CHESTER
Chester is a 9 year old black labrador who had an acute episode of tetraparesis (off all 4 legs), after a disc rupture in his neck, on the 26th June 2009. An MRI scan showed that there was a disc injured and associated haemorrhage at the base of his neck (C5-6 worse on the left side). He needed immediate surgery to decompress the spinal cord, and at the time it was advised that he would need further preventative surgery. This was because several other discs in his neck were degenerate, and this increased chance of this happening again.
Assessment: Chester was referred to Linhay on the 6th July 2009, as his owners felt they could not mange him at home, due to the degree of disability, as well as the problem with likely recurrence with one of the other discs. He was able to sit up by that stage and had voluntary movement in all four limbs, but was unable to stand without assistance. He had reduced neurological function (very slow reflexes), and knuckled on all four limbs. He also had the complication of having hip dysplasia and osteoarthritis.
Treatment: After increasing Chester’s pain relief using acupuncture, we were able to begin an intensive 3 week rehabilitation programme, where we effectively taught Chester to walk again. He was fitted with a special harness and we started work on our hydrotherapy treadmill, as well as other therapeutic exercises, to improve his ability to place his limbs and build strength. He improved on a daily basis and was discharged from Linhay on 23/7/09. His ongoing care was then carried on by another ACPAT physiotherapist closer to his home where he was seen as an outpatient.
Follow-up: Chester had recovered sufficiently to have his second lot of surgery on 15th September 2009. This was a ventral slot (fenestration of discs with an approach from under the neck) where the degenerate discs were removed. This prevents further disc problems occurring in the neck. He did well post operatively, but the owners felt that the specialist care he could receive at Linhay would be ideal to maximize his recovery. He was re admitted for further rehabilitation, including acupuncture and physiotherapy, both in the hydrotherapy treadmill, as well as with land based exercises. Chester progressed very well, and was discharged on October the 20th 2009.
His owners will continue at home with a controlled exercise programme, under the supervision of their own Chartered physiotherapist, and with our advice and ongoing support as required.
Wednesday 23 December 2009
Tuesday 22 December 2009
Charlie - TB retired chaser/point-to point gelding
Charlie is a 12 yr old TB ex chaser/point-to-point gelding. He was purchased in the summer 2009 for hacking and riding club activities. After a few months his owner notice that he had started to become argumentative in accepting the contact when ridden, he also appeared intermittently lame on both FL's and right the HL especially on a right circle.
Charlie was worked up by equine vet Richard Stringer who rasped his teeth and took x-rays of his front feet. He then liased with farrier Graham Tully who gave Charlie more heel support both in front and behind. Charlie also had a new saddle fitted and received several acupuncture sessions with vets Wendy Vere and Kate Rew.
Physiotherapy Treatment: Helen Mathie and Louise Towl, Chartered Physiotherapists, treated Charlie regulary over a 4 week period which included:
Soft-tissue release to bilateral scapulo-thoracic and thoraco-lumbar epaxial muscuature; laser cluster following soft-tissue release to epaxials; Biomag to TMJ (bilateral) and masseter muscles; baited cervical side flexion stretches as daily exercise programme. In addition Helen rode Charlie twice weekly in a low outline to encourage stretching through the topline and back musculature.
He was reviewed by Richard mid-December 2009 who felt that Charlie was less sore through his poll, neck and back and was now sound in front and behind. The plan is to continue weekly physiotherapy treatments as required as well as twice weekly remedial schooling. In addition his owner is to ride Charlie out hacking and aims to complete a dressage test at Bicton in January 2010!
Charlie was worked up by equine vet Richard Stringer who rasped his teeth and took x-rays of his front feet. He then liased with farrier Graham Tully who gave Charlie more heel support both in front and behind. Charlie also had a new saddle fitted and received several acupuncture sessions with vets Wendy Vere and Kate Rew.
Physiotherapy Treatment: Helen Mathie and Louise Towl, Chartered Physiotherapists, treated Charlie regulary over a 4 week period which included:
Soft-tissue release to bilateral scapulo-thoracic and thoraco-lumbar epaxial muscuature; laser cluster following soft-tissue release to epaxials; Biomag to TMJ (bilateral) and masseter muscles; baited cervical side flexion stretches as daily exercise programme. In addition Helen rode Charlie twice weekly in a low outline to encourage stretching through the topline and back musculature.
He was reviewed by Richard mid-December 2009 who felt that Charlie was less sore through his poll, neck and back and was now sound in front and behind. The plan is to continue weekly physiotherapy treatments as required as well as twice weekly remedial schooling. In addition his owner is to ride Charlie out hacking and aims to complete a dressage test at Bicton in January 2010!
