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How to approach
the canine athlete
I
n equine sports medicine veterinary surgeons play a
central role in the management of performance-
related issues, including injury prevention and
restoration of athletic activity. For the small animal
practitioner however, management of the canine
athlete is often an entirely new concept. Consequently,
the client can be left with a lame dog, a feeling of
extreme disappointment and perhaps even a
reluctance to seek veterinary advice in the future. They
will often turn to paraprofessionals of varying ability for
treatment, occasionally to the detriment of the dog.
Common disciplines include Agility, Obedience,
Sled racing, Canicross, Flyball, Greyhound racing,
Field trialling and Shepherding (Figure 1). Each
discipline places different demands on the individual
in terms of skill requirements, muscle strength, power
and endurance, as well as focus and concentration.
Equally, each discipline will predispose to a specific
complement of injuries (Figure 2).
Understanding movement
Prior to embarking on a management plan, it is
essential that the clinician is well versed in exercise
physiology and the principles of sports-related
training, along with having the ability to diagnose and
appropriately treat commonly encountered
performance-related problems. Rest and non-steroidal
therapy are rarely appropriate, or successful,
standalone treatment options in these patients.
Historically, orthopaedic examinations and
interventions have largely focused on the kinematics of
movement, with little thought to how the injury affects
the kinetics of movement globally or how global
movement patterns can affect local motion kinematics
and predispose to injury.
Understanding global movement patterns is key to
becoming proficient in the management of sporting
dogs. For non-performance animals, an improvement
in mobility following treatment may be viewed as a
clinical success, even if the patient retains a slight or
even moderate degree of lameness. In a performance
animal however, anything less than restoration of full
athletic activity is deemed a failure.
A sound animal is often far removed from being
able to tolerate the demands of rigorous and repetitive
training. Restoring soundness on its own is merely the
first step on the recovery ladder, and a good clinician
should be able to assist with rehabilitation of
musculoskeletal structures, training regimes, nutrition
and injury prevention in order that the patient can
attain full physical fitness.
Movement in vertebrates is the result of complex
and highly coordinated mechanical interaction
between bone, muscles, ligaments and joints. It is
controlled by the nervous system and influenced by
external load or force. Injury to, or a lesion within, any
of the elements of this system will change the
relationship within the system and lead to tissue
degradation, instability or disability of movement, and
eventually result in a clinical pattern of lameness.
During any form of sporting activity the load placed
on both the musculoskeletal and neuromotor system is
increased. How an individual adapts to this increasing
challenge will, in the end, determine both athletic
potential and predisposition to injury. The veterinary
surgeon has a role to play, often in conjunction with a
physiotherapist in being able to: modify, manipulate
and control the mechanical environment to prevent
injury; correct for movement abnormalities; and
facilitate tissue healing and repair. Certain disciplines
predispose to certain injuries, due to numerous factors
such as:
Lack of movement variability
Rapid acceleration and deceleration of body
segments
Abnormal body positioning
Extreme nature of the challenge
Endurance requirements
Lowri Davies of the SMART
(Sports Medicine and
Rehabilitation Therapy) Clinic
helps us consider the different
needs of our more athletic
canine patients
Figure 1: Welsh Collie Trial champion
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Tools for diagnosis
Other factors, such as nutritional status, endocrine
function and the individuals immune status, can affect
both performance and predisposition to injury. The
diagnosis of the presenting problem should be
followed by diagnosis of the cause of the problem, with
imaging being regarded as a means of confirming
diagnosis rather than a fishing exercise.
Detailed history taking and examination
procedures should be the diagnostic cornerstones.
Some tools, such as video imaging, however, are
invaluable when it comes to assessing functional
movement patterns and in determining whether these
are contributing to chronic overuse injury patterns.
From this the clinician should be able to ascertain:
Which muscle groups the animal relies on to
complete the task
Dynamic stability during performance (to include
local and global stabilization)
How the injury alters performance
The demands of the performance on the body and
how this varies depending on the sport; i.e. Agility
will challenge the participant differently to
Obedience or Canicross
In this way the patient must be viewed not only in
terms of the injury or individual limb lameness but
rather as a complete system. For example, if we take
the case of cranial cruciate disease, most veterinary
literature ignores the concept of the joint as an
organ. Rather, discussion centres on either the
biology or the biomechanics of the cranial cruciate
ligament (CCL) when attempting to address causes
and treatment options. In order to provide the best
therapeutic approach it is essential to consider the
joint as an organ system, the correct functioning of
which requires that all tissues comprising the joint
must work together, biomechanically and
biologically, to maintain joint health and allow full,
pain-free function.
