Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017030
Bronx is an 11yr, MN Weimaraner, Catahoula Leopard dog mix who presented for a trial of acupuncture treatments. Bronx has been intermittently scuffing his feet while going up the stairs for the past 6 months. Other than this, he has had normal mobility. On examination, trigger points and sensitivity in the TL to cranial lumbar region were found as well as in the right proximal quadriceps and left semimembranosus, semitendinosus, and biceps femoris mm. Five acupuncture and massage treatments were performed. Bronx was reported to be scuffing less at the end of the sessions, and improvement in myofascial palpation was noted after each treatment. Furthermore, acupuncture was able to be used as a diagnostic tool to better localize Bronx’s pain.
History and Presentation:
Bronx is an 11yr, MN, Weimaraner, Catahoula Leopard dog mix who presented for acupuncture treatments. Over the past 6 months he was noted to be intermittently scuffing his feet while going up the stairs. Aside from this Bronx has been doing well with his mobility and is able to run and play. His past medical history includes an episode of otitis extema and a mass on his left medial pelvic limb. Other than this, Bronx has been relatively healthy.
Physical Examination and Clinical Assessments:
On physical examination, Bronx was a great body condition score of 4/9. No abnormalities were appreciated on general physical examination. On neurological examination, no ataxia was observed on gait analysis. Conscious proprioception was within normal limits for all four limbs. Reflexes were +2 (normal) in all four limbs. Overall, no neurological abnormalities were appreciated. On myofascial examination, Bronx had normal cervical range of motion. He had sensitivity on palpation of the thoracolumbar to cranial lumbar epaxial musculature as well as the lateral epaxial musculature in the lumbar region. There were trigger points in the right triceps, right proximal quadriceps, left hamstrings, and left medial thigh musculature. He was resistant to extension of the left hip, but had normal abduction. There was also mildly decreased left
shoulder flexion. Bronx was symmetrically/normally muscled.
Medical Decision Making:
Since Bronx did not have a specific diagnosis or any other diagnostics, and the main findings on my examination were myofascial, I took the approach of targeting local trigger points and myofascial dysfunction. Since Bronx had not had any prior acupuncture treatments, I also wanted to target points that had strong connections to the parasympathetic nervous system at the beginning of my treatment session in order to help Bronx relax and be more comfortable during the sessions. I started with a smaller needle size and less points in the beginning to introduce Bronx to acupuncture gradually, and then increased the number of points per session and needle size since Bronx tolerated the initial session well.
I focused on two main problems for Bronx – his back pain and the abnormalities found in his pelvic limbs (resistance to left hip extension and myofascial trigger points). Differentials for back pain included myofascial dysfunction due to the finding of local trigger points with absence of neurological abnormalities, intervertebral disc disease – which can be present and cause pain with a nonnal neurological examination, and neoplasia. Bronx was not painful enough for disconspondylitis to be a differential, and he was also systemically healthy.
Differentials for his pelvic limb abnormalities include coxofemoral joint osteoarthritis due to his resistance to extension and scuffing while going up the stairs, with the absence of other orthopedic or neurological findings on examination, muscle strain/myofascial dysfunction due to several trigger points that were isolated – and because these could have arose out of compensation for his lower back pain, or much less likely neoplasia since Bronx did not seem to be overtly painful in this region.
Definitive (or Putative) Diagnosis (or Diagnoses):
Unfortunately, further diagnostics were not performed in this case, so I was unable to obtain a definitive diagnosis. My differentials remained the same throughout treatment.
For the first acupuncture treatment, I used less needles as well as a smaller size (red Seirin) since it was his first time receiving acupuncture. My first points were GV20, GV14, and bai hui to focus on the parasympathetic nervous system and relaxation. I also did these points because, with the exception ofbai hui, they were far away from any sore or tender areas so that Bronx’s first experience with having acupuncture needles placed were positive. Other points were chosen based on focusing on where Bronx appeared to be sensitive on palpation (listed below). 5 treatments were performed. After the first treatment blue Seirin’s were used to have more stimulation since Bronx tolerated the first treatment with red Seirin’s very well. All treatments involved dry needling. Massage (effleurage) was also perfonned gently around the needles while in placed and for about 10 minutes after the needles were removed. Points selected are listed below:
1.) BL22 and BL25 as local areas of tension, a local quadriceps trigger point on the right, GB29
and GB30 on the right (I worried that he might have pain in his hips contributing to his difficulty up the stairs) and ST36 bilaterally (chosen as a last point to have a more distal point on the hind limb and for its GI and parasympathetic effects).
2.) Bai hui, GV14, BL 54 (right), GB29, 30 (right), BL25 – was very reactive on the left this treatment. Massage was focused on the right hamstring and triceps.3.) Bai hui, four points along the bladder line from the TL to LS region (focused on areas of tension rather than exact location of points), 2 quadriceps trigger points on right, 1 right hamstring trigger point
4.) Bai hui, GV14, Stomach 36 (right), 5 bilateral points in the TL to LS region along with inside bladder line – focusing on areas with the most tension.
5.) Bai hui, GV14, ST36 (right), GB30, 5 bilateral points along the bladder line from BL23 to sacral region focusing on areas with most tension.
Outcomes, Discussions, and References:
Bronx appeared to respond well to the treatments overall. His owner reported that he didn’t see him scuffing when going up stairs as much near the end of the series of treatment sessions. Based on my palpation before and after each session, I felt that Bronx seemed to have less trigger points and myofascial restriction after each session. After his third session, he was even rolling on his back happily afterwards. Massage was also combined into the session, so it is a little hard to say how much response was due to acupuncture versus the massage, however the combination seemed to be very effective for Bronx. Bronx had no adverse events reported with his acupuncture treatments.