Austin - 9 yr old male labrador with C5/6 spinal cord compression
Austin was a rescue labrador who started to develop neurological signs with intermittent episodes of acute neck pain in June 2009. He collapsed one day and was sent immediately by his referring vet to orthopaedic surgeon Damien Bush. C5/6 decompression surgery via a ventral slot approach was perfomed and once stable Damien referred Austin down to Linhay to start his rehabilitation.
Assessment - Austin arrived at Linhay on bonfire night very quiet and unable to stand/walk. He was laterally recumbant and could just about manage to wag his tail and lift his tail albeit briefly. He was assessed by vets Patrick Ridge & Wendy Vere, alongside Chartered Physiotherapist Louise Towl. He had deep pain sensation in all four limbs but very weak withdrawal reflexes. FL/HL reflexes were present in all 4 limbs but Austin initally had diffculties emptying his bladder independently.
Treatment - Austin remained on Vetagesic initally to help manage his post-operative pain, he was also on Metacam daily. Wendy performed several acupuncture sessions to further assist with pain relief. He required frequent postural changes alternating between right and left side-lying as well as supported sternal recumbancy to enable him to interact with his environment. He needed assistance to eat and drink as he wasn't able to maintain an appropriate head and neck position at first. He was fitted with a spinal harness for all physiotherapy sessions to ensure his neck comfort an safety. In addition Austin was stretchered outside for toileting during the first two weeks.
Austin was worked daily over a physio 'peanut roll' in both functional sitting and standing positions. In addition he was positioned in side lying for soft-tissue/joint ROM sessions. At the end of week two Austin attempted to stand and was then progressed onto the hydrotherapy treadmill with the physiotherapist supporting him. He initally needed help with positioning his FL/HL's and maximal trunk support via a sling and theraband system. From that moment on he seemed to suddenly turn a corner and began to progress rapidly on a daily basis. By the end of week three Austin was walking outside for toileting with moderate support from a spinal harness.
He was discharged home after four weeks of intensive rehabilitation to his owners who had been visiting Linhay on a weekly basis. Helen visited Austin at his home last week and is pleased to report that he has progressed even further thanks to his owners input. He is now independently ambulant around the house and garden and is back to his cheerful self.
It must be stressed how cases like this can take weeks to improve and need a significant amount of appropriate, timely physiotherapeutic and nursing input. Owner commitment and compliance on discharge is paramount for successful outcome and not all cases will return to the same level of function.
Assessment - Austin arrived at Linhay on bonfire night very quiet and unable to stand/walk. He was laterally recumbant and could just about manage to wag his tail and lift his tail albeit briefly. He was assessed by vets Patrick Ridge & Wendy Vere, alongside Chartered Physiotherapist Louise Towl. He had deep pain sensation in all four limbs but very weak withdrawal reflexes. FL/HL reflexes were present in all 4 limbs but Austin initally had diffculties emptying his bladder independently.
Treatment - Austin remained on Vetagesic initally to help manage his post-operative pain, he was also on Metacam daily. Wendy performed several acupuncture sessions to further assist with pain relief. He required frequent postural changes alternating between right and left side-lying as well as supported sternal recumbancy to enable him to interact with his environment. He needed assistance to eat and drink as he wasn't able to maintain an appropriate head and neck position at first. He was fitted with a spinal harness for all physiotherapy sessions to ensure his neck comfort an safety. In addition Austin was stretchered outside for toileting during the first two weeks.
Austin was worked daily over a physio 'peanut roll' in both functional sitting and standing positions. In addition he was positioned in side lying for soft-tissue/joint ROM sessions. At the end of week two Austin attempted to stand and was then progressed onto the hydrotherapy treadmill with the physiotherapist supporting him. He initally needed help with positioning his FL/HL's and maximal trunk support via a sling and theraband system. From that moment on he seemed to suddenly turn a corner and began to progress rapidly on a daily basis. By the end of week three Austin was walking outside for toileting with moderate support from a spinal harness.
He was discharged home after four weeks of intensive rehabilitation to his owners who had been visiting Linhay on a weekly basis. Helen visited Austin at his home last week and is pleased to report that he has progressed even further thanks to his owners input. He is now independently ambulant around the house and garden and is back to his cheerful self.
It must be stressed how cases like this can take weeks to improve and need a significant amount of appropriate, timely physiotherapeutic and nursing input. Owner commitment and compliance on discharge is paramount for successful outcome and not all cases will return to the same level of function.
Molly - 2yr old whippet bitch with cervical fracture
Molly is a 2 yr old whippet bitch who sustained a C3-4 vertebral end-plate fracture with associated spinal cord and epaxial muscle bruising. This happened during a rotational fall whilst out being exercised at the end of September 2009. She was referred to Linhay for spinal rehabilitation by orthopaedic surgeon Damien Bush.
