Case Study: River
Physiotherapy for Return to Sport Following Bilateral Patella Surgery — Supporting an Active Agility Dog Back to Full Performance
Patient Summary
Presentation and Background
River is a 5-year-old Papillon competing in agility and hoopers — two demanding canine sports requiring speed, precision, tight turns, and repeated jumping. He had undergone bilateral tibial crest transposition surgery in 2019 to correct patella luxation in both hindlimbs, and had been actively competing since. His owners noticed that he was becoming reluctant during tight turns, disengaging during repetitive exercise sequences, and occasionally appearing tired towards the end of sessions — never lame, but not performing at his best.
Recent veterinary radiographs had shown no cause for concern, and his vet felt the reluctance was more likely to be movement-related than pain-driven. River was referred for physiotherapy in April 2025, with the goal of optimising his movement, addressing any compensatory patterns that had developed since surgery, and supporting his return to full competitive performance.
River came with an additional complexity: he is a nervous dog, prone to anxiety in new environments, and assessed as a bite risk. This meant the approach to assessment and treatment had to be carefully adapted to keep him comfortable and build trust at every stage, before any meaningful physical work could begin.
Rehabilitation Programme
At first assessment, River was intermittently placing his left hindlimb laterally in stance, off-loading his forelimbs when standing square, and showing circumduction of both hindlimbs during movement — more pronounced on the right — with reduced stifle flexion, a lean through the right shoulder, and thoracolumbar sway. His quadriceps were symmetrically underdeveloped and mildly hypotonic bilaterally, reflecting the long-term effect of bilateral surgical history. Palpation was not attempted at first session due to his anxiety, and all early work focused on building confidence and engagement. His rehabilitation was structured across four phases.
The priority in the earliest sessions was not physical output but trust. River was introduced to the clinic environment and equipment gradually, with all exercises built around positive reinforcement and kept short enough to maintain his engagement. Heat applied to the lower back and thighs at home helped prepare his tissues before each exercise session. Raised cavaletti poles encouraged him to begin lifting his hindlimbs more deliberately, and channel walking with stop-start cues introduced the concept of square hindlimb placement in a controlled, low-pressure way. A low paws-up exercise was introduced to begin loading the hindlimbs and promoting postural awareness. Progress was measured as much in River’s willingness to participate as in his movement quality — both improved steadily from the outset.
As River’s confidence grew, palpation became possible and revealed the key physical targets: symmetrically underdeveloped quadriceps, mild hypertonicity through the tensor fasciae latae bilaterally, and adductor tightness that was gradually resolving. Manual therapy was carefully introduced as River allowed it, beginning with light massage to the gluteal and thigh regions. Exercise progressions were made at each session: poles were raised and narrowed to increase proprioceptive demand; sit-to-stand work was moved onto a narrow foam pad to counter River’s tendency to rotate his distal limbs in sit; forelimbs were progressively raised during sit-to-stand to increase the loading demand through the hindlimbs; and balance work was developed using a wobble cushion under the hindlimbs and a raised surface under the forelimbs. Side-stepping exercises were introduced over raised poles to develop lateral limb control, which is particularly important for the turning demands of agility. Hydrotherapy continued alongside physiotherapy throughout this period, providing additional low-impact cardiovascular and muscular conditioning.
River’s recovery included two unrelated setbacks that required the programme to adapt rather than pause entirely. A grass seed embedded in one hindlimb caused temporary lameness and a period of reduced loading on that leg, with some muscle loss in the left hamstring as a result. The programme was modified to address this while maintaining gains elsewhere, and the hamstring recovered well within a few weeks. Later, an emergency veterinary visit for a separate medical issue required a short break from physiotherapy. On both occasions, River returned to his programme with good compliance and continued to progress. By October 2025, stance had become more consistently square, and channel walking showed much more controlled and symmetrical placement of all four limbs.
In the final phase, the programme shifted toward exercises with direct relevance to agility and hoopers performance. Figure-of-eight work around cones was introduced to develop controlled lateral spinal flexion in both directions — mirroring the demands of tight turns in competition. Mini push-up exercises challenged forelimb and shoulder strength, addressing the long-standing right shoulder lean identified at initial assessment. The forelimb-on-wobble-cushion exercise was reversed so that forelimbs were challenged on an unstable surface while hindlimbs were on raised foam pads, increasing upper body demand. Pole work was progressed to greater heights and narrower spacing, building the stifle flexion and hindlimb engagement needed for clearance over agility obstacles. Appointments were extended to six-weekly intervals, reflecting River’s established maintenance level and continued stable progress. At his most recent session in February 2026, gluteal mass was described as nice bilaterally, all major muscle groups were comfortable and well-toned, and River was performing a near-playbow depth on his mini push-ups — a significant upper body strength achievement.
The Result
Over eleven months, River moved from a pattern of reluctance, disengagement, and compensatory movement — accumulated over years following bilateral stifle surgery — to consistent square stance, improved hindlimb engagement in movement, developing bilateral strength, and active sport participation without reported concern. The circumducting gait pattern that was present throughout has reduced progressively as muscle tone and proprioception have improved, and the conditions that were driving it — quadriceps weakness, adductor tightness, and poor postural awareness — have all responded to the programme.
River’s case also demonstrates something less commonly discussed in canine rehabilitation: the importance of the animal’s emotional state in achieving physical outcomes. His early anxiety was a genuine clinical barrier. The time invested in building his confidence was not a detour from the rehabilitation — it was part of it.
What Made the Difference
Three things stood out in River’s programme. A patient, trust-first approach to a dog who found the clinic environment stressful meant that by the middle of the programme he was arriving with a waggy tail and actively engaging with exercises — without that foundation, the physical work would not have been possible. Consistent owner commitment to a daily home exercise programme over eleven months provided the repetition and continuity that clinic sessions alone cannot deliver; the improvements in muscle tone and postural control seen at assessment reflected work happening at home every day. And sport-specific progression — building exercises that directly replicated the movement demands of agility and hoopers, including turning, lateral steps, controlled deceleration, and forelimb loading — meant the physiotherapy programme was always working toward the same goal as River’s sport training, not in parallel to it.
River’s case shows that physiotherapy has a meaningful role not just in post-surgical recovery, but in the long-term management and performance support of dogs in active sport — even years after the original procedure.
Physiotherapy for return to sport following orthopaedic surgery