Thus, successful treatment should consider not
only the CCL but also the synovium, joint capsule,
articular cartilage, menisci and subchondral bone. It
must also consider the neuromuscular consequences
of injury, such as alteration in somatosensory and
proprioceptive function. Since the stifle joint is part of
the locomotor system, any rehabilitation programme
should consider how the changes within the stifle
joint affect the system as a whole, i.e. the back, trunk
and other limbs.
Getting a good view
The second challenge that a veterinary surgeon faces
is that the majority of diagnostic or imaging options
available to us look at anatomical or structural changes
within the recumbent animal. Lameness issues in the
canine athlete may be of physiological origin and only
manifest under certain conditions of performance or
activity. For example, the lameness may only present
on certain surfaces, after a certain period of activity or
after one particular activity. Accurate diagnosis can
therefore be a challenge and is often time-consuming.
It should include:
A thorough history, including identifying
performance- or training-related issues
Detailed observation and gait analysis, including
video analysis of the dog in training
Gentle palpation and manipulation of the complete
musculoskeletal system
As the patient is examined, it is easy to forget that it
is a living, moving structure. A muscle group may only
be painful when it is actively contracting, or a structure
may only be painful in one position; so the patient
should be assessed dynamically at all times, not only
when trying to establish on which leg it is lame. The
limb should be moved around and individual muscle
performance or responses should be gauged. The
limiting factors to joint motion should be identified: in
other words, do they reside within the joint or within the
surrounding structures? The quality and control of the
movement should be assessed; if control is lost, at
which point during the stride does that loss of control
occur; is it seen throughout the stride or only during
the outer ranges of motion?
Figure 2: Weaving in agility requires excellent balance to
allow rapid change of direction and can lead to sliding
injuries of the fore limb along with trauma to the hypaxial
and epaxial musculature of the trunk
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How to approach the canine athlete
Clinical examination
At rest, the animals stance should be assessed
(Figure 3), looking to see if the animal stands square
through the axial and appendicular skeleton. The
animal should be viewed from the front, sides, back
and above. Any deviation in the thoracic and lumbar
spine should be noted, along with any lordosis or
kyphosis. All four limbs should be positioned vertically
under the body; any movement away from this plane
points to compensatory weight shifting. In the healthy
individual, 30% of body weight should be taken by
each fore limb and 20% by each hind limb.
Limbs may be abducted to reduce the load and/or
adducted to increase the load placed through them
(Figure 4). Fore limbs can be pulled under the body to
increase the load in front and move the centre of
gravity forwards. When the fore limbs are pushed out
in front of the body and the pelvis is rotated caudally to
facilitate increased loading of the hind limbs, the
Figure 3: Examination of posture in the standing patient
Figure 4: Pronounced abduction and offloading of the left
hind limb coupled with a forward shift in centre of mass and
increased loading of the left fore limb
Figure 5: Gait
analysis on grass;
the uneven
surface can assist
with highlighting
subtle lamenesses
centre of gravity is moved backwards. Any such
change in the animals centre of gravity alters the load
on the various components of the musculoskeletal
system and affects the balance of tissue injury and
repair. A successful treatment protocol should restore
normal weight distribution in all gaits.
The animal should be viewed at the walk and trot,
both in a straight line and on the circle. If possible the
dog should be assessed on different surfaces and on
sloping ground (Figure 5). Many subtle lamenesses
are not obvious on level, tactile surfaces; if the animal
is placed on a wooden floor where greater effort is
required to control movement, then often the lameness
will be more pronounced.
The gait should be described further in terms of:
cranial and caudal components; stance and swing
phases; arcs of flight; and linearity of the movement.
Attention should also be paid to individual joint motion;
e.g. increased stifle flexion or hock extension may be
seen when hip extension is reduced. The movement or
otherwise of the pelvis and the lumbar, thoracic and
cervical spine should be noted. The laterality of
movement should also be gauged: is there equal
movement on either side of the median plane, or is it
greater to the left or right? The control of limb and
trunk motion should also be assessed: is it smooth and
synchronous or erratic and disjointed?
Palpation and manipulation
Following on from gait assessment, a thorough
palpation and manipulation of the individual should be
undertaken. Information regarding general muscle
symmetry, muscle mass and resting tone should be
collected. Subtle changes within individual muscles,
including odema, trigger point formation and the
presence of lactic acid, should be identified (Figure 6).
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Skin and fascial mobility are good indicators of the
individuals hydration status, whilst focal tightness can
point towards regional pathology. Subclinical
dehydration can contribute to poor aerobic
performance, fatigue and tissue injury, and must be
identified and corrected for.
