Observations : Exercises done at home: crawling, sitting, sit pretty (beg). Sometimes notice the muscles around his knee fasciculating.

Assessment : A couple of acute trigger points at lowest point of the spine – T10/T11 anticlinal. Stifle ROM is great – no patella luxation present and R/stifle is mildly hyperextending. Discomfort in FL protraction BL.

Manual Treatments Delivered : Massage to thoracic paraspinals FL protraction stretch

Therapeutic Exercise Programme: In Clinic + Home Prescription : To add in: Bows Squats – have his front paws on the

Electrotherapy Delivered : LASER: 6J to TL junction

Observations : Regularly doing his exercies – crawling now too. Sally has noticed that Rusty is avoiding jumping up the see the cats, instead preferring to run around to see them.

Assessment : Reassessed the “sit pretty” – he needs to work on the coming back down in the same spot and also try to prevent him grabbing hold of you. Muscle mass is developing nicely – still need to build the tone and mass of R/bicep femoris. Circumference of thigh is now symmetrical – 28.5cm bilateral – fantastic! A couple of acute trigger points at lowest point of the spine – T10/T11 anticlinal RHS – only thing we now need to work on. Stifle ROM is great – no patella luxation present and R/stifle is no longer hyperextending. Hips are now comfortable too – can flex, extend and abduct with no problems or discomfort.

Therapeutic Exercise Programme: In Clinic + Home Prescription : Sit in correct posture – then beg position followed by standing up on back legs. – ADVANCE THIS TO GOING BACK INTO A SIT POSITION. Alternate the 2 so he does 5 reps of each exercise. ADVANCE this so that Rusty now has to come back down to a sit posture after standing up. Make sure he stays in the same position and try not to let him lean his paws on you. Sit to Stand with front legs on a raised platform (about 26cm). Start with 5 reps, see how he does can add more if coping. Ensure that step has got a non-slip cover so Rusty feels secure to stand on it. ENSURE THE STEP IS NOW 26CM HIGH. Stretches for hip mobility – nose to tail & active hip stretch & rolling in the sphinx. Adding in crawling and also adding in nose under chest. Stairs – whenever throughout the day ** NEW EXERCISE – THE PLANK. 2 objects 17″ apart, the same height. Get Rusty to stand with front paws on one. hind paws on another and stretch his back straight for a treat and hold

Electrotherapy Delivered : 2 x 4J applied to T10-T11

Treatment Plan : I am happy for Rusty to stop having daily Loxicom. Speak to doggy day care and try to prevent Rusty from jumping on and off objects with the other dogs.

Review Plan By : November 18, 2023

Observations : Owner has been regularly performing the home exercise programme. Calmly doing the stairs & performing S2Ss and sit,down,sits very well. He absolutely loves doing his exercises – very keen. Doing them religiously and very successfully. He sitting in a better posture – not holding the leg out as often. When lying down he can hold sphinx quite happily. Reason for referral: luxating patella 2/4 RHS

Assessment : L/hip is now able to extend fully without rotation. Full flexion in correct alignment. No luxation of L/patella felt today. Stiff to extended nicely. R/stifle is no longer hyperextending. R/hip good RoM, full extension achieved with limb in correct alignment. LH = 27cm. RH = 26c.5m – only 0.5cm left to go. 14/07: L/stifle no issues with extension today – good ROM. R/stifle is no longer hyperextending Hips still uncomfortable to fully extend – rotation in flexion and extension LH = 27cm, RH = 26.5cm

Therapeutic Exercise Programme: In Clinic + Home Prescription : Sit in correct posture – then beg position followed by standing up on back legs. – ADVANCE THIS TO GOING BACK INTO A SIT POSITION. Alternate the 2 so he does 5 reps of each exercise. ADVANCE this so that Teddy now has to come back down to a sit posture after standing up. S2S with FLs on raised platform. Start with 5 reps, see how he does can add more if coping. Ensure that step has got a non-slip cover so Rusty feels secure to stand on it. ENSURE THE STEP IS NOW 26CM HIGH. Stretches for hip mobility – nose to tail & active hip stretch & rolling in the sphinx. Stairs – whenever throughout the day

Treatment Plan : Very pleased with his progress. R/stifle hyperextension is no longer an issue. Muscle mass is building nicely and I anticpate to be even behind when I next assess him in 8 weeks time. Continue with home exercises as these have been very effective.

Review Plan By : July 14, 2023

Observations : Owner has been regularly performing the home exercise programme. Calmly doing the stairs & performing S2Ss and sit,down,sits very well. He still sits in an unusual posture when relaxing. Reason for referral: luxating patella 2/4 RHS

Assessment : L/hip is now able to extend fully without rotation. No luxation of L/patella felt today. Stiff to extend stifle however. R/stifle is still hyperextending though not as bad as initial consultation. R/hip good RoM, lateral rotation of limb in retraction. LH = 27cm. RH = 26cm.

Therapeutic Exercise Programme: In Clinic + Home Prescription : Sit in correct posture – then beg position followed by standing up on back legs. Alternate the 2 so he does 3 reps of each exercise S2S with FLs on raised platform. Start with 3 reps, see how he does can add more if coping.

Treatment Plan : Very pleased with the muscle and joint adaptations already. To review progress in another 2 weeks time

Review Plan By : July 14, 2023

Chief Complaint / Areas of Concern : Luxating patella 2/4 RHS

Date of diagnosis : 22/05/2023

Owner’s Goal : Work on hip muscle strength & joint flexibility To work on good form in functional movements To build stifle flexor strength to prevent stifle hyperextension & stabilise the patella.

Home Environment : Loves a ball though short distance (approx 2m or so). Loves to chase the birds in the garden Full house access Carpet mostly, kitchen is tiles Access to sofas & beds – tends to look out of the window & will jump off sofa to run to the door etc. Sleeps on the owners bed.

Daily Activity : 7am walk for approx 20 minutes 9am walk for approx 20/30 minutes Paw Seasons 3 mornings a week – off lead as a group in the field Sometimes in the PM will go for a longer walk weather dependent – can be up to 1 hour Largely on lead but sometimes off lead in the field Ball obsessed

Static Observations : Thoracolumbar kyphosis – more lumbar

Observational Gait Analysis : Lack of hip extension Throws ribcage to RHS Can trot though preference to walk or canter Fixation of stifle position

Palpation Assessment : L/hip abducts in flexion, lateral rotation in extensiom, discomfort at end range L/stifle – muscle guarding with initial palpation but eased into flexion & extension quite nicely. Mild luxation felt. R/hip similar to L/hip though RoM slightly better. R/stifle hyperextending in extension – likely causing exaggerated patella luxation. Hypotrophic & hypotonic hamstrings bilateral, R/quads & sartorius Acute trigger points caudal thoracic paraspinals

Short Term : Increase strength and muscular support, reduce pain and inflammation, increase range of motion, encourage even weightbearing,

Long Term : Improve strength and fitness, achieve normal posture, reduce secondary compensations.