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The Case:

KIRA (Jack Russell breed, 6 y.o., weight 6'20Kgs. Sterilised at 6-7 months old)

She's been an agility dog all her life and enjoys it a lot. December 30th 2016 had an accident (her puppy fell just on her lumbar spine and hurt her). Nothing on the radiographs, treated with NSAIDs + muscle relaxant for 2 weeks. Fully recovered from her lumbar spine pain, started a lameness on RHL.

- Clinical History:
2 y.o. RHL patella subluxation = Vet treatment: NSAIDs 1'5 months + Fortecortin + 1 month rest and conditioning slowly.
Pregnancy on 2014 (nowadays she's living with her little boy named Tapón (the one who fell on her back on January)
- Actual medication: Cosequin
- Home environment: slippery floor, with stairs only at the Car park
- On her first physical examination (Feb 4th 2017) we found: knock-kneed HLs, arched carpal joint. Hardly let us evaluate right patella + tarsus crepitus. Pain at palpation sacrum and lumbar area (L3 to L5). Not able to evaluate hip extension and sacrul flex. Gulick FLs 11cm bilateral, RHL 18cm LHL 18,5cm

She used to have agility trainings twice a week + competitions some weekends. Within 2 weeks she's having her last agility competition before retiring. After few sessions we gain muscular balance (Gulick July 8th 2017: RHL 20cm, LHL 21cm), still pain at L3-L4-L5 palpation but not at any sacrum ROM.
Owner does stretchings and exercises at home and the weird thing is that when she's on the street, Kira is limping RHL only between walk and trot gait. At cornstach test everything is perfect, perfect stance...At the pool we did cavaletti backwards on a mat on the water and she does it perfectly. When we finished exercises , RHL limping again but when coming into the area of exercising her gait is perfect again. And now after 3 days she's lameness on LHL few seconds randomly. When rechecking nowadays Kira has pain only at right iliopsoas palpation, but if we do exercises to stretch iliopsoas actively she does them perfect too. No complain at all, no soreness after exercising.

We don't know what else to do, test, or recommend to the owner and within 2 weeks she's having her last competition where we are afraid that maybe they won't allow her to compete if they see she's limping at some point before trotting. Do you have any idea of what we could do??

I.F.

Hello I,

Okay, so it sounds to me like the back pain and the iliopsoas pain are likely secondary to an Sacroiliac joint dysfunction. You say the sacrum doesn’t move… and I think that’s a big issue. It may also be contributing to a worsening of the patellar issue. If the SIJ isn’t moving properly and is painful, dogs will often roach their backs - causing a sore area in their back further up, and over using the iliopsoas as well (or the iliopsoas is irritated because of the back pain) - either way, it sounds like the iliopsoas is not primary. An SIJ problem with pain at the joint and at the piriformis muscle can reduce the strength, timing, and contractility of the gluteal muscles, which in turn can worsen a patellar issue - the glute is needed to stabilize the entire leg, not just the hip and SIJ. As well, an SIJ issue, causing a gluteal timing/strength/motor control issue can also impact coordination for the abdominals and cause core stability issues. I’ve seen dogs lose their ‘timing’ when they trot (sort of like the back end isn’t keeping up) and they need to do a little skip to re-align the timing.

So… work more on the SIJ. I’d use the thigh thrust technique - several times, and with varying pressure. Check for positional asymmetry of the pelvis. (See the video and the paper on the topic on the FourLeg Membership Website). Video Training 17, The Article - Canine Sacroiliac: Hip and SI disease. Once you get some movement at the SIJs then also check & work on Motor Control & Timing. - See Video Training 16. I assume you’re also doing some mobilizations of L3 -5. I’d do flexion mobs, some specific traction, transverse pressure on the spinous process in flexion, and tail pull traction for home.

In my head, she is very much a case for manual therapy!

Cheers,

Laurie