Sonny and his Torn Knee Ligament
The sound of barking dogs greeted me as I strode up the slate steps. A woman with a smile in her voice called out “Come on in!” as she wrangled the canines away from the door. There were three of them – a gigantic Tibetan Mastiff, a yellow Lab and a chocolate Lab. I knew immediately who I was there to see; the yellow Lab who was enthusiastically wagging his tail while balancing on three legs.
Sonny, this exuberant five year-old Labrador Retriever, had torn a ligament in his right knee. He underwent surgery to repair his cranial cruciate ligament (oftentimes referred to as the anterior cruciate ligament or “ACL”). The surgery went well and Sonny was expected to return to full activity following a period of rest and rehabilitation. However, it was now ten months since the surgery and Sonny was still limping. His surgeon was at a loss to explain why.
Even when Sonny put his right hind foot on the ground, it was clear that he carried more of his weight on his left hind leg. And when Sonny walked, he had a distinct limp. The dog’s body showed the tell-tale signs of this asymmetrical balancing act: his back was constantly tense, the muscles of his right hind leg had atrophied and the muscles of his left hind leg were taut. Sonny’s tight shoulders indicated the extra work his front legs were doing too.
Since the veterinary surgeon could find no reason for the dog’s continual limp, it was possible that Sonny’s habit of protecting his injured, painful leg had become so ingrained that he had forgotten what it was like not to limp. He had spent months guarding against pain, first from the injury and then from the surgery. In doing so, Sonny had lost the supple, confident use of his body. His continued limping put a constant strain on his opposite hind leg, leaving him predisposed to tearing that ACL. We certainly wanted to avoid that!
My job was to help Sonny feel that moving freely was safer and more comfortable than limping. To do this, I tapped into the same bodily intelligence – the nervous system – that created the limp in the first place. After all, limping is an appropriate response to pain, protecting the injured area and helping to reduce discomfort. The drawback only comes when the limp has outlived its usefulness, and the imbalance creates strain and the potential for further damage.
Some people hold up the opposite hind leg to get the dog to stand on the healed leg. But without the proper preparation, the dog’s nervous system would flag that experience as unsafe and develop additional compensations, such as further tightening the back. But I knew that if I created a learning environment where Sonny could explore what it was like to stand on his right leg safely and comfortably, he could regain confidence and pleasure in moving freely again.
This mindful approach to recovery was introduced to me in my training as a Feldenkrais Method® practitioner for people and it led to my creation of the SENSE MethodSM for animals.
I went over to Sonny’s dog bed and encouraged him to lie down. Sonny did as he was asked, but quickly popped up again. We repeated this a few times. Tail constantly wagging, Sonny was just too excited to lie down while there was a new person in his home! It is certainly possible for me to work with dogs while they are standing up (I do it with horses all the time), but lying down would allow Sonny’s muscles to relax, give me more opportunities to move his back and legs, and generally allow for quicker results.
It’s been my experience that most dogs will begin to settle down and enjoy the session once they feel that my hands are offering them a way out of their usual discomfort. The key is to get their attention in such a way that they can experience this change.
There are many ways to approach this. Since Sonny knew the verbal cue, “Down”, I started there. Each time Sonny responded to my request by lying down on his bed, he received a small piece of dog biscuit. Since he wanted to immediately stand up and play, I very gradually increased the time between Sonny’s correct response (lying down) and his reward (the treat). Subtlety and patience are essential. If you increase the interval between the cue and treat too much, too soon; the dog will just give up and leave. If, on the other hand, you keep handing over treats non-stop, the dog doesn’t learn how to stay in position, and it would be difficult to get anything accomplished.
Each time Sonny lay down, I used my fingertips to gently lift the muscles along his back. Keeping my touch light, I used slightly more pressure as I lifted the soft tissue up toward his spine in an arc, releasing the pressure gradually as the tissue eased back down. I worked down one side of his spine and up the other. My movements were light, slow and rhythmic. Sonny soon began to relax.
