Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017042
Abstract: Chloe has a history of a right cruciate ligament tear and repair 9/2014. She has been in physical rehabilitation since that time, but recently presented for a consult to see if acupuncture could be added in to help manage her increasing pain. Chloe responded well and her owners have noticed a change in both her comfort and energy level.
History/Presentation: Chloe is an 11 yo spayed female Border Collie who tore her cruciate 8/14 and had an extracapsular repair 9/14; she was also diagnosed with arthritis in both hips at the time. She has been in rehab since then with treatments including massage, laser, and core strengthening exercises. In 8/15 she was diagnosed with a left iliopsoas strain that has become chronic. Chloe is maintained on Dasuquin, Rimadyl, and Denamarin daily and Adequan monthly. She is a very nervous dog and has thunderstorm anxiety. She has been so painful the past month we have been unable to perform much beyond laser/massage and her owners are concerned about her declining activity level.
Physical Examination/Clinical Assessments: On physical exam Chloe is overweight and nervous. She displays a narrow based stance in the rear, resents exam of her groin, and has decreased range of motion in her hips. She has medial buttress and crepitus in both stifles, pain on extension of the left stifle, and decreased muscling in both thighs. She is very sensitive to palpation near her shoulders (deltoids and triceps) and on palpation of her paraspinals from her thoracolumbar (TL) to lumbosacral (LS) junction; multiple areas of fascial restriction and myofascial trigger points (MTrPs) are found in the lumbar spine with significant reaction to palpation near L3-4. Neurologic exam is normal.
Differential Diagnoses: Decreased activity r/o secondary to back pain, osteoarthritis (OA), degenerative joint disease (DJD), HD, intervertebral disk disease (IVDD), soft tissue strain. Pain in stifles r/o torn cruciate, meniscal tear, OA/DJD. Shoulder pain r/o compensatory v. primary muscle strain/sprain, elbow dysplasia. Back Pain r/o IVDD, OA/DJD, compensatory strain, iliopsoas strain.
Definitive Diagnosis: Bilateral cruciate tears – right surgically repaired, left confirmed with drawer and pain on extension; HD – Radiographic evidence; Muscle strain in the thoracic limbs likely compensatory; Iliopsoas strain confirmed on direct palpation of muscle and extension of hip – secondary to cruciate disease and HD.
Medical Decision Making: As she has a history of stifle injuries, hip dysplasia (HD), and lower back pain/iliopsoas pain, I focused the first treatment on targeting the LS spinal segments and Bai Hui to interact with the central nervous system (CNS). I used ST36 when I felt the dog was comfortable enough to allow distal points, both as a peripheral as well as autonomic point, and reinforced with GV20 and GV14 for an anti-inflammatory effect. For peripheral points I did not try to access SP points (9/10) with needles but instead with laser, which I also used on ST34/36; in the second treatment I was able to needle the hip triad. Fascial restriction and MTrPs in the lumbar spine were treated with BL points directly.
Acupuncture Treatments: 5/17 – 0.16 Seirin – after massage placed GV20 and GV14, allowed to wander then placed GB21, BL19-23, 27, 28 (bilateral, associated with MTrP, dry needle), and Bai Hui (BH). Laser was performed on ST36/34 and SP9/10. 5/26 – More comfortable, still MTrP in lumbar spine. 0.2 Seirin in GV20 and GV14, as well as BL 19-22 (bilateral, dry needle). 0.16 Seirin used at BL52, 54, GB 29,30 as well as left ST36. Dog reacted vigorously to touch at ST34 on the left so used laser. 5/30 – more nervous, laser stifles bilaterally (ST34/36, SP9/10) treated BL 19-23 with 0.16 Seirin. 6/7 – GV20, GV14, BH, BL10, GB21, BL13-15, 19-23, 26-28, ST36, ST34.
Outcomes, Discussions, and References: Chloe’s owners noticed an improvement almost immediately; two days after the first visit she asked to go for a longer walk and after the second visit she was able to go down a flight of stairs and started playing with toys. She is much more comfortable on palpation of her back and for the first time during our 4th session she laid down, completely relaxed. As neither her rehab plan nor her medications have altered I attribute the changes to acupuncture. Meta-analysis has shown evidence that acupuncture is effective in treating chronic lower back pain in humans (Vickers et al., 2012) and it has been shown that this pain relief provided by acupuncture can last up to 6 months (Haake et al., 2007). Studies have shown positive effects of acupuncture in dogs with pain associated with osteoarthritis, with the hips and stifles responding better than other joints (Janssens 1986). Extrapolating the human data to dogs provides me with hope that Chloe’s lumbar pain can be addressed for years to come and acupuncture will be another tool in my multi-modal pain “toolbox”.