The following Cranial Cruciate Ligament case study involved a canine client I massaged. This post is adapted and modified from a report originally presented on the Harmony Animal Massage website.
Please note: CCL and ACL are often used interchangeably. Cranial cruciate ligament is the term applied in animals and anterior cruciate ligament is usually used in reference to people. However, both terms refer to the ligament located toward the front of the knee. There are four ligaments that stabilize the knee or stifle joint. The medial and lateral ligaments are located on the sides, outside the stifle joint. The caudal (toward the tail) ligament and the cranial (toward the head) ligament are located inside the knee joint.
Mia, a three-year-old Chow Chow, initially developed a limp in her left hind leg for which she was prescribed a NSAID (non-steroidal anti-inflammatory). Her symptoms seemed to subside, but a few weeks later, she ruptured her cranial cruciate ligament (CCL) in her left stifle while sliding on a slippery floor. After a veterinary examination and x-rays, TPLO (Tibial Plateau Leveling Osteotomy) surgery was performed at Canada West Veterinary Specialists. During the operation, a meniscal tear was also discovered and repaired.
During the week following the surgery, Mia experienced severe constipation with no bowel movements for nine days. Normally a very finicky eater, her appetite was extremely poor following the operation. She was also prescribed pain medication.
Mia is a very affable dog in general. Eager to meet people, she leans into you for a hug once you have gained her trust. She was very receptive to massage once the initial introductory phase occurred. She was occasionally restless during the first few sessions, but this was to be expected. Overall, however, she reacted positively to touch, often falling into a deep sleep or eagerly stretching her legs to embrace the massage strokes.
The overall goal was to decrease pain and discomfort, prevent body fluid stagnation, encourage normal range of motion activity, and accelerate the recovery process.
Canine Massage sessions began with two sessions per week for the first few weeks followed by program of weekly massages. Initially, pressure was light (TTouches, Effleurage), especially on the injured leg. Great care was taken to insure a delicate approach to the stifle and surgery site. Emphasis was placed on body fluid circulation and preventing stagnation. Gentle Passive Range of Motion (P-ROM) on both hind legs was used to encourage normal movement patterns. A demonstration of this P-ROM exercise was given to Mia’s guardian so that she could continue a daily regimen. Long and fluid effleurage and other circulatory strokes and were employed during a full body massage to encourage blood, lymph, and water movement to address Mia’s constipation and digestive issues following surgery. As the treatments progressed and Mia developed more mobility, a more comprehensive massage program was engaged, using deeper techniques, like petrissage and skin rolling, to loosen hypertonic gluteals and sticky muscle fascia (from inactivity). Veterinary consultations were maintained by Mia’s guardian and encouraged throughout the process.
Mia gained mobility and weight-bearing abilities at a steady pace during her recovery. By the fourth massage session, she was placing full weight down using her injured leg, but there was still some muscle guarding at this point. After her first hydrotherapy (treadmill) appointment and a fifth massage session, a noticeable improvement in her gait fluidity was observed. The most substantial weight-bearing activity was recognized on session seven. At this point, both walking and trotting gaits were excellent and muscles were relaxed and supple. Care was taken by Mia’s guardian not to overexert her on walks. When she was taxed, she became fatigued and her limp reappeared. By the tenth session, Mia was engaging immediately with the massage, embracing it with full cooperation, stretching and relaxing. Continued TTouch, Effleurage, MLD, and Compression strokes were used to encourage fluid movement in the injured leg and entire body.
Mia continued a weekly maintenance massage program for a few more months then tapered to monthly sessions. Mia’s guardian was very receptive to utilizing integrative therapies like canine massage and hydrotherapy.