Archive for the ‘General’ Category

Meet Bogey!

Sunday, January 4th, 2015

Bogeymeet-01Bogey is a young, energetic, active dog who partially tore his ACL in his knee.  He originally came to us with a mild lameness that had improved with rest, but recurred every time his owners tried to allow more activity.  We started his rehab sessions with therapeutic laser and cryotherapy to decrease pain and inflammation in his knee.  After a 2 week period of strict rest and exercise restriction, his lameness resolved and we guided his owners through a more gradual return to his normal activity.  He started walking in our underwater treadmill which provides more strengthening for his muscles since he has to walk through the resistance of the water, but less work for his joints because the buoyancy of the water helps to support his body weight.  We started strengthening exercises for his hind legs, back, and abdominal muscles to help prevent a recurrence of his injury.  Months later, Bogey is still doing great, has not had anymore episodes of lameness, and is stronger than ever.  He even starts wagging his tail when the car approaches CRCG now!

Pelvic Limb Issues

Tuesday, July 8th, 2014


The ankle bone’s connected to the knee bone, the knee bone’s connected to the hip bone….I always thought that song was funny, but as I went through vet school, I came to appreciate its simplicity. We often think of limbs as bones with “stuff “ around it to support it. The most amazing part is that “stuff” is what shapes how a pet moves and functions. Bones are the framework: muscles, tendons, ligaments, fascia, joint capsules, and cartilage are the initiators (with a little help from the nervous system). When we look at all of the problems that can occur with the rear limbs, a significant portion of them can be attributed to problems with the soft tissues or problems resulting from malfunctions of these tissues.

For example, our favorite–the cranial cruciate ligament. Like the human ACL, it is one of the most common ligaments injured in pets. We have seen chronic degeneration that is congenital, but most often there is chronic tearing of the ligament over time due to excessive and repetitive wear. When the CCL tears or ruptures, there is significant lameness, and changes begin within the knee joint that lead to arthritis.

Another example is patellar luxation or knee caps that “pop.” This has typically been seen in smaller dogs in the past, but has been noted more often recently in larger dogs. There are many reasons why this can happen: the groove that the patella tracks in is not deep enough, the femur is bowed to a particular degree, or there is asymmetry to the quadriceps muscle mass or inappropriate timing of the muscles causing the patella to be pulled in one direction or the other. This problem can lead to inappropriate ambulation, limping, inflammation and arthritic change in the knee.

This brings about the question of why these things are happening and why are we seeing more and more of these problems occurring in our pets?

The next few ideas are purely speculation and there is no significant scientific evidence to speak of, but in my years of practice and experience, I think they are worth exploring.

Like human babies, puppies have to learn how to walk. They have to develop muscles and a gait like any child. What if they learn a gait the inappropriate way? What if they do not develop muscle like they should due to lack of exercise or too much exercise? Who teaches them how to walk? These are interesting, unanswered questions with a huge amount of possibility. Since muscles and bones remodel and respond to what the body is “taught,” how do we think this might affect them as their life progresses? I am not discounting the notion that some dogs are born with congenital problems, but if identified early or if we are proactive in our treatment, it’s exciting to think what changes are possible and we do know that we have made positive contributions to these changes with rehabilitation.

Just some things to chew on. What do you think?

How Do We Love Our Pets? Let Us Count The Ways

Sunday, June 1st, 2014

We found this great article in the Denver Post and wanted to share it.

How do we love our pets? Let us count the ways

By Susan Jennings, Digital First Media, Denver Post


Being a dog or cat in America these days is nice work if you can get it.

Pet owners spring for gourmet kibble, canine couture and doggy daycare, where their animal companions can spend the day watching Animal Planet while being monitored by webcams for their parent’s viewing pleasure.

According to a Harris Interactive poll, 91% of pet owners say they consider their pet to be a member of the family.

It’s no wonder then that our obsession with our four-legged friends has moved beyond the aisles of the local pet super store and is making us taking a holistic look at their health and quality of life.

Here’s a look at some of the niche services now available to your furry, feathered and scaled friends.


Whether your cat has developed a limp or your dog is recovering from surgery, now you can enlist the help of physical therapists or veterinarians who’ve received specialized training to help rehabilitate the family pet.

They employ many of the same techniques used on humans (in fact, may of the pet physical therapists out there also work with people) including things like manual therapy, cold laser therapy, sports conditioning and even underwater treadmills.

Physical therapy is one of the fastest growing specialities in veterinary medicine as more vets have started recognizing the benefits of rehab, and schools have begun offering training programs on the subject.


