Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 10S2018029
Abstract:
Mojo, an older mixed breed dog with neck pain responded very well when acupuncture was added into his treatment plan for moderate myofascial banding and acute onset neck pain. His neck pain and mobility improved as did his overall back comfort and kyphotic conformation.
History and Presentation:
Mojo is a 11 year old male castrated mixed breed dog. He lives with 3 other dogs and two young children. His long term medical problems are primarily osteoarthritis of the hips which has been managed with carprofen and glucosamine. Prior to first exam, he was acutely reluctant to move his head any way but down/flexing and had trouble accessing his food and water comfortably. He appeared to be favoring his right thoracic limb. The owner gave Mojo gabapentin in addition to his other medications and he showed no improvement over the next 48 hours. The owner reported no known trauma.
Physical Exam and Clinical Assessment:
Mojo presented with little voluntary mobility to his neck in all directions. No lameness was noted in his thoracic limbs. When he turned, his neck had minimal range of motion and he used his eyes to turn first. He had mildly delayed conscious proprioception on the right pelvic and right thoracic limb, but no overt pain through palpation of these limbs. He showed minimal range of motion in his neck both right and left, though more pronounced to the right. He carried his head straight out from his body and had significant myofascial banding on both sides of the neck. His discomfort extended all along the mid thorax to lumbar vertebrae where he had mild kyphosis. His pelvic limb gait showed mild stiffness. Aside from proprioceptive deficits, he had normal reflexes in all limbs and normal remaining neurological exam. His hips had mild crepitus and decreased range of extension bilaterally and his stifles appeared within normal limits.
Problem List:
Neck/Back Pain
Delayed Conscious Proprioception on right side Hip osteoarthritis
Differential Diagnosis:
Neck/back pain: Stroke, fibrocartilaginous embolism (FCE), brucellosis, tick-borne, toxoplasmosis, diskospondylitis, nerve sheath tumor or other cancerous tumor, osteoarthritis, spondylosis deformans, intervertebral disc disease (IVDD), inflammation secondary to overuse, congenital vertebral abnormality, immune mediated polyarthropathy, trauma from jumping on/off furniture or playing with other dogs, myofascial restriction in neck and in thoracolumbar spine
Delayed Conscious Proprioception: Multifocal stroke, FCE, tick-borne, diskospondylitis, nerve sheath tumor, multiple myeloma, IVDD in focal in neck or multifocal, hip or shoulder dysplasia, degenerative myelopathy, immune mediated polyarthropathy, trauma like cruciate disease, hyperadrenocorticism, soft tissue myofascial nerve entrapment.
Putative Diagnosis:
IVDD or soft tissue myofascial restriction in the neck and back and osteoarthritis of hips,. Mojo has no fever, loss of appetite or change in water intake that led me to believe other diagnoses were more likely.
Medical Acupuncture and Related Therapy:
Dry needling and massage was started on a twice a week basis. His treatments focused on light massage and trigger points primarily in the neck, back and hips. He was quick to relax and lay in lateral recumbency once the first few needles were placed. Treatment included classical music, distal limb massage for lymph and blood flow stimulation, and 0.16-0.18 x30mm Seirin coated needles. Specific points included GV14, GV20, Bai Hui for both local neck neuromodulation and parasympathetic upregulation. Further points included bilateral BL10 for neck pain and access to the cranial cervical spinal nerves, and trigger points on the neck and along the dorsal spine on the inner bladder line. These included BL13, 15, 18, and 19 to access the thoracic spinal nerves. He showed tension in both SI11 and SI12 on the right more than the left. On the caudal half, needled points included BL54, BL27, BL28, GB29, GB30 to focus on the sacral nerves and gluteal nerves that may contribute to hip pain. More distal points included ST34, ST36, LR3 for neuromodulation of autonomic system, LU7 for the master point of the neck, LI11 for anti-inflammation and immune modulation, and then baxie for digital nerve communication with the cervical spinal cord.
Outcomes and Discussion:
After Mojo’s first treatment, his back flattened out and he was able to eat from his food bowl on the floor. His neck comfort improved dramatically over the next few treatments. His exact diagnosis is unknown but suspected to be myofascial and soft tissue related. Targeting the myofascial bands in his neck and cranial back were paramount in recovering his comfort in walking and eating. His pelvic limbs also improved in stiffness through his course of treatment, but less robustly than his neck. He would likely benefit from both electroacupuncture and laser therapy. Given his decreased hip function, he is at increased risk of further myofascial restriction due to compensation for the hind end and will benefit from continued acupuncture.
This is a case that I would have just continued to wait out the oral medication treatment or add in more medication like methocarbamol. I feel that I am now able to offer a faster form of relief for these painful patients instead of wait for oral medication and rest to do the work slower. Also, for Mojo, I believe I can manage his pain and decreased mobility through acupuncture in place of long term oral medication at this time.
References:
1. https://www.ncbi.nlm.nih.gov/pubmed/30622617
Wang CC, Huang CH, et al. (2018, Dec 2). Therapeutic Effect of Superficial Acupuncture in Treating Myofascial Pain of the Upper Trapezius Muscle: A Randomized Controlled Trial. Evid Based Complement Alternate Med, doi: 10.1155/2018/9125746
This article shows the immediate relief that is achieved by acupuncture.
2. https://www.ncbi.nlm.nih.gov/pubmed/30400984
Cerezo-Telles E, Torres-Lacomba M, et al. (2018, Nov 6). Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health Qual Life Outcomes, 16(1):207
This study shows that the dry needling with stretching creates better analgesia than just stretching alone. Acupuncture is a key component of physical therapy and treatment.