Little by little, Sonny became more focused on what I was doing and we relied on the treats less and less. The lifting motion helped relieve the tension in those over-worked back muscles. Even more importantly, Sonny experienced that movement in his back was possible and comfortable.
This is an important step in creating change – letting the animal experience that it’s possible to feel differently. This helps break the vicious cycle of habits and allows change to be not only possible, but an easier and more comfortable option.
After slowly outlining Sonny’s spine on both sides, I placed my hands on the fullness of his ribcage. I delicately slid his ribcage in various directions, helping to relieve the strain in his shoulders and neck. I also worked with Sonny’s sternum and individual ribs, reminding him that these parts could move. I supported the muscles along Sonny’s shoulders, which elicited great, deep breaths of apparent appreciation. At this point, Sonny had stopped thinking about getting up to play or investigate any noises.
I supported and guided Sonny’s body, letting him feel how his different parts could move easily and comfortably. I always kept the movements safe and easy, continually checking the dog for any signs of stress. I noted the depth and rate of his breathing, the look in his eyes, and the set of his ears and tail. To reduce the chance of anxiety, I worked with his non-injured side first. I alternated between moving the left hind leg, then the right hind leg, so Sonny could experience how the movement of both hind legs felt similarly safe and comfortable. As we ended that first session, Sonny was more comfortable and relaxed in his body, although the limp was still present.
I returned several more times to work with this lovely dog. Since the brain is stimulated by novelty and variation, I repeated non-habitual movements in various ways to reinforce Sonny’s learning. I used a small book held against his paw to simulate a floor. With this artificial floor, I helped Sonny “stand” on first his left, then his right hind leg, all while he was safely and comfortably lying down. He was able to experience what “standing” was like with a relaxed back! I imagine that it had been quite a long time since his nervous system registered “standing” while his back was relaxed and supple. I then carried this sensation into actual standing and walking, since it was important that Sonny learn how to keep his back supple as he stood and moved, helping to ensure his overall ease of movement.
With Sonny standing, I lightly moved his hips, pelvis, spine and ribs. I then gently shifted his weight in a circle, moving his mass from one paw to the other. I encouraged Sonny to walk, and I was happy to notice how much freer he looked. Now that Sonny had improved his coordination, the different parts of his body worked together to share the effort of moving. And happily, Sonny’s limp disappeared. This exuberant Labrador had regained confidence in his body and could once again run and play with joy.
Could Your Animal Have an Unnoticed Limp?
A great many dogs who have sustained an ACL tear exhibit issues arising from the injury even years later. While most of them do not have the distinct limp that Sonny exhibited, they have what I refer to as an “unnoticed limp”. Even long after the original injury, the injured leg often had less muscle mass than the non-injured leg. While not obvious at a casual glance, careful observation shows that they are not using the repaired leg fully.
These dogs may run and play, but over time such unbalanced use is likely to take a toll on other parts of the body. I believe that is one reason why so many dogs end up injuring the opposite ACL too. While some dogs may have a genetic predisposition to ACL weakness, for many others biomechanical forces may be to blame.
You may wonder why this happens. In simple terms, here’s why. The nervous system is responsible for maintaining the body’s safety. When an injury occurs, the nervous system registers pain to keep the animal from using the injured part. The animal limps to reduce the discomfort, allowing the injured part to rest. It’s an effective strategy. Gradually the pain subsides and, in many cases, the limp disappears. Well, almost disappears. In actuality, the nervous system may not entirely let go of the limp. It doesn’t want re-injury to occur, so it may retain a trace of the limp. And while it may be unobservable to all but the trained eye, the animal (and that includes us humans!) may unconsciously tense the back muscles more on one side when walking or habitually bear more weight on the unaffected leg. There are as many ways to limp as there are individuals, and it often becomes a habitual and unconscious act.
Such a habit may go unnoticed for years, until problems start developing with the weight-bearing hip, knee or foot. Or maybe the back gets strained from the constant tension. Fortunately, there is a way out of this vicious cycle, since nervous systems are capable of continuously learning and improving. With the right hands-on help, these animals, like Sonny, can discover more appropriate and comfortable ways to move.