Here’s another example of a practice that has been used to help humans and even injured race horses for centuries now being used for the benefit of dogs.

Hydrotherapy allows animals that are recovering from surgery or soft tissue injuries or suffering from things like osteoarthritis and orthopedic or neurological conditions to improve muscle tone and promote tissue repair without putting unnecessary stress on their bones, tendons and joints. Not to mention, ti’s a great form of general fitness-especially for overweight and obese dogs–improving cardiovascular health and muscle tone.

Think you can just lead your dog to the nearest swimming pool for a dip? Think again.

Hydrotherapy experts say that the type of pool and water you should seek for your pet varies depending on their size and specific needs. Options available include underwater treadmills, hot tubs, and anti-swim jets and pools.


Another healing technique from the Far East, acupuncture is part of a family of procedures that uses thin metallic needles to stimulate different anatomical points and is most often used to treat chronic pain.

In China, it’s been used on animals for thousands of years and is becoming more widespread elsewhere, complementing the Western medicine used to treat sick pets and livestock.

Search for an animal acupuncturist in your area by visiting the American Academy of Veterinary Acupuncture.


Finally, even when you’ve done all you can to rehabilitate and heal an ailing pet, you’ll inevitably be faced with the heart-wrenching decision to let go of your loyal friend.

To help you through this process many veterinarians and specialty clinics are offering hospice care – counseling clients on using medication to make their pets more comfortable and offering euthanasia in the comfort of your home.

The International Association for Animal Hospice and Palliative Care, which was founded in 2009, no has more than 200 members and is growing, according to founder Dr. Amir Shanan, as pet owners are willing to spend more money for peace of mind.


Responsible pet ownership takes planning and knowledge. The Denver Dumb Friends League is a great resource when it comes to tackling some of the issues that can arise. Visit

The American Veterinary Medical Association also is an authority on pet health and wellness. Get more information at

Top 5 Conditions that Respond to Rehabilitation Therapy

Monday, May 12th, 2014

Top 5 Conditions That Respond to Rehabilitation Therapy

Suzanne Starr, DVM, CCRP, Paws in Motion Veterinary Rehabilitation Center, Natick, Massachusetts


The goal of physical rehabilitation, in combination with medical and surgical care, is to restore normal or near-normal mobility and musculoskeletal function. Manual therapy includes massage, stretching, passive range-of-motion (ROM) exercise, and joint mobilization. Modalities include heat and cold therapy, therapeutic neuromuscular electrical stimulation, laser therapy, and therapeutic ultrasonography. Targeted exercise can include use of exercise balls or wobble boards, cavaletti rails (ie, horizontal poles positioned at varying heights and distances for dogs to step over), underwater or land treadmills, and pools.

Although dogs with assorted conditions can benefit from physical rehabilitation, the following are the top 5 canine conditions that the author believes best respond to rehabilitation therapy.

Top 5 Conditions That Respond to Rehabilitation Therapy

1. Postoperative cranial cruciate ligament rupture surgery
2. Postoperative femoral head and neck ostectomy
3. Spinal cord diseases
4. Osteoarthritis
5. Obesity

1. Postoperative cranial cruciate ligament rupture surgery
Cranial cruciate ligament disease is one of the most common orthopedic conditions in dogs. Surgery is arguably the best approach to restore stability when the cruciate ligament has been damaged. Regardless of the surgical procedure, rehabilitation initially involves pain management, massage, passive ROM, and icing. As tissues heal, patients often progress to weight-shifting exercises and water treadmill walking (Figure 1). As lameness improves, therapy may include leash walking (ideally involving hills), followed by jogging and trotting.

Figure 1. Because underwater treadmill walking has little impact on the joints, it can benefit dogs affected by orthopedic and neurologic conditions.

2. Postoperative femoral head and neck ostectomy
Femoral head and neck ostectomy is most often performed to treat Legg-Calvé-Perthes disease (ie, avascular femoral head necrosis), coxofemoral luxation, and femoral head and neck fracture. In addition, this surgery can be a salvage procedure for painful hip dysplasia or osteoarthritis. Adequate pain management is important to encourage early use of an affected limb. Early therapy involves massage and gentle, passive ROM. After the skin incision has healed, underwater treadmill activity can promote partial weight bearing and return to normal gait. Once the affected limb is used in a four-legged walk, additional weight-bearing exercises can be introduced. Tools (eg, balance board, exercise ball) can help improve weight bearing while strengthening the core.

