Vet Times The website for the veterinary profession https://www.vettimes.co.uk PHYSICAL TECHNIQUES UTILISED IN CANINE COMPLEMENTARY THERAPY Author : CATHERINE F LE BARS Categories : Vets Date : November 3, 2008 CATHERINE F LE BARS details how a measured approach to therapy can result in effective treatment and a vast improvement in a patient s quality of life OSTEOARTHRITIS (OA) is commonly encountered in companion animals and often cited as one of the top three reasons for euthanasia. Affected dogs suffer from chronic pain and reduced mobility, which in turn leads to other degenerative changes and a further reduction in quality of life. Effective management is geared towards relief of pain, preservation of joint function and the recovery and/or maintenance of normal activity. This article looks at several of the complementary therapies available to the veterinary surgeon, with emphasis on physical therapy techniques. Osteoarthritis treatments can be categorised into conservative and surgical. Traditionally, conservative treatment has revolved around the use of drugs, such as NSAIDs, corticosteroids and analgesics, to control the pain associated with OA and to improve mobility. In the past few years, veterinarians have adopted a multimodal approach, employing nutraceuticals, weight reduction and/or control programmes, and exercise modification (in addition to medical treatment, where indicated). Complementary medicine has become more popular as veterinarians worldwide have adopted techniques proven in human medicine, such as acupuncture, physiotherapy and massage, homoeopathy, and nutritional therapy. These are used in addition to more conventional treatments, 1 / 11
which contrasts with alternative medicine, where these therapeutic strategies replace conventional treatment. It should be noted that few controlled studies have been conducted in animals and, therefore, evidence to support the use and success of some of these treatments is largely anecdotal or extrapolated from trials in humans. Diet management The key to conservative management is weight reduction and control, which can be achieved by restricting caloric intake and encouraging an increase in activity that is acceptable to the animal. Body condition scoring is the most useful tool available to veterinarians in general practice for assessing the level of obesity and the amount of weight loss required. A five or nine-point scheme estimates subcutaneous and abdominal fat relative to superficial muscles by the visual assessment and palpation of areas such as the ribcage, waist and dorsal spinous processes. Once the individual s optimal bodyweight has been determined, or a target weight has been found, an appropriate diet should be formulated. It can be difficult to overcome the behavioural, social, metabolic and hormonal influences of obesity, and client compliance is crucial to the long-term success of any weight control plan. Dietary management must be tailored to the individual, taking into account concurrent disease (allergies, renal impairment, GI disease, etc) and the degree of weight loss required. A properly formulated diet supplemented with proteins, but restricted in fat and energy, will help to preserve lean muscle mass. Dietary supplements may help reduce the need for more conventional medications in OA by providing nutrients that are capable of modulating the inflammatory response, protect against oxidative damage, and/or are utilised in the repair process. Such supplements include long chain omega-3 fatty acids, chondroitin sulphate, glucosamine hydrochloride, antioxidants and greenlipped mussel extracts. Physical therapy An appropriate exercise programme is important to preserve and improve musculoskeletal health. Affected animals should exercise gently and regularly, and should not demonstrate pain, lameness or stiffness during or following activity. A range of motion activities, such as swimming, help maintain the compliance of periarticular soft tissues, while reducing the risk of injury. Hydrotherapy pools are available across the country, and their use is particularly indicated when the animal is obese or has difficulty moving. Aquatic therapy, in the form of underwater treadmill exercises and swimming, may be used to improve muscle strength and joint function while avoiding 2 / 11
the pain and damage that might arise from concussive activities. The positive effects of physiotherapy on man have been recognised for decades, and new techniques are used extensively in veterinary medicine. Physiotherapy is aimed at preserving or restoring locomotor function by means such as exercise, stretching and massage, thermal agents, electric current, ultrasound, lasers, magnetic fields and extra-corporeal shock waves, to stimulate joints and muscles, and hasten functional recovery. The owner may carry out passive joint mobilisation and stretching at home studies have indicated increased flexibility and amplitude of joint movements following 21 days of treatment. The affected joint is gently flexed and extended 10 times, twice daily. Stiff joints should be held in a fully flexed and then fully extended position for 10 seconds. Manipulating the entire limb in a bicycle movement completes the exercise. Active therapeutic exercises are commenced as early as possible and tailored to the animal s clinical signs. Short sessions, several times per day, are recommended, with the level of difficulty raised gradually, in line with the animal s tolerance. Examples include lead walking (in straight lines or figures-of-eight), load-pulling, obstacle courses, wheel-barrowing, and sittingstanding exercises. Assisted therapeutic exercises are used when the animal cannot move properly by itself. In general, the animal receives support during the sessions, which may be conducted on different surfaces to help stimulate proprioceptive function. Massage decreases pain and accelerates recovery by relieving muscle tension, increasing blood flow to the painful muscles and mobilising adhesions. Techniques include stroking, kneading, rubbing, circular pressure, shaking and percussion. Massage may help to relieve muscle tension, improve joint and muscle function, reduce and/or prevent venous stasis and lymphostasis, mobilise adhesions and regulate muscle tone. Although only trained personnel should perform advanced massage techniques, stroking, kneading and shaking are appropriate for home therapy. Heat and cold Thermotherapy includes the use of both heat and cold for treatment of pain. Heat is often of benefit in dogs with chronic osteoarthritis, whereas cryotherapy should be reserved for those with acute flare-ups, or to relieve pain and/or inflammation following exercise. Both procedures are suitable for use at home by an appropriately trained owner. Cold contributes to pain relief and the reduction of inflammation by slowing down the conduction of small-calibre nerve fibres and causing peripheral vasoconstriction, which slows down local 3 / 11
