Merlin is a 3 year old MN pitbull, border collie, cattle dog mix. He does dock diving and agility and is a very active, muscular dog. He became suddenly painful after an agility class 11 weeks ago. He was painful on palpation of his LS and R SI and unable to walk up stairs. He would intermittently chew at the R hind and had a subtle R hind lameness, he has dribbled urine a few times. Rads were fairly unremarkable, maybe subtle tipping at his LS. 4dx negative. He has penn hip from last year DI L 0.29, R 0.31 with no evidence of OA. He improved with carprofen, gabapentin, methocarbamol, Clonidine (behavioral), laser, Assisi loop, acupuncture (to patient tolerance) and strict crate rest for 2 weeks. Rehab (core strengthening, leash walks) was started, gabapentin and Clonidine was continued. After 5 weeks, he was doing well-walking 3-4 miles with no lameness or soreness, he was given 5-10 minutes of off leash yard time and became mildly painful again. He was exercise restricted and 2 weeks later an MRI was performed
7 weeks post initial injury
MRI and Depomedrol epidural
MRI report Conclusion:
1. Dynamic mild lumbosacral stenosis due to disc protrusion and spondylolisthesis without evidence of cauda equina neuropathy.
2. Bilateral dynamic moderate lumbosacral foraminal stenosis with moderate to marked right L7 radiculoneuropathy and mild left L7 radiculoneuropathy.
The degree of abnormal hyperintensity in and/or around the right L7 nerve would explain the persistent right pelvic limb lameness. It is suspected that there has been acute dynamic and/or recurrent trauma to the L7 nerves. No evidence is present to suggest there is concurrent iliopsoas disease.
He is my own dog and I am wondering how likely it is to get him back to agility. He was very fit and strong with good core strength prior to this injury. He is also very high drive and needs to work. I have seen working dog studies showing 50/50 return to work with medical therapy and up to 90% with surgical. Would this be the same for agility?
Right now, he is comfortable with no obvious lameness with a 4 mile walk/trot. His rehab to this point has been focused on balance, standing on unstable surfaces, sit/down/stand, stretching with ff on peanut, 3 legged stands, figure 8’s, weave through cones. I still see a significant weakness with him with diagonal leg lifts especially standing on the right hind, otherwise I have a hard time finding weakness. He used to be a very strong tugger and he has not wanted to pull back and tug yet.
1. I was hoping to get more exercise ideas to target his paraspinal muscles and any other favorites you might have. I would also love advice on when to decide to make things harder for him.
2. At 12 weeks post injury should I be able to allow for more twisting activities (spins, twirls etc) or wait until I improve the diagonal leg lifts? When should I be brave enough to let him off leash in a small yard again?
3. Do you think there is significant benefit in utilizing an UWTM once a week? I have a land treadmill and can also run with him.
4. What would you recommend as lifestyle restrictions long term (ie. dock diving etc)?
I have watched your great videos on the LS and SI mobilizations and he responded well. I am trained in acupuncture and chiropractic and more recently rehabilitation. I have never rehabbed an LS injury and want to be sure I give him the best chance to return to agility or at least an active hiking/running/swimming life. I look forward to your advice.
Julie
LS disease and L7 nerve root compression
Re: LS disease and L7 nerve root compression
Hi Julie,
I'm sorry you're going through this with your own dog!
So, from what I've seen and read, I would not be quick to jump into surgery... but that's okay, lots to work on before having to make that decision!
I have a few dogs on treatment with L-S disc disease.
My gut feeling is that agility, especially competitive agility, could be problematic for the long run. However... I am happy to be proven wrong.
My goals would be: Pain Management, Reduce Inflammation, Strengthening & Conditioning, and Symptomatic Treatment as needed... with the hope that spondylosis helps to stabilize the region while there is still good intervertebral disc spacing.
Rehab Treatments: Laser, acupuncture, Shockwave, PEMF, Mobilize SIJ and L5, 6, 7, S1 region, Tractions, and perhaps Nerve Glides (see Adverse Neural Tissue Tension videos on FourLeg)...
