Beyond Rehab - Getting the Canine Athlete Back To Performance M. Christine Zink, DVM, PhD, DACVP, DACVSMR, CVSMT A businessman who is playing weekend warrior and gets injured in a tag football game gets a diagnosis, then undergoes surgery if necessary. This is followed by a period of physical therapy to regain the function of the injured structures. His physical therapy is completed once our weekend warrior is feeling good enough to walk up stairs and maybe play a little ball again, but perhaps more cautiously. A professional football player, however, takes the additional step of undergoing sports retraining to move from everyday function to the maximal function required by the sport. He needs to learn how to tackle, catch a pass, and run the ball in ways that fulfill the requirements of the sport, yet protect him from re- injury. Dogs that participate in canine sports are like the professional football player. Regaining simple daily functions isn’t enough. The dog has to go to the next level and regain those special abilities that not only make him successful in agility but also help prevent reinjury or future injuries. That’s what canine sports retraining is. The primary goal of physical rehabilitation is to heal and then strengthen the affected limb/muscles while making sure to support the rest of the body through the healing and strengthening process. The therapist will choose appropriate modalities to aid in the healing of the primary injury. Common physical rehabilitation modalities such as therapeutic ultrasound, transcutaneous electrical neuromuscular stimulation (TENS), laser, neuromuscular electrical stimulation (NMES), magnetic field therapy, manual therapy, underwater treadmill, and swimming can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions that are seen in competition and working dogs. Once the dog has reached pet-level fitness (has attained the ability to climb stairs, go outside to eliminate, get on and off the bed or couch, and go for short walks), the canine athlete can begin to retrain in the activities that he has to undertake to perform his sport(s) or job. The retraining program should begin with the components of the performance event or job that are least stressful to the body and best protect the dog from re-injury, then gradually progress to more complex physical requirements of the sport/job. For example, agility dogs that have had surgery for CCL insufficiency should start retraining using low jumps and straight-line sequences of 3 to 4 obstacles. They then can gradually progress to tighter turns and higher jumps. Obstacles like the weave poles that create torque on the stifle should be the last skills to retrain. In addition, the client should be advised how to monitor the dog to determine whether the retraining program needs to be modified. This can happen with dogs that are so driven to work that they risk re-injury, because the dog is just progressing more slowly than expected, or because other injuries surface that were masked by the more urgent injury. Depending on the injury, it takes 2 to 4 months of retraining (3 to 4 training sessions a week) to go from pet-level fitness to working dog fitness, although this is highly variable. As a part of the sports retraining program, it is important to reset the body’s neurological homeostasis. The dog’s stance, head position, placement of limbs, symmetry, muscular size and tone all need to be reset for optimal function. Of course, the musculoskeletal system is entirely dependent on the nervous system, which provides for initial growth and development, maintenance of muscle size and tone, and coordination of movement and fine motor skills. Thus, chiropractic therapy should be incorporated into all levels of the rehabilitation program, from the earliest stages beginning a few days after the injury and/or surgery. What does a canine sports retrainer need to know? It is essential that a canine sports retrainer be knowledgeable about and have significant experience with: Exercise physiology and nutrition for the canine athlete Developmental conditions that affect a dog’s performance, such as hip or elbow dysplasia, osteochondrosis, etc. Injuries that can occur in the canine athlete, such as cranial cruciate ligament insufficiency, iliopsoas strain, medial shoulder instability, etc. Various surgical techniques that are used for repair, such as the comparative risks and benefits of TPLO, TTA and extracapsular techniques for repair of cranial cruciate ligament insufficiency Principles of canine rehabilitation for developmental conditions, injuries and surgical repair in the canine athlete Drugs that can affect a dog’s performance The sports in which dogs compete. It is particularly important that the sports retrainer be familiar with current training techniques since they can impact dogs’ return to competition or the potential for later re-injury. In addition, the sports retrainer should be know the muscles that are used for different aspects of the various canine sports. How long is the sports retraining period? This depends on many factors, including: The dog’s age. Older dogs take a little longer to regain their competition condition. The dog’s level of fitness when first entering rehabilitation. Canine athletes have an edge over the average pet dog because they usually are in better muscular condition. This is a significant advantage in rehabilitation and this advantage generally shortens the sports retraining period. The nature of the injury/surgery/illness. For example, a dog that has just been diagnosed with Addison’s disease might see a canine sports retrainer to get a plan for training and competing in agility that will help minimize stress while maximizing muscle strength and overall fitness. This dog will likely be able to compete within weeks of diagnosis. In contrast, a dog that has had surgery for medial shoulder syndrome will require very specific, progressive exercises to gradually increase weight- bearing