Our 10-year-old female Cocker Spaniel, Millie, seems to have partially torn her right cranial cruciate ligament while playing chase with our new Labrador puppy. She is 17 kg [37 lb], and our vet says she is overweight. We are not keen on surgery. Can you suggest any alternative options?
C.S., via email
Partial or complete rupture of the anterior or cranial cruciate ligament leading to instability of the knee—or stifle joint as it's known in animals—is very common in dogs.
The cranial and caudal cruciate ligaments (attached in a crisscross fashion), along with the collateral ligaments, work with the patella, or kneecap, to stabilize the knee joint and prevent excessive motion of the lower leg.
Cranial cruciate disease can affect dogs of any age but more commonly older dogs, as it's more often caused by degeneration than trauma or injury. The degeneration can be from repeated joint stress from day-to-day activities. But injuries while playing or doing agility may also cause the problem.
Certain dog breeds, especially large ones like Boxers, Labrador Retrievers and Mastiffs are more likely to suffer from cruciate disease.
Overweight dogs and those with underlying conditions like Cushing's and other autoimmune diseases are also at increased risk, as are neutered dogs (especially females), possibly because there is delayed closure of growth plates in animals that are neutered before maturity. This leads to larger bones and joints, and more stress on the ligaments. It's a good idea to delay neutering dogs more prone to cruciate disease.
Symptoms and diagnosis
Cruciate injuries tend to affect just one back leg, while degenerative cruciate disease affects both. Signs and symptoms include sitting asymmetrically with one knee rotated outward, dragging or carrying one limb and lameness that worsens after exercise and improves with rest.
Another clue is there may be only mild improvement on anti-inflammatory medication and painkillers.
Vets will carry out a full orthopedic and clinical exam including a "cranial drawer test" and checking for pain on extension of the stifle joint. They may also perform X-rays to look for water around the joint, arthritis and to rule out bone cancer, especially in older dogs.
The standard treatments are nonsteroidal anti-inflammatory drugs (NSAIDs) like carprofen and meloxicam, limiting exercise, and surgery to repair the torn cruciate ligament.
Surgical treatment reportedly has an 85 percent success rate in dogs of most sizes and is advised by most orthopedic specialists. But in cats and small dogs weighing less than 15 kg (33 lb), there is a 50 percent chance of a return to full function without surgery.
I used to perform lots of these surgeries, but since studying complementary medicine, I have had good success using nonsurgical therapies for torn cranial cruciate ligaments.
Cage rest. Strict cage rest for two to three months will work in small dogs. The return to function will not be 100 percent, but fibrosis (scar tissue formation) in the joint will stabilize the leg over time, and the dog will be able to walk reasonably well.
Weight loss. If weight is a contributing factor, as it sounds like it may be with Millie, it's important to restrict your dog's calorie intake so she reaches her target weight. This is especially important because the opposite knee is at risk of the same problem.
My preferred diet is a raw one free of artificial additives. See my book, You Can Heal Your Pet, for a guide on how to switch your pet to a raw diet.
A good homeopathic vet can provide an individualized treatment plan based on your pet's constitution. But here are some remedies I have found to be effective.
Ruta grav is excellent for ligament injuries, especially in the knee joint.
Suggested dosage: 6c, 3-4 times daily until improved
Arnica can be combined with Ruta grav if the injury is caused by trauma or sports.
Suggested dosage: 30c every 2-4 hours, up to 4-6 doses the first day and then 4 times daily until improved
Bryonia is useful if the stiffness is worse after exercise.
Suggested dosage: 6c, 3-4 times daily until improved
Rhus tox can be taken if the stiffness is worst after rest.
Suggested dosage: 6c or 30c, 4 times a day initially, then reduce to 1-3 doses daily with improvement
Traumeel is good topical remedy available as a cream.
