Lameness, back pain, cow hocked, etc

[lehughes]

Hey Laurie

I am hoping you can help me with a case.

Georgia is a June 2017 model Labradoodle. In March of 2018 she started experiencing some pain in her hind end. History of bunny hopping in the rear since she was 4 months and on and off rear limb lameness,no specific side noted by owner. Referring surgeon felt that she had normal hips on xrays and very steep angles in the knees and noted a "meniscal click on the RH stifle with hyperflexion". He recommended TPLO of both knees when she was old enough and referred her to us for rehab until she was.
At that time I found that she was mildly uncomfortable with drawer on the LEFT hind leg and she was occasionally favoring the left hind. We started her on a program for core and hind end strengthening and body awareness. She started to exhibit signs of tightness and discomfort over the lumbar spine and L/S junction and bilateral iliopsoas pain and was resistant to hind limb extension. So the rehab techs sent her back to me. I found her sore over the both SI joint, PSIS on the right and sore over the piriformis. I started adjusting her and the techs continued with her program and she improved. Over the course of her rehab I found that she often had SI issues (not always consistently the same side) and discomfort with hind limb extension and in the iliopsoas bilaterally. We were treating for this with me adjusting her and the rehab techs doing her UWTM, laser and therapeutic exercises and she was improving. although she still was externally rotating the legs a bit at the sit. She can do a tuck sit on the plank or against the wall, but on her own the legs are always rotated a bit.
Then she had a setback and was favoring the left hind again, so she had an apt at her regular vet who is also the surgeon and he recommended U/S of the stifle that showed changes toboth CCL's (left worse than right and joint effusion on the left, none on the right) and she had TPLO on the left. Sept 2018. We did rehab post TPLO and she was doing very well. Then by 8 weeks post op the rads looked great, but she started to have some SI dysfunction and iliopsoas discomfort again. Improved with adjustments and laser. Once that TPLO had healed, her surgeon scheduled the other side. I felt that she had been doing fine on the right hind at that time. This time she did well initially, but then ended up having an open pustule at the end of the incision and not using the leg as well. Thesurgeon felt there could be infection and plate was removed March 2018.
She did well after this, very occasionally would still be sore over the lumbar spine and SI's if she did more burst activities. Improved with adjusting. And in June of this year she was back to full normal activity and was going to doggie daycare.

End of July she seemed sore along her back again and they started to notice that she was more cow hocked at the trot. And she was weight shifting off left hind again as noted by us when in for rehab.
By the end of the summer owner says she was limping on the right hind, but we have never seen this.

At this point she has an abnormal gait where she is more cow-hocked in the rear and short striding, I feel on both sides. And at the sit she will slightly externally rotate the hind legs, although she can sit square when on a board. I am including some video and pictures.
She is tight along the adductors, this improves with laser but then re-occures. She is PSIS on the left and sometime AS on the right. No discomfort in the iliopsoas on either side currently. When I adjust her, mom says her gait improves for a few days and then it is back to being more cow hocked again. She is not currently sore in the iliopsoas on either side. And not sore along her back. Really right now she is not sore except in the tight adductors. Laser and massage and then she is not sore. But it returns.
She is on leash only currently. And I have Mom doing weight shifting with her positioned in a square stance.

Any ideas on where we go from here?

Talk to you soon,
J

[lehughes]

Okay, so now with your case, I don’t think that the stifles were ever the main issue… certainly not so much that they are continuing to cause recurrent back troubles.

So I’d be thinking L-S instability as an additional line of thought. Try sliding / pushing L7 into the sacrum to see if you can recreate pain (i.e. pinch a nerve).
Is there a dramatic decrease in tone of the epaxials adjacent to L7?

Maybe fascial tightening - diaphragm, iliopsoas…
I find that if I’m having to do adjustments all the time, but they don’t stick, then the issue is in other tissues (ooh poignant… I might use that rhyme again one day!)
So try long prolongued stretches of hip extension while holding onto the chest and then leg stretches plus front leg stretches.
Try diaphragm releases as well.

Is she spayed? Could be intra-abdominal scar tissue tightening.
Try moving and shifting things around in there. Yes, there are specific techniques… but it’s likely just easier to say try to push and pull stuff in her abdomen to see if you find any restrictions or discomfort. (If yes, then hold and let the stretch do the work.)

I’m going to say that the L-S instability if my top pick… just my gut.

Okay, back to you!

Cheers,

Laurie