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Week 1: Rehab Instructions: Mindset & Expectations

Here are your key points for the week.

  • Mindset
  • Timeline
  • Preparing Your Home
  • Rest
  • Icing
  • Walking Slow
  • Support


I know you will agree with me that up to this point, this entire experience has been extremely stressful for both you and your dog. With that being said, take a deep breath because you now have TopDog here to give you guidance on how to best help your dog through this process safely and successfully so that they can return to 100% normal functionality.


You are probably wondering how long this recovery process is going to take. What I can tell you is this: First of all, don’t be shocked or alarmed if you experience minor set backs during the recovery process. It happens all the time and 95% of the time, everything turns out to be alright in the end. Secondly, right off the bat you need to understand what I mean by the concept of FULL RECOVERY. From my years of experience I can tell you that 100% recovery (i.e. full function & full muscle development) will take up to 6 months. Now this does not mean at the end of the 12 weeks your dog is still going to have a limp. To the untrained eye your dog is going to appear 100% normal and yes they are going to feel much better as well, but at the end of the day, it takes a long time for all of the muscle mass and other soft tissue strength in that leg to return to its optimal condition. Remember you are trying to protect the other hind leg from injury. You will hear me time and time again talk about how my veterinary colleagues confidently state the statistic that anywhere for 30-60% of dogs who tear one ACL, will tear that other ACL within one year. What they are saying is true. What they are not telling you is that if you rehab your dog effectively, this statistic is reduced dramatically. We are going to make sure that your dog does not turn into a statistic.


I am not going to go too in depth on this topic because within the Home Rehabilitation Guide we have thoroughly detailed this. Just make sure that you do your best to secure your home for your dog to the best of your ability.


During the first week you really need to focus on allowing your dog the time to rest and relax. Again, the entire experience was very stressful for your dog. The first week is also the time in which they are experiencing the greatest discomfort. 99% of the time they should be resting, relaxing and being nurtured by you. If they won’t let you perform one of the therapies then don’t push them, let them rest.


  • Cold therapy is incredibly effective in so many ways. It is nature’s best anti-inflammatory and it also relieves pain.
  • Rule of Thumb: Ice for the first 72 hours and then use moist heat after, but icing after exercise and therapy is always a good idea.
  • Some dogs are not crazy about the cold on their skin, so I have found that it is best to place a towel or face cloth in between the ice and skin.


For the little bit of time that you will be allowing them to walk around (i.e. for elimination purposes)… I BEG OF YOU… Make sure that they are on a very short leash and are walking at a very slow pace. If you find that your dog needs some extra support or that you need greater control, I encourage you to check out the TopDog Support Rx Total Body Harness System. This harness was developed here at TopDog and is a very affordable and effective solution. Click Here for the SupportRx Total Body Harness Video Good luck this week and make sure you come over and check out our incredible Facebook support community. Feel free to share your dog’s story or ask questions. There are hundreds of dog owners just like you who have already been through the surgery and recovery process and are very willing to offer their guidance.


Have a Question or Comment about Week 1: Rehab Instructions: Mindset & Expectations?

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173 thoughts on “Week 1: Rehab Instructions: Mindset & Expectations
  1. Woody says:

    Thank you for all of this valuable information Dr. James!! Good stuff:) Bella is on week one and is being a big baby but we are following instructions and giving her lots of love!

    • Dr. James St.Clair says:

      Awesome woody. The first week is always the hardest. Just make sure that her pain is under control at this point. I often see that many veterinarians do not continue pain medications for long enough. For my patients I start with 2 weeks of pain medications..then I recheck them and often I will continue with this medication for another week after that point but in some cases if the dog is really really doing well we will stop with the meds at 2 weeks.

  2. alex says:

    Is the day after surgery ,and my dog got very needy, she is very social but she wants more and more comfort form me, is this normal? is because the stress of the traumatic surgery? I’m walking her how you recommend, i’m massaging her already, and icing…in the order that you recommended.
    What else I can do to make her feel better! Is killing me to have her on the crate, she never been in only traveling overseas. Thank you for your time and your incredible web!!!!!

