Case Study

 

The use of hydrotherapy in a 1 year old  female West highland Terrier post Femoral Head and Neck Excision of the right hip

 

Summery

 

A 1 year old female West Highland Terrier was referred for hydrotherapy after a veterinary surgeon performed a femoral head and neck excision (FHNE) on the right hind limb due to Legg- Calve- Perthes Disease. On assessment aims and goals of the treatment were decided with the hydrotherapist and the owner. From this a treatment plan was put in place. Functional outcome measures demonstrated improvement in the dog’s foot placement and loading even after just one session.

 

Introduction

 

Legg- Calve Perthes (Avascular necrosis) disease is an uncommon disease that occurs in young small breed dogs (Scott, 1999). It is a developmental and degenerative disease (Scott, 1999). The disease causes loss of blood supply to the developing bone of the femoral neck, causing the bone to become weak and it time the bone can no longer support the femoral head (Dassler, 2002). The disease causes clinic signs of pain and lameness (Scott, 1999). Due to the natural of the disease, surgical intervention in the form of a femoral head and neck excision (FHNE) or a total hip replacement is normally advised by a veterinary surgeon (Fitzpatrick, 2016). A FHNE is the removal of the entire femoral head and neck within the hip joint (McKee, 2013). A fibrous pad forms between the smooth base where the femoral neck was and the hip socket, this creates a pseudoarthrosis (false) fibrous joint (Piermatteri et al., 2006). The hip muscles provide the support for the hip (Piermatteri et al., 2006). Due to this post operation rehabilitation work is very important to ensure these muscles perform to obtain good limb function (McKee, 2013). Hydrotherapy is a branch of physiotherapy which uses the properties of water to aid rehabilitation (Cartlidge, 2015), it has been used in humans since the 1900’s (Becker, 2000). Rehabilitation aims to maximise the functional movement and recovery of the patient (Cartlidge, 2015).

 

Case History

 

A 1 year old female neutered West Highland Terrier was presented at Myerscough Veterinary Hospital following the owners concerns of the dog was showing signs of lameness post exercise and yelping in pain. On presentation a full assessment was preformed, including X-ray’s and a full blood profile. This revealed bilateral legg- calve perthes disease in the hind limbs. The right hind limb was most effected.  The decision was made to perform a FHNE on the right hind limb, for the dog to go through rehabilitation via hydrotherapy and then to reassess the left hind limb post rehabilitation of the right hind limb. The dog was referred for hydrotherapy at 2 weeks post operation and was on pain relief medication in the form of Loxicom (11kg dose once a day) and Tramadol (10mg up to 3 times a day), in order to have a multi modal effect. The dog was also on a joint supplement (YUMOVE). The vets recommended hydrotherapy with restricted land exercise.

 

Assessment

 

Myerscough veterinary hospital emailed a referral form to My Vet Hydro for outpatient treatment and a full hydrotherapy assessment was performed. The owner reported that the dog was using the leg (right hind) when moving yet but was only toe touching when the dog was walking.

A gait assessment was performed, due to the dog only being 2 weeks post operation the gait assessment only included the dog posture and watching the dog loose in the room.  Gait observations can be used to clarify which lames are effected and to what severity, however it can be difficult and challenging for the observer to get an accurate analysis (Arthurus, 2011). Observations gait assessment is also very subjective (Anderson and Mann,1994: DeCamp, 1997: Gillette and Angie, 2008). Therefore, observations must be just that and not to base the treatments on the observations alone.  Observations of the gait assessment show that the dog was completely off loading the right hind at the walk and only toe touching at the stance. The dog was using a compensatory gait pattern by increasing the weight load going into the left hind limb (contralateral limb) and the left forelimb, this pattern agreed with Fishcher et al. (2013) study on lameness.. The dog also had a shorten swing phase in all the limbs to help balance the dog.  All these observations agreed with current research into gait change in lame dogs (Fishcher et al., 2013: Witte and Scott, 2011). The dog also had poor proprioception in the right hind limb.

