Additional Physiotherapy and Stretches
When Sam, my black Labrador retriever, was diagnosed by his veterinarian with Degenerative Myelopathy, a progressive deterioration of nerve pathways in the spinal cord that can lead to paralysis, I searched for ways to help him live his best life for as long as possible. That search led us to rehabilitation therapy. Samís rehab therapy has consisted of hydrotherapy using a canine underwater treadmill and physical therapy by a Certified Canine Rehab Practitioner. Links to finding a Certified Canine Rehab Practitioner, hydrotherapy resources in your area and descriptions of what hydrotherapy is and how it can benefit your dog can be found at:
The Canine and Equine Rehabilition Gateway - CCRP Practitioners by State
David Levine's Website for Facilities for Animal Physical Therapy/Rehabilitation
The Association for Canine Underwater Therapy Membership Directories
Hydro-treadmill Therapy at TOPS Veterinary Rehab - TOPS Veterinary Rehab was the first veterinary rehab practice in the US to use hydro-treadmill therapy for dogs. You might also want to look at their descriptions of the other rehab treatment modalities.
Explanation of hydro-treadmill therapy benefits from Scout's House Rehabilitation Center - Scout's House is the rehab center in the AKCCHF video about caring for a dog with DM. Their website also has descriptions of some of the other rehab options.
You can also locate rehab facilities through your veterinarian. New facilities are being added all the time, so if you don't find a rehab facility on the above lists, do a Google search using "canine underwater treadmill", "canine rehab therapy" or "animal rehabilitation facilities" in your area. Both hydrotherapy and rehab therapy can be tremendously useful in maintaining mobility and quality of life in a dog with DM. If you are able, both in location and in budget, I highly recommend both hydrotherapy and rehab therapy with a CCRP. Unfortunately, as yet, there aren't a tremendous number of animal rehab centers across the country and there's also a cost factor involved, so I've created this webpage with some of the exercises and stretches that have been part of Sam's rehab.
If you are wondering whether exercise can really help, a study done at the Department of Clinical Veterinary Medicine, Section of Neurology, Vetsuisse Faculty, University of Bern, Switzerland, and published in the Journal of Veterinary Internal Medicine, July-August 2006, indicated "daily controlled physiotherapy increases survival time in dogs with suspected Degenerative Myelopathy." To see the abstract of the article go here. Lila also has a summary of the article with the exercise chart in the Files section on the Degenerative Myelopathy webpage here.
If your dog has been diagnosed with DM, I encourage you to go to the DM Database and fill out the survey there. The DM Database is designed to gather information about dogs diagnosed with DM and to aid research in finding a cure.
There is a new, noninvasive, DNA test for DM that I encourage everyone who suspects their dog has DM to think about available through the Univerity of Missouri-Columbia Veterinary School. Go here for more information.
I am sharing some exercises and stretches that have helped my Labrador retriever, Sam, rebuild and maintain strength and mobility after being diagnosed with Degenerative Myelopathy. There are, however, other conditions that present symptoms similar to Degenerative Myelopathy and a dog with DM may have other coexisting diseases, so it is critically important that you discuss any exercises and/or stretches, the type, amount and frequency, with your veterinarian before attempting them with your dog. You might want to print these exercises out to take with you to your vet to discuss what might be useful for your dog. Watch your dog closely and stop the exercises if s/he shows signs of fatigue or discomfort. Start slowly and gradually increase as your dog is able. If at all possible, do seek out the nearest rehab facility for your dog.
Start on small grade (20-30 degrees) slopes/hills walking a short distance, do two repetitions if possible. Gradually add repetitions and distance.
Work up gradually to steeper grade slopes (35-50 degrees), do several repetitions at a time depending on your dogís stamina. Zigzag/slalom walking back down.
Climb a good size hill. Zigzag/slalom walking back down. By walking down at an angle, the dog avoids putting too much pressure on the shoulders and rear and possibly falling.
These exercises build strength in the leg muscles and improve balance. (Thanks to Roseanne and Nitro[GSD] now at the Bridge.)
