SIJ issues

[Kriszty]

I hope this is OK, Laurie, but I went through your handout on Iliopsoas strains, and I tried to adapt it to an adductor strain (plus some general strengthening). Would you possibly be able to take a look and see if it looks alright/if there is anything crucial I have missed? Thanks so much!
Kriszty

Rosi Rehab Plan


Treatment - Acute Phase (Week 1 and 2)
1. Pain Management: Continue gabapentin 300mg twice daily and 4-cyte
2. Prevent Re-Injury: As your dog is healing, it is important to prevent further
damage by disallowing off leash running, playing with other dogs, playing
fetch, sprinting, or allowing burst activities (i.e. chasing a rodent or bird) or
jumping onto the couch, bed or back of a vehicle.
a. Leash walks only until told otherwise.

3. Modalities: Continue with PEMF (17 hz 30mins) bed L side down 30mins 3 times daily.

4. Easy Therapeutic Exercises- 5 times weekly
a. Leash Walks. The dog should not look worse at the end of the walk.
Distance or time is dependent upon the quality of post-walk
movement.
b. Weight shifting: With all 4 legs standing squarely on a non slip surface press against each hip and shoulder to cause the dog to resist against you. 10 reps 30 seconds each
c. 3-Leg stands: With the dog in standing, lift the unaffected rear leg off
the ground and have the dog balance for 5, 10, 15, or more seconds
(as able). Repeat 5 – 10 times, two or more times a day.
d. Sit to Stand Exercise: Simply work on sit to stands as an exercise as a
way to use muscles in a non-challenging way. Non slip surface 10 reps
e. Backing Up: Encourage your dog to back up (leading movement with
rear legs). Repeat a few times per session.

5. Stretches : Rosi on her side LH up, stabilise pelvis and gently lift back leg up hold for 30 seconds x 2 2-3 times daily

Treatment – Sub-Acute Phase (Week 3-4)
1. Continue with gabapentin and 4-cyte
2. Therapeutic Exercises: (At this stage you want to encourage a low load of
normal stresses to the affected tissues in order for proper healing and fiber
alignment to occur.) Exercises 5 times weekly
a. Continue with leash walks, and exercises from the Acute Phase as
deemed appropriate by your rehabilitation therapist.
b. Sit-stands with front legs elevated on sofa. 10 reps
c. Hill walking / Stair walking: Add some of these every day or
whenever out for a walk.
d.Step up exercise : front legs on box hold 1 back foot on box and tap other back leg quadriceps to encourage ‘pushing up’ onto box. 10 reps
e. Eccentric / Concentric : Walking backwards DOWNhill 100m
f. Stimulate Gluteal muscles: using the e-stim on tetany settings with both paddles on the gluteal muscle. Pull RH backwards whilst machine is on. 10Mins.
f. Underwater Treadmill: This tool could be utilized as a way to safely
engage in cardiovascular exercise and apply a low load of stress. Time, distance, speed, and water height should all be determined by the quality of the gait when in the water. Once,
twice or even three times a week could be beneficial.

3. Continue with stretch as described above. Continue with PEMF bed.

Chronic as described on your handout, week 4-8.

[lehughes]

I would think that a small tear would cause PWB, but not NWB. So, you might want to look further...

But if you come back to the adductor, then circles, side stepping, both directions (around an object and/or up and down a hill). I'd also get her backing off of things and onto unstable surfaces (i.e. back up off a platform and onto a (stabilized) peanut ball, rolled up piece of memory foam, couch cushion... just be creative with what you have at your disposal).
You could also do 3-leg standing (lift the 'good' hind leg) and loop theraband around the affected one, and pull on it (outwards) to activate adductor.

You're protocol looks fairly good. I'd just throw in some of the stuff I list here.

Good luck again... this time around!

Laurie

[drwall]

Kristy,

I find this discussion very interesting because I am fascinated with the canine athlete. I am not as versed on SI dysfunction as David and Laurie so I read their comments with great interest and I continue to learn. I am sorry you are having these difficulties with your own dog.

