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Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4918.


Abstract
Griffin, an almost 12-year-old castrated male Cairn terrier weighing 17lbs, presented for acupuncture after a two-month history of refusing to go up the stairs and no longer riding with his front legs up on the center console in the truck, as was his habit. Physical and myofascial examination found trigger points and sensitivity along the length of the thoracolumbar spine. The skin also seemed abnormally adhered to the underlying fascia, which resolved with releasing massage. Acupuncture was started at the beginning of May 2016 to primarily treat back pain.

Electrical stimulation was introduced early on as an adjunctive form of treatment. Within two-three sessions, Griffin was willing to walk up the stairs. Within five treatments, he was assuming his normal position when riding in the truck. Since starting acupuncture, his owner reports that he is more playful, has more energy, and generally moves better. Initially, sessions were done at least once a week, but maintenance has been achieved with sessions spread out to every two-three weeks.


History Presentation

There is no serious pertinent medical history, and Griffin has no history of previous surgery. Two minor medical issues included a dental cleaning performed for an erosion on the buccal aspect of his cheek in 2008, which healed completely following the dental cleaning. He also experienced a presumptive soft tissue injury to his back in 2013 after rough play, which resolved with non-steroidal, anti-inflammatory medications (carprofen), methocarbamol, and rest. Recent radiographs showed mild vertebral spondylosis from T-11 through L-3, but were otherwise unremarkable. An abdominal ultrasound was performed in May 2016 due to a slight elevation in liver enzyme. There were no significant findings.

Griffin lives at home with one housemate, a six-year old spayed female Australian shepherd. He is not currently on any medications other than flea/tick and heartworm prevention.

Acupuncture was pursued as a non-medical treatment option when he refused to go up stairs and ride with his front legs on the center console in the family vehicle.


Physical Examination and Clinical Assessments

May 13

·     Exam findings: trigger point right shoulder, mild tension on neck palpation (lateral flexion bilaterally), tenderness and cutaneous reflex on palpation of T-13 and L-2/L-3

·     Points used: GV-20, GV-14, BL-21, BL-22, BL-23 bilaterally (nine points total)

·     Comments: Did very well with baby food, laid down, and relaxed through session

 

May 16

·     Response to last treatment: seemed perkier, more energy day after acupuncture, tired at tend of the day but could have been from being in hospital all day

·     Exam findings: Right shoulder trigger point from 5/13 less reactive; tension/discomfort

~T-6 through T-11

·     Points used: GV-20 (shook out after a couple mins), BL-17, BL-17.5, BL-18 bilaterally (seven points total)

·     E-stim: BL 17-18 (L only); mode mixed/continuous 100/100, output 2.0

May 18

·     Response to last treatment: seems more comfortable, humping housemate more than usual, walked up stairs for first time in a long time a few days after last tx

·     Exam findings: cutaneous reflex from scapulae to mid thorax, less reactive than last visit

·     Points used: GV-14, BL-18, BL-19, BL-20 (bilaterally), lateral points to BL-18, BL-19, BL-20 (left only) (10 total points)

·     E-stim: BL 18-20 (R only); mode mixed/continuous 100/100, output 3.0

 

May 23

·     Response to last treatment: more energy, seems to move better

·     Exam findings: cutaneous reflex and tenderness from scapulae to mid thorax still, less reactive than last visit

·     Points used: GV-14, BL-18, BL-19, BL-20, BL-21 (bilaterally) (nine total points)

·     E-stim: after 10 minutes, BL 18-21 L only; mode mixed/continuous 100/100, output 2.5

 

May 25

·     Response to last treatment: increased energy, moves better, stood on center console – which he hadn’t done since prior to starting acupuncture

·     Exam findings: cutaneous reflex prominent mid to caudal thorax and to L-3, less reactive than last visit

·     Points used: GV-14, BL-22, BL-23, BL-23.5, and BL-25 bilaterally (10 total points)

·     E-stim: 15 mins R side BL 22-25; mode mixed/continuous 100/100, output 1.1-1.2

 

