7/11/16. Goal for treating Injuries Diagnose Understand healing Strengthen to prevent re-injury

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1 Laurie McCauley DVM, DACVSMR, CCRT, CVC, CVA Canine Rehabilitation Institute Goal for treating Injuries Diagnose Understand healing Strengthen to prevent re-injury Definition - damage to a ligament secondary to a stretch or without an associated bone fracture or joint dislocation At 1 year post ligament tear - only 80% tensile strength 1

2 Slower healing and strengthening then tendon or muscle injury Takes 3-4 months to start to strengthen a ligament compared to 3-4 weeks to start to strengthen a muscle Definition - damage to a muscle or its attaching tendon, usually as a result of a strenuous activity Can be accomplished during sports or during a course of normal daily living Tear or damage blood vessels Local bleeding +/- bruising Thick or firmer tissue Pain on palpation Irritation of nerve endings 2

3 Grade 1 Mild damage (<5% fibers damaged) Pain on palpation Minimal loss of function and strength Takes 2-3 weeks to heal Grade 2 >5% muscle fibers torn but not full tear Significant loss of strength and function 2-3 months to heal May come back to normal function Grade 3 Complete rupture of muscle or tendon (Calcaneal tear) May have palpable defect Acute Hematoma Chronic Fibrous tissue If caught early, may be able to fix surgically 3

4 Lay down unorganized fibrous tissue With proper blood flow and stretching Organize into strong bonded tissue May never be as strong as un injured tissue Strengthening healthy tissue around it decreases chance of re-injury Increase chance of injury if worked without warming up Can be injured when first start exercise program if do too much to fast Can get injured when muscle builds faster then tendon and ligament Muscles start to have physiological changes in 3-4 weeks Tendons and ligaments start to have physiological changes in 3-4 months Abduction Away from midline Adduction Toward midline Internally rotate front of limb rotates toward midline Externally rotate Front of bone rotates away from midline 4

5 Palpate muscle in short and then stretch Short - feel trigger point and tight muscle more severe injury Injury can be acute or chronic repetitive injury If chronic - slow decrease in function, (ability to perform), speed, activity (not just getting older) Stretch feel more subtle trigger point and tight muscle Teres Major Pectoral weakness Supraspinatus Infraspinatus Subscapularis Deltoideus Biceps brachii Triceps Flexor Carpi Ulnaris Middle Gluteal Sartorius Tensor Fascia Lata Pectineus Gracilis Gastrocnemeus Superficial Digital Flexor Deep Digital Flexor Longissimus & Spinalis systems Teres Major Loca.on: From the caudal border of the scapula to the teres major tuberosity (proximal medial humerus) Ac.on: Flex shoulder, internally rotate forelimb Injury: Plant and twist, common in agility dogs wrapping around a jump 5

6 Teres Major Stretch: Extend the shoulder and externally rotate the forelimb Clinical Signs: Short stride in the forelimb, slower.mes, changes in weaving habits, wider turns around jumps Palpa.on: Push scapula ventrally. Finger.ps point to the point of the shoulder. Strum at your finger.p just caudal to proximal humerus Pectoral Weakness Loca.on: 1 st 2-3 sternebrae to proximal humerus Ac.on: Adduct forelimb Short: Normal posi.on of forelimbs when in sternal recumbency Palpa.on: Decreased tone in the muscle Clinical Signs: Atrophy common in geriatric dogs Strengthen: Side steps to both sides Supraspinatus Loca.on: Cranial to scapular spine; tendon palpated just cranial to line from acromion to greater tubercle Ac.on: Extends shoulder, shoulder stabilizer Injury: Dog nose dives and hyperflexes the shoulder, repe..ve ac.on injury, no pull harness 6

