Laurie's Blogs.

Hi Laurie

I have my Monday mornings set as rehab review!  Thank you for your website and the work that you do to further rehabilitation continuing education.

I am a recent technician CCRP and work part time in a rehabilitation practice and part time in a general practice.  One of my rehabilitation clients has had a Tibial Tubercle Advancement (TTA) on each hind (Female spayed, 4 year old chocolate lab with a 4/5 body score).  Her first TTA had a summer recovery and progressed very well, like a text book.  The second TTA is a winter recovery in Canada where we have had snow, melting, ice and more snow.  It is hard for mom and dog to go out safely to walk as the walking paths are not always ice free.  The pet is doing more flexing walking through the snow (a good exercise) however there are some lateral slides even with all the walking precautions taken.  This stifle is recovering a little slower with some minor set backs.  We are just 7.5 weeks out and I am getting some pain and 1/5 weight bearing lameness on the recent surgery leg.  The hamstrings are very firm on both legs and the quads on the recent surgery leg is slightly decreased in mass and not as toned as the other leg.  There is a 1.5cm thigh mass difference between the surgery and non surgery leg.

I cannot illicit sacroiliac joint pain but I can see that she does hike the surgery leg up some and I worry that she may need an adjustment.  I have the client doing some pain control for 2 weeks and gentle exercise at home and increase the laser and UWTM to weekly for 2 weeks to see if we can catch up on the ground lost.

Is it probable to have a SI injury with carrying one leg a little higher and not weight bearing equally?

Thanks

LG

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Hi LG!

I'm glad to be spending Monday mornings with you!!

As for your case...  I find that SIJ dysfunctions are more likely caused from a slip, fall, hit, etc... but hiking a leg for a prolonged period of time could result in some kind of back dysfunction.  Usually however, I find that it tends to affect L5 - L7 more often than the SIJ... but I always check the SIJ.  Testing for pain is a good place to start... so the strumming of the SIJ and/or piriformis muscles work for testing pain at the SIJ and pushing downwards and then from either side on the L/S spinous processes would tell you about the lumbar region.  1.5 cm difference if not too shabby at 7.5 weeks post op.  Good job!  When I see things go a little sideways at this point in time, I start to question - meniscal derangement, implant problem (i.e. broken screw), BackPain, or worse case - infection at the plate... yes this late, or could be a slip related muscle pull (likely iliopsoas, maybe pectineus), or MCL / LCL sprain.  I'd also target management of triggerpoints in the quads/sartorius and/or iliopsoas because of the slight off-loading positioning... Lasering this region may help.

When the dog is a bit more sound, I get them  into 'bootcamp' around this time... and engage in more advanced strengthening:

Step ups, Squat blocks, sit to stands facing uphill, backing up, Trotting over poles etc, destination jumping (onto a platform or over a jump), rear legs only on a land treadmill, backwards on a land treadmill, Weave poles, tug of war, play keep away...

I find that the one-leg higher thing can be common.  And they do usually rehab better on the first leg than the second leg... which is where bootcamp can help them to 'change their brain' about using the leg.  From that perspective, I might also suggest simply putting a bootie on the good leg when the owner takes the dog our on any walk... just to change the focus to the 'newer surgical leg' being the stronger one.  BUT... you are doing the right thing by trying to get the pain under control first.

I hope this helps!

Cheers,

Laurie