When Surgery Is Not the Answer
Hip dysplasia is one of the most common referrals I see at a specialty canine rehabilitation practice. Most of those referrals arrive after a DVM has already had the surgery conversation with the owner and either the owner declined, the dog's age or health status makes anesthesia a meaningful risk, or the supervising vet wants to pursue a structured conservative program before committing to a triple pelvic osteotomy, total hip replacement, or femoral head and neck ostectomy.
I want to be direct about my scope here. As a CCRA, I do not diagnose hip dysplasia and I do not make surgical recommendations. That is the DVM's and board-certified surgeon's territory. What I do is build and execute the rehabilitation plan once the clinical decision to pursue conservative management has been made. That plan has to be sophisticated enough to actually move the needle on pain and function, and that requires understanding the imaging, the scoring systems, and the biomechanical reality of what a dysplastic hip is doing under load.
Conservative management is not a consolation prize. Done well, it produces measurable improvements in gait symmetry, hindlimb muscle mass, pain scores, and owner-reported quality of life. Done poorly, it is just telling someone to "keep the dog lean and take it easy" and hoping for the best. I have strong feelings about which of those approaches I want to be associated with.
PennHIP vs OFA: What the Scores Tell Me
Before I design a single exercise, I want to look at the imaging and understand the quantitative picture of joint laxity. The two primary systems I see in practice are OFA hip scoring and PennHIP distraction index measurement, and they tell me different things.
OFA scoring uses a ventrodorsal extended hip radiograph and classifies hips into seven categories from Excellent to Severe. It gives me a categorical picture and a rough sense of how much osteoarthritic remodeling has already occurred. A dog scored Moderate or Severe on OFA almost always has visible periarticular osteophytosis and potentially significant acetabular remodeling that I need to account for when I'm selecting range-of-motion techniques.
PennHIP uses a distraction radiograph series to calculate a distraction index, which is a ratio of femoral head displacement relative to acetabular diameter. A DI of 0.3 or below indicates tight, well-congruent hips. A DI above 0.7 tells me there is substantial passive laxity in that joint, and my entire exercise philosophy shifts toward building periacetabular muscular stability rather than pushing through full range of motion work early in the program.
The practical difference for my programming: OFA tells me about current pathology and remodeling, PennHIP tells me about intrinsic laxity. A dog can have a borderline OFA score and a high distraction index, which means the joint is loose but has not yet developed severe arthritic change. That dog needs aggressive stabilization work now, before the secondary osteoarthritis catches up. A dog with a moderate OFA score and a lower DI may have more remodeling-related stiffness as the primary complaint, and I focus more on extensibility work and pain-modulating modalities.
I always read these scores in combination with my own hands-on assessment. Ortolani sign presence or absence, the feel of joint crepitus during passive range of motion, muscle mass asymmetry measured with a tape and consistent bony landmarks, and gait pattern under load all add clinical texture that a radiograph score cannot provide.
Therapeutic Exercise Selection for the Dysplastic Hip
Exercise selection for the dysplastic dog is not random. Every movement I prescribe has a specific physiological target, and I progress or regress it based on how the dog responds week to week.
Periacetabular Muscle Strengthening
The gluteal group, iliopsoas and external hip rotators are the primary dynamic stabilizers of the coxofemoral joint. In dysplastic dogs, these muscles are almost universally underdeveloped relative to breed expectations because chronic pain has suppressed voluntary loading. My first priority is rebuilding that muscle mass.
I use sit-to-stand repetitions on stable ground before progressing to unstable surfaces. The concentric and eccentric demands of a controlled sit-to-stand directly load the gluteals and hamstrings in a functional movement pattern. I typically start with sets of five to eight repetitions and judge progress by how symmetrically the dog shifts weight through both hindlimbs during the movement.
Backing up exercises are another staple. Asking a dog to walk backward on a slight incline loads the hip extensors concentrically with reduced spinal loading compared to incline walking forward. Dogs catch on to this quickly and it is easy to teach owners for the home program.
Proprioceptive and Neuromuscular Work
Dysplastic hips have chronically aberrant mechanoreceptor input. The ligamentous laxity disrupts normal joint position sense, and the secondary osteoarthritis further degrades the quality of afferent signaling. I integrate cavaletti pole work, balance disc standing, and controlled terrain walks to rebuild the neuromuscular contribution to joint stability.
I am careful about progression on unstable surfaces with high-DI dogs. A dog with significant passive laxity on a wobble board is not learning to stabilize, it is just struggling. I use brief duration holds on mildly unstable surfaces and prioritize quality of postural response over duration.
Flexibility and Range of Motion
Osteoarthritic remodeling around the acetabular rim frequently causes a loss of hip extension range, which is the range most critical to normal propulsion in gait. I assess end-feel carefully during passive range of motion to distinguish capsular restriction from pain-limited range, and I target the iliopsoas specifically with manual stretching because iliopsoas contracture in the dysplastic dog is nearly universal and frequently underaddressed.
Aquatic Therapy and the Dysplastic Dog
The underwater treadmill is one of the most clinically powerful tools I have access to at a specialty canine rehabilitation practice, and for hip dysplasia specifically it is often the intervention that creates the clearest early functional improvement.
Water depth is not incidental. I adjust fill level deliberately based on the dog's weight, body condition and primary complaint. For hindlimb offloading in a painful dysplastic dog at the start of a program, I fill to approximately greater trochanter level. At this depth, ground reaction forces through the hindlimbs are reduced substantially while the dog still has to recruit hip flexors and extensors through their functional range to maintain gait cycle. As pain decreases and muscle mass builds, I progressively lower water depth to increase effective loading.
