Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 357

Treatment: Patient sedated and ultrasound‐guided
intralesional stem cell/autologous conditioned serum
injected into both iliopsoas tendon insertions.

Postinjection rehabilitation therapy:

Week 1‐2: Short‐line leash walks for urination and
defecation purposes no longer than 5 minutes each.
Indoor and outdoor management to rest hip flexors
by preventing jumping, playing, or excessive stair

use. Cryotherapy over the injection site q.i.d. for 4

days. Non‐end‐range passive stretching of the hip

flexors as tolerated. Omega‐3 fatty acids and

Robaxin® prescribed. Diet reduced to reflect resting

energy requirements.

Week 2‐6: Weekly rehabilitation, starting week 2

for manual therapies, therapeutic ultrasound, and

laser therapy. Client education: moist heat or

warm‐ups prior to massage and passive stretching

performed b.i.d. Use tummy rubs to encourage

active hip extension, and slowly add sartorius

stretches. Passive stretching assigned: iliopsoas,

sartorius, and hamstrings bilaterally, 5 reps of each

for 15–30 seconds as tolerated. PROM of stifle, tar­

sus, and toes assessed daily. Passive stretching/

PROM thoracic limbs.

Initial therapeutic exercises minimized as early

goals of therapy are pain reduction, healing, and

regaining flexibility. Cookie stretches to hips, weight

shifting on stable footing, play bows, and low front

feet up performed o.d. to b.i.d. for first 4 weeks. Low

repetitions, gradually increased. Calm indoor search

games and seated thoracic limb tricks to offer distrac­

tion from boredom.

Flat terrain walks increased in 3–5‐minute inter­

vals weekly if no regression to circumduction or off‐

weighting. Discussed walking in controlled and

deliberate manner without leash pulling, and advised

monthly chiropractic.

Week 6‐10: Bimonthly rehabilitation therapy

results in no lameness or off‐weighting. Patient

demonstrates comfortable mobility despite

expected loss of conditioning. Rehabilitation

modalities remain unchanged. Goals switched to

regaining strength while protecting healing tissues.

Therapeutic exercise includes hill walking, figure‐

of‐eights, and short‐distance side hill walking.

Limited jogging on long line after warm‐up time.

Patient taught to back consistently and straight for

10 steps, before progressing to doing this facing up

and down slopes. One walk per day involves the

additional hill work. Sit‐to‐stand work progresses

to: hills or an indoor slope shifting weight to the

rear, perch pivots in both directions, three‐leg

stands on stable footing progressing to wobble sur­

face, walking cavalettis, and sit pretty.

Exercise routine mixes easier and harder catego­

ries, giving client flexibility to prevent boredom and

provide rest periods. Bodywork reduced to once

daily after exercise. Robaxin® D/C at 4 weeks.

Dietary protein increased for increase in activity and

muscle recovery.

Figure 14.5 Ventrodorsal pelvis view. Note remodeling
and fragmented appearance of left lesser trochanter.

Figure 14.6 Ultrasonographic image of the iliopsoas
insertion.

(Continued)