Featured in the Sept/Oct 2007 Issue of Mushing Magazine:In previous articles I wrote about injuries to the spine and shoulder. In this article I am going to concentrate on the wrist injuries that dogs most often sustain during distance and sprint racing. Although the reasons for these injuries are caused by different factors, such as terrain, poor conditioning, pre-existing injuries, fatigue, and a host of other circumstances, the treatment for simple sprains and over-use syndromes are pretty simple. It’s when you get more serious injuries such as fractures, torn tendons, and chronic synovial swelling, that you need to look farther into the dogs future and determine your plan of treatment and rehabilitation.Prevention is the first key to preventing injuries whether it is to the wrist, back, shoulder, or mind. When I do football screening and physicals it’s pretty easy to weed out those athletes that are going to be prone to injuries: overweight, poor flexibility, bad attitude (at least in humans), poor muscle tone, poor cardiovascular. All of these apply to our dogs and can be taken into consideration before we begin asking them to go out on that first 5 mile training run. It’s important to think early in the season about our training and conditioning methods, and to be looking ahead at our dog’s health and potential problems. I know this sounds too simple, but trimming toe nails is the first thing I do now before we start training. If the toe nails are too long or the nail bed is inflamed the dog will compensate to get off the irritation, causing the foot to rotate, invert or evert, which can put pressure on the ankle and/or the joints above it. When I haven’t done that, I have ended up with torn and broken nails and a sore nail bed that I asked the dog to work through and continue running. That inadvertently changed the gait of the dog just enough to make me wonder if better dog care could prevent an adaptation by simply trimming toe nails.When the foot hits the ground everything changes, (that’s the name of a class we take in physical therapy). If the dog has a sore foot and changes its gait pattern it may create elbow and shoulder problems that continue to re-occur when the original cause may come from the foot. Check for torn pads, irritated or split webs, look at the wear pattern on the pads to determine if the dog is pushing off in an even pattern or pushing off on the corner of one pad. That will project all the way up the leg and give you an indication that certain muscle groups in the leg are working asymmetrically and can be a precursor to tendonitis. The next thing to look at is the range of motion of the ankle. The pad of the foot should be able to touch the back of the leg when you flex it. And the ankle should be able to fully extend with the leg straight. The joints in the toe should have good flexion and extension without any end range blocks or pain. I like to feel each joint to see if there is any heat, swelling or thickness of the ligaments and capsule. I know of one dog that had severe restrictions in ankle flexion with a hard end feel (like a bony block) that was pain free and finished the Iditarod. I don’t think that dog would have made a very good sprint dog because of the inability to move through the necessary range and would eventually break down at high speed. The main injuries that I see are acute ankle sprains, swelling from overuse, and the occasional fracture. If you suspect a fracture, those ALL go into the vet for x-rays. Usually the wrist is hypersensitive, the range of motion is not just painful, and it feels unstable to you when you move it. Here are some of the symptoms you will find for an inflammatory response in the ankle: heat, loss of motion, redness, swelling, pain, joint malfunction crepitation, atrophy of the muscle. Which reminds me, when you are checking motion and swelling go slow, be gentle, don’t be in a hurry. Don’t make it worse than it already is. The way we treat those on humans also can apply to dogs. PRICE: Protection, Rest, Ice, Compression, and Elevation. Well, almost all, I have yet to successfully elevate an extremity on any dog. It may seem obvious to say, but running in the snow provides plenty of ice. Keep a small supply of zip lock sandwich bags in your sled, fill them up with snow and when you bag the dog, wrap the bag onto the ankle with Coban or Ace wrap. Don’t wrap them to tight. I think, for a lot of us, rest is the most under-rated part of the equation. We are often in such a hurry to get the dog back into training that we don’t give it enough time to completely heal, which sometimes causes a chronic inflammatory condition. I know, I own that one myself. A dog who returns to competition before being ready may be more easily reinjured and consequently hurt all season. This is my criteria for returning a dog back into the team for competition:• Reabsorption of acute swelling• Full pain-free range of motion of the in- jured part• Normal strength and power as compared to the opposite side• Normal size of muscular mass as compared to the other side• Normal endurance of the injured part• Regaining previous speed and agility for the lower extremity injured* Running full speed straight ahead without a limp* Cutting and playing while running free without a limp Compression to a wrist sprain is somewhat controversial, but in my opinion if you do it right, and combine it with ice, it will help in the healing process and lessen time it takes to get back into the team. I prefer wrapping it myself with Coban rather than a Velcro wrist wrap. The problem with the Coban is if you start at the toes and wrap it too tight and in circles going up the wrist, the toes will swell and you will cut off the circulation in the foot. It is better to do a light wrap in figure eights starting at the base of the toes and working up. This can be your best friend or your worst enemy; it takes some practice and some patience on your part and your dog’s. I don’t run the dog with the wrap on, it will just work its way down the foot and create more of a problem. This is only for a dog that is in the bag or on the truck. I take athletic tape and wrap the top of the Coban to prevent it from rolling down on the dog’s foot. As part of the rehabilitation from a wrist sprain, I do a lot of gentle range of motion in a pain free range and very gentle distraction (pulling on the joint in a straight line) of each joint, from the toes up to the wrist. Then I like to make sure all the bones of the wrist are mobile and pain free. Swimming is a great way to get the muscles and joints working again in a non-weight bearing exercise program. When the dog starts back in harness, its always good to start slow on a good surface and be ready to bag the dog if any symptoms re-occur. Remember, time is on your side. Don’t start your dog too early in hopes that it will make that next race.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. Wes is a past Oregon Veterinary Physical Therapist Liaison. 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!”