and loading of the shoulder joint in the context of the specific sport(s) in which the dog competes to protect the shoulder from re-injury. The sports retraining period for this dog would be 2 to 3 months or longer depending on the dog’s progress. What kind of additional information do you take into consideration when you establish an appropriate sports retraining regimen? Whether the dog is spayed/neutered and if so, at what age What sports the dog competes in and at what levels (what titles the dog has) The owner’s goals in each sport The dog’s structure, including angulation front and rear, length of loin, length of body relative to height at the withers, amount of bone, etc. What kinds of exercise the dog and its owner enjoyed when the dog was healthy Previous injuries or illnesses the dog has experienced, including stresses on other parts of the body due to compensation for the current condition The dog’s food, supplements, and medications What are some examples of sports retraining exercises? These can be divided into four broad categories. Dogs undergoing sports retraining should be provided with an appropriate combination of: Strength exercises. The classical form of strength training for humans is weight lifting. Dogs strength train by moving their bodies over short distances, particularly when they push against something that provides resistance. Examples of strength training include playing tug, running up hills, pulling weights, wrestling with other dogs, and performing stationary strength exercises such as begging or crawling. Stationary exercises are particularly helpful in the early stages of sports retraining because they strengthen targeted muscles without the disadvantage of impact. For example, begging can be used as a stationary exercise to strengthen the abdominal and paraspinal muscles to support the spine, that control center for all of the dog’s agility movements. Getting a dog to stand after begging without putting the front feet on the ground strengthens the rear leg muscles that are so important for speed and jumping. Waving is a stationary exercise that strengthens the front limbs. Performance events that require predominantly strength include flyball, obedience, agility, and rally. Endurance exercises. This kind of exercise gets the heart beating faster and the lungs breathing harder to supply more oxygen to the muscles to help produce energy for contraction. Examples of aerobic training for humans include running, step exercises, or riding an exercise bicycle. The most common aerobic exercises for dogs are trotting long distances (greater than 20 minutes) and swimming long distances (as opposed to the in and out moves that the dog makes when retrieving in water, which provides more of a strength workout). Performance events that require significant endurance include mushing, herding, field trials, and hunt tests. Performance events that have both endurance and strength components include tracking and lure coursing. Proprioception exercises. Proprioception is the knowledge of where one’s body parts are in space. There are special nerves for proprioception and, as with other nerves, they can be trained. As you can imagine, strong proprioceptive abilities are critical for agility dogs who need to clear jumps without over jumping or hitting the bar, do two-on/two-off contacts, and weave accurately. Exercises that improve proprioception include having the dog walk over 15 to 20 jump poles randomly scattered on the ground and the agility ladder, through which the dog steps very slowly. Most dogs undergoing sports retraining can do as much proprioception training as there is time for as long as the dog doesn’t get bored. Preparation and Recovery Exercises. A proper warm up increases physiological and metabolic rates, increases heart and breathing rate, increases blood pressure and oxygen and energy availability to their muscles, increases temperature of muscles and joints which assists in full range of motion and function, increases glide of the muscle fibers and joints which in turn decreases chance of strains, and allows nerve impulses to travel faster giving the chance of a better performance. Warm ups should include activities that recapitulate the amount of flexion and extension of the limbs and core that will occur during training or competition. Stretching should only be done near the end of the warm up period and should be active, in which the dog stretches itself. The cooling down period should involve decreasing the intensity of exercise slowly over 10 to 15 minutes moving from a trot, to a vigorous walk, then a slow walk and PROM. This helps the dog’s body to remove metabolic waste products from muscles, which prevents soreness and tension. Skill training. This involves retraining each of the skills that are a part of the canine sport(s) in which the dog participates. It is not that the dog needs to be retrained how to perform each component of the sport. Rather, it involves a specific plan of modulated return to the sport such that the risk of re- injury or new injury is kept as low as possible. What additional information should a sports retrainer provide? The sports retrainer should look at the dog whole-istically. In addition to providing information on fitness exercises and sports-specific training, the sports retrainer should advise the owner on: The dog’s diet and any changes that might be made to improve healing and promote muscle strength. For example, levels and digestibility of proteins and fats in the dog’s diet might need to be modified to help provide building blocks for healing and energy for exercise. Nutritional or other supplements that might aid in healing or prevent additional injury. What adjunct therapies, such as chiropractic, acupuncture, massage, heat/ice treatments etc. will promote healing and prevent re-injury

REFERENCES 1. Zink MC. In: Zink MC, Van Dyke JB, eds. Canine Sports Medicine and Rehabilitation. Wiley-Blackwell; 2013:176– 200.