7 Supraspinatus Short: Shoulder extension Stretch: Shoulder flexion Clinical Signs: Short strides, less reach, slower.mes Palpa.on: Pain on hyperflexion; pain on flexion with pressure on the tendon Strengthen: High 5 s & play bows Infraspinatus - Contracture Loca.on: Caudal to the spine of the scapula Ac.on: Extends and flexes the shoulder, external rota.on, abduc.on of limb, supports the shoulder joint Injury: Seen in field dogs Infraspinatus Contracture Short: Flex shoulder Stretch: Extend shoulder, adduct limb, internal rota.on Clinical Signs: Abduc.on and external rota.on of limb at the shoulder Palpa.on: Thickened at muscle tendon interface Tx: Laser, ultrasound, massage, stretch, strengthen walking then, backwards walking 7

8 Subscapularis Loca.on: Middle third of medial scapula to proximal medial humerus Ac.on: Extends shoulder, abduc.on, shoulder stability, internal rota.on of the forelimb Injury: Acute abduc.on of the limb, medial shoulder instability Subscapularis Stretch: Flex the shoulder, externally rotate, abduct Clinical Signs: Internal rota.on of the limb, short stride, trouble jumping or weaves Palpa.on: Flex shoulder, externally rotate, palpate medial aspect of scapula Strengthen: Hi 5 s, hemistands, wheelbarrow Deltoideus Loca.on: Spine of the scapula and acromion to the proximal lateral humerus Ac.on: Shoulder flexion Stretch: Shoulder extension Clinical Signs: Short stride, dog resists passive shoulder extension Palpa.on: Taunt band above the triceps when a`emp.ng to extend the shoulder, spasms on shoulder extension 8

9 Deltoideus Injury: Chronic repe..ve injury Strengthen: Cavaleb poles, walking backwards Biceps Brachii Loca.on: Distal cranial scapula to medial proximal radius and ulna Ac.on: Extends shoulder, flexes elbow Injury: Jump and turn, land in eccentric posi.on Short: Extend shoulder, flex elbow Stretch: Flex shoulder and extend elbow Biceps Brachii Clinical Signs: Short stride, slower movement Palpa.on: Thickened tendon palpated medial to the point of the shoulder; muscle belly thick and lobular (trigger points) in the distal 1/3 9

10 Triceps Loca.on: From proximal humerus (3 heads) and scapula (caudal head) to the olecranon Ac.on: Extends elbow, flexes shoulder; major muscle of standing in the front Short: Flex shoulder, extend elbow Stretch: Extend shoulder, flex elbow Triceps Clinical Signs: Lameness in the forelimb afer exercise, short stride, trouble turning or jumping Palpa.on: Acute heat and swelling in the lateral or long head of the triceps; pain on palpa.on. Chronic Leathery feel from significant fibrous.ssue, resists stretch Strengthen: Down to stand, Walking backwards Flexor Carpi Ulnaris Loca.on: From ulna and medial humerus to accessory carpal bone Ac.on: Flex carpus Injury: Hyper- extension injury; Dog jumps off height Short: Flex elbow and extend carpus Stretch: Extend elbow and flex carpus 10

11 Flexor Carpi Ulnaris Clinical Signs: Lame or lame afer exercise on the forelimb. Palpa.on: Directly caudal to the radius and ulna the muscle and tendon can be hot, swollen (2-3x normal size). Usually unilateral so compare to contralateral side Strengthen: Digging, walking in sand, swimming Middle Gluteal Loca.on: Wing of the Ilium to greater trochanter Ac.on: Extend the hip, abduc.on, internal rota.on, stabilize the hip Injury: Trigger point secondary to hip disease (abnormal use) with ter.ary atrophy Middle Gluteal Stretch: Flex the hip, adduct the limb, externally rotate the limb Clinical Signs: Diminished hip, short stride, less ac.ve Palpa.on: Muscle shape should be consistent (concave to convex); if trigger point then concave- convex- concave Strengthen: Backwards walking 11

12 Sartorius Loca.on: Most cranial thigh muscle, feels like a pencil Ac.on: Flexes the hip, flex and extend s.fle Injury: Acute toe touch weight bearing Chronic secondary to hip or s.fle injury, causing painful or restricted hip or s.fle extension Causing compensatory shortening Sartorius Stretch: Extend the hip and flex the s.fle (for cranial head) Clinical Signs: Short rear stride, restricted hip extension Palpa.on: Trigger points just distal to ilium (80%) or just above patella (20%) Strengthen: Cavaleb poles, stairs, crawling Tensor Fascia Lata Loca.on: Cranial aspect of thigh between Quadriceps and sartorius muscles Ac.on: Hip flexor Injury: Hip or s.fle disease, trigger point 12