metabolism. The simplest technique involves massaging the area with ice for five to 10 minutes. Alternatively, apply a cold pack to the affected joint for 10 to 25 minutes intermittently. The treatment can be repeated three to six times daily if required. Heat improves blood flow and encourages the relaxation of all musculo-tendinous and periarticular tissues and is particularly indicated before exercise, physiotherapy manipulations and other techniques such as extracorporeal shock waves. Superficial heat is applied for 15 to 20 minutes between one and three times a day, or several times weekly. Superficial heat can be provided by the application of hot packs or infrared heat lamps, or as part of aquatic therapy when warm water is used. Hot packs are useful for distal joints (such as toes, carpus, tarsus, stifle and elbows). For deeper structures (such as hips, shoulders or the spine), therapeutic ultrasound should be used. Ultrasound Therapeutic ultrasound (US) is useful in patients undergoing passive mobilisation and stretching exercises. US waves raise tissue temperatures, increase skin permeability (encouraging the passive diffusion of drugs into deeper tissues) and have vibratory properties, which produce both fibrolytic and cicatrising effects. The resultant pain relief and tissue warming reduces ankylosis, improves joint mobility and reduces muscle spasms and contraction. The duration and intensity of therapeutic US must be adjusted to the individual s needs. However, in general, five to 10-minute applications are given daily (initially) and then two to three times per week. Most equipment offers two frequencies 1MHz (low frequency) and 3MHz (high frequency); and two modes continuous and pulsated. High frequencies produce greater thermal effects, and vibratory effects are more evident with pulsated US. Electrical stimulation has also been used with varying degrees of success. Treatment modalities include transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS). TENS is used rarely in the veterinary field, but has been shown to reduce acute and chronic pain associated with OA. EMS can be useful for strengthening muscles, preventing disuse atrophy, restoring and/or preserving joint mobility, and strengthening joint stability. Extra-corporeal shock wave therapy (ESWT) uses very short acoustic waves emitted at low frequency and under very high pressure. The high-energy wave lasts for a microsecond and consists of a high peak (up to 100x atmospheric pressure) followed by a trough. Studies in veterinary medicine are rare, but have demonstrated rapid and sustainable pain relief and improved mobility. ESWT works especially well when preceded by the application of superficial heat and followed by passive mobilisation exercises. A standard protocol involves three to four sessions, given at intervals of seven to 10 days. 4 / 11
Acupuncture Acupuncture has shown some efficacy in the reduction of pain associated with osteoarthritis, but conflicting reports and a lack of controlled studies still limit its use in companion animals. The use of acupuncture on companion animals is relatively new in the western world. Debates have arisen from the issues surrounding the use of a technique that was originally developed for humans on animals that have significant anatomical and physiological differences. Practitioners of traditional Chinese medicine believe that pain is associated with disruptions to the circulation of energy throughout the body, in the form of Qi (spiritual energy) and blood. Acupuncture seeks to restore this flow of energy by the stimulation of points located along meridian lines in the body. Western medical and veterinary acupuncture focuses more on the known neurophysiologically modulating effects of inserting an acupuncture needle into specific sites on the body, which are called acupuncture points (AP). These points have been described as areas of lower skin electrical resistance, which are also characterised by increased sensitivity to pressure and temperature. A high percentage of AP are also trigger or Ah shi points, which are non-specific areas that consist of chronically contracted muscle spindle fibres, which are highly sensitive to pressure and can elicit pain in remote areas. The stimulation of these points by thin flexible needles elicits a number of responses, including the release of endorphins, serotonin and encephalins (which alter pain processing), and local changes within the spinal cord and nerves, which result in the relief of pain and muscle spasticity. The success of acupuncture to treat a particular condition relies on the stimulation of appropriate AP and the technique used. Acupuncture techniques used in veterinary medicine include acupressure (manual stimulation of specific acupuncture points many owners can be taught acupressure techniques for home use), dry needle acupuncture (sterile acupuncture needles inserted into specific acupuncture points), aquapuncture (AP are stimulated by the injection of sterile solutions), electroacupuncture (electrical stimulation of acupuncture points), moxibustion (stimulation of an acupuncture point by heat), laser, US and gold bead implantation. Summary Practitioners of traditional Chinese medicine would consider acupuncture as merely one facet of treatment, adopting a more holistic approach than many of their western counterparts by combining acupuncture with other techniques, such as homotoxicology and homoeopathy. It is beyond the scope of this article to address the much-debated discipline of homoeopathy, other than to mention that Rhus toxicodendron (poison ivy) and Bryonia (wild hops) have been used with some regularity to provide relief from stiffness and pain associated with OA. 5 / 11
Osteoarthritis is a common and chronic disease, and effective treatment of affected animals requires a measured approach, with attention given as much to lifestyle management as to medical intervention. Additional therapies, including nutritional supplementation, physiotherapy and acupuncture, show promise in their ability to restore and protect joint function, and help patients regain an acceptable quality of life. References are available on request to the editor. 6 / 11
Aquatic therapy, when utilised in the form of underwater treadmill exercises and swimming, may improve muscle strength and joint function while avoiding the pain and damage that might arise from concussive activities. 7 / 11
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Acupuncture has shown efficacy in the reduction of pain associated with osteoarthritis, but a lack of controlled studies still limit its use in companion animals. Photo: NICK THOMPSON, WESTON CHIROPRACTIC AND HOLISTIC CENTRE, BATH. 9 / 11
Passive joint mobilisation and stretching carried out at home can improve flexibility and amplitude of joint movements. 10 / 11
Powered by TCPDF (www.tcpdf.org) Dietary supplements, such as green-lipped mussel extract, may help reduce the need for more conventional medications. 11 / 11