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What the heck is Manual Therapy as part of Rehab? …And how can it help my dog??

10 May 2017

    By Sue Van Evra, BScPT, MSc, BHScPT, Dipl Canine Rehab

 

If you’ve ever been treated by a physiotherapist for an injury, rehab after surgery, or a problem area in your body…chances are you’ve had some Manual Therapy! 

What do physiotherapists mean when they talk about Manual Therapy? Well, the definition is: 

‘skilled, specific research-based hands-on techniques, including but not limited to manipulation/mobilization of joints and soft tissue’…

Ok, but what is ‘mobilization’? and ‘manipulation’?

All joints in the body (ie ankle, shoulder, and joints between the vertebrae, or in the jaw) have different shapes. Mobilization is a treatment that involves moving joints in specific directions (depending on the shape of the joint), sometimes slowly, and sometimes very fast (which is then a ‘manipulation’). 

Human Shld

 

 

 

 

 

  BackMob

 

These movements have many benefits: help to loosen a stiff joint, increase range-of-motion, decrease swelling, decrease pain, and relax muscles. 

Aside from mobilization, Manual Therapy also includes passive stretching, massage, myofascial work (hands on release of tight tissues ) and passive range-of-motion of any affected area.

So how does this apply to dogs??

 

Other than a few extra vertebrae, a few different muscles, and no collar bone, dogs have very similar anatomy to humans! Dogs can have stiff joints, pain, tight muscles, swollen joints, etc. just like people! Manual Therapy treatment can improve how a dog can move and how it can function! (ie make it easier to get up from lying, to go up stairs, play at the dog park or to navigate weave poles in agility!)…So Manual Therapy is an important part of Rehab for both dogs and humans!

 

Dog Stretch  Dog Shoulder

 

There are lots of new fitness and exercise trends for dogs! There are lots of pieces of exercise equipment that help to improve strength, balance, agility, etc. 

Dog Balance   Dog Ball

 

These are fantastic tools to help target specific areas! But these exercises are not enough on their own! Manual Therapy is a must to ensure that the joints and soft tissues are moving normally to maximize the benefit of the exercise program…otherwise, it is easy to develop compensating patterns of movement, and secondary problems!

A recent study ( Celenay et al, 2016) showed that Manual Therapy AND a muscle stabilization exercise program is more effective than exercise alone for decreasing pain and disability and increasing range-of-motion and quality of life in patients with neck pain! 

Finally, it is important to seek help from Physiotherapists who specialize in Canine Rehabilitation, who are SKILLED at Manual Therapy and who have very detailed understanding of anatomy, joint movement, and rehabilitation. There are 5 very skilled Physiotherapists at the Canine Fitness Centre that can help!

Please call with any questions or to book an appointment for your dog! We would be happy to answer any questions or give further information!

 

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Tissue Healing

27 Mar 2017

Margaret Kraeling, DPT, CCRT

There has been a lot of interest in regenerative therapy in recent years. This is a very exciting field which could certainly have many implications in our approach to treatment of musculoskeletal injuries both in people and in our canine clients.

Most commonly we are hearing about some very exciting results from the use of stem cells and PRP injections.

PRP (platelet-rich plasma) has a platelet concentration that is 3-8 times higher than in blood which provides an increased availability of growth factors that stimulate the healing process. It will promote stem cell recruitment and directly stimulates collagen production.

PRP

The use of stem cell therapy in orthopaedic conditions such as ligament and tendon injuries as well as degenerative joint conditions have shown good results for tissue healing and pain relief. Some studies are showing on MRI, an increase in articular cartilage and meniscus volume. 

The patient’s own stem cells are harvested usually from abdominal fat tissue and occasionally from bone marrow. These are then injected into the area of damage. This is often accompanied by an injection of PRP to further promote growth and differentiation of these cells.

It is exciting to see where these techniques might be in 10 – 20 years!  For now, research is still rather new.

 

However, those of us in the profession of physiotherapy have been using several approaches to tissue healing for many years. These techniques are well substantiated in the literature.

Laser in particular is extremely beneficial for tissue healing as the results of numerous studies have shown. In addition to providing pain relief, laser can encourage collagen synthesis (a building block of all tissues), improve the strength of ligaments, improve blood supply to healing structures, prevent scar tissue formation at the site of injury, as well as stimulate nerve tissue healing such as following peripheral nerve reconstruction.

