Understanding Locomotion and Gait Analysis of the Dog Robert L. Gillette, DVM, MSE, DACVSMR

Transcription

1 Understanding Locomotion and Gait Analysis of the Dog Robert L. Gillette, DVM, MSE, DACVSMR Motion is the one common feature of all animals. Motion is a result of a combination of nerves stimulating muscle to move bone. Abnormal motion occurs when this chain of events is disrupted. Locomotion of an animal is described as its gait. The walk, trot, and gallop are three forms of gait. The walk and trot are symmetrical gaits. In this type of gait the movements of the right side mirror the movements of the left side. The gallop is an example of an asymmetrical gait, whereby the limbs of one side move in a different pattern then limbs on the other side. Canine locomotion can be compared to a symphony orchestra playing a composition. "All parts must blend into a harmonious pattern, from the gentle sway of the head and tail for balance to the coordinated efforts of each limb and body muscle to accomplish its special function. Conversely, also like an orchestra, if all movements are not attuned to the whole, a major fault should be evident" (Roy 1971). There are five basic normal movements of canine locomotion. They are the straight run, turn, movement initiation, movement deceleration/termination and jumping. Each of these movements disburses or absorbs different forces in relation to the body. All activities utilize at least four of the five normal movements. While a dog is running in a straight line the rear legs act to propel the dog forward. The back, or paravertebral muscles, acts to lift the front end up in the air. Neither of these two actions are less important. The rear legs are needed for forward motion. If the paravertebral muscles do not lift up the front end of the body, the front end will be jammed into the ground. The front legs of the dog act to absorb the forces produced by the rear of the dog. In the turn, there is an increase in the lateral forces placed upon he dog. The front legs play a greater role in navigation than the rear legs. If there is a MuSk fault in the front end the rear end must compensate, which places abnormal forces on the rear end of the dog. When the dog initiates movement, the rear legs have the most influence. The paravertebral muscles also act to raise the body up and forward. There is minimal action placed on the front end. When the dog beings to terminate movement there is a braking action placed upon the front end which increases the force actions placed upon the front end structures. The jump is similar to straight running except there are greater forces employed by the paravertebral structures. Knowing how the body moves and how the biomechanical forces interact provides information that can be utilized by the veterinary diagnostician. Since these actions are utilized but all active animals it allows this information to apply to all athletic and working patients. The canine structure is divided into segments when analyzing motion. The axial vertebral column is made up of many joints and is divided into anatomical segments. The cranial segment is the head, followed caudally by the neck (cervical), thoracic, abdominal (lumbo sacral), and tail. The appendicular segments are the front legs and the back legs. These are subdivided into smaller segments by the leg joints: shoulder,

2 elbow, carpus, hip, stifle, tarsus & phalanges. Locomotion as a whole is a result of the individual movements of these segments. Gait analysis is used to assess the movement of each of the individual joints and how they affect locomotion. Subjective gait analysis is the most common diagnostic tool to assess lameness. This should be done prior to any physical palpation. It starts by observing the animal while it is calm and resting, looking for conformational abnormalities or abnormal stances. For example, does the dog seem to hold one leg up or put most of its body weight on a particular leg. After these observations are noted the animal is analyzed while moving. The gait is a description of a particular series of leg and body movements used for locomotion. In the trot one front leg and the contralateral rear leg are in support and that is followed by the other front leg and its' contralateral rear leg in support. This is the gait pattern that can give the best picture of abnormal gait. If one of the segments is impaired the gait will be out of balance. The patient is observed moving in a straight line toward and then moving away from the clinician. Next it should be assessed moving in a straight line from the right side and then the left side. Then it should be observed moving in a circle, once clockwise then counter clockwise. Most gait abnormalities can be detected with subjective gait analysis. A dog with a lesion causing severe sharp constant pain will carry the limb and keep the weight off it when lying down. A dull aching pain will produce a limp during the gait analysis. A lesion that produces a small pain that occurs in certain phases of locomotion allows the dog to adjust their gait for relief. This altered gait can lead to subsequent orthopedic problems. Quantitative gait analysis assigns numerical values to motion and includes the application of kinetics and kinematics. The force plate is an example of kinetic analysis being used to assess lameness. The numerical values of the ground reaction forces are used to determine variances of gait. Video analysis is used to assess the kinematic parameters of locomotion. With kinematic analysis, linear parameters of movement can be measured to assess horizontal and vertical motion. Also, angular parameters can measure the degrees of movement of the joints to analyze specific joint motion. It is important to understand that canine locomotion occurs is a result of the summation of all of the body segments and joints moving and working together. In that sense, these components must work together to provide adequate locomotion. If one component does not move correctly, the other components must adapt their movement to correct the body s movement as a whole. It is very important that the veterinarian have a good understanding of normal movement. Video, both normal and high speed, is very helpful in describing how to best watch the animal move. This lecture will use both normal video and high speed video to provide the attendee with the knowledge of normal and abnormal locomotion.