So after reading your recent comments here are some general thoughts.
1) Stem cell and DJD of inter tarsal joints - I have performed numerous regenerative medicine treatments for DJD, however, I have discontinued doing so. I did get clinical improvement in most patients, however, it was not lasting, usually not over 9 months. If pain is localized to the inter-tarsals DJD consider 2mg Triamcinolone and PolyGlycanSA. If pain is not localized there I would not be to concerned
2) I do a fair amount of MSKUS and find it to be extremely difficult, especially when interpreting structural injury in muscles. A 0.3cm structural abnormality is very small. I have never seen muscle fiber disruption in the adductor but I don't have much experience visualizing this muscle. All but the cranial portion of the muscle must be evaluated by imaging through the gracilis, making interpretation of lesions in the adductor even more difficult. If however, I had pain in the region and identified a structural lesion on MSKUS I would consider regenerative medicine therapy. I am currently using PRP u/s guided into lesion. I also like extracorporeal shock wave for soft tissue injuries also.
3)The one consistent problem that I find that produces myalgia of the gracilis and adductor is cranial cruciate ligament disease. Dogs with CCLD ambulate with their limbs in very slight ABduction and this likely creates a mechanical overload of these two muscles.

Rick

[Kriszty]

Thank you for your replies, Laurie and Rick.
She has not been NWB since the trial, is only very slightly lame now.
I will add in the exercises you recommend Laurie.
She is booked in to have a specialist U/S next week, so I will see what she says about the adductor. She certainly had pain on palpation (cranial part). I will let you know!
I will also check the cranial cruciate ligament, thank you. Shock wave might be an option.
Thank you both very much for your thoughts!
Kriszty

[David Lane]

As someone who loves using regenerative medicine, I personally would not push for it in a 3mm muscle tear. I don't know what my size threshold is for when I would use it... but it's greater than 3mm.

Stem cells will give palliative benefit for 11m in addressing OA (vs 9m with PRP which is less invasive and at our facility about 1/3 the cost). There is nothing that will heal or reverse arthritis.

David Lane DVM
ACVSMR

[Kriszty]

She/we are still struggling. Not crying on adductor palp anymore, but still mildly sore, and she is still abducting that leg a lot. Not lame.
We had a sports vet come and she feels she is not using her pelvis or lumbar spine properly, so she has exercises for spine flexion and extension (in down and stand) and 3 leg standing with the L/RH on a paw pod and trying to maintain a flat pelvis. She is fine with RH elevated but struggles with L, tilting towards me/away from leg.
Nationals beginning of april so starting to feel worried. Any further thoughts ?
Thanks!
Kriszty

[lehughes]

So frustrating!
Equally frustrating to not be able to put my hands on the dog... it makes all of our recommendations a bit 'blind'!

So, the hock OA may be part of the issue. Perhaps you need more focus there. (modalities, mobilizations, nutraceuticals, and maybe one of those back on track hock wraps).
Lumbosacral disc disease? Try lots of traction, laser, and other therapies at the L-S jct.
Hip labrum? Laser and any other therapies at the him (medially)... but perhaps you've been doing that b/c of the adductor tear.
Learned postural adaptation (but I think this is a long shot if you have been focussing on all of the other things.) But try gait retraining by bandaging into external rotation and walking the dog x 10 mins this way (once a day).

Sorry Kriszty... I wish my hands could cross the ocean to be of more assistance!

Laurie

[Kriszty]

Not sure if this helps, but here is one of the runs on the day she pulled up NWB LH. Some slipping, but clearly lots of abduction , and looking back I think she has been abducting hind legs for awhile/ages. https://youtu.be/B0C_EcPiG7E
I am treating the hock OA now with NSAIDs and gabapentin , plus 4cyte and pentosan courses (neutraceuticals). I do grade 2 caudal joint mobes and traction . Was told not to make them any higher due to her hypermobility . I dont think she is painful in them anymore, previously on cranial pressure in standing she was taking a step forward, not anymore.
Currently I have ace bandage hobbles to try act as a proprioceptive guide but that is wrapping into internal rotation , could def do some wrapping to external . I am pushing on her adductors laterally to get them to activate with my hand on laterally, both on the flat and on a foam surface.
She might have a bit of mild L-S disease but not obviously uncomfortable and she had 4 lots of shock waves therapy on it a few months ago.
Not sure about hip labrum, but don't think so, never seemed to have any hip pain.
I think learned postural adaption is a possibility , maybe from an initial adductor injury ages ago?
Thanks so much for your help !!
Kriszty

[lehughes]

Okay... where are you again? Perhaps I can find you a physio nearby - change of hands & skill set to 'look' at your dog!
Laurie

[Kriszty]

Perth, Western Australia.
Jaime Jackson has looked at her a couple of times, and Leigh has a couple of times too.
Thanks
Kriszty