There is one very interesting study in which embryonic cells were implanted into a completely severed spinal cord in rats. The area was then irradiated over the skin with laser daily for 14 days postoperatively. The 3-6 month follow up demonstrated a much-improved function as well as histologically showing that the anatomical connection of the previously transected cord was re-created.

Laser 

Another modality that we frequently use is pulsed electromagnetic field. A variety of studies show that it can benefit many musculoskeletal disorders. Among those are non-union of fractures, tendinopathies, nerve regeneration, osteoporosis, as well as a wide variety of joint disorders.

 

Shock Wave is one of the newer modalities being used in physiotherapy. It has shown some excellent results in healing of soft tissue as well as stimulating bone cell proliferation. Success rates are reported at 61 – 80% improved function and quality of life following treatment with shock wave on conditions such as rotator cuff, plantar fasciitis and tennis elbow.

Shockwave 

In addition to the variety of modalities utilized for tissue healing, there is another very important approach which is the very basis of physical therapy, and that is exercise. Studies on the effect of exercise on connective tissue date back many decades and clearly show that exercise increases the maximum strength of tendons and ligaments and demonstrates an increase in total collagen content. Various types of exercise have been studied including sprint training, endurance work, heavy weight training and eccentric muscle training. In addition, it is important to recognize the importance of the ability of the nervous system to fully activate the muscle – in other words neuromuscular control of functional activity.

Combining therapeutic exercises with some of the modalities discussed above can produce even better results.

The variety of exercise possibilities is limited only by the imagination of the person designing the program! However an exercise program must be designed with specific goals in mind depending on the stage of recovery as well as the long term expectations of functional activity.

My favourite exercises (including for myself personally at the gym!!!!) include a large component of balance or proprioceptive work. We are able to recruit many muscles at the same time as well as work on timing of muscle recruitment and motor control which is important in all functional activities going forward. In the gym we see people working on wobble boards and BOSU ‘balls’. Exactly the same type of equipment is used for the dogs as well as several pieces that are designed for dogs specifically. I like to have the dog place their front feet on one piece of equipment (ie. A BOSU) and their hind feet on another – perhaps a wobble board or an air cushion. From this position, there are many possibilities from simple weight shifting to a diagonal-leg stand where one front leg and the opposite hind leg are lifted and the dog balances on the remaining two. This is rather like the human “superman” exercise but done on an unstable surface. Try it out to see how much of a workout it can be. Add it to your “core strengthening” routine!

3-Leg Wobbly

So, although the idea of regenerative treatments is very exciting, the amount of long term research has still not caught up to the push to provide these procedures. Are we focusing on the right thing?  Or should we be relooking at existing strong and plentiful research that demonstrates tissue healing, and is readily available? There are still many proven approaches to improve tissue healing that we can rely on while these new therapies are being studied.

 

 

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Stop Sitting Pretty!

27 Mar 2017

By Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physiotherapy), CAFCI, CCRT

www.FourLeg.com

www.CanineFitness.com 

 

Sit PrettySee the picture… this is what we’re talking about.  Teaching your dog to do this is all the rage in canine sporting groups, training groups, and trick groups.  People have been told that it’s a good exercise for building “the core”.  And while it might just get your dog to activate his or her abdominal muscles, it might also be doing damage as well.

 

I do not recommend ‘Sit Pretty’ as an exercise.  Here’s why:

 

1. It’s not functional.  When is this skill needed in a dog?  Does is translate to any other functional movement?  Do we actually know that it builds core muscles?

Answers:  Never.  No.  No.

So, those who are promoting and loving this exercise are doing so based on hearsay or just because they’ve seen others doing it and are looking for something to add to their dog’s training regimen or trick roster.

 

2.What happens to the facet joints during ‘sit pretty’?  The facet joints are the joints of the spine that control movement.  With the exception of the first two vertebras, each other vertebra is joined to the vertebra above or below it (or ahead or behind, in the case of 4-legged creatures) by a set of facet joints as well as the disc.  The facet joints transfer load, allow for movement, and also block undesirable movement. 

