Hej Gang!  (Which is Swedish for Hey Gang! - a little bonus learning moment for you!).  

So I get lots of GREAT questions and comments about all of the videos, audios, etc... and I often cut and paste them to use for future blog postings... but I'm getting so many potential blog postings, that I want to share them sooner than later with YOU, the MEMBERS!  In particular, questions that relate to a training video or audio, I think are timely to share with EVERYONE of you that are watching the weekly content!

So THIS bonus blog below is you Wednesday kick in the pants - to USE the site... and if you haven't listened to the recent AUDIO on Exercise Prescription... then go back and listen to it - because this question & answer will hopefully fill in some blanks that perhaps others of you are having as well!

Happy re-listening & reading below!

Hi Laurie - So just a follow up clarification to what I am processing about the audio. 

I am having trouble articulating my question so let me use an example.

Chronic elbow arthritis:  I am controlling pain with acupuncture laser mobs and manual therapy, drugs...I am supporting the surrounding muscles that might be tight from dis/or altered use, range of motion etc. and I am encouraging weight bearing. 

My question is about exercises for the elbow.  I would be thinking to try waving or high fives or low tugs- are those good exercises or are they too hard on the elbows.  If I have pain controlled, I should be really encouraging movement at the elbow, right? to tolerance ?   I sometimes worried that it would be too much and I could cause harm.  (I am of a rather fretty nature to begin with)

I know I sound like an idiot, this is such a basic concept but I feel like I am really closing in on it and I just want to be crystal clear.  

Thanks - K

________________________________________

 Hey K, 

So... unfortunately the elbow example boils down to 'elbows suck' as an answer.

But should you pick hip, stifle, shoulder... etc...

 So, lets say any OA joint:

In that scenario, you ask yourself, "what's the worst that can happen if I overdo it?"  You flare the joint.   Not something you want to do every time, but not a 'biggie' in the big picture of things... and if you DO flare the joint, you end up knowing 'how much was too much'.   My point with this is that when you are prescribing exercises you do your best to pick exercises / exercise progressions that won't flare anything up...but so long as you're not 'over the top' crazy with your progressions / prescriptions, then the worst that can happen is you flare up the joint...

Now - lets say 'said' animal comes in from after a session with you, or after doing the exercises you prescribed and he/she was 'sore' afterwards.

You need to ask:  How soon afterwards (during the exercise or after)?  If after, how soon after?  How long did the soreness / stiffness last?  Has he/she recuperated from the soreness/stiffness yet?

Then - you need to re-assess the joint in question to OBJECTIVELY determine whether the joint is any 'worse for wear' i.e. still flared up... and/or evaluate the muscles in that limb... because sometimes muscle use in new or greater ways & 'growth of the muscle via small microtears... which is what happens when your muscles are sore after going to the gym'... hurts. 

So, for example, when we start an arthritic dog on the treadmill... or start 'pushing' a post-operative dog, we warn the owners that he/she may be a little sore afterwards, but that the soreness should not last more than that night or the next day, and that this is typical for building muscles.  (Now, I don't want the dog to be crippled...but a little bit of soreness happens, and is a common phenomenon with 'physio / PT' in the human world... so I just explain to folks that a little bit of soreness can be expected.) 

I start exercising - little bits at a time BEFORE pain is controlled with the goal of maintaining function and helping with pain relief.

Once the pain is controlled - fair game to push it a little... so to tolerance...but also a little bit beyond (that's where improvement comes in).  Finding out what CAN be done, not just what they're willing to do.

So, if we go back to your elbow case... you are actively 'controlling' pain... so some easy exercises (like wave / high 5 / low tugs) are all appropriate... and not any harder on the dog than walking... which I presume he/she has to do to toilet anyways.  These are perfect, non-impacting exercises that won't do any damage - as would be UWT.  Add in short leash walks - increasing time/distance every 2nd or 3rd day.

When you control the elbow pain (does that ever really happen?  Perhaps 'manage' or 'moderate' is a better descriptive for elbows) - you might challenge it by adding hills to the walk, maybe higher cavalettis for the dog to step over (bend higher), or swimming.  Now this is a case where I'm never going to prescribe jumping or high-end activity... down hill walking is as 'risky' as I would get. 

And then let's take a different case:  Let's say a post-op Extracapsular repair.  What's the worst that can happen if you progress to hard or too fast?  The line breaks or a meniscal tear.  What actions are likely to cause either of those scenarios?  Burst activity... hit by another dog... leg goes into hole & hyper-extends, twisting or turning at high speed...

So those types of activities (bursts, speeds, turning & twisting... not finding holes or being hit by another dog) are best left until LATE stage rehab...but indeed, YOU should be the one adding them into rehab eventually  b/c that's what they'll need to deal with when they go back to the park!

Lets go with a prescription of UWT, Cavaletti's, 3-leg standing, leash walking (maybe using a hill along the way)... and let's say the dog gets sore?  

What is the likelihood that any of these activities caused a meniscal tear or implant failure?  Slim to None... if they did - things weren't 'right' to begin with and it would have happened anyways.  So what has likely gone on?  You have either flared the joint (reaction:  okay, lesson learned, lets cut back a little - maybe 1/3 or 1/4 of amount of exercise) OR you have caused muscle soreness (reaction:  that's actually okay, it tells us that the muscles are responding and growing - so you can carry on with the current prescribed amount of exercise, or if the owner is a little stressed about it still, then cut back by about 1/4 or maintain the same without progressions for a session or two - tops).

 I hope that helps!!!

Cheers,

Laurie

Laurie@FourLeg.com