Guest guest Posted September 17, 2008 Report Share Posted September 17, 2008 Pending the case, I usually start swimming them 6-8weeks post sx. I think it is great to help with ROM and using the water to cause less strain/weight on their knee. I haven't had a bilateral case yet, so not sure on that one. - , RVT, CCRA Subject: Swimming and TPLOTo: VetRehab Date: Wednesday, September 17, 2008, 11:44 AM Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?Thank you in advance for your input,Maja Wichtowski, RVT, CCRT Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2008 Report Share Posted September 17, 2008 At this moment I'm trying to get my PhD on the subject of the influence of hydrotherpay on dogs. in the study we can see that with a TPLO you can do very beautifull things with swimming for pain and ROM but less for the real building of muscles. That's what I think and see of course. After swimming the dogs are more relax and can do more on the treadmill. I start the swimming of the dogs also at 6w I can see that the dogs realy need the treadmill to for the best results. Bart Menten master physiotherapy master physiotherapy for dogs teacher university of ghent and school for vet. assist. hydrotherapy, physiotherapy, training of sportingdogs student for PhD "influence of hydrotherapy on dogs ceo of westpool-hydronics NV cofounder of the "belgian association for certified animal therapists". www.hydrokine-westpool.be ,www.westpool.eu 0476/81.49.10. Van: VetRehab [mailto:VetRehab ] Namens sVerzonden: woensdag 17 september 2008 19:17Aan: VetRehab Onderwerp: Re: Swimming and TPLO Pending the case, I usually start swimming them 6-8weeks post sx. I think it is great to help with ROM and using the water to cause less strain/weight on their knee. I haven't had a bilateral case yet, so not sure on that one. - , RVT, CCRA From: tsavo13aol <tsavo13aol>Subject: Swimming and TPLOTo: VetRehab Date: Wednesday, September 17, 2008, 11:44 AM Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?Thank you in advance for your input,Maja Wichtowski, RVT, CCRT Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. No virus found in this incoming message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 No virus found in this outgoing message. Checked by AVG. Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 We don't swim our TPLO's, underwater treadmill primarily along with some other healing/pain modalities for the first few weeks. We start this 2 weeks post op. Once they progress, we will then begin to introduce/transition to land based rehab treatments as the patient can handle. We may begin to swim them after the 8 weeks post op rads are done and we see good bone healing. Sherman DVM VetHab Raleigh, NC From: tsavo13aol (DOT) com <tsavo13aol (DOT) com>Subject: Swimming and TPLOTo: VetRehab@yahoogroup s.comDate: Wednesday, September 17, 2008, 11:44 AM Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?Thank you in advance for your input,Maja Wichtowski, RVT, CCRT Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. No virus found in this incoming message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 No virus found in this outgoing message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 I guess I should have been more clear. When I said "swimming", I meant the UWT. - R. From: tsavo13aol (DOT) com <tsavo13aol (DOT) com>Subject: Swimming and TPLOTo: VetRehab@yahoogroup s.comDate: Wednesday, September 17, 2008, 11:44 AM Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?Thank you in advance for your input,Maja Wichtowski, RVT, CCRT Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. No virus found in this incoming message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 No virus found in this outgoing message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 I agree with - around 2 weeks is a good time to start the UWTM in an uncomplicated case. As far as actual swimming I think this is a bit more complicated to answer and depends on a lot of factors regarding the individual patient. Having said that - somewhere around 6 weeks I would start thinking about it if you have a pool. Having a Lab I know he would swim all day 1 week post-op so " controlled " swimming is important. Dave Levine > > From: tsavo13aol (DOT) com <tsavo13aol (DOT) com> > Subject: Swimming and TPLO > To: VetRehab@yahoogroup s.com > Date: Wednesday, September 17, 2008, 11:44 AM > > > > > Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx? > > Thank you in advance for your input, > > Maja Wichtowski, RVT, CCRT > > > Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. > > > No virus found in this incoming message. > Checked by AVG. > Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 > > > No virus found in this outgoing message. > Checked by AVG. > Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 Back between 1998-2000 when an UWTM was really just a dream for me I would swim TPLO's on a very regular basis. The surgeon, that I worked with at the time, and I never really saw much of a problem with it, though we were both pretty green on the subject at that time. We would start them swimming very early, 4-7 days post op, though the sessions would only last 3-5 min. at most. We did have two cases that occurred tibial crest avulsions though in those cases the osteotomy was made very cranial, leaving a very wispy piece of bone behind, compared to what I see today. From what I remember most of our patients did pretty well overall and we would routinely cut 2-3 dogs per week. I'm much more conservative now in my practice and am not advocating swimming at early acute phases of recovery but it makes me think about how little we may really know about the recovery of canine orthopedic conditions. I think the real problem with swimming is that we have no way to manipulate one of the most important variables