Mar 302013
 
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Recovery from a serious soft tissue injury, such as a ligament tear/strain, or maybe a meniscus tear can be a long process, but in some cases using rest and slow rehabilitation without surgical intervention is much better than the surgical alternative. Recently a study in people demonstrated the long term process can be better in fact than using a surgical procedure. In some cases it is easy to get through a minor injury, but on the other hand there is a lot of work required to fully rehabilitate a more serious injury. Most dogs don’t come with an “easy” switch. Some dogs are very intense for their toys and very stoic when it comes to showing pain.

So how do we know what to do and when to do it? How do we know when they are ready to move on to greater challenge and how do we create a gradient of work so they progress gradually and do not re injure themselves? How do we avoid creating permanent changes to behavior that is used to compensate for the injury and lingering inflammation and pain? Re injury is certainly something we are trying to avoid. This can lead to chronic problems, as a result of scar tissue and a worsening condition.

Know their behavior! If you are working your dog in any dog sport, an important responsibility is your understanding of what is good for them and what is normal for them. Detection of injury and subsequent rehabilitation requires you to see normal behavior. Being able to see deviations from normal is an essential skill. And what is normal anyway? Knowing how they walk and run, how they shift between different gaits such as walking, trotting and a full run, how they accelerate, how they turn on the ground, how they decelerate and accelerate, how they jump when extended and when collecting and turning – in both directions. Only you can truly know what is normal for them. This comes from observation and understanding. Understanding comes from knowledge and learning combine with observation. Effort is required.

It is important to know when they are injured and the sooner it can be diagnosed, the better. But this is not always easy so some effort is required. The more you know and the greater understanding you have the easier this will be. Rehabilitation, treatment and diagnosis have been challenging in Joey’s case. At first I noticed the change in behavior for a warmup exercise so I know when and how the injury occurred. Unfortunately it took almost two months and more serious injury to pinpoint what was wrong. He just did not show any abnormal behavior, or pain much of the time. Running for his ball initially seemed normal. His jumping became more deliberate, but I could not see what he was doing or why initially, which can be tough to see as a handler. It can be tough even with experienced people watching as well, however. Later his injury and compensatory behavior became more obvious. Now I can easily see the behavior. And it is critical in order to be able to exercise him and get him using his bad rear leg once again without hurting it.

In addition, different injuries cause different compensation by them and in some cases can clearly identify the injury. For soft tissue such as ligaments and tendons, the injury is most obvious when cold. Warming up often hides the injury completely when it is less serious. Movement of limbs includes processes such as extension (push), flexion (pull) and torque, or rotation (push, pull, and turning). Which of these movements, the corresponding pain and how they compensate can provide the most useful diagnostic information. Going through this process has also helped me see even greater detail in the mechanics of canine motion.

An important point to always keep in mind is: Do not over work them! There should be no increased lameness following a rehab session. Proper warmup and cool down are required. And the excercise must be as guarded and graded as necessary to provide the benefits of movement without adding to irritation and inflammation. A dog will always do better when warmed up and can easily over work themselves or be over worked. When they cool, the results of the session will be much more obvious. Lameness, or increased lameness, protecting the limb, holding it up or out etc should never increase or you are adding to the problem, not subtracting from it. I see this mistake too often and the consequences are often slowed recovery and setbacks. But on the other hand it can also be hard to know where you are in recovery when you don’t see anything.

We have had one setback and it has been an additional month now and we are just getting back to where we were prior to the setback. Joey has a medial collateral ligament strain/tear in his right knee. He only runs on his right lead, which is normal if he is turning right. When he turns left he has to hop since he is on the wrong lead. When he runs straight, he always puts his left leg down first and back, then his right leg and he keeps both legs close together. He is basically pushing with both together and using the left as the primary force and adding the right as he can, basically protecting his right leg. This is done by always running on his right lead, which is not at all normal for him. Normally he is quite balanced and will use the appropriate lead for whatever turn he will have to perform. When running for his ball, he will run out with either a left or right turn normally after he catches it, as he does not favor one lead over another under normal conditions.

He is in fact trying to avoid full extension and the outward rotation of the knee during that extension, which is the function of the MCL. When he sits and stands, he also normally uses the MCL to keep his knee straight, preventing outward rotation. While more seriously injured, he would hold his knee out in order to avoid using his sore MCL. This is a behavior he no longer does in most cases as far as I can tell.

