Hunching puppies

[backontrackvetrehab]

It's weird how cases come in multiples...
I've seen a few younger dogs (10-18mos) lately who have presented for tucking of the rear end, low tail carriage, reluctance to sit, etc. Thus far they have all have been working dogs (guide dogs, service dogs, etc) and Labs or Goldens. I have found lumbar and SI issues generally, and most have responded to pain meds, manual therapy, Acupuncture, and therapeutic exercises, although one of them has only showed minimal improvement so far.

I have another similar case on the schedule to come in the next few days, but this one is an 11 month old intact female Doberman that sounds more severe than the others - she won't stand for more than a few seconds before lying down, may be constipated, has an extremely tucked posture all the time, and the owner report audible popping (not sure from where) when she moves. Apparently she has been like this for several months. She also has a history of vaginitis, dietary indiscretion and false pregnancy so I certainly cannot rule out an abdominal pathology as a primary cause, but am also planning to closely evaluate her hips, stifles, lumbar spine and pelvis. Sounds like an interesting case, so I figured I would put my feelers out there and see if anyone else has seen cases like this and if there are any other thoughts I might consider with them?

Thanks,

Joni Greenberger, DVM, CCRT, CVA

[backontrackvetrehab]

Wow. what a crazy case. This dog's lumbar spine from about T13 through L4 is completely stuck in severe flexion, with no mobility at all, but also less pain or spasticity on manipulation of the spine than I would expect. The pelvis is extremely flexed with almost no SI motion and the tail is hyperextended. Almost no sacral motion as well. Her hips, stifles, tarsi, all have good ROM and she compensates for the lumbar and pelvic flexion with hip extension. She has a very difficult time lying down and has figured out how to lie down with her front limbs on a chair while standing in the back end. She cannot sit at all. Very tight in the quadratus but not the pectineus or iliopsoas. Wide based stance in the rear but CPs normal and rear limb reflexes normal as well.

On radiographs, her R SI joint is definitely narrower than the L, and it looks like there is some wedging at L4-5 and some facet changes at L2-3. The L ilium appears to be a little bit caudal to the R and both are rotated dorsally relative to what I would consider normal. its very hard to visualize the sacrum, but it doesn't look normal. Interestingly, at 10 months old, all of her growth plates appear to be closed. (just attached the rads!) My initial thought is that the pelvic/sacral misalignment may have happened traumatically in the process of birth or shortly thereafter, and that the lumbar flexion is secondary, but I suppose it could be the opposite too.

Incidentally, she also has "that Doberman head bobbing" thing which she was doing for over a minute during the exam (looked like a focal seizure). The owner has been told that this is normal by other veterinarians, but in light of everything else, I'm not so sure... The plan as of now is to get her spayed to rule out any underlying reproductive etiology and to start doing regular Acupuncture (+/- electro) and manual therapies to see if we can get things aligned better. I'm also doing a trial of Gabapentin to cover neuropathic pain due to presumed nerve root pinching. Of course she is a typical puppy, wiggly, dramatic, and easily stressed, so we'll see how successful we are with this plan! Has anyone else seen something like this? I'd love any thoughts or input anyone has on this case!

Joni

[lehughes]

Hi Joni!

Thanks for posting! Super interesting case!
So, I have found that a number of dogs have or develop a 'rounded back' during their first 1 - 2 years subsequent to a lumber spine or sacroiliac joint dysfunction. I think the pain makes them roach and then they grow that way. 50% of the puppies I evaluate when I do puppy litter assessments have some sort of axial skeleton dysfunction. I figure that the worst ones of those could be the ones that would turn out like your doberman if left untreated. (Potentially). The roaches are harder to correct the long they have been that way (I figure that all of the ligaments & soft tissues on the ventral surfaces of the spine become shorted and taut... hence giving you that solid / rigid sensation to move, motion, glide the 'roached' spinal segments.

So, firstly, to answer what I'd do with the more typical ones (i.e. not the doberman just yet), I mobilize the SIJ, L/S & whatever else seems to be the primary issue. Then I do a bilateral dorsoventral pressure with a sustained hold (i.e. grade 4 sustained hold) to try to 'stretch out' the ventral ligaments. Additionally, I like to prescribe extended planks. (i.e two cinder block fronts on one, rears on another, and then slowly stretch them apart so that the dog is using abdominals but had a flatter back appearance. I'd have the owners do this with the dogs... to try to gain endurance in this posture, and to try to get some 'volitional' flattening of the back. Any other extension exercises might help as well: Lovin' on the stairs, crawling under, walking UP hill. Most of the ones I've seen have come along. But I've not seen anything that looks / sounds as bad as your doberman!

So for the doberman, I'd agree that my guess would be that she was 'messed up' from infancy to have grown this way! I think your plan is perfect actually! She'll be one of those cases where you try thing, learn things, and modify along the way.

Keep us posted!
Laurie

[backontrackvetrehab]

Thanks Laurie!

I'll keep you posted on the Doberman...One of my other cases is an English Cream Retriever Autism Service Dog (currently in the puppy-raising phase) who does fine with exercises but has a really hard time getting up from a down position. He holds his tail very low, misses jumps, and is kyphotic through the lumbar spine. Radiographs of the hips and lumbar spine are normal. He has flexion at both SI joints with heat and pain there, as well as some compensatory restrictions at L2-5. He is very uncomfortable with muscle wasting around the tailbase as well even though ROM feels good. We started him on Gabapentin, Glucosamine, and omega fatty acids, and have been doing manual therapies, acupuncture, and LASER for the past month but have not seen as much improvement (mostly in terms of the altered posture when standing up from a down position) as the caretaker hoped for. It sounds like he does better for a couple days after treatment, then goes back to his status quo. He is no longer visibly lame but is still kyphotic with low tail carriage and weight shifted forward. What I'm wondering is if you think it's reasonable to expect that we can get these dogs to totally "normal" if this is a conformational or neonatal issue? Or should we work on trying to have more reasonable expectations for what rehab can accomplish in these cases?

Thanks,

Joni

[lehughes]

Hey Joni,
With your service dog... I'd go back to check on those SIJ's and the sacrum, and the first few coccygeal vertebrae. In fact, I'd do a trial of a number of generic techniques in these areas if you're not 100% sure on a dysfunction. I'd add tail pulls too.
If he's still a puppy, I think there is still room for improvement.
Before chalking it up to conformation, I'd try to 'think outside the box' and work on things that would typically cause pain in the sacrum, tail base, SIJ's, L/S. Lots of manual therapy!
Hang in there and just start 'trying stuff' on him!

Good luck!
Laurie