of exercise... speed. Furthermore, the biomechanics of swimming gives you great flexion of the stifle though little extension without tricking the patient into extending their stifle by tickling/touching there foot, hence another variable of exercise that is not easily manipulated while swimming... range of motion. And of course you need to be in the water with them in order to do this. At this point in my career I admit that I really don't care much about when I start rehab on TPLO's. I leave it up to the surgeon. If they ask me when I want to see them I generally say that anywhere between 2-8 weeks is fine. Every dog that I see does have some of the same problems but they all have different owners, surgeons, body conditions, ages, activity levels and probably many more variables then I can list. I have found that somewhere between 2-8 weeks of rehab does tend to have a positive benefit to canines recovering from CrCL disease, but looking at a patient as an individual and taking in account to that patients needs I think is the single most important concept in rehab. At this point in canine rehabilitation I think we all need to be mindful that there really should not be “protocols” for what we do. With all that said when should a TPLO start swimming? I have no idea. I do know that it is much easier to manipulate exercise variables within the underwater treadmill vs. swimming. Happy rehabbing, Robby J Porter III, VT, LMT, CCRPAnimal Rehabilitation CenterMandeville, LA70448 Swimming and TPLOTo: VetRehab@yahoogroup s.comDate: Wednesday, September 17, 2008, 11:44 AM Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?Thank you in advance for your input,Maja Wichtowski, RVT, CCRT Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. No virus found in this incoming message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 No virus found in this outgoing message.Checked by AVG.Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 When talking about swimming I think that you have to factor in the surgeons opinions as well. If you are working in the same facility as the surgeon it is easier to have better communication with them about using the water. (especially if they are paying for the treadmill/pool) I still have people coming to our facility 2 months after a TPLO because the surgeon told them not to swim until after the post op rads. We start the UWTM at 2-3 weeks and then not swim until 7-8 week rads. My concern with swimming is that we do not have control of the leg and if they do use the leg vigourously we might have to worry about patellar tendonitis. I actually am seeing a patient that had an extracap done and was told by the general practitioner that did the surgery to swim 2 weeks after surgery. I swim and the dog was severely lame and then the owner came to us for a proper rehab program. Dog is now 8 weeks and doing well. I think that UWTM is also better in the early stages since it does encourage weight bearing and gait training where swimming does not. AS has been previously stated swimming really does not do a lot for strengthening the hind legs as even most healthy dogs do not use their hind legs very much. This discussion is one of the big reasons that I built a pool with a treadmill across the end so that we can treadmill and swim. Cheers Jeff Bowra I agree with - around 2 weeks is a good time to start the UWTM in an uncomplicated case. As far as actual swimming I think this is a bit more complicated to answer and depends on a lot of factors regarding the individual patient. Having said that - somewhere around 6 weeks I would start thinking about it if you have a pool. Having a Lab I know he would swim all day 1 week post-op so " controlled " swimming is important.Dave Levine > > From: tsavo13aol (DOT) com <tsavo13aol (DOT) com> > Subject: Swimming and TPLO> To: VetRehab@yahoogroup s.com> Date: Wednesday, September 17, 2008, 11:44 AM> > > > > Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx? > > Thank you in advance for your input,> > Maja Wichtowski, RVT, CCRT > > > Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. > > > No virus found in this incoming message.> Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> > > No virus found in this outgoing message. > Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> -- Jeff Bowra DVMCanine Rehabilitation Practitioner Aldergrove Animal Hospital26841 Fraser HighwayAldergrove, BC, Canadawww.familypetdoc.comwww.thespaw.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 Hi Jeff. You bring up an interesting issue... patellar tendinitis post-TPLO. It took me a while to convince our surgeons that the onset of tendinitis (rad evidence of thickening vs. clinical lameness) was not due to over enthusiastic rehab (in fact, I think we're all pretty conservative) but to the altered biomechanics of the stifle and a direct result of the cut necessary to perform the TPLO procedure. I'd be curious if those who are " pre-hab'ing " are seeing less tendinitis/tendinosus? Amie --------- Swimming and TPLO> To: VetRehab@yahoogroup s.com> Date: Wednesday, September 17, 2008, 11:44 AM> > > > > Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx? > > Thank you in advance for your input,> > Maja Wichtowski, RVT, CCRT > > > Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. > > > No virus found in this incoming message.> Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> > > No virus found in this outgoing message. > Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> -- Jeff Bowra DVMCanine Rehabilitation Practitioner Aldergrove Animal Hospital26841 Fraser HighwayAldergrove, BC, Canadawww.familypetdoc.comwww.thespaw.