Layla Karas

Pets Age: 
4 year old
Pet Type: 
Female neutered, Boxer

Layla is a good example of a forelimb lameness case that can be frustrating in general practice. She first presented in June 2013. Her main presenting complaint was that she had been intermittently stiff on the right fore, usually after a period of rest following a vigorous walk. These signs were temporarily responsive to rest but resumed once more challenging exercise was brought in.

On initial observation there was less flexion in the right elbow than the left when resting in sternal recumbency. On gait evaluation during her first appointment she lacked impulsion from the hind end and showed a lack of dynamic stifle flexion. She tended to overload her forelimbs with the marked cranial bias to her gait pattern that she displayed. There was also a reduced range of dynamic flexion occurring about the right elbow leading to slight shortening of the right fore stride length. This was leading to overloading of the left fore. It was challenging for her to maintain her balance when walking on a circle, particularly to the right as she would start to abduct the right hind and shortened further through the left fore. It also became apparent that she lacked spinal flexibility from the cervical to the lumbar region when walking on a circle in either direction.

On palpation there was some discomfort through the brachiocephalicus muscle, particularly on the left. Mild effusion was present on palpation of the left elbow. Mild medial and lateral effusion were present on palpation of the right elbow and there was some discomfort on palpation of the medial compartment of the right elbow. The groove between the long and lateral heads of the triceps was also reactive on the right. There was a trigger point in the latissimus dorsi on the right near the border with the trapezius. The paralumbar musculature was hyperaesthetic and tense to palpation. There was some tenderness on palpation of the iliopsoas muscle just cranial to the wing of the ilium, bilaterally but most notably on the left. Bilateral sciatica was present and this was most prominent on the right. Her abdominal tone was suboptimal, reflecting her need to develop improved core function. Mild effusion was present in the right stifle and at times she appeared to offload this limb. Mild effusion was present in the left hock and she resented palpation in this area.

Although Layla’s gait abnormalities were subtle, they reflected suboptimal biomechanics. This was very likely leading to the more dramatic right hind lameness signs that were sometimes seen at home. We instigated a rehabilitation programme aiming to ease the muscular tension and discomfort described above. Our physiotherapy aims were to develop her core stability and recruit her hind limb musculature more appropriately to decrease and control the load being placed over her forelimb joints, most importantly the right elbow. Techniques employed included acupuncture, chiropractic treatment, soft tissue work, physiotherapy homework exercises and aquatic treadmill walking.

In the early stages of her rehabilitation programme the attended the clinic for an hour weekly. By the time that Layla was six weeks into treatment, she was able to spend a decent proportion of her walks off lead and no right fore stiffness had been seen for 4 weeks. She had also been able to resume agility training without ill-effect.

On gait evaluation at week six, no right fore gait abnormality was seen. There had been an improvement to the degree of hind limb impulsion generated when she walked with improved activation of her hip and stifle flexors and extensors. Spinal flexibility had also improved when walking on a circle in either direction. Right hind abduction had subsided.

On palpation, the paraspinal muscle hyperaesthesia that had been initially noted had eased. The effusion that was present in the elbows had resolved. Elbow manipulation was well tolerated and the quality of movement was reasonable. No sciatica was detected. Her abdominal and hind limb muscle tone had improved significantly.

After 8 weeks of weekly treatment, we were able to start to reduce her treatment frequency to fortnightly and then monthly. We see her now for maintenance treatment every 6-8 weeks. This is to ensure that she maintains her improved neuromuscular recruitment patterns and to address any areas of increased muscular tension before she develops a functional imbalance. She is so vigorous in nature that on-going Smart Clinic contact helps to reduce the effects of wear and tear.  

Layla’s case is an interesting example of a lameness which is not purely due to an inflammatory focus, but more the ‘tip of the iceberg’ in a case of chronic functional imbalance. Certain muscle groups had become over-used (i.e. triceps and longissimus lumborum) and others had become under-used (i.e. rectus abdominus, abdominal obliques, quadriceps and hamstrings). For many dogs a cranial pattern like Layla’s would not necessarily produce a forelimb lameness but her propensity to twist and turn at speed with a considerable mass behind this speed leaves her open to higher forces over her joints. Improving her proprioceptive awareness in all four limbs has also been very beneficial to her progress.