In Week 3, we discuss the importance of physical compensation. You now are a personal trainer for your dog. We also show you how to do Sit-to-Stand exercise with your dog. If you haven’t done so yet, we would recommend joining our Facebook Group. It is a great place to interact with other dog owners who are going through the same.

Physical Compensation

It is important to understand that because your dog has not been fully using their surgically-repaired leg for some time, they are having to compensate in other areas of their body in order to function. The rule of thumb is that a dog carries 60% of their weight on the front legs and 40% on their back legs. Therefore, if your dog is only just toe-touching on one hind leg, then all of the weight it should be carrying is being displaced elsewhere. Some weight goes onto the front legs and some goes to the other hind leg. A lot of compensation is also absorbed by the spine.

This is why establishing a comprehensive total body approach to your therapy is one of the keys to success. Remember: The goal is to heal the “bad” leg and prevent injury to all the “good” legs.

Be a Personal Trainer

You really need to think of yourself as a personal trainer to your dog. What exactly do I mean by this?

A personal trainer:

  1. Has a plan
  2. Guides you
  3. Pushes you when you don’t want to push forward
  4. Has expectations
  5. Knows what is best for you and how to accomplish your goals.

The same holds true for you and your dog. Just stop and think about it.

Sit-to-Stand Exercise = SQUATS

If understood and used properly, this exercise can be your most powerful exercise to rebuilding muscle in that hind leg and improve the overall range of motion in your dog’s joints. Again, it goes back to you acting as a personal trainer. Compare this exercise to doing squats and lunges in the gym. The key is that you need to perfect your “form.” If you don’t have good form, the exercise is not nearly as effective. With that being said, it is going to take you time to accomplish “good form”. “Good form” is when your dog is sitting square, not shifted to one side. The key is to perfecting Half Sits if you will. This is when you do not allow your dog to sit all way down. You tell them to sit and then quickly tell them to stand.

Don’t get frustrated if this takes some time to master.


Suggested Readings


  1. Cindy thanks for your kind words. What I can tell you from experience is that Adequan is a great product, I used to be one of the largest prescribers in the state of CT until we developed our own joint supplement called GlycanAid-HA Advanced. The reason we did this was because I personally saw greater value in providing a daily oral joint supplement then a maintenance once a month injection with Adequan. Again this is my personal option. From the research my understanding of Adequan was that it got into the joint within 24 hours and then only stayed there for around 72 hours. For me I felt is was critical that we are making this optimal joint health ingredients available every day. That said, Adequan is still very popular with many veterinarians What oral joint supplement have you been using? What I think is critical is the origen of the ingredients and the quality. Looking forward to your response. Dr.J

  2. Hi Dr. StClair,
    Your website is SO helpful. Thank you for what you do! My Lhasa Apso had TTA surgery October 1st. She’s recovering well and is going to a local vet rehab place. My question is this…are Adequan injections necessary for her recovery? I’m very squeamish with needles so I declined the injections knowing I wouldn’t be able to give them at home. She is on a joint supplement.

  3. Sandy I think I am missing something here. How are you keeping her on the leash yet you have the dog dog open and she can freely go in and out. By now her bone should be well healed so your risk is definitely minimal, my only concern is the other hind leg and injuring that one. As for your other dog and week 3…heck no to the dog door. For me this is an accident waiting to happen.

  4. Christine in a traditional FHO the post-op restrictions in the past have been minimal, most vets used to tell people to let their dog do what every that want. My approach was more structured and conservative in the hopes of preventing compensation injuries. I can totally understand how she is becoming for frustrated with confinement now that the pain of surgery is gone and she is starting to improve. My suggestion would be to discuss this with your vet and ask them why at this point you need to have strict confinement. If they are ok with our guidelines then I would get out there and start to conservatively exercise more with her, as long as you have her on a leash and she is controlled, but you need to get the ok from your vet.

  5. Cozette , only toe touching 4 weeks post-op for me is not good enough. For my patients I continue with pain management for quite a long time, at least until they are using the leg well on a regular basis only because I don’t want pain to be a part of the equation of them not using the leg..and since dogs don’t CRY or really tell us when they are in pain, I always defer to using pain meds if they are tolerated. My recommendation would be to go back to your veterinarian and see if they will prescribe you more pain meds and test you dog out…meaning. Does the dog do better and use the leg more when they are on the pain meds. I call this a pain trial. If they don’t then you can discontinue the pain med. My other recommendation would be if possible to locate and utilize a canine rehab facility in your area. On our website you can find a directory that list all the current facilities in the USA. Hope this helps and give me and update.

  6. Lourdes I apologize for the delay in my response. My personal and professional life for the last 6 weeks has been out of control and just now I am finally getting a chance to sit down and focus. That said, your situation is difficult and at the same time extremely typical. All doctors seem to have their own “way” of doing things ie. they do what has work well for them in the past. Some are extremely conservative and others are more aggressive. My BEST advice is to find a local canine rehab facility in your area and seek their advice. These rehab professionals are invaluable. We have a very extensive directory on our website that list all of the facilities across the country. From my stand point conservative but rational PT early their later post-op is critical for so many reasons. At minimum doing slow controlled leash walking, massage and stretching is harmless and yet the benefits can be tremendous. At the end of the day, since I am unable to evaluate your dog and have a patient/doctor relationship you have to follow along with your surgeons guidelines, that is way I think it would be best for you to at least have an evaluation with a certified canine rehab specialist. Best of luck.

  7. Hi Dr. J, I have sent three emails now and have not received a response??? Here are my latest questions. It will be 4 weeks since my French Mastiffs TPLO surgery this Thursday August 20th. Her vet who I believe is more old school but a good vet has told me to continue to keep her confined and I have. I have started the previous week the heat therapy and PROM. He just told ne to start that last week but does not want her walking much. He said since she is a large dog he wants the bone to heal first. I am concerned since he is 69 he may think “old school” and not as aggressive as younger vets. What are you thoughts and recommendations at this point ? She is toe touching but not putting alot of weight on the leg yet. What excercises should I be doing at this point. I did do the sit/up last week but my vet recomended not yet. Thoughts ? Please make sure you have 1 l in the word philips for my email address. Thanks, Lourdes.

  8. Our vizsla (1 yr 4mo old) is 4 wks post op FHO. She is still limping and toe,touching. When excited (like going to kennel for her treat) she trots on 3 legs with bad leg fully raised. She gets 2 10-15 min walks aday and some evening time to,roam around the house. How often should she be practicing sit stand? (Reps etc) she’s been off pain meds for almost p2 wks.

  9. Our young Bella has had to have the FHO surgery due to a break. The femor was broke in two places at the head and neck ares resulting in two surgeries and them having to remove more bone than normal. I was told in no uncertain terms that it was 8 WEEKS of strict confinement. She is just over a year old and coming to the end of week three she is doing very well. Muscle growth is coming along, sit to stand exercises are doing as well as to be expected considering she is not at all interested in sitting and staying anywhere. The vet told us at the last check up that she is doing VERY well. She is using the leg and her spirits are high. Except when she is in confinement. She is growing more and more restless and I am concerned that she is going to damage or hurt whatever is going on in there. Spinning around in her kennel repeatedly in my mind could result in the twisting that we are trying to avoid. What do I do?

  10. Today marks 12 weeks post t.p.l.o for my dog. I am stll keeping her on.leash when outside our fenced yard where we have trails in the woods and enticing wildlife. She doesnt have a reduced speed without the leash! My concern is her use of the dog door in and out of the house. I havent seen this issue addressed. She often exits quickly.Also regarding use of.the dog door,is it advised for my other dog just into week 3 to have access to the dog door when supervised?

  11. Catherine as long as your going up and down the stairs is slow you are fine to allow her to do this at this point….so you are good there. As for the incorrect posture, this is something that is going to take some time to work through. My best results have been by focusing on what I call the quick puppy squats. In this situation it really helps to have a dog who is treat/food focused only because they are much more responsive to quick commands because they want that treat bad. In the online rehab center on we have a video that discusses this topic. Essentially when you ask your dog to sit you do not allow them the time to get all the way into the sit position….you need to interrupt them quickly as they are beginning to sit and then take a few steps backward and ask them to come to you. This can be a bit tricky and requires you to be fast and on top of things. Don’t expect perfections right off the bat though

  12. Diane being that you are now 5 weeks out if things are the same I would definitely have him checked out be the surgeon. That said all dogs heal and recovery different and your guy would not be the first to recovery a little slower than most. The variables are endless. That said, if the surgeon says all is well I would make sure, if he were my dog, that I had him on a stellar joint supplement and I would probably continue with pain management (ie. NSAIDs and tramadol) for a few more weeks and continue to push forward with therapy. The right joint supplement would no doubt help him tremendously in creating and optimal joint environment.