3. Spinal cord diseases
Common spinal cord diseases include intervertebral disk disease, fibrocartilaginous embolism, degenerative myelopathy, spinal trauma, and inflammatory CNS disease. Classic signs are proprioceptive deficits and severe paresis or paralysis of the pelvic or all limbs, depending on lesion location. A thorough neurologic examination is essential. When indicated, cerebrospinal fluid tap and MRI or CT should be pursued. Once the diagnosis has been confirmed, therapy, including physical rehabilitation, can be planned. Physical rehabilitation therapy has a role in both these circumstances.

Therapeutic goals for dogs with spinal cord disease include reducing pain, maintaining joint flexibility, preventing or reducing muscle atrophy, and restoring coordination and proprioception. Techniques depend on the severity of signs and spinal cord disease, but massage, passive ROM, targeted exercises using an exercise ball (Figure 2), and water therapy are commonly used. In dogs with severe paresis or paralysis, the benefits of water therapy are extensive. Buoyancy of the patient when surrounded by water strengthens mobility, as dogs often initiate movement in the water before initiating movement on land. When the dog can walk without support, adding exercises such as stepping over obstacles (eg, cavaletti rails) can help improve overall coordination.

Figure 2. Targeted exercises, such as using an exercise ball, can help core conditioning, weight bearing, balance, and ROM.

4. Osteoarthritis
Patients with osteoarthritis can benefit from a multimodal therapeutic approach. A patient’s condition often deteriorates rapidly becomes a vicious cycle: because the arthritis is painful, the animal typically becomes more sedentary, leading to muscle atrophy and weight gain, subsequently worsening the condition. Pain management through analgesic medication and physical therapy can help. Gentle exercise in an underwater treadmill or a pool helps build muscle strength and endurance while minimizing stress on painful joints. When the patient is able, targeted weight-bearing exercise is ideal to strengthen the joints.

5. Obesity
In the United States, an estimated 50% of dogs between 5 and 10 years of age are overweight or obese, making this one of the most common canine medical disorders. Health problems caused or complicated by obesity include joint and/or musculoskeletal problems, exercise and heat intolerance, and pulmonary and cardiovascular disease. Although attention may be given to designing the appropriate diet for weight loss, exercise is often overlooked. When combined with caloric restriction, exercise can induce a negative energy balance critical for weight loss. Scheduled sessions of physical activity can help burn calories,  build muscle mass, and improve client motivation and compliance. Exercise sessions should be customized for each patient.

Closing thoughts
Therapists not only provide a service during rehabilitation sessions, but also participate in designing daily home plans. Clients often benefit greatly from receiving specific guidance following their pet’s injury or surgery. In addition, therapists can recommend slings, harnesses, wheels, and other assistive devices that can help patients and caregivers. It is therefore important for general practitioners and specialists to consider and discuss rehabilitation as part of their patients’ complete care plans when appropriate.

SUZANNE STARR, DVM, CCRP, practices at and owns Paws in Motion Veterinary Rehabilitation Center in Natick, Massachusetts. Her areas of interest include senior and postoperative patient care. Dr. Starr completed an internship at Angell Animal Medical Center and earned her DVM from Tufts University.


Importance of Rehab

Sunday, January 5th, 2014

ImportanceofRehab-01WHY IS REHAB IMPORTANT?

If your dog is young, old, post-operative, or arthritic, it might be time to consider canine rehabilitation. Essentially physical therapy for dogs, canine rehab can help with many different doggy afflictions. People often are surprised to hear that rehab is an option for their own dog, and we are frequently asked how rehab works or why someone should consider it for their furry companion.


Canine rehab is a field of veterinary medicine that focuses on soft tissue injuries (muscle pains, ligament tears, and tendon strains, for example). Rehab is a way for dogs to reinforce normal neurological pathways, to gain strength and coordination, and to increase joint range of motion. It identifies painful or problematic areas; rehab vets can help with those undiagnosed lamenesses for which other vets may prescribe just R & R (or “rest and Rimadyl,” in the veterinary world). Canine rehab utilizes three main treatment options: 

epcorgis_small_squareExercises are at the core of canine rehab. Just like people, dogs respond well to small amounts of consistent exercise. If you want to tone your biceps, for example, you focus on high repetitions, low weights. The same is true for your dog: if Fido just had knee surgery and has lost tone in his hamstrings, we ask him to start with gentle weight-shifting exercises a few times a day instead of hiking him to the summit of Pike’s Peak.

