By Dr. David Lane, DVM
Last month`s article provided an overview of veterinary sports medicine and rehabilitation therapy (VSMR), what it includes, who it benefits, and how to find a practitioner. This month`s article will focus more on the different treatment options available, and when they might best help your pet.
Manual therapy is an umbrella term for musculoskeletal techniques that involve “hands on” manipulation of tissue, and includes chiropractic style manipulations, rehabilitation therapy style mobilizations, stretching, and massage.
Research on the human side has shown that manipulations (usually performed by chiropractors) and mobilizations (usually performed by physiotherapists) are equally effective techniques for almost all conditions. Currently, there is no canine research on the effectiveness of either of these techniques on their own, but data that is being reviewed for publication found that when these techniques are combined with acupuncture, they produce rapid improvements in comfort and mobility.
Manipulations are tiny rapid “thrusts” that are applied to targeted areas of muscle spasm, usually along the spine. These movements trigger local muscle relaxation, reduce pain, and may also improve the quality of neural signalling. Manipulations are a safe and effective tool for treating muscular origin back pain, especially of the deeper stabilizer muscles. Back muscle pain is very common in dogs.
Mobilizations are similar to manipulations and are divided into four categories depending on the technique. Some mobilizations are used for reduction of joint pain in either the back or limbs, and other mobilizations are used to improve mobility. Mobilizations differ from manipulations in that they aren’t single rapid thrusts, but are repeated slower movements instead.
Massage encompasses a number of techniques intended to decrease muscle spasm, reduce pain, and enhance lymphatic flow. Muscles often experience a self-perpetuating pain-spasm-pain cycle, which massage can help interrupt. Most dogs tolerate massage therapy very well.
Stretching can be employed as a component of massage, as part of rehabilitation treatment to improve flexibility, or as part of an owner’s/handler’s injury prevention program.
As mentioned above, chiropractic manipulations are an excellent tool for relieving primary back pain, which is quite common in dogs. However, back pain can be secondary to lesions located elsewhere such as limb arthritis or iliopsoas spasm. Secondary back pain generally just keeps recurring if it is being treated by chiropractic techniques alone, and better results are achieved if chiropractic treatment is combined with other modalities.
Rehabilitation medicine employs a wide variety of techniques to improve comfort and mobility, including the manual therapy skills (mobilizations, massage, stretching) discussed above. It also uses targeted therapeutic exercise programs to build strength, coordination, and endurance. Human research has shown that strength and coordination training are the most effective tools available for preventing sports injury.
Most of us associate rehabilitation therapy with recovery from surgery, especially orthopaedic or spinal surgery. That’s because appropriate rehabilitation programs can speed patient recovery, reduce the chance of surgical complications, and help prevent further injury. For example, when I prescribe a rehabilitation program for my cruciate surgery patients, part of that program targets the non-surgical knee. It’s thought that building strength of the musculature surrounding the opposite knee will reduce the chance of it from needing surgery later on. Exercise programs often involve various implements such as inflated balls, cavaletti bars, wobble boards, treadmills (land or under water), tension bandages, swimming, etc.
Rehabilitation therapists are also trained in the use of different tools that facilitate healing and reduce pain or spasm, including laser, therapeutic ultrasound, TENS, electrical stimulation, extracorporeal shock wave, or pulsed electromagnetic therapy.
Acupuncture is a technique that uses needles to invoke a neurologic response, and it is an excellent tool for addressing muscular pain (especially when it is combined with manual therapy). Acupuncture can be divided into two broad catagories, Traditional Chinese Medicine (TCM) style acupuncture, and IMS or myofascial trigger point therapy.
The difference between the two lies in the choice of where to place the needle. TCM acupuncture employs specific acupoints that may consider the pet’s emotional and internal medical health in addition to any musculoskeletal considerations. On its own, TCM acupuncture takes more time to achieve a full effect; it is not uncommon to need four to eight sessions over several weeks before a full response is noted.
IMS acupuncture involves placing the needle in palpable areas of hyper-irritated muscle to elicit a reduction in pain and spasm. IMS style needle placement, although fast and effective, is not always as well tolerated by the patient as TCM needle placement is.
Regenerative Medicine involves collecting and concentrating either stem cells or platelet rich plasma (components of the body with robust ability to heal damaged tissue) and injecting them where they are needed most. It is most often used for tendon or ligament repair, and for addressing arthritic pain. For a complete discussion about current techniques in regenerative medicine, see the Feb/March 2015 issue of Pet Connection Magazine
Conventional Veterinary Medicine
Many sports medicine related conditions require prescription drugs to reduce pain. Others are best treated with surgery. Regenerative medicine techniques need to be performed by a licensed veterinarian. Joint injections to reduce arthritic pain also require a licensed veterinarian.
Because VSMR is such a new specialty, it is not yet comprehensively taught in veterinary schools. As a result, different veterinarians have different levels of comfort when attempting to diagnose or treat VSMR conditions, especially subtle lameness issues. In the same vein, veterinarians who specialize in VSMR conditions are not the best people to talk to about other health issues (dental disease, skin conditions, internal medical illness etc.). It is not uncommon for owners to have one veterinarian address their pet’s general health needs, and then seek another veterinarian to address their VSMR concerns. Both veterinarians can then work as a team to maximize your pet’s health and comfort.
Sports Medicine Specialists (DACVSMR)
Sports medicine and rehabilitation therapy specialists are veterinarians who have demonstrated comprehensive knowledge and experience with all of the above modalities. To even write the qualification exam, they must already have extensive experience treating animals, and have published original research that advances our understanding of sports medicine in pets. The qualification exam itself is 12 hours long, and covers the material from 18 textbooks as well as hundreds of research papers. To date, only three Canadian veterinarians have achieved this status in small animal practise.
It’s thought that rather than selecting just one of the above listed therapies, your pet will see faster and more complete results if you combine therapies. For example, chiropractic and massage therapy make an effective team, especially if it can be combined with acupuncture or perhaps laser therapy as well.
Blinded research undergoing publication review examined the benefits of combined acupuncture and manual therapy (CAMT), and found that dogs receiving two appointments scheduled six days apart showed significant improvement in an ability to go up or down stairs, walk, trot, jump, rise from a lying position, as well as less stiffness after rest or exercise.
It can sometimes be difficult to find a professional trained in more than one of the above modalities, so it might be necessary to assemble a therapeutic team – for example, scheduling acupuncturist appointments to follow shortly after a manual therapy treatment. Because these therapies all have the potential to yield rapid and obvious results, attentive owners can quickly discern what combination works best for their pet.
A word about cats
Most of this article was focused on dogs, but that doesn’t mean that cats can’t benefit from VSMR treatment as well. Research has shown that over 90% of cats 10 years of age or older have arthritic changes that can be seen on x-ray, but that only 20% of those same cats show outward signs of pain. Do they feel less pain than other species, or are they just better at hiding it? Likely they are just better at hiding it.
Although cats can be less cooperative patients than dogs, most of them tolerate manual therapy, acupuncture, and other treatment techniques. Therapeutic exercise is harder to do with cats than with other species, but there are ways to trick them into moving. In short, most of the information above can be applied to cats as well as dogs.
Dr David Lane, owner of Points East West Veterinary Services, is a BC veterinarian who works exclusively with pets experiencing painful or restricted movement. He has graduated from certification programs in chiropractic, acupuncture, and rehabilitation medicine, and plans to write the VSMR specialty exam in less than a year. For further information, please visit www.pointseastwest.com