Case Studies

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Milo was born in April 2023. He was a small puppy, and, according to his guardians, walked “funny” from the moment he arrived in his new home. In October 2023 Milo was admitted for routine sterilisation. At this point radiographs were taken of his hind quarters. A diagnosis of bilateral hip dysplasia and bilateral medial patella luxation was made. The primary care veterinarians wished to wait for skeletal maturity before intervening surgically. Milo was referred to Animal Health and Hydro for physical rehabilitation and pain management. In the week preceding the initial rehabilitation assessment, Milo started limping on his left forelimb. At the initial consultation Milo was very unhappy, and mildly aggressive depending on which joint was being palpated. He returned to the primary care veterinarian for rads of the forelimbs. The diagnosis was bilateral angular limb deformity. Surgery was scheduled and performed in December 2023 - bilateral ulnar osteotomy.

Milo returned for rehabilitation three weeks post-surgery. It was noted that he showed more pain in his hindquarters and that he was weak. The goals of therapy were to manage Milo’s pain, both post-operatively and in the hind limbs. It seems as though weight shifted considerably from the forequarters to the rear following surgery. Milo’s hind limb problems would need to be managed until he reaches skeletal maturity. Further goals would be to enhance post-surgical repair and recovery and improve Milo’s function and quality of life. Client education is imperative in terms of providing skills and tools to manage Milo’s activity (no running, jumping or playing for twelve weeks post-op) and to provide information to modify the environment to reduce risk of further injury.

Milo visited the rehab facility weekly for five months before client commitments made further therapy sessions difficult. During those visits Milo was exposed to numerous manual therapies, photobiomodulation therapy and hydrotherapy. In Milo’s case underwater treadmill sessions were particularly useful to provide exercise, improve joint range of motion and strengthen his musculature while protecting his joints.

It was noted that when Milo was experiencing pain, he was very snappy. On questioning the client, it was discovered that the pain medication was not being administered. Liaison with referring veterinarians is all in a day’s work for rehab practitioners and this oversight was easily rectified.

Milo returned to therapy sessions in September 2024 (three months later). It was noted that he had a particularly difficult winter with much pain. However, September is springtime in the Southern hemisphere. At this reassessment session Milo was spunky, happy and eager to run. We await the decision regarding surgery to correct his hind limb issues.

The client is pleased with Milo’s recovery and response to therapy. She understands that rehabilitation is likely to be a lifelong commitment. 

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George, a five year old blind Schnauzer, presented with chronic RHL lameness and was diagnosed with IVDD (lumbosacral). Physical rehabilitation, acupuncture and laser therapy were performed weekly together with a daily home exercise program, that was performed vigilantly by his owners. George presented with challenges being completely blind, which limited the ability to perform some rehabilitation exercises and progression of the rehab program at times. The combination of regular treatments, monitoring and persistence and dedication of his owner, enabled George to improve, build up his core strength, muscles and use of his RHL.

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At five months of age Riley presented with progressive hindlimb weakness and a swaying gait. She was referred to one of the largest specialist veterinary practices in Johannesburg. Riley was Ortolani positive on both hips but not painful. The specialist surgeon asked for an MRI scan which revealed spinal compression from T2 to T8. On 5^th July 2021 Riley underwent left sided hemilaminectomy T2 – T8 extending to dorsal laminectomy T2/T3/T4. Following the surgery, she retained deep pain perception but was non-ambulatory. Her physiotherapy began immediately post-op.

The referral centre has an in-house veterinary physiotherapist who applied ice twice a day in the initial phases. Therapeutic laser and TENS (transcutaneous nerve stimulation) were performed twice daily. Comfortable that Riley’s pain was being managed, therapeutic exercises started a few days after the surgery. These included assisted standing with activation of the abdominal musculature. As she responded, standing bicycles, weight shifting, and rhythmic stabilisation were added. The right hind limb showed some degree of extensor rigidity while the left was flaccid. Passive range of motion helped to overcome the rigidity and allow other exercises. Riley tired very quickly.

After two weeks of intensive therapy Riley was allowed outside in a support sling. When outside the therapist assisted with support, walking and hind limb paw placement. Her family visited twice a week as they did not reside close to the facility. Riley really responded so well to these visits and tried even harder in her sessions that followed the family interactions. By the end of July (3 weeks) Riley was able to push herself up into a standing position and hold this for 3 seconds. Underwater treadmill sessions, with gait training, started soon after this.

One month after the surgery Riley was discharged. Physical rehabilitation sessions continued, and Riley’s family were given home exercises. One of these exercises was to place Riley over a peanut and rock her backwards and forwards. Riley was able to sit properly at this point. Assisted sit to stands were added. She made great progress once she was sent home. The power of love can never be underestimated!

