Canine Cranial Cruciate Ligament Injuries – Surgery or what??

How Cranial Cruciate Ligament Injuries can be managed when surgery isn’t the first choice.

Ruptures and partial tears to one or both Cranial Cruciate Ligaments (CCL) is a remarkably common injury in our doggy friends.  While certain breeds seem to have significantly more frequency of injury, I see it pop up in a wide variety of breeds, ages and sizes of dogs.

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(image: petmd.com)

Traditionally, it has been believed that typically only small dogs, under about 15kg, fare just as well with conservative management as they do with surgical repair options. At significantly less cost also. This belief is based on a study which showed very positive outcomes for the small dogs and not so much resolution of lameness in the bigger dogs. Some practitioners, however, have been questioning the assumptions since.

Dr Narda Robinson DVM is one practitioner who has been quite vocal about the lack of options many pet owners are given when faced with a CCL injury. She has compiled some good evidence here to endeavour to debunk many commonly held beliefs around why surgery should be the primary go-to option for sorting out our dogs dodgy knees.

So, when an owner makes the decision to give the surgical option a miss, at least on a trial basis, what is the conservative option?

  • The first step is to ensure the dog is a healthy weight or slightly underweight to help reduce the loading on the stifle joint. Being overweight is one of the biggest and most manageable risk factors noted to contribute to CCL damage.
  • Next, keeping your dog’s activity controlled. Complete crate rest was once advised however studies have shown it to be not necessary. Rest and avoiding jumping up and down from vehicles, beds etc; minimising risk of slipping on smooth floors, and going for frequent short controlled leash walks is the ideal for 6-8 weeks.
  • Finally, the use of anti-inflammatory or analgesic medication as required.

From an osteopathic perspective it is possible to boost the effects of this conservative management firstly by recognising that it is, in most cases where the lameness has developed gradually and insideously, strongly likely that biomechanical restrictions in the dogs body have contributed to asymmetrical weight bearing through the hind legs and the stifle joint. This asymmetry and dysfunction can be addressed using Osteopathic techniques which are gentle and often pain free. By allowing the dog’s body, especially the lumbar and pelvic regions to function to the best of their ability, it is possible to minimise overloading of individual joints and enhance circulatory and nervous flow to the joints and tissues and hence allow the body to do it’s best healing work.

One of the big risks of CCL damage is that around 50% of dogs will present with damage to the other CCL within 6 months of surgery to repair injury to the first. This suggests two possibilities. Firstly, the obvious one that during recovery, the ‘good’ knee will be taking more than its fair share of workload, and secondly, that there is some underlying biomechanical factors that haven’t been addressed in the first instance which are continuing to throw excess loading into the joints. Whether post-surgery, or opting for the conservative option, it is therefore crucial to ensure the dog’s body is actually able to work symmetrically, as well as to then formulate a thorough rehabilitation plan to help ensure the dog begins to use themselves evenly. This rehab can begin within the first few weeks post-surgery or during the rest period if managing conservatively.

Allied therapies including dietary changes (examples here and here) and nutritional supplementation and herbs, hydrotherapy, acupuncture, laser, orthoses, stem cell therapy and cryotherapy are some of the many that may be useful within the management plan for CCL rehabilitation.

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(Image: Web-dvm.net)

From a preventative point of view, again it is crucial to ensure dogs are able to use themselves as symmetrically as possible. This can be achieved by osteopathic preventative/maintenance visits from a young age, to thoroughly examine and uncover any dysfunctional regions of the body and remove these restrictions before they begin to significantly alter the way the dog is moving. Ensuring that dogs are given consistent, relatively controlled activity allows them to develop strong and healthy musculoskeletal systems – so avoid the weekend warrior approach of relatively little or no exercise during the week followed by manic ball chasing or frisbee catching at the weekend. Make exercise a big part of your daily routine so your dog has a good baseline level of fitness and strength to help cope with the inevitable extra fun at the weekends or on holidays. Also, make sure nails are kept trimmed regularly, both to avoid slipping risk and also to help avoid changes in limb posture which may occur if the dog is feeling discomfort during activity from overly long nails.

For further advice or consultation, please don’t hesitate to contact me to discuss how Osteopathy can be of use in helping prevent, manage or rehabilitate a CCL injury.

 

 

Osteopathy for the Agility Dog

How to avoid and treat agility injuries for a long and fruitful agility career.

It’s a well known fact that for all the amazing benefits Agility offers dogs and their handlers and the relationship between both, it can be a hard sport physically on the dog (and the handler, but that’s another story!).  Injuries can be either acute or chronic in nature, and management of the inherent risks presented by obstacles such as A-frames, jumps and seesaws is an important part of making sure your dog gets to have a long and enjoyable agility career. Factors which add to the risk of agility are the speed at which the dog is travelling, the tight lines often needed to navigate today’s courses and the athleticism required to traverse these obstacles, all of which leave the dog open to repetitive stress on various parts of their body as well as potential falls from or hitting the obstacle.