13 Tensor Fascia Lata Stretch: Extend hip Clinical Signs: Short rear stride Palpa.on: Trigger point at proximal aspect Strengthen: Cavaleb poles, stairs, crawling Pectineus Loca.on: Acetabulum to femur Ac.on: Adduct rear limb; stabilize the hip Injury: Strain in splay injury; excessively.ght or trigger points if hip instability Pectineus Stretch: Abduct the rear limb Clinical Signs: Inability to Abduct limb or extend the hip Palpa.on: With the femur perpendicular to the pelvis, abduct the limb, feel next to femoral artery Strengthen: Sidestepping 13

14 Gracilis Loca.on: Most medial caudal muscle of thigh Ac.on: Extend hip, flex s.fle, extend tarsus, adduct limb Injury: Grade I, II, III strain, Trigger points Stretch: Flex hip, extend s.fle, flex tarsus, abduct Gracilis Clinical Signs: Wide based stance in dogs with cervical issues, Weak - rear legs slide out when sibng Palpa.on: Feels like a hard boiled egg, trigger points at proximal aspect, inability to keep back straight and touch rear toes to the elbow (hip flexion with s.fle extension) Strengthen: Sideways and backwards walking Gastrocnemius Loca.on: Medial and lateral distal femur to calcaneus Ac.on: Extend s.fle, extend s.fle Injury: Grade I, II or III Strain Dog or cat Short: Flex s.fle & extend tarsus Stretch: Extend s.fle then flex tarsus slowly 14

15 Gastrocnemius Clinical Signs: Depending on degree of injury, mild short stride and slower to Non- weight bearing lameness and plan.grade stance. Palpa.on: Bulge at origin at or just below fabella; bulge at muscle tendon interface distally; bulge in the common calcaneal tendon Strengthen: Backwards walking Deep Digital Flexor Loca.on: Just caudal to the.bia, metatarsals and to distal P3 Ac.on: Flex s.fle, extend tarsus, flex digits Injury: Torn at distal aspect, cut on sharp object; strain of muscle belly Deep Digital Flexor Clinical Signs: Popped to; short stride Palpa.on: No resistance on extension of the digit where the tendon has been transected; Tight and tender on palpa.on of the muscle belly Strengthen: Swimming, walking on sand 15

16 Superficial Digital Flexor Loca.on: Just distal to the gastrocnemius muscle, part of the common calcaneal tendon, caudal to the metatarsals and down to distal P2 Ac.on: Extend tarsus, flex digits Superficial Digital Flexor Injury: Torn at distal aspect; grade I strain Clinical Signs: Fla`ened toe or toe; long nails can contribute to stretch as well Strengthen: Swimming, walking on sand Longissimus and Transversospinalis System Loca.on: Lateral to the cervical, thoracic and lumbar spine Ac.on: Extends and rotates spine, laterally flexes spine Lateral flexion has eccentric on one side with concentric on the other Injury: T- bone, moun.ng, long nails/lordosis, pulling weight forward or back/kyphosis, any over use or abnormal use 16

17 Longissimus and Transversospinalis System Stretch: Lateral flexion, flexion, and rota.on to the opposite side Clinical Signs: Unable to move correctly (unable to perform cookie stretches), unable to flex spine Palpa.on: Excessively.ght or trigger points lateral to the spine Strengthen: Sit up and beg, crawling Rest - Ice - Compression - Elevation 17

18 Do not stretch an acute injury, you may reinjure the tissue or prevent stabilization of the tissue Gently stretch a chronic repetitive injury Fibrous tissue needs to become organized Do not stretch a hyperextension injury Laser Ultrasound Massage Cryo if acute Heat if chronic Warm up before stretch or exercise Strengthen S Essential to prevent injury S Active stretch better then passive stretch post injury S Warm up S Mirror sport activity 18

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