May 31

·     Response to last treatment: increased energy, moving better

·     Exam findings: cutaneous reflex prominent mid to caudal thorax to L-3, similar to last tx

·     Points used: GV-14, BL-22, BL-23, BL-23.5, and BL-25 bilaterally (10 total points)

·     E-stim: 15 mins L side BL 22-25; mode mixed/continuous 100/100, output 1.2-2.1 (worked up to 2.1)

 

June 6

·     Response to last treatment: did ok, then didn’t want to go up stairs for two nights, no standing on center console

·     Exam findings: entire back more reactive, reflexes to light tough along T 10-L3

·     Points used: GV-14, BL-17.5, BL-18, BL-19, BL-20, and BL-21 bilaterally (11 total points)

·     E-stim: R only 25 mins, BL 17.5-21, mode mixed/continuous 100/100, output 1.2

 

June 8

·     Response to last treatment: playing with housemate, but wouldn’t do stairs on Monday or jump into car yesterday

·     Exam findings: sensitive to superficial touch – twitching, reflexes to light tough along T-10/L-3 as previous visit

·     Points used: GV-14, BL-17.5, BL-18, BL-19, BL-20, and BL-21 bilaterally (11 total points)

·     E-stim: R only 25 mins, BL 17.5-21, mode mixed/continuous 100/100, output 0.9-1.0

 

June 13

·     Response to last treatment: doing stairs and up on center console – improvement since last tx

·     Exam findings: less sensitive to palpation along spine, still reactive ~T-8/L-1 (shorter distance than previously)

·     Points used: GV-14, BL-15, BL-17, BL-17.5, and BL-18 bilaterally, bai hui (10 total points)

·     Tried Hwato needles for first time (sample pack) – more reactive to placement

·     E-stim: L side 15 mins, BL 15-18, mode mixed/continuous 100/100, output 2.0

 

June 15

·     Response to last treatment: still doing stairs and on center console in truck

·     Exam findings: less sensitive to palpation along spine, still reactive more cranially ~T-5/T-13 (shorter distance than previously)

·     Points used: GV-14, BL-15, BL-17, BL-17.5, and BL-18 bilaterally; hip triad (BL-54, GB-29, GB-30) – left only (12 total points)

·     E-stim: R side 20 mins, BL 15-18; mode mixed/continuous 100/100, output 1.4

 

June 29

·     Response to last treatment: doing well at home, still doing stairs and stands on center console in truck

·     Exam findings: some cutaneous reflex mid to caudal dorsum along spine

·     Points used: GV-14, BL 19-23 bilaterally (11 total points)

·     E-stim: L side 15 mins, BL 18-23; mode mixed/continuous 100/100, output 1.5

 

 

July 7

·     Response to last treatment: doing well at home, 1 week since last tx – using stairs more regularly

·     Exam findings: some cutaneous reflex present, but not as reactive

·     Points used: GV-14, BL 12-15 bilaterally, bai hui, SI-11+ SI-12 (left only) (12 total points)

·     E-stim: L side 15 mins, BL 12-15; mode mixed/continuous 100/100, output 2.0

 

July 12

·     Response to last treatment: doing well, no major differences noted, willing to do stairs routinely

·     Exam findings: similar to last tx, mild cutaneous reflex on palpation of spine but no obvious trigger points

·     Points used: GV-14, BL-20, BL-21, BL-22, BL-23, and BL-25 bilaterally, bai hui (12 total points)

·     E-stim: R side 20 mins, BL 20-25; mode mixed/continuous100/100, output 2.0

 

July 19

·     Response to last treatment: doing well at home, still doing stairs

·     Exam findings: not overly reactive, mild cutaneous reflex mid to caudal dorsum

·     Points used: GV-14, BL-20, BL-21, BL-22, BL-23, and BL-25 bilaterally; hip triad (BL-54, GB-29, GB-30 – left side), bai hui (15 total points)

·     E-stim: L side 20 mins, BL 20-25; mode mixed/continuous 100/100, output 1.8-2.0

 

July 22

·     Response to last treatment: continuing to do well at home, still doing stairs