Walk parallel on small grade slope back and forth, working both right and left sides, do several repetitions if possible. Gradually work up to steeper slopes. Because the dog will be walking on the uneven surface, with one side lower than the other, this exercise helps with balance and strength. (Thanks to Roseanne and Nitro[GSD] now at the Bridge for these tips.)
Do figure 8ís, weaves and circles around cones, trees, stools. On figure 8ís, try to get the dog as close to the cones as possible without knocking into them. Hold a treat or toy and play chase the treat/toy around the cones to make it fun letting the dog catch the treat. These exercises can be done inside or outside and build control and balance. Sam sometimes has a cone at the end of his cavaletti rails, goes around the cone and back through the rails.
There are any number of ways to set up cavaletti rails at home. You can place a ladder on the floor and walk the dog through the ladder rungs one at a time. If the ladder rungs are too close together for your dog, you can also use dowels placed in bricks or bent soda pop cans about 1-3Ē off the floor, depending on strength and agility of the dog. Sam started practicing at home on an old ladder from a bunkbed. Sam's CCRP/PT at the rehab center showed me how to take orange cones that you can buy at Home Depot or Lowes, cut holes with a craft knife at various heights and put 3'4" cut pvc pipe through the holes. I got some old orange cones and had the local hardware store cut 3'4" lengths of pvc pipe ($2.29 for 10' - I used 2 10' lengths). I used a utility knife to cut holes in the cones and set up Sam's cavaletti rails course. You could also use plastic milk bottles filled with sand or rocks in place of the cones. The object is to get the dog to step over the rungs, not hop over them, and to be aware of where they are placing their feet. Start slowly and gradually increase as the dog is able. This exercise really helps with strength and balance in the legs.
You can also purchase cones, "Hoops and Hurdle cones", with precut holes and rods online from Wolverine Sports. (Thanks to Lila and Jack for the Wolverine link.)
Have your dog walk backwards. Sam and I practice this in the hallway. Walking backwards uses muscles in a different way, strengthening them. (Thanks to Lila and Jack[Corgi].)
Walk your dog over uneven terrain like beach sand or trails.
Practice sit-to-stands on a carpeted or grassy surface for traction. Sitting and standing builds core and front/back leg muscles. Start with 2-4 repetitions then increase as dog is able. Try, if possible to work up to 7-10 reps, 2-3 times a day. Correct sitting and standing positons are important. Sam needs to sit with feet tucked under him and push up evenly with both legs. If we don't do the sits regularly, Sam seems almost to forget how to make the muscles work for a sit. When we do the sits daily, he has much less trouble.
Sam uses a wobble or balance board at the rehab center. Lila and Jack[Corgi] use one at home that Lila made. Here's what they do quoting Lila: "The wobble board can be used in different ways. I find that for Jack it works best if his back feet are on the board, one on each side of the center. I manually move it back and forth so that he has to use his thigh muscles to compensate. When we are done with that back end, I often put the front end on it with the rear legs stationary and do the same thing. This works a whole different group of muscles. The wobble can easily be made at home. Jack's is made using a wooden shelf, and a dowel that already had a slice taken off. I glued it with Gorilla Glue and covered it with a carpet mat."
Work with your dog on rolling over. This works the back and core muscles.
Back Stretch - With your dog lying down, hold a treat or toy back toward the tail so the dog will reach back toward his/her tail. This stretches the back muscles and helps flexibility. Do several repetitions on each side.
Head, Neck and Shoulder Stretch - With your dog lying down or sitting, hold a treat or toy above his/her head to get a head and neck stretch and then lower the treat down between the front paws. Do several repetitions up and down.
Forward Stretch - With your dog lying down, hold a treat out about 2-4" at floor level in front of the dog so the dog stretches forward to reach the treat. Do two repetitions.
Elbow Extension Stretch - This stretch helps with range of motion in the front legs which experience more stress and tension as DM makes the hind legs more unstable. While your dog is lying down slide your hand under the dogs armpit with the thumb over the top of the elbow joint (see picture). Lightly grasp the leg with the other hand lower toward the paw. Very, very gently extend the leg parallel to the ground and stretch the leg toward you and back toward the hind leg. Hold for a count of ten. As in all the stretches watch your dog carefully and Stop if the dog resists. Don't force the stretch.
