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I am seeing a 13 YO MN Schnauzer/poodle mix for right-sided medium MSI discovered by the owner who is a vet nurse. We have added on pain medications including gabapentin and amantadine as well as galliprant and he has improved significantly. However, he does also have underlying IVDD (multiple spots on his last CT scan so that neurologist related that he's not a surgical candidate).

We have him in hobbles and he is doing well - placing the limb more and more and thus, the owner would like to start rehab.

I have looked through the literature and my issue is that I cannot seem to find a good overview/step by step progression of a pet through conservative Management for MSI.
When do you take the hobbles off to progress through to 3 leg stands?

Here is my plan:
1-3 weeks: PT once weekly; Acupuncture weekly
PT includes: cross friction massage with scalenes, PROM (NO adduction or abduction)
In hobbles: 3 leg stands on stable surface
Laser therapy

4-6 weeks: PT once weekly; Acupuncture weekly
PT added on:
In hobbles: three leg stands with theraband pull; front limbs elevated and not elevated
push up
side stepping
figure eights
wheel barrow
back up hill

Thoughts?

Warmly,
Jessie

Hi Jessie,

I love conservative management of MSI cases. So, firstly, on FourLeg, you'll find:

Articles
Protocol: Medial Shoulder Hypermobility


Video Training
Video Training 05: Bandaging for Medial Shoulder Instability

Video Training 07: Assessing for Medial Shoulder Joint Instability

Video Training 170: Medial Shoulder Exercises Part 1

Video Training 171: Medial Shoulder Exercises Part 2

Video Training 172: Medial Shoulder Manual Therapies

So, you don't say how long the dog has been in hobbles. But I'm going to say that I prefer getting the dogs into a bandage versus rigid hobble as soon as possible. I think hobbles have a role to play post-operatively, but not conservatively. An Ace Bandage / Tensor bandage wrap will do better to support the joint while stimulating the muscles to work to support the joint.

You go with success in order to figure out when to progress. I say start a new challenge with the wrap on. When that is successful, then take it off to do the same exercise. If that is successful, the progress to a harder exercise with the wrap on. Progress to same exercise with wrap off.

I also use clinical function to decide when to progress. Is the dog no longer lame? Or not lame when a certain exercise is added? If so then you can likely progress. If lameness (of some degree - maybe just a few steps with a head bob then normal) is worsened with the new exercise, then either stick with it or back off a wee bit before adding in the new challenge.

With your plan - I would add medial and lateral glides to the GH joint. You are NOT getting the medial compartment to shorten (as you would with a surgical intervention). You are instead wanting the muscles to take over function. You want the joint to settle (in regards to inflammation or pressure within the joint). And you want to protect joint cartilage. So if you are doing 3-leg stands with hobbles - I'd say that's week 1 only. Progress as soon as able to diagonal leg stands. Progress to using an ace wrap vs hobbles. Stretch the scalenes versus friction massage (target lengthening versus a technique designed to break down scar tissue / adhesions).

I'd likely progress faster. Maybe 2 week increments versus 3. And think of your progressions as: 1. isometric first (3-leg stands, x-leg stands) - stable then wobbly, no resistance then theraband resistance. 2. Concentric control (step ups, side stepping, weaves / figure 8's. 3. Eccentric control & strengthening (down hill walking, push ups) 4. Dynamic challenges (faster weaves, challenging balance, short retrieves) - this is your end stage.

Does this help? It's impossible to say exactly what to do. The individual patient's abilities, tolerance, etc have to come into the prescription.

Cheers,

Laurie