L-S joint hyperextension instability in flygility dog

[StephB]

Hi,

I would really love some help on this one. I have a 4yr 7 month old flygility and agility lurcher that has had lumbar pain on and off for over 8 months. It appears it started after he caught the lure at a lure coursing event and became tangled. He was having lumbar laser treatment at 10J/cm2 once a week and core strengthening (peanut work, belly lift with one leg lifts, working on diagonal lifts etc) and it improved but never resolved. The owner became unwell and unable to work her dog. He continued to run around and chase rabbits off lead through uneven forest terrain. She now wants him to come back into work and he now has significant lumbar pain at L-S.
I sent him to the specialist who confirmed L-S pain, especially on lordosis testing but negative reaction to tail jack. He had a CT done. Here are the findings:
Mild periarticular osteophyte formation and subchondral erosions are noted in the diarthrodial portion of the sacroiliac joints. Subtle subchondral erosions are noted in the fibrocartilage portions of the sacroiliac joints. No spinal abnormalities are noted. The soft tissues of the longitudinal ligament and dorsal annulus extend 2.3 mm dorsal to L7 in full extension which is considered a normal range. No evidence of a transitional vertebra or intervertebral disc degeneration is visible. Most of the abdomen is included and this is within normal limits.
Conclusions: There is moderate bilateral sacroiliac osteoarthrosis.

The specialist surgeon noted the SI changes but doesn't think that is the cause of his pain (of note, he doesn't react at all to DV movement of his ilium relative to his lumbar spine). The surgeon noted that although there is no evidence of significant degenerative disc disease or nerve root compression, he is concerned about the degree of subluxation that occurs when the dog is positioned in extension. The surgeons at his clinic believe this causes significant problems in dogs with these clinical signs.

At the moment, he has just had a corticosteroid depot epidural placed and is on strict rest for one week. I plan to start laser treatment twice weekly in 1 wks time. He is not allowed to chase rabbits at the moment. He will restart UWT in 1 wk also. The owner really wants to get him back to being a competitive dog and avoid surgery. Do you have any advice on exercises to avoid, exercises that are good to do. Any tips on how to engage his abdominal core better than just belly lifts (tummy tickles) during his work out? Any help would be greatly appreciated!!

Thanks, Steph

[lehughes]

Hey Steph!

So if this dog were to come to me, I would mobilize the lumber spine and SIJs.
Even if he is hypermobile, getting things moving properly and gliding can have a neurophysiologic effect to reduce pain. Do your L/S mobs in Flexion to open up the joints.
Check for SIJ pain by strumming across the dorsal SIJ ligs and the piriformis, and sacrotuberous ligament - pain on any of them indicates pain at the SIJ. Try some generic mobs (gapping, thigh thrust, etc).
Modalities and exercise won't fix this if there is a form closure issue. As well, the mobilizations will help with pain management which will mean that any exercises you do afterwards will have a better impact on strength and motor control and timing. Pain messes with all of that.

Get him doing cookies at the hip for home exercise, cookies under the chest, etc.
Don't worry about core exercises until you manage the pain in the back and SIJ. Greyhounds are the guys who are typically core-deprived.

All in all - refocus your strategy and treatments, and I think you'll note a marked improvement.

Cheers,

Laurie

[StephB]

Hi Laurie,

I was just re-reading this post to refresh my memory for these sorts of cases and I wondered what do you mean by 'form closure issue'?

Thanks,
Steph

[lehughes]

When I teach my spinal manual therapy classes, I talk about form closure, force closure, motor control & timing. Form closure has to do with the position of the joint and the normal mobility within the joint (i.e. is the joint stiff or painful). Force closure would be having adequately strong muscles (gluteals in the case of an SIJ). Motor Control & Timing, means that the key stabilizing / supporting muscles contract WHEN they need to. There are often 'timing' issues in muscles when the adjacent joints have pain... and you need to retrain them.

So, to answer your question specific to the case at hand - if the joint isn't moving properly, you need to mobilize it.

Thanks for asking!

Laurie