MASSAGE, TACTILE EXERCISE, EXERCISE BALL and WEIGHT SHIFTING EXERCISE:
Sam does modified exercises on the exercise ball where he rests his weight across the ball and works his core and hind legs at every visit to the rehab center plus massage and stretching by Jean, Sam's CCRP, and me, at home. Pat and Oscar[Lab mix] gave me permission to quote from Oscar's instructions which are so clear and easy to follow.
Massage, Tactile Exercise, Exercise Ball and Weight Shifting Exercise instructions from Pat and Oscar's rehab vet:"Massage - When a pet shifts weight off an area, another area of the body has to pick up the additional stress. Often these muscles will tense due to the additional workload. Massage is meant to be a gentle, soothing addition to rehabilitation. This can be performed while lounging with your pet. Make sure the pet is comfortable and relaxed; often having the pet laying on its side is handy. Start with gentle stroking with mild pressure or 'effleurage' over the pet's body in a head to toe and top to bottom directions. Next, perform some mild 'petrissage' - a gentle 'kneading' and sweeping motion over the most affected area(s). It is common to perform these manipulations in a series of '3'. Massage shoulder muscles, one time a day.""Tactile Exercise - This exercise stimulates all the structures of the leg (joints, muscles, nerves, etc.). With the leg extended, gently 'pulse' the bottom of your pet's foot with the palm of your hand. Or, if the pet is standing, use a 'stomping' motion. Do this for 1-2 minutes with each foot 2x a day.""Exercise Ball - Use of the exercise ball can be for multiple purposes. First, it is used to increase muscle strength - core muscles of the abdomen/chest and the appropriate limbs. Also, it can help to assist with fine motor control - smoothing out muscle movement. This exercise can be very tiring, especially for a pet that has been down for a while. Start with short sessions and provide rest periods.* Place front feet on ball; place rear feet on floor in near normal stance.* Gently roll ball forward and back, and side to side.* Perform one time a day; attempt to work up to 7-10 minutes per session.* An appropriate ball size would be one that is about shoulder height. An exercise ball can be obtained at a sporting goods store (i.e. Dick's Sporting Goods) or general purpose store (i.e. Target, WalMart)".
"Weight Shifting Exercise - In this exercise, we are re-educating both nerves and muscles. All four feet should be placed in a normal standing position. If needed, gently support the pet's body weight. If able, let the pet stand on its own. If/when the pet starts to sink, gently rise back into a standing position. Subtle weight shifting is added by gently moving the pet side to side, and forward and back.* Perform for 3-5 minutes, 1-2 times a day. Increase time as tolerated.* Also, can perform with front feet on a step to increase weight bearing on the back leg."
INFORMATION SITES ON DM:AKC Canine Health Foundation DM Videos - Two informative videos about DM and how to care for a dog with degenerative myelopathy.Yahoo Groups Degenerative Myelopathy List - A Yahoo list group for owners of dogs with Degenerative Myelopathy, a great source for information and support.Links Page at the Degenerative Myelopathy List - An extensive list of links for harnesses, carts, ramps and other resource sites.DM Roster - Assorted articles about Degenerative Myelopathy including information about Dr. Clemmons, physiotherapy for DM dogs, carts, etc.Degenerative Myelopathy of the German Shepherd Dog - An informative article about DM.Degenerative Myelopathy of German Shepherd Dogs by Dr. R.M. Clemmons - An article by the recognized authority on DM.The DM Database - A survey designed to gather information about dogs diagnosed with DM to aid in research.The DM Flash Test website - Dr. Clemmon's has developed a DM test for GSD.DNA Test for DM - DNA test for DM available through OFA/University of Missouri-Columbia Veterinary School.
WHERE TO FIND REHAB FACILITIES:The Canine and Equine Rehabilition Gateway - CCRP Practitioners by StateDavid Levine's Website for Facilities for Animal Physical Therapy/RehabilitationThe Association for Canine Underwater Therapy Membership Directories
ASSISTIVE DEVICES:Assistive device is a term commonly used in human rehabilitation for things like canes, walkers, any thing that make living with a disability easier. I've used it here for things like harnesses, paw protection and carts that make life easier for our dogs, and for us.
