Post by southern-staffords on May 25, 2008 16:07:30 GMT
Strains & Sprains
A troublesome type of Injury
At trials we see many dogs doing these very sudden stops on contact points. You know, one moment they're flying over the obstacle then SLAM, they stop dead. Did you ever wonder how mach potential for damage to joints there is in this method especially with all the stress that comes from rapid acceleration and deceleration from jumps, stops and tight turns. The Working K-9 Vet Dr. Henry de Boer looks at one of the most common but frustrating types of injury.
Question?
My dog has been diagnosed with a strain or sprain. What does this mean, and how should I handle it?
Answer...
Strains and sprains can be one of the more frustrating injuries that we deal with in our working dogs. They can be difficult to diagnose specifically, and can be very troublesome from the standpoint of healing. Strains refer to damage of a muscle-tendon unit, which is the structure that attaches muscle to bone, while sprains refer to damage of a ligament, which attaches bone to bone. The damage that occurs is most commonly over-stretching of these units. Sprains and strains can be further characterized as chronic or acute, as well as mild, moderate and severe in nature.
Definitions
An acute strain or sprain is as a result of a single over-extension or flexion of a muscle-tendon unit or ligament, while chronic refers to repeated trauma of the same variety. The mild, moderate or severe designation refers to the qualitative nature of the injury.
In general, chronic strains and sprains are characterized by a persistent, lengthy, non-specific lameness with varying degrees of swelling at the site of the problem. Chronic sprains are more likely to have notable swelling associated with them than a chronic strain. They are also more likely to have evidence of change on an x-ray. Mild strains and sprains are typically characterized by a very minimal lameness while moderate level strains and sprains are usually manifest with a very noticeable lameness. The lameness tends to become exaggerated with activity. Severe strains and sprains usually are manifest by a severe lameness, to the point in some instances, where the leg is not being used at all. In general, with increasing qualitative degree, the swelling at the site increases. It is important to note that the swelling is subtle and confined to the area of the injury. Rarely is the swelling obvious from simply looking at the leg, it has to felt by someone very knowledgeable with canine anatomy and function.
Diagnosis
Now that we have defined our terms, we need to look at how these situations are diagnosed and treated. Diagnosis is typically made by evaluating the history of the injury if known, evaluating the gait, careful palpation of the affected leg by a veterinarian, and x-rays. In my opinion high quality x-rays are always warranted when evaluating a moderate level lameness in a working dog. X-rays are not only important from the standpoint of evaluating any subtle soft tissue changes that may exist, but also they are important in distinguishing skeletal disorders (e.g. elbow dysplasia), that can create lameness that would look very much like a strain or a sprain. Clearly, defining accurately the nature of the problem is paramount importance if we are to undertake a successful treatment regimen. Even with careful observation, palpation, and x-rays, pinpointing the exact problem may at times be difficult. Fortunately in most cases of mild and moderate strains or sprains, treatment is quite similar.
Prognosis
The changes for recovery from these injuries is related not only to the initial magnitude of the problem, but also to the level of compliance to a satisfactory treatment and rehabilitation regimen. In general, severe strains and sprains as well as those that are chronic are less likely to resolve or be satisfactorily rehabilitated without substantial intervention such as surgery. For acute, mild and moderate injuries initial icing of the region can be beneficial to reduce swelling and pain. Icing should be performed as much as is possible until the swelling subsides, or at least stabilizes, which could take several days. Once stabilization of the swelling occurs warm compressing several times a day for three to four days will help increase the blood flow to the affected area and hasten the healing process.
Treatment
Medications, while probably not warranted in mild injuries are certainly beneficial for moderate level lamenesses. In the case of strains muscle relaxants are appropriate to ease the discomfort associated with muscle spasms. These spasms are not as likely in the case of sprains, so their benefit is more limited. Pain relievers and anti-inflammatory medications are appropriate for either strains or sprains. Their effect is to not only make the leg more comfortable, but to enhance healing by virtue of quieting the inflammatory process. These medications will typically decrease the lameness, but it is important to realize that while the lameness is improved the healing process is far from over. Do not be misled by this artificial improvement. Steroids such as prednisone and methylprednisolone and related medications should be avoided. While these medication can have a dramatic effect on the lameness they will result in a very slow healing process.