  13. Hi…My 5 year old pit bull had TPLO done on May 11 – three weeks ago. He just doesn’t seem to be progressing very quickly and I hope that it’s still in the normal range. My main concern is that after he’s inactive for a period of time, his leg stiffens up so bad that he doesn’t want to put hardly any weight on it. With a little activity, he is able to use the leg better but this doesn’t seem to be improving with time. I think his walks are contributing to his soreness…on the days we walk a little more, he seems to get sorer. By more, I only mean about 10-15 minutes per walk 2x a day. Should I be concerned?

  14. Hello Dr. James,
    My 5 yr old lab Sophie had a TTA two weeks ago. Her recovery seems to be on track. Your information and videos are a great help! I have 4 stairs coming into my home that I have been avoiding since surgery (I lift her completely up and down using a harness). At which point should I allow her to try to walk up and down them herself with my assistance? Also, Sophie’s sit has been off to one side since I brought her home as a puppy. How do I correct so her weight is balanced and her recovery sit/squat is effective?

  15. Jane you are totally fine so far…..Even with the TPLO I always tell people that it is still a 6 month total recovery if we are protecting the other knee in the process. Second…if you have not already done so…make sure that you are giving him a really good daily joint supplement that promotes optimal internal joint health and comfort. There are only a few products on the market which I think are adequate and of course our GlycanAid HA is one of them but I can guide you to other options if you like.

  16. Sam, yes it is totally fine to provide this more expanded access as long as he is not acting wild and jumping on things.

  17. Sam I would have a tendency to start with week 2 and move forward. It never hurts to be more conservative…because people run into more problems when they are more aggressive. Good luck. Dr.J

  18. Laurie, somehow I missed your post here. Very sorry. The watery bloody discharge is called serosangious discharge and is normal. The “knee out” is usually a positional indication that the knee is bothering her. Over time this will correct but since you already had a set-back I would have a tendency to move forward conservatively. You will always here me tell people that FULL recovery takes a good 6 months…keep your eye on this mark and this mark only. From your description I would start at about week 3 and then slowly move forward. Make sure you have her on a comprehensive joint supplement moving forward…it is so critical in my mind.

  19. My australian shepherd had tplo surgery for a fully torn acl and meniscus 3 weeks ago. He is now putting weight on the leg but does still limp…is this ok? He is just starting to do sit and ups. Is this limp ok? Also, when he just standing he keeps the leg in the air, otherwise he uses it almost exclusively now. We are up to a 15 minute walk. Thank you, this site is a god send.

  20. Hi Dr Sinclair, please can I ask another question!… Your book says that after FHO it is extremely important to keep my dog confined when not doing the exercises. I am keeping him confined to one room. At what point would you usually say it’s ok to let him have access to the whole lower floor of the house? ( I know he won’t be jumping or doing stairs for a while! But at week 3 is it ok for him to roam around when he wants to?) thank you for all the information you have on your website by the way. My vet has even asked for top dog details as he was so impressed with the week by week FHO guide!

  21. Week 3- due to insicion not healing, my dog is now in week 3 but has been in the clinic since the surgery, his stitches only came out today,he is only just home today…should I still begin sit to stand exercises or wait?

  22. Marie, pain very much can be a part of they equation. First think I think you want to do is have your veternarian run some simple bloodwork on your dog to make sure that there is not something else causing the inappetance. From there I would probably have your dogs hip re-xrayed simply because in some young dogs who are still growing they can form a BONE SPUR which can be very painful and no matter what you do they will not use the leg. Once these two things are checked off then you can move forward. For my patients I tell my clients to go ahead and feed their dog anything they will eat, in most cases they are cooking for their dogs chicken, rice or sweat potatoes. This makes me sad for her but you can get through this for sure.

  23. Marie this is a great question and the reality is that it is widely variable. Some surgeons only prescribe pain meds for the first week. Others like me continue that patient on pain medications until the dog is using the leg near 100%. I never want pain to be a part of the equation or inhibit the dog from improving. That said it would be best to discuss this with your veterinarian. If you think your dog would benefit from a longer pain management protocol then simply ask them.

  24. Diane in situations like this you pull way back to week one and just rest, ice, rest, ice. Give it five day of strict rest and then start to rebuild exercise level and evaluate. If the limp is still there then I would have her checked out. I am sure all will be well.

  25. Hi, my 8 year old lab had TTA surgery April 6 but at 2 weeks had a setback when her leg swelled up and started leaking watery blood. Since finishing prednisone and still taking Cipro she is now back to taking 2 15 minute walks a day. But she “knees out” when putting the foot down. Will that correct once her leg gains strength? X-rays show all hardware in place. Also, how many weeks behind am I? Thank you.

  26. We’ve got a little 8 mth old Chihuahua who just had FHO surgery on one leg (4 weeks ago now). We are having A LOT of trouble getting her to use the leg. She toe touches and uses it very slightly on occasion when she gets excited by another dog. She has no appetite, so we have no luck with treats. She fully compensates on sit to stand and ball bouncing, and slow walking. No luck with distraction techniques (scrunchy on the other foot), or swimming, or contralateral leg raising techniques, or the underwater treadmill. We are SO frustrated! Right now we have a pup that won’t walk on 4 legs or eat. We are headed to our 3rd rehab specialist on Monday. We have been using your videos and guide as much as we can and are very thankful or them. Any advice you have would be appreciated.

  27. Buca, 3 year old Rotti, just had acl surgery and is on week three. She has had a setback, tweeked her knee a bit going down a ramp. She is limping and doesn’t want to use her leg indoors but will on her daily walks. There is no swelling and no other indications of a failure of the surgery. I’m sick over this as I can’t afford another surgery or even doctor’s appointment at this time. I have her back on the tramadol as well as continuing with Rimadyl to ease any pain she has. Any suggestions as to how to proceed? Do I keep up with week three or go back to week 2 again?

  28. Linda I would keep the time low and allow her to tell you when she has had enough, whether it is 5 minutes or 20…she will tell you.

  29. Nick no doubt this is one of the more difficult bilateral surgeries to recover from. They key for me is good consistent long term pain management and then just simply work on building those primary hind leg muscles that support the hip joint. This is where the sit to stand exercises and the hill walking really come into play…but again pain management is key…Dont cut her short only after two weeks.
    Tasmania is pretty cool. Got to love our global reach and our ability to help even dogs like samantha on the other side of the world.

    All the best, Dr.J

  30. Hi There, my husky who is two years ruptured both Acl’s. The left leg was repaired 2 weeks ago but the right will be done in 6 weeks. How much time should she be walking on both sore legs?

  31. Hi. Samantha is a 14 month old kelpie cross something. She has just finished 2 weeks post op. She had a bilateral FHO. Are there any different procedures to rehabilitate both legs? she’s walking/staggering quite well, but not really using the legs properly (No surprise, really!)
    Regards from Tasmamia

  32. Laura that is a great question and in all the years I have been doing this, you are the first to ask this. My answer would be it all depends on how he is doing. If he is really doing well and not limping after the 20 minute “leisure stroll” then increase the totally amount of time that you are spending. The purpose is to know what you baseline is (ie. how long before you can see then they are tired or slightly limpy) and then work up from there over time. Hope you are both doing well at this point. All the best, Dr.J

  33. My dog is entering his third week after TTA surgery. He has been putting weight on his leg since day one when we take our slow controlled walks. My question concerns the walks: what exactly does a 15-20 minute walk mean? When we walk he sniffs, and eats grass, and stops and listens, etc. We may spend 20 minutes outside, yet barely walk 1/4 mile. What exactly are we aiming for?
    Thanks for your help!

  34. Angela, thank for your kind words. I am just grateful that I can hopefully help you guys. As for this recent episode here is what I recommend my clients to do with similar situations. When something “happens” during the recovery process and you have a “set back” like this…I move to strict rest, rest, rest and NSAIDs for 3-5 days. If the dog is not getting better or at least close in function prior to this setback then I would have a tendency to want see the dog for an evaluation. Its tough because it really is a due edge sword…you don’t want to over react and your don’t want to under-react. That said I would also consider broadening your joint support with more than just chondroitin. As for the omega3’s according to Dr Bauers report a few years ago you would have to be giving 100mg/kg of EPA to positively effect the joints…just be sure to check you dosing. Hope all returns to normal soon.

