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Hello Laurie,

I have a patient with another problem that I'm hoping you can give me suggestions on. A 1 yr old Lab came to me to check for cruciate issues. His history is that he has had a couple of incidents when he is rough housing with the other dogs or jumping around the owner to get attention and comes up lame on the LR leg. The last time it took him a good 24 hr to get back to normal walking. On exam I could not find any restrictions or obvious pain in joints or muscles. He sits square and I didn't find any hip or iliopsoas pain. The owner wanted to do x-rays to make sure the hips were ok and then decided since I would be doing them sedated to send them to OFA for preliminary screening. At the last minute she noted that each time he shows this lameness she finds a large lump on his inside thigh which goes away with the lameness. 

I feel that the L hip is slightly lax and did find a positive Barden's sign. However, with the lump the owner described I'm thinking he is getting a muscle cramp in the gracilis or semimembranosus muscle. We talked about doing exercises to strengthen the gluts to hopefully hold the hip tighter as he keeps developing over the last year, but I also wanted to do something to work on stretching the inner thigh muscles and avoid these cramps. I also feel that toning the core is important in all programs so will use the exercises from the blog today.
For the inner thigh stretching I can only think of a PROM stretch where the dog is side lying on his right side and the owner straightens the stifle and flexes the hip by moving the toes toward the front leg and then abducting the leg. However, I expect AROM is better. Yes? I can think of AROM exercises, but it is not stretching, but contracting the muscles such as the rear legs standing on books (maybe all 4 on books) and gradually pull the books apart so that the inner thighs tighten supporting the dog.

Other ideas? Corrections?
Thanks for all you do. 

CC

Hi C!

Thanks for the support regarding the blogs!  It’s sure been interesting!!
Just for you, hot off the press, I’ll attach a pdf document of the Strengthening The Core document.  I think I’ll put it up on FourLeg as a bonus for members as well!

Okay, so now for your patient.

I think you have to wonder if the hip is your red-herring.  Sure, your thinking makes sense (potentially), but in that scenario, I would think that a ‘tight muscle’ / lump would have to be pectineus, since the others don’t react with hip pain / hip laxity.
So then, to add to the differentials, I’d wonder about primary strain of Gracilis (1st choice) or Adductor (less likely, in fact, highly unlikely), okay, so my second choice would be semi-membranosis instead.

Try stretching and compare side to side… Leg forwards like a hamstring stretch, but then abduct about 45 - 50 degrees or so.  Is there a difference from side to side.  
Palpate the length of the muscle, compare from side to side - feel for any fibrosis / ropey-ness… be sure to get up high and touch the insertion as well.

IF the trouble is primary gracilis, then Passive stretching is fine.  Then working on exercises that incorporate speed and turning to the contralateral side as the injury (i.e. racing greyhounds) - how exactly to do that will depend on what this dog and owner know in regards to training and activities, and how much the dog knows.  So that means, you’ll have to have a conversation about it to figure it out!

I agree with you in regards to strengthening the hip.  I think that these are the cases that we can prevent further CHD development. Lots of strengthening!!!

If you wanted to play with ‘active-assisted’ stretching, I’d put the dog up onto 4 blocks and position them so that you have the ‘affected’ hind limb abducted and forwards of the ‘non-affected’ hind limb.  But then I’m not 100% convinced that this will achieve what you want it to.  So maybe, if you want to try it, just incorporate it periodically, and see what you think!

I hope this helps!

Cheers,

Laurie