Agility injuries in dog athletes: Are veterinarians dropping the ball?

By Narda G. Robinson, DO, DVM, MS, FAAMA

With annual entries for the American Kennel Club (AKC) agility trials now surpassing one million,¹ we can see how quickly the popularity of canine agility has grown.

Achieving success at agility requires dogs to quickly maneuver around, over, and through obstacles, such as weave poles, A-frames, and tunnels. Do they enjoy the challenge? Handlers argue they do. Are the dogs trying to please the handler? Most likely, they are. Is agility a safe and healthful sport? Not for everyone, and not all the time.

If, according to research, agility dogs are incurring injury in record numbers,² what are veterinarians doing to protect their health and welfare?

A 2013 internet-based survey found 32 percent of dogs participating in agility developed one or more musculoskeletal problems as a result.³ Ten years later, another group found 77 percent of survey respondents claimed "at least one of their personal dogs had experienced an injury that caused them to moderate or stop agility training."⁴ Border collies lead the pack in terms of injuries, which is sad because they seem perfectly suited for the sport—quick, intelligent, with boundless enthusiasm."⁵

That's not all. More than a third of respondents in another survey reported "at least one of their dogs had likely acquired one or more infectious diseases at agility competition or training events through interactions with other dogs." Issues included respiratory tract infection (26.1 percent), digestive tract disease (12.2 percent), and external parasites (6.7 percent).⁶

While retrospective surveys paint a general picture, the details remain fuzzy. As Markley et al. noted, "These data provide valuable current insight into the possible effects that training and competition variables may have on injury risk in agility dogs. While no definitive recommendations can be made regarding training or competition based on these data, they provide a starting point for future, prospective studies."

"Specifically," they stated, "This survey indicates a need for further studies evaluating the biomechanics of agility obstacles and obstacle training techniques and their effect on musculoskeletal development and injuries. There is also a significant need for studies evaluating strength and conditioning programs and training periodization in canine athletics, both for performance and injury prevention. With the increasing popularity of companion dog sports, there is a definitive need for research on sport specific training and injury prevention in order to provide better training and care recommendations to these canine athletes."

Moreover, "Future studies should consider collaborating with agility organizations to obtain data from all competitors in order to address potential sampling error and self-selection bias."

Another drawback of internet surveys pertains to recall bias. Over time, handlers have more difficulty recalling facts, such as when the injury occurred, its relationship to a certain sport, and what type of training the animal had prior to participating. The lack of comprehensive veterinary records and full physical exams introduce further complications.

As such, we have a wildly popular activity with the capacity to generate substantial economic benefit for the local community,⁷ combined with fiercely dedicated participants that appear to be having an outrageously enjoyable time.

How unpopular, then, might it be to question the ethics of agility and ask if we are doing all we can for its canine participants? Very, but here goes.
Despite the fun, the busyness, the attention, and the cheers dogs receive when they run an agility course, what are we, as veterinarians, doing to protect these dogs' health and prevent chronic injury?⁸

What are veterinary colleges teaching about assessing athletes' physical and mental preparedness? How many have attended an agility event and observed the psychological and physical pressure these sports put on our patients?

Finally, how well-equipped are we to ask a dopamine-driven pet parent to stop entering competitions when fast-paced trials are taking a toll on their loved one's neck, back, and limbs?

If dogs are the new "kids," should we not institute preparticipation physical exams and determine in advance their eligibility for agility? Are we adequately advising clients about the risks of agility for both them and their dogs?⁹

With millions of dogs participating each year and many getting injured, at what point do we call this an "epidemic"?^10,11 Colleagues, let's get into the game and stop sitting on the sidelines. We can do much more to proactively protect patients from overuse injuries and persistent pain.

Make myofascial palpation part of every exam

All dogs are at risk of sustaining soft tissue injury at agility events. They are even more likely to experience strains and sprains if they have inadequate warm-ups, inherently poor flexibility, fatigue from overtraining, lack of sufficient training, sudden turns and falls, bad footing and slippery surfaces,¹² too little recovery time, and collisions with equipment.