  35. Hi Dr. James! First of all, thank you so much for your web-site and all the help it offers. It has been a difficult 2 weeks for my German Shepherd, Tymon (male, 95 pounds) and me! He had TPLO surgery 2 weeks ago Saturday, so we are starting our third week. I have been following your suggestions both on website, emails, and additional book. He seemed to be doing fine and not limping anymore-of course, not putting full pressure on leg, but doing well. We had our first visit to the vet Saturday at the two week mark and he was crazy in the car (typical). I sat with him in the back of our SUV with limited space to keep him as still as I could but he was all over the place. Yesterday, he started limping more pronounced. It was a big day for him-we can not really walk him that much because here on the north shore of Long Island, EVERYWHERE is covered with ice and snow. I am on a steep hill and I can’t even walk down to my mailbox without slipping. So, I am just walking him out to a small area that I struggle to keep ice/snow free to take care of business. I am just concerned that he is limping more than he was before our vet visit. The Vet said he was healing great and looked fine, but he didn’t see this new limping. I did tell the vet that once and a while he will jump up on back legs and he said that was alright. I’m not allowing that, but it’s hard to control a bored 95 pound shepherd. I seem more concerned about that than the vet. Do you think the new limping is a problem? I am massaging it and putting heat. It is not red/swollen. He does not seem to be in pain when I touch it. He is on anti-inflammatories, omega 3’s and chondroitin. Thanks! Angela :)

  36. Brian, first off please thank your veterinarian for being progressive and recommending our resources. This is obviously a good veterinarian who cares about helping you both through the process and focused on long term success. I would love to know who they are. As for where to start I would at this point start at week 2. The first week is focused on icing and decreasing the inflammation resulting from surgery. Week two really starts the healing/recovery process. Best of luck with everything and keep me informed. All the best, Dr.J

  37. Hi Dr James. I’ve been following your guidance and things have been going great. My Rosie is 4 weeks post op now. She not only had TPLO on her right knee, but MPL surgery at the same time, same leg. The inicision on outside looks wonderful, hair growing over it. Her incision where the plate is looks so lumpy to me and I can definitely feel the plate and screws. Is that normal? In addition, last night I noticed it has turned red which it wasn’t before. I felt it and it doesn’t feel warm and the incision is closed, no seeping or anything. Rosie doesn’t seem to be bothered by it and is putting weight on it, doing great with puppy swats, her 15 minutes walks, etc. Am I doing too much? Is this a normal part of healing?

  38. Good morning,

    My 7 year dog is 2 weeks post TPLO surgery and is going today to get his stitches removed. He seems to be doing well, and is not limping and does not seem to be in pain. He lifts his non surgery leg to go to the bathroom about 50% of the time. The other half he lifts his surgery leg. Our Vet had recommended your website for the the PT excercises and i thank you for all this information. The only thing was that our Vet had stressed strict rest for our dog for the first 2 weeks home besides the 5 minute bathroom walks. He told us to wait to start the PT until the sutures were removed. my question is should i start with the week 1 PT excercises or go to the week 3 excercises. any insight would be appreciated. Thank you so much, brian

  39. Eva thanks for reaching out and I am thrilled that we are able to help. No doubt I wish that I could get GlycanAid HA to your doorstep. Australian regulations makes it extremely difficult to due so. Since we have some many Aussie’s that utilize our information and other products it is still a goal of ours to get GlycanAidHA into the country. That said for now I think Cartrophen is a great option for Uli. Hope you are well and thanks again for reaching out.

  40. Hi Dr James St.Clair,
    my 7 year old staffie Uli had TTA, starting week 3 post surgery. We are finishing second bottle of Meloxicam. I wanted to put him on GlycanAid -HA supplement, but due to some regulations you can’t mail it to Australia. So Uli is getting Cartrophen injections ( weekly, 4 together). I didn’nt decide yet what next. Total body harness system is so useful, especially when Uli’s weight is 27kg. Excellent website, thank you so much

  41. June I will have my staff check this link. You can also go to you tube and search for topdoghealth and find all of the videos there. Thanks for the heads-up. All the best, Dr.J

  42. I love the fact that you found us all the way down in Brazil. Thank god for the internet. We are so fortunate. Best of luck with the recovery and if you need us we are here. Dr.J

  43. Deb there is no doubt that I wish it was easier to distribute to Australia but customs is tight there. The Royal Canin food should help. Just keep pushing forward with a consistent conservative approach and I am confident that you will find success.

  44. Linda this is a bit shocking to me. Did they put him on any pain medication after that visit? In my patients if I have a set back like this I always put them back on an anti-inflammatory and pain med for 5-7 days with strict rest. If they are not back to where they were prior to the set-back then I do further investigation. If the surgery was the lateral suture repair then I focus on trying to isolate pain around the lateral fabellar bone, where the surgery was anchored to. Often you can just put pressure on this bone and the dog will react. In these cases if the surgery dated back to July, I will often suggest removing the implanted suture from surgery. If there is no pain there then I may also recommend to my clients to do a joint tap to just make sure there is no infection in the joint. As for the rehab you have to start back at week 1-2 and simply focus on your slow controlled leash walking. Its back to baby steps.

    Hope this helps and keep me up to date on the progress. All the best, Dr.J

  45. Dr James

    I would like to tell you that we are Brasilians and live in the South of Brazil After my Pituca Mikaele TTA surgery , I was so stressed that I searched in the internet informations about recovery and we were so luck and blessed that we found you. Thank you so much!

  46. Congratulations, Dr James!!! You are helping my dog so much!! She is on week 4 . She is doing pretty well and so I am.
    Thank you so much!!!!

  47. Thank you so much for your response – Morley responds well to food treats so the half sits should work well. I would love to get your GlycanAid, but I live in Australia and I believe you can’t ship it here? My vet has recommended (and he has been on it for approximately 2 months) that we feed him the Royal Canin Mobility Large Breed, which supposedly has all the things he needs.. Anything you can suggest we use to help him would be much appreciated.
    We did have him on something called ‘Glyde’ powder for awhile previous to RC but I didn’t really notice any improvement

  48. My 6 yr old lab had acl surgery in July. Rehab was progressing along nicely until about 2-3 weeks ago. He suddenly stopped using the leg entirely. Had vet and surgeon relook a few days ago. Said that the were able to totally manipulate the leg with no apparent pain to dog and he just needs more time to heel. What level of rehab should we return to since he won’t put the leg down at all?

  49. In this case Yvette I would advice you to contact the surgeon who performed the surgery. That being said I think it would also be a benefit to get back on to some pain medications for a week trial and “see” if there is an improvement with pain medication.

  50. Deb in a situation like this I would then leave this exercise out. Remember that FULL recovery is baby step and it this exercise is creating more discomfort than benefit then I would not push through. That being said you can also alter the exercise to what I call half sits or quarter sits. This usually only works well with dogs who are very food or treat oriented. What you do is ask then to sit but just as they are starting to posture to sit then you take a step back and ask then to quickly come to you. What this does is activate all the muscle groups involved in the sitting process but you interrupt the process. Essentially this are micro-squats. Over time as you build muscle to support those hips you can get them to sit farther and farther down. In addition if you have not already done so I would strongly encourage you to start your dog on our joint supplement GlycanAid HA on the loading dose for the first 30 days. This will ensure the optimal nutrients for the joint on a natural level instead of just masking the pain and joint discomfort with the anti-inflammatory and pain meds. Of course you need to continue with this medications that your doctor prescribed but this would be one additional benefit. Best of luck. Dr.J

  51. Hello, my dog Sophie just had the new TTA Crown surgery 3 weeks ago. She was doing great and now she seems to be holding her leg up in the house but walking on it outside. I am hoping that she did not tweak the screw that was placed in her knee. have you heard of this new surgery for torn Acl. I had dogs that had Knee Sugery in the past but so far this procedure was less stressful on her and us until this week where she appears lame. Any advise?

  52. Hi Dr James,
    Firstly, many thanks for your website, it is very reassuring to be able to always check that we are on track!
    Our 4yr old Newfoundland had TPLO surgery on his left hind leg 3 weeks ago, has had sutures out, and appears to be doing well, attempting to use his whole foot to weight bear.
    My question is that he really struggles with the sit stand exercise. He has bad hips, the right one in particular, and needs surgery soon.. He shakes and quivers when attempting to sit, with his nose towards the ceiling and usually wants to lean against a wall or furniture for support. He is on Previcox and Tramadol daily.
    Many thanks

  53. Joanne thanks for the email. First off it is totally common for them to have small set backs along the way. That being said some dogs need to continue with pain management in my opinion for a long period of time. I never try to RUSH my patients off pain meds…if your dog needs pain meds for a full month after surgery in order to feel good and recover then that is totally fine. Obviously in her situation there was a direct correlation between stoping pain meds and the limping. As for the oral antibiotics and the ear infection..usually oral antibiotics alone are not enough to kick an ear infection and you would need topical ear meds. As for the sit-to-stand exercises I would hold off until she stabilizes and is feeling better. Best of luck. Dr.J

  54. Mary Lou with an FHO now 6-8 weeks out he should not still be knuckling the foot over though it is great that he is toe touching. One of the most common things I see, in my personal opinion, is that we don’t continue pain management for long enough with these FHO surgery dogs. My recommendation would be to discuss this with your doctor and ask for a 7-10 day course of pain meds again. I would go with an NSAID and tramadol (3x a day). Do this for a week and tell me if he uses the leg more. If he does then continue with these medications until he is using the leg near 100% of the time and doing really well.

