. Ramps or steps can be used later on down the line to help dogs with furniture but this is usually evaluated on a case by case basis.
As Physiotherapists we are best placed to aid with any queries around the home environment, prehab and rehab. Each case is different, here at Stott and Paws Physiotherapy we tailor the advice and treatment given dependent on you and your dog to get them back to being their best.