Molly did not have any surgery following her accident as the fracture was deemed to be stable. However we had to ensure that she was positioned and handled correctly at all times to ensure her comfort and safety during her rehabilitation.
Assessment - Molly was assessed by vet Kate Rew and Chartered Physiotherapist Helen Mathie. Although Molly was bright and alert on arrival she was laterally recumbant favouring left side lying. She demonstrated increased tone through the right side of her trunk, right forelimb and right hindlimb. She was not able to stand without assistance and knuckled over onto the dorsum of the right fore and hindlimbs respectively. Reflexes were present in all four limbs but were brisk in the right FL/HL, withdrawal response was present in all 4 limbs. There were no signs of cranial nerve involvement. Due to the increased tone in the right side of Molly's body she was quite uncomfortable through her neck muscles.
Treatment - Molly was on Metacam for pain relief however we felt that she would also benefit from acupuncture to address in particular her neck discomfort. In addition part of her daily regime consisted of frequent postural changes (alternating right and left side lying with supported sternal recumbancy) to help prevent secondary soft-tissue shortening as a result of her altered tone. Daily physiotherapy included gentle passive joint ROM, soft-tissue mobilisation and facilitated standing/balance work in a spinal harness. She didn't get on well with the physio 'peanut ball' so was worked in a more functional supported standing position instead. During all Molly's physiotherapy treatments she was handled and positioned in such a manner as not to increase her tone by giving her a large base of support. She was a cheerful little soul but as with many neurological cases had a tendancy to fatigue quickly, therefore treatment sessions were 'little and often'.
Molly was fitted with a lightweight neoprene carpal splint to help prevent the right FL knuckling however due to proximal muscle weakness in her right shoulder girdle she found it difficult to initiate movement against gravity, let alone move the limb with the added weight of a splint! However over a period of 4 weeks Molly progressed to further proprioceptive and stengthening work in the hydrotherapy treadmill. Throughout all her hydrotherapy treadmill sessions Molly needed to be assisted by the physiotherapist in relation to the the right FL/HL placement. The treadmill was favoured instead of the pool as the sensation of Molly's pads on the treadmill belt helped to stimulate a normal gait pattern but within a buoyant environment that assisted her weak muscles.
Molly was discharged home to her dedicated owner after four weeks of intensive rehabilitation. She is now independent around the house and has frequent physiotherapy sessions as a outpatient with another Chartered physiotherapist closer to her home.
Molly did not have any surgery following her accident as the fracture was deemed to be stable. However we had to ensure that she was positioned and handled correctly at all times to ensure her comfort and safety during her rehabilitation.
Assessment - Molly was assessed by vet Kate Rew and Chartered Physiotherapist Helen Mathie. Although Molly was bright and alert on arrival she was laterally recumbant favouring left side lying. She demonstrated increased tone through the right side of her trunk, right forelimb and right hindlimb. She was not able to stand without assistance and knuckled over onto the dorsum of the right fore and hindlimbs respectively. Reflexes were present in all four limbs but were brisk in the right FL/HL, withdrawal response was present in all 4 limbs. There were no signs of cranial nerve involvement. Due to the increased tone in the right side of Molly's body she was quite uncomfortable through her neck muscles.
Treatment - Molly was on Metacam for pain relief however we felt that she would also benefit from acupuncture to address in particular her neck discomfort. In addition part of her daily regime consisted of frequent postural changes (alternating right and left side lying with supported sternal recumbancy) to help prevent secondary soft-tissue shortening as a result of her altered tone. Daily physiotherapy included gentle passive joint ROM, soft-tissue mobilisation and facilitated standing/balance work in a spinal harness. She didn't get on well with the physio 'peanut ball' so was worked in a more functional supported standing position instead. During all Molly's physiotherapy treatments she was handled and positioned in such a manner as not to increase her tone by giving her a large base of support. She was a cheerful little soul but as with many neurological cases had a tendancy to fatigue quickly, therefore treatment sessions were 'little and often'.
Molly was fitted with a lightweight neoprene carpal splint to help prevent the right FL knuckling however due to proximal muscle weakness in her right shoulder girdle she found it difficult to initiate movement against gravity, let alone move the limb with the added weight of a splint! However over a period of 4 weeks Molly progressed to further proprioceptive and stengthening work in the hydrotherapy treadmill. Throughout all her hydrotherapy treadmill sessions Molly needed to be assisted by the physiotherapist in relation to the the right FL/HL placement. The treadmill was favoured instead of the pool as the sensation of Molly's pads on the treadmill belt helped to stimulate a normal gait pattern but within a buoyant environment that assisted her weak muscles.
Molly was discharged home to her dedicated owner after four weeks of intensive rehabilitation. She is now independent around the house and has frequent physiotherapy sessions as a outpatient with another Chartered physiotherapist closer to her home.