On palpation it was noted that the dog had poor muscle tone and bulk in the Gluteals, the Biceps Femoris and the Quadriceps complex. This was in both hind limbs but the right hind was the weakest of the two as expected. There was increased tone in the thoracic sling, in particle the Superficial Pectorals. There was also increased tone in the lumbar epaxial muscles.

All this information was recorded on the computer system via an assessment form.

Priority list

  • Weight bearing into the right hind
  • A balance stance
  • Increase proprioception into the right hind
  • Decrease/ release tone in the Epaxial and Superficial Pectoral muscles
  • Increase tone and bulk in the hind limb muscles

Goals and aims

Goals were set using the SMART system:

Systematic- the goals for this dog are:

  • To get a balanced stance
  • Increase muscle bulk and tone in hind limb
  • To get correct loading on fore and hind limbs
  • To achieve a more normal gait
  • To get the dog to a stage were owners can walk him on short off lead walks again.

 

Measureable- the outcomes will be measured via:

  • The ability to stand balanced
  • The ability to weight bear on the right hind- number of steps
  • The ability to go on a short walk

 

Accurate- the outcome measures will be recorded via owners observations, the hydrotherapist’ observations via palpation and video evidence.

Reliable- the results will be subjective, but should be repeatable with a large sample size.

Time- the immediate goal of getting a more correct foot balance and placement was aimed to be achieved within this session, the short term goals of improving muscle bulk/ correct loading/ normal gait/ walking more is aimed to be achieved within 8-12 weeks, the long term goal is to have the dog in the best condition of the next surgery.

Home Programme

 

The home programme for this dog included a full discussion with the owners regarding the home environment. From these adjustments were advised to help the dog at home.  The flooring at home was mainly laminate, therefore it was advised that carpet runners were placed where the dog spent most it her time to avoid slipping. The home programme also included the owners doing square sits with the dog, which they were shown how to do this correct (so the dog was sat square) by the hydrotherapist, the owners were shown how to adjust the dog’s limbs to get the sit in the correct position. The owners were told to only do one or two sit at a time to avoid the dog becoming too tired and it was recommended they did this 3 or 4 a day. The home programme is a progressive programme that will change as the dog advances. It was also recommended that the dog was changed from a collar and lead to a Y shaped harness with two point control, as this encouraged controlled and balanced movement.

The session

 

Based on observation and experience one of the treatments used was the underwater treadmill (UWT). In the UWT the therapist has full control of the buoyancy, speed and limb use (Miles and Wills, 2005). Which was very important in this case with the dog only being2 weeks post surgery. The dog was fitted with a ruffwear harness and flat collar prior to hydrotherapy work, to ensure the therapist had full control and the dog could be kept balanced. Therapeutic handling was used at all times, this allowed the dog to have confidence and trust in the therapist, it also made the session more proprioceptive rich as the dog was actively participating in the session. The behaviour and communication signals were monitored at all times to ensure the dog was happy and confident. The main motivation was treats, which was used to encourage the dog to move in the UWT.

 

Techniques and Treatments

 

Shower work was performed as a stimulation technique and a warm up for the UWT. This included using the shower to massage over worked muscles around the thoracic sling, lumbar epaxials and to stimulate the under used muscles of the hind limb. Diagonal shower work was used to help with the motor patterning work. The showering work was kept to a minimum as the dog was weak and needed the strength to work in the UWT.

