PHYSIOTHERAPY | REHABILITATION | HYDROTHERAPY
Hip Dysplasia in Dogs
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What is Proprioception Exercises?
What is Hip Dysplasia in Dogs?
Hip dysplasia (dɪsˈpleɪzɪə) in Dogs is a disease of the hip in which the ball and socket joint is malformed. This malformation means that the ball portion and its socket don’t properly meet one another, resulting in a joint that rubs and grinds instead of sliding smoothly. This can cause crippling lameness and painful arthritis of the joints. It is a genetic (polygenic) trait that is affected by environmental factors.
Hip dysplasia is one of the most common skeletal diseases seen in dogs. Gender does not seem to be a factor, but some breeds are more likely to have the genetic predisposition for hip dysplasia than other breeds.
Your dog’s hip joint is constructed very much like the ball joints of your automobile. The bone of the thigh (the femur) ends in a ball that fits into a socket (acetabulum) formed by the pelvis. This type of arrangement forms a very strong joint that allows a great range of motion and weight-bearing. But for it to work properly, the ball must be held deeply and snuggly within the socket.
What causes Hip Dysplasia and are there certain breeds at risk?
What is the cause of Hip Dysplasia
In canines, it can be caused by a femur that does not fit correctly into the pelvic socket, or poorly developed muscles in the pelvic area. Large and giant breeds are most susceptible to hip dysplasia (possibly due to the BMI of the individual animal), though, many other breeds can suffer from it. For a list of top 100 breeds affected, by percentage, visit the OFFA.
To reduce pain, the animal will typically reduce its movement of that hip. This may be visible as “bunny hopping”, where both legs move together, or less dynamic movement (running, jumping), or stiffness. Since the hip cannot move fully, the body compensates by adapting its use of the spine, often causing spinal, stifle (a dog’s knee joint), or soft tissue problems to arise.
Signs and Symptoms of Hip Dysplasia in Dogs
Symptoms depend on the degree of joint looseness or laxity, the degree of joint inflammation, and the duration of the disease.
• Early disease: signs are related to joint looseness or laxity
• Later disease: signs are related to joint degeneration and osteoarthritis
• Decreased activity
• Difficulty rising
• Reluctance to run, jump, or climb stairs
• Intermittent or persistent hind-limb lameness, often worse after exercise
• “Bunny-hopping,” or swaying gait
• Narrow stance in the hind limbs (back legs unnaturally close together)
• Pain in hip joints
• Joint looseness or laxity – characteristic of early disease; may not be seen in
long-term hip dysplasia due to arthritic changes in the hip joint
• Grating detected with joint movement
• Decreased range of motion in the hip joints
• Loss of muscle mass in thigh muscles
• Enlargement of shoulder muscles due to more weight being exerted on front legs
as dog tries to avoid weight on its hips, leading to extra work for the shoulder
muscles and subsequent enlargement of these muscles
Hip Dysplasia – The importance of a proper diagnosis process
The classic hip dysplasia diagnostic technique is with appropriate X-rays and hip scoring tests. These should be done at an appropriate age, and perhaps repeated at adulthood – if done too young they will not show anything. Since the condition is to a large degree inherited, the hip scores of parents should be professionally checked before buying a pup, and the hip scores of dogs should be checked before relying upon them for breeding. Despite the fact that the condition is inherited, it can occasionally arise even to animals with impeccably hip scored parents.
Your veterinarian should perform a complete physical exam on your dog, including a blood chemical profile, a complete blood count, an electrolyte panel and a urinalysis. Inflammation due to joint disease may be noted in the complete blood count. As part of surveying the physical symptoms and fluid work-ups, your veterinarian will also need a thorough history of your dog’s health, onset of symptoms, and any possible incidents or injuries that may have contributed to your dog’s symptoms. Any information you have on your dog’s parentage will be helpful as well, as there may be a genetic link.
In diagnosing suspected dysplasia, the x-ray to evaluate the internal state of the joints is usually combined with a study of the animal and how it moves, to confirm whether its quality of life is being affected. Evidence of lameness or abnormal hip or spine use, difficulty or reduced movement when running or navigating steps, are all evidence of a problem. Both aspects have to be taken into account since there can be serious pain with little X-ray evidence.
What can you do for your pet with Hip Dysplasia
Available Surgical Correction for Dogs diagnosed Hip Dysplasia in Singapore
There are several different types of surgery available here in Singapore to help dysplastic dogs. They are mostly expensive and the results are mixed. The fact there are so many dissimilar techniques being used on heavy breeds at the same time, suggests that none of them give as good a result and the pet owner will hope for.
This is because they all target the results of hip dysplasia – not the cause. The results of hip dysplasia are an improperly shaped hip. But the cause of hip dysplasia is weakness and looseness of the ligaments and cartilage that hold the hip together.
