358 Canine Sports Medicine and Rehabilitation
range of extension. To focally stretch test the
sartorius, the stifle is first placed into flexion,
then hip extension is slowly added. The sarto
rius stretch is not a large movement in the nor
mal dog, however, when affected, a difference
is appreciated in flexibility and comfort.
For muscle injuries, pelvic limb radiographs
are generally unremarkable. Avulsion of the
lesser trochanter may be noted in acute trau
matic avulsions of the iliopsoas tendon, and
mineralization within tendons sometimes can
be seen in chronic cases.
Musculoskeletal ultrasonography is an excel
lent diagnostic modality to confirm the diagnosis,
grade the severity of strain, and assist with prog
nosis. The skill of the diagnostician is paramount
so as to not overinterpret ultrasonographic
findings or dismiss a diagnosis because a grade I
strain is ultrasonographically normal. Sequential
imaging may assist the rehabili tation therapist
make a decision regarding when to increase exer
cise, bearing in mind the importance of treating
the patient rather than the image.
Treatment
Conservative medical management with reha
bilitation therapy is recommended for acute
and chronic muscle strains. At‐home medical
management includes short courses of NSAIDs,
muscle relaxants, cryotherapy that transitions to
moist heat, restricted activity to prevent ongo
ing damage, and controlled exercise to stimu
late proper repair and body use. Adminis tration
of NSAIDs beyond the first 24–48 hours has
recently fallen out of favor in the human litera
ture as there is increasing evidence that it may
delay tissue healing and carries a risk of adverse
reactions (Jones et al., 2015).
In general, muscle relaxants are well toler
ated and may facilitate easier passive and active
stretching exercises. Pain management can
promote limb use and thus reduce further
contracture of the tissues that accompanies
avoidance postures and guarding, particularly
if the patient will not have the option of concur
rent rehabilitation therapy.
Rehabilitation therapy is highly successful in
the management of most strains, along with
proper education and guidance of clients
through the recovery process homework. Follow
ing recovery, as with any injury, proper con
ditioning and transition to sport as well as
teaching injury prevention strategies may
help prevent new or reoccurring strains.
Rehabilitation involves use of physical modali
ties such as therapeutic ultrasound, phono
phoresis, and laser therapy to aid tissue repair
(see Chapter 7). Because these modalities also
reduce pain and increase tissue extensibility,
the rehabilitation therapist will often find the
patient more receptive to manual therapies fol
lowing their use. However, these modalities
should be viewed as complements to skilled
manual therapies and do not replace the impor
tance of proper massage, the release of myofas
cial trigger points, and working with the patient
to regain normal flexibility and range of motion
through appropriate stretches and therapeuticWeek 10‐16: Rehabilitation therapy once monthly.
Light cantering in a controlled environment for up to
5 minutes after 15 minutes of walking. Light tracking
permitted on walks, including wooded terrains. Return
to swimming/wading in water permitted for controlled
periods once weekly, adjusting work to prevent fatigue.Week 16: Patient remains sound with significant
progress in fitness. Periodic recheck and rehabili
tation therapy tune up is recommended at 3‐month
intervals. Client is taught proper warm‐up/cool‐
down routines, and continues once weekly at‐home
bodywork to maintain suppleness and to monitor
for early signs of strain recurrence.Exercise now includes long‐distance trotting,
uphill sprints, increased water play, and swimming.
Patient is transitioned to off‐leash except in slippery
conditions. Ongoing core work is encouraged while
fine‐tuning proprioception.Case discussion: Due to the chronic history of ili
opsoas strains, orthobiological intervention was
chosen to augment rehabilitation therapy for this
case. Manual therapies were very important as
numerous muscle groups and the neck/spine had
been compensating for some time. Endurance
training remains an important part of the training
regimen.