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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?

To ask a question or leave a comment for TopDog veterinarian, Dr. James StClair, simply enter your name, email below. (Your email will never be shared or publised)


154 thoughts on “Week 1: Rehab Instructions: Mindset & Expectations
  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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!

  8. 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.

  9. CHERYL says:

    sorry he had TTA

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