Laurie's Blogs.

QUESTION

Hi Laurie,

I wanted to ask you a Q if you have a moment to answer.

I don’t see many sporting dogs typically but I’m getting a run of these with what looks like iliopsoas tenderness. 

History:

Intermittent lameness with excessive exercise, responsive to rest but flares again once exercise returns. Radiographs all joints normal, Lumbar spine palpation reveals slight tenderness only. Pain on palpation of iliopsoas at ventral vertebral bodies and insertion, and pain on hip extension and internal rotation, but a couple have also been very sore over piriformis and palpation of the sciatic nerve.

Question:

What is the best way to treat: Soft tissue therapy and stretching? How long do they need to rehab (i.e. do they take a long time typically or just like any other soft tissue injury - with several factors affecting this.

Would love your knowledgeable experienced answer! Many thanks!

M.

ANSWER 

Hi M., 

So my first question is whether you are finding the tenderness unilaterally or bilaterally.  When I find it bilaterally, I tend to think either CENTRAL - back issue somewhere between T9 - S1 (facilitating the insertion of psoas minor and/or psoas major), or COMPENSATORY for offloading of either the hind end (i.e. crappy joints) or front end (same deal). 

Okay... so if you have an isolated iliopsoas strain - they are nasty!  They do take a long time... and you really have to work out a graduated exercise program that incorporates standing balance tasks, eccentrics (down hill or stair walking), perhaps even walking backwards down hills for a change, then controlled jogging, I eventually add in short distance ’burst’ (i.e. retrieved in a confined area - either in the house or in a yard just about 10 feet from the fence), then gradually increase the distance.  I’d keep the dog on leash until most of the lameness subsides, then when you are feeling gutsy, prescribe 2 or 3 minutes of off leash running within the walk... maybe allow 2 or 3 bouts of this within a walk - no other dogs (or only old boring dogs).  Progress the off leash time every 3 or 4 days if well tolerated.  My rule of thumb for progressing exercises is no exacerbation of lameness with adding the new exercise... progress every week if able - or maybe every two weeks.  You can get the dog doing all sorts of non specifics too:  walking over poles, walking across foam, crawling under poles, backing up, slow weave poles, walking with a sock/bootie on the good leg, etc, etc.  In fact it would be good to give this kind of dog owner lots of exercise ideas like that... and encourage them to find tricks / games to do with their dog (mind games, hide and seek in the house, etc)... as without their sport - both dog and owner are lost.

Beyond that, yes, whatever you would normally do for a soft tissue injury (modalities, stretching, manual therapies are all justified).  Advise the owner that these things take more time than a typical soft tissue injury (the owners will be chomping at the bit to get going... but they will be their own worst enemy if they go back too soon!).  Prep them for the potential of 3 months before gettng back to full speed... IF all goes well.  (Better safe than sorry with this group of owners - if you say 2 - 3 months, they’ll only hear 2 months.)

If you have pain at the piriformis, look at the sacroiliac joint.  That was my Masters research (still gotta submit it to be published somewhere).  I found a near 100% correlation (one toy poodle screwed me up) between measured pelvis asymmetry and piriformis pain.  It makes sense that whatever movement / maneuver the dog did to strain the iliopsoas could quite likely have put the SIJ out of whack too.  I usually find a ventrally rotated pelvis (anterior rotation).  However if it’s chronic and the dog has been holding it’s leg up / compensating, I have found dorsal rotations as well.  (The occasional cranial slip or caudal slip... but those aren’t the norm as a correlation with iliopsoas, I’d say.) 

I hope that helps!  Let me know if you have any other question.

Cheers,

Laurie