·     Exam findings: more cutaneous reflex mid dorsum along spine, R epaxials especially tight (bent needle while trying to place – generally more difficult to needle today despite same needles we have used for weeks)

·     Points used: GV-14, BL-18, BL-19, BL-20, and BL-21 bilaterally; SI-11 + SI-12 (left only), bai hui (12 total points)

·     E-stim: R side 25 mins, BL 18-21; mode mixed/continuous 100/100, output 1.5

 

July 26

·     Response to last treatment: continuing to do well, still doing stairs, sits on center console in car

·     Exam findings: less prominent cutaneous reflex on palpation of spine, but anticipates needle placement for first time today

·     Points used: GV-14, BL-18, BL-19, BL-20, BL-21, and BL-22 bilaterally; outer bladder points lateral to BL-18 + BL-19, right side only; bai hui (14 total points)

·     E-stim: L side 25 mins, BL 18-22; mode mixed/continuous 100/100, output 1.5

 

August 9

·     Response to last treatment: doing well at home, still doing stairs, sits on center console in car, lame on one hind leg last week – owner unsure of side

·     Exam findings: cutaneous reflex on palpation of spine (mid-thoracic), no lameness noted today

·     Points used: BL-20, BL-21, BL-22, BL-23, and BL-25 bilaterally; GB-29 (left only), BL-54 (left only) (12 total points)

·     E-stim: R side 20 mins, BL 20-25; mode mixed/continuous 100/100, output 2.0

 

August 12

·     Response to last treatment: continuing to do stairs and sit on center console, doing well

·     Exam findings: mild cutaneous reflex on palpation of mid thoracic spine, but not overly reactive

·     Points used: BL-19, BL-20, BL-21, BL-22, BL-23, and BL-25 bilaterally; GB-29 (right only), SI-11 + SI-12 (right only) (15 total points)

·     E-stim: L side 20 mins, BL 19-25; mode mixed/continuous 100/100, output 2.0-2.2

 

August 23

·     Response to last treatment: continuing to do well at home, doing stairs and sitting on center console in car, did fall backward off stairs last week, but owner caught him – did not seem to be lame or injured afterward

·     Exam findings: mild to moderate cutaneous reflex present on palpation of entire length of spine – mid thoracic most prominent

   Points used: GV-14, GV-20, BL-15, BL-16, BL-17, BL-17.5, BL-18, BL-19, BL-20, BL-21, and BL-22 bilaterally (20 total points)

·     E-stim: R side 25 mins, BL 15-22; mode mixed/continuous 100/100, output 2.0

 

September 12

·     Response to last treatment: was doing well, but has not wanted to do stairs for last two nights, sits on center console in car

·     Exam findings: moderate cutaneous reflex present along length of spine, not localized to one particular segment

·     Points used: GV-14, GV-20, BL-19, BL-20, BL-21, BL-22, and BL-23 bilaterally; SI-11 + SI-12 (left only), bai hui (15 total points)

·     E-stim: L side 25 min, BL 19-23; mode mixed/continuous 100/100, output 1.3

October 7

·     Response to last treatment: reluctant to do stairs, takes several minutes to convince him, did fall off center console this morning on the way to the hospital

·     Exam findings: cutaneous reflex present along length of spine, very reactive today to gentle manual pressure

·     Points used: BL-17, BL-18, BL-19, BL-20, BL-21, and BL-22 bilaterally; hip triad (BL-54, GB-29 + GB30 – right only) (15 total points)

·     E-stim: L side 15 mins, BL 17-22; R side 15 mins, BL 17-22; mode mixed/continuous 100/100, output 1.4 (L) and 1.5 (R)

 

October 12

·     Response to last treatment: collided with housemate (Freya) while rough-housing; jumped over her, but didn’t make it; fell and stubbed his LF paw (digits 3+4) – licking but no lameness anymore

·     Exam findings: tender and reactive mid thoracic/thoracolumbar spine, no evidence of fracture of digits 3+ 4 LF

   Points used: GV-14, GV-20, BL-17, BL-18, BL-19, BL-20, BL-21, BL-22, BL-23, BL-24, and BL-25 bilaterally; BL-54 (right only), bai hui (22 total points)