    • Dr. James St.Clair says:

      Alex this is totally normal in the first days after surgery. Often it is a mix of pain from surgery and stress from the experience. I would say just make sure you are on the right pain medications, which should include an anti-inflammatory and a pain medication like tramadol. Otherwise a whole lot of love like you are doing and this should pass. good luck. Dr.J

  3. Leslie says:

    My dog Emmett is a three yr old Blue Heeler. He had his surgery Friday. He came home the same day. Emm and I were sent home with NO information. No pamphlet, no directives, nothing. I’m so thankful to have found your website prior to his surgery. Emm goes out to do his business tripod style. However he does put his lame leg down to brace himself for pooping. Is this okay? I have been unable to view your videos with my iPad. I was able to find a few other videos for PROM and massage on YouTube. So far I have been icing him and massaging him all over. I also did flex his ankle a bit but have been hesitant to work his hip or knee. (Although he does lay on it and bend it sitting up). I guess I am asking if there is anything I am doing wrong, or if there is something more I could be doing for him.

    • Dr. James St.Clair says:

      Leslie from the sound of things you are doing fine. It is very common for them to lay on the “bad” leg…they do this as a protective measure. As for the videos…we are looking into why some people have problems viewing on the iPad. You can find all of the videos on you tube if you simply search for topdoghealth inside of you tube. Don’t be scared to do the PROM but if he is weight bearing on the leg consistently while walking then you can skip the PROM exercises if you don’t feel comfortable with it. Make sure if you feel like the information we provided is valuable to you and your dog please share it with the veterinarian who did the surgery. This information is all free for everyone whose dog is going through major ortho surgery. Good luck and just stay consistent increasing the activity level slowly day after day.

      • Leslie says:

        Dr. St. Clair, I will definitely share your site with Emmett’s doctors. Emm is feeling stronger with each day. He keeps trying to pull on the lead and is getting quite restless in his kennel. So I have been taking him on more walks for shorter time to break up his day. He also has been trying to kick dirt after his potty breaks. Today we tried the bicycling exercise for the first time and I noticed a click in his knee. He let me do this for a few times but then looked at me as though to stay “that’s enough’” Is the clicking normal? He’s only five days out of surgery.

        • Dr. James St.Clair says:

          Leslie the short answer to this is yes and no. They big question is whether the clicking is related to any associated limping when you are out walking. I know you mentioned that it was when you were doing the passive range of motion but try listening during a walk. If there is no limping associated with this then I would just give this some time and of course discuss this with your veterinarian. All the best, Dr.J

  4. Kelia says:

    Need week 2 rehab instructions please


    Hello – my Dog – 130lb Rotweiller had surgery Aug 6th – one week ago. Should I be on week one or week 2 for his Rehab? If I should be on week 2 – could you send me week 2 Rehab instructions – so I can keep on track?
    Thank you so much – your guide and instuctions have been awesome! Rocky is doing well and seems to be on track to what you are saying I should expect! (oh and I was the very nervous owner!) thanks again. Paula

    • Dr. James St.Clair says:

      Paula I am a bit late for your immediate question. The big picture is that FULL RECOVERY is going to take a good 6 months. Make sure you visit and watch the videos that I have in our online rehab center http://www.topdoghealth.com/rehabcenter. There is a video on measure muscle that is very important. Glad Rocky is healing well. Dr.J

  6. sally says:

    Rex is home. he is doing so well. the other dog (pugs) is not bothering him. Rex is eating and drinking and eliminating. i have a large yard with a large dog pillow bed that they use outside. Rex was tired after eli inating and just gently walked to the pillow and laid down.
    question: i notice that he seems to begin panting with mouth open and closed just when he is resting, is this due to pain? also notice he is very thirsty, is that normal?

    • Dr. James St.Clair says:

      Sally this can be pain or a sign of anxiety. I would call your veterinarian to just discuss this with them and see if they can tweak his pain meds first or then need to run a quick chemistry to make sure his kidneys are doing ok.

  7. Annette says:

    Have a 18 month Cavalier KC that has both back knee caps floating. Luxating Patella. Oscar has had surgery on his left back knee but only to pin the knee cap in place. It was unsuccessful. I cant help but blame myself for his recovery and it failing. He has to have further surgery on the same knee to do the full surgery by cutting the cartlidge attached to the bone make the groove deeper then put it back together. Both knees were grade three. The left is a grade 1 after the last surgery. I am really anxious about recovery the second surgery and then surgery on the right knee. I have received your emails on recovery for ACL, should I follow the same recovery instructions?

    • Dr. James St.Clair says:

      Annette, the guidelines for recovery for MPL surgery are the same. It is all about conservative management after surgery…allowing the body to heal properly and then implementing the right strengthening exercises into your daily routine after the surgery. I would just focus on one knee at a time and you should be totally fine. He has is whole life ahead of him and overall the surgery to correct these is very successful.

