Laurie, thank you so much in advance for letting me consult with you on this one patient!
Dino is an 8-month old Whippet presented to me for evaluation of his lameness last week. He was accidentally injured by a scalpel blade when he was delivered via C-section. The wound had gotten severely infected early on so the injured site had to have multiple debridement and suturing. It took the wound three weeks to heal.
About two weeks ago, Dino fell over onto the ground after strenuous play with other dogs in the park and started limping on the left pelvic limb. He was seen by his regular vet, who diagnosed him with a sprain and referred the dog to us. After being on meloxicam for a few days, Dino got back to normal, but is still under restricted activity (no running or playing with other dogs).
On gait analysis, he looked semi-normal upon walking. Upon trotting, we noticed him circumducting his left pelvic limb crossing the midline.
On an orthopedic exam, significant muscle atrophy of his left caudal hip muscles was noted (Please see picture). The entire area where muscle atrophy was noted was very taut and hard like callus unlike right caudal hip which was firm but supple as normal muscle should be. He had decreased ROM of left hip joint (decreased extension) and decreased flexion of the stifle joint. His iliolumbar muscle looked equivocally hypertrophied (it is a muscular breed, so it was hard to tell).
We started him on laser, massage over the hardened area then UWTM exercise.
The questions I have for you regarding treatment for Dino are:
1. Could massage/myofascial release along with laser treatment over a few months release the scar tissue and resolve the muscle contracture and allow full development of the left hip muscle or would surgical release of the scar tissue be necessary for him to develop left hip muscle and develop normal ROM of left hip joint? If you think massage is beneficial to this dog, could you please give me tips on the type of massage technique you would use and the duration and frequency of the massage sessions for them to be effective in helping realign the scar tissue properly? Owner would like to avoid surgical intervention if possible.
2. I am considering using therapeutic ultrasound to help with the abnormal scar tissue and suspected contracture of the hip muscle. What do you think about the use of therapeutic ultrasound? I wanted to use higher heat to heat up the muscle for effective stretching of the contracted muscles.
3. This dog is from a racing line (both parents are competitive racing dogs). Dino loves running, and the owner would like to get him involved in racing as a hobby (not competitive racing but more as his hobby). Do you think we may be able to rehabilitate him to the point he could run or hunt?
4. If you have any advice or suggestions that I can incorporate into his treatment to help him, I would greatly appreciate it.
Thank you so much in advance for your input. .
Scar tissue lameness?
Scar tissue lameness?
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Re: Scar tissue lameness?
Okay, so my first question back to you is what did the dog look like before this new injury. Has there always been this dramatic of a difference from side to side?
Given the history, I would think maybe on the fall, he tore some of the scar tissue in the area. I once saw a horse that had slipped on ice and tore her tensor fascia lata muscle, and her leg crossed under her as you describe. So my second question is whether this new dysfunction is because of an injury to the muscle or network of scar tissue that was enabling function to glutes and or TFL or whether the presence of all of the scar tissue is the primary issue? In other words, what is the acute part of this case and what is the chronic part? I think you are still searching for the answer to what is the acute part of this injury. And of course the other pieces of the puzzle - how is the SIJ? and how is the iliopsoas? As those would be the other two components that could be at the root of the acute injury at hand.
So really you have a two part problem.
The scar tissue is part of your chronic problem.
So, you could use Ultrasound if you have one (and hooray, he’s a greyhound with a short coat, so you are less likely to overheat the hair.) You’ll need at least 1.0W/cm2 for 10 minutes. I wouldn’t go higher than 1.5W/cm2. My gut says aim for 1.2.
Massage / Myofascial release would include fascial stretches. Starting superficial and then working deeper, (i.e. for superficial you can use the heal of each hand push them into the tissue just enough to engage skin and the first layers of fascia and then separate them away from each other.) You can move deeper and deeper into the tissues. If you find a particularly knotty bit then you can do the same with two thumbs. Between those techniques you can do any kind of sweeping effleurage. Other myofascial techniques are anything that would ‘bend’ the tissues (i.e. hands moving in different directions), reminding yourself to go slow and steady, which is what fascia responds to.
