Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4996.
A case of severe arthritis and gait abnormalities in a canine with no known history. Following treatment with acupuncture, a brief improvement in gait, comfort, and activity were noted.
Lady is an approximately 8-year-old retriever/mixed breed dog that was rescued in April 2016 – no known history, unable to walk, and a starting weight of 108.9 lbs. Lady has since been diagnosed with hypothyroidism and has lost at least 28 lbs. In addition, the rDVM’s physical exam revealed crepitus in the stifle/hocks, decreased range of motion in both hips, and hyperextension of the left front carpus while standing, and skin allergies. The owner has reported that although Lady has been walking better, she had noticed a decreased amount of walking in October 2016 (has slowly increased in duration since then). Lady’s current treatment for her various conditions includes glucosamine supplements, omega-3 fatty acid supplements, Tramadol, Rimadyl, Apoquel, and ThyroTabs.
Physical Exam and Clinical Assessments:
Upon physical exam, Lady was bright, alert, and responsive (although she would be restless during her visits) with a body condition score of 4/5. She had nuclear sclerosis OU with a round white corneal opacity OD, moderate dental calculus, lichenification of both elbows, and a 1.5-inch area of alopecia over the left hip (previous “hot spot” that was healing), a stiff gait. Her gait was very stiff in the forelimbs and a firm thickening of the joint was noted in both elbows. The front left carpus was slightly dropped. A decreased range of motion was also noted in both hips. Mild generalized muscle atrophy was noted in both pelvic limbs. The neurologic examination was within normal limits
Previous laboratory testing revealed a slightly elevated T4 (currently on medications), but the rest was within normal limits.
On myofascial palpation, taut bands were present in the mid-cervical to cranial-thoracic region of the spine, the triceps, the lumbar region of the spine, and the caudal thigh muscles.
Medical Decision Making:
Due to Lady’s history and pain/discomfort associated with her chronic and severe osteoarthritis, she was an ideal candidate for acupuncture1,2. Especially since acupuncture can serve as an adjunct to pharmacological treatments for pain by affecting the local tissue (tissue matrix deformation, fascial release, increased blood flow/oxygenation, nerve communication) and altering systemic and homeostatic balances. I decided to focus on the areas of the most severe arthritis and address trigger points caused by load shifting.
Dry needling was performed on Lady once a week for 3 consecutive weeks, and it was recommended that treatment be continued thereafter based on response (either weekly, bi-monthly, or monthly). Twelve points were chosen as an initial introduction to acupuncture during the first visit. Her second visit consisted of 30 points used on both sides of the body. I would have liked to attempt electro-acupuncture on her third visit, but Lady had been restless. Acupuncture points were chosen based on location (introductory points, for example), neuromodulation activity, and ability to balance sympathetic/parasympathetic tone. Seirin red needles (0.15 x 30 mm) were used and points chosen included:
Introductory points: Yintang, GV 20, Bai Hui
Elbow points: LU 5, LI 10, LI 11, HT 3, SI 8
Shoulder points: LI 15, TH 14, SI 9
Hip points: BL 54, GB 29, GB 30
Stifle points: ST 34, ST 35, ST 36, SP 9, SP 10
Neck points: BL 10, cervical spinal neck points
Trigger points along spine: a combination of points in the areas of BL 11-15 and BL 22-25
Needles were removed after 10-15 minutes.
Outcomes, Discussions, and References
Lady’s first visit served as an introduction to acupuncture since she tended to hate restraint when going in to the veterinary clinic, so only a small number of needles were placed. Lady’s owner did not notice a significant difference after that first visit. However, a change was seen as soon as 10-15 minutes after the second visit. According to her owner, “Lady seemed to have a pep in her step…. she came the closest to trotting that [her owner had] ever seen!” She also had an easier time getting up and maneuvering on stairs. Changes were also seen after the third visit but the benefits seemed short-lived2.
I currently work with a lot of geriatric patients that suffer from the effects of osteoarthritis. Being able to use acupuncture as another way to provide pain relief outside of using pharmaceuticals (which sometimes owners have a hard time giving for various reasons) could be beneficial to those patients. In Lady’s instance, acupuncture was able to provide additional relief to a patient who was having difficulties despite already being on a number of medications to manage her pain.
- Vickers AJ, Cronin, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis. Arch Intern Med. 2012 Oct 22; 172 (19): 1444-53.
- Lin X, Huang K, Zhu G, et al. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. J Bone Joint Surg Am. 2016 Sep 21; 98 (18): 1578-85.