This older technique was popular in the 1970s. It involves cutting the pectinious muscle of the groin to lessen the pain of dysplasia. Cutting this muscle was said to decrease the normal pressure that presses the ball of the femur into the acetabular socket. Some veterinarians thought it might be helpful in certain cases of hip dysplasia. However, the relief provided was usually temporary and arthritic changes in the joint continued or possibly sped up. Few veterinarians still perform this surgery but it is no longer recommended by most veterinarians.
Proper home care and conservative management
If the Hip Dysplasia in your pet is not severe yet, it does not mean that you should not do anything. Early diagnosis allows pet owner to prepare and possibly prevent it from getting worst. Or if surgery is not an option, there are more natural ways to management and live with a dog diagnosed with hip dysplasia.
The importance of Rehabilitation and Physiotherapy for Hip Dysplasia in Dogs
Conservative Management of Hip Dysplasia
Physiotherapy has an important role in the management of hip dysplasia. Whilst hip dysplasia is a progressive disease, the condition can be affected by external factors. The main feature of the disease is joint laxity which leads to changes in the joint, abnormal wear and subsequent osteoarthritis.
Initial symptoms that your dog may exhibit can be reduced exercise tolerance, problems going up and down stairs, difficulty rising and lameness after exercise. If your primary care vet or orthopaedic clinician should refer your dog to our rehabilitation service a full physiotherapy assessment is undertaken by one of our chartered physiotherapists. Findings might be – altered gait pattern, with or without lameness, reduced weight-bearing load on the affected limb, weakness of specific muscles (most commonly the gluteal muscles) pain manifested by intolerance to be touched in the affected area or during certain movements or postures and reduced range of movement (ROM). Your dog may exhibit all of or just a few of these clinical signs.
Rehabilitation aims to address the above findings and to maintain and/or prevent progression of the disease. After physiotherapy assessment is completed, a list of focus points is formed and a rehabilitation treatment plan is implemented.
Aims will include the following
• Reduce pain
• Strengthen the affected muscles
• Improve and maintain soft tissue flexibility
• Improve and maintain ROM
• Enhance gait patterning
Targeted exercises specifically for the gluteal muscles Balance and coordination exercises “Hands on” therapy such as massage and basic stretching for pain relief and improving flexibility Pain relief might be provided using laser therapy and ice.
Hydrotherapy Treatment Options
- Hydrotherapy, particularly underwater treadmill, can be a useful tool for strengthening specific muscles and improving gait patterns. The buoyancy of the water provides support to the body which in turn reduces the load on the affected joints whilst exercising the necessary muscles.
- Any physiotherapy program which is prescribed for your dog is constantly
re-evaluated and progressed based on the response to treatment. Owner participation is key as so much of the therapy can be used on a daily basis and provided at home. Detailed instructions are always provided.
|Timeline||Physiotherapy Aims||Rehabilitation Therapy options|
|Week 0 to 2||Reduce post operative swelling||• Game Ready (Ice Therapy)|
• Soft tissue massage
|Reduce muscular guarding and maintain soft tissue flexibility||• Laser • Soft Tissue Massage • Heat therapy • Careful stretches|
|Allow careful limb loading||• Assisted active exercises|
|Week 2 to 4||Progress limb loading and gait re-education||• Home exercise program|
• Neuromuscular electrical stimulation
• Underwater Treadmill
|Increase muscle mass||Low level exercise program and muscle stimulation|
|Maintain soft tissue length and flexibility||• Passive joint range of movements and stretches|
|Management at home||• Exercise restriction|
• Advice regarding flooring
• Advice regarding assisted walking with harness and sling if required
• Advice regarding cavaletti pole work, gradients, steps and different surfaces
|Week 4 to 6||Continue as above, include core stability exercises||Progression of home exercise program to challenge balance, body awareness and strength|
|Advice on maintaining controlled exercise when dog feeling better|
|Week 6 to 12||Increase exercise tolerance||Increase exercise level, considering land and water based options.|
|Continue to increase core stability||Home exercise program considering land and water based exercises|
|Week 12 onwards||Return to full function or establish deficits and advise regarding long term management.||Progress to off lead exercise and previous exercise level if appropriate.|
Darryl L. Millis, MS, DVM, DACVS, DACVSMR, CCRP Professor of Orthopedic Surgery & Director of Surgical Service
Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Diplomate of the American Academy of Pain Management, is a a founder and past-president of the International Veterinary Academy of Pain Management.
Janet B. Van Dyke, DVM
Diplomate American College of Veterinary Sports Medicine and Rehabilitation, CCRT, CEO
Ludovica Dragone, DVM, CCRP
Vice President of VEPRA, Veterinary European of Physical Therapy and Rehabilitation Association.
Andrea L. Henderson, DVM, CCRT, CCRP
Resident, Canine Sports Medicine and Rehabilitation
Steven M.Fox, MS, DVM, MBA, PhD
President Securos. Inc