Firstly, let’s realize that the facet joints in the dog’s back are designed to transfer forces from limbs to the body / spine with the dog in ‘normal dog positions’ (sitting, standing, lying down, and moving directionally).  When a dog is in a ‘sit pretty’ position, there are 180 Newtons of force going through the facet joints.  Compare that to normal walking (approximately 107 Newtons) or standing (approximately 26 Newtons).  Walking upstairs comes close at 170 Newtons, but standing erect on two-legs exerts the greatest amount of force through the facet joints.  Surely there’s no benefit to that!

 

3.The consequence of making facets do what they’re not intended to do.  It has been reported that when a dog has more extension forces on their back that their bodies will adapt by smoothing out the joint surfaces that are being bashed together.  In quadrupeds, it’s the facet joints that get smoothed out and enlarged, allowing more slip and slide of the joints in extension.  This protects the back from painful bashing… but it also serves to de-stabilize the spine.  Essentially, the joints are no longer blocking movement, they are now allowing more movement as an adaptation of what is being asked of the body.  It might sound like a good short term solution.  However, when this occurs it also means the more stresses and forces go through structures that shouldn’t be stressed further (i.e. the disc, or the muscles, or small local ligaments), and when this happens, the body needs to come up with another way to stabilize the area.  How the body does this is by adding bone to try and stabilize (otherwise known as spondylosis).  Spondylosis is when a bridge of bone is formed between each vertebra on the underside of the vertebra.  While I tell people not get freaked out about the presence of spondylosis (i.e. their dog is not crippled or paralyzed by its presence) it does mean that there is an area of the back that has become overly stiff, and subsequently, a different area of the back is likely becoming too flexible to compensate.  And neither is ‘great’!

 

4.The iliolumbar ligament.  Who?  Maybe you’ve never heard of it.  Your dog hasn’t… because he/she doesn’t have one!  The iliolumbar ligament is found in people.  It’s a strong ligament that helps to stabilize the lumbosacral junction (basically the junction between the low back and the pelvis / tail bone).  It is a ligament that is likely found in people and not in 4-legged animals because as 2-legged creatures we need more stabilizing mechanisms to help us stay upright!  It is thought that the muscle Quadratus Lumborum is what helps stabilize the spine of quadrupeds in the absence of the iliolumbar ligament.  But this is a pretty thin, small muscle in dogs, so it’s not likely to be providing the same stability that a strong ligament can!

 

5.More missing ligaments!  An interesting study was conducted looking at the ligaments of quadrupeds (i.e. dogs / horses / rodents), bipeds (humans), and pseudobipeds (birds).  The researchers found that a set of ligaments (to the side of the vertebra in the thoracic spine) were absent in any of the quadrupeds they studied.  They speculated that these additional ligaments were a development subsequent to the mechanical challenges unique to having an erect spine.  They also discussed how developmental scoliosis was not a typical problem in quadrupeds, but is a more common occurrence in humans and birds. 

 

Essentially, being upright is associated with high facet joint forces, a higher incidence of scoliosis, and the need for additional ligaments. Dogs are not designed for time spent in an erect posture. (Nor are goats, horses, or pigs… in case you were wondering!)  All in all, I can find no redeeming qualities in the Sit Pretty exercise.  As such, my professional recommendation is to just stop it, and your dog will be better off for it!

 

References:

1. Breit S. Functional adaptations of facet geometry in the canine thoracolumbar and lumbar spine Th10-L6). Ann Anat 184: 379-385, 2002.

2. Buttermann et al.  In vivo facet joint loading of the canine lumbar spine.  Spine, 17(1): 81-92, 1992.

3. Evans & deLahunta.  Miller’s Anatomy of the Dog, 4th Edition.  Elsevier, St Louis, MO, 2013.

4. Jiang et al.  A comparison of spinal ligaments – differences between bipeds and quadrupeds.  J Anat 187: 85-89, 1995.

5. Gregory et al. The canine sacroiliac joint. Preliminary study of anatomy, histopathology and biomechanics Spine 11(10): 1044-1048, 1986.

6. Woodburne & Burkel. Essentials of Human Anatomy, 8th Edition.  Oxford University Press, New York, NY: 559-560, 1988.

 ADDENDUM

The expanded version of this blog can be found at:  

http://www.fourleg.com/Blog-Search?t=Sit%20Pretty

and alternative exercises can be found at:

http://www.fourleg.com/Blog-Search?t=DoThisInstead

 

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