Monday 26 October 2009
Harvey - Brachial Plexus - 7 year old Male Black Labrador
Reason for referral:
Road traffic accident (RTA) 19/12/06. Paralysis of right fore limb and cervical pain. Provisional diagnosis - brachial plexus injury
Medical history:
19/12/06 - Seen by own vets and hospitalised post RTA. Given intravenous fluids, pain relief and treatment for shock. Cranial nerve function ok. Painful right shoulder, elbows and dorsal rib area. No obvious signs of internal injury detected.
20/12/06 - Non weight bearing 24 hours post incident. Radiographs performed and nothing abnormal detected. Diagnosis: probable muscle damage and soft tissue injury.
21/12/06 - Neurological exam: Right fore (RF) paralysis and negative sensory and motor function at all levels. No deep or superficial pain RF. Suspect brachial plexus avulsion. Sent home and for re-evaluation in 2 weeks.
2/1/07 - Referral for physiotherapy assessment. RF ongoing paralysis and yelped when moving at times.
Physiotherapy Examination:
Non weight bearing (NWB) right fore limb. Loss of full carpal extension. Muscle atrophy RF scapular and shoulder area. Loss of deep pain and withdrawal reflex. Slight muscle twitch of biceps and triceps, so possible proximal nerve recovery. No distal nerve recovery at present.
Physiotherapy Treatment:
Began muscle stimulation of triceps and biceps + dynamic forelimb stretches on physio ball with assistance. Advised owner re corrective limb placement/weight bearing position.
Follow up: To continue with home exercise programme and refer for veterinary rehabilitation programme and acupuncture.
Veterinary examination:
3/1/07 - Cervical pain C7-T1 and reluctance to move head and neck laterally, especially to right. Associated cervical paraspinal muscle spasm and pain referral pattern right shoulder and neck. Taut muscle band under cranial scapula. NWB right fore and pain especially right shoulder. Has deep pain and very weak withdrawal reflex and superficial pain response. Proprioception negative. Muscle atrophy infraspinatus, supraspinatus, biceps and triceps.
Treatment:
Acupuncture of cervical points: BL11, CV14, and various trigger points neck and shoulder area. LI15, TH14, SI9, LI11, TH5, BL60. Needling of deep cervical and subscapular acupuncture points initially painful, but Harvey soon relaxed and analgesic effect obviously demonstrated after approximately 5 minutes. Electroacupuncture for 5 minutes from BL11 TH14/LI15.
Physiotherapist demonstrated muscle stimulator and physio ball exercises again and owners to continue at home to slow muscle atrophy.
4/1/07 - Owners phoned to say dog much more comfortable after treatment and definite movement of shoulder after acupuncture treatment. Dog seemed to be dragging the limb less.
9/1/07 - Much improved limb placement. Harvey able to hold his limb straight when sitting. Good superficial and deep pain response, and limb withdrawal stronger. Definite proximal limb response but distally still a poor response. Poor proprioception RF limb. Still NWB but holding limb higher when walking. Neck pain resolved, and he was much more comfortable with lateral movement of head and neck. Repeated electro-acupuncture.
Began hydrotherapy treadmill exercise but due to C7-T1 focus of pain, care re over-extension of RF shoulder and dorsiflexion of head/neck (free swimming not appropriate at this stage.) Did 3x2 minute sessions initially with support, to encourage proprioception. Harvey attempted to compensate with other 3 legs and tired easily.
16/1/07 -Repeated treadmill session of proprioceptive work with assistance 3 x 2 minutes. Concern regarding the muscle atrophy and owners having trouble with exercises. Given large peanut ball as dog is reluctant to use physio ball.
Harvey developed lick granuloma on the dorsum of his right fore paw, so applied a light dressing and prescribed antibiotics.
18/1/07 - Improved generally although still muscle atrophy++. Slow 2 minute warm up on treadmill, then proprioceptive work with assistance 2 x 3 minutes. Tried swimming in treadmill, however although he showed some ability to advance the RF limb he tired easily after 2 minutes. Discussed splinting, although difficult at present, as inability to advance the limb, due to muscle weakness.
23/1/07 - Aquatic treadmill and assisted proprioceptive work 3x3 mins after warm up. 3 minutes free swimming with life jacket supporting dog, enjoyed this although tired quickly. Arranged to book free swimming session weekly along with weekly treadmill and acupuncture sessions.
25/01/07 - Good proximal forelimb activity when free swimming and assisted proprioceptive and limb weight bearing / placement on treadmill. Tried floats to encourage weight bearing on RF limb, as Harvey had developed a compensatory gait pattern. Continued work on a peanut ball to improve distal limb function and muscle strength.