The dog was taken into the UWT via an incline ramp, which the therapist guided the dog for a calm and controlled entry. Once in the UWT the dog was allowed to find its stance and settle before the water was added. The water was added to hip level for maximum support and buoyancy. Tragauer et al. (2002) found that a dog is weight bearing 38% when at the trochanter of the femur. This helps the dog be allow to rebalance. This water on the skin surface is very proprioceptive enriching, so having the water at a higher level gives the dog more feedback as to where the limbs are. The therapist placed each limb in the correct position for a square balanced stance to help re-educate the correct loading of each limb, the UWT to an ideal environment for this as it gives a flat level surface to work on and the buoyancy of the water keeps the dog more stable and able to load the limbs. The therapist stroked the muscles in the hind limbs used for the standing (the anti gravity muscles- mainly the Bicep Femoris muscle), this encourages the muscle to activate and the dog to weight bearing more evenly through the hind limbs. Movement patterning and sequencing, this was in the form of gently lifting the dogs legs and then placing them out in the natural pattern the dog would walk at. This was used for muscle memory as the dog avoided putting weight through the right hind limb on land. Postural adjustments and rhythmical stabilisation techniques were used, this encouraged the dog to activate the forelimb and hind limb muscles and to load correctly into each limb. All these techniques encourage the dog to re load the weight more correctly to get the dog in a more balanced position. In dogs with hind limb weakness or injury this is very important, as dogs naturally have 60% of their weight in their forelimbs (Fischer et al., 2013), so it is important not to add to this. Dynamic movement patterning was use in the form of walking on the treadmill, due to the dogs physical condition this was kept very slow and short. The advantages of the water being high for the buoyancy, also means the dog has more resistance to exercise through (Millis and Levine, 2004). There were 3 x 30 seconds sessions of walking. The therapist aligned the dog using their arms and hands throughout each session, these kept the dog in alignment and therefore for the dog to use the correct muscles in the correct way and to encourage core muscle usage.  Soft tissue mobilisation techniques were used throughout the session, especially in the thoracic sling muscles, in order to help relief tension.  All of the techniques were used to help with land based activities and movement and to improve muscle strength.  At all times within the session the therapist positioned themselves to ensure that the dog felt comfortable and that they could effectively influence the correct movement and posture of the dog.

At the end of the water base part of the session the therapist movement shaped the dog down the external ramp. Downhill ramp work helps with eccentric loading of the hind limb muscles and core strength.

The dog was then showered, heat therapy and soft tissue mobilisation technique were used on the over used muscles of the thoracic sling.  The dog was then dried using a towel, the towelling technique used allowed the therapist to use compression and soft tissue mobilisation to target muscles to get a normal stand position.

 

Outcome of session

 

The difference in the dog was immediately observed. The stand position of the dog was more balanced, and the dog was weight loading more into the right hindlimb. The owner reports an improvement at home in the gait for 3 days post session. Within the session improvements where immediately seen via better stance position, muscles less tight and more equally loading of the limbs

The dog is booked in to come for a session next week, the dog will be re assessed each session in order to measure the outcome from the last session and get the maximum from each session via clinical reasoning and subjective assessment.

A detailed record is kept of each session, this ensures that progress can be easily monitored and outcomes can be assessed over time.

 

Conclusion

This case study shows that hydrotherapy is an important part of the rehabilitation of cases post FHNE.

 

Reflection

 

This session went well, the dog was comfortable in the environment and the outcome measure shown the dog had improved and benefited from the treatment. I believe this session went so well due to me using scientific reasoning to treatment plan and therefore targeting the correct muscles to encourage the correct loading. My careful thinking of my position and posture helped the session, this ensure I could help the dog to the maximum without restricting her movement. I believe the dog was so willing and able to improve due to a good analgesia programme in place and therapeutic handling within the rehabilitation centre.

 

References

 

Anderson, M.A. and Mann, F.A.. (1994) ‘Force plate analysis: a non-invasive tool for gait evaluation.’ Compendium  continuing education for the practicing veterinarian, 16, pp 857-867

Arthusus, G. (2011) ‘Orthopaedic examinations of the dog. 1. Thoracic limb’ In practice, 33, pp 126-133

Cartlidge, H. (2015) ‘Hydrotherapy for the osteoarthritic dog: why might it help and is there any evidence?’ The Veterinary Nurse, 6, pp 600-605

Dassler, C.L. (2002), Canine hip dyplasia: Diagnosis and non-surgical treatment, In Textbook of Small Animal Surgery, Philadelphia: Saunders.

