Case Study – Reintegration back into agility following a non-agility injury
My 2 ½ year old Border Collie cross, Dodger, launched himself off the our front veranda and immediately came up non weight bearing on the right hind. Within a few minutes, he began to put some weight on the injured leg.
Upon examination, there was mild joint swelling of the right knee with pain on performing the anterior cruciate stress test. No other injury was found.
At this point, I need to remind everyone of the stages of soft tissue healing. Soft tissue injuries are injuries to muscle, tendons and ligaments, often referred to as strains (muscles, tendons) and sprains (ligaments). The appropriate treatment of soft tissue injuries is absolutely dependent on the timing post injury. Healing stages are broken down into three:
Early Stage 1 – 24 to 48 hours (known as the hemorrhagic phase) and late stage 1 – days 3-5 (substrate phase): Goals of treatment are a reduction of pain, swelling and inflammation. Use the principles of RICE – rest, ice, compression and elevation.
Stage 2 (days 5 – 21) – also known as the regeneration phase
Goal of treatment is to help the new collagen fibres in the soft tissue organize and align in the strongest possible way and to prevent adhesions. When collagen fibres run parallel to one another, they are the strongest. Up until approximately day 14 post injury, exercise should be limited to low intensity activities and passive range of motion.
Stage 3 (3 – 6 weeks, lasting up to one year) – also known as the remodelling phase
As healing continues the tissue at the injury site changes from cellular to fibrous to scar-like tissue. The goals of treatment are to improve muscle strength, maintain ligament or muscle extensibility, improve joint mobility and retrain the proprioceptive sensory system.
Dodger’s treatment the first day consisted of low powered laser, knee joint compressions and passive range of motion. Dodger’s activity was reduced to on leash walking and trying to keep him quiet in the house.
Forty-eight hours later, the swelling in the knee was gone and the pain much less. However, Dodger was having considerable trouble weight bearing on the right hind when tested in standing. Further examination revealed he had strained his first toe flexor of the right hind and the sartorius, quadriceps, iliopsoas muscles on the right, high in the groin. I added laser for the toe flexor and the affected muscles and stretching of the hip of all major muscle groups. I began with exercises on the flat such as circles, series of sit-lay-stand combinations, and backing up.
Day 5 post injury, I began short sessions of strengthening, balancing and proprioception work using a fit disc and stool in various combinations. Each day I increased the level of difficulty and length of his sessions. By day 10, I added backing up on a flight of stairs, short periods of tugging and contact work (at the end of the ramp only). At this point, his toe flexor and knee were totally asymptomatic however he continued to have tenderness in the groin. Laser was being done every second day and stretching of the hip was done daily.
Day 16, Dodger was allowed back to his regular twice a day walks and very limited toy playing. Day 21, I began working him on a tunnel and grid jump sequence with jumps at 6” and 10”. Day 23, he went for a 15 minutes swim at the therapeutic pool in addition to grid work. By this time, there was no evidence of pain in any of the injured structures. Foundational contact work for the dog walk continued. Laser was discontinued, but stretching every second day continued.
Day 28, I increased the challenge of the grid work, adding more jumps at full jump height. I resumed limited weave pole training and teeter training.
Day 32, Dodger participated in a seminar, consisting mostly of jump work. I limited his jump work to 16” and he tolerated full participation without any exacerbation of symptoms.
I am confident that Dodger has fully recovered from his injuries, however I continue to monitor the structures that were involved to ensure he is holding his gains. Had I not carefully assessed, diagnosed and treated his injuries, he would have likely developed chronic problems that could have shortened his agility career and contributed to functional restrictions as an older dog.