3 References: DeCamp CE. Kinetic and kinematic gait analysis and the assessment of lameness in the dog. Veterinary Clinics North America (Small Animal Practice) 1997;27: Gillette, R. L., Zebas, C. J. A Two Dimensional Analysis of Limb Symmetry in the Trot of Labrador Retrievers. Journal of the American Animal Hospital Association. Hildebrand, M, Symmetrical gaits of Dogs in relation to body build. Journal of Morphology, 1968;124: Leach DH, Dagg AI. A review of research on equine locomotion and biomechanics. Equine Veterinary Journal 1983;15: Leach DH, Dagg, AI. Evolution of equine locomotion research. Equine Veterinary Journal 983;15: Roy, W. E., Examination of the canine locomotor system. Veterinary Clinics of North America, (1): Sumner Smith, G, Gait Analysis and Orthopedic Examination. In Slatter, D.S. (ed): Textbook of Small Animal Surgery 2nd ed, W. B. Saunders, Philadelphia, (1993).

4 Diagnosing and Managing Non Surgical Lameness of the Front Limb Robert L. Gillette, DVM, MSE, DACVSMR In a recently published article, Robinson et al describe the most common problems presented to small animal practitioners. Lameness is listed as the second most common problem presented by dog owners. Lameness can have many different causes that result in numerous options for veterinarians to choose from in terms of clinical management. The first step is to identify the primary cause of the lameness and any secondary issues. This will dictate the management plan. In certain problems surgery is the appropriate method of management, although many lameness problems can be managed without surgery. There are also times when the client may decline surgery as an option and a conservative plan needs to be developed. Clinical management of lameness has changed drastically in the past twenty years. When I graduated from veterinary college we had two options for nonsteroidal antiinflammatory drugs (NSAIDs), aspirin and phenylbutazone. Today we have many different NSAIDs, other related drugs, new diagnostic tools and new therapy regimens that we have adapted from the human physical therapy world. Although management of musculoskeletal disorders can be grouped together the can be divided into front leg problems and rear leg problems. Management and treatment maybe somewhat between related to the difference between actions and forces of the front legs versus rear legs. The front legs receive more forces and perform greater braking actions than the rear legs. Managing front leg lameness can be different than rear leg lameness. The canine structure is divided into segments when analyzing motion. The axial vertebral column is made up of many joints and is divided into anatomical segments. The cranial segment is the head, followed caudally by the neck (cervical), thoracic, abdominal (lumbo sacral), and tail. The anatomical components are vertebral bones, the paravertebral muscles and nerves that stimulate these muscles. The appendicular segments are the front legs and the back legs. The anatomical components are the long bones, skeletal muscles and the nerves that stimulate them. These are subdivided into smaller segments by the leg joints: shoulder, elbow, carpus & phalanges. It is important to remember the antebrachial muscle groups that manipulate the toes. Locomotion as a whole is a result of the individual movements of these segments. Palpation Basics Physical palpation can be used to determine location of any primary, secondary, and/or tertiary pain associated with lameness or a drop in performance. Canine palpation is an art and gets easier with experience. Try to be consistent during the manipulation. This allows for left and right comparisons. Understand musculoskeletal anatomy and