DeCamp, C.E. (1997) ‘kinetic and kinematic gait analysis and the assessment of lameness in the dog’ Veterinary clinics of north America, small animal practice, 27, pp 825-840

Fischer, S., Anders, A., Nolte, I. and Schilling, N. (2013) ‘Compensatory load redistribution in walking and trotting dogs with hind limb lameness’ The Veterinary Journal, 197, pp 746-752

Fishcher, S., Andres, A., Nolte,I. and Schilling,N. (2013) ‘Compensatory load redistribution in walking and trotting dogs with hind limb lameness’ The Veterinary Journal, 197, pp 746-752

Gillette, R.L. and Angle, T.C. (2008) ‘recent developments in canine locomotor analysis, a review’ the veterinary journal., 178, pp 165-176

McKee, M. (2013) ‘Diagnosis and management of chronic joint pain in the dog’ In Practice, 35, pp 227-242

Piermatteri, D.L., Flo, G. and Decamp,C. (2006) The Hip Joint, In Handbook of Small Animal Orthopaedics and Fracture Repair, Philadelphia: Saunders.

Scott, H. (1999) ‘Non- traumatic caused of lameness in the hindlimb of the growing dog’ In Practice, 21, pp 176-188

Tragauer, V., Levine,D. and Mills, D.L. (2002) Percentage of normal weight bearing during partial immersion at various depths in dogs,  in proceedings of the second international symposium on physical therapy and rehabilitation medicine, August 10-14th, Knoxville, University of Tennessess College of Veterinary Medicine.

Witte, P. and Scott, H. (2011a) ‘Investigation of lameness in dogs. 1. Forelimb’ In Practice, 33, pp 20-27.

Case Study

 

The use of hydrotherapy in a 1 year old  female West highland Terrier post Femoral Head and Neck Excision of the right hip

 

Summery

 

A 1 year old female West Highland Terrier was referred for hydrotherapy after a veterinary surgeon performed a femoral head and neck excision (FHNE) on the right hind limb due to Legg- Calve- Perthes Disease. On assessment aims and goals of the treatment were decided with the hydrotherapist and the owner. From this a treatment plan was put in place. Functional outcome measures demonstrated improvement in the dog’s foot placement and loading even after just one session.

 

Introduction

 

Legg- Calve Perthes (Avascular necrosis) disease is an uncommon disease that occurs in young small breed dogs (Scott, 1999). It is a developmental and degenerative disease (Scott, 1999). The disease causes loss of blood supply to the developing bone of the femoral neck, causing the bone to become weak and it time the bone can no longer support the femoral head (Dassler, 2002). The disease causes clinic signs of pain and lameness (Scott, 1999). Due to the natural of the disease, surgical intervention in the form of a femoral head and neck excision (FHNE) or a total hip replacement is normally advised by a veterinary surgeon (Fitzpatrick, 2016). A FHNE is the removal of the entire femoral head and neck within the hip joint (McKee, 2013). A fibrous pad forms between the smooth base where the femoral neck was and the hip socket, this creates a pseudoarthrosis (false) fibrous joint (Piermatteri et al., 2006). The hip muscles provide the support for the hip (Piermatteri et al., 2006). Due to this post operation rehabilitation work is very important to ensure these muscles perform to obtain good limb function (McKee, 2013). Hydrotherapy is a branch of physiotherapy which uses the properties of water to aid rehabilitation (Cartlidge, 2015), it has been used in humans since the 1900’s (Becker, 2000). Rehabilitation aims to maximise the functional movement and recovery of the patient (Cartlidge, 2015).