  8. sally says:

    my dog Rex is going in to have 2 sugeries; FHO on left hip and MPL on right knee. he was hit by a car b4 i rescued him. ive read everything u have on both surgeries, however the hip is one that need movement during recovery and the knee is more slow and controlled recovery. do i just follow the slow and controlled for both? should i do more hands-on movement whith the hip during massage time?
    im very worried about activity level since he is so hyper (boxer/red healer) . i also have another dog, smaller and when Rex gets his surgery (aug 1st) the other dog will want to play. ive set up a gated area in bedroom, what else can i do for the other dog? feeling overwhelmed already and not even had the surgery yet.

    • Dr. James St.Clair says:

      Sally I think anyone dealing with this your plate would naturally be overwhelmed. As for Rex, yes I would have a tendency to take the conservative route with recovery and focus more on slow/controlled and time. I am constantly telling people that full recovery takes 6 months and it is better to be conservative over time then aggressive. Allow the body to heal itself and adjust over time. No doubt dealing with both dogs is going to be a challenge which is only going to be more difficult come 4-8 weeks out of surgery. I think initially keeping them isolate is going to be critical and you are going to have to just give each dog “Their time” with you. It is going to be hard but you can do this, I am sure. Good luck. :) Dr.J

  9. Lisa Loudon says:

    Dear Dr StClair-my peekaboo had ACL surgery last june-she has now had the right ACL surgically repaired today-it’s been a tough-heartbreaking long road. I did everything I was told to do and she still ruptured her other stifle. Do we have bad luck or is this common? I’m over come with fear,dread and greif for my poor girl? She was finally after one year getting around beautifully with no metacam or limping then POW! also her liver enzymes are elevated. Is this from metacam? or any steroid? Thanks-Lisa-heartbroken

    • Dr. James St.Clair says:

      Lisa the first thing I would say is yes this can still happen even for those who do everything right after the first surgery. The problem is there is no way of knowing if there was partial damage to the other ACL that has been going on for a long time. Many times dog injury both at the same time but one is worse than the other so the focus is on the worst side. Yes the elevate liver values can be related to the non-steriodal use, but once you stop with this medication the number should improve quickly. That being said you can always discuss with your doctor the use of SAM-E (A liver health anti-oxidant) to help the liver cleanse. My question to you would be after the first surgery did you provide your dog with a comprehensive joint health supplement and if so which one had you been using? In my world this is critical for life time use after a joint injury such as an ACL tear. Looking forward to your response.

  10. Lois Hansen says:

    Dr. StClair,
    Thank you for this wealth of information.Our 4yo Great Dane was diagnosed physically by our Vet.Then another Vet (sitter) also looked at her and agreed there was a issue.Then we took her to a specialist who took xrays and agreed that both legs had ACL problems.My problem is that after giving her 2 wks of anti-inflammatory pills and rest, she appears fine. She has never been in physical pain, but had a slight limp on/off for a few months.Plus she didn’t put weight on the left leg 2 wks ago but now does.My concern is that we are being too aggressive and should postpone such a serious operation.I would really appreciate your input.My husband and I looked at the DVD of her xrays and didn’t see anything.Of course we don’t have an experienced eye. Thank You, Mrs. Lois Hansen

    • Dr. James St.Clair says:

      Lois…from the sounds of it your dog has bilateral (both sides) partial ACL tears. The best course of action is to have this knees evaluated by an expert with her under sedation…..I will tell you this…all partial tears will eventually become full tears. That being said in some smaller dogs we have rehabbed them with partial tears and the dogs have not gone on to fully tear the ACL ligament…of course that was with aggressive physical therapy and promotion of scar tissue development. If your dog has partial tears, depending on the degree, often surgery is no doubt the best option. As for you seeing anything on the X-ray…you won’t. The ACL ligament is a soft tissue structure and you can not see this on an X-ray. All that being said..moving forward surgery or not…it would be a good idea to get her started on a really good joint support supplement moving forward in her life. Hope this helps and if you have any further questions please ask.

      • Lois Hansen says:

        Dr. St.Clair,
        Thank you for your response.She has been on an excellent joint supplement all her life. However, I was very impressed with Glycandaid and will probably purchase when mine run out.
        We found out that she definitely has fully torn both legs and will have the first surgery this month.I will reread/rewatch all your info prior to the second surgery in the future. Thank you so very much for all this wonderful information.

        • Dr. James St.Clair says:

          Lois you are very welcome and good luck with everything. If you need us just ask.

  11. Heidi says:

    Hello. My choc. lab just had TTA surgery yesterday. We are doing the cold therapy on her leg but how often are we suppose to do it? ( I see it says for the 1st 72 hrs) , but is it 3x a day , every few hrs? thanks for your help.