  55. Dr. James,
    My dog Layla (11 year old Shih Tzu) torn ACL and had extra-capsular suture stabilization on October 10th. Three days after surgery she started walking on the leg she had surgery on. On Friday, October 24th she had stitches removed.
    This was also the last day she was given pain/anti-inflammatory medication. From that evening onward I noticed that she started limping occasionally so I took her back for a reassessment this past Tuesday.
    Dr. did not think it was an infection because long enough time has passed since the surgery and said that maybe it is because of scar tissue forming in the joint and causing discomfort.
    He touched the surgery area and said it was a little warm but she did not have a fever and is eating normally. She was given pain medication for a week and antibiotics. I have to take her back in a week (Nov 4th) for reevaluation.
    Dr. James I am a little worried that she started this occasional limping during week 3 after doing great for the first two weeks. Is this common? Should I continue with her doing “sit-stand” exercises or wait until she stops limping?
    I was also told by a friend who is a pet groomer that she has a lot of wax in one of her ears and suggested that I have it checked out since this may be a sign of ear infection.
    Would antibiotics that were prescribed for her knee clear out ear infection as well if this was the case?
    Dr. James the information posted on this website has been very helpful. I found rehabilitation videos very useful as well.
    I also purchased GlycanAid-HA and just received it.
    Thank you so much Dr. James.

  56. Forgot to say that he is still toe touching as well. By reading some of the earlier posts I think I will try going back to the Tramadol.

  57. After many serious hit and run injuries on April 1st of this year we had our last right hip surgery #3 on this hip with a FHO in early September. We have been working at weeks one and two and have started week 3 with the sit stands. He does quite well with this but poops out quickly. 5 minutes is about his max. He still has knuckling over of the foot. Any suggestions. He is at the last week of the load dosage for GlycanAid as well.

  58. Cheryl if he is progressing physically normally outside of that small incision infection set-back then yes I would continue to move forward with his therapy. Otherwise I would say…right back at you..YOU are an awesome mom for doing everything you can to help make Coopers surgery a success. Hope you are both well. Dr.J

  59. Dianne if she is only toe touching still then I would strongly recommend that call veterinarian and ask if you can continue with pain management until she is using the leg more. I assume that when they removed the staples they examined her to make sure the everything was still good? Often times I don’t thing we continue with pain management long enough.

  60. Doreen this is a great question and a very smart thought. The answer to your question about the muscle quivering is that it really could be due to either, pain or muscle fatigue. The problem is how do we know which one, we can’t ask them. Therefore I think it is a great idea to test this out and defer to pain or discomfort as the cause. I absolutely think it is a good idea to give at least an anti-inflammatory prior to physical therapy and I recommend this to all of my client also depending on the surgery and how the dog is doing post-op.

  61. My dog Cooper is 3 weeks post op but had a mild incision site infection – looks great now but still healing – is it okay to start week 3 or should i wait until the incision site is completely – all but 1.5cm to heal fully – there is no leakage or redness and he is putting his foot down on slow controlled walks – thanks for your help this website and YOU are awesome!

  62. I have noticed the last few days that Emma has a little more limp than usual. Staples came out Wednesday 10/15. And she is still doing the toe touching. Is this normal?
    Thank You

  63. Hi Dr. J: question for you. In the TTA operated leg the muscle is quivering quite frequently, particularly after the exercises. Is this a sign that the muscle is weak or is it a sign of pain? Humans are usually given pain medication before physical therapy, should our girl be given pain meds before professional rehab? Thanks so much!!!

  64. Doreen I wish I could answer this question for you specifically but since I don’t have a doctor/patient relationship with your dog I can’t answer this for you. What I will tell you is this..all dogs progress differently. If your dog is tow touching that is better then not using the leg at all, but it does seem to me that now after 13 days they should be bearing a little more weight than that. I would strongly encourage you to give your surgeon a call and just ask them if this is typical for their cases. Also just make sure that your pain management is complete with an anti-inflammatory, a pain medication like tramamdol and of course a really high quality joint supplement for support. Best of luck, Dr.J

  65. Should my rotti still be toe touching 13 days after tt? Is it ok to take her for rides in the car? She is crated.

  66. Anita, I would say that this is totally normal. If the other knee is not completely stable she is going to find ways of sitting or using the leg to protect her comfort. The one thing I would strongly encourage you to do is..if she is not on a really good joint supplement, then please consider topdog product called GlycanAid HA Advanced. This natural supplement will make a huge difference in both the short and long term. Recovery is a slow consistent conservative process. All the best, Dr.J

  67. Anita I would say that as long as the knee is not HOT to the touch and she is using the leg more and more each and every day then I would be happy. As for the Metacam…this is a once a day medication so just make sure with your veterinarian that everything is solid.
    All the best, Dr.J

  68. In week 3 the stand to sit exercise: My dane had her L knee Sx three weeks ago. It was determined that she has quite advanced arthritis for a dog her age. she will require the R knee done as well sooner rather than later. When I get her to do the sit position, she is able to do with her ‘new’ knee but her other affected knee splays out to the side. What are your recommendations for this situation? Thanks!

  69. We just entered Week 4. There is still a considerable amount of fluid in the knee. Is this normal? She is taking Metacam Qday and putting full pressure on the leg.

  70. Heidi, yes this is totally typical. This is way slow controlled leash walking is the key to recovery. And yes you would want to do the PROM on a consistent basis if he is not using the leg regularly in the house. Sounds to me though you are doing a great job.

  71. Hello Dr. James,

    My dog is one month post extra cap surgery. (He was pretty sick the week after his surgery due to an infection, which is why we are on week 3 of the guide. He’s a 68# hound/border collie mix and about 3 1/2 yrs. old.) I’m very thankful for your website, guide & videos! My dog is walking on his foot when we do controlled leash walking on the grass outside — most of the time. Inside the house in his confined rooms, he still rarely puts his foot down on his surgically-repaired leg. Is that normal? Do we continue passive rom exercises until he uses his foot almost all of the time?
    Thank you very much!

  72. Jenn, yes this fluid can be normal and take some time to resolve. The key is to massage for the toes up the leg back towards the core of the body. At this point moist heat would be indicated for sure. Good luck and you are very very welcome. ;) Dr.J

  73. Hello…

    My dog recently had surgery Aug 13 so it’s been a week now. He still has swelling and some fluid I noticed near his ankles from surgery. My friends dog had the same type of fluid and eventually it worked it’s way out. I did notice by massaging the area made the liquid leak out from his incision. At first I thought he had opened his incision and it was bleeding but the fluid was more watery and not so much like blood. I was told by my doctor this is normal and means he is recovering. Is this normal or should I be concerned? I am trying to ice to get the swelling down. Should I continue? I know in week 2 it says heat. Any advise would be helpful.

    Thank you so much!!

  74. Deb, I apologize for being late. For some reason I was unable to log-in and answer questions for a few weeks. I have no problem with swimming because it is a non-concussive exercise the only concern I have is getting in and out of the water safely. If you are swimming from a beach it is best to walk with your dog into the water up to your their knees and then release. Just make sure there is no bounding in and out of the water and you should be fine. Tell me how the GlcyanAid is going when you have a chance. All the best, Dr.J

  75. Hi Dr J ,
    Polo is my 13 y/o white Shepard and had her TPLO on her left knee in 2011 and her rt knee done 3 wks ago she is leash walking short distances and I wondered if were ok to take her swimming?
    I have just started her on GlycanAid again today.

  76. The diarrhea with mucous is a colitis (ie. inflammation of the colon/large intestine). Did they put him on a gastroenteric food? As for which medication is better…they are actually very different. Rimadyl is an anti-inflammatory and therefore relieves discomfort related to inflammation, whereas tramadol is a synthetic opiod and more addresses pain.

  77. I took him bck to surgeon on Saturday . They made him eat dog food out of their hand. I bought 2 cases he won’t et unless I hand feed him. He still likes fruit and yogurt. When I took him to vet that did surgery he lost 10 lbs. they took urine and blood work. I am awaiting results. I started giving him rimadyl again it seems to work with pain but I have only been giving him one steed of one and a half. I am not sure if that or tramadol is better to give. He has diarrheal with mucous in it can’t understand.

  78. Jessica this is horrible and I am worried like you. I would no doubt take him back to the surgeon who did the surgery. 3 weeks out he should be doing better. He should be more comfortable by this point. Everything I would have mentioned you already tried and I worry that he may have an ulcer and that is why he does not want to eat. Generally these are treated with famotidine and Sulcralfate…but you need this to be confirmed. I wish there was more that I could offer but without seeing him and examining him I can’t offer the advice you need. Please keep me up to date with your findings.