Medications, icing, and hot compressing are all very important, however, by far and away the most important component of a treatment regimen is rest. It is absolutely essential that the affected area be rested for a sufficient period of time to allow for healing to take place. Failure to heed this fact greatly enhances the probability of re-injury, which in turn enhances the probability of the problem becoming chronic or severe in nature. In general leash walking, minimizing stairs, and allowing no jumping is essential until which time no lameness has been observed for a week. Avoid the temptation to test the leg. Testing can be a recipe for disaster.
Once no lameness has been observed for a week, I usually recommend a gradual rehabilitation program that runs in seven to ten day intervals.
During the first interval the dog is allowed to quietly trot on soft level footing for several times daily.
The second interval would involve faster trotting for longer periods of time.
The third interval would be full speed trotting as well as some low jumping if warranted. During the first three intervals sudden turns, chasing and jumping heights should be avoided. We need time to not only rehabilitate the muscle tendon unit or ligament, but also to re-strengthen the muscles that will have diminished in tone from the decrease in activity level.
Activity during the fourth interval can be gradually increased to normal. If at any time during the rehabilitation process the lameness reoccurs, you need to back up to where you were approximately two weeks previous.
Medications during the rehabilitation process are inappropriate, as they are likely to mask symptoms we need to see to assess our progress. Clearly this is a slow process, which can be frustrating if you have an event upcoming, however, the more carefully it can be adhered to the greater the probability of success.
Prevention
So, with luck we have got our friend back to normal, how do we avoid this type of injury again with this dog or prevent it in another dog? The truth is we probably cannot prevent it in all cases. We ask a tremendous amount of our dogs and injuries are a fact with performance. We can keep this type of injury at a minimum however by keeping our dogs in excellent physical condition, keeping weight down, and warming them up gently before heavy activity. Those exercises that are high impact should be kept at a minimum to avoid the wear and tear that is inherent with them.
The potential for long term problems with these injuries is substantial. As working dog owners and handlers we have a responsibility to our dogs to do everything in our power to prevent or properly rehabilitate these injuries to ensure not only their working careers, but, more importantly their comfortable longevity.
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A troublesome type of Injury
At trials we see many dogs doing these very sudden stops on contact points. You know, one moment they're flying over the obstacle then SLAM, they stop dead. Did you ever wonder how mach potential for damage to joints there is in this method especially with all the stress that comes from rapid acceleration and deceleration from jumps, stops and tight turns. The Working K-9 Vet Dr. Henry de Boer looks at one of the most common but frustrating types of injury.
Question?
My dog has been diagnosed with a strain or sprain. What does this mean, and how should I handle it?
Answer...
Strains and sprains can be one of the more frustrating injuries that we deal with in our working dogs. They can be difficult to diagnose specifically, and can be very troublesome from the standpoint of healing. Strains refer to damage of a muscle-tendon unit, which is the structure that attaches muscle to bone, while sprains refer to damage of a ligament, which attaches bone to bone. The damage that occurs is most commonly over-stretching of these units. Sprains and strains can be further characterized as chronic or acute, as well as mild, moderate and severe in nature.
Definitions
An acute strain or sprain is as a result of a single over-extension or flexion of a muscle-tendon unit or ligament, while chronic refers to repeated trauma of the same variety. The mild, moderate or severe designation refers to the qualitative nature of the injury.
In general, chronic strains and sprains are characterized by a persistent, lengthy, non-specific lameness with varying degrees of swelling at the site of the problem. Chronic sprains are more likely to have notable swelling associated with them than a chronic strain. They are also more likely to have evidence of change on an x-ray. Mild strains and sprains are typically characterized by a very minimal lameness while moderate level strains and sprains are usually manifest with a very noticeable lameness. The lameness tends to become exaggerated with activity. Severe strains and sprains usually are manifest by a severe lameness, to the point in some instances, where the leg is not being used at all. In general, with increasing qualitative degree, the swelling at the site increases. It is important to note that the swelling is subtle and confined to the area of the injury. Rarely is the swelling obvious from simply looking at the leg, it has to felt by someone very knowledgeable with canine anatomy and function.