Suggested dosage: rub gently onto the affected knee several times a day
Acupuncture and acupressure
These traditional Chinese techniques increase circulation to the joint and reduce pain and inflammation. They can be performed by a qualified vet, or you could try acupressure on your pet yourself, using your fingers to apply gentle pressure to specific points on her body (see You Can Heal Your Pet for a detailed guide). The following points can help in cruciate disease:
BL60 (Urinary bladder 60). Known as the "aspirin point," this is a general point to temporarily relieve pain in any condition. It's located on the outside of the hind leg in a depression midway between the Achilles tendon and ankle bone. Apply firm but gentle pressure for about a minute, two to three times a day, or as often as needed.
The "Eyes of the Knee," the two hollow spots on either side of the knee. Apply pressure to these points for one minute several times a day; this can greatly alleviate knee pain.
This involves injecting a liquid in and around the joint to stimulate ligament regeneration. Many holistic vets report high success rates with this technique for treating cruciate ligament degeneration or tears, without the need for surgery.
Stifle braces specifically for cranial cruciate ligament injuries work by resisting the forward movement of the tibia to prevent overextension of the stifle joint, easing pressure on the injured ligament.
The braces should be worn for three to six months, on one or both hind legs. My Pet's Brace (www.mypetsbrace.com), the Posh Dog Knee Brace (www.poshdogkneebrace.com) and the BT Balto Cruciate Knee Brace (www.baltodogbrace.com; available in the UK via www.zoomadog.co.uk) are a few options on the market.
Try the following supplements, which promote healthy joints:
Green-lipped muscle, an excellent source of omega-3 fatty acids that is very palatable for dogs.
Synoquin, a natural blend of chondroitin sulfate, glucosamine hydrochloride, dexahan (a purified form of omega-3-rich krill oil), zinc and vitamin C
Cosequin, a combination of chondroitin sulfate, glucosamine and manganese ascorbate.
Suggested dosage: for all of the above, follow the label instructions
Comfrey (Symphytum officinale) contains allantoin, which helps speed cell growth. It also contains rosemarinic acid and other compounds with anti-inflammatory, analgesic and astringent properties, and it's a useful aid for chronic arthritis as well as ligament and joint problems in dogs. See the box for a recipe to make your own.
Make your own comfrey ointment
17 fl oz (500 mL) comfrey-infused sunflower oil (see recipe below)
¾ oz (20 g) high-quality beeswax
15 drops lavender essential oil
1) Heat the oil in a large glass bowl over a bain-marie or double boiler until warm.
2) Grate or chop the beeswax and add to the oil; stir until dissolved. Add the lavender essential oil (this acts as a preservative).
3) Transfer the mixture into sterilized jars. Allow to cool and harden, then label the jar.
4) Ointments made this way can last up to a year.
To use the ointment, gently massage a little of it between your fingers and apply to the skin.
WARNING: Comfrey should not be ingested, so place a buster collar (also called an Elizabethan collar or cone) around your dog's head to stop them from licking the ointment.
Comfrey-infused sunflower oil
1¾ oz (50 g) dried comfrey leaves
17 fl oz (500 mL) sunflower oil
1) Fill a dry, sterilized glass jar with dried comfrey and cover completely with the sunflower oil, leaving a small space for the oil to breathe.
2) Screw the lid on tightly and leave the jar in a warm place for four to six weeks, or until the oil has taken on the color of the plant. Shake the jar vigorously every day.
3) After the oil has infused, pour it over a sieve to strain the herb off into a sterilized bottle, preferably a dark one.
4) Label, date and store in a cool, dry place. Use within three months.
Rohini Sathish, DVM, MSC, MRCVS, MHAO, MCIVT
Dr Sathish is an award-winning holistic vet with 22 years of experience. After training in acupuncture, acupressure, energy healing, Emotional Freedom Technique (EFT), animal communication and herbal medicine, she now actively integrates conventional veterinary treatments with complementary therapies and is co-author of You Can Heal Your Pet (Hay House UK, 2015). You can contact Dr Sathish at her website: www.rohinisholisticvetcare.com