Updated: Feb 13
The benefits of passive range of motion (PROM) exercise straight after stifle surgery in canine
In recent years, the application of Veterinary physiotherapy techniques after orthopaedic surgeries has increased. Veterinary surgeons are becoming more aware that surgery, along with its traditional protocols, may not on its own be enough to return the animals to normal function. Complications create further problems, and it is these that may be addressed with physiotherapy modalities. There is considerable evidence which suggests that postoperative early vet physiotherapy following surgical complications after stifle surgery in dogs helps to decrease oedema and inflammation; encourages early weight bearing of the operated limb; prevents muscle wastage; increases stifle joint range of motions and; enhances balance and proprioception recovery. Furthermore, it is suggested that the rehabilitation in dogs should commence on the first day after stifle surgery to achieve better outcomes and recovery rates (Davidson et al., 2005; Piermattei et al., 2006; Marsolais et al., 2002; Monk et al., 2006).
Image: 1 Right Hind limb stifle joint extension It has long been recognised that immobilising the joint is detrimental to the mobility, Akeson et al., (1980) found that immobilization of the joint causes significant losses in lubrication by synovial liquid and increased collagen formation which in turn results in stiffness of the joint. In a different study, (NOYES et al., 1974) investigated the effect of immobility on the anterior cruciate ligament in primates where it was shown that after eight weeks of the joint disuse, the functional capacity of the ligament significantly reduced but after restarting exercises, it returned to near normal. However, ligament strength was only partially recovered. By demonstrating the detrimental effects of immobilisation on joints these papers suggest that early movement is more beneficial than immobilisation in terms of overall joint health. There are several studies that suggest that an early range of motion (ROM) on the operated stifle joint in dogs increases the mobility, improve cartilage nutrition, strength of collagen fibres in the ligaments and reduces the process of osteoarthritis (Marsolais et al., 2002; Levine and DNb, 2014).
Image: 2 Right Hind limb stifle joint flexion Furthermore, there are a number of studies on the effect of early motion in humans (Beynnon and Johnson, 1996; Glasgow et al., 1993; Shelbourne and Davis, 1999). These suggest that early PROM post-surgery is effective in reducing pain, joint effusion, minimising scar formation that limits joint movement, development of degenerative processes in joint and benefits in the increase of ROM, muscle mass and strength of the limb. In summary, the studies reviewed demonstrated the benefits of passive range of motion exercise straight after surgery that enhance movement and the healing process in the joint. It should therefore be considered in early rehabilitation after orthopaedic surgery in dogs.