Another tool of rehab is hydrotherapy, the use of water to aid in your dog’s treatment in the form of underwater treadmills and swimming pools. The buoyancy of water helps alleviate stress caused by weight-bearing on your dog’s joints, while still offering strengthening properties as your dog swings its legs through the water. Depending on your dog’s issues, a rehab vet may utilize the treadmill, the pool, or both.

Lastly, rehab incorporates different modalities to offer a well-rounded treatment plan. Cold laser, therapeutic ultrasound, and muscular electrostimulation are available to your dog. All reduce pain, encourage greater blood flow, and increase the rate of healing. Used alone or in conjunction with exercises and hydrotherapy, almost every patient feels the benefits of these modalities.


Any dog can benefit from rehab. Our typical patients include post-operative and geriatric dogs, but we also have young, healthy pups. If your dog is in agility and you’re looking to improve her weave-pole time, we can help with that. If your puppy is too uncoordinated to function all four limbs at once, we can help with that, as well.

Post-operative patients (especially all you TPLO’s out there) are the most obvious rehab candidates. Just like in people, dogs need more than just strict rest to fully recover from orthopedic procedures. Surgeons have learned that six weeks of strict cage rest after slicing-and-dicing does not result in healthy dogs or happy owners. Rehab helps ease a dog back into normal activities by safely strengthening the muscles around the weakened bones or joints.

Pre-operative patients are less obvious rehab candidates. If your dog just “blew out a knee” and had corrective surgery, the surgeon likely told you that more than 80% of such patients end up “blowing out” their other knee. Rehab will help your dog strengthen BOTH legs after the first surgery to help protect both knees, thereby decreasing the risk of a second surgery (and a second surgery bill). This is true for non-knee anatomy, as well: wrists, elbows, shoulders, hips, ankles, and spines can benefit from a little extra muscular support, as well.

Even if your dog is already scheduled for surgery, it’s a good idea to bring him or her by beforehand for an introduction to some of the exercises that will follow the surgery; that will give him/her a head start post-operatively. They can jump right into the treatments rather than spending some of that precious post-op time in the introductory phase (this is especially true for the underwater treadmill).

fitpawsYoung and old dogs are both known for their lack of limb-control (known as proprioception). In older patients, it’s likely due to a medical condition, such as arthritis or a neurological disease; in puppies, it’s due to…well, being a puppy! Exercises to help your dog place its paws accurately and work on balance can make a significant difference in your and your dog’s lives. Take dogs diagnosed with degenerative myelopathy, for example. This is a debilitating neurological condition with 6-month prognosis from the time of diagnosis without rehab. With it, they can stay comfortable for a year or more.

Dogs with a bum leg or two also find rehab useful. Some dogs are born with inherently bad joints: think bulldogs, dachshunds, and German shepherds. Some are born with angular limb deformities, which occur when bones do not develop and meet correctly within the joint.

Healthy dogs can benefit from rehab, as well, for all of the same reasons just listed. Rehab can help agility or working dogs strengthen muscles and avoid injuries. Hunting dogs can improve their retrieval times and decrease risk of injury by improving their proprioception. Even if your dog is just your walking buddy who likes to play fetch, rehab can help improve their overall fitness level to help prevent any number of metabolic and orthopedic complications that accompany an aging animal. Just like exercises keeps your own cardiovascular, gastrointestinal, musculoskeletal, and nervous systems in better shape, they help your dog in the same ways.


massageAt CRCG, your first appointment will be an evaluation. A rehab vet examines your dog as a whole, feeling each palpable muscle, tendon, ligament, and joint. This gives the vet a complete picture of what is painful for your dog and how to best approach treatment. The vet then demonstrates and helps you practice various simple exercises for you to do with your dog at home. The vet also lays out a general game plan for rehab, and you both discuss how that does or doesn’t work with your own goals or schedule.

Appointments can include any of the methods discussed above: exercises, hydrotherapy, and manual modalities. During each appointment, you are right there with your dog. A tech does not whisk your dog away “to the back” for treatments; you are an integral part of each step along the way in your dog’s rehab. Rehab is truly a team effort, and without your dedication at home, it would be a slower and less successful process.

Who else is part of your dog’s rehab team, you may wonder. A rehab vet is a veterinarian who underwent additional training and certification. A certified veterinary technician may also make an appearance to help with certain exercises.


Visit our website (, give us a call (303-762-7946), or come visit us at CRCG! We’re happy to answer any questions or help determine if your dog could use some form of rehab.