SIJ issues

[Kriszty]

Hi Laurie,
I am hoping you can help with a SIJ issue I am having with one of my dogs. I read your very helpful article and diagnosed she has a L cranial slip (causing her to off weight and have issues with jumping). Tried to treat it using the general methods you recommend in your video training but that didn't help much. Took her to the chiro who corrected the problem which made a HUGE difference in her performance (went from knocking bars in 3/4 runs to having 7 runs with only 1 bar). Then yesterday I noticed she was struggling again and sure enough the L iliac crest was more cranially located. I have rebooked her into the chiro, but don't really want to have to keep taking her every week. Is there anything else I can do apart from the gapping etc? She does not drop her topline when I pull each leg out slowly caudally.
Thanks
Kriszty

[David Lane]

In your office, do ST ligament stretches, plus appropriate mobilizations. At home, have the owner do tail pulls. Hopefully the tail pulls will reduce the number of appointments required. The severity and chronicity of the underlying issue will be a big factor in determining how long it takes to resolve the condition.

Other than that, it is a matter of correcting underlying muscle imbalances that may be contributing and making sure that the patient is engaging in an appropriate level of fitness for it's "messed up" pelvic musculature. I find I frequently have to remind competition dog owners that there are different fitness levels at different locations within the same dog, and it is the weak link in the chain that needs to be accounted for when exercising. In this case, the pelvic region might need some molly coddling.

David Lane DVM
ACVSMR

[Kriszty]

Thank you very much for your reply, David! Much appreciated.
This is my dog (finally have a Dx for the offweighting she has been doing for *years*!)
I am very new to rehab and not sure how to do a ST ligament stretch, or which mobilisations would be appropriate- I have been doing the 3 that Laurie described on her video training (cranial thigh thrust, and the 2 gapping ones). I will add the tail pulls back in for sure. It is a longstanding problem, so I figured it was not going to be fixed overnight.
Re the muscle imbalances, I thought if the Trendelenberg sign was negative (normal) the muscles were ok? I was thinking of doing some more gluteal building work with step ups and 3 leg standing whilst tapping her gluteals and epaxials , and diagnonal leg standing (she already does a lot of hill running and walks in an underwater spa for 15mins 3 times weekly). She is an agility dog so she already does lots of jumping, backwards and sideways walking. Interestingly she has never been able to back up in a straight line, she always goes off to her right, no matter what I try, so I suspect that is related. She gets equissage massage and stretching twice weekly, and is able to stretch her L leg out comfortably both hip and Lumbar/L-S etc. Normal hips. She is entire and has had a litter.
Definitely agree the pelvis needs some molly coddling, happy to do it if I know what to do
Thanks again
Kriszty

[David Lane]

A couple of thoughts:

I find it hard to recommend specific mobs or exercises on a patient I haven’t seen, because my answer varies depending on the patient’s unique presentation. So, in the absence of focused advice, I would suggest carpet bombing with every mob in your armory and see what happens.

Emphasize the exercises that the patient has the most difficulty performing.

The Trendelenburg test is positive when the resting tone of stabilizing muscles is so abnormal that the body cannot instantaneously respond to sudden weight shifts without a period of vulnerability or collapse. Just because a dog doesn’t fail that test, doesn’t mean they are normal (in the same way that just because you didn’t find a drawer sign, doesn’t mean that the cruciate is healthy). Subtle imbalances in strength and firing patterns may only come out during hard exercise, when it is impossible to measure (because the dog is halfway over the A-frame etc. – I always compare it to the Heisenberg Uncertainty Principal… but non-physics nerds just give me a funny look when I say that, so I’ve had to stop). We have no way of measuring muscle tone when the dog is free running, unless we stop them from running.

The backing up symptoms that you noticed is classic SIJ.

David Lane DVM
ACVSMR

[Kriszty]

Thanks again, David!
The chiro I took her to was very nice and showed me how to mobilise her pelvis to correct the issue. Which was good as it came out again the afternoon after coming back.. he said to do as little as possible, unless there is an issue as 'dogs are fragile'. It does seem to be coming out very frequently so I feel we definitely need to build more muscle up in that area.
Thanks
Kriszty

[lehughes]

David has done a great job of answer your questions here.

My only additions to this would be that if there is a continuance of pain, then most likely there needs to be glute strengthening addresses. And even more so since you say it's a chronic issue.

For the strengthening, I'd use e-stim on the glutes, doing a contralateral leg slide (caudally) when the stim is on. Try first on solid ground, feet standing width apart. Progress to standing an elevated surface with front feet and back feet stretched further apart (i.e. using two blocks). Progress further by doing the same using two unstable surfaces.

I'd add fascial work as well.

Beyond that... I'd say x-ray the hips.

Best of luck and keep up the good work!

Laurie

[Kriszty]

Thanks Laurie!
Hips are normal, she has had a litter though so I was wondering about hypermobility after watching your vid?
Kriszty

[Kriszty]

More issues! Can't catch a break at the moment poor dog.
So she was running at a trial on the weekend and the ground was more slippery than normal (short compact grass, not wet though) but she did slip a couple of times during a run, so I stopped. Took her back to the car on all 4 legs (sound) and got her out 30mins later on 3 legs ((
There was a rehab vet at the trial, luckily, and she looked at her and got pain on her L adductor near the origin and U/S her and found a 0.3cm tear. She feels that her entire back end is hypermobile, which accounts for her SIJ issues, and also the OA in her hock with the body trying to stabilise. And would put her at more risk of injuries like this.
Does this sound likely, do you think?
She has recommended- hobbles, gentle stretching, gabapentin. Stem cell therapy to the hocks (I have to look into this as have never used before and was under the impression it is not that effective). Stabilising and strengthening exercises to commence in 2 weeks time. Full return to function in 12 weeks.
TIA!
Kriszty

[lehughes]

Oh Kriszty,

I'm sorry your having this next issue with your dog!

Well, hypermobility would account for so many issues. That being said, so many agility dogs are hypermobile. But yes, hypermobility can put a body at risk of injury.
If that's the case, you either strengthen her like crazy in order to compete, or you take her out / find a different sport.

In regards to treating a muscle tear. I don't understand the need to jump to regenerative medicine so quickly in vet med. We don't go there first in people... so it's just something that makes me scratch my head is all. I'd say try your stretching, modalities, leash walking, specific exercise, and I'd be okay with gabapentin as a pain med choice. I'm not sure about hobbles. It wouldn't be my first choice. Tissues need movement to heal... My choice would be an elastic bandage (if anything). Maybe wrapping it creatively around the rear legs (always stop at the top with both ends on either side of the body) and then pinning the ends to a harness to keep it in place. (I'm seeing it in my head but I'd be hard pressed to describe it.)

Best of luck on this round!!

Laurie

[Kriszty]

Thanks for your reply, Laurie.
Yes its been very disheartening. Of course, she is a very competitive dog that just won Agility Dog of the Year.. and she LOVES the sport..so not an easy decision to retire esp at her age
The stem cells were for the OA in the hock, not the muscle tear. However, the OA is in the intertarsal joint, so I think it is going to be super hard to get them in there..
Do you think a small muscle adductor tear would be enough to cause NWB lameness?
I will take the hobbles off.
I am feeling pretty daunted in having to strengthen the entire back end.. are there any exercises you would recommend in particular?
Thanks so much
Kriszty