Yes to laser if you have it and/or shockwave, and of course any passive or active stretches that you can get the dog to do. Dry needling into the scar tissue also seems to work well. I would consider e-stim as well - over the glutes (or TFL, or Hamstrings, or vastus lateralis) with the weight shifting or 3-leg stands.
I wouldn’t even contemplate a surgical release of anything until you give it a try first. Surgery causes scarring as well… so it might not be as permanent of a solution as you would think (at least not in some cases).
As for racing. That’s a toughy. A dog this imbalanced from side to side could run for fun, but because he is compromise / asymmetric he is also more likely to injure himself (either an accidental specific injury or compensations that develop over time because he is having to deal with his left sided limitations). So the answer is sort of a yes and no… maybe a trial and error… maybe a wait and see.
Within your treatments being done, I’m not sure you are gaining much from the UWTM, unless you are seeing that he uses the leg more in the UWT than he does on land. If not, then I think you could use your clinic time better with the other therapies and prescribe glute / limb building exercises for home.
I think I got all of your questions. I hope this helps a bit.
Back to you in regards to other thoughts on what was injured acutely.
Cheers,
Laurie
Given the history, I would think maybe on the fall, he tore some of the scar tissue in the area. I once saw a horse that had slipped on ice and tore her tensor fascia lata muscle, and her leg crossed under her as you describe. So my second question is whether this new dysfunction is because of an injury to the muscle or network of scar tissue that was enabling function to glutes and or TFL or whether the presence of all of the scar tissue is the primary issue? In other words, what is the acute part of this case and what is the chronic part? I think you are still searching for the answer to what is the acute part of this injury. And of course the other pieces of the puzzle - how is the SIJ? and how is the iliopsoas? As those would be the other two components that could be at the root of the acute injury at hand.
So really you have a two part problem.
The scar tissue is part of your chronic problem.
So, you could use Ultrasound if you have one (and hooray, he’s a greyhound with a short coat, so you are less likely to overheat the hair.) You’ll need at least 1.0W/cm2 for 10 minutes. I wouldn’t go higher than 1.5W/cm2. My gut says aim for 1.2.
Massage / Myofascial release would include fascial stretches. Starting superficial and then working deeper, (i.e. for superficial you can use the heal of each hand push them into the tissue just enough to engage skin and the first layers of fascia and then separate them away from each other.) You can move deeper and deeper into the tissues. If you find a particularly knotty bit then you can do the same with two thumbs. Between those techniques you can do any kind of sweeping effleurage. Other myofascial techniques are anything that would ‘bend’ the tissues (i.e. hands moving in different directions), reminding yourself to go slow and steady, which is what fascia responds to.
Yes to laser if you have it and/or shockwave, and of course any passive or active stretches that you can get the dog to do. Dry needling into the scar tissue also seems to work well. I would consider e-stim as well - over the glutes (or TFL, or Hamstrings, or vastus lateralis) with the weight shifting or 3-leg stands.
I wouldn’t even contemplate a surgical release of anything until you give it a try first. Surgery causes scarring as well… so it might not be as permanent of a solution as you would think (at least not in some cases).
As for racing. That’s a toughy. A dog this imbalanced from side to side could run for fun, but because he is compromise / asymmetric he is also more likely to injure himself (either an accidental specific injury or compensations that develop over time because he is having to deal with his left sided limitations). So the answer is sort of a yes and no… maybe a trial and error… maybe a wait and see.
Within your treatments being done, I’m not sure you are gaining much from the UWTM, unless you are seeing that he uses the leg more in the UWT than he does on land. If not, then I think you could use your clinic time better with the other therapies and prescribe glute / limb building exercises for home.
I think I got all of your questions. I hope this helps a bit.
Back to you in regards to other thoughts on what was injured acutely.
Cheers,
Laurie
LAURIE EDGE-HUGHES