5 remember the body should be symmetrical. If the technique is consistent and there is variation between the left and right side the deviation should be documented. The appendicular skeleton is always analyzed beginning distally and then move proximally. Start with a sound leg first. This allows the examiner to assess how the dog is going to respond to normal palpation. Responses elicited on the other legs can then be referenced to the responses of the normal leg. Begin by assessing the pads and webbing. Then flex and extend each phalangeal joint. Special attention should be paid to the sesamoids. These are a common problem in athletic and working dogs. The second and seventh sesamoids of the front paws are the ones most commonly affected. Palpate the long bones and soft tissue structures of the foot and then move proximally to the carpus if palpating the front leg. The joint should be flexed and extended and then stressed medially and laterally. Palpate the long bones and soft tissues of the antebrachium and then move proximally to the elbow. Flex and extend the elbow joint, stress it medially and laterally, and then rotate clockwise and counterclockwise. Palpate the long bones and soft tissues of the brachium and move proximally to the shoulder joint. It should be flexed, extended, and then brought up to the flank. Afterwards, palpate all of the muscles bellies. Lameness is not itself a disease but can be a sign of a disease process, pain, a structural impediment, deformity or weakness. Lameness is usually described in terms of region, i.e. shoulder, elbow, etc. Although this is a unique identifier, it does not designate the tissues causing the problem. Treatment for lameness should be designed to heal the tissues that are injured or to manage the tissue abnormality. There are many causes of lameness that are musculoskeletal based where surgery will not correct the problem. These can be chronic or acute in presentation. They can be very complex cases and may involve multiple visits to the veterinarian before a true diagnoses and management plan can be determined. The first step towards designing a plan to resolve or manage a musculoskeletal lameness is by identifying the primary source and any related issues. A non surgical plan is typically designed to manage pain/inflammation, structural stressors and the behavioral or mental state of the patient. Initially our goal is to address pain issues and slow or stop the inflammatory cycle. After that is done we can develop a long term management plan. Initial Plan The first step is to stop or minimize the activities that are stimulating the problem. Usually there are certain movements that are inciting the problem. For example if the problem is in the distal extremity the problem will be exacerbated every time the leg bears weight. One way to reduce stress on the structure is by applying a splint. A semiflexed splint will transfer the stance phase energy around the distal structures to a more

6 proximal location. Usually 5 7 days will be long enough to allow the structures to calm down but a short enough time to prevent any splint complications. Rest and structured activities can be designed to reduce the stressors on the shoulder, hip or back related problems. The second step is to provide some NSAIDs or pain relievers to help break the inflammatory cycle. The intent here is to relieve the ongoing presenting pain and not to establish a long term drug regimen. Commonly used NSAIDs are deracoxib (Deramaxx ), firocoxib (Previcox ), carprofen (Rimadyl ) and meloxicam (Metacam ). Other pain relievers include tramadol, gabapentin or methocarbamol. The drug selected is dependent upon the tissue type that is causing the primary source of the lameness and the clinician s experience. My personal experience is to use Deramaxx or Rimadyl for joint based or intra articular problems. I use Metacam for skeletal muscle pain. I do not have any studies that show this, it is my clinical experience. Before prescribing any medication please be aware of the biological action and potential negative side effects of these drugs. Some therapeutic modalities have shown to be successful in relieving pain and stimulating the healing process. These include Low Level Laser Therapy (Laser), neuromuscular electrical stimulation (e stim), therapeutic ultrasound and magnet therapy. All three of these modalities have shown to be effective. E stim and ultrasound are commonly used in human physical therapy. They are not used as much in the veterinary world because they need skin contact (need to shave the fur) and the length of therapeutic treatment time can be 15 to 30 minutes. Laser therapy is being used effectively in the field of veterinary rehabilitation. Typically there are two classes of laser systems used: a class 3b system and a class 4 system. They both have shown to be effective but typically the treatment times for a 3b system are two to three times longer than a class 4 laser. These modalities allow for a focused treatment at the source of the lameness. They reduce inflammation, enhance healing and relieve pain. My clinical experience is that these modalities can play a beneficial role in rehabilitation and managing lameness. Follow up management Once we are able to stop the pain and inflammatory cycle, we can develop a long term management plan. Some cases may not need anything after the initial effort, but most will need follow up management. In these cases it is important that the client understand that we are working to manage the lameness and not necessarily cure the problem. The focus of the program is to minimize actions that create the problem and utilize modalities that focus treatment at the source thus minimizing the need for systemic pain relievers. Joint health supplements like Glycoflex or Dasuquin are beneficial. It is important that the client be educated that this a management plan and typically not