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From a training perspective it is very worthwhile to aim to minimise the repetitive nature of the work the dog does, especially with young dogs whose growth plates are still very susceptible to damage from excess and repetitive pressure. Keeping the work they do varied, while practicing the skills might look like breaking the exercise down into small chunks and practicing each part at a slower more controlled pace to perfect the skill, then building those parts to perform the full obstacle. Working on many small varied parts of the greater task, at a slower pace, allows the trainer and dog to refine their skills and communication while avoiding many high speed repetitions of the full obstacle.

As mentioned above, injury to growth plates in young dogs is one worry when involved in intense competitive training, and this is largely mitigated by changing the way the dog is worked at least until physical maturity. Other risks such as sprains, strains, contusions (bruising from hitting an obstacle) and postural changes due to repetitive movements of an asymmetrical nature can be more readily managed or mitigated with the help of Osteopathy and other rehabilitation or wellness options such as swimming.

Osteopathically we look at the way the dog is moving and using their body and then palpate (feel) to identify any restrictions in the joints and any tender points, tightness or weakness in the muscles, ligaments or tendons. When identified, gentle manual techniques ranging from soft tissue work (massage like techniques) through to joint manipulation can be applied to restore healthy and full range movement throughout the body. Ensuring that the musculoskeletal system has full movement not only allows these tissues to function well, it also allows the circulatory and nervous systems which have branches running all through these tissues to function optimally. This promotes healing and gives the dog the best chance of recovering fully from any injuries, as well as helping to avoid injuries in the first place.

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Agility buffs, your dogs are athletes! Their bodies are working very hard while having an absolute ball, so make sure you give them the benefit of keeping that body working to it’s best ability and you’ll give them the best chance of a long, enjoyable and injury free time leaping and bounding their way through their favourite pastime.

 

Why does my dog lick to the point of bleeding?

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A common problem dog owners find themselves facing is when their beloved dog develops a habit of excessively licking a paw or leg, or sometimes even a body part to the point a sore develops. Often this is put down to anxiety, however it is often also triggered by a pain sensation which either becomes chronic, thus the dog continues giving it attention, or becomes a comforting habit. In the case of a chronic irritation, this can be as a result of localised pain, referred pain or pain in another area which causes the dog to seek comfort and the feel-good endorphin release provided by the licking behaviour. Similar to the way we humans rub a sore muscle or joint, our dogs find the best way they can to manage the discomfort.

Obviously if open sores are present we will want the owner to be consulting a vet for investigation for underlying factors such as parasites, allergies and arthritic joints amongst other sources as well as for topical management strategies, whether that be antibiotics, antifungals, antihistamines etc to help settle the local tissue response. An Elizabethan collar may also be an appropriate strategy to help break the licking habit and protect the skin while the underlying problem is addressed. From an Osteopathic perspective there is much we can do to help alleviate this discomfort.

One of the most common sources of lick sores when no definitive underlying problem has been identified is referred pain or nerve pain from a more central restriction or dysfunction in the body. In these cases, we search for tissues and joints around the spine, limb and associated areas which can alter the function of the nerves, blood vessels and pain sensitive structures all the way to the tip of the toes. If you’ve ever sat on your leg or slept on your arm and then moved to find your limb initially ‘dead’, closely followed by a strong pins and needles sensation or many other odd sensations associated with nerve and blood flow restriction, you’re sure to be able to picture the sensations your dog is trying to ease.  By finding these kinds of restrictions in the tissues it is often possible to create take enough pressure off these sensitive structures which may allow the dog to return his attention to the more fun things in life.

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A new home for Canine Osteopathy

Some may have noticed changes to my logo and business name. These came about after being offered a great opportunity to increase the canine component of my practice. Whilst previously I saw a good amount of dogs in my travels around predominantly equine  and human visits, as of the start of January I have been working within the  K9 SWiM – Canine Wellness Centre NSW, North Richmond providing osteopathic treatment to the canine members of the family. I am delighted to be able to offer this dedicated time in my schedule for your doggy family members.

The article below appeared in K9 SWiM’s January newsletter and is well worth a read to help understand the work I do with dogs.


Osteopathy has, over the years, become such a huge part of my life. I graduated from UWS in 2003 with a Master of Osteopathy and promptly set about establishing my human practice. Having been a little obsessed with animals since the time I could express my feelings, and having spent my childhood and teen years collecting stray cats, dogs and horses much to my parents hidden delight, it really was no great surprise to anyone that animals would creep into the practice one way or another.

In 2009 I was able to complete, with distinction, the Graduate Diploma of Animal Chiropractic through RMIT in Victoria. This course was the result of an amazing amalgam of Osteopathic, Chiropractic and Veterinary practitioners, with lecturers and tutors from all three fields. Our discussions over meal breaks were educational to say the least! To say this refueled my passion for Osteopathy and it’s potential to make a difference to all creatures, great and small, is a mammoth understatement.

