The most common hind leg injuries in the dog are cranial cruciate ligament (CCL) insufficiency and iliopsoas muscle strain. CCL disease was previously discussed in this column; therefore, the focus here will be on the iliopsoas.
Interestingly, iliopsoas injuries are common in humans. While the spelling of iliopsoas looks intimidating, just ignore the "p" when pronouncing (il-e-o-so-as). The name is based on the fact that two muscles (the psoas major and iliacus) join to form the iliopsoas. These two muscles together move the leg forward at the hip and when standing, aid bending the lower back to the side.
Injuries to the iliopsoas result from excessive force on the muscle. This can occur in dogs competing in athletic activities where the muscle is contracting while it is stretched. However, iliopsoas injury can also occur when a dog slips into a splay-legged position during rough play with other dogs or when jumping out of a vehicle.
Dogs with iliopsoas strains can have variable amounts of lameness ranging from subtle, intermittent reduced weight bearing on the affected side to a significant lameness that worsens with activity. Affected dogs will have discomfort and spasms when the muscle is touched during examination. Pain may be accentuated by stretching the muscle while examining.
X-rays are generally not useful in the early phases but may reveal mineralization where the muscle attaches to the femur in longstanding cases. The use of CT scans, MRI and ultrasound may be used to identify iliopsoas injury. However, the history, physical exam and response to treatment can provide evidence to support the presumptive diagnosis of iliopsoas injury.
Treatment depends on severity and how long-standing the problem is. For acute (recently started) injuries, treatment generally includes controlled activity, cryotherapy (ice packs) and non-steroidal anti-inflammatory drugs such as carprofen. Herbs including boswellia, turmeric and ginger have anti-inflammatory effects that can be helpful. In severe cases, muscle relaxants may be used to reduce pain and muscle spasms.
Rehabilitation techniques including laser therapy can be beneficial for reducing pain and improving healing. Acupuncture can also be valuable for promoting healing and pain management. Additionally, proper alignment of the sacroiliac joints, lumbar spine and front part of the pelvis are critical. It is important to note that it can take four-six weeks or longer to recover from an iliopsoas injury.
For chronic injuries, supportive care and management are similar to the acute injuries, except there is a need to reinitiate the inflammatory process to assist in remodeling and healing of the tendon fibers. Maintaining proper alignment and mechanics of movement are essential to avoid ongoing strain to the muscle. Laser therapy, acupuncture, massage, stretching and heat can benefit healing a chronic iliopsoas injury.
Iliopsoas injuries can be slow to heal and are prone to reinjury. Some performance dogs can never return to competition. Household companions may also be limited in their ability to hike as much as they did prior to the injury. Ongoing osteopathic or chiropractic care is valuable along with regular laser therapy sessions, massage and core strengthening programs. Core strengthening activities focused on the gluteal, hamstring and iliopsoas muscles include controlled, slow walking up and down gradual hills, use of cavaletti poles, and standing with the front paws on an elevated surface.
Keep in mind that it is important to gradually increase the activity to avoid reinjury. Chronic iliopsoas problems can take longer to heal than the acute injury. Regenerative medicine treatments with stem cell injections can be used for patients that do not response to conservative therapy and rehabilitation management. Surgery may be an option when the iliopsoas strain occurs at regular intervals.
Nutritional supplements and other products that may be of benefit during the recovery process include glucosamine, vitamins C, D and B complex, and manganese. Each of these has some value in supporting the connective tissues and tendons.
If you suspect that your dog has an iliopsoas injury, contact your veterinarian for an evaluation and therapy plan.
Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs.
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Integrative pet vet: A common cause of lameness in dogs - Glenwood Springs Post Independent