7 a curative plan. It is important to discuss the fine balance between the benefits of activity and their effects on the inflammatory process. It will reduce the exposure to improper joint stress, address pain issues and manage inflammation and biological remodeling. This involves a structural weakness so the body will attempt to stabilize this with reparative tissues and muscular adaptations. The exercise routine should minimize activities that stimulate inflammation or inappropriately stress the injured structures. It is important to note that this does not mean that the patient is not able to participate in any activities. By setting up an activity plan that includes controllable activities, we allow the patient be active but reduces the risk of re injury. The patient can go for walks on a short lead. In most dogs, the leash provides control during the walk. Using a short lead 1 3 feet in length allows control of the patient and prevents lateral movement and pulling at the end of the lead. This minimizes any exaggerated or distractive forces affecting the structure during the activity. The terrain of the course can affect the activity, a flat solid surface is better than hilly soft surface (i.e. no beaches). During the walk, evaluate the patient for signs of fatigue, discomfort or pain. This will determine the length of the walk. The patient should be evaluated during the walk, immediately post walk, approximately one hour post walk, a few hours later, in the evening and then the next morning for pain or the effects of fatigue. Underwater treadmill (UWTM) is an excellent way to allow exercise and minimize negative factors of impact stress. Low impact exercise or movement of the joint has a positive effect on intra articular health. Hot packs can be applied to the joint prior to exercise and cold packs can be placed around the joint post exercise. NSAIDs can be used on an as needed basis to help manage activity or lifestyle related inflammation and pain. Focal pain management (i.e. Laser therapy) can be used to address joint pain and reduce the amount of oral NSAIDs. Summary Lameness is a common problem presented in today s veterinary practices. Correctly identifying the primary cause of the lameness is key to developing the proper treatment plan. Once the tissues involved are identified, the proper drugs and dosages can be selected to stop or slow the related inflammatory processes. In addition, rehabilitation modalities can used to help treat and manage the problem. Lastly, a proper therapeutic exercise program can be developed to help reduce reoccurrence of the lameness. References Robinson, N., Dean, R., Cobb, M., & Brennan, M. Investigating common clinical presentations in first opinion small animal consultations using direct observation.

8 Veterinary Record, doi: /vr , Gillette, R. L & Angle, T. C. (2008) Recent Advancements in Canine Locomotor Analysis: A Review. The Veterinary Journal, 178: William W. Muir III, Clifford J. Woolf. Mechanisms of pain and their therapeutic implications., Journal of the American Veterinary Medical Association Nov 2001, Vol. 219, No. 10, Pages E. J. Valtonen. A double blind trial of methocarbamol versus placebo in painful muscle spasm., Current Medical Research & Opinion 1975, Vol. 3, No. 6, Pages C. Nielsen, G. E. Pluhar, Diagnosis and treatment of hind limb muscle strain injuries in 22 dogs., Veterinary and Comparative Orthopaedics and Traumatology (VCOT) Issue: 2005: Issue Pages: Gro Jamtvedt, Kristin Thuve Dahm, Anne Christie, Rikke H Moe, Espen Haavardsholm, Inger Holm and Kåre B Hagen, Physical Therapy Interventions for Patients Osteoarthritis of the Knee: An Overview of Systematic Reviews. PHYS THER. 2008; 88: Ferreira D.M., Zângaro R.A., Balbin Villaverde A., Cury Y., Frigo L., Picolo G., Longo I., & Barbosa D.G.. Analgesic Effect of He Ne (632.8 nm) Low Level Laser Therapy on Acute Inflammatory Pain, Photomedicine and Laser Surgery. April 2005, 23(2): doi: /pho Bjordal J M, Johnson M I., Iversen V, Aimbire F, & Brandao Lopes Martins R A. Low Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo Controlled Trials Photomedicine and Laser Surgery. April 2006, 24(2): doi: /pho Gur, A, Cosut, A, Sarac, AJ, Cevik, R, Nas, K, & Uyar, A, Efficacy of different therapy regimes of low power laser in painful osteoarthritis of the knee: A double blind and randomized controlled trial. Lasers in Surgery and Medicine, Volume 33, Issue 5, pages , December 2003 Marcos G. Rosemffet, MD, Emilce E. Schneeberger, MD, Gustavo Citera, MD, Marı a E. Sgobba, MD,Claudia Laiz, PT, Haydee Schmulevich, PT, Patricia Artcanuturry, PT, Susana Gagliardi, MD,and Jose A. Maldonado Cocco, MD. Effects of Functional Electrostimulation on Pain, Muscular Strength, and Functional Capacity in Patients With Osteoarthritis of the Knee, JCR: Journal of Clinical Rheumatology, Volume 10, Number 5, October 2004:

9 Richard M. Dubinsky and Janis Miyasaki. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence based review), Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74;173 Neurology 74 January 12,