My new qualifications prompted me to take a leap of faith and head overseas to Ireland to focus on the animal side of practice, and I have just after nearly 8 years, returned from a wonderful time living the Irish life while building up strong skills and experience in my practice with horses, dogs and people.

People often ask why on earth a dog might need an Osteopath, and like with horses and humans, the answer isn’t necessarily a quick one.

What is Canine Osteopathy?

​Canine Osteopathy is a gentle hands on therapy for dogs which ultimately aims to restore movement wherever in the body it may be lost, and to reduce pain and discomfort resulting from these restrictions. When the joints, muscles, ligaments or tendons, connective tissue or even the vessels and organs of the body aren’t free to move pain and discomfort will often result. Many activities we, and our dogs consider a part of normal daily life, can result in these sorts of restrictions. Degenerative processes due to age, injury, breed predisposition or just bad luck can also create compensation and restriction of free and full range of motion. Helping to reduce the these restrictions can have huge effects on the comfort levels of the dog plus helping dogs gain the most from tailored rehab programmes after surgery and is where Osteopathy holds great value for our beloved animals.

The major goal to Osteopathic treatment is finding and addressing restrictions in movement, the premise being that restricted movement, in any tissue of the body, will reduce the capacity for full health of those tissues. This obviously can result in altered gait, altered ability to carry out normal activities of daily life and predispose the body to injury and/or pain. So with that in mind, the Osteopath primarily uses their hands to find and reduce restrictions in normal movement of the body to allow the natural healing ability to work to its best capacity. That’s the abbreviated version.

​The full version is something I’m only too happy to converse at length whenever anyone asks! Even 15 years into my professional life I am still blown away, on an almost daily basis, by how powerful it can be to simply allow a body to move. The changes are often much bigger than even I expect, particularly with animals compared to humans, as they have no preconceived ideas as to what they should or shouldn’t be feeling, and what their pain does or doesn’t mean to their life.

Problems in dogs that Ostepathic treatment can help

So what might an owner see that might give them cause to think an Osteopath could help?

Obvious lameness especially if of uncertain origin

​Is your dog suddenly throwing in an occasional hop or obviously favouring one limb?

Crooked posture at rest or in movement  

​Do they appear to be running like a crab?

Do they always sit and slump to one side or repetitively circle one direction only, when trying to get comfortable to sleep?

Does one limb seem to lose grip or slide out the side when on slippery surfaces?

Difficulty with normal daily activities

Is your dog showing reluctance or struggling to jump up or down from furniture, or negotiating steps?

Are they slowing down and/or avoiding obstacles during agility or jumping?

Changes in temperament

​Has your dog started being less tolerant of touch, seeking less social contact or refusing to play with people or other animals like usual?

Growling or teeth baring are late signs a dog is uncomfortable either physically or psychologically.

Recent trauma or surgery

Has he your dog had any falls or slips, or been barreled by another dog in play?

Is your dog progressing as expected with rehabilitation after surgery or showing signs she that they need some help recovering from surgery?

Aging or degenerative processes

Has he your dog been diagnosed with osteoarthritis in any joints of the limbs or spine, either primary or subsequent to an injury?

Are they simply slowing down as she they get older and finding it tougher to get going after rest?

Less obvious signs of pain or altered nervous system function

​Has your dog been excessively licking or chewing at a limb or body part?

Are they showing signs of weakness in the back or front end?

Have they been diagnosed by the vet and being managed for neurological conditions such as Wobblers syndrome or Disc Disease?

Some of these presentations are ones which Osteopathy can bring a full resolution to the problem, such as when there is simple restriction after a slip, fall or jarring. Some require ongoing maintenance treatment to help the dog as the process of healing occurs at the rate the body can heal, for example after a successful cruciate repair, or helping a dog who has had an amputation adjust to life without a leg at each corner. Finally some can simply be assisted in maintaining the best function of the surrounding areas of the body, so that the problematic area causes the least impact upon the dogs daily life.

How Canine Ostepathic treatment helped Roly the Jack Russell 

Occasionally these cases surprise you and make an almost miraculous turn around, like one wonderful little Jack Russell Terrier “Roly” who presented with full hind limb paralysis. Roly had 3 treatments over the space of a month, and along with veterinary management involving medication to manage pain and bandaging to protect his limbs, and some simple home exercises I prescribed for his owners to carry out, he was up and walking, albeit with reduced coordination. I next saw him almost a year later when visiting his owner to work on one of her horses and could hardly believe when I saw him leaping around the place as though there had never been a problem. He is a perfect example of how sometimes, simply giving their systems the space to heal by removing any restrictive roadblocks can reap huge rewards.

I am very excited to have the opportunity to work with the K9 SWiM team, and have access to the vast skills and knowledge base of the rest of the team, not to mention the ability for my clients to access the hugely beneficial hydrotherapy options.
I greatly look forward to helping your dogs achieve their best physical health in 2018, Initial consultation with you and your dog is generally up to one hour and then subsequent consultations are up to forty five minutes. If you have any queries please don’t hesitate to contact me on 0452 472 959