More on Dynamic Stretching

Clarification on dynamic stretching:

Standing high fives: dog is standing (four paws on the ground) and giving you a high five.

Sitting wave: dog waves 3-5 times in a row before putting his paw down.

Toe-kicks: same as standing high fives, but while you're standing facing the dog, you lift your foot about dog's elbow height so dog has to shift weight forward and reach forward to touch your foot with its paw. Switch feet and continue. It's ok if your dog starts to take a step forward to adjust for the weight shift, you can just take a step back.

Figure 8 through legs: make sure you change directions. Many don't believe me but a direction change is required.

Circle work: large enough circles to get your dog into and maintain a trot. Change of direction is required.

Walking backwards: when dog is going backwards make sure it's in a straight line.

Robin Pelletier

Agility Warm Up

There just isn't enough warm-up happening in agility! Especially dynamic stretching.

Many get confused with the stuff that goes on while you're waiting your turn to run as being a warm-up. That stuff, IMO, is to rev, ready, and focus your dog.

I also see good intentions happening on the first day of a multi-day trial, but the energy usually fades by day three which is when your dog needs it the most.

Warm muscles can keep a slip from turning into an injury.

Five minutes of trotting is the minimum warm-up to do.

Dynamic stretching routine:
- Standing high fives
- Sitting waves
- Toe-kicks
- Figure 8 through legs
- Circle work
- Walking backwards, etc .

Multiple reps of each AFTER the 5 minutes of trotting.

The practice jump is not a dynamic stretch its a ballistic event. Ballistic events require dynamic stretching. So if you warm your dog up and then do the practice jump to get your dog's "head in the game" great, but it can't replace a dynamic stretching routine.

A dynamic stretching routine consists of activities that increase the body's temperature and increase blood flow to the muscles so they can be ready at a moments notice. A good dynamic stretching routine uses movement patterns that require muscles group activation, muscle groups that will be used during the trial, but activities that don't replicate the actual activity you're going to do in the trial. You want to save the "bang" for the competition, don't waste it on the warm-up.

Robin Pelletier
www.poodlesinmotion.com

More About Feet

I have been doing stretches for several week to try to alleviate the heel pain associated with plantar fasciitis.

The TOE EXTENTION is a new stretch I added a couple of weeks ago that has made a big difference.  If done properly (you really have to pull back hard), it provides the best stretch of the tendons on the bottom of the foot.

Foot stretches to prevent plantar fasciitis

Stretches

Heel pain can be caused by stress placed on the plantar fascia ligament when it is stretched irregularly, which causes small tears and inflammation. Stretching and strengthening exercises can help the ligament become more flexible and can strengthen muscles that support the arch, in turn reducing stress on the ligament.

Exercises for plantar fasciitis-when combined with other steps such as resting, avoiding activities that make heel pain worse, using shoe inserts, icing, or taking pain relievers-usually succeed in relieving heel pain. 

Stretching exercises should create a pulling feeling. They should not cause pain. It's best to do each exercise two or three times during the day, but you do not need to do them all at once.

1. Plantar Fascia Stretch by Rolling

The plantar fascia can be stretched by rolling it over a round object such as a ball, weights bar, rolling pin or can or bottle.

Plantar fascia stretch by rolling

• While seated, roll the object with the arch of your foot.
• Roll the foot repeatedly over the object, applying increasing downwards pressure.
• If you are able to, progress to doing this exercise while you are standing up.
• Using an object which can be cooled in the freezer, such as a bottle or can, also applies cold therapy at the same time!  (A frozen plastic bottle of water works great!)

2. Calf Stretch 

This exercise stretches the muscles at the back of the lower leg (the calf) and the Achilles tendon.

Stretch for the Gastrocnemius muscle

• Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.
• Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.
• Hold the stretch for 15 to 30 seconds. Repeat 2 to 5 times.  
• Repeat the set 3 times a day.
• Gradually hold the stretch for longer (up to 45 seconds).

3. Another Calf Stretch

In addition to the above stretch this one will stretch the Soleus muscle lower down in the back of the leg.

Soleus muscle stretch

• Stand in front of a wall with the leg to be stretched just behind the other.
• Bend both knees and lean forwards slightly. Make sure you keep the back heel down. 
• If you need more of a stretch, raise the toes on an object 1-4 inches tall or move further back from the wall.

4. Stretching on a Step

Stretching on a Step

• Stretch by standing on the edge of a step and slowly lower the heels down below the step.
• Start using both legs and progress to one leg at a time
• Hold for at least 15 seconds.
• You should feel a gentle stretch.
• Be careful not to over-do this one

5. Towel Curls to Strengthen your Foot

Strengthen your foot with towel curls

• While sitting, place your foot on a towel on the floor and scrunch the towel toward you with your toes.
• Then, also using your toes, push the towel away from you.
• Make this exercise more challenging by placing a weighted object, such as a soup can, on the other end of the towel.