10 Diagnosing and Managing Non Surgical Lameness of the Rear Limb Robert L. Gillette, DVM, MSE, DACVSMR The diagnosis and management of the rear legs can be different from the front limbs. This is because the forces and actions differ between the front legs and the rear legs. We are typically discussing the same types of tissues: bones, ligaments, muscle, tendons and related fascia. So the treatment modalities and medications can be the same but may be directed in a different format. The rear legs create more forces of action and perform less braking actions than the front legs. Managing rear leg lameness can be different than front leg lameness. As discussed in the presentation on the front leg, the canine structure is divided into segments when analyzing motion. The axial vertebral column is made up of many joints and is divided into anatomical segments. The cranial segment is the head, followed caudally by the neck (cervical), thoracic, abdominal (lumbo sacral), and tail. The anatomical components are vertebral bones, the paravertebral muscles and nerves that stimulate these muscles. The appendicular segments are the front legs and the back legs. The anatomical components are the long bones, skeletal muscles and the nerves that stimulate them. In the rear legs, these are subdivided into smaller segments by the leg joints: lumbosacral joint, hip, stifle, tarsus, & phalanges. It is important to remember the antebrachial muscle groups that manipulate the toes. Locomotion as a whole is a result of the individual movements of these segments. While a dog is running in a straight line the rear legs act to propel the dog forward. The back, or paravertebral muscles, acts to lift the front end up in the air. Neither of these two actions is less important. The rear legs are needed for forward motion. If the paravertebral muscles do not lift up the front end of the body, the front end will be jammed into the ground. Palpation Basics The palpation of the rea limb is similar the front limb. The appendicular skeleton is always analyzed beginning distally and then move proximally. Start with a sound leg first. This allows the examiner to assess how the dog is going to respond to normal palpation. Responses elicited on the other legs can then be referenced to the responses of the normal leg. Begin by assessing the pads and webbing. Then flex and extend each phalangeal joint. Special attention should be paid to the sesamoids. These are a common problem in athletic and working dogs. The second and seventh sesamoids of the front paws are the ones most commonly affected. Palpate the long bones and soft tissue structures of the foot and then move proximally to the tarsus when palpating the rear leg. The joint should be flexed and extended and then supinated and pronated. Palpate the long bones and soft tissues of the antebrachium and then move proximally to the stifle. Flex and extend the stifle joint, stress it medially and laterally, and then rotate clockwise and counterclockwise. Palpate the long bones and soft tissues of the

11 brachium and move proximally to the hip joint. It should be flexed, extended, and then brought up to the shoulder area. Afterwards, palpate all of the muscles bellies. Lameness is not itself a disease but can be a sign of a disease process, pain, a structural impediment, deformity or weakness. Lameness is usually described in terms of region, i.e. hip, stifle, etc. Although this is a unique identifier, it does not designate the tissues causing the problem. Treatment for lameness should be designed to heal the tissues that are injured or to manage the tissue abnormality. There are many causes of lameness that are musculoskeletal based where surgery will not correct the problem. These can be chronic or acute in presentation. They can be very complex cases and may involve multiple visits to the veterinarian before a true diagnoses and management plan can be determined. The first step towards designing a plan to resolve or manage a musculoskeletal lameness is by identifying the primary source and any related issues. A non surgical plan is typically designed to manage pain/inflammation, structural stressors and the behavioral or mental state of the patient. Initially our goal is to address pain issues and slow or stop the inflammatory cycle. After that is done we can develop a long term management plan. Initial Plan The first step is to stop or minimize the activities that are stimulating the problem. Usually there are certain movements that are inciting the problem. For example if the problem is in the distal extremity the problem will be exacerbated every time the leg bears weight. One way to reduce stress on the structure is by applying a splint. A semiflexed splint will transfer the stance phase energy around the distal structures to a more proximal location. Usually 5 7 days will be long enough to allow the structures to calm down but a short enough time to prevent any splint complications. Rest and structured activities can be designed to reduce the stressors on the shoulder, hip or back related problems. The second step is to provide some NSAIDs or pain relievers to help break the inflammatory cycle. The intent here is to relieve the ongoing presenting pain and not to establish a long term drug regimen. Commonly used NSAIDs are deracoxib (Deramaxx ), firocoxib (Previcox ), carprofen (Rimadyl ) and meloxicam (Metacam ). Other pain relievers include tramadol, gabapentin or methocarbamol. The drug selected is dependent upon the tissue type that is causing the primary source of the lameness and the clinician s experience. My personal experience is to use Deramaxx or Rimadyl for joint based or intra articular problems. I use Metacam for skeletal muscle pain. I do not have any studies that show this, it is my clinical experience. Gabapentin, methocarbamol and/or metacam can be used for nerve root pain, paravertebral muscle pain (back pain) and some lumbo sacral based pain issues