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2008 Report Share Posted September 18, 2008 Thank you everyone for your input on this subject. A surgeon mentioned a possible concern regarding swimming and TPLOs. Specifically, he recalled an article that suggested that swimming may compromise the recovery of TPLO patients. Has anyone ever read such an article? The surgeon asked that I ask the VetRehab group about swimming and TPLOs in general. All of your input confirms my understanding of the proper use of this modality. 2nd question to the group: I recently rescued a 5yr old boxer-x (60#). He is an orthopedic nightmare. He has bilateral hip dysplasia (grade IV on right, Grade III on left), came with bilateral CCL rupture (2yr old injury), and an un-united anconeal process at the right elbow. He had bilateral TPLOs 6 weeks ago. Rehab was commenced immediately post-op - icing, pROM, Laser therapy, and now includes controlled leash walks, therapeutic non-impact exercises. We started swim therapy last week (controlled, assisted, 15min maximum swim time). 7 days post-op he developed severe inflammation and heat in his left hind limb - was diagnosed as a Staph infection via FNA and cytology, and was placed on ABs. 3 weeks post-op he became acutely lame on his right hind limb - this resolved in a week and did not include inflammation. 6-week post-op rads were taken yesterday and showed bilateral tibial tuberosity avulsion and left fibula fx, with bilateral, proximal, displacement of the patella. Scary rads! It appears that this is a rare complication following TPLO sx, happening in 7% of cases, but occurs most often in bilateral cases. The surgeon suggests that we wait a month and re-check rads then. Hopes are that the fx will heal and that there will be no need for revision. After reading several veterinary articles on this complication, it appears that revision - involving removal of hardware - was indicated. So the question to all of you is simply, has anyone had experience with this type of TPLO post-op complication and what was the surgeon's course of action? Again, thank you for the input, Maja Wichtowski, RVT, CCRP Re: Re: Swimming and TPLO Hi Jeff. You bring up an interesting issue... patellar tendinitis post-TPLO. It took me a while to convince our surgeons that the onset of tendinitis (rad evidence of thickening vs. clinical lameness) was not due to over enthusiastic rehab (in fact, I think we're all pretty conservative) but to the altered biomechanics of the stifle and a direct result of the cut necessary to perform the TPLO procedure. I'd be curious if those who are "pre-hab'ing" are seeing less tendinitis/tendinosus? Amie --------- Swimming and TPLO > To: VetRehab@yahoogroup s.com > Date: Wednesday, September 17, 2008, 11:44 AM > > > > > Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx? > > Thank you in advance for your input, > > Maja Wichtowski, RVT, CCRT > > > Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. > > > No virus found in this incoming message. > Checked by AVG. > Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 > > > No virus found in this outgoing message. > Checked by AVG. > Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06 > -- Jeff Bowra DVM Canine Rehabilitation Practitioner Aldergrove Animal Hospital 26841 Fraser Highway Aldergrove, BC, Canada www.familypetdoc.com www.thespaw.ca Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 19, 2008 Report Share Posted September 19, 2008 I may have missed this in a previous discussion, but when "patellar thickening" is seen on radiographs post TPLO, has it been documented that it is tendinitis or some form of pathological change compared to hypertrophy? thanks JanJanet Steiss, DVM, PhD, PT Associate Professor Dept of Anatomy, Physiology & Pharmacology College of Veterinary MedicineAuburn University AL 36849______________________________ To: VetRehab From: forpawsrehab@...Date: Thu, 18 Sep 2008 16:10:16 +0000Subject: Re: Re: Swimming and TPLO Hi Jeff.You bring up an interesting issue... patellar tendinitis post-TPLO. It took me a while to convince our surgeons that the onset of tendinitis (rad evidence of thickening vs. clinical lameness) was not due to over enthusiastic rehab (in fact, I think we're all pretty conservative) but to the altered biomechanics of the stifle and a direct result of the cut necessary to perform the TPLO procedure. I'd be curious if those who are "pre-hab'ing" are seeing less tendinitis/tendinosus?Amie--------- Swimming and TPLO> To: VetRehab@yahoogroup s.com> Date: Wednesday, September 17, 2008, 11:44 AM> > > > > Does anyone feel that swimming is contraindicated in TPLO cases? If so, why? If not, when would you commence swimming? If the patient had bilateral TPLO, would the answer remain the same? Do you take into effect the age of the patient, the weight of the patient, and whether the CCL rupture was an acute vs. chronic condition prior to sx?> > Thank you in advance for your input,> > Maja Wichtowski, RVT, CCRT > > > Looking for spoilers and reviews on the new TV season? Get AOL's ultimate guide to fall TV. > > > No virus found in this incoming message.> Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> > > No virus found in this outgoing message.> Checked by AVG.> Version: 7.5.524 / Virus Database: 270.6.21/1675 - Release Date: 16/09/2008 19:06> -- Jeff Bowra DVMCanine Rehabilitation PractitionerAldergrove Animal Hospital26841 Fraser HighwayAldergrove, BC, Canadawww.familypetdoc.comwww.thespaw.ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2008 Report Share Posted September 20, 2008 Yes Jeff, I am with you on the swim and UWTM in the same ‘tank” and in fact we have the same supplier.... this gives the best of both worlds, not only for orthopaedic, but for neuro cases... means we can do gait training for short sessions, then quickly lower them into the pool and have them swimming for strengthening... Love having UWTM and pool together tania Quote Link to comment Share on other sites More sharing options...
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