Everything he does this way now, always on one lead, hopping, etc, is a result of compensation, which I do not want to rehearse and make permanent and more importantly, it means he is still injured. Previously I saw his balance return and I knew he was ready to progress, but he went into overdrive on a couple of occasions before being fully warmed up and he hurt his knee again. Warmup with this type of soft tissue injury is critical to preventing reoccurrence. Not irritating the joint is critical to successful progress. Again, this is very challenging when it comes to dogs. I find I have to be 100% ready and 100% focused, as sudden bursts and re injury happen almost instantly. In my case with Staffordshire Bull Terriers, which are driven and powerful and they accelerate hard in an instant. This means their knees need to be good and that they are tested on that first push and every subsequent push. They are quickly at full stride, which also means full extension of their limbs. This means pushing ligaments, tendons and muscles to the limit.

So I need calm exercise at this point without destroying his ability to become fully excited. I don’t want them to rehearse compensatory behavior nor do I want to hurt their drive. For Joey this means keeping his ball close to him when we play. In fact, not more than 12″ away initially. Otherwise he blasts out of the gate to get it and this simple burst can be too much for him, especially if it occurs prior to being warmed up.

After he initially injured it by jumping cold in a soft sandy type surface, he injured it again running on wet and slippery, muddy grass. I heard him yalp on 2 occasions, but I did not see if it was while jumping or landing. I also saw him begin to hesitate when jumping, which turned out to be getting on his right lead and always jumping with his right leg forward from his left and close together, using mostly his left leg for power. Eventually after repeating this cycle, he could no longer use his right leg and began to show clear lameness and protecting it even when standing and sitting. This is something I had hoped to avoid, but because diagnosis was so difficult, we could not isolate the problem until it became more obvious, which it did suddenly.

As he started to improve, he started to be able to do his warmup excercise he was unable to do previously. He could now sit up and back “Sit Pretty” and then stand into a full stretch from this position. With his knee sore, he would not do this. He also began to lose the hop I would see if he was turning left, which meant he was now running on the left lead again. Since previously he was always on the right lead, he would always come to a stop or return to a trot or walk, hopping his right foot and again this disappeared so I could assume he was on his right lead. Seeing which lead they are on and how they move is extremely important.

Basically I am looking for movement without irritation and the inflammation that can result. Knowing their normal gate, and their full repertoire of movement helps to guide me in the work I do with him. Knowing the sounds he makes when doing well and having fun; the grunts and groans and whines, unlike the squeals and yalps of injury or sudden pain that accompany behavior to be avoided. As I continue to slowly progress, just like when training jumping skills or other obstacle performance skills, I slowly add more motion while expecting to see the same normal behavior. I do not want to rush this; just maintain a level of fun and enjoyment and usage that helps healing and maintain strength and mobility. No irritation, or stiffness should be present if I am warming up and cooling down properly and working him to a sufficient, but not excessive level. Stiffness after rest following a workout is a definite sign I have done too much and with this type of injury is not helpful. He does need motion and to use the limb, however all lameness is to be avoided.

Even when we see and know they are running and jumping normally under reduced output and controlled circumstances, patience is required in order to progress slowly and take care to prevent accidents while increasing the level of activity and excitement. This is tougher to do in some dogs than others and I failed in my initial attempt with Joey. At the time I did not know exactly what to do and how to get him having fun without bursting. I let the ball get too far away from him and I let him get too far away from me. Now I have a better handle on this and a great warmup game. Hopefully in the future he does not burst out and if he does, that his right rear leg is warmed up and ready for some increased level of workload.

It has been over 6 months now but the alternative of surgical intervention I am not fond of unless it is necessary. The only way for me personally to know this is to do the work and see where it goes. A surgeon will always prioritize surgery ahead of rest and slow rehabilitation, if he thinks surgery will work. My view is that surgery is to be used only if other methods don’t work, that is the injury is too severe, or there is an abnormality that needs to be corrected. Surgery, although an important consideration is a last resort! Any surgery carries risks and it always requires a difficult and careful rehab as well. But their are injuries that will not heal without surgery.

Being good to your dog while asking them to perform with you is essential. Asking them to perform with you carries a significant responsibility in my opinion. Personally I believed this to be true before I started running dog agility with my dogs. But I do see a lot of people asking their dogs to perform for them without knowing anything about the impact of training and performance on them either physically or psychologically.

Training dogs to perform and run agility at their best has also led to a detailed understanding of canine movement, running, jumping, turning, acceleration and deceleration. Knowing each dog specifically and uniquely is essential. Understanding that changes in their behavior have a cause. The dog always changes for a reason, especially if they are good at something and usually do it well, be it jumping, weaving or whatever. Knowing more about their psychological and physical abilities will also help you get the most from your relationship and have the out fun while performing at your best. And most importantly, knowing your dog and their normal behavior can help prevent serious injury and guide you through a successful rehabilitation and recovery.

Richard Ford, M.Sc.
@mybullseyeview

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