Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4937.
A male Tibetan Mastiff was presented by the owner for decreased mobility and activity. Physical exam revealed pain in all four limbs as well as neck and spinal pain. Acupuncture was instituted addressing the underlying sources of the dog’s pain as well as the secondary myofascial restrictions found on exam. The dog responded well to treatment and continues to do well with only intermittent treatments needed to maintain comfort and function.
The 10.5-year-old 54.5kg intact male Tibetan Mastiff was presented by the owner for increasing difficulty rising from recumbency, decreased interest in going for walks, and refusal to jump in and out of the owner’s truck. Intermittent lameness had been noted in both the thoracic and pelvic limbs. Symptoms were worse after recumbency and improved with activity. The owner did not feel any one limb was more affected than the others. The dog had also started to shy away when the owner reached out to pet him on the head. All symptoms began roughly a year prior and seemed to be getting progressively worse. Symptoms were exacerbated in cold and wet weather. Some improvement had been seen with NSAIDs and glucosamine-chondroitin supplements but the dog was not currently taking anything. The rest of the medical history was non-remarkable. The dog was kept lean and well exercised. There was no history of surgeries or trauma. Historically, the dog had been walked twice daily, he had access to a large fenced in area on the owner’s property where he played with his housemate (a FS Tibetan Mastiff) and in good weather he accompanied his owner on long hikes in the local state park. He was current on HWP and flea-tick prevention and there was no history of exposure to tick-borne diseases.
Physical Examination and Clinical Assessment
On physical examination, the dog was BARH and vital signs were within normal limits. Mild generalized loss of muscle mass was noted in all four limbs as well as along the spine. A Gr I/IV lameness was noted in the right thoracic limb and there was a stiff gait in the pelvic limbs. There was significant hesitation prior to sitting and marked difficulty rising from recumbency. There was also marked reluctance to turn the head in any direction.
There was no long bone pain detected but pain was elicited with gentle palpation of the spine with the most pain detected in the cervical and lumbar areas. Some discomfort was elicited with palpation/manipulation of the shoulders, elbows, hips, and stifles but no joint laxity, crepitus or effusion was appreciated. Proprioceptive positioning was normal in all limbs as was tactile placing. Hopping, wheelbarrowing, hemi-walking and extensor postural thrust were not evaluated due to patient discomfort. All spinal reflexes were normal as were all cranial nerves.
Myofascial exam revealed the following: pain on palpation of the temporalis muscles, taut bands on the dorsolateral neck, tenderness on palpation of the mid-cervical vertebrae (started to shake R thoracic limb), tight painful triceps, extensors, and flexors of both thoracic limbs. Ropes of muscle were palpated on the lateral thorax bilaterally just caudal to the humeri (trigger points). The lumbar paraspinal muscles were ropey. There was pain on palpation of the sacrum. Both iliopsoas muscles were tight and painful. The gluteal muscles were painful. Both gastrocnemius muscles were very tight.
No other abnormalities were detected on physical examination. No lab work or radiographs were obtained.
Medical Decision Making
The acupuncture intervention protocol that was developed to treat this patient incorporates both neuroanatomic and myofascial components. The use of regional points was incorporated as well as these are very useful in clinical practice due to the fact that they group together. Lastly, master points were incorporated as a way to address the autonomic pathways and help improve homeostasis. The sequence of the treatments took in to consideration the time that would be required for the connective tissue and nervous system to respond.
Dry needling with Seirin No.3 x 30mm needles was performed twice a week for the first six weeks, then decreased to once every other week. At the time of this writing, a total of 18 treatments has been performed. Treatments will be tapered to the frequency necessary to maintain the animal’s improvement. Points Selected with Relevant
Anatomy and Rationale for Use:
GV-20 trigeminal n, cr cervical sp nn, sympathetic regulation
LI-4 radial n, nervi vasorum (sympathetic regulation, temporalis mm pain) Master Point
GV-14 cervicothoracic sp nn (neck and back pain, thoracic limb pain and weakness) SI-3 ulnar n (cervicothoracic pain) Master Point
SI-9 axillary/radial n (shoulder or thoracic limb pain) SI 11/12 suprascapular n (myofascial dysfcn)
LI-15/TH-14 suprascapular n (shoulder joint pain) BL 11/12 cervicothoracic sp nn (shoulder pain) GV-3 mid-lumbar sp nn (lumbar pain)
GV-4 cr lumbar sp nn (lumbar pain) BL-10 cr cervical sp nn (cervical pain)
GB-20 cr cervical sp nn (splenius capitis pain)
TH-5 radial n (pain distal antebrachium, myofascial restriction of extensors of antebrachium) Master Point
LI 10/11 radial n (extensor trigger points)
TH-10 radial n (elbow pain related to triceps restriction) GB-22 (latissimus dorsi trigger point)
BL 23/25 thoracolumbar sp nn and mid-lumbar sp nn respectively (lumbar pain) BL-40 tibial n (pelvic limb pain)
BL-60 fibular n, tibial n (lumbar pain, hamstrings)
GB-29 cr gluteal n/GB 30 sciatic n/BL54 sciatic n (hip triad) GB-31 femoral and sciatic nn (hip, pelvic limb pain)
Bai Hui mid to caudal lumbar sp nn (hip, lumbosacral pain, pelvic limb pain) BL 23/25 thoracolumbar sp nn and mid-lumbar sp nn respectively (lumbar pain) BL-39 common fibular n (pelvic limb pain)
The owner reports that since starting acupuncture treatments the dog is more comfortable, he seems happier and he is more relaxed. In addition, the dog is sleeping better, he has less trouble rising from recumbency, he does not seem as stiff after resting, and he is more interested in play. He also no longer flinches when the owner reaches to pet his head.
The dog is now able/willing to jump the 30” to get in to the back of the owner’s truck, he is willing to walk a full mile now instead of the 1/2 mile he was doing previously and walks have been extended to a full hour instead of the previous 30 min. the dog used to be able to do.
These improvements were all in response to acupuncture alone as no other treatment modalities were used concurrently. Additionally, there were no changes in the patient’s lifestyle other than those that resulted from increased patient comfort (i.e. the owner was able to gradually increase the length and speed of walks.) No adverse events were noted.
This case demonstrates that some patients can have their orthopedic and neurologic pain managed quite well without the chronic use of pain medication. Not only does this avoid the side effects associated with many of these drugs, it also means that on particularly bad days there is the availability of additional pain relief through the use of medication.
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