The whole body should be assessed, starting at
the head and working down the fore limbs, back,
abdomen and hind limbs. Tightness or spasm in one
muscle may well affect joint range of motion and have
significant implications for gait, e.g. pathology of the
biceps brachii may well inhibit elbow extension
(Figure 7). Whilst pain in an individual muscle may
reflect local strain, it may equally reflect an imbalance
of breakdown and repair within the muscle fibres in
response to overload as a result of compensatory
weight shifting away from another painful focus.
During joint manipulation, total range of motion
along with a functional pain-free range of motion of an
individual joint should be established. Pain within the
functional range of motion is likely to be of greater
clinical significance than that encountered when the
joint is pushed to endstage flexion or extension.
However, pain in the outer ranges of motion may well
affect jumping performance or performance times.
The quality of joint motion and the nature of the
endstop should be assessed along with joint stability.
The elastic properties of individual muscle groups
should be tested. Tension in the hamstrings can limit
the cranial phase of the hind limb stride, whilst
quadriceps dysfunction may limit stifle extension.
All manipulation should be carried out slowly, in
order to inhibit muscle spindle activity and facilitate
stretch through activating golgi tendon organ
receptors. Best practice should include examination of
both the standing and recumbent patient (Figure 8), as
altering the patients posture can often help identify
painful foci.
Injury types
Injuries of the canine athlete can largely be
differentiated into acute trauma and chronic overuse
injuries. Acute injuries may be due to extrinsic causes,
such as a direct blow from another individual or piece
of equipment, or intrinsic e.g. tissue strain. Acute
injuries to the musculoskeletal system are relatively
rare in the canine athlete compared to human athletes.
The most commonly encountered include: acute
rupture of the CCL, either in isolation or in conjunction
with collateral ligament damage; traumatic fractures;
and muscle strains.
Overuse injuries are more commonly encountered
and include shoulder joint instability, biceps
tendonitis, lumbosacral disease, illiopsoas muscle
strain and non-specific neck or back pain that may or
may not be associated with a shifting lameness. The
Figure 6: Palpation of the paraspinal musculature enabling
assessment of muscle mass and tone along with signs of
pathology including odema, spasm, myofascial trigger points
and local concentrations of lactic acid
Figure 7: Fore limb manipulation for assessment of elbow
extension and restrictions in the biceps brachii Figure 8: Examination of the recumbent patient
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cause of overuse injuries can include extrinsic factors
such as the type of training surface, the intensity of
training and the type of equipment. Intrinsic factors
include gait biomechanics, conformation, neuromotor
patterns, muscle imbalances, lack of flexibility, age
and body composition.
Laboratory testing
Although not commonly encountered, conditions such
as hypoglycaemia, exertional rhabdomyolysis and
anaemia are seen more frequently in the canine athlete
than in the population at large. Some endurance
sports such as sled racing can also lead to low levels
of free thyroxine, due to increased use within the body
rather than clinical hypothyroidism.
Laboratory analysis prior to the onset of training
should be considered in the elite athlete in order that
they are able to train effectively and improve
performance; e.g. aerobic function may well be
severely impaired if the animal has a reduced red
blood cell count.
Conditioning and training
Inappropriate nutrition and conditioning can both
predispose to injury in the canine athlete. A failure to
address either can lead to poor adaptations during
rehabilitation and a failure to return to athletic activity.
Veterinary surgeons involved in sports medicine
should be able to provide appropriate advice
regarding both nutrition and conditioning to fulfill their
role in assisting with injury prevention.
Rest following injury or due to seasonal nature of
the activity results in rapid loss of cardiovascular
endurance and a slower downregulation of skeletal
muscle fitness, with loss of endurance and power-
generating capacity. Inevitably a loss of flexibility will
occur, particularly in the presence of low grade
pathology. This can manifest as either reduced range
of motion at the level of a specific joint or a general
loss of flexibility such as in the vertebral column where
a large number of individual units function as a whole
(Figure 9). It is necessary to work strategically towards
regaining performance levels of fitness by employing
appropriate training methods, a factor which becomes
even more important when rehabilitating after injury.
A large proportion of human, canine and equine
athletes are training and competing at the extremes of
their capabilities. This places significant stress on the
body which is reflected in changes within the
endocrine and immune systems. Exercise training and
exercise itself is known to cause predictable
Figure 9: Assessing lateral flexion of the cervical vertebrae
How to approach the canine athlete
physiological changes with corresponding alterations
in peripheral blood components. These changes can
reflect both normal physiological adaptations and
pathophysiological abnormalities resulting from the
stress of exercise.
