Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4948.
Brody is a nine-year-old castrated male Labrador Retriever who presented for a history of mild stiffness and overall decreased energy level. On myofascial palpation, it was found that he had tight bands in his cervical region, trigger points along the thoracolumbar junction, lumbosacral junction and sacral region. Tight bands were found in the biceps femoris, semimembranosus and semitendinosus on both hindlimbs. His gait showed a slightly shortened cranial phase of the left hindlimb at the walk. Acupuncture and massage were used to treat trigger points and tight bands. Overall, his trigger points drastically reduced in sensitivity and his taught bands improved between treatments. His stride also improved back to normal.
Brody’s previous history is relatively unknown as he was adopted two years ago as a stray. In this time, his medical history includes low grade ear infections and a few lipomas in his abdomen. His presenting complaint included sporadic mild stiffness and overall decreased energy. Brody recently had a change in lifestyle; he was moved onto a large property with unlimited outdoor exercise. He also spends most of his down time on the hardwood floor, rather than his bed. He is not on any medications or supplements.
Physical Examination and Clinical Assessments
Brody’s physical examination was unremarkable. Heart and lungs auscultated normally with a heart rate of 70 bpm and respiratory rate of 30 bpm. His body condition score was 5/9 with good muscling. Neurologic exam was normal with full range of motion noted in all his limbs and neck. No pain was elicited during the exam evaluating range of motion. During myofascial palpation, tight bands were noted bilaterally along the cervical region, most notably in the cranial cervical region. Trigger points were palpated in the thoracolumbar junction and lumbosacral junction, bilaterally. On the left, sensitivity was also found along the entire sacral region. Tight bands were found in the biceps femoris, semimembranosus and semitendinosus on both hind limbs. His gait showed a slightly shortened cranial phase of the left hind limb at the walk. No further medical assessments were completed at this time.
Medical Decision Making and Acupuncture Treatment
Brody’s treatment would be two fold; concentrate on his main source of pain, his sacrum, then also treat his compensatory pain in his neck and hind limbs. Since this was his first acupuncture treatment, I decided to use only a few points and be more aggressive in future treatments. As introductory points, I used GV-20 and GV-14. I chose Bai Hui as a master point for lumbosacral pain and pelvic limb dysfunction. This targeted the lumbar spinal nerves and impacted the sciatic nerve to improve the function of the pelvic limbs. Next, BL-10 and BL-11 were placed bilaterally. These points in combination with GV-14 targeted cervical pain via stimulation of the cervical and cervicothoracic spinal nerves. Brody responded well to the dry needling and another session was performed three days later. Again, points GV-20, GV-14, Bai Hui, BL-10, and BL-11 used. Additionally, BL-21 and BL-27-28 were used on the left to treat local trigger points. Taught bands in the semimembranosus and semitendinosus were treated with massage. Two additional treatments were used using the same points as the previous session, each a week apart. All treatments used Seirin 0.20 x 30mm needles, dry needling only.
Outcomes, Discussions, and References
With the use of only dry needling and massage, Brody’s clinical signs of discomfort improved. The cranial phase of his stride returned to equal that of the other limb and his palpated trigger points improved to very subtle differences in sensitivity on each side of his thoracolumbar and lumbosacral junctions and sacrum. The tight bands in his cervical region diminished while the tight bands in his hind limbs waxed and waned. After massage, the tight bands were noticeably more relaxed but did tighten back to their original form within the week between treatments.
Generally Brody is demonstrating signs of chronic arthritis onset. When detected early, these dogs can greatly benefit from multiple modalities, such as laser, acupuncture and massage, to offset their discomfort and delay treatment using pharmaceuticals. Even with advanced disease when pharmaceutical pain management is standard of care, complimentary physical therapy and acupuncture can help lower dosages of drugs necessary for pain management in addition to providing a multimodal approach in therapy. Adding complimentary therapies to lower drug dosages can help lower the side effects of these drugs, keeping dosages at a safer level. A combination of these therapies, exercise, and a healthy weight can all contribute to a longer, comfortable life. Veterinarians can bring more value to their practice by offering multiple modalities to their clients for a pet’s arthritis with greater outcomes. Future research can also be conducted comparing pain management using only pharmaceuticals to pain managements using one or more additional modalities (acupuncture, laser or massage).
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