Lasering aching elbows that are caring much of a weaker dog’s body weight.

As a veterinary rehab therapist  I have seen my fair share of hind end weakness in older dogs. This loss of function can be from a variety of causes. A thorough exam is a great place to start to rule out issues such as tick diseases, weakness from anemia or endocrine imbalance, and to localize any areas where pain may play a factor.  Arthritic joints and orthopedic injury can lead to a pet that doesn’t want to move because of pain and discomfort.

Do We Really Know the Cause of the Weakness?

The hind end weakness that I am referring to is the generalized geriatric hind end weakness that we often see in senior aged dogs. Several of my patients go through a progressive decline in function that is not arthritic in nature but rather a neuromuscular degeneration. We can be quick to call this neurological decline Degenerative Myelopathy (which is a truly terrible disease similar to ALS in people) and set ourselves on a negative course of doom and gloom for the patient. In my rehab career I have seen many dogs with hind end weakness but only a few of them actually had true DM (diagnosed by DNA testing and/or MRI screening). The DM dog’s  journey of decline to complete dependency was fairly quick (months) and very heartbreaking because their bodies gave out well before their spirit did. So let’s just agree that dogs can have many other neurological things happening to their body (age related muscle loss, spondylosis, lumbrosacral disease, degenerative disks to name a few) besides DM to bring them to their weakness issues. Why is this distinction important? In short, TIME. Many of these non-DM related causes have a much slower rate of decline and that makes all of the difference when keeping a dog on their feet. Can we manage this hind end weakness, whatever the cause, and give these dogs a good quality of life? Sure we can!

Needs and Goals: Let’s Be Realistic

The first place to start is with setting realistic goals. In the case of age related progressive hind end weakness, we will never restore full function in our pets. Rehabilitation therapy will slow the process of weakness and decline but won’t change its course.  My rehab goal is to improve quality of life, teach families how to manage a changing pet, and keep my patients on their feet for as long a possible. In the older patient, I usually find that once we begin rehab therapy we are maintaining where they are now in function and may be able to get back some activities such as being able to climb stairs again or getting on the bed without help. If they are currently able to just walk around the block before tiring out, rehab therapy will not get them back to that three mile walk that they used to do a few years ago. Rehab therapy will realistically keep the weakening dog walking that block for as long as possible with the least amount of help and secondary issues. They can still play ball or tussle with their canine buddies, but with some modification to avoid over fatigue and injury.

 I like to have my owners identify some things that their dog used to enjoy doing but  are not able to do any more. These lost activities can be markers for improvement if they return or goals to achieve with therapy. It is also important to find out what actions an owner needs their pet to be able to do (like get in and out of the car, up and down entry stairs) in order for the owners to feel comfortable taking care of their pet at home. There is a delicate balance between the level of care that a person is able to give and the level of care that a disabled pet actually needs.

Managing Hind End Weakness: The Plan

1. Manage any source of pain. While the neurological decline leading to weakness may not be a painful process, there is often secondary pain in some of the joints and muscles because of how a pet is moving or compensating. If they use their front legs to push themselves to their feet or to carry most of their weight, maybe the elbows and surrounding muscles are sore. Often times the muscles of the spine are affected by changes in posture, falling over because of instability, or slipping on some surfaces.  Oral medication such as NSAIDs and supplements as well as laser therapy and/or acupuncture are great resources for pain control. Massage or a warm compress on aching muscles can bring relief and comfort as well. Let’s not forget home care devices such as the Assisi Loop for portable pain control.
2. KEEP THEM LEAN!! These dogs are having a hard time lifting their body mass and staying on their feet. Carrying excess weight will make the loss of strength and mobility even worse and eventually shorten the amount of time that they have with you. 
3. Consistent home exercise. Shorter walks twice daily are a great way to keep a dog moving and grooving. Mix it up with changing terrain by walking on grass, pavement, sand, and other surfaces to increase the feedback your pet gets from their feet to their brain. Challenge stability by adding in wide circles or figure 8s to a walk. Encourage pets to step over things like tree branches to lift their feet. Walking on a low unstable surface such as an air mattress can help to strengthen core muscles and promote body awareness for stability.  Avoid the long hikes or play activity that may cause over fatigue that takes days to recover from. 
4. Acupuncture. I like to think that this modality is great for helping what does work to work a little better. Acupuncture will help to strengthen the nerve-muscle connection and is our go-to therapy when there are incontinence issues along with the hind end weakness. With acupuncture there is an increased circulation to problematic areas, nerve and muscle stimulation, and usually a general sense of well being for the patient. 
5. Formal Rehabilitation Therapy. Adding in aqua therapy and targeted exercises can work to strengthen muscles and build endurance for home exercises and activities. About half of my rehab session with a patient and their people is spent talking. Each session is therapy for the pet and the owner because watching a pet change can be hard. Use your rehab therapist as a valuable resource to help with solutions for home care needs. We are reassessing needs and goals all of the time and having someone to guide the way can reduce anxiety for both the owner and their pet. 
6. Environmental Changes. Slick, slippery floors are a huge problem with the hind end weakness pets. They can lose their footing and then not be able to get themselves back up without assistance. Placing throw rugs over slippery surfaces  will help your dog to navigate at home without falling. Block off stairs if the pet can not go up and down them without some issue such as slipping or falling. Ramps to get in the house or car have their place but you need to find the right size and fit that works for your situation. 
7. Mobility Aids. There are so many products out there when you look online or in stores that picking one for your needs can be a bit overwhelming. My advice is to look at the reviews, see what worked and did not work for that particular item, and think twice before purchasing anything. I have a box full of items that people bought on their own that ended up not working at all. For the larger dogs, I do have one product that I consistently recommend and that is the Help Em Up harness system. You can use it to help a dog get into the car, up the stairs, get onto their feet, and to stabilize them during other day to day activities. This harness system is not for everyone but seems to be helpful to the majority of my families that use it.
   
   

We Are Here For You!

It can be a very difficult thing to watch a beloved furry family member age and decline in mobility, among other things. It is important to remember that this journey of age related change is inevitable, but we can make it a whole lot more comfortable for everyone. There is help out there for you and your pets. You just need to take that first step with your veterinary professional to start your journey of management and support.