Some of the harnesses are combinations that help meet different needs. Fagin models a combo harness of a Sure-Fit front and Hartman Harness rear that met his needs better. Sam wears his Help'Em Up front and back for getting in and out of the car. For just lounging around the house, he wears the looser, more comfortable 3in1 Vest Harness plus the "Hip Lift" part of the Help'Em Up.The Ruff Wear Web Master Harness - The Ruff Wear Web Master Harness is a lift and support harness that many rehab centers use. The Ruff Wear harness has just been redesigned. Jack[Corgi] is wearing the older version in the picture below with a homemade Biko brace.The 3 in 1 VestHarness(vented fabric version) - A lift and support harness from Canine Friendly available online and in stores from Moochie and Company, also available from other online retailers like Muttropolis(unvented fabric version). When Sam first started rehab both the rehab and hydro therapists told me to use a harness instead of attaching the leash to the collar. Should Sam start to fall down, the harness would provide more support and wouldn't hurt his neck like the collar might. Sam has one in red shown in the picture below.Four Paws Harness - The Four Paws harness is very similar to the 3 in 1 VestHarness and can be found at Petco and Petco online.Hartman's Hip Helper aka Hartman Harness - A full body harness that can help with walking. Chloe[white Boxer] models her Hartman Harness in the picture above.The Help'Em Up Harness - A full body harness with grips on the chest and hips to help with lifting and support.Premier Sure-Fit Harness - Fagin[GSD/brindle pit bull mix], in the picture above, models a Premier Sure-Fit front harness attached to a Hartman Harness rear. To find out more about Fagin go to Fagin's story.Bottom's Up Leash - The Bottom's Up supports the dog's hind legs when walking.Walkabout Harness - A walking aid harness that fits like a pant.Drs.Foster and Smith Comfort Lift - A lift and support sling.AST Pet Support Suit Dog Harness - A custom tailored, heavy duty support harness for dogs.Sir Lyon Puff sling - An easy to make sling created from folding, cutting and sewing a sweatshirt.Simple homemade lift - If you sew or know someone who does, a homemade lift is simple to make. Take a hand towel, fold it in half longwise. Sew webbing available at WalMart or Joanne's along the outside edge of the towel looping extra webbing to make handles the right height for you and your dog. See picture to the right.
PAW PROTECTION:Jack's home made booties protect the feet when the dog knuckles and provides traction on slick inside floors - Lila created some easy and inexpensive homemade duct tape booties for Jack[Corgi]. Pictures and her instructions are below.
Jack's Booties - The secret to start the booties is to get the foot size right. I initially made a pattern by having Jack stand on a piece of paper and drew an outline. I found for him that baby booties 0-3 months were the best fit. I took all the booties outside and sprayed them with Plasti Grip (a rubber coating) and let them dry.I then used small pieces of duct tape to shape the boot to conform to Jack's foot. I used a thin piece on the right, a thin piece on the left, and then a thin piece to join the two over the toe to form the shape. Then I lay larger strips across the top, and across the bottom to cover. There is a piece that goes up the heel, and another that covers the toe for added protection.I then re-sprayed the booties with Plasti-Grip for additional protection.For indoor booties, I went to the fabric store and got the stuff they put on the bottom of kids pj's. I made a new boot, covered it with Shoe Goo and placed a piece of the non slip stuff on the bottom in the shoe goo before it dried!The velcro strap is made by using two pieces that have adhesive on the back and putting them together. There is a inch or two overlap around the ankle . This is used over and over again with each boot. I tried thinner velcro but it didn't work as well. This stuff also grips the knit boot- which aids in holding it up.
Paw Pads - Neoprene stickers that attach with medical grade adhesive to the paw to provide traction.Pro-Active Paws - Dog boots that protect the paw.Muttluks - Dog boots available on line and at PetsMart.Soft Paws -Vinyl nail caps that glue on to your dog's nails to help reduce scrapes and scratches from knuckling.