Diagnosis
Now that we have defined our terms, we need to look at how these situations are diagnosed and treated. Diagnosis is typically made by evaluating the history of the injury if known, evaluating the gait, careful palpation of the affected leg by a veterinarian, and x-rays. In my opinion high quality x-rays are always warranted when evaluating a moderate level lameness in a working dog. X-rays are not only important from the standpoint of evaluating any subtle soft tissue changes that may exist, but also they are important in distinguishing skeletal disorders (e.g. elbow dysplasia), that can create lameness that would look very much like a strain or a sprain. Clearly, defining accurately the nature of the problem is paramount importance if we are to undertake a successful treatment regimen. Even with careful observation, palpation, and x-rays, pinpointing the exact problem may at times be difficult. Fortunately in most cases of mild and moderate strains or sprains, treatment is quite similar.
Prognosis
The changes for recovery from these injuries is related not only to the initial magnitude of the problem, but also to the level of compliance to a satisfactory treatment and rehabilitation regimen. In general, severe strains and sprains as well as those that are chronic are less likely to resolve or be satisfactorily rehabilitated without substantial intervention such as surgery. For acute, mild and moderate injuries initial icing of the region can be beneficial to reduce swelling and pain. Icing should be performed as much as is possible until the swelling subsides, or at least stabilizes, which could take several days. Once stabilization of the swelling occurs warm compressing several times a day for three to four days will help increase the blood flow to the affected area and hasten the healing process.
Treatment
Medications, while probably not warranted in mild injuries are certainly beneficial for moderate level lamenesses. In the case of strains muscle relaxants are appropriate to ease the discomfort associated with muscle spasms. These spasms are not as likely in the case of sprains, so their benefit is more limited. Pain relievers and anti-inflammatory medications are appropriate for either strains or sprains. Their effect is to not only make the leg more comfortable, but to enhance healing by virtue of quieting the inflammatory process. These medications will typically decrease the lameness, but it is important to realize that while the lameness is improved the healing process is far from over. Do not be misled by this artificial improvement. Steroids such as prednisone and methylprednisolone and related medications should be avoided. While these medication can have a dramatic effect on the lameness they will result in a very slow healing process.
Medications, icing, and hot compressing are all very important, however, by far and away the most important component of a treatment regimen is rest. It is absolutely essential that the affected area be rested for a sufficient period of time to allow for healing to take place. Failure to heed this fact greatly enhances the probability of re-injury, which in turn enhances the probability of the problem becoming chronic or severe in nature. In general leash walking, minimizing stairs, and allowing no jumping is essential until which time no lameness has been observed for a week. Avoid the temptation to test the leg. Testing can be a recipe for disaster.
Once no lameness has been observed for a week, I usually recommend a gradual rehabilitation program that runs in seven to ten day intervals.
During the first interval the dog is allowed to quietly trot on soft level footing for several times daily.
The second interval would involve faster trotting for longer periods of time.
The third interval would be full speed trotting as well as some low jumping if warranted. During the first three intervals sudden turns, chasing and jumping heights should be avoided. We need time to not only rehabilitate the muscle tendon unit or ligament, but also to re-strengthen the muscles that will have diminished in tone from the decrease in activity level.
Activity during the fourth interval can be gradually increased to normal. If at any time during the rehabilitation process the lameness reoccurs, you need to back up to where you were approximately two weeks previous.
Medications during the rehabilitation process are inappropriate, as they are likely to mask symptoms we need to see to assess our progress. Clearly this is a slow process, which can be frustrating if you have an event upcoming, however, the more carefully it can be adhered to the greater the probability of success.
Prevention
So, with luck we have got our friend back to normal, how do we avoid this type of injury again with this dog or prevent it in another dog? The truth is we probably cannot prevent it in all cases. We ask a tremendous amount of our dogs and injuries are a fact with performance. We can keep this type of injury at a minimum however by keeping our dogs in excellent physical condition, keeping weight down, and warming them up gently before heavy activity. Those exercises that are high impact should be kept at a minimum to avoid the wear and tear that is inherent with them.
The potential for long term problems with these injuries is substantial. As working dog owners and handlers we have a responsibility to our dogs to do everything in our power to prevent or properly rehabilitate these injuries to ensure not only their working careers, but, more importantly their comfortable longevity.
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