 

Case History

 

A 1 year old female neutered West Highland Terrier was presented at Myerscough Veterinary Hospital following the owners concerns of the dog was showing signs of lameness post exercise and yelping in pain. On presentation a full assessment was preformed, including X-ray’s and a full blood profile. This revealed bilateral legg- calve perthes disease in the hind limbs. The right hind limb was most effected.  The decision was made to perform a FHNE on the right hind limb, for the dog to go through rehabilitation via hydrotherapy and then to reassess the left hind limb post rehabilitation of the right hind limb. The dog was referred for hydrotherapy at 2 weeks post operation and was on pain relief medication in the form of Loxicom (11kg dose once a day) and Tramadol (10mg up to 3 times a day), in order to have a multi modal effect. The dog was also on a joint supplement (YUMOVE). The vets recommended hydrotherapy with restricted land exercise.

 

Assessment

 

Myerscough veterinary hospital emailed a referral form to My Vet Hydro for outpatient treatment and a full hydrotherapy assessment was performed. The owner reported that the dog was using the leg (right hind) when moving yet but was only toe touching when the dog was walking.

A gait assessment was performed, due to the dog only being 2 weeks post operation the gait assessment only included the dog posture and watching the dog loose in the room.  Gait observations can be used to clarify which lames are effected and to what severity, however it can be difficult and challenging for the observer to get an accurate analysis (Arthurus, 2011). Observations gait assessment is also very subjective (Anderson and Mann,1994: DeCamp, 1997: Gillette and Angie, 2008). Therefore, observations must be just that and not to base the treatments on the observations alone.  Observations of the gait assessment show that the dog was completely off loading the right hind at the walk and only toe touching at the stance. The dog was using a compensatory gait pattern by increasing the weight load going into the left hind limb (contralateral limb) and the left forelimb, this pattern agreed with Fishcher et al. (2013) study on lameness.. The dog also had a shorten swing phase in all the limbs to help balance the dog.  All these observations agreed with current research into gait change in lame dogs (Fishcher et al., 2013: Witte and Scott, 2011). The dog also had poor proprioception in the right hind limb.

On palpation it was noted that the dog had poor muscle tone and bulk in the Gluteals, the Biceps Femoris and the Quadriceps complex. This was in both hind limbs but the right hind was the weakest of the two as expected. There was increased tone in the thoracic sling, in particle the Superficial Pectorals. There was also increased tone in the lumbar epaxial muscles.

All this information was recorded on the computer system via an assessment form.

Priority list

  • Weight bearing into the right hind
  • A balance stance
  • Increase proprioception into the right hind
  • Decrease/ release tone in the Epaxial and Superficial Pectoral muscles
  • Increase tone and bulk in the hind limb muscles

Goals and aims

Goals were set using the SMART system:

Systematic- the goals for this dog are:

  • To get a balanced stance
  • Increase muscle bulk and tone in hind limb
  • To get correct loading on fore and hind limbs
  • To achieve a more normal gait
  • To get the dog to a stage were owners can walk him on short off lead walks again.

 

Measureable- the outcomes will be measured via:

  • The ability to stand balanced
  • The ability to weight bear on the right hind- number of steps
  • The ability to go on a short walk

 

Accurate- the outcome measures will be recorded via owners observations, the hydrotherapist’ observations via palpation and video evidence.

Reliable- the results will be subjective, but should be repeatable with a large sample size.

Time- the immediate goal of getting a more correct foot balance and placement was aimed to be achieved within this session, the short term goals of improving muscle bulk/ correct loading/ normal gait/ walking more is aimed to be achieved within 8-12 weeks, the long term goal is to have the dog in the best condition of the next surgery.

Home Programme

 

The home programme for this dog included a full discussion with the owners regarding the home environment. From these adjustments were advised to help the dog at home.  The flooring at home was mainly laminate, therefore it was advised that carpet runners were placed where the dog spent most it her time to avoid slipping. The home programme also included the owners doing square sits with the dog, which they were shown how to do this correct (so the dog was sat square) by the hydrotherapist, the owners were shown how to adjust the dog’s limbs to get the sit in the correct position. The owners were told to only do one or two sit at a time to avoid the dog becoming too tired and it was recommended they did this 3 or 4 a day. The home programme is a progressive programme that will change as the dog advances. It was also recommended that the dog was changed from a collar and lead to a Y shaped harness with two point control, as this encouraged controlled and balanced movement.