Plan:
Harvey is to continue an intensive 6-8 week rehabilitation programme with swimming, aquatic treadmill and regular acupuncture sessions. We aim to see an improvement in limb proprioception over the next 2-3 weeks and to maintain or improve muscle strength and bulk during this time. We may splint the limb using an Ortho-vet splint once the lick granuloma on Harvey’s paw has resolved.
The owners are to carry on with progressive exercise programme at home using peanut ball and muscle stimulator initially. Owner compliance is essential in these cases and we do find they really need our advice and guidance with these long term rehabilitation cases, especially when there is a plateau in the animal’s progression.
Although we hope Harvey will regain use of his right fore, a full recovery of total limb function may not be possible in this case. It is important that the owners are informed of this and have a realistic view of the likely outcome.
Road traffic accident (RTA) 19/12/06. Paralysis of right fore limb and cervical pain. Provisional diagnosis - brachial plexus injury
Medical history:
19/12/06 - Seen by own vets and hospitalised post RTA. Given intravenous fluids, pain relief and treatment for shock. Cranial nerve function ok. Painful right shoulder, elbows and dorsal rib area. No obvious signs of internal injury detected.
20/12/06 - Non weight bearing 24 hours post incident. Radiographs performed and nothing abnormal detected. Diagnosis: probable muscle damage and soft tissue injury.
21/12/06 - Neurological exam: Right fore (RF) paralysis and negative sensory and motor function at all levels. No deep or superficial pain RF. Suspect brachial plexus avulsion. Sent home and for re-evaluation in 2 weeks.
2/1/07 - Referral for physiotherapy assessment. RF ongoing paralysis and yelped when moving at times.
Physiotherapy Examination:
Non weight bearing (NWB) right fore limb. Loss of full carpal extension. Muscle atrophy RF scapular and shoulder area. Loss of deep pain and withdrawal reflex. Slight muscle twitch of biceps and triceps, so possible proximal nerve recovery. No distal nerve recovery at present.
Physiotherapy Treatment:
Began muscle stimulation of triceps and biceps + dynamic forelimb stretches on physio ball with assistance. Advised owner re corrective limb placement/weight bearing position.
Follow up: To continue with home exercise programme and refer for veterinary rehabilitation programme and acupuncture.
Veterinary examination:
3/1/07 - Cervical pain C7-T1 and reluctance to move head and neck laterally, especially to right. Associated cervical paraspinal muscle spasm and pain referral pattern right shoulder and neck. Taut muscle band under cranial scapula. NWB right fore and pain especially right shoulder. Has deep pain and very weak withdrawal reflex and superficial pain response. Proprioception negative. Muscle atrophy infraspinatus, supraspinatus, biceps and triceps.
Treatment:
Acupuncture of cervical points: BL11, CV14, and various trigger points neck and shoulder area. LI15, TH14, SI9, LI11, TH5, BL60. Needling of deep cervical and subscapular acupuncture points initially painful, but Harvey soon relaxed and analgesic effect obviously demonstrated after approximately 5 minutes. Electroacupuncture for 5 minutes from BL11 TH14/LI15.
Physiotherapist demonstrated muscle stimulator and physio ball exercises again and owners to continue at home to slow muscle atrophy.
4/1/07 - Owners phoned to say dog much more comfortable after treatment and definite movement of shoulder after acupuncture treatment. Dog seemed to be dragging the limb less.
9/1/07 - Much improved limb placement. Harvey able to hold his limb straight when sitting. Good superficial and deep pain response, and limb withdrawal stronger. Definite proximal limb response but distally still a poor response. Poor proprioception RF limb. Still NWB but holding limb higher when walking. Neck pain resolved, and he was much more comfortable with lateral movement of head and neck. Repeated electro-acupuncture.
Began hydrotherapy treadmill exercise but due to C7-T1 focus of pain, care re over-extension of RF shoulder and dorsiflexion of head/neck (free swimming not appropriate at this stage.) Did 3x2 minute sessions initially with support, to encourage proprioception. Harvey attempted to compensate with other 3 legs and tired easily.
16/1/07 -Repeated treadmill session of proprioceptive work with assistance 3 x 2 minutes. Concern regarding the muscle atrophy and owners having trouble with exercises. Given large peanut ball as dog is reluctant to use physio ball.
Harvey developed lick granuloma on the dorsum of his right fore paw, so applied a light dressing and prescribed antibiotics.
18/1/07 - Improved generally although still muscle atrophy++. Slow 2 minute warm up on treadmill, then proprioceptive work with assistance 2 x 3 minutes. Tried swimming in treadmill, however although he showed some ability to advance the RF limb he tired easily after 2 minutes. Discussed splinting, although difficult at present, as inability to advance the limb, due to muscle weakness.
23/1/07 - Aquatic treadmill and assisted proprioceptive work 3x3 mins after warm up. 3 minutes free swimming with life jacket supporting dog, enjoyed this although tired quickly. Arranged to book free swimming session weekly along with weekly treadmill and acupuncture sessions.
