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The Role of Physiotherapy in Canine Hock Instability

Like humans, active dogs of all ages are susceptible to broken bones or ligament tears due to trauma or strenuous activity.

For dogs who enjoy intense running or jumping like canine athletes, the small hock joints on the back legs can be particularly vulnerable to injury. 

Animal Physiotherapist Susan Yuen from Physio for Pets explains what happens when a dog is suffering from canine hock instability and the various treatment options to give your dog the best chance of making a full recovery.

What is the hock joint?

The hock joint is anatomically known as the tarsal joint. It is a composite joint comprised of:

  • Tarsocrural joint
  • Talocalcaneal joint
  • Proximal and distal intertarsal joint
  • Tarsometarsal joints
  • Vertical intertarsal joints
The tarsocrural joint is responsible for the majority of the movement within the tarsal (hock) joint and allows the joint to move in flexion and extension (Evans and de Lahunta, 2013).

What causes hock joint instability?

The tarsal (hock) joint has minimal musculature covering the joint so this joint is reliant on the fibrous joint capsule and surrounding ligaments for support (Duerr, 2020). When the surrounding ligaments of the tarsal (hock) joint are stretched and strained beyond their normal capacity then this can cause a tear, otherwise known as a sprain.

Ligament sprains can occur through direct trauma which may be experienced through collisions between a motor vehicle and dog (Duerr, 2020). 

Alternatively, ligament sprains can occur gradually over a period of time when a dog repeatedly performs movements that involve:

✔️ Running on slippery surfaces
✔️ Falls
✔️ Repetitive twisting and turning
✔️ Vertical jumping and landing initially on both hindlimbs

Photo Credit: Thera-Paw Inc. 

Tarsal (hock) ligament sprains cause hock joint instability because the damaged ligaments allow for uncontrolled movements to occur within tarsal joint. So instead of the joint allowing just flexion and extension, there may be some side to side “wobble” occurring.

What are the physical signs of hock instability?

The physical signs associated with tarsal (hock) instability may vary depending on the number of ligaments damagedseverity of ligament sprain and whether it is an acute or chronic episode.

Common physical signs include:

✔️ Intermittent or constant limping in hindlimb

✔️ Swelling at the tarsal (hock) joint

✔️ Localised pain at the site of the ligament sprain

✔️ Mild to moderate wasting of the hindlimb muscles

✔️ Thickening of the tarsal (hock) joint in chronic cases

✔️ Favouring the hindlimb in standing

Swelling media aspect of the Hock Joint seen from both angles

Diagnosis of canine hock instability

Diagnosis is done by physical examination whereby the tarsal ligaments are manually stressed (Duerr, 2020). The short and long collateral ligaments of the tarsal (hock) joint are commonly damaged.

Testing the collateral ligament integrity is performed with the tarsal (hock) joint firstly in extension. If the lower limb moves medially or laterally when the tarsal joint is stressed in extension, this indicates damage to the long collateral ligaments (Duerr, 2020).

The second testing position is performed with the tarsal (hock) joint in flexion. Again if the lower limb below the joint deviates medially or laterally when the joint is in flexion, this indicates damage to the short collateral ligaments (Duerr, 2020).

The physical exam can be supported by stress x-rays.

The Role of Physiotherapy

Tarsal (hock) joint instabilities that are mild to moderate grades can be treated conservatively and this is where physiotherapy plays an important role.

1. Pain

The first priority when treating tarsal (hock) joint instability is to manage your dog's pain. Having a discussion with your vet regarding the most appropriate medication (eg. anti-inflammatories and/or analgesics) for your dog will ensure that they are comfortable and thus willing to use the injured hindlimb during rehabilitation.

2. Swelling

Damage to the tarsal (hock) ligaments will allow extra uncontrollable movement to occur in the joint especially with normal activities eg. walking, running and jumping. So it’s not uncommon for swelling to occur around the tarsal (hock) joint post exercise.

Cryotherapy can be used to reduce swelling. Cryotherapy i.e. cold therapy can be applied in many different ways.

✔️ Gel ice pack wrapped in a damp tea towel
✔️ Cool damp flannel
✔️ Water immersion
✔️ Ice massage (below)

✔️ Low level laser therapy (LLLT) is a non thermal treatment modality that can help reduce inflammation and swelling at the tarsal (hock) joint (Millis and Levine, 2014). LLLT achieves this by delivering light energy to the tissues which is then absorbed and converted to chemical energy within the cells, optimising cellular function (Millis and Levine, 2014).

3. Muscle Atrophy

Following injury, the muscles in the hindlimb will decondition as a result from pain and disuse

In the early stages of physiotherapy rehabilitation, this can be minimised by using neuromuscular electrical nerve stimulation (NMES). NMES selectively recruits type 2 muscle fibres, facilitating an increase in muscle mass and strength (Millis and Levine, 2014).

As muscle function improves, therapeutic exercises can be added to challenge the injured limb. The function of therapeutic exercises should focus on improving stability, proprioception and balance in the hindlimb.

4. Hock Braces

For mild to moderate cases of instability, a flexible hock brace is a necessity. The hock brace needs to allow flexion and extension of the tarsal (hock) joint plus provide stability by limiting medial, lateral and rotational movements that are available due to ligamentous damage.

It’s best to seek the advice from your animal physiotherapist as they can help you choose an appropriate hock brace for your dog’s needs. It’s important for dog owner’s to be educated on:

✔️ How to put the brace on
✔️ How long to wear the brace
✔️ When to use the brace
✔️ How to check for pressure areas

In the long term, the use of a hock brace provides a better quality of life that is less restrictive for the dog’s that have tarsal (hock) joint instability.

Photo: Thera-Paw Inc. - Custom Tarsal Wrap

Written by Susan Yuen, Animal Physiotherapist from Physio for Pets, February 2023 for Australian Dog Lover (all rights reserved).


1. Duerr, F.M. (2020) Canine Lameness. New Jersey: Wiley Blackwell.

2. Evans, H.E., de Lahunta, A. (2013) Miller’s Anatomy of the Dog. 4th ed. Missouri: Elsevier Saunders.

3. Millis, D.L., Levine, D. (2014) Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia: Elsevier Saunders.

About the Author

Susan Yuen is an Animal Physiotherapist who runs Physio for Pets in Perth, Western Australia.

Susan provides physiotherapy for a wide variety of different animals ranging from cats, dogs, horses and the occasional goanna.

Susan graduated from Curtin University in 1997 as a physiotherapist and then completed her Postgraduate Diploma in Veterinary Physiotherapy from the University of Liverpool to pursue her lifelong dream of working with animals. She is currently the Vice Chair of WA Animal Physiotherapy Special Interest Group.

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