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.

agility fall

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.

 

Pain and lameness in ridden horses

Lameness

Call Sam Sherrington on 0452 472 959 for more information on Human and Animal Osteopathy.

It is established that more than 47% of the sports horse population in normal work may be lame, without having been identified as such by their regular owner or trainer. A new study by the industrious and ever driven Sue Dyson and team has made huge headway by testing the validity of a list of easily observed behavioural features that may indicate lameness in the ridden horse. The ethogram allows owners and riders to be more attuned to the signs that their horse may be in pain and thus could help to reduce the incidence of undiagnosed lameness in performance horses. The study compared the frequency and reliability of a group of 114 behaviours and reduced the list down to 24 reliable signs that occur significantly more frequently in lame horses than non-lame horses under saddle in trot and canter, when working large, on 20m and on 10m circles.

Many of the behaviours discovered to be significantly more common or exclusively seen in the lame group of horses are commonly viewed as purely behavioural and thus often addressed by stronger tack/equipment or punitive training methods. This study therefore provides some very compulsive evidence for always giving the horse the benefit of the doubt when a new or unusual behaviour crops up during work.

In my practice I’ve long seen many of these features as signs of pain in one part of the body or another, so it is fantastic to have some solid evidence to affirm the link and to help owners become more adept at recognising that these behaviours are in fact a cause for action. As the study concluded –

If ≥ 8 of the 24 identified behaviours linked to pain are observed within a fixed period of 3-5 minutes, it may be advisable to seek out a specialist for assessment of pain (lameness) in the horse.

So, keep this list of prime signs in mind if, while working with your horses, they begin to show undesirable behavioural changes. Young or green horses may be expected to show some of these signs as they are physically and mentally establishing their work, however if the behaviour continues then it is also well worth considering as a possible sign of pain.

  • Ears back
  • Mouth repeatedly opening and closing
  • Tongue exposed or tongue repeatedly moving in and out of the mouth
  • Working on 3 tracks in a straight line.
  • Increased frequency or changes in frequency of steps within a gait, especially if when going from large to small diameter circles.
  • Incorrect canter (Changing behind/in front)
  • Unwillingness to move forwards and resistances.
  • Spontanously breaking from one gait to another
  • Stumbling and toe dragging

The full list of 24 signs is below for those really keen to keep on top of this aspect of horse management.

First port of call for all overt lameness cases is your vet, and once veterinary sources of pain are eliminated Sam Sherrington – Equine Osteopath if in the Hills and  Hawkesbury regions of NSW, Australia or another Osteopath or Chiropractor (or Veterinarian trained in biomechanical treatment of horses) who has university level training to assess and treat musculoskeletal causes of lameness and pain.

Dyson, S., Berger, J., Ellis, A.D., Mullard, J., 2018. Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J. Vet. Behav. 23, 47-57. http://www.journalvetbehavior.com/article/S1558-7878(17)30172-7/fulltext