  79. My 11 month old german shepherd is now 3 weeks post bilateral FHO surgery. He hardly eats and is looking emaciated I have tried everything possible. I took him off rimadyl and just gave him tramadol. I don’t know if his stomach is upset I started Pepcid. He is done antibiotics for about 5 days now. I believe he is getting weak from not eating. He was doing better last week. We have been following your guide. I have called vet numerous times. I am getting very worried not sure what to do.. He doesn’t even want to walk one I have to make him. He can go up the stairs .i do not let him do that . He basically lays all day. We take him out every two hours and walk him around block. Sunday he is starting pt. I am not sure I did the right. Thing doing this to him. Please help and let me know how I can make him eat and build himself up. Everyone sees how thin he is. I gave him filet and he didn’t want it. Made him turkey and rice,chicken and rice ground beef. He doesn’t want anything. He eats eggs or blueberries a little . Will not touch his food which he liked. So confused.

  80. Steven, sorry for the delay. Some how you question got buried under a stream of other email.s To answer your question if there was going to be a problem you would have known either immediately or at latest the next day. From the sound of it everything is ok. As to your question about how much slow walking is okay…I would say that it really all depends on your dog. Some dogs heal and progress through recovery faster. No doubt I am conservative in general especially around this early (3 weeks) into recovery. You have to remember that it takes a good 6-8 weeks to form primary scar tissue and callus where the bone was cut. That being said the plate that was put in to support the TPLO is very strong in an of itself so you have some leeway. If you are doing 20 min walks and you think that he will be fine doing 30 minute walks by all means try it..and see how he does. The big thing is to not allow him to undertake any explosive activity. Hope this helps.

  81. Steven you would know pretty much right way if not the next morning. No doubt it gets harder and harder to control them the better they feel weeks out of surgery. In the home rehab guide we have guidelines for distance and time but if your dog is doing really really well you can always do more slow controlled leash walking as long as he tolerates it. Good luck.

  82. My 2 year old 75lb boxer mix got loose during the third week after TPLO surgery and took himself out on a short walk, including a large flight of stairs. How can I know if he did damage? Would there be latent effects, or would I know right away? Also, how much slow walking is okay?

  83. Absolutely this is fine. Again the key is getting in and out of the water safely and slowly. If they also have an underwater treadmill this would be even more valuable than swimming alone.

  84. John you would want to follow the advice of the therapist at that facility. I absolutely have no problem with a dog swimming 3 weeks out as long as you are super careful getting in and out of the water. The swimming itself is very safe. Keep up the great work.

  85. My 10 year old female Australian Shepherd is going into week 3 post op for ACL surgery. She is doing great! She is placing weight on her surgical leg and appears in good spirits. She has been on GlycanAid-HA for 4 weeks and the vet is very pleased with her status. My vet said that it was ok to get her back into hydrotherapy but I wan’t sure if it was still a little too soon. I started Lexie in hydrotherapy 2 months before she had surgery and she did really well with it. Any recommendations?? Thanks again for all of your help!

  86. I have a question about when it’s ok to start swimming after ACL surgery. We are starting week 3 and the vet says that Lexie is looking great! She is placing weight on her repaired right back leg. I had Lexie swimming at the local indoor swim rehab prior to surgery and my vet said it was ok to get her started again. We would be starting at step I, two laps with a break between. Is it too early to start or should I wait another week or two? Thanks!!

  87. Lisa my question would be is he still on an anti-inflammatory and pain med? Do you have him on a good joint supplement? In a situation like your dogs it really is all about a comprehensive approach and then patience, the right plan and time. You may want to consider getting him in to a good support harness. TopDog has two but there are several on the market that you should look into.

  88. My 11 year old 80 lb dog is on about week 3 after his FHO. He has bad knees and arthritis in his elbow, so he had other joint issues as well. He’s putting some weight on the leg and is getting around quite well. He had trouble sitting before, so I’m imagining the sit to stand exercise will be a challenge. His balance is still bad as well. Is there a way I can help him with the sit to stand exercises given his other compromised joints?

  89. He did send the fluid in and it was normal. The vet has been flushing her leg daily and she is on antibiotics. Cold packs? heat? She is doing much better and walking on her leg again. Back to previous therapy?

  90. Laura this is obviously unfortunate but you and your dog will make it through. I always live my the mantra “It could be much worse”. Moving forward I think that starting fresh from day one is a good idea because she has not even started using the leg. I would discuss with your veterinarian a longer period of pain medications until she is at least confidently using the leg on a slow controlled walk. Good luck on Monday. Dr.J

  91. My dog had TPLO surgery 3/27/14. On 4/11/14 she had her stiches removed. The surgerical nurse was concerned b/c she was still tucking her leg and had not even tried to walk on it at all – no toe tapping. She said bring her back Monday if no improvement. Vet examined her yesterday and learned a screw was too long rubbing against tissue causing her pain – they are doing another surgery on her today to fix. What should I expect – am I starting back at square one. I don’t really feel like I’ve been given the guidance to gauge her progress by the vet. It is your website that has been helpful but I’m looking at today’s surgery as starting over again – is that a good outlook view. I’m just not really sure now how to help her and kind of upset she has been in even more pain for the past 2 weeks then she should have been. Need some direction.

  92. Hey guys….for the longest time I have been wanted to create a specific book for dogs with back surgery (IVDD) intervetebral disc disease. There are a ton of different exercises that can be done with these dogs and hopefully in the near future I will tackle this. As for now by recommendation is to find a local canine rehab facility in your area or go back to the surgeon and ask for specific exercises that you can do. Following along with the conservative plan of our of our existing books is not a bad thing and at least provides you with some basic therapy framework. All the best, Dr.J

  93. Mary seroma’s are very common and no they should no affect the end result in any way. One comment…often times if there is a local infection the blood work will not show any changes…it is not a bad idea to have the fluid that is extracted from the seroma sent to the lab to be cultured…you can discuss this with your veterinarian and see what they think. If the fluid is clear with a slight blood ting usually it is ok but it never hurts to run a culture.

  94. Thank you for responding to our request regarding your weekly rehab. Need to confirm if these exercise also applies to dogs recovering from rupture disc surgery. Our 10yr old dachshund is now his 3rd week recovery and I have been doing the rehab exercise per your booklet. Schnitzel is walking but confined to his crate; he only goes outside to go “potty” in addition to twice a day walking for few minutes. As of last week he has started on the sit/squat exercise, which he does very well. Please advise if we are doing right for him. Looking forward hearing from you…thank you!

  95. It ended up she has a seroma. The vet has flushed it out three times and given her two shots of an antibiotic along with the pills she is taking…is this common. Does this effect the healing as far as the TPLO surgery? Lab work s not showing a bacterial infection.

  96. Mary set backs are totally normal and expected. That said if you have been strict with confinement and restricting excess activity I would wonder why she is having a setback. I would feel the joint daily for excess heat and gently palpate it for increasing pain….You can never discount the potential for infection so just watch her.

  97. Linda even though your dog is 6 months post surgery I would read through and try to utilize the exercises and therapies that we detail. As always we alway encourage people to find a local professional canine rehab facility in your area for the best of the best results. There is obviously a reason why she is still favoring the leg 6 months out whether the joint is not 100% stabile or secondary arthritis that is bothering her…so you may want to take her back to your veterinarian to just just have then try to identify the underlying reason for her delayed recovery. Also you will here me say time and time again…not all joint health supplements are created equal so I would just used TopDogs joint health supplement called GlycanAid HA as a reference to compare ingredients with your current supplement.

  98. My 11 yr old golden had TPLO surgery 3 wks ago today. She had been stepping on the surgery leg last week but is now limping a little more. No injuries and we are following instructions exactly. Our vet started her back on rimadyl, does this sound normal? Do they all have set backs?

  99. My dog is 6mo. Post sx. She still favors that leg when sitting or squatting. I just found you’re web site so have not been following rehab. Sug. She is 10 and does well once she gets going but has hard time getting up and down. Takes joint sup. and mobic and ultram. Is there anything to do to help her . Thanks

  100. Jane if this is clear with blood ting fluid than it is serosanguinous fluid and this can be normal. Any build-up of fluid the body will eventually absorb yet there are times when the fluid pockets are larger and I drain them one or two times and then it usually stops. I would just ask your surgeon what they want you to do just so they know.

  101. My 3 year old Boxer Samson had TTPL surgery 3 weeks ago. There was a lot of drainage for 14 days but he finally got his staples out. Now he has fluid building up under the incision. What do you advise and what is causing this?

  102. Weekly instructions are very helpful. I have week #3 and #5 but appear to have missed one. Can you send instructions for week #4 to me? THANK YOU.

  103. Patty it sounds like you handled this perfectly. Once she starts bearing weight on the leg again…a the level she was prior to the fall then you can restart you therapy from where you left off. Accidents like this/ set backs happen all the time…it is just part of life, but sounds like you are a smart home and took control. All the best, Dr.J

  104. My dog’s surgery was February 25th she is a 6 year old Golden. She was doing so well. The biggest problem was getting her out of the house we have a raised ranch. On Saturday my 15 year old fell while taking her out. We iced it right away and she has been crated. The next day she had diahrea and vomitting everything and was limping, put her on the chicken and rice and she is now eating fine. Back on Previcox for pain and of course ordered your harness to make taking her out easier. Should we be doing anything extra?