The session

 

Based on observation and experience one of the treatments used was the underwater treadmill (UWT). In the UWT the therapist has full control of the buoyancy, speed and limb use (Miles and Wills, 2005). Which was very important in this case with the dog only being2 weeks post surgery. The dog was fitted with a ruffwear harness and flat collar prior to hydrotherapy work, to ensure the therapist had full control and the dog could be kept balanced. Therapeutic handling was used at all times, this allowed the dog to have confidence and trust in the therapist, it also made the session more proprioceptive rich as the dog was actively participating in the session. The behaviour and communication signals were monitored at all times to ensure the dog was happy and confident. The main motivation was treats, which was used to encourage the dog to move in the UWT.

 

Techniques and Treatments

 

Shower work was performed as a stimulation technique and a warm up for the UWT. This included using the shower to massage over worked muscles around the thoracic sling, lumbar epaxials and to stimulate the under used muscles of the hind limb. Diagonal shower work was used to help with the motor patterning work. The showering work was kept to a minimum as the dog was weak and needed the strength to work in the UWT.

The dog was taken into the UWT via an incline ramp, which the therapist guided the dog for a calm and controlled entry. Once in the UWT the dog was allowed to find its stance and settle before the water was added. The water was added to hip level for maximum support and buoyancy. Tragauer et al. (2002) found that a dog is weight bearing 38% when at the trochanter of the femur. This helps the dog be allow to rebalance. This water on the skin surface is very proprioceptive enriching, so having the water at a higher level gives the dog more feedback as to where the limbs are. The therapist placed each limb in the correct position for a square balanced stance to help re-educate the correct loading of each limb, the UWT to an ideal environment for this as it gives a flat level surface to work on and the buoyancy of the water keeps the dog more stable and able to load the limbs. The therapist stroked the muscles in the hind limbs used for the standing (the anti gravity muscles- mainly the Bicep Femoris muscle), this encourages the muscle to activate and the dog to weight bearing more evenly through the hind limbs. Movement patterning and sequencing, this was in the form of gently lifting the dogs legs and then placing them out in the natural pattern the dog would walk at. This was used for muscle memory as the dog avoided putting weight through the right hind limb on land. Postural adjustments and rhythmical stabilisation techniques were used, this encouraged the dog to activate the forelimb and hind limb muscles and to load correctly into each limb. All these techniques encourage the dog to re load the weight more correctly to get the dog in a more balanced position. In dogs with hind limb weakness or injury this is very important, as dogs naturally have 60% of their weight in their forelimbs (Fischer et al., 2013), so it is important not to add to this. Dynamic movement patterning was use in the form of walking on the treadmill, due to the dogs physical condition this was kept very slow and short. The advantages of the water being high for the buoyancy, also means the dog has more resistance to exercise through (Millis and Levine, 2004). There were 3 x 30 seconds sessions of walking. The therapist aligned the dog using their arms and hands throughout each session, these kept the dog in alignment and therefore for the dog to use the correct muscles in the correct way and to encourage core muscle usage.  Soft tissue mobilisation techniques were used throughout the session, especially in the thoracic sling muscles, in order to help relief tension.  All of the techniques were used to help with land based activities and movement and to improve muscle strength.  At all times within the session the therapist positioned themselves to ensure that the dog felt comfortable and that they could effectively influence the correct movement and posture of the dog.

At the end of the water base part of the session the therapist movement shaped the dog down the external ramp. Downhill ramp work helps with eccentric loading of the hind limb muscles and core strength.

