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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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Behaviour Matters: When your dog’s behaviour might be a symptom

20 Jan 2017

By MONIKA HOYER, BSc, CPDT

 

Most problem behaviours seen in our dogs are predictable and have relatively straightforward solutions. Every so often, however, we are surprised by behaviours that appear to be unpredictable or unreliable. Sometimes they occur suddenly and are completely out of character for the dog in question. 

 

Popular media trends showing that dogs can benefit from training to solve problems has meant that owners take changes in behaviour seriously, but sometimes it also means they focus only on the behavioural component and not on the physical factor that might be contributing to behaviour. 

 

Early in my career with dogs I was contacted by a family with a not quite two-year-old large breed mix. The family reported that in the last couple of months the dog had started showing aggression towards people and other dogs. I usually start my work on cases like this with a sit down discussion with the owners where we go over the dog’s history and discuss the situations in which they have observed this behaviour. The family told me of two particular incidents that illustrated their concerns. 

 

This dog loved other dogs, loved to play, greeted politely and initiated play without incident. However, in the recent months the dog would start to play with another dog and then mid-game would become aggressive towards her playmate. 

 

The second was an incident where the dog had been riding in the car. She was perfectly calm and relaxed for the entire ride and after the car had been parked. When her owner came around and let her out of the car the dog jumped down onto the sidewalk and without warning lunged at a familiar neighbour walking by.

 

A few things stood out to me during this discussion. 

  1. The dog did not appear to discriminate between unknown and known animals and people. The aggressive acts were directed evenly at friends and family as they were at strangers. 
  2. The behaviour occurred with a sudden shift in attitude on the part of the dog with no prior build up.
  3. The assumed trigger that set the dog off the day before would not reliably trigger the same response the next day. 

 

As a result the family was walking on eggshells around what had previously been their very loving family pet. They could not trust their dog and neither party was happy.

 

After our talk I asked them to bring their dog inside. When she entered the building the problem began to be clear to me almost immediately. I asked them to walk her and then trot her in a circle around the room. Then I asked them to have her sit. What I saw during these two simple exercises was the key to her aggressive behaviour.

 

The first hint was the way she stood when not in motion. Here is what it looked like:

Cow Hocked

 

This is commonly called being cow-hocked. It’s a term used to describe the relative position of the hocks and toes in the animal’s hind end. In cow hocked animals the hocks (the bony heel on their hind legs) are turned in and their hind feet point outwards. Certain breeds are more prone to being cow hocked than others to varying degrees of severity and most slightly cow-hocked animals are just fine. 

 

This dog, however, was so severely cow hocked that when she stood her hocks would at best, be touching, and at worst, be overlapping. When she walked her hocks clicked against each other with every step. 

 

She could not trot. When she needed to move faster than a walk she could not move her hind legs separately and would start to hop with both hind legs together. This is commonly called bunny hopping.

The video below is an example of a bulldog that must bunny hop with both hind legs to get up the stairs in this home. This is likely because the dog either finds moving his hind legs up the stairs one at a time to be painful, restrictive, or unstable feeling.

 

 

When asked to sit she flopped immediately into a down. When coaxed back up into a sit she sat back on her tail with her legs sticking out to the front and side. She was unable to maintain a sit position for any length of time and would frequently lie down after only a few seconds.  

sloppy sit

I recommended that before we start any physical aspects of her training that she see a vet for a full work up including a thorough exam of her rear. The result was, that at only 18 months old the poor girl was suffering from painfully severe hip dysplasia. The sudden unpredictable outbursts were not a behaviour deficit but rather a response to pain. When in a situation where she was suddenly in pain, the dog’s response was to direct aggression at the nearest possible cause. So the nearest person or dog was at risk.

 

Pain is not an excuse to ignore aggressive behaviour, but the physical contribution to the behaviour needs to be addressed if any training or behavioural modification will work. With her medical care team managing her pain her owners and I were able to move forward with training programs to help change her reaction to pain. 

 

We also teamed up to find better ways to manage her physically so as to prevent the painful stimulus and manage any outbursts. 

 

There are many physical conditions that can adversely affect your dog’s behaviour. 

So if you have noticed any sudden changes in your dog’s mood, reluctance to perform previously reliable behaviours, or an increase in irritability consider that there might be a physical factor contributing to or even causing the problem. If you think your dog’s problem might be pain, bring them to the Canine Fitness Centre for a full assessment. We’re happy to help. 

 

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