Finding and fixing myofascial strain patterns, taut bands, and trigger points require hands-on palpation and a solid understanding of functional muscular anatomy. How many of us learned that in school? Not many.

For example, to identify the cause of "shoulder" injury, one needs to palpate the entire region and not just look for ligamentous laxity or tenderness in a tendon. Yes, naming a condition "biceps tendinopathy," "supraspinatus tendinopathy," or "medial shoulder instability" fills a box on the medical record.

However, it may also miss the source of the problem. Why blame the tendon when the culprit is likely an over-shortened muscle belly? By ignoring the inciting cause, we waste precious time targeting treatments toward the muscle's tendinous attachments rather than lengthening the muscle belly and allowing the tendon to glide more freely over bony projections. First-line care for myotendinous pathology would change from invasive procedures to medical acupuncture, massage, and photomedicine.

In addition, the term "medial shoulder instability" is needlessly vague and broad. If we determine the shoulder joint passively abducts too far, we could seek to identify the specific structures involved and find out why. Does a disparity exist in the agonist/antagonist balance? Could the instability arise from arthrogenic muscle inhibition¹³ and not ligamentous laxity or tendinopathy? Might we begin with strengthening under-firing muscles and proactively addressing joint pain with science-based integrative approaches?

Further, from a preventive perspective, what needs to change in agility course design to lessen the impact on thoracic limbs? Could we incorporate evidence from recent research that identifies risky angles and troublesome terrain and then change things to improve safety?

Learn where the iliopsoas lives and how to keep it happy

Iliopsoas strains also rate high on the list of myofascial maladies affecting agility dogs.¹⁴ While we may tend to see them in isolation,¹⁵ iliopsoas strains often co-exist with other pathologies.¹⁶ These include, most commonly, cranial cruciate ligament instability (CrCLI), and/or dysfunctions in the coxofemoral, lumbosacral, non-CrCLI limb, and thoracic limb.

Essentially, expect widespread musculoskeletal pathology when you discover a shortened or painful iliopsoas muscle because even hind limb and back pain or dysfunction eventually translates to the head, neck, and thoracic limbs.

Several integrative rehabilitation and physical medicine strategies can help lessen the load on the iliopsoas muscle complex, we should first perform postural and movement analysis, comprehensive myofascial palpation, and specific orthopedic analyses as warranted.

There's more to dogs than muscles and bones

We are typically trained to focus on the musculoskeletal system when looking for sources of lameness and poor performance. However, all body systems participate in agility—not just muscles and bones.

Preparticipation visits and post-participation workups should include assessment of the cardiovascular, neurologic, and endocrine systems. Forcing a dog with compressive myelopathy to run an agility course is unethical, as is attributing a poor showing to "laziness" or insufficient training instead of looking for actual answers. For example, could an endocrinopathy, such as hypoadrenocorticism (Addison's disease) or hypothyroidism, cause dogs to not keep up? If their balance is off, how well-functioning are their ophthalmologic and vestibular systems?

It is up to veterinarians to diagnose and foresee problems in sporting dogs—not the chiropractors, naturopaths, and trainers who typically attend these events. The more we see agility dog parents declare a human chiropractor or physical therapist as the athlete's primary care provider, the more urgently we need to catch up.

Narda G. Robinson, DO, DVM, MS, FAAMA, practices osteopathic medicine and veterinary medicine. Dr. Robinson taught science-based integrative medicine at the Colorado State University College of Veterinary Medicine and Biomedical Sciences for 20 years. In 2016, Robinson established her own academy in Fort Collins, Colo., where she teaches medical acupuncture, integrative rehabilitation, medical massage, and other integrative medical approaches. Columnists' opinions do not necessarily reflect those of Veterinary Practice News.

References

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3. Cullen KL, Dickey JP, Bent LR, et al. Internet-based survey of the nature and perceived causes of injury to dogs participating in agility training and competition events. J Am Vet Med Assoc. 2013;243:1010-1018.
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