Observations : Was fine after the last session and has been ok this week. Owners have been doing the hill walks and the HEP where they can, but it has not been everyday. He is able to do 10 seconds of weight-shifting and 5 second 3 legged stands fairly easily.

Assessment : Stifle RoM has improved considerably Hip extension still very limited bilateral R>L R/ shoulder mm hypertonic

Manual Treatments Delivered : Massage to R/ shoulder, L/stifle soft tissue after US & LH medial thigh (gastroc & gracilis) LH gastroc & gracilis stretch x 3 for 10 seconds L/stifle PRoM 10 reps RF PRoM & shoulder extension stretch x2 for 5s

Therapeutic Exercise Programme: In Clinic + Home Prescription : Walk over legs – Weight shifting = 10s x 3 3LS = 5s x 3 Feeding with FLs raised NEW EXERCISES 3 x knee bends of L/knee prior to walks 3 x active hip stretch for 10 seconds after walks Walking up inclines ADVANCE 3 knee bends prior to walks 3 x active hip stretch after walks

Electrotherapy Delivered : SWUS 10 mins L/ stifle Laser 4J per point to medial, cranial and lateral L/ stifle, 8J to hips bilateral PMFT pain relief setting L/ stifle; R/shoulder VD & Hips VD

Treatment Plan : Week 3 of 4 sessions.

Assessment : Quiete a nervous boy, unable to perform much hands-on assessment.

Therapeutic Exercise Programme: In Clinic + Home Prescription : Walking over legs Weight-shifting 10 seconds x 3 3 legged stands – 5 seconds each forelimb, may require chest support

Electrotherapy Delivered : Laser 4J to r/ hip Laser 4J per point to medial, cranial and lateral stifle SWUS 10 mins to L/ stifle

Chief Complaint / Areas of Concern : When he was coming over to his new home, he got his leg caught when getting him out of the car. Owners thought that he had pulled a muscle so left it a few weeks, then called Tag to let them know. Went to Nikos who diagnosed partial CCrLR of the LH.

Date of diagnosis : 08/05/2023

Owner’s Goal : Help to rehabilitate conservatively due to age.

Previous clinical history : Previous owner passed away 5 days before he came to new owner. Husband got rid of him straight away. He was very panicked & limping but due to adrenaline the symptoms didn’t begin to show until the next day. When getting up from rising he would hold the leg up for a few strides but this would wear off. He was very overweight when he came to new owners, and seems to be coping better now he is slimmer.

Medication history : He has been on Loxicom 1 x daily in the AM. He ran out of this last week, though he is on it for the forseeable. Haven’t noticed much difference whilst not being on this.

Concurrent Conditions : Skin conditions

Home Environment : 2 sausage dogs & 2 cats. All animals get on quite well in the house. Stays on the ground floor – he is allowed upstairs but chooses not to. Laminate flooring throughout the downstairs, vinyl in the kitchen.

Daily Activity : Walks daily, sometimes 2. 45 minutes, mixture of on lead & off lead. Pulls a lot when out on walks. Has a collar with a fixed lead. No balls. Likes to carry a stick & have it thrown for him. Mainly a sniffer. Don’t really notice much of a limp now in terms of exercise.

Current Limitations : Just got him a new sofa which is about 50cm high with a rug in front of it. Finds this easier. Pulls up with front legs & steps up with the back. Quite a docile dog, doesn’t do zoomies. Triggers: barks at people out the front, gets up if he thinks someone is at the door. Doesn’t get up to greet people. Garden access: no real stairs required to get around the ground floor. Slabs & grass.

Behavioural notices : Quite anxious initially but settled down after talking.

Body Condition Score : #5 – Ideal weight

Static Observations : Straight back. Wide chest. Cranial loading, predominantly on the RF.

Observational Gait Analysis : WB isn’t too bad on the LH – medial rotation of hock in flight. Shorter stride length & lack of hip muscle engagement.

Palpation Assessment : Hypotrophic & hypotonic bicep fem, hamstrings & quads LH Hypertonic medial gastroc and gracilis No heat or swelling of the L/stifle

Range of motion : L/stifle: flexion good, extension good but limited by muscle tension. Moderate crepitus L/hip: moderate extension achieved – muscle tension R/stifle: flexion good, extension limited, hard to decipher whether muscle or joint restriction, mild crepitus. R/hip: very restricted extension.

Patient Specific Goals : – Walking up inclines when out on walks – Feed him with front legs raised on exercise step to encourage weight bearing on the hinds

Treatment Plan : 4 weekly sessions of US, laser, massage & HEP advancement

Review Plan By : August 5, 2023