CARTS AND WAGONS:Eddie's Wheels - Carts for handicapped dogs.Walkin' Wheels - Adjustable wheelchair for dogs.DogKarts.com - Wheelchairs for dogs, part of Handicappedpets.com.Clydesdale Hauler Wagon, aka Ripley's Cart - A wagon just the right size for a large dog with DM when walking or carting is no longer an option.All-Terrain Cargo Wagon - A large wagon for all types of surfaces.Fold It and Go Wagon - Unfold and it's a wagon large enough for a dog, fold it back up to put in the car.Track'r Bicycle Trailer/Jogger from Solvit Products - A jogger that can let your DM dog come along with you to the ball games, the park, or just to get out of the house for a while and smell the fresh air. You can also find the joggers on ebay.Take a look at Jack's chariot pictured below.
PHYSIOTHERAPY AND STRETCHES:AgilityNerd Simple Stretches - Pictures and descriptions of standing simple neck, shoulder, and back stretches.The American Boxer Club on DM in Boxers - An article about DM in Boxers including some exercises.Jim Colla's physiotherapy exercises - Exercises and stretches for dogs with DM.
My number one human, the one I call She, said I could tell you my story, so here goes.
I was born in Missouri at what She calls a puppy mill. When I was eight weeks old, they loaded me up and shipped me to a Petland where I lived in a glass cage for a long time and only got out a couple of times a day to run around in the store. No one recognized what a very handsome boy I am. I canít understand that Ďcause Iím gorgeous, with sleek black fur and beautiful amber eyes. I got bigger and bigger. Petland put a clearance sign on me Ďcause I was outgrowing the cage. A young couple came in to the store and felt sorry for me, bought me and took me home. They couldnít keep me, though, there was some kind of argument. I didnít do anything, but the old people of the house didnít want a dog. I was in big trouble Ďcause if they didnít find anyone to take me I was headed for the animal shelter. Lucky for me She heard about my situation from a friend and came and took me home with her.
Living with She and the others was great. I got to take good walks and sniff stuff. But it wasnít long until I started limping and sitting down Ďcause it hurt. I went to the vet. He said my hips were very bad and had to be fixed. I had two operations before I was a year old. That was no fun. I didnít like it. I had to have physical therapy after each trip to the vet hospital. She would do therapy on my legs which hurt some, but the Boy or Girl would feed me treats while I was doing the therapy. That helped Ďcause I love treats.
I have always been a good dog. Anyone will tell you that. I did do some bad things, though, when She had to be away taking care of her mom. There was the screen door I knocked out and ruined, the ripped up Berber carpet (that was fun to pull those loops out!), the crunched up music cassette tapes, the salmon can that stuck on my nose when I got into the recycling and wouldn't come off and the red ink pen that somehow got all over the carpet when I chewed on it. She said she didnít know how I could have got red ink from one end of the room to the other. Can I help it if Iím a retriever and like to carry things in my mouth? Anyway, now Iím older I donít do stuff like that any more. Thatís for puppies. I'm too busy these days to cause mischief. I have to wake everyone up in the morning, go out and get the newspaper, do my exercises and stretches, clean the pots and plates before they go into the dishwasher, guard the house, be the doorbell when someone comes to the door and help reduce my She's blood pressure by having her pet me and rub my tummy. I'm a very busy dog.