  105. Lori of course all dogs heal and progress differently, so the guidelines that we provide are really to be used as basic guidelines for recovery. The fact that he is toe touching and putting weight on the legs is great. Sometimes in smaller dogs it takes a bit longer because they do so well on three legs because they are light weight. The most important thing is that on a slow controlled leash walk he is touching the foot down. If you feel as if he is still in pain then I would definitely contact your veterinarian for more pain medications. Of course it is always a good idea to get him seen by a certified canine rehab expert in your area. All the best, Dr.J

  106. Hi my yorkipoo is into week three after an acl tear and surgery. His sutures are out and dr says he is where he should be at this point. I started him on Glycan aid ha as well. I will start the sit to stand now. Should I still be doing moist heat and bicycles too? He isn’t putting weight consistently on leg, mostly he does when standing or potty. I think he thinks it will still hurt…he’s pretty smart!His meds end today.

  107. Grace with set backs like this I always recommend 3-5 days of NSAIDs and strict rest and then re-evaluate. Of course discuss all of this with your veterinarian. Moist heat is awesome and promotes blood flow, enhances healing etc. Restricting a dog after TPLO is a challenge especially when they start to “feel” better. I think the dog walker is a great solution for mid-day exercise but you have got to control the rest.

  108. My german shepherd,Samson is in his 3 week post TPLO surgery.I had been leaving him in a confined,temporary,small fenced area.well,he managed to take the fence door off its hinges! and got out into the back yard.He is still putting weight on the leg,but does look like it was strained,dont know if any internal damage yet.Vet said i need to keep him in his crate and also have increased tramadol and acepromazine.I have someone that will come and take him out to go potty in the late morning,since I leave for work at 6:30am. Do you have any other suggestions?will moist heat be helpful? Thanks

  109. I totally understand Lyndsi. No doubt the GlycanAid HA is going to help in a big way and I look forward to hearing about his success.

  110. Thanks Dr. StClair,
    Unfortunately a rehab facility isn’t a n option for us as we are too far away to make repeated trips. He has a progress check with our vet on Monday, so I will definitely talk to them about it. Also, I just wanted you to know that we started him on the GlycanAid HA about a week ago. We would’ve started sooner, but he was having a hard time with stomach upset because of antibiotics following surgery. I’m hoping it will support his joints during this recovery and afterwards. Thanks so much for the advice and we will just keep trying to help him progress as he becomes more comfortable.

  111. Lyndsi, with a dog who had both front and hip surgeries I would strongly encourage you to fine a local rehab facility in our area. We have a great directory of places at That said if your dog does not want to do the exercise that means he is telling you something like he is really uncomfortable. Make sure and discuss with your veterinarian that his pain management is right! ALSO you really should consider if you have not already get him on our joint supplement GlycanAid HA and at the loading dose for the first 4 weeks. Though it is only a supplement it provided valuable ingredients that will promote optimal joint health. Good luck…:( Poor boy.

  112. Dr. StClair,
    I asked you a question in the FHO section of the rehab center and appreciated your response. We have been following the rehab instructions as closely as possible. Our 13 month old rottweiler who had FHO and elbow arthroscopy for displasia is now starting his 3rd week of recovery. I feel that he is doing pretty well, but I am a bit worried about something. During week 2, we were supposed to start with sit-stand exercises. I’ve tried every day since week 2 began and he refuses to even attempt to sit. When he sits on his own accord, he really takes his time and does it gingerly. I can tell it is hard for him. Should I be worried about this, or just give him more time? Obviously I can’t force him to sit, so we haven’t been doing the sit-stand exercises. I’m just worried that he isn’t getting the exercises he needs to progress. Thanks so much!

  113. That is great news Pam. As to whether our supplement GlycanAid HA will help her my answer would be 100% hands down yes. This supplement is packed with the essentials for optimal joint health and not only do we of course make it right here in the USA we make it will only USA ingredients that are the best of the best.

  114. Dr. St clair, We do have a rehab facility. She went to her first session last week. Several of the exercises they told me about, you had already suggested, and she has been doing based on the 2nd week instructions. She has 6 more sessions to go. She is taking Rimadyl (which we are almost out of) and Tramadol. Do you think the supplement might help her?

  115. Pam the BIG question I would have for you is what are you doing to support the other hind leg. What supplements are you using? If your dog on a non-steriodal anti-inflammatory (NSAID) or pain meds? Many dogs who recover well from one FHO can thrive with the right program. I am psyched that she is doing so well. You just have to keep strengthening her. You should if possible find a canine rehab facility in your area and work with them to condition her. On TopDog’s website we have a complete directory to all of the facilities in the country. Here is the link.

  116. Jennifer, you are a trooper. It sounds like to me…you are doing the best you can do…no doubt. She is a wild women. Just stay patient and consistent…She will be free once again :)

  117. Dr. StClair,

    Thank you so very much for this site. My german shepherd pup had FHO due to severe degenerative hip dysplasia. She is only 5 months old. I’m scared she will have to have the surgery on the other leg as well. I have been religiously following your instructions. I took her to PT on Friday and they said she is doing really well for 2 weeks out from surgery and is already putting a lot of weight on the leg, not just toe touching. She has been very weak in both hind legs since we got her at 9 week. She is still weak and I know her right leg is way over compensated. Do you have any suggestions that are different than what you provided? Again, thank you so much for this web site. It has eased my anxiety and giving me a lot of direction.

  118. Unfortunately, we do not have a rehab facility in our area. We have to travel four hours to the vet clinic who did her surgery. I have kept her at arms length at my side whenever we walk, but she wants to go! I never allow her to get in front of me. We use a harness, but will try the harness you have suggested. It almost feels like I am lifting her front legs off the ground when we walk because I have to restrain her that much. She has been on the double dose of GlycanAid HA for a month and we are using the Flexerna. She LOVES the GlycanAid. I am amazed how much easier it is for her to get up from laying down than it was before her surgery. I also feel the GlycanAid had contributed to her ease of movement. Thanks for your response.

  119. Jennifer sounds to me like you are doing a great job. Just remember that it takes a good 8 weeks have decent callus formation which is essential. If she can handle what you are doing and is not more lame after the exercises then I would say she is doing well. It is hard to remember that in most dogs is takes a full 6 months to get FULL recovery where everything is balanced again. Do you have a canine rehab facility in your area? As for the pulling, this can be a big problems is dogs who are very aggressive and explosive in their pulling. The shorter the lead (and I mean arm length) the less ability to pull. Of course there is also the Easy Walk harness. You are doing great.

  120. Hi Dr. James,
    We are into week 3 post TPLO. Our 80 pound, 5 year old lab is healing as expected. She has been putting close to full weight on her leg. She is still a little stiff getting up. We had a 2 week check up and the surgeon said everything looked great. We have started doing figure 8’s, 5-7 minutes of walking (some curb work during the walk), and puppy squats. I have been doing these all in one session, trying to get 3 sessions in a day. Is this too much this early? She is currently on 100 mg of Tramadol every 12 hours. We couldn’t do Rimadyl due to a near death reaction to it. Also, we weren’t very good when it came to training our lab on a leash when walking. We have always let her walk out in front of us at a fairly fast pace, therefore, she does not know slow. The last 2 1/2 weeks has been hard trying to do slow controlled leash walks. Now that we are out of the back yard walking she really pulls. I don’t let her walk out in front, she walks right by my side, but it is very difficult to keep her there restraining her the whole way. Any suggestions on how to get her to not pull? Does the pulling affect the rehab on her knee? Thanks for all of your help. I have followed your instructions religiously so far so I am wanting to do everything right.

  121. Nikki, no doubt very scary when something like this happens. The potential reasons for this are limitless and I really don’t like speculating because my mind always seems to go the worst option. My suggestion is this. If she is not better within 1-2 days or if her limp on one leg is significant I would bring her to your veterinarian as soon as possible. I wish I had a magic ball and make your worries disappear but unfortunately I am not that good. Make sure your have her pain meds on board and strict rest and then reevaluate. Keep me informed please.