25/01/07 - Good proximal forelimb activity when free swimming and assisted proprioceptive and limb weight bearing / placement on treadmill. Tried floats to encourage weight bearing on RF limb, as Harvey had developed a compensatory gait pattern. Continued work on a peanut ball to improve distal limb function and muscle strength.
Plan:
Harvey is to continue an intensive 6-8 week rehabilitation programme with swimming, aquatic treadmill and regular acupuncture sessions. We aim to see an improvement in limb proprioception over the next 2-3 weeks and to maintain or improve muscle strength and bulk during this time. We may splint the limb using an Ortho-vet splint once the lick granuloma on Harvey’s paw has resolved.
The owners are to carry on with progressive exercise programme at home using peanut ball and muscle stimulator initially. Owner compliance is essential in these cases and we do find they really need our advice and guidance with these long term rehabilitation cases, especially when there is a plateau in the animal’s progression.
Although we hope Harvey will regain use of his right fore, a full recovery of total limb function may not be possible in this case. It is important that the owners are informed of this and have a realistic view of the likely outcome.
Bella - Neutered Female Border Collie with Hip Dysplasia
The owner reported Bella had demonstrated recurrent lameness post agility and also noticed a failure to extend her hindlimbs over jumps. She had an increased tendency to sit afterwards, and tended to “pull” herself with her front legs rather than use her back end (as demonstrated in photo). She was originally prescribed rest and non-steriodal anti-inflammatories (Metacam). Bella’s problems continued however, and x-rays were performed by her referring vet.
Bella was diagnosed with Hip Dysplasia October 2003. Her right hip was worse and there was pain particularly on extension of R hip. Her vet advised use of Metacam with hydrotherapy and restricted land based exercise. Her prognosis with regard’s to her agility prospects was questionable, so her owner took the responsible decision to retire this very talented performer. She began Seraquin joint supplement, to help maintain her existing joint function.
Bella was referred to The Linhay during July 2006 as although retired from agility, she still demonstrated intermittent lameness and discomfort after exercise.
On examination, Bella had reduced extension and flexion of both hips, although the right hip was worse. She resented any manipulation and demonstrated a considerable pain response ie became very grumpy! Hip extensor muscles were very tight and there was also paraspinal spasm of the lumbar muscles (lower back).
There was considerable muscle wastage around the hips on both sides. Bella had discomfort associated with mobility changes and muscle weakness - a common, vicious cycle of events with hip dysplasia and arthritis.
On gait analysis, Bella had a typical compensatory gait pattern, using her forelimbs and throwing herself onto her forehand, to avoid using her hindlimbs. She avoided any hip extension and generally had a very short and stilted gait.
We started acupuncture weekly for 3 weeks, and she had a response after only two treatments. Acupuncture is excellent for helping with chronic pain associated with hip dysplasia and osteoarthritis. We also began hydrotherapy using a combination of pool and aquatic treadmill. Bella was much less grumpy on manipulation of the hips, and began to move more freely on land. Once we had adequate control of Bella’s chronic pain state, we were able to work on building up the muscle strength and endurance in her hindlimbs. If the soft tissues supporting the joint are strengthened in this way, the ball-and-socket hip joint then becomes more stable and more mobile. Sessions were bi-weekly initially then weekly for the first month. We continued to see an improvement in Bella’s gait and general ability to exercise on land, without stiffness afterwards. Bella's owner reported that Bella was much happier in herself and wanting to do agility again (although not allowed too!).
Bella, 6 months later, looks sound on land and during gait analysis on the aquatic treadmill. She has 4-6 weekly acupuncture and hydrotherapy sessions to maintain her much improved quality of life and happy retirement!
Piki - 12 Year Old with Osteoarthritis of Hips and Elbows
Reason for Referral:
Geriatric dog with osteoarthritis of hips and elbows. Bilateral hip dysplasia diagnosed as 7 year old.
Medical history:
October 2003: Given Cartrophen injections 4 weekly then annual top ups. This helped initially.
November 2005: Worsening of symptoms and reluctance to walk. Prescribed Rimadyl (non-steriodal anti-inflammatory) and Seraquin (neutraceutical joint supplement), which did improve her mobility, although she still struggled in cold/damp weather.
November 2006: Progressive worsening of mobility and reluctance to walk. Dog very dull and depressed, especially in cold and damp conditions.
Veterinary examination:
Generalised osteoarthritis and severe pain and reduced ROM bilateral hips and elbows. Piki was very uncomfortable and generally restless.