Iíve had a pretty good life. Iím 13 now and a cancer survivor. I had a nasty growth cut out of my jaw. The vet said I dodged a bullet on that cancer and that I was one lucky dog. Iíve got a macho scar there now. I still look good, though, just tougher. My big fight now is this problem Iíve got with my back end and legs. Iíve always been a little wobbly in my hind end. IĎve never been able to jump Ďcause of the hip dysplasia and the two surgeries and I canít walk really far Ďcause I get too tired and I hurt. In October, 2006, though, I got really wobbly, my back legs started crossing and I fell down a lot. I couldn't sit down, when I tried I just fell. It got so bad I couldnít get up or walk without help. She took me to the vet. The vet looked me over, did some tests, and said he thought it was something called Degenerative Myelopathy. He said there wasnít a lot he could do, but he told She hydrotherapy might help and gave her a brochure about a regional canine rehab center. She did a computer search and learned as much as she could about DM. She found out hydrotherapy and rehab therapy help so she called up my two friends at the rehab center and got me started doing hydrotherapy and rehab. Iím not crazy about the underwater treadmill tank I have to walk in. Mind you, Iím a water dog. Give me a lake, pond or muddy stream to swim and swish about in and Iím happy. I just donít like the walls that come up around me in the tank. All the treats She feeds me and the sweet talk and praise make it tolerable, though. I love the massage and exercises I do at rehab therapy. I have to balance on a board, step over sticks, walk around cones and stretch out on a giant ball. I get treats all the time. Itís great! My muscles got a lot stronger. Everyone said my butt looked great now, not so boney any more. They all said it was amazing how much I improved. Iím not saying Iím 100% now. Iím not, but I can walk about a mile, get up myself up, play with other dogs and generally lead a dogís life. I'm still a little wobbly at times, but I'm walking. Thatís a lot better than I was before I started rehab Ďcause back then I needed help to go out in the yard to go potty and was just lying around all the time not able to get up by myself.
So thatís my story. Iím 13 years old now and showing my age, but She says Iím holding my own. I go to hydrotherapy and physical therapy. I take one Centrum Silver capsule a day (the human vitamins) the vet neurologist recommends along with fish oil or flaxseed oil. She gives me salmon and sardines with my other food and a little bit of extra vitamin D3. My She thinks the vitamin D3 is pretty important. I also get my glucosamine chondroitin tablets and LubriSyn CA. Those help my arthritis a lot. I get lots of treats like apple bits and dog biscuits, but I have to do my sits, cavaletti rails and stretches to get them. We walk everyday even if it might not be very far. I get lots of massage and tummy rubs, too.
Some vets may say thereís no hope for a dog with Degenerative Myelopathy. I know of dogs that are still around years after they got the diagnosis. I think itís worth trying the hydrotherapy, rehab exercises and vitamins. All that sure has helped me 'cause it's April, 2008, over a YEAR, after the diagnosis of DM I'm still doing my walks and living a regular dog's life.
6-24-1995 to 7-13-2008
Sam died July 13, 2008. He had been losing ground, getting weaker, walking less. The day of his death he wanted to walk farther than usual, and I had to make him turn around and go home fearing he would tire himself. Later that day he became very quiet, refused to eat, even treats, and refused water. His gums went pale and his breathing became more labored. I took him to the Cincinnati Animal Referral and Emergency Center, the wonderful animal hospital. They rushed him right in and started doing tests. When the vet came in with tears in her eyes, I knew. Sam was severely anemic, probably bleeding internally. He was in great discomfort. I couldn't let him suffer any more, so he went peacefully to sleep in my arms. Sam was a great dog, my wonderful companion for over a decade. I miss him every day.
Many, many thanks to Sam's wonderful physical therapist, Jean, and canine underwater treadmill owner and operator, Carmen, at the rehab center. Sam owes so much of his quality of life to them. A grateful thank you, too, goes to Sam's vet, Dr. Ron, who's given Sam such good care over the years. He gave me the brochure about the rehab center and said rehab therapy might help Sam.
Thanks, too, to Monica and the Yahoo DM list. Thanks to Roseanne and Nitro[GSD], now at the Bridge; he doesn't have to do exercises anymore. They shared some of Nitro's therapy tips with us. Thanks to Lila and Jack[Corgi] for even more great exercise tips, homemade booties, pictures and a look at Jack's personal gym. Thanks to Pat and Oscar[Lab mix] for all the exercises from Oscar's rehab vet. Thanks to Jessica and Chloe[white Boxer] for the Hartman Harness pictures and to Helen and Fagin[GSD/brindle pit bull mix(4/4/93-10/8/07)] for the Sure-Fit/Hartman Harness pictures. Thanks, too, to Elaine for the link to the AKC Canine Health Foundation article and Marcia for pointing out the DM videos. I have received so much support, wonderful information and ideas from the people on the Yahoo DM List. Many thanks to you all.