By Dr. David Lane DVM
Veterinary sports medicine and rehabilitation therapy (VSMR) is the newest specialty to become available for pets. On the human side, sports medicine specialists are primarily concerned with treating serious athletes. On the veterinary side, the specialty is much broader. It combines sports medicine with rehabilitation therapy (the veterinary equivalent of physiotherapy) and is applied equally to couch potatoes, geriatrics, and weekend warriors, as it is to competition, working, or otherwise athletic dogs.
The non-surgical treatment of musculoskeletal pain draws from many disciplines, including chiropractic medicine, physiotherapy, acupuncture, pharmacology, regenerative medicine, conventional veterinary medicine, and massage. On the human side, most of these fields are kept separate even though they often use overlapping techniques. On the veterinary side, practitioners may focus on only one technique or they may be trained in multiple disciplines. Some fields, such as regenerative medicine, can only be practised by licensed veterinarians. Other fields such as chiropractic, or rehabilitation therapy are open to either veterinarians or specifically trained non-veterinarians including chiropractors and physiotherapists.
Although the original diagnosis of your pet’s problem needs to be made by a veterinarian, that veterinarian might prescribe treatment to be provided by a non-veterinary professional. For example, few veterinarians are in a position to provide an hour long massage for your pet (without it becoming very expensive), so they might instead recommend you see a specifically trained canine massage practitioner instead. Therapeutic exercise programs are often handled this way as well.
VSMR seeks to diagnose and treat any dog who is suffering from painful or restricted movement. This means any dog that is limping or moving abnormally, or can no longer perform physical feats that he or she used to. A common early sign of trouble is a reduced ability to jump into the car – a dog that now hesitates before jumping, or jumps onto the floor before moving onto the seat.
Dogs with any sort of lameness issue, especially issues that are subtle or are proving hard to diagnose, benefit from a sports medical exam. Even dogs with a known diagnosis such as arthritis, benefit from sports medicine techniques. Some of the treatment may be directed at the arthritis itself, perhaps by using joint injections and/or regenerative medicine, or treatment may be directed at the rest of the body so that it can better compensate for the arthritic joint(s).
Geriatric dogs are often afflicted with multiple painful musculoskeletal issues that can substantially limit their quality of life. For many of these patients, the VSMR treatments they receive are key to relieving pain, resulting in an improved quality of life and ultimately an increased lifespan.
Competition and working dogs are big proponents of VSMR techniques. Agility dogs in particular were a driving force behind the growth of this specialty. Experienced handlers immediately know when their dogs are not performing 100%, and often detect lameness issues far earlier than the average pet owner. Many of these dogs have subtle muscular lesions that traditional veterinary education programs rarely discuss how to diagnose or treat.
Dogs that are recovering from major surgery or have suffered physical trauma, also benefit from VSMR techniques. This is where rehabilitation medicine shines, both to resolve secondary pain issues, and to develop specific exercise programs to speed recovery and prevent recurrence of injury. Dogs afflicted by non-surgical neurologic disorders, or who are recovering from neurosurgery also fit in this category. We are now learning that many injuries that were always thought to be surgical problems in the past, can now be resolved by non-surgical methods.
Lastly, VSMR techniques can be incorporated into a wellness or preventive medicine program. Competition dog handlers know this better than anyone. Targeted exercise programs are an effective way to prevent sports injury. Many lameness issues develop slowly over time. They may suddenly become apparent one day, perhaps after a minor run or fall, but the seeds of injury were likely planted long before. Only after the dog was unable to compensate for these seeds, did the issue become apparent to the owner. These are known as “repetitive stress” or “cumulative trauma” injuries, and when they are detected early, treatment is often simpler and less invasive.
What signs should I look for?
Changes in mood or attitude: Decreased willingness to play, or reduced interest in things that are happening in the surrounding environment, sleeping more, fearfulness or irritability. Many of these changes happen as dogs get older, but in many cases it is also a reflection of pain. Not all dogs tell you when they are hurting; some just become quiet and withdrawn… they look like they’re sleeping but they’re not.
Changes in posture: Carrying the tail differently, changes in the backline, sitting on one hip or rolled back more onto the pelvis, shifting off of one leg, one foot less splayed than the others, holding the head or ears differently. Dogs don’t change their posture without a reason. It they used to stand, sit, or lie in a certain position but don’t anymore, then they may be experiencing some degree of discomfort.
Changes in movement: Any reduction in movement or athletic ability, stiffness after exercise or rest, hesitating before jumping into the car or negotiating stairs, no longer completing a head-to-tail “wet dog shake”, staggering or incoordination, weakness, scuffing nails, limping, asymmetric movement when walking or trotting, moving around the house less, flinching or dropping away when getting touched or petted, popping weaves, stutter stepping, knocking bars, wider than usual turns… the list goes on and on.
You might have noticed that all those categories started with the word “change”. If you are used to your dog standing, moving or acting a certain way, and that changes then it is prudent to first make sure that they are not in pain.
How do I find a VSMR practitioner?
The first step in treating your dog’s problem is to get a diagnosis, and that requires a veterinarian. Working with your regular veterinarian is a good first step. If he/she is unsure of the specific diagnosis or treatment options for your pet’s problem, then request a referral to another veterinarian more experienced in VSMR responsive conditions. Most veterinarians will volunteer that referral.
Not all VSMR techniques require a veterinary referral, although this varies province to province. For instance, in most places you can book an appointment with a massage practitioner without a veterinary referral. However, the best place to start is with a precise diagnosis, and then pick the most appropriate treatment option based on that diagnosis.
In selecting a practitioner, please ensure that they are graduates of comprehensive canine specific education programs. Veterinary chiropractors should have graduated from an AVCA recognized program. Rehabilitation therapists should have graduated from an ACVSMR recognized program. Acupuncturists should have graduated from an IVAS or Chi institute program. Massage therapists also must have had extensive training over many months. Veterinarians with specialty DACVSMR status have the most comprehensive training in this field, training that includes all of the above modalities.
Next month, in part II of this article, we will discuss the pros and cons of each therapeutic option, and where they can be best used for your pet.