There is some variation according to the type of surgery performed, but the approach to rehabilitation after surgery is fairly consistent.
We typically begin immediately after surgery, either one- or two-days post-op. The initial 10 to 14 days is focused on pain management and trying to prevent the loss of muscle and range of motion that typically occurs after surgery. Many of these patients already have deficits from before surgery and we are trying to avoid further losses during this period of discomfort after surgical trauma. There may be changes in their analgesic medications to optimize pain control. Laser therapy can help not only with pain, but can increase circulation and healing at the surgery site. We will typically perform gentle passive range of motion and stretching exercises on the affected joints as they tend to stiffen after surgery. Cold or warm compresses may be used as indicated as may TENS therapy, which can be helpful with pain and increasing circulation. We typically do not perform active, weight bearing therapeutic exercises during the immediate post-operative period. Spinal surgery patients often receive acupuncture during the immediate post-operative period as do some patients requiring additional pain control.
Typically, at 10-14 days post-surgery, the primary surgeon has re-examined the surgery site and released the patient for more active rehabilitation (and removed any skin sutures). At this point, we perform the full initial rehab assessment including the various measurements and stance analysis. The inaugural therapeutic plan is formed at this time and active rehab begins. The exercises are chosen based on the patient, the type of surgery, the amount of muscle loss and the results of the initial assessment. Many patients will be introduced to hydrotherapy at this time.
The length of time the patient requires rehabilitation varies considerably. Our goal is to optimize their therapy and return them to function as quickly as possible without overdoing it and causing pain. To some degree, the type of surgery will dictate what a typical recovery period may be expected. The individual’s status will impact those typical predictions. Young, well-muscled dogs with surgery shortly after injury will typically finish rehab faster than an older pet with dramatic muscle loss, significant arthritis and delays prior to surgery. Spinal surgery patients are the most variable as that is based on return of spinal cord function. We will always try to provide an idea of expected recovery after the full assessment of the patient. Our goal for “graduation” is not 100% normal function; that is not truly necessary. We strive to get them to at least 80% function and be confident they can maintain well in their home environment. As they begin to reach that level, we typically start by reducing the frequency of rehab sessions while monitoring to make certain they aren’t losing ground. We typically check back 4-6 weeks after “graduation” to confirm they are at least maintaining their gains if not continuing to improve following rehabilitation. Most are continuing to improve after finishing formal rehab. The needs (and goals) of the athletes, competition dogs and spinal patients will vary considerably from the average post-operative orthopedic patient and are very much case by case regarding the expectations for recovery.
Elizabeth F. Baird, DVM, CVPP, CCRT, cVMA
Steele Pain Management & Rehabilitation Center
