Kaffee has been actively competing in obedience for several years following a few years of agility and herding. He has always been a very active dog and loves swimming and hiking. I felt like Kaffee was in fit and in good condition.
This is why I was surprised when Kaffee came up lame on his back right leg while playing ball at an agility trial in June. He was walking on 3 legs for the weekend. Not having a diagnosis I knew that he had some muscle injury and would need rest for at least a few weeks. His initial treatment for the first week involved strict confinement to the house with no running, jumping, playing or jumping up on furniture. After a few days of rest he improved some walking on all 4 legs at a walk but at the trot he would limp and or hop. I had Arnica and DGP at the trial which he had for 2 days before we got home.
His activity during his second week consisted of a 5 minute then 10 minute walks on a leash on a flat surface, not a flexi. I wanted him to walk and not have the freedom of a flexi to trot. If he showed any signs of hoping at his trot we cut back in the walk on leash times. He did intermittently still hop at a trot still walking on all 4 legs at a walk. He continued on DGP and Trameel.
Week 3: Going into his third week I realized just rest was not going to help Kaffee recover and that I needed a diagnosis to determine his rehab progress. Our wonderful vet Dr. Toni Barnes in Flagstaff diagnosed him with iliopsoas strain based on her physical exam. The iliopsoas, or hip flexor is a major muscle extending from the lower spine, along the pelvis, and attaching to the inner part of the upper femur bone. Much like a groin muscle pull it is very painful and requires strict rest and a time to heal. Dr. Barnes suggested a Chinese herb to help with his pain management and cold laser treatments weekly. I am quite against the use of non-steroidal anti-inflammatories such as Rimadyl unless absolutely necessary so I was happy she did not suggest its use. Kaffee did not seem to be in discomfort.
Dr. Barnes told me I could progress Kaffee’s time walking on leash if there was not any evidence of a lameness such as limp or hop at any gate.
By the end of 4 weeks Kaffee had progressed to walking on a flexi for 30-40 minutes with no limp or trot. We continued cold laser with a total of 4 treatments.. He was now ready to move to the next stage of rehab.
The following rehab has been documented in video. Rehab has included caveletti poles progressing to jump grids; balance discs, massage, stretching, longer leash walks and slowing increasing his freedom to run in an enclosed area.
Week 5: Kaffee started on walking over one inch caveletti poles spaced 12 inches apart. Walking over a large wobble board, and putting his hind feet on the 22 inch balance disc stretching forward to a treat. We also continued our 30-40 minute walks.
Kaffee has never liked to stretch out his back legs so our work involved rewarding him for doing this short stretch with both hind legs. I really believe that the laser treatment also used on his back has helped him be able to relax his hind legs and stretch them out behind him. A first for Kaffee. I also massage his back, legs and hips.
Week 6 and 7: Caveletti work progressed to trotting over 3 inch caveletti poles spaced 12 inches at first and then 2 feet apart. We started tugging on the wobble board and getting him to balance the board with 4 feet on it. Used the boso trainer for stretching exercises having him do a stand extended out to a treat; then a sit to stand; sit to stand. Laser treatments stopped after week 6. During this time he did not seem to be in any pain so the herb for pain was stopped. Started work on Peanut: he would stand on hind legs and stretch across the peanut for his treats. (Video Part 2 shows Kaffee’s work on the balance discs)
Week 8 we started fleix leash walks on trail in Flagstaff for 45 minutes. He did well with this added activity. Continued with stretching back legs; 3 inch trot caveletti work; wobble board, boso upside down (more instability of disc) with hind legs on ball; 22 and 14 inch balance disc work with tugging to keep hind feet on discs; sit > stand > down > sit progressions. Started backing up with obedience work: heel forward to back-up. Fronts and finishes.His proprioception was greatly improving so we added the very challenging egg to stand on. For this entire week I supported his standing since it was very wobbly and he was not yet confident. The goal of his balance disc work was to strengthen his supporting muscles, proprioception, develop core strength, improve his coordination and confidence on the discs.
Week 9 we progressed to jump grids with a faster gait (see video); for 2 days he did 6 six inch jump grids; then with no signs of limping or hopping after a day of rest we put the grid jumps to 12 inches.
NOTE: Every day before he did any work on cavelettis or jump grids he warmed up with a 15 minute leash walk.
This week he also did a leash walk on a wooded trail for 2 hours… happy boy to finally be back with us on our training and hike days.
Christine Zink also recommended playing tug, walking and trotting uphills, wrestling with another dog and standing on 2 legs. Kaffee now is tugging with me with his back legs to remain on the balance disc; playing tug with Myst where he is pulling back using his back legs and doing hill work. We use the FitPAWS Peanut to have him stand on 2 legs and stretch over the peanut for treats (see video).
As in human athletes, soft tissue injuries take a long time and a lot of effort to get to heal. Additionally Kaffee is an older dog. Christine Zink writes that “older dogs take a little longer to regain their competition condition.”
What is critical in any rehab program is to carefully watch the dog for any lameness or signs or discomfort using the effected leg. Any of these signs should indicate that a step backward needs to be taken until the dog can do the exercise without any signs of lameness.
Week 11: Kaffee is back to some obedience but only jumping 12 inches after a long warm-up. His first show will be in 2-3 months depending on his continued progress.
Week 12: Since Kaffee has done so well he was allowed to swim...A very dear friend has a lovely salt water dog swimming pool which Kaffee loves. He does not jump into the water but slides in and just swims around sometimes swimming after a ball but also just enjoying being in the water. This went well.
This week we also went on a longer leash, trail walk for 2 1/2 hours. Again he did well. Still do not trust him off leash since he might choose to chase a squirrel.