Riley continued to progress until November 2021 where she seemed to have a dip in physical ability. At this point she was still being carried up and down the stairs and helped a great deal at home. It was suspected that the hips may be playing a role as Riley was growing and moving more. The program was adjusted to a twice weekly. The sessions alternated between hydrotherapy and land-based exercises. Riley was still dragging her hind paws. Booties were supplied. Despite her physical shortcomings she was determined to move and very active.

The time spent walking in the underwater treadmill gradually increased. Riley walked inclines and declines and at different water levels depending on her ability and capacity on the day. Riley was constantly challenged with therapeutic exercises. Increasing the difficulty of the exercises enhanced the outcome. She progressed form weight shifting on a solid elevated surface, to an inflatable disc. Riley was walked over foam mattresses, up and down ramps, over cavaletti rails and around obstacles. Many of these exercises were also performed at home.

Riley’s rehabilitation continued until September 2022 – a journey of 15 months. Her recovery was possible because of good surgical interventions, appropriate in hospital care, intervention by trained physical rehabilitation practitioners and a dedicated family. Riley is mobile, pain-free, and happy.

To watch a video of Riley’s amazing rehabilitation progress please click HERE.

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Numbi was driven over in the driveway of his home on 6th December 2019. He was 11 months old. He sustained severe pelvic injuries. After 5 days in hospital he underwent surgery. The ileal fracture on the left hand side was plated. The fracture of the right ischium was not repaired. Fortunately no acetabular fractures were present. Physiotherapy began in hospital and he was soon weight bearing on his right rear leg. The left rear limb remained non-weight bearing and he began to hold this limb beneath his body with rotation of the paw. Numbi was referred to our rehabilitation practice at the end of January 2020. At presentation Numbi was shifting most of his weight onto his forequarters. The left hind limb was non weight bearing and knuckling. Sensation was present.

Therapy began with gentle release of the hip area bilaterally. This was followed by gentle standing and weight shifting onto the rear limbs. The client was most adept and these exercises were also performed at home. Slowly but surely the left hind limb released. Heat, photobiomodulation and massage were the mainstay of early treatment, followed by stabilising exercises and slow deliberate movements. After three weeks, when the soft tissue restrictions were released and the area was more pliable, his therapy moved to the pool. Hip extension remained restricted.

Early in March Numbi started to use the left hind limb. After that there was no going back. In the middle of March the clients went on leave and COVID lockdown happened. We did not see Numbi again. A follow up call after lockdown about 4 months later revealed that Numbi was “full of beans and running around like crazy!”

Click HERE to Watch a Video of Numbi's Amazing Progress!

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Bella’s initial clinical examination took place in September 2018. She was one year old. Bella is a Labrador with bilateral hip dysplasia. 6 months prior to our meeting (March 2018) Bella had undergone a femoral head and neck ostectomy (FHO) on her left side. She had been on a home exercise program after the surgery, but her weight was a consistent problem (37 kgs). The referring veterinarian preferred not to perform an FHO on the contralateral side until Bella had lost 5 kgs. The discussion with the client revolved around using hydrotherapy to assist with weight loss.

At this point, the left hind limb was not fully rehabilitated. There was a 3 cm difference in circumference at the proximal thigh and a 5 cm difference mid-thigh. Both limbs showed a decreased hip extension of 135 degrees on the left hip and 134 degrees on the right. Normal hip extension is between 160 and 165 degrees. Hydrotherapy session finally began in January 2019 after much discussion. At this point Bella’s hind limb circumferences had equalised but measure less than in September 2018.

Bella started in the underwater treadmill. Weekly sessions were advised and she was placed on a commercial weight loss diet. By June 2019 she was performing activities she has not tried in months (like climbing on the bed). Bella was more active, interactive and happier. She lost 3 kgs but also strengthened her hind quarter musculature. NSAIDs were only being administered after hydrotherapy sessions. By June 2019 Bella’s thigh circumferences had increased by 2 cms all round, coupled with weight loss. Her hip extension has increased to 158 degrees on the left-hand side (operated side) and 155 degrees on the right.

After lengthy discussions with all parties it was decided to continue the hydrotherapy and forego the proposed FHO on the right hip. Bella visited our facility every 2 weeks for a hydrotherapy session (except during lockdown). She had ups and downs, and weight fluctuations but she was happy and well-managed until August 2022. Her weight remained at 36 kgs. She was tested for an underactive thyroid. All results were normal. She became less active and started to lick her right hind paw. Bella’s ability to walk in the underwater treadmill decreased. She was doing less and less despite daily NSAIDs and frequent LASER therapy to her hip. Radiographs revealed increased osteoarthritis in the right hip joint. In December 2022 Bella underwent an FHO to her right hip. Our facility performed routine post-op management. Bella was back in the UWT 3 weeks post-FHO and she has not looked back.