  122. Dear Dr James
    Bonnie my Victorian Bulldog had TPLO surgery on both her back legs 3 weeks ago, she is walking , sometimes a little stiff as day wears on and doing great, but tonight she was sat in her bed and suddenly yelped really loud got out of the bed and sat straight down! She was a little stiff when she did get up but no obvious limp, what co you think may have caused her the pain, I’m not sure if she was trying to turn round at the time and may be twisted it! Thank you .
    Nikki ( U.K. )

  123. Denise I just got a similar question from another pet owner whose doctor said something similar. All I can say is that some surgeons are aggressive with post-op therapy and some are WAY conservative. There is no unanimous protocol accepted across the board for all surgeons. They all have their own “WAY”. Because your surgeon is overseeing and in charge of your dogs surgery and recovery it is important that you follow their advice. That being said what you may want to do is print out a copy of the TPLO home rehab guide and bring it to the surgeon and ask if it is ok that you follow these guidelines. The guidelines that we provide are by nature very conservative and as you can read from the hundreds of positive testimonials from other pet owners, these instructions have been instrumental in their dogs recovery success. You may also just point out to the surgeon that people who undergo ACL repairs all are required to do post-op physical therapy..shouldn’t this be the same for our pets. At the end of the day here at TopDog our purpose is only to educate pet owners on the basics of post-op therapy, teaching people exercises and therapies to help strengthen their dogs and not only help the surgery leg but also hopefully prevent future injury to the other hind leg due to compensation injuries.

  124. My 2year old Chocolate lab (Cooper) had TPLO surgery on his left hind leg last Friday (1-18-14) and the orthopedic surgeon has said no excercise other than taking him to go potty for 8 weeks. Cooper is doing very well, toe touching the day after surgery and starting to put some weight on the leg. We were instructed to do very slow controlled walks when taking him out to go potty and only walking a little bit for purposes of potty only. I understand that the leg needs time to heal. We were told that his ACL was a complete rupture and that because the knee has been stabilized that this shouldn’t be an issue for him. I am concerned about him having full function in this leg down the road and was looking forward to the rehab procedures you have indicated. Is this typical to wait so long before incorporating any rehab exercises?

  125. You are very kind but honestly it is because of you that Carson is doing so well. All I can emphasize over and over again is stay conservative with a eye on the prize of having him get back to 100%. Don’t let him fool you because no doubt he will try to tell you that he is ready to run like a mad man YET his will only 5, 6, 8 weeks out of survey… believe him because he is not ready. Keep reminding yourself that FULL recovery can take up to 6 months..just be careful

  126. We are in week 3 from TTA with Carson, our 3/12 yr. old Presa Canario, and prior to surgery on his left knee he was also favoring his right knee the most. I started him on the GlycanAid a few days prior to the surgery and wow now he walks normal on the right knee and it is amazing how well he is doing with his left knee. I have always given both dogs the supplement but yours is obviously much better! We will most likely not have to do the TTA on the right knee since he is doing so well. Thank you so much for all you do and your web site, you are awesome!!!

  127. Melanie, no quite sure how I miss you question but I do very much apologize. As long as there is no excessive heat coming from this swelling and he is doing well I probably not worry all that much. Of course it is best to have your veterinarian just check it out and feel the site. The level of exercise and quality of exercise is really all based on how well your dog doing. It he is progressing well/normal and sitting with good form then I would say you are fine to perform this exercise but again just to be safe have them quickly just check him out. Good luck and sorry again.

  128. Kimiki unfortunately I can’t see what he is doing but I will tell you that at 3 weeks he should not be sitting normally on it and of course is favoring it. The healing is still to early. It is very common for dogs with this injury to sit to the side and then have the surgery leg stretched out slightly and at a 1/2 flexed knee position. Full flexion may still be uncomfortable. What I try to focus on is the concept of half squats where you are not even giving him the time to get all the way down in the sitting position but instead catching him on the way down. I think I show this is the puppy squat video found at

  129. Hello Dr. James, We have started our Bullmastiff Boone on week 3 of TopDog Health rehab. We noticed when performing the puppy squats he is favoring his left hind leg, which was operated on. He is sitting to the right. Please let us know how we can correct this? Thank you in advance!


  130. Hi there,

    My dog had TPLO surgery 3 weeks ago, he seems to be doing well but it still looks a bit swollen. Is that normal after three weeks?
    Should I continue to do the sit-stand exercises if it’s swollen? He’s doesn’t seem to be limping and his knee is in a good position while he’s sitting.


  131. Dean I just commented back to someone else about the cold affecting the recovery. This is fairly common. If the limp this time is more significant I would recommend asking your vet for more NSAIDS or even it may be a good idea to have them check your boy out to make sure all is well with the surgery and plate. As for when to start the “sit-to-stand” you can start slowly with this. When you think about it he already sits and stands a certain amount on a daily basis. As you know the recovery is a process that can last a full 6 months. It just take time and patience and a good plan which you have.

  132. My bullmastiff is into week 3 post op. He had a TPLO done just over 2 years ago on his opposite leg. He recovered great from his first TPLO following your rehab guide. He is using his leg on slow leash walks, but does limp noticeably, especially when just getting up & walking slowly around room after laying for a period of time. Should I wait to start the “sit/stand” exercises until he is not limping so noticeably or go ahead & proceed. I can’t remember how soon I started last time. The weather is very cold here and that seems to be slowing the recovery effort a bit as well.

  133. It is recommended that you at least wait until the sutures or staples are remove. Also just make sure that you take extra special caution while they are in the tub or shower that your dog does not get over excited or stressed and then injure themselves on the slippery ground. Just be careful.

  134. Darla absolutely this is fine. There is no problem using GlycanAid HA with any anti-inflammatories.

  135. Charlene, why so many surgeries? Are you really restricting your dog after surgery? How many weeks post-surgery are these re-injuries happening? I am assuming that Lincoln is having the lateral suture repair (Extracapsular repair)?

  136. Lincoln has had crutiate liagament surgery 3 times on his left leg and 2 on the right which we are 2 weeks into and having sutures out today but I’m noticing he is holding up his leg again and was putting more weight on it before this, I can’t understand why this keeps happening but the vet has told me Lincoln has a lot of muscle mass in the back legs and has stretched the liagment from the swelling after surgery this last time, so it will be interesting to see what he says today?

  137. Denise the guidelines that we provide are to lay the foundations of the basics of post-operative orthopedic recovery. No doubt it would be best to find a local canine rehab facility in your area. If you go here we have a very comprehensive directory of the facilities that are available in you area. I of course am a big fan of hyaluronic acid and that is why we incorporate that into our joint product called GlycanAid HA (hyaluronic acid 25 mg). No doubt these injections should help.

  138. Terrie unfortunately I can not comment on medication dosing or medication duration outside of just generally mentioning how I personally do this with my patients. I have a tendency to stick with tramadol for around 4-6 weeks depending on how the dog is doing. At this point then wean and ask the owner to pay close attention to any change is usage or function. Tramadol is a very safe drug and I really like to give my patients the benefit of the doubt. That being sad depending on whether your dog had a TPLO or TTA or Extracap. repair, long large your dog is and how long the injury to surgery window was….all factor into how long the recovery can be. I can tell you that in many dogs it is common for them to use the leg fairly well while walking and then when they go to stop they shift the weight off of the leg. You are still only in the real beginning of recovery and from the sounds of it you are doing very well so I would just keep doing what you are doing and give it at least another 4-6 weeks to see more marked improvement.

  139. Our dog had “fishing line” surgery on her left rear leg in August and did not recover well. She had her TPLO surgery early October to her rear right leg as it lost strength and had a partially torn ACL. The vet wants to inject hyaluronic acid (3-5x)into our dogs left rear leg to help it heal as it is inflamed and weak. Molly is an 8 year old blue tick coon hound. Should we start rehab on our complicated friend and follow your 3 week protocol
    ? Thank you!

  140. Zoe’s 3.5 weeks out from surgery. I started her on GlycanAid HA this past Saturday (she was on Glycoflex III). I’m giving the loading dose. Therapy is limited to 2x/day Mon. – Friday and 3-4x/day Saturday and Sunday. She walks well with slight limp (sometimes a bit stiff at first, but does losen up as walk progresses). Question is about how much longer before she stops toe touching and bears steady weight while standing? Will the slight limp go away? Also, She’s still on tramadol 3x/day (morning, after work and before bed). When is a good time to start decreasing the tramadol?

  141. Can you email me the do,s and dont,s for 7 weeks out after tplo surgery. We are doing some exercising. no off leash yet or back to normal routine. Thanks

  142. Linda if your dog is no longer on pain medications ie. An anti-inflammatory and tramadol then I would contact your veterinarian and discuss this with them. Pain management is key as long as the surgery is still stable.

  143. Wayne that is a great question. Once the incision is healed there is no reason that you can not bathe your dog. My biggest concern is that you are very careful in the tub so that he does not slip or struggle and potential injure the leg. If you are careful he should be fine. The other option would be to just towel bathe him.

  144. My Dobe, Awol,will actually have 4 weeks in on 10/26; but when stitches taken out, infection was discovered and he is on antibiotic for 4 weeks. Is it normal to still do toe touching and lifting? Outside he will walk on it. I was doing the sit-stands and he did quite well, but worried we ‘overdid’ so stopped.