The dog was then showered, heat therapy and soft tissue mobilisation technique were used on the over used muscles of the thoracic sling.  The dog was then dried using a towel, the towelling technique used allowed the therapist to use compression and soft tissue mobilisation to target muscles to get a normal stand position.

 

Outcome of session

 

The difference in the dog was immediately observed. The stand position of the dog was more balanced, and the dog was weight loading more into the right hindlimb. The owner reports an improvement at home in the gait for 3 days post session. Within the session improvements where immediately seen via better stance position, muscles less tight and more equally loading of the limbs

The dog is booked in to come for a session next week, the dog will be re assessed each session in order to measure the outcome from the last session and get the maximum from each session via clinical reasoning and subjective assessment.

A detailed record is kept of each session, this ensures that progress can be easily monitored and outcomes can be assessed over time.

 

Conclusion

This case study shows that hydrotherapy is an important part of the rehabilitation of cases post FHNE.

 

Reflection

 

This session went well, the dog was comfortable in the environment and the outcome measure shown the dog had improved and benefited from the treatment. I believe this session went so well due to me using scientific reasoning to treatment plan and therefore targeting the correct muscles to encourage the correct loading. My careful thinking of my position and posture helped the session, this ensure I could help the dog to the maximum without restricting her movement. I believe the dog was so willing and able to improve due to a good analgesia programme in place and therapeutic handling within the rehabilitation centre.

 

References

 

Anderson, M.A. and Mann, F.A.. (1994) ‘Force plate analysis: a non-invasive tool for gait evaluation.’ Compendium  continuing education for the practicing veterinarian, 16, pp 857-867

Arthusus, G. (2011) ‘Orthopaedic examinations of the dog. 1. Thoracic limb’ In practice, 33, pp 126-133

Cartlidge, H. (2015) ‘Hydrotherapy for the osteoarthritic dog: why might it help and is there any evidence?’ The Veterinary Nurse, 6, pp 600-605

Dassler, C.L. (2002), Canine hip dyplasia: Diagnosis and non-surgical treatment, In Textbook of Small Animal Surgery, Philadelphia: Saunders.

DeCamp, C.E. (1997) ‘kinetic and kinematic gait analysis and the assessment of lameness in the dog’ Veterinary clinics of north America, small animal practice, 27, pp 825-840

Fischer, S., Anders, A., Nolte, I. and Schilling, N. (2013) ‘Compensatory load redistribution in walking and trotting dogs with hind limb lameness’ The Veterinary Journal, 197, pp 746-752

Fishcher, S., Andres, A., Nolte,I. and Schilling,N. (2013) ‘Compensatory load redistribution in walking and trotting dogs with hind limb lameness’ The Veterinary Journal, 197, pp 746-752

Gillette, R.L. and Angle, T.C. (2008) ‘recent developments in canine locomotor analysis, a review’ the veterinary journal., 178, pp 165-176

McKee, M. (2013) ‘Diagnosis and management of chronic joint pain in the dog’ In Practice, 35, pp 227-242

Piermatteri, D.L., Flo, G. and Decamp,C. (2006) The Hip Joint, In Handbook of Small Animal Orthopaedics and Fracture Repair, Philadelphia: Saunders.

Scott, H. (1999) ‘Non- traumatic caused of lameness in the hindlimb of the growing dog’ In Practice, 21, pp 176-188

Tragauer, V., Levine,D. and Mills, D.L. (2002) Percentage of normal weight bearing during partial immersion at various depths in dogs,  in proceedings of the second international symposium on physical therapy and rehabilitation medicine, August 10-14th, Knoxville, University of Tennessess College of Veterinary Medicine.

Witte, P. and Scott, H. (2011a) ‘Investigation of lameness in dogs. 1. Forelimb’ In Practice, 33, pp 20-27.

One thought on “Case Study:

  • September 28, 2017 at 5:51 pm
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    Hi! Thanks for this info! Really enjoyed reading this page.

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