We continue to see her twice a month. Her weight is stable at 32.5 kgs. She is happy and healthy. Bella’s human is thrilled with the outcome and delighted to have Bella with her, for longer, and pain free.

Click HERE to watch a brief video of Bella's progress. 

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Maggie is a five-year-old Golden Retriever. She presented at our rehabilitation facility on 9^th June 2022. Her symptoms had been present for four weeks. The client simply wanted her companion to be able to walk again, without requiring surgery. Based on the clinical presentation polyradiculoneuritis was suspected. There were no funds available for any diagnostics, so our treatment program began.

Initially, Maggie lay in lateral recumbency and could wag her tail. On presentation for rehab, she could lift her head, roll over and wag her tail. Deep pain perception was present, but she was unable to pull away. We treated Maggie on that day using electroacupuncture. A further three sessions were suggested which included electroacupuncture, manual therapies and hydrotherapy. Maggie’s guardian was very capable and involved in her recovery. We advised on how to stimulate movements at home, beginning with moving Maggie into sternal recumbency. She was propped up in that position for short periods throughout the day.

Maggie returned eight days later, and she had responded very well. Her legs were moving, she was rolling onto her back and kicking. She was trying to sit up. Maggie was fitted with a float coat, assisted into the underwater treadmill, and encouraged to move in the water. Care was taken to support her head as she struggled to hold it up.

Maggie improved in leaps and bounds! The next step was to teach her to stand. Maggie lives on a smallholding, so we used hay bales to support her. By the end of June (28^th) Maggie started to crawl. At the rehabilitation centre we added rhythmic stabilisations and gait training to her therapy sessions. The electroacupuncture was repeated. In the water, her legs started to move, and Maggie was keen to participate. This was the day we got over the “hump” and never looked back!

There were more home interventions (under our guidance) than therapy sessions because of financial constraints. There was home hydrotherapy in the farm dam, and lots of support from her siblings! Maggie was mobile in less than three months from the onset of her neurological signs.

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Abby is a five year old female neutered German Shorthaired Pointer. She was referred to me by a locum veterinarian who was concerned about tendon contracture in the right hind paw. The practice principal had diagnosed a partial rupture of the Achilles tendon in May 2020. Rest and NSAIDs were advised. 13 months later Abby was referred to me. I immediately recommended a consultation with a specialist surgeon. Amazingly, the surgeon was able to reconnect the tendon despite the time that had elapsed. Apart from the contracture of the digital flexor tendons, there was severe muscle atrophy of the hind limb. The difference in thigh circumference between the two rear limbs was 4.6 cms. Following on five weeks from the repair,  Abby started rehabilitation and our challenges were:

- breed tendencies (active and highly strung)

- tendon contracture

- decreased ROM of the right hock (especially in flexion) 

- muscle atrophy

We tried to teach the client to perform heat and stretching of the distal limb, but the dog was not cooperative. The compromise was to treat Abby twice a week. The first three weeks of therapy consisted of photobiomodulation, heat and massage to release the tendons. This was very uncomfortable for Abby. After release we performed gentle weight shifting exercises to encourage weight bearing. The water in the underwater treadmill assisted with support in the early phases. After two months of therapy Abby was becoming increasingly resistant to our efforts. The circumferential difference between the two rear limbs had decreased to 1.5 cms. The digits remained slightly flexed and hock ROM improved marginally. It was decided to stop therapeutic interventions and reassess a month later. (This still has to happen). 

I am surprised and very pleased at the response. I was uncertain that we would be able to regain use of the limb because of the length of time that the injury had been present. 

Please click HERE to watch a video of Abby's rehabilitation progress.

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'Bitsy' is a three-year-old female spayed terrier mix who became paralyzed in the hind legs after jumping across another dog in the car and taking a tumble. Bitsy's owner was referred for acupuncture treatment after two weeks of conventional treatment with a diagnosis of disc rupture at the T10-T11 intervertebral space. We began integrative therapy which included Chinese Herbal Medicine, photobiomodulation (cold laser) therapy and electroacupuncture. After biweekly acupuncture and laser treatments for one week, Bitsy was already showing strength in her hind legs and was beginning to be able to wag her tail again! Because of a dedicated owner and continued weekly laser and acupuncture treatments, Bitsy is able to move her hind legs and stand for brief periods. Bitsy now is active at home, has a new cart and is entering the rehabilitation phase of her recovery. It is uncertain how Bitsy would have done without integrative therapy but look at her now! Go Bitsy!!