6. Marble Pickups

Using your toes will strengthen your feet. 

• Put marbles on the floor next to a cup. 
• Using your toes, try to lift the marbles up from the floor and put them in the cup.

BEFORE YOU GET OUT OF BED

Many people with plantar fasciitis have intense heel pain in the morning, when taking the first steps after getting out of bed. This pain comes from the tightening of the plantar fascia that occurs during sleep. Stretching or massaging the plantar fascia before standing up can often reduce heel pain.

• Stretch your foot by flexing it up and down 10 times before standing.
• Use a towel to stretch the bottom of your foot (towel stretch ).
• Massage the bottom of your foot across the width of the plantar fascia before getting out of bed.

Other steps can help reduce heel pain when you take your first steps after getting out of bed. You can:

• Wear a night splint while you sleep. Night splints hold the ankle and foot in a position that keeps the Achilles tendon and plantar fascia slightly stretched.
• Always wear shoes when you get out of bed, even if it is just to go to the bathroom. Quality sandals, athletic shoes, or any other comfortable shoes with good arch supports will work.

Participating in Sports

If you are participating in sports, it is very important to warm up and do stretching exercises before your sport. Warming up and stretching will make your plantar fascia more flexible and may decrease the chance of injury and inflammation.

You may want to take a pain reliever such as a nonsteroidal anti-inflammatory drug (NSAID), including aspirin, ibuprofen, or naproxen sodium, to relieve inflammation and pain. Some people take NSAIDs at least 30 minutes before doing recommended exercise, to relieve pain and allow them to participate and enjoy the exercise. Other people take NSAIDs after they exercise.

Exercises to Avoid

Some exercises may make your heel pain worse. One example is exercise that involves repeated motions and pounding of the foot against a hard surface such as running or jogging. You should avoid this type of exercise.

Plantar Fasciitis

Well, I can now add this to my list of ITICES.  Hopefully, early treatment and routine preventive maintenance will relieve this one.  It hasn't stopped me, but the pain is not fun at all.

What Is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

                 

Causes

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.  (Mine is a high arch.)  Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. (Does baking dog treats barefoot on hardwood floor constitute "non-supportive.)  Obesity may also contribute to plantar fasciitis.  (Another reason to loose those extra pounds!)

Plantar fasciitis can also be caused by very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength.

Symptoms

The symptoms of plantar fasciitis are:

• Pain on the bottom of the heel
• Pain that is usually worse upon arising or when walking after resting.
• Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

  

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

• Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
• Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
• Limit activities. Cut down on extended physical activities to give your heel a rest.  By walking on the painful foot you are continually aggravating the injury and increasing inflammation. Rest as much as possible and stop any unnecessary activities which place additional stress on the fascia.
• A good plantar fasciitis taping technique can help the foot get the rest it needs by supporting the plantar fascia. Tape is applied in strips across the plantar fascia taking the stress off the foot which healing to take place.
• Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

• Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
• Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
• Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
• Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
• Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
• Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

Long-term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Menina's Recovery Timeline

Feb  ?    

Injured right rear leg

Feb 15  

Dr. Laviola - Chilhowee Veterinary Clinic - Xray: No broken bones, very inflamed right rear hock, anti-inflammatory and restricted activity.

Feb 25   
Dr. West  - Chilhowee Veterinary Clinic - Recheck - felt like tendon was moving on heel (tuber calsis) bone.  Referred to orthopedic specialist.

Mar 2  
Dr. Blackford - Blackford Surgical Referral - Repaired luxated superior digital flexor

Mar 3  
Restricted Activity - Walk on leash only to potty.  Absolutely no running, jumping, or stairs!

Mar 16  
Removed Cast - Start 3 Week Crate Restriction.  Walk on leash only to potty.  Absolutely no running, jumping, or stairs!

April 6  
Start 1 Month Walking and Swimming - No running or jumping.  Start walking and swimming. As long as she is not sore, continue to increase the activity. Also do range of motion exercises on the hock to help her tissue to heal in the right orientation.

May 5  
Start Month 3 Restriction - Try some running. Don't start agility yet.  Must avoid weaving and jumping until the 3-month restriction is over.

Jun 6     

One Month Re-Introduce Agility Training. Gradually return to agility activities.  Make sure you gradually re-introduce jumping and weaving.  The tissue should be adequately healed so she shouldn't  re-injure herself. Dr. Blackford has never had a re-injury for this problem, but she has never repaired this problem in an agility dog.  The scar tissue (when adequately healed) should be stronger than the normal tissue.  There have been reported cases of Shelties breaking down in the other leg. Hopefully that won't be a problem for Nina.

Jul 1  
Ready for Agility Competition - Assuming all goes according to plan.  Wish us well!