Jump grid has added a few 16 inch jumps along with the 12 inch jumps. He warms up with several of the 12 inch grids at a trot.
AND.. he is now allowed off leash at our training field to see how he does. Since we are in a quite warm summer month he does not choose to run around but enjoys the freedom of walking or trotting around.
UPDATE WEEK 16
SWIMMING AND HIKING UPDATE...
Since another month has passed working on Kaffee's rehab with some interesting new findings about his rehab, I thought I would add to this original post. Three and a half months after the injury and the rehab discussed above we went to Lake Tahoe for vacation. We stay a short distance from a wonderful beach on the lake where in the early morning I take the dogs for a walk and then a swim. Kaffee swam every day. He goes in the water and swims out for his ball but then stays in the water floating and swimming so he got a lot of swimming in in 7 days... No problems :-) .. HOWEVER, I did notice that when we walked on medium size rocks (which were an uneven surface) along the lake he seemed a little off on the right or injured leg. The small rocks and flat surfaces have not bothered him.
THEN, this week I took him on a short hike late afternoon out on the trails where we live. The terrain is hilly, with rocks to climb on and just a very uneven and perhaps hard terrain for him. A few times I thought I noticed him not walking smoothly on his right leg.. but no residual and nothing uneven since at all gaits. We have done a lot of hiking for the past 2 months. The first month it was all on leash and up to 2 1/2 hours. Then for the past 2 weeks he has been off leash and we have walked for an hour... no problem.. but the trails (in Flagstaff, AZ) are smooth with no uneven surfaces... So, I found this interesting and thought it should be noted in his rehab.... uneven surfaces are still causing him some problems and need to be avoided.
I have been increasing his jumping work and he is now doing curves and circles with jumps at 16 inches. No problem during or after jumping. Today (16 weeks out from injury) I had him do a few short 16 inch jump circles and then progressed over a 20 inch triple since there is extension over this type of jump. No problem. We then went into the obedience ring and he nicely jumped the high jump for his dumbbell retrieve and then the bar jump for his utility exercise... Very happy with this work but we only do it a few days a week.
Kaffee has greatly improved with his balance disc work. His proprioception has really improved and he now can balance on the small wobble board with all 4 feet standing. He sits with all 4 feet on the large balance disc. We also do Rear feet on large disc and front on small disc with STAND to DOWN (rocking back into the down). On the Peanut he does SIT to STAND; NEW Pivot work on platform but stepping over jump bumps with rear legs; crawling under my legs; and then combining a line of PEANUT > EGG > DONUT > LARGE DISC to walk across and stand and sit on each individually. VIDEO TO COME...
UPDATE: 6 months
Kaffee has continued progressing on his balance discs (see Video #3) and has also progressed with his jump work.
His jumping has included jumps in a circle; tunnels to jumps and stride regulator to 20 inch height. He is now hiking on all trails for up to 2 hours. Last weekend he returned to competition obedience and had no trouble with the jumps. He got a High in Trial on Friday and a High Combined (Open and Utility) on Saturday. I am very pleased with his progress from his rehab.
UPDATE: 1 1/2 Years Later (November 2014)
Kaffee is doing exceptionally well after his iliopsoas injury over one and half years ago. I have worked very hard to strengthen his hind end with regular balance disc work. He also will stretch forward for me on not only discs but also other objects we find. He always had trouble stretching his back legs.
We hike regularly (3-4 days a week) from 30 minutes to 3 hours. I also work him in obedience which he continues to love and be happy at. He is actively competing in obedience this fall having to jump his full height of 20 inches. HOWEVER, I do not jump him at this height between shows. If I am going to jump him I put the obedience jumps down to 12-16 inches for his go outs and dumbbell retrieve. One week before a show I have him progress his height back to 20 inches by doing jumping grids and one jump with stride regulator. I then use the stride regulator with the obedience jumps since he is not a good jumper and studder steps.
This work has greatly improved his jumping at shows and he has not hit or brought down any bars when competing. AND very importantly I always give him a good warm-up (see my recent blog post on obedience warm-up which shows and talks about how I warm up both my dogs including the use of the Back-on-Track coats to keep their muscles warm and help prevent injuries).
PLEASE NOTE.....This documentation and the two videos are only what I did with my Border Collie based on my knowledge and experience and some work with my veterinarian. There are many different degrees of injury and each dog responds or is ready for rehab work differently. This information only documents what we did and what has worked so well for Kaffee. Several things are important (1): I tried to be careful and conservative in my rehab and work with Kaffee always carefully monitoring his gait and effected leg; (2) I believe that a walk on a loose lead for 10-15 minutes is an excellent warm-up for all dogs beginning their performance work or in this case rehab exercises and always do this with Kaffee; (3) Balance disc work needs to approached carefully with injured dogs and for those not familiar with using the discs on dogs. Confidence and coordination are very important along with slowly progressing to more advanced disc work.
ILIOPSOAS UPDATE: see my new update on iliopsoas (blog writing May 2016)
A few excellent resources you can find online to provide you with more information.
1. Zink, Christine DVM & Canapp, Debra DVM(2008). Sports Retraining for Agility Athletes: excellent article especially if you are retraining your dog after an injury for agility.
2. Canapp, Sherman DVM 2007), Non-responsive Hind-limb Lameness in Agility Dogs: Iliopsosas Strains: printed in Clean Run. Excellent overview of the iliopsoas injury: causes, diagnosis, treatment.
3. Zink, Christine DVM & Canapp, Debra DVM, Preventing Re-injury of Soft-Tissue Injuries: printed in Clean Run March 2010.
Deb Gross offers an excellent online class from Fenzi Academy on preventing and rehabbing iliopsoas injuries.