Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained fro client/author/4971.
“Andee”, is an agility athlete who has been lame this summer and fall. Over the past weeks of treatment, he has been responsive to acupuncture and LLLT (low level light laser therapy), targeting the strain pattern in his shoulders, lateral thorax and caudal lumbar area. Acupuncture has also been directed at his chronic rear foot chewing.
Andee is a 36 lb MC 7 year old beagle/bulldog mix who is an active and eager agility athlete (Level 5); in the past 8 months he has had intermittent right fore lameness, with reluctance to jump and climb. Andee does not do well with NSAIDs, has a history of pancreatitis and also has a history of allergic pedal dermatitis. On initial presentation in April, Andee had a subtle right fore lameness when moving at a trot. The owner noted that he initially started favoring his right fore after an agility practice when he slipped and fell down on his side coming out of a tunnel. He improved on Tramadol 25 mg TID and intermittent periods of rest, but throughout the summer he still occasionally limped. He performed well at summer trials but in September seemed to hesitate jumping, and was increasingly lame after activity.
The owner limited his jumping and climbing while we started weekly LLLT on his back and hips in late September, along with his right shoulder. Pertinent history was that as a 12 week old he had suffered trauma to his right elbow that resulted in a Salter Harris fracture of the lateral humeral condyle. He had surgery and has a compression screw in the distal humerus. He had healed easily after surgery and even though he has had a shortened stride in the swing of his right front leg, and some right scapular atrophy, he had not demonstrated lameness on this leg until this year. Radiographs attached from April and August.
Andee also has a longstanding history of chewing on P3 and P4 on both hind feet until they are red and swollen. The owner has used Temaril P for short courses over the past 3 years, as well topical Chlorhexidine cleanser and Betagen spray on the feet. The Prednisone in the Temaril P may have helped mask or attenuate his pain somewhat during the summer.
Physical Examination and Clinical Assessment:
On exam October 31, 2016, Andee moved freely around the room. On myofascial exam, he exhibited tenderness to palpation along his entire bladder line, and on his lateral thorax bilaterally (lattismus dorsi caudal to scapulas very tender and tight). Trigger points were noted in the caudal aspect of the triceps bilaterally, with the right side trigger point larger and more tender than the left. He also was very tender to palpation of the attachment of the iliopsoas over his caudal lumbar muscles bilaterally. His ventral neck muscles also had taut bands on palpation. (Video of exam included).
Predominantly, his strain pattern was behind his shoulders, along his thoracolumbar muscles extending to his lumbar paraspinal muscles. His central toes on his rear feet were red and swollen from licking (see photo attached, before and after).
Medical Decision Making:
After ensuring that there was no visible arthritis, bone density changes, or screw migration in his right elbow from previous radiographs, LLLT therapy was started in early October over both shoulders, scapulas, the bladder line, neck, and lumbar paraspinal muscles. The ActivetPro laser was used at a 1000 HZ setting for 15 minutes weekly. This helped, but he still limped occasionally. His stride is shortened by a slight reduction in flexion in his right elbow and the fall he experienced earlier in the year may have exacerbated the strain pattern in his thorax and muscles deep to his scapulae, extending to the attachment of the lattismus dorsi muscle on thoracolumbar fascia. His foot chewing is typical of an allergic response, but the chronicity and targeted location also suggests a possible obsessive compulsive tendency exacerbated by stress (i.e. from chronic pain, being limited and restricted in his agility).
On October 31, Andee was given a trial session of acupuncture using six Serin #3 30 mm needles (Autonomic points for relaxation: GV14, Bai Hui; for shoulder pain: bilateral GB21, BL13). He was very worried and not too cooperative initially. He eventually relaxed and kept needles in for 15 minutes. Two days later he responded with increased drive during agility practice with less visible lameness.
His next treatment on Nov 15 targeted the strain pattern caudal to his scapula/lateral thorax and lumbar area, along with the dermatitis on his rear toes. LLLT was done on his thoracolumbar spine/bladder line and ventral neck concurrently. Acupoints included GV20, GV14, Bai Hui (autonomic input), LU5, GB21, BL 13, BL15, BL18 (shoulder and thoracic muscle strain and pain), BL25 (caudal lumbar pain), ST36, SP6 (allergic chewing of rear feet). Trigger points were also needled in the long head of the triceps on both caudal forelimbs. Serin # 3 30 mm needles were used.
On November 22, his thoracolumbar myofascial exam was improved with less tightness and tenderness to palpation. Another acupuncture treatment was given along with LLLT. In addition to the points used on Nov 15, the following points were added: LI 11, LI4 (autonomic points), GB20, SI11 and SI 12 (for neck and shoulder tightness). The triceps trigger points were not needled as they were less prominent and less sensitive to palpation.
Outcome and Discussion:
Andee attended an agility trial on Nov 19 and Nov 20 and performed eagerly with no hesitation at the jumps or climbing obstacles. After the second AP treatment, his feet were less red and the owner reported on Nov 22 that he seemed to be chewing less. He was much more relaxed and cooperative during his most recent treatment. The owner now massages his back and shoulders daily and has also been much more careful to allow him to warm up with a 10 to 15 minute walk on a leash before practicing agility. We plan to administer AP monthly through the winter so he will be ready to go in the spring. He is very close to getting his “catch”.
After his first AP treatment when he was so nervous, it became obvious to me that allowing Andee to relax with LLLT and relaxation points for few minutes, before placing more painful needles, made the experience less stressful, more effective, and easier for everyone.
References: Wall, Rick. “Introduction to Myofascial Trigger Points in Dogs.” Topics in companion animal medicine 29.2 (2014): 43-48.
Wright, Bonnie. “Management of Chronic Soft Tissue Pain.” Topics in companion animal medicine 25.1 (2010): 26-31.