Home Again

We arrived home yesterday after a long weekend at Harriman.  I really enjoyed the agility trial.  It was fun to watch the dogs and handlers, good to learn more about the agility sport, interesting to meet new dog folks, and helpful to get to know fellow TVKC club members.  It broke my heart to have to keep Menina in her crate the whole weekend.  I have several questions yet on her recovery.  Here is the email I sent to her surgeon today.

• Surgery: March, 2, 2010, Dr. Blackford repaired luxated superior digital flexor

• Recovery: 
  
  1. Cast removed 3/16/2010.
  2. Activity still restricted to crate and short leash for potty.  Using ace to keep her calmer.  Limited activity for 3 more weeks after cast removal.
  3. Using prescribed gentle forward and backward movement to leg for physical therapy several times daily.
  4. Appears to be healing a little every day.  Affected leg appears a little stiff when she walks - range of motion is not yet equal to left leg.  Infrequently, but sometimes, I do see her limp (just a single step) if she walks quickly outside.
  5. Per your instruction, I plan to gradually introduce leash walks after our three week crate restriction. Start 4/6/2010
  
  HERE ARE MY QUESTIONS: 
  
• Would swimming be beneficial?  If so when, how much?
  
• At what point can start a gradual I return to agility training?  Jumping? Weaving? Teeter? A-Frame?  Walk?  Tunnels?
  
• Registration for May and June competition are opening NOW.  When can I anticipate being able to compete? 
  
• Should I get you to look at her again for evaluation prior to training or competing??????  I so want to get back "normal" but I must make sure that we give her the best chance for complete recovery.  Your guidance is appreciated.

The Patient is resting well.

Well, surgery it was.

We visited Dr. LeeAnn Blackford this AM. Nina was diagnosed with a luxation of the superior digital flexor tendon.

• This is an uncommon injury usually seen in the Sheltie, but can occur in any breed.
  
• The superficial digital flexor tendon is the caudal-most component of the calcanean (or Achilles) tendon.
  
• Its retinaculum holds it on the caudal aspect of the tuber calcanei.
  
• When this retinaculum tears, usually due to exercise-related trauma, the tendon can luxate medially or laterally.

What does all that mean? Well, a little canine anatomy first. Take the rear right leg ... Focus of the purple tendon:

The Achilles' tendon is on the back side of the leg. It consists of two major and three minor tendons.

(1) Gastrocnemeus tendon - the main tendon that attaches to the heel (or calcaneous bone)

(2) Superficial digital flexor - second main tendon that partially attaches to the calcaneous bone and then passes over the end of the heel bone and attaches to the digits; this tendon flexes the digits.

Three minor tendons (not shown)

The detailed diagram below shows that bursa cushions the purple tendon (superior digital flexor) where it runs over the heel bone (tuber calsis). This is the bursa that has been so swollen on Nina during the last few weeks.


Now we need to review the definitions of a few terms....

retinaculum [ret″ĭ-nak´u-lum] - a structure or that retains an organ or tissue in place. In this case the retinaculum has been described as a sheath covering the tendon.

luxation - [luksā′shən] a dislocation or a displacement.


So, in plain English, Nina's Achilles tendon was dislocated off the heel bone due to a torn sheath that holds the tendon in place.

The surgery was performed to repair the torn sheath to stabilize the dislocation.


The following three diagrams show how the surgery that was performed on Menina this morning.

Surgery? I hope not.

A call from Dr. West at Chilhowee Veterinary Medicine. yesterday has left me apprehensive about a potential turn in Menina's diagnosis. He is worried that she may have a torn sheath on one of the ligaments that connects to her swollen hock joint. He will re-examine her tomorrow and recommend a course of action. I got Ace Russell's (Nina's trainer) recommendation for an orthopedic specialist in west Knoxville. Let's hope we don't have to go down the surgery path. Blackford Veterinary Surgery Referral

I went ahead and officially canceled our entry in the Montgomery Kennel Club Agility Trial in Autaugaville, AL - we were wait listed for the weekend of March 12. I also withdrew from the Tennessee Valley Kennel Club Agility Trial at Harriman, TN. I will wait until I know more about what is ahead for us to decide on what to do for the Youngsville, NC and Oak Ridge/Harriman, TN Trials already registered. I feel better now that March is officially a "GET WELL" month.

Bursitis

Menina and I have been training with Ace Russell for about five month's at Meadowbrooke Kennels. It has been so incredibly fun finding out what we can do. We have plans to start competing in March starting with the Tennessee Valley Kennel Club Agility Trial at Harriman, TN on March 19 - exactly four weeks from today. We were rocking and rolling until last weekend when a sore leg turned into a painful limp. Upon closer examination, I found a severely swollen joint on her back right leg. X-rays by our local vet assured us the next day that no bones were broken. She diagnosed bursitis (fluid buildup on the bursa) in the tarsus or the dog's "heel" equivalent.

Our hope is that this will heal with anti-inflammatory medication, rest, and ice. Please wish us the best, we have lots we want to do.