Moderate to severe muscle atrophy of gluteals, hamstrings and quadriceps, and hindlimb weakness generally. Difficulty sit-stand and owners report dog reluctant to rise without assistance. Very stiff and stilted action as lame forelimbs and hindlimbs. Acupuncture point SP12 reactive which may indicate sciatic pain L>R. Acupuncture performed bilateral, local elbow points LI11,TH10, LU5 and bilateral hip points BL54, GB20/30. Also BL23, BL40, BL60, ST36/SP6, lumbar Ba Hui.
30/11/06 - Much improved and owners reported Piki “bounding around like a 2yo!”
Dog much happier and very much improved mobility-excellent response after only 24 hours post acupuncture treatment. Repeat acupuncture using similar points repeat acupuncture 1 week.
4/1/06 - Acupuncture repeated using same points and dog wanting to go for walks at home and demeanour much more like she used to be.
9/1/07 - Begin bi-weekly aquatic treadmill sessions to strengthen hindlimb muscles and improve joint ROM in elbows and hips. Initially 2min warm up then 2x 3mins, 2 min warm down and coped very well.
Bi-weekly treadmill for 4 weeks and excellent improvement in muscle strength and cardiovascular fitness.
Discussion with referring vet. Reduced Rimadyl dose to half, and maintain on joint supplement.
Plan:
Reduce treadmill to once weekly for 3-4 weeks then owner very keen to carry on with 2 weekly maintenance sessions as there has been such an improvement in Piki’s willingness and ability to exercise.
Acupuncture sessions 4-6 weekly to maintain relief from chronic pain.
Progressive home exercise programme with small frequent walks 4-6 x daily.
Prince - Obese 8 Year Old Neutered Male Labrador
Prince first came to us at the beginning of November 2006. His caring owners were seeking advice & support to help Prince lose weight.
At 75.15 kg he weighed more than double his healthy weight. This was exacerbating an existing problem he has with both his stifle (knee) joints, as well as predisposing him to other problems such as heart disease.
After ruling out a thyroid condition & assessing his lifestyle, we decided with his owners to hospitalise him on an individual diet & exercise plan.
His daily food ration is divided into 4 meals, to help him burn off the energy over the day. He is also fasted for 1 day a week – a situation that is quite natural for dogs, & one that Prince accepts well.
Prince has regular sessions on our hydrotherapy treadmill as well as going for walks in surrounding fields. The hydrotherapy treadmill has enabled us to build Prince’s exercise up slowly, as he was extremely unfit to begin with. The warm water also helps to support his joints, & gives him gentle resistance to work against.To help with the pain in his joints Prince receives acupuncture treatments. He began with twice weekly treatments for 4 weeks, reducing to weekly treatments at present. This has helped his ability to exercise, & has enabled us to stop his anti-inflammatory medication.
Initially Prince managed 4 minutes at a time on the treadmill & couldn’t walk far.
Five weeks later, Prince weighs 64.8kg. He loves his treadmill sessions & can manage 20 minutes each time.
By February 2007, Prince weighs 53kg, having lost over 20kg in weight. He is doing very well & can already enjoy a new lease of life, playing with a ball & going for fun walks.
Popi - Agility Collie
The inner thigh muscles of the hind limb that Popi keeps re-injuring are the Gracilis and Adductor muscles. These muscles attach from the pelvis to femur and tibia bones. Their action is to draw the hind leg in and under the body, bend the knee, and extend the knee and hock. They can easily be overstretched and injured in agility work, and are at risk when they are not well developed and exercised sufficiently.
In July o6 Popi attended the Linhay for an assessment. She was in full work and competing, but the owner was concerned she may re-injure and wanted advice on an exercise program to prevent re-occurrence. The owner did not allow Popi to work off lead very often; most free exercise work was done at training sessions 2 times a week. It became apparent that Popi was not doing enough specific muscle training work to achieve suitable strength and muscle support and balance of the hind limbs particularly and she could generally improve on overall muscle development to work at top agility level safely and injury free.
On examination Popi was sound on a straight line but on a left circle a mild shortened stride of the right hind was apparent. There was some muscle wastage of the right thigh circumference and an obvious muscle imbalance with more muscle definition of the front and back thigh muscles i.e. quadriceps and hamstrings in comparison to less defined inner and outer thigh muscles i.e. adductors and abductors respectively. On palpation a taut right adductor muscle band and tendon insertion was felt. A mild soft tissue strain was diagnosed.
The soft tissues were treated with veterinary acupuncture and manual physiotherapy. Advice was given on an exercise/reconditioning program, stretching pre/post exercise, combining straight line controlled work with lateral, circle, weaving work to achieve a good muscle balance of the hind limbs. Popi also started fitness and gait training on the hydrotherapy treadmill; free swimming could also be introduced to assist strengthening of the thigh muscles with circles, figure of 8, sharp turns working against the resistance of the water and using jets to increase the work load. Popi remained in full training and competing.