  145. Dr. James I’m wanting to give my dog Smokey (a 37 pound cockapoo) a bath but he is just starting his third week of rehab. He seems to be doing very well thus far. We are just starting the stand to sit exercises that you highly recommend. He is slow walking very nicely and seems to be putting a lot of weight on his injured right leg. As I mentioned he underwent surgery for a CCL tear on Oct 4th. How long should I wait to try and give him a bath? Thanks for all your help the first two weeks of Smokey being home. I look forward to the next 10 weeks of rehab with Smokey.

  146. Karen the big question is do you associate that “clicking” sound with any lameness. Often this can be associated with a meniscus injury. In my practice if there is not lameness then I strongly encourage my clients to get on a loading dose of GlycanAid HA, the joint supplement we make here at ensure all the essential joint elements are available and usually within a few weeks this resolves. You have to rememeber that unlike the cruciate ligament the meniscus and the ability to heal over time. Wish you luck. :)

  147. Thank you for your help with this rehab, for my Golden, Shelby. We are right on track. I have noticed some “clicking” noise in her surgical leg/knee. It has happened 3 or 4 times. I don’t know what is going on. We will see our Vet on Tuesday and hopefully, everything is ok. Thanks, again. karen

  148. Linda that is great that you are helping her through this. Poor thing. So first things I would say is that I would expect comments like yours considering that this was a very chronic injury that then got opposed to a more typical situation where they dog has an injury and then gets immediately fixed. That being said…of course your recovery with her is going to take much longer not only because she has significant muscle atrophy in the leg but also I am sure there is a ton of arthritis. GlycanAid HA should no doubt make a big difference but we have to give it time to take effect (I always tell people 30 days but most say around 14 days they notice a change). So that leaves us to the question of where is she if you are following the Home Rehab Guide. This is were I am going to ask you to do some evaluation of her yourself and answer that question yourself, because not only can I not see her or touch her but more importantly YOU know what she can and can not do everyday. If she is doing well with 15 min walks and is not more lame after this then you can do one of a few things…you can increase the time, you can increase the intensity ie. speed or what I would rather see you do is make it more challenging were you interject some small hill work and curb walking. At the end of the day you don’t have to feel like you need to follow the guide on a week by week basis, but rather understand the exercises and therapies and continue to challenge her everyday. Hope this helps.

  149. Hi Dr. James,
    We are fostering a 3 year old overweight Lab who had TPLO surgery 6 weeks ago. (We have had her 3 weeks) She had a complete tear of the cranial cruciate ligament and a medial meniscus tear that was untreated for at least a year and a half. I recently found your site and downloaded the Rehab Instructions and also started her on Glyconaid HA last week, along with fish oil. We are also working on her weight issue. My question is time wise we are on week 7 but she is really not up to that point in her rehab and I’m having trouble finding where in the Rehab Guide to start. Right now she walks 15 minutes on dirt and sand twice a day with shorter walks and some swimming. It seems the progress is slow. I can see a lot of compensation in her gaite but I don’t know how to correct it. Any suggestions would be greatly appreciated.
    Thanks for sharing all this helpful information.

  150. You are very very very welcome is a passion, lets just say that. I was completely frustrate by that level of care and information that we available and I decided to change that. ;) And then we started created innovative products to support these dogs like out new T.U.S.H harness (coming in the beginning of October) and our other joint products. We are in the business of empowering YOU! to help your dog. Now to Jet, ( love the name BTW) at 3 weeks the majority of the swelling should be subsiding. At this point you need to focus on the moist heat and massage to reduce the swelling provided that it is not already not d/t infection of some kind. Is he using the leg at a slow walk? As for when the swelling should go down it is different for all dogs but I would expect by this point for it to be gone….again if he is not progressing in turns of functional use then I would check with your vet.

    We are here if we you need us. Dr.J

  151. Dr. J, Thank you so much for coming up with this type of therapy and putting it all in an email/video system. It is helped us so much and I cannot believe this information is free! My Chocolate Lab, Jet, had his cruciate surgery on 9/6/2013. We are going into week three of the therapy. Funny thing is; my vet gave me your rehab info in a booklet form and I told them I was already following you online. Anyhow, I have a question about Jet. About this time, how should the knee look? Jet had a complete tear and initially he was put on 4 weeks of bed rest before having surgery. At the time, my vet didn’t know it was a complete tear – and didn’t know until the orthopedic surgeon got in there. The actual knee area still looks swollen and I’m afraid to massage that part. When should I expect the swelling of that particular section to go down?

    Thank you for your time,

  152. Lynn there is no doubt that she can get back there but it is going to take some time. I always tell people that for an injury like this the full recovery is somewhere around 6 months. My biggest concern is that we get this leg back to the same size and function as the “good” leg….At the same time I want to protect that “good” leg like it is the president of the USA. It kills me that the statistic of dogs who tear one ACL and then go on to tear the other is solo high…and it is all because of compensation and not allowing the body to BALANCE OUT again. My best advice to you is be patient, take things slow…..and TEST. If we do great with a 10 minute walk then push it to a 12 mintute walk, and then 15 and then 20 and then 25 and then 30 and then 30 with short jog and then 35 with longer joggg….you get the point. Retrain her like and ATHELE…and provider her with a solid joint support supplement like GlycanAid HA from topdog and you will be amazed. ;)

  153. Hi Dr. James,

    First, I would like to thank you for your website. It has been instrumental in Sage’s recovery.

    Sage is a 9 yo Pitbull mix. We were in the midst of training for our 10th marathon when she injured her knee. I took her to the beach and while running in the sand she yelped, then I had a three-legged dog. I am amazed at how quickly she is recovering. SHe was toe-touch weight bearing 24 hrs post surgery. Within about 3 days she was walking as if nothing happened to her. I am taking all of your recommended precautions and keeping her leashed.
    My question is, will Sage be able to run long distance again? I’m planning on cutting back to half marathons, but I will still be asking her to run upwards of 10 miles on any given Saturday. Am I being unrealistic? Your opinion is greatly appreciated.
    Thank you for your time!
    Lynn Berry

  154. Debbie I spoke with our webmaster and he says this is strange. Further research showed that sometimes there is a problems embedding the you tube videos. I can watch all of them on my computer except 3 of them are coming up with error message. What you can do is if the error message appears then if you go to you tube and search for topdoghealth you can find all the videos there. I apologize for this inconvenience. Unfortunately technology does not always cooperate but our team is working on it now and it should be fixed shortly. Best of luck.

  155. We were trying to see your sit to stand video but it does not work, there is no link when we click onit, could you please let me know when it is up and running again…thank you!

  156. Hi Susan, If you want you can bring her in and I can help demonstrate how to work around this improper sitting you are describing. With the fact that she had a partial tear for some time before surgery and with the current regimen that we have her on with GlycanAid HA and the exercise, I promise that she will return to normal function. It is just going to take time. Like I had mentioned to you, the best senario is when a dog fully tears the ligament and then has surgery immediately. The recovery time is always shorter for these dogs. In your case, because it was slightly more chronic in nature the recovery is going to be a bit more drawn-out, but she will get there. By all means come in and we will work on your questions and concerns.

  157. Hi Dr. J,
    Little Jenny is into week 3 since you did her acl.
    I’m trying puppy squats but she will not sit straight down, and is very casual about how she gets up. The video online was just now having a problem so I’m not seeing the proper form. I know she’s just compensating and realize she’s been doing it for many months now. I’m afraid she’ll just return to her pre-surgery compensating strategies if I let her.
    Is this super-critical or can I make up for this by walking her on slight inclines, figure 8s (which I think she’s too small to benefit much from) and up and down small curbs?

  158. Ginny thanks for contacting us. I would really focus hard on reducing that weight as you will be amazed at how much of difference that actually makes. Also keep us informed of your experience with GLycanAID, I know that you are going to be amazed as this an extremely comprehensive joint supplement with on the best of the best ingredients. Good luck.

  159. Hi Dr. James,Thanks so much for the info you send but my dog is actually in her 10th week after surgery.I think I clicked on the wrong one for your site.She has alway done the sitting off to one side even before the surgery,except when she was a puppy.She is 8 years old and a little overweight.She also has some arthritis in her ankles back etc.She has been on vetprofen, tramadol, and cosamine ds( other glucosamine products too) with msm for 2 years for her arthritis.She also has diabetis and gets insilin 2 times a day.I really enjot watching your videos though.I also ordered some GlycanAid to try.

  160. Heather, what a bummer that now 2 years later it happened again. We of course appreciate your kind words and I hope that everything goes well. By all means contact us if you need our help or have any questions. Regards, Dr.J

  161. Just a quick thank you – we used your guide 2 years ago when our 3yr old lab tore his left acl and we got him through the TTA surgery and rehab. Unfortunately 2 years later he has torn the right ACL and we went with an extracapsular. The rehab guide for TTA was great and I still have all the notes so we are using the Cruciate guide this time around and I don’t know what I would do without it!

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