In the recent past, there was little attention paid to animals after back and joint surgery, and when the stitches were finally taken out veterinarians figured our job was done. Or worse yet, we'd encase wounded limbs in casts, splints, or braces and immobilize the joints or keep neurological patients basically cage ridden (bedridden). Looking back, I shudder to think of the withered limbs, stiff joints, and weakened bones, cartilage, ligaments and tendons that resulted. With 20/20 hindsight, veterinarians now know we broke the most basic medical mantra to first, "do no harm."

Dr. Darryl Millis is a board certified orthopedic surgeon at the University of Tennessee College of Veterinary Medicine, the co-author of the first comprehensive book on veterinary physiotherapy, "Canine Rehabilitation and Physical Therapy" and coauthor of another book, "Essential Facts of Physiotherapy in Dogs & Cats."

Millis was an orthopedic surgeon before he got involved with rehabilitation. When asked what sparked his interest in rehabilitation, Millis remembered witnessing the shift in human healthcare where patients with back injuries were being encouraged to get out of bed and on their feet. He noted that at one time if an athlete blew a knee, it was career ending, but with physical therapy if they weren't back to near full function within a year, it was almost considered a treatment failure.

But it was a tank with swimming dogs at the Mississippi State veterinary school that made pet physical rehabilitation Millis's life's work. At Mississippi they took post-op dachshunds after back surgery and put them in a whirlpool to swim. Millis made the observation that these active water-dogs seemed to recover quicker and regain motor function earlier than similar patients who were confined to their cages for rest. NOTE: This observation was validated by a recent study (Dr. Diane Dunning at Illinois) that showed that dogs with lower back disk disease stand — in approximately half the time — and ambulate — in half the time — with rehab.

Today's physical rehabilitation menu includes physical modalities, manipulation (massage, stretching, passive range or motion), and therapeutic exercises (leash walks, aquatic exercise, sit-to-stand exercises, going over barriers). Rather than just guessing what works, motion analysis and force plate analysis have shown the true benefit from specific exercises. With research and resources such as Millis's book or courses, veterinarians or people under their supervision know what to do for a specific pet with a specific mobility problem.

While some rehabilitation can be delightfully low-tech, like encouraging a veterinary technician to not just walk a dog post-op to let it go pee-pee, but to also get the animal to touch the affected leg down each and every step and eventually stride toward a complete recovery, it can also be much more complex.

In more high-tech applications, rehab specialists can utilize an underwater treadmill filled with a certain temperature and depth of water specific to this dog's joint problem, with the platform at a certain incline, moving at a precise pace. Going a step further, no pun intended, the targeted joint is put at the level of the water so it has to break the surface tension, thus ramping up the degree of difficulty.

Specialists can also affect motion underwater by putting water wings on the animal's opposing good limb (if the right rear leg had knee surgery, a water flotation device may be placed on the left rear leg), which forces tremendous hip and knee flexion so that stance time on the operated leg is about the same as the good one. This kind of advanced procedure works on huge NFL lineman with knee surgeries as well as tiny Chihuahuas.

While rehabilitation is typically used as a powerful adjunct therapy with surgery, anti-inflammatory drugs and special diets, sometimes rehab is the primary treatment. Millis vividly remembers an 8-year-old golden retriever, Maggie, who had had two knee surgeries on both legs for luxating patellas (kneecap won't stay in place). When Millis looked at the post-operative radiographs, he noted they were the most arthritic joints he'd ever seen; the surgeries had been failures. Maggie could barely get up and walk 15 feet and couldn't jog at all. Drugs didn't agree with her gastrointestinal tract, the owner wouldn't authorize any more surgery, but the owner did want to try physical rehabilitation. Millis didn't think the underwater jogging treatment plan had a chance, not with knees joints that looked like cobblestone grinding against cobblestone.

Millis ending up eating crow and Maggie ended up walking. With about 6 weeks of therapy (5 days per week) the dog was walking normally. By 5 months, Maggie was jogging and force plate analysis showed normal weight being carried on both rear limbs. With therapy, Maggie, returned to near normal activity.

Of course, veterinary medicine's goal is to prevent problems rather than treat them. When asked what people could do to help prevent arthritis and joint injury, Millis replied with his voice rising for emphasis, "Don't let your pets become overweight and exercise them regularly."

Pet owners are getting "bigger and bigger dogs and providing them with less and less activity." Obesity puts excessive strain on the joints. Dogs have the genetic exuberance to be running machines. Ligaments, tendons and bones need to be stressed by regular exercise to remain flexible and strong."

The last word on this story is a reminder to get out that leash and walk your dog daily. Amazingly, the health benefits work on both ends of the leash.