Specific Rehab Exercises:
The Pelvic Tilt exercise in sternal recumbency to retrain control in extension and low impact squishing of nerve (note: nerves should be able to tolerate a little bit of squish, poke, traction, etc... but an inflamed nerve doesn't have resiliency to these stresses.)
Balancing / Stability: I'd do the 3-leg slides with stimulation of the abdominals to address core stability. When this is good, then progress to the diagonal leg stands.
Think Abdominals instead of Epaxials in strengthening...
Return to Sport Mindset:
SLOW DOWN your progressions... and test along the way with SMALL activities.
Stop the strict crate rest restrictions. Go with relative rest, versus 'time'-related strict rest. So, I'm thinking, reduce what caused a flare, treat with therapies, and start adding in exercises as soon as the acute pain is gone.
Try Easier Sports first - Scent Hurdle, Flyball, Rally-Obedience, Scent Detection, Tracking. (MAYBE these will just be gateway sports to get back to Agility, or Maybe they become his new sport(s)...)
Instead of thinking Lifelong Restrictions... see how he does with therapies. To speculate Lifelong restrictions NOW is to just guess... (and I'm not sure dock diving is harder on the L-S than Agility). So, let's just see how it goes.
Now, as for your other questions, not addressed already.
1. Don't worry about epaxials... and maybe minimize the ff on peanut stretch - as it likely increases the extension and potential pinch on the nerve roots / cauda equina... And I don't think it's adding to what you are trying to accomplish. IF you want to stretch / strengthen iliopsoas, then do the eccentric version (back feet on step, front feet on floor and reach out and forwards to get a treat and then come back to neutral).
2. When he's not acute, you can allow some off leash time in the yard... but start with 5 minutes and just see. You may need to do tail pulls afterwards. Think about 'test an activity' and proactively treat to reduce inflammation... until the nerves increase their resiliency.
3. UWTM offers you nothing in this case.
4. Lifestyle restriction, have yet to be realized.
I think I hit on all of the things I wanted to say / point out / discuss.
I hope this helps to get you thinking in a helpful direction!
Cheers,
Lauri
I'm sorry you're going through this with your own dog!
So, from what I've seen and read, I would not be quick to jump into surgery... but that's okay, lots to work on before having to make that decision!
I have a few dogs on treatment with L-S disc disease.
My gut feeling is that agility, especially competitive agility, could be problematic for the long run. However... I am happy to be proven wrong.
My goals would be: Pain Management, Reduce Inflammation, Strengthening & Conditioning, and Symptomatic Treatment as needed... with the hope that spondylosis helps to stabilize the region while there is still good intervertebral disc spacing.
Rehab Treatments: Laser, acupuncture, Shockwave, PEMF, Mobilize SIJ and L5, 6, 7, S1 region, Tractions, and perhaps Nerve Glides (see Adverse Neural Tissue Tension videos on FourLeg)...
Specific Rehab Exercises:
The Pelvic Tilt exercise in sternal recumbency to retrain control in extension and low impact squishing of nerve (note: nerves should be able to tolerate a little bit of squish, poke, traction, etc... but an inflamed nerve doesn't have resiliency to these stresses.)
Balancing / Stability: I'd do the 3-leg slides with stimulation of the abdominals to address core stability. When this is good, then progress to the diagonal leg stands.
Think Abdominals instead of Epaxials in strengthening...
Return to Sport Mindset:
SLOW DOWN your progressions... and test along the way with SMALL activities.
Stop the strict crate rest restrictions. Go with relative rest, versus 'time'-related strict rest. So, I'm thinking, reduce what caused a flare, treat with therapies, and start adding in exercises as soon as the acute pain is gone.
Try Easier Sports first - Scent Hurdle, Flyball, Rally-Obedience, Scent Detection, Tracking. (MAYBE these will just be gateway sports to get back to Agility, or Maybe they become his new sport(s)...)
Instead of thinking Lifelong Restrictions... see how he does with therapies. To speculate Lifelong restrictions NOW is to just guess... (and I'm not sure dock diving is harder on the L-S than Agility). So, let's just see how it goes.