12 depending on which tissues are causing the problem. Before prescribing any medication please be aware of the biological action and potential negative side effects of these drugs. Some therapeutic modalities have shown to be successful in relieving pain and stimulating the healing process. These include Low Level Laser Therapy (Laser), neuromuscular electrical stimulation (e stim), therapeutic ultrasound and magnet therapy. All three of these modalities have shown to be effective. E stim and ultrasound are commonly used in human physical therapy. They are not used as much in the veterinary world because they need skin contact (need to shave the fur) and the length of therapeutic treatment time can be 15 to 30 minutes. Laser therapy is being used effectively in the field of veterinary rehabilitation. Typically there are two classes of laser systems used: a class 3b system and a class 4 system. They both have shown to be effective but typically the treatment times for a 3b system are two to three times longer than a class 4 laser. These modalities allow for a focused treatment at the source of the lameness. They reduce inflammation, enhance healing and relieve pain. My clinical experience is that these modalities can play a beneficial role in rehabilitation and managing lameness. Follow up management Once we are able to stop the pain and inflammatory cycle, we can develop a long term management plan. Some cases may not need anything after the initial effort, but most will need follow up management. In these cases it is important that the client understand that we are working to manage the lameness and not necessarily cure the problem. The focus of the program is to minimize actions that create the problem and utilize modalities that focus treatment at the source thus minimizing the need for systemic pain relievers. Joint health supplements like Glycoflex or Dasuquin are beneficial. It is important that the client be educated that this a management plan and typically not a curative plan. It is important to discuss the fine balance between the benefits of activity and their effects on the inflammatory process. It will reduce the exposure to improper joint stress, address pain issues and manage inflammation and biological remodeling. This involves a structural weakness so the body will attempt to stabilize this with reparative tissues and muscular adaptations. The exercise routine should minimize activities that stimulate inflammation or inappropriately stress the injured structures. It is important to note that this does not mean that the patient is not able to participate in any activities. By setting up an activity plan that includes controllable activities, we allow the patient be active but reduces the risk of re injury.

13 The patient can go for walks on a short lead. In most dogs, the leash provides control during the walk. Using a short lead 1 3 feet in length allows control of the patient and prevents lateral movement and pulling at the end of the lead. This minimizes any exaggerated or distractive forces affecting the structure during the activity. The terrain of the course can affect the activity, a flat solid surface is better than hilly soft surface (i.e. no beaches). During the walk, evaluate the patient for signs of fatigue, discomfort or pain. This will determine the length of the walk. The patient should be evaluated during the walk, immediately post walk, approximately one hour post walk, a few hours later, in the evening and then the next morning for pain or the effects of fatigue. Underwater treadmill (UWTM) is an excellent way to allow exercise and minimize negative factors of impact stress. Low impact exercise or movement of the joint has a positive effect on intra articular health. Hot packs can be applied to the joint prior to exercise and cold packs can be placed around the joint post exercise. NSAIDs can be used on an as needed basis to help manage activity or lifestyle related inflammation and pain. Focal pain management (i.e. Laser therapy) can be used to address joint pain and reduce the amount of oral NSAIDs. Summary Lameness is a common problem presented in today s veterinary practices. Correctly identifying the primary cause of the lameness is key to developing the proper treatment plan. Once the tissues involved are identified, the proper drugs and dosages can be selected to stop or slow the related inflammatory processes. In addition, rehabilitation modalities can used to help treat and manage the problem. Lastly, a proper therapeutic exercise program can be developed to help reduce reoccurrence of the lameness. References Robinson, N., Dean, R., Cobb, M., & Brennan, M. Investigating common clinical presentations in first opinion small animal consultations using direct observation. Veterinary Record, doi: /vr , Gillette, R. L & Angle, T. C. (2008) Recent Advancements in Canine Locomotor Analysis: A Review. The Veterinary Journal, 178: William W. Muir III, Clifford J. Woolf. Mechanisms of pain and their therapