STEP BY STEP WITH WES RAU: SHOULDER AND LOWER BACK INJURIES

My past issues have focused more on the shoulder area, as well as general injures that occur in the dog and how to treat them. I would like to start looking at more specific body parts in the lower back and other joints. In this article I will begin to work on the pelvis, specifically the Sacrum and the Sacroiliac joints. In one of the last classes that I taught, I had an Alaskan husky out of a great sprint line who had been a world class dog. I say “had been” because last year the dog stopped driving, didn’t extend on the right hind leg, ended up being dropped from the main team, and was laid off for the rest of the season. The dog came back on the team this spring but after one month of training the same symptoms started to crop up again. She started to back off her tug line. Her right hip extension became noticeably decreased, especially with hard work or at high speeds. She seemed to be able to find a gear where she was comfortable but only for short periods of time, and then she would revert back to what the owner described as “a struggle to keep up with the other dogs.” Interestingly, I could extend her hips to full extension out behind her, which is what we all do to check range of motion. But when I loaded or compressed the Right SI joint, (Sacroiliac joint) and extended the hip at the same time the dog almost crumpled to the ground. All the x-rays taken were normal and the rest of the physical exam was normal so we started working on the SI joint and the surrounding ligaments. She is now running back in the team and doing well after 4 treatments consisting of manipulation to the SIJ and cold laser treatments to the posterior SI ligaments. I looked back in my log and saw that out of the last 43 dogs that I have treated, 28 of them were treated for lower back problems, and of the 28, 20 of them had SIJ involvement. These numbers made me think that all of us could use a little refresher on the SIJ and learn some tools to treat it with.The SIJ is a combined synovial and cartilaginous joint. The opposed surfaces on the wings of the sacrum and ilium are covered by cartilage, and their margins are united by a thin joint capsule. The wing of the sacrum and the wing of the ilium are rough and have irregular projections and depressions which interlock. I describe this surface as being like the surface of the moon with its many craters. I am amazed at how these surfaces can interlock and be held together so tightly by the surrounding ligaments (Evans & Christensen, 1979). When the joint is disarticulated by injury or during a necropsy, the fibro cartilage usually remains attached to the sacrum. The sacrum and the ilium stay firmly attached, to form the sacroiliac synchondrosis (Evans & Christensen, 1979). What all this means is that when your dog gets hit by a car, falls off a cliff, or gets kicked by a moose, the structures that take the brunt of the injury are the attaching ligaments and the capsule. On the back of the dog between the sacrum and the ilium is the Posterior SI ligament. This is the easiest to palpate and the one we can treat very effectively. The other is the joint capsule around those moon-like surfaces on the sacrum and the ilium. Have you ever unknowingly stepped off a step thinking the floor was right underneath you and landed 6 inches lower than you thought you would? The jar can go clear up to your head. But the structure that often gets hurt is the posterior SI ligament and the intra articular surface on the sacrum and the ilium. Every time you step down and go into extension on that side it hurts, so you will shorten your stride. Hmmm, sounds like the dog we were talking about, doesn’t it?Most of us aren’t working on the dog that fell off a cliff, or was hit by the car, but we might be treating the dog that either got kicked by a moose, fell going around a corner and hit ice, or most likely, for no reason at all, just started looking OFF. Remember the rules from previous articles; Observe, feel, and move. You may have already observed that the right rear leg has a shortened stride, or is pacing, crabbing, or is just DIFFERENT from what was normal for your dog. If you see these symptoms, go to the sacrum and feel the “groove” on the outside of the sacrum between the sacrum and the ilium. You are now on the Posterior Sacroiliac ligament. Feel down the groove and look for any thickening or tenderness. The dog will look back at you or may drop down towards the floor in a sitting position. That’s a good indication that you may be on the right spot. This is the time when you have several options to do different techniques. The first thing I like to try is sacral distraction. Take your hand with your fingers pointed towards the dog’s head and press down and away as if you were trying to pull the sacrum off towards the tail of the dog. If that hurts, then go the other way. Press gently on the upper part of the sacrum as if you were putting pressure towards the shoulder of the dog. Next, lay your dog on its side (left side down) and rotate the Ilium (pelvic wing) forward and backwards. One direction will feel better to the dog than the other. That is the direction you will want to go. On acute injuries it’s a good idea to ice the ligament. Take a Dixie cup full of water and put it in the freezer. Use that to massage and cool down the injury. On injuries 48 hours old or older, hot and cold contrast really does feel good. I like to do 5 minutes of cold and 5 minutes of heat, switching 3 times and ending up with the cold. This helps to dilate and constrict the blood vessels which then helps flush out the lactic acid, relaxing the muscles around the joint. Follow that with GENTLE joint oscillation. (You should be moving the sacrum gently forward and backwards and moving the ilium on the sacrum.) . In my opinion, the sacrum is the key to the lower back. After you have spent time on the sacrum and the surrounding ligaments, then go to the next two vertebrae above them and massage around and oscillate them as well. The tail pull takes the pressure off the joint. Sacral distraction can also take the pressure off of the joints, lumbar traction can help, and standing or sideline lumbar joint oscillation relieves lumbar pain (see previous articles). Take all these techniques, put them in your bag of tricks and help your dogs be the best that they can be. Evans, H., & Christensen, G. (1979). Miller’s Anatomy of the dog. Philadelphia, PA: W.B. Saunders Company.Wes Rau is a physical therapist living in Powell Butte, Oregon. He has earned his Bachelor’s degree at Loma Linda University and holds certification in manual therapy. He is currently in private practice in Redmond, Oregon. Wes has been running dogs since 1992 and enjoys stage racing. He claims that he is “a better physical therapist than musher!”

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