Now, as for your other questions, not addressed already.
1. Don't worry about epaxials... and maybe minimize the ff on peanut stretch - as it likely increases the extension and potential pinch on the nerve roots / cauda equina... And I don't think it's adding to what you are trying to accomplish. IF you want to stretch / strengthen iliopsoas, then do the eccentric version (back feet on step, front feet on floor and reach out and forwards to get a treat and then come back to neutral).
2. When he's not acute, you can allow some off leash time in the yard... but start with 5 minutes and just see. You may need to do tail pulls afterwards. Think about 'test an activity' and proactively treat to reduce inflammation... until the nerves increase their resiliency.
3. UWTM offers you nothing in this case.
4. Lifestyle restriction, have yet to be realized.
I think I hit on all of the things I wanted to say / point out / discuss.
I hope this helps to get you thinking in a helpful direction!
Cheers,
Lauri
LAURIE EDGE-HUGHES
Re: LS disease and L7 nerve root compression
Thank you Laurie for your thoughtful reply! I really appreciate all the information you gave me.
I have incorporated the stretches and changes you suggested and he is still feeling well.
He even tugged this week with a decent pull back!
He does the 3 legged slide test on the flat well. I elevated his FF to challenge him more as he is still struggling with the diagonal leg lifts-I need to train a single rear leg target as I think sometimes its his lack of understanding of the exercise along with it being hard for him...
I did enroll him in a Scentwork class, but I still want to try to get back to agility.
I was going to use your return to sport checklist as a guide of when to start his retraining. We are not quite ready yet. His muscling is almost symmetric, but his core still needs more work.
When it comes to retraining for agility I was thinking that straight lines would be easier than turns. So straight line jump grids to start for coordination and managing his stride, power and speed. If he does well with that for a week, add some cone wrapping work-2 cones 8-12' apart to control his speed, but allow him start to bend and maybe also have a low height, bending jump grid that also doesn't have much speed involved. He measures to jump 20" so I was planning on a month of 8, 12, 16" progressions. Does this make sense?
Thank you again,
Julie
I have incorporated the stretches and changes you suggested and he is still feeling well.
He even tugged this week with a decent pull back!
He does the 3 legged slide test on the flat well. I elevated his FF to challenge him more as he is still struggling with the diagonal leg lifts-I need to train a single rear leg target as I think sometimes its his lack of understanding of the exercise along with it being hard for him...
I did enroll him in a Scentwork class, but I still want to try to get back to agility.
I was going to use your return to sport checklist as a guide of when to start his retraining. We are not quite ready yet. His muscling is almost symmetric, but his core still needs more work.
When it comes to retraining for agility I was thinking that straight lines would be easier than turns. So straight line jump grids to start for coordination and managing his stride, power and speed. If he does well with that for a week, add some cone wrapping work-2 cones 8-12' apart to control his speed, but allow him start to bend and maybe also have a low height, bending jump grid that also doesn't have much speed involved. He measures to jump 20" so I was planning on a month of 8, 12, 16" progressions. Does this make sense?
Thank you again,
Julie
Re: LS disease and L7 nerve root compression
Regarding your return to sport conditioning /trials, I think you are on track.
Low jump heights, straight lines.
Wide turns before wrap arounds.
Then wrap arounds without jumps.
Then incorporate jumps.
Perhaps you contemplate / trial running contacts to avoid slamming into extension. But honestly, I'd video your dog doing both methods to see what looks best. And/Or video what he does now and evaluate his lumbosacral region.
I'm glad things are going well so far!!!
Cheers,
Laurie
Low jump heights, straight lines.
Wide turns before wrap arounds.
Then wrap arounds without jumps.
Then incorporate jumps.
Perhaps you contemplate / trial running contacts to avoid slamming into extension. But honestly, I'd video your dog doing both methods to see what looks best. And/Or video what he does now and evaluate his lumbosacral region.
I'm glad things are going well so far!!!
Cheers,
Laurie
LAURIE EDGE-HUGHES