One study on sled dogs demonstrated changes in
their blood parameters compared to the population at
large. A moderate increase in their total white blood
cell count was seen, mainly due to a significant
increase in neutrophil numbers coupled with a
decrease in lymphocyte counts; alterations in red
blood cell parameters were also seen. These changes
can be attributed to two factors, namely an increase in
plasma volume and gastrointestinal losses.
Endurance training in dogs has been shown to
cause a 1327% increase in plasma volume with a
concurrent drop in packed cell volume. Human and
canine studies have also demonstrated exercise-
induced gastrointestinal bleeding. A drop in
haemoglobin concentrations can potentially affect
energy partitioning and push energy generation
towards increased anaerobic metabolism, thereby
increasing fatigue and muscle pain and reducing
function. At a higher level it can significantly alter
performance and contribute to overtraining problems.
Regular sampling can give invaluable advice
regarding the individuals immune system and allow for
steps to be taken to prevent further damage through
alterations in the training intensity and/or appropriate
drug therapy.
Equally, thyroid hormone function can be affected
by training. Many canine and human athletes will
commonly have serum thyroxine (T4) concentrations
lower than the reference range, yet clinical
hypothryoidism is uncommon. Thyroid hormone
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controls the bodys metabolic rate and these hormones
can be altered via feedback mechanisms as a
consequence of metabolic rate changes. They affect:
Metabolism of fat and carbohydrate within the body
Oxygen uptake by the body organs heart, liver,
kidneys
Growth and development of the musculoskeletal
system
Reproduction
Hair and skin condition
Activity levels
Exercise tolerance and pain
Results from human studies have shown that
exercise and training can have variable implications on
thyroid hormone concentration and function. The effect
of exercise on thyroid hormone concentrations in dogs
have also been evaluated in a few studies. The results
are variable, with some showing that training and
sprint racing did not have a significant impact on
serum concentrations of free T4, T3 or thyroid
stimulating hormone (TSH) in racing Greyhounds but
did decrease total T4 concentrations. In others,
however, serum T4 and fT4 concentrations were found
to be 40% lower than in the reference population.
Similar changes have been seen in Alaskan sled dogs.
This alteration is likely to be associated with increased
metabolism and clearance of thyroid hormone, as well
as volume of distribution and disposal rate.
Thyroid hormone levels alter most dramatically
during the course of training. After periods of extreme
exercise a marked and sustained (4-day) increase is
seen in serum TSH concentrations. Training individuals
with low levels of circulating thyroid hormone can often
be unrewarding and even damaging to the individual
depending on the severity of the deficiency. Again,
repeated sampling throughout the season will help to
detect the problem in the early stages and allow
measures to be taken to prevent it reaching a stage
where the animal is showing clinical signs such as
extreme exercise intolerance, fatigue and muscle pain.
Nutrition
Achieving the correct balance of nutrients to maximize
athletic performance and tissue repair is integral to the
wellbeing of the canine athlete. There is a need for
disciplined specific nutrition: sprinting dogs require
readily available glycogen stores for energy; while
endurance breeds will need to adapt to using fat as
the major energy source.
It is not easy to predict the daily calorie
requirement for an individual athlete. The daily energy
requirement (DER) is a measure of the daily calorie
requirement for the maintenance of body weight and
condition and varies widely from animal to animal. The
resting energy requirement (RER) is the amount of
calories required by an animal at rest in a
thermoneutral environment and does not support
exercise, growth or reproduction. The RER is
determined by (body weight in kg)
0.75
x70. For active
and working dogs, the following calculations have
been used:
Light work 2x RER
Moderate work 3x RER
Heavy work 48x RER
The timing and frequency of feeding can be critical
in the canine athlete. Feed too close to an event and
performance will be impaired; however, lack of energy
substrate can lead to lack of focus, loss of
performance and, ultimately, collapse through
hypoglycaemia. In athletes undergoing sustained
athletic activity, preloading in the days preceding the
competition may assist with making glycogen and fatty
acids available.
Conclusion
Successful management of the canine athlete requires
a holistic approach, taking into account the individuals
psyche, nutrition, hydration and training regime. Subtle
changes can make the difference between soundness
and injury, as well as enhancing performance times.
The clinician will be challenged with a need to revisit
exercise physiology and performance nutrition, as well
as being well versed in the more commonly
encountered disciplines of lameness diagnosis and
management and acute injury management. The
satisfaction of returning an athlete to peak physical
performance is immense and will ensure a loyal client
for years to come.
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