Controlled leash walks
The main exercise for most patients in the early rehabilitation period is slow, short, controlled leash walks in which the
patient is encouraged to achieve the most normal gait possible and use the affected limb to the best of its ability. Unfortunately,
this exercise is often performed incorrectly; if a patient is led too quickly, the pet tends to skip with the affected limb
or not use the limb at all. Slow walks increase stance time, flexibility, strength, and weightbearing. When an animal has
mastered the slow walk, faster walks can further develop endurance, strength, balance, coordination, and proprioception.32
Walking inclines provides a low-impact method to strengthen the gluteal muscles as well as the cranial and caudal thigh muscles.
The handler should be able to control the patient's head and may want to have it slightly raised to transfer additional weight
to the hindlimbs or slightly lowered to transfer weight to the forelimbs, depending on the desired effect. It is best to start
with small inclines and progress as the patient is able. Declines are also beneficial for forelimb muscle strengthening and
limb use. Walking downhill may also result in increased hock, stifle, and hip flexion during the stance phase of gait because
the limbs are advanced further cranially under the body as the dog walks downhill.32 Although walking results in some joint motion, the joints do not undergo their maximum range of motion.33
Treadmill walking
Figure 4. Walking on a treadmill encourages early limb use after surgery and challenges proprioception. A harness can be used
for support if needed.
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Most dogs that are accustomed to walking on a leash readily take to treadmill walking with minimal training (Figure 4). The front of the treadmill should face toward the center of the room or a hallway. A person standing in front of the treadmill
with treats or words of encouragement often helps with patient compliance. Start the patient on a stationary treadmill, and
slowly increase the velocity to the desired setting. Treadmills for dogs are available, but many of the models used by people
can be modified for dogs by adding an overhead bar with a support system that can attach to a harness. Harnesses help support
the dog in case it stumbles or falls. Variable incline and speed controls are also useful. Joint range of motion is similar
in dogs walking on a treadmill or over ground. Normal dogs tend to have an increased stance time and shorter stride length
while walking on a treadmill compared with walking on ground.34 Further studies are needed to determine whether patients, particularly those with osteoarthritis, benefit from these alterations
in gait. Walking on a ground or underwater treadmill is an unnatural experience for dogs and challenges their balance, proprioception,
and coordination. Most animals are more likely to use an affected limb on a treadmill. Inclined treadmill activity may offer
additional strength training.
Dancing
Dancing exercises allow additional weight transfer to the patient's hindlimbs. This activity increases weightbearing and challenges
balance, coordination, and proprioception. Hip extension is greater with dancing backward as compared with dancing forward,
and stance time is slightly increased with dancing. Assess a patient's range of motion before dancing so that a comfortable
range of motion is not exceeded. The patient should be consistently using the affected limb at a walk before graduating to
dancing. Muzzle the patient during initial sessions for handler safety.35
Wheelbarrowing
Another form of therapeutic exercise, wheelbarrowing, focuses on using the forelimbs. Place your hands under the dog's caudal
abdomen and gently lift the dog's hindquarters off the ground a few inches while the dog walks forward. Lifting the animal
higher does not seem to increase the peak force placed on the forelimbs. This is likely because of the decreased stride length
when wheelbarrowing and the partial hindquarter support. While shoulder extension is increased with wheelbarrowing, the extension
and flexion of the other joints are less than achieved with walking.35
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