Unfortunately she was still episodically becoming sore after competition. She re-injured the LH adductors at the World Championships in October 2006. Treatment with acupuncture and physiotherapy was administered and water treadmill exercise. An ultrasound scan of the adductor region was advised at this stage to determine the degree of muscle/tendon damage; this is a very useful tool in human sports medicine to help determine a prognosis regarding continued sport. Unfortunately we are still waiting for this scan to be done.
With treatment and exercise Popi continued to become symptom free, a scan would be now be more useful in the acute stage of injury. Since the end of October Popi has continued weekly water treadmill sessions and re-examinations of the musculo-skeletal system. She has continued to put muscle on generally and now has a minimal difference in muscle circumference right to left hind. Popi continues with a daily regime of controlled exercise, gradients/hills, walk, trot, transition changes, physioball/balance exercises, alternate days of circles, figure of 8, weaving, free running, normal agility training sessions.Popi had one recent episode of stiffening up after training, the owner was not able to warm her down sufficiently as she was too excitable, then she travelled home for 2 hours in the car and was stiff on return home. The owner was advised in future to leave the training site, warm the dog down for 15 minutes, use a warm dog coat and special dog thermal pack under the car blanket, then a short walk on return home.
Now in February 2007 Popi has remained sound is in full work and competing. This rehabilitation program takes dedication from the owner to perform the home exercises and general exercise regime. Unfortunately with Popi’s chronic injury history it will no doubt mean she is susceptible to re-injury. The scar tissue that keeps developing post strain is non-functional and the muscle-tendon area each side of the scar is put under greater stress during exercise. If the owner continues to work hard on a daily program and with a combined team approach at the Linhay, we will endeavour to keep Popi competing at top level.
In July o6 Popi attended the Linhay for an assessment. She was in full work and competing, but the owner was concerned she may re-injure and wanted advice on an exercise program to prevent re-occurrence. The owner did not allow Popi to work off lead very often; most free exercise work was done at training sessions 2 times a week. It became apparent that Popi was not doing enough specific muscle training work to achieve suitable strength and muscle support and balance of the hind limbs particularly and she could generally improve on overall muscle development to work at top agility level safely and injury free.
On examination Popi was sound on a straight line but on a left circle a mild shortened stride of the right hind was apparent. There was some muscle wastage of the right thigh circumference and an obvious muscle imbalance with more muscle definition of the front and back thigh muscles i.e. quadriceps and hamstrings in comparison to less defined inner and outer thigh muscles i.e. adductors and abductors respectively. On palpation a taut right adductor muscle band and tendon insertion was felt. A mild soft tissue strain was diagnosed.
The soft tissues were treated with veterinary acupuncture and manual physiotherapy. Advice was given on an exercise/reconditioning program, stretching pre/post exercise, combining straight line controlled work with lateral, circle, weaving work to achieve a good muscle balance of the hind limbs. Popi also started fitness and gait training on the hydrotherapy treadmill; free swimming could also be introduced to assist strengthening of the thigh muscles with circles, figure of 8, sharp turns working against the resistance of the water and using jets to increase the work load. Popi remained in full training and competing.
Unfortunately she was still episodically becoming sore after competition. She re-injured the LH adductors at the World Championships in October 2006. Treatment with acupuncture and physiotherapy was administered and water treadmill exercise. An ultrasound scan of the adductor region was advised at this stage to determine the degree of muscle/tendon damage; this is a very useful tool in human sports medicine to help determine a prognosis regarding continued sport. Unfortunately we are still waiting for this scan to be done.
With treatment and exercise Popi continued to become symptom free, a scan would be now be more useful in the acute stage of injury. Since the end of October Popi has continued weekly water treadmill sessions and re-examinations of the musculo-skeletal system. She has continued to put muscle on generally and now has a minimal difference in muscle circumference right to left hind. Popi continues with a daily regime of controlled exercise, gradients/hills, walk, trot, transition changes, physioball/balance exercises, alternate days of circles, figure of 8, weaving, free running, normal agility training sessions.Popi had one recent episode of stiffening up after training, the owner was not able to warm her down sufficiently as she was too excitable, then she travelled home for 2 hours in the car and was stiff on return home. The owner was advised in future to leave the training site, warm the dog down for 15 minutes, use a warm dog coat and special dog thermal pack under the car blanket, then a short walk on return home.
Now in February 2007 Popi has remained sound is in full work and competing. This rehabilitation program takes dedication from the owner to perform the home exercises and general exercise regime. Unfortunately with Popi’s chronic injury history it will no doubt mean she is susceptible to re-injury. The scar tissue that keeps developing post strain is non-functional and the muscle-tendon area each side of the scar is put under greater stress during exercise. If the owner continues to work hard on a daily program and with a combined team approach at the Linhay, we will endeavour to keep Popi competing at top level.
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