Water temperature matters. I keep the water warm enough to facilitate tissue extensibility and reduce muscle guarding, which is particularly useful in dogs that come in stiff and reluctant to load the hindquarters at the start of a session. A warm-water aquatic warm-up before land-based exercises consistently produces better range of motion and more symmetrical gait during the land work that follows.
I track UWTM sessions quantitatively: speed, duration, water depth, observed gait symmetry and any gait deviations that emerge with fatigue. Fatigue-related asymmetry on the UWTM is one of the earlier signs that I have pushed session length past the dog's current functional capacity, and catching that early prevents setback flares.
NSAID Stewardship: The Rehab Perspective
This is where my lane matters a great deal. I do not prescribe NSAIDs. The supervising DVM manages the pharmacological side of pain control. What I do is communicate clearly about what I observe during rehabilitation sessions that is relevant to that pharmacological management.
Pain that is inadequately controlled during rehabilitation is not just a welfare concern, it is a clinical problem. A dog that is protecting significantly during UWTM work or refusing to load through a sit-to-stand is not going to build the periacetabular muscle mass the program requires. The exercise stimulus cannot reach the target tissue if the dog is guarding against it. When I observe consistent pain behaviors that suggest the current analgesic protocol is insufficient for the exercise demands of the program, I document that specifically and communicate it to the referring DVM.
The inverse is also true. As dogs improve through rehabilitation, the analgesic requirements often decrease. I have seen multiple patients transition from daily NSAID administration to as-needed dosing after three to four months of a well-executed conservative program, and that outcome is meaningful for long-term organ health. The supervising DVM makes those tapering decisions, but rehabilitation data is often what drives them.
Multimodal analgesia conversations are increasingly common in my practice environment. Gabapentin adjunction, omega-3 fatty acid supplementation at clinically relevant doses, and therapeutic laser as a pain-modulating adjunct are all tools the DVM may deploy alongside the rehabilitation program. I am familiar with the evidence base for each and I can have an informed conversation about their role in the overall plan, while being clear that prescribing decisions are not mine to make.
The Owner Conversations I Actually Have
The clinical work is the part I trained for. The owner conversations are the part that determines whether the clinical work actually happens.
The first conversation I always have is about expectations and timeline. Conservative hip dysplasia management is not a six-week program with a graduation day. It is a chronic disease management strategy that evolves as the dog ages and the joint changes. I tell owners that we are playing a long game. We are trying to delay or reduce the severity of functional decline, manage pain as a chronic condition, and preserve muscle mass that protects the joint. That is a meaningful and achievable goal, but it is not the same as a cure.
The second conversation is about the home program. I can see a dog two or three times per week at a specialty canine rehabilitation practice. That dog lives at home the other 165 or so hours per week. What happens in those hours matters enormously. I build a written home exercise program for every patient, and I spend real time in the appointment teaching the owner to execute it correctly. Cavaletti pole spacing, the specific cue for backing up, how to perform an iliopsoas stretch safely, what normal post-exercise fatigue looks like versus concerning lameness: all of that gets covered.
The third conversation is about weight management. Body condition score is one of the most modifiable variables affecting hip dysplasia progression and pain severity. Every kilogram of excess body mass increases joint loading forces in a way that no exercise program fully compensates for. I approach this conversation without judgment, because owners are doing their best, but I am direct about the clinical impact. If the dog needs to lose weight, I say that clearly and I work with the DVM to make sure there is a plan.
The fourth conversation, which not every owner needs but some do, is about what re-evaluation looks like. If the conservative program is not producing the functional improvement we hoped for over a defined trial period, that is clinically meaningful information and the surgical conversation deserves revisiting. I want owners to understand that choosing conservative management is not a permanent closing of the door on surgical options. It is a first-line approach with clear evaluation checkpoints.
Building a Long-Term Management Framework
Hip dysplasia in a dog that is going to live another eight to ten years requires a framework, not just a protocol. The program I build at initial intake is almost never the program that dog is on two years later, and that is appropriate.
I reassess muscle mass at every visit using consistent tape measurements over standardized bony landmarks. I track Glasgow Composite Pain Scale scores at intake and discharge each session. I review gait video periodically to document changes that are not visible in the moment. These data points give me a longitudinal picture of how the patient is actually progressing, which is far more clinically useful than any single-visit impression.
As dysplastic dogs age and secondary osteoarthritis advances, the exercise program shifts. The high-intensity strengthening work of the early program gives way to maintenance-level activity that focuses on preserving what has been built rather than pushing for new gains. The UWTM continues to be valuable well into the later stages because it allows meaningful cardiovascular and muscular work with reduced mechanical joint stress.
Flare management is part of the framework too. Dysplastic dogs have bad weeks. Weather changes, overexertion at a family gathering, a long car trip: any of these can produce a symptomatic flare in an otherwise well-managed patient. I give owners a written flare protocol so they are not starting from zero when that happens. Reduced activity duration, application of cold therapy, and a clear threshold for when to call the clinic are all part of that document.
Conservative hip dysplasia management, executed with clinical rigor and consistent owner partnership, is a legitimate and often highly effective approach to one of canine orthopedics' most common diagnoses. I am proud of what we accomplish for these dogs at a specialty canine rehabilitation practice, and I think the rehabilitation field has more to contribute to this space than it is sometimes given credit for.