·     E-stim: L side 10 mins, BL-17 through BL-25; R side 10 mins, BL-17 through BL-25; mode mixed/continuous 100/100, output 1.1-1.4

Medical Decision Making and Acupuncture Treatment

Back pain and reluctance to do stairs (secondary to back pain) were the primary issues that were targeted with acupuncture treatment. The Bladder points chosen (BL-15 through BL-25) typically reflected trigger points on palpation of the spine, in addition to resentment or reaction to palpation of the vertebrae and epaxials. The inner Bladder line was primarily used, targeting the longissiumus and iliocostalis muscles. Innervation for BL-15 through BL-17 included cranial thoracic spinal nerves. The mid thoracic spinal nerves are influences when BL-18 and BL-19 are used. BL-20 affects the caudal thoracic spinal nerves, and BL-21, BL-22, and BL-23 affect the thoracolumbar nerves.

The mid lumbar spinal nerve innervates BL-25. Outer Bladder line trigger points were occasionally used where knots in the muscle or ropey segments were palpated. The hip triad (BL-54, GB-29, GB-30) and shoulder points (SI-11, SI-12) were used intermittently as adjunctive points for general mobility and compensatory stress when off-loading back pain.

Neuromodulation and pain relief was achieved on multiple levels, but primarily by loosening the muscles supporting the back, which were regularly tense and reactive to palpation. The needles also influenced the local collagen fibers, underlying connective tissue, nerves, and vessels. Effect was achieved by mechanoreceptor and nociceptor activation in addition to vasodilation, which promoted local circulation. Nerve stimulus from acupuncture points traveled to the spinal cord for local effect, in addition to long-loop systemic effects depending on the point chosen.

Dry needling was used for the first few sessions, with electrical stimulation added fairly early in treatments and used continuously from then on. Blue Seirin needles have primarily been used due to how tight his muscles are; uncoated needles are more difficult to insert. Massage was used for adjunctive treatment with the primary goal of releasing fascial tension under the skin along the back. The total number of treatments since starting acupuncture in May 2016 is 22 treatments. The frequency of treatments was initially ~2x/week for first six-eight weeks, then weekly, and now every one-two weeks for maintenance. We unfortunately do not have a laser available in our practice, but hope to acquire one soon.

Outcomes, Discussions, and References
Markers of progress have consistently been willingness to go up the stairs at home on his own, and whether he rides with his forelimbs up on the center console when riding in the truck. With how reactive and tender his back has been on palpation, loosening the bladder lines and trigger points has resulted in an increased level of comfort and has hopefully alleviated pain response. One adverse event was reaction to electrical stimulation during one visit (needle was adjusted and stimulation produced a sharp turn toward his back, in addition to flexing his back muscles). For the two-three sessions following this event, Griffin anticipated needle placement. He seemed to be more reactive to Hwato needles used at visit on 6/13/16 (sample package), so Seirin needles were used from them on.

This case has taught me to be thorough with my myofascial exam at the beginning of each session, as the sensitive areas along Griffin’s back to be slightly different at each visit. Clinically, this is a good example of how an active dog with mild vertebral spondylosis and very tight muscles can be treated effectively with acupuncture. There was no true “pain” perceived initially by owner. But with treatment, it became evident almost immediately that he had been uncomfortable and unwilling to go up stairs and assume his typical position while riding in the car.

CAnderson- Griffin Video 2

 

Sources
Melzack, Patrick & Patrick Wall. 1965. Pain Mechanisms: A New Theory. Science. Vol 150, No 3699. Pp. 971-979.

Robinson, Narda. Interactive Medical Acupuncture Anatomy. 2016. Teton NewMedia. Jackson, Wyoming.

Robinson, Narda. One Medicine, One Acupuncture. 2012. Animals. 2:395-414. Robinson, Narda. The Benefits of Medical Massage. 2010. Veterinary Practice News.

Schoen, Allen M. Veterinary Acupuncture: Ancient Art to Modern Medicine. 2001. Mosby- St.Louis, Missouri.