Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 10S2018040
Abstract:
“Ty” is a 12 year old Yorkie Terrier that presented to Albany Veterinary Clinic on January 31, 2019, for severe lameness, non-weight bearing on both pelvic limbs, and excruciate pain. One month after acupuncture, laser therapy and massage therapy was initiated, “Ty” showed improvement in range of motion, and was able to walk again.
History and Presentation:
Initially, “Ty’s” right rear limb was lame but the lameness shifted to the left rear limb the next week. He was not able to stand to urinate or defecate. He was anorexic, and depressed.
Physical Examination and Clinical Assessment:
Initial findings included a body condition score of 2/5, tachycardia, due to pain, tension in abdomen, that I suspected was due to constipation, and a full urinary bladder. He had a poor sitting posture with the right rear limb held to the side, the left cranially extended, and thoracolumbar kyphosis. Range of motion revealed marked restriction in stifle flexion in the left, and extension in the right limb. Bilateral medial buttress with joint capsule thickening and effusion was present. He also had bilaterally medially luxating patella, that remained misaligned from the trochlear groove, and the drawer sign was positive on the left stifle. Neurological exam revealed normal conscious proprioception in all four limbs. He presented a normal muscle tone, as well as positive patellar reflex. The withdrawal reflex was normal and there was no crossed extensor reflex. Myofascial palpation revealed trigger points in quadriceps, biceps femoris, and popliteal muscles. His cervical region was very tense, with taut bends, as well as multiple trigger points in the cervicothoracic region along the trapezius muscle, infraspinatus, and latissimus dorsi, likely secondary to compensatory mechanism, to reduce weight on hind end. Palpation of the spinal muscles, especially in caudal lumbar region appeared tender, with trigger points in the lumbar and sacral regions. X-rays revealed stifle joint effusion, displaced patella, several osteophytes, and evidence of degenerative joint disease.
Problem List:
Ataxia on the pelvic limbs, pain, constipation, as well as urinary retention. “Ty” was not able to take the stance to have a bowel movement, or to urinate.
Differential Diagnosis:
Soft tissue injury and hematoma, myositis, osteosarcoma, degenerative joint disease, luxated patella, cranial cruciate ligament rupture, osteoarthritis.
Definitive Diagnoses:
Due to the history of trauma that the patient suffered, (slipped on ice) non-weight bearing, neuromotor and myofascial dysfunctions manifested, I consider bilateral luxated patella, and left stifle dysfunction as the putative diagnosis.
Medical Decision Making:
Initiated acupuncture, laser therapy and massage. Our main goal was to keep “Ty” pain-free, and to make him walk normally again. I informed the owner about science-based medical acupuncture, low laser therapy, as well as massage. I explained how all these techniques work together trough neuromodulation, photobiomodulation, and somatic stimulation from soft -tissue manipulation. To increase the patient’s well being, I started every session with a passive touch and light effleurage to help him relax, followed by petrissage and friction. These procedures were very well tolerated and they prepared him for acupuncture, initially at GV20, GV14, and Bai Hui, to stimulate the parasympathetic system. I used these in order to relax the patient and to reduce the sympathetic tone. Also Bai Hui is a point used for lumbosacral pain. For dry needling I used Seirin needles, type J 0.16x30mm, and 0.18 x30 mm. Because I felt myofascial tenderness, and taut bends in upper cervical and craniothoracic region, I performed dry needling on BL 11 and BL 12, for cervicothoracic spinal nerves, using Serein needles, 0.18 x30 mm, and 0.2 x 30 mm. I occasionally used Carbo needles 0.18×20 mm. As well, I started acupuncture on the hip triad: BL 54, for gluteal pain, GB 30 to stimulate the sciatic nerve, GB 29 for local tenderness, and BL 31 for femoral nerve stimulation, and for pelvic limb pain. For these areas I used Seirin needles 0.18 x 30mm, and 0.2 x 30 mm, depending on Ty’s tolerance. For stifle pain I used mostly ST 36, ST 34, SP 9 ,SP10, using mostly Seirin needles 0.14×15 mm. For BL 40 used Seirin needles0.18x30mm. Occasional was able to use BL 60,with Seirin needles 0.14x15mm. Acupuncture at this points would promote peripheral and somatic afferent nerve stimulation, and increase blood flow to a specific region. In addition to acupuncture, I used low level laser therapy. Photo bio modulation will reduce inflammation, and also causes vasodilatation, bringing more oxygen to the injured tissue, improving the natural healing. I used ActiVet Pro and started unwind procedure for 2 minutes at 1000Hz, from the cervical area to the tail. I continued with 1000-3000 Hz for 10 minutes on the pelvic limbs, mostly on the lateral and medial sides of the thigh, iliotibial band, hamstring and quadriceps muscles, for 1-2 minutes on the patellar ligament. I continued the daily low laser therapy for 3 more treatments, using the same protocol: unwinding at 1000Hz for 2 minutes, followed by 1000-3000 Hz for 15 minutes, going 360 degrees around the stifle, and on both sides of the thigh.
Outcomes, Discussion, and References:
After 3 weeks, “Ty” started to bear weight and was able to walk for short distances without being supported. The gait was still abnormal at this point. He had started to use the right pelvic leg more. The owner was happy that “Ty” was able to go for walks. He was comfortable during acupuncture sessions, less anxious, due to the parasympathetic effect of GV 20, GV14, and ST36. There are numerous studies that show how the acupuncture at ST 36 can be effective in modulating the autonomic nervous system, and increase the parasympathetic tone.
After continuing acupuncture for 3 more treatments, “Ty’s” gait had improved, the lameness was reduced, and he patient was able to move without help. Even though the patellar ligament of the left leg was still medially luxated, and the drawer sign still present, the stifle stabilized further and the patient became comfortable. Due to local stimulation, myofascial mobility is improved, and the inflammation related to the stifle dysfunction was reduced. His overall well being improved significantly.
Watching “Ty’s” recovery, I realized how valuable acupuncture can be for various conditions. Acupuncture/dry needling has beneficial effects on the nervous, musculoskeletal and other systems , based on many scientific studies and systematic reviews. As a result of acupuncture therapy the patient regained his mobility, as well as his comfort level, without the side effects of anti-inflammatory medication.
After having completed the Medical Acupuncture for Veterinarians course I have become more inclined to detract clients from invasive surgeries, instead recommending the combination of medical acupuncture, laser therapy approach, and other scientific and evidence based techniques.
References:
1) Sun Y, Gan TJ, Dubose JW, et al. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth 2008;101:151–60.
2) Robinson N. The scientific basis of acupuncture pathways. Veterinary Practice News. September 30, 2013. Accessed at http://www.veterinarypracticenews.com/Medicine/The-Scientific-Basis-Of-Acupuncture-Pathways/ on 08-17-14.
3). White A, Foster NE, Cummings M, et al. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford) 2007;46:384–90.
4) Robinson N. Veterinary medical acupuncturists point to science. Veterinary Practice News. March 27, 2013. Accessed at http://www.veterinarypracticenews.com/Medicine/Veterinary-Medical-Acupuncturists-Point-To-Science/ on 08-17-14.