    • Dr. James St.Clair says:

      Heidi…when it comes to icing post-op I would have to say the more the better. It is common for people who have a similar surgery or total knee replacement to be on consistent cooling devices for the first 72 hrs. If you can do the icing every few hours that would be great. Cold therapy is by far the best anti-inflammatory and pain medication that is naturally available.

  12. Lali says:

    Dr.J. We are having tplo on July 7. Im little confuse about when is to do icing and when to start moist heat. My dog will spend 2-3 nights at the hospital after surgery. Thank you

    • Dr. James St.Clair says:

      Lali that is a great question..it really all depends on how much icing they do immediately after the surgery and the few day post op. I would discuss this with your veterinary team. Icing is best for 72 hours post-op and immediately following any therapy when inflammation is going to be induced. If you are doing aggressive therapy and you feel the joint and it is hot or painful then you would use cold therapy in this immediate situation.

      • Lali says:

        Hello again, Dr.J. Ok, Eva (my weim) just out from tplo surgery. The doc said that beside AcL she also torn her miniscus as well and there are signs of early arthrutis. I already got the supplements from web( the one you recomend. So , at this point how worry we should be about her recovery? And is Rovera 75 mg is good to keep her confy and pain free or I should ask for different meds? Thank you for helping us, Lali

        • Dr. James St.Clair says:

          Lali, Rovera is fine. This is just another generic of the original Rimadyl which is a great twice a day anti-inflammatory. By now Eva should be doing better now that the initial pain of surgery is less. Just continue to be conservative with the recovery and follow the guidelines that I laid out and all should be well.

  13. Cindy Walker says:

    My dog Abby had MPL surgery on her right rear leg on Tues, June 24. Abby is a four year old yorkie/bichon. The Vet has her in a cast for two weeks with weekly check ups. Cast should stay dry and Abby confined to crate except for potty breaks.

    My question is how do I apply the week 1 instructions? Should I start after the cast comes off? We have been giving her massages but leaving her leg alone.

    Thanks for your help!

    • Dr. James St.Clair says:

      Cindy great question. Depending on the situation if your dog is in a cast for a period of time after surgery then you can’t really start many of the first weeks for therapy…that being said once the cast comes off that is when you should start week one…the only thing that is different is that you would not use the cold therapy..you could move straight to the moist heat therapy…but everything else would stay the same. Good luck.

  14. Dawn McCaskill says:

    I am having problems getting the videos on my iPad. Are they not compatible with apple products?

    • Dr. James St.Clair says:

      Dawn, these videos are all hosted on you tube and therefore should not have a problem playing on an iPad. If you can not get them on the website you can simply go to you tube and search for topdoghealth and find them there. Hope this helps.

  15. Elisa says:

    Hi Dr James
    My cocker spaniel had her second FHO last Tuesday. The first time around, it was easy to keep her calm but this time she is very excitable,pulling on the lead when I take her out and trying to bounce. I am pleased that she does not seem to be in much pain (she is not on any pain killers or anti-inflammatories on her vet’s advice) but I am stressing that she will hurt herself or ruin her stitches. Any advice welcome.
    Cheers Elisa

    • Dr. James St.Clair says:

      Elisa, honestly that is amazing. Wow..she is one tough girl. She must be to happy to get rid of those bad hips. In the old days these dogs after FHO surgery really had no restrictions. Veterinarians wanted them to run out of the gate. For the last 10 years I have promoted a much different approach which is conservative in nature. The reason for this is that I want recovery to be safe and consistent over time. I am always try to avoid any compensation injuries. Your best bet of course is to keep her on a leash so that you do have more control. From the sounds of it she wants more exercise therefore I would suggest giving it to her but make sure it is controlled.

      • Elisa says:

        Thanks. I guess she just has a high pain threshold. I’ll keep being bad cop and keep her under control!

  16. Pamela says:

    Just about all of these questions and recommendations are for LARGE dog. I have a 6 lb. Yorkie who just had surgery for luxation of left patella. I understood it is mostly the smaller breeds experiencing this poor genetic bone formation. I don’t see you so much addressing the itty bitty dogs.

    • Dr. James St.Clair says:

      Pamela that is simply because in general far more larger dogs have orthopedic surgery than these smaller dogs. Not all patellar luxations require surgery. I did and ACL yesterday on a 6 lb yorkie but in general we do not see a lot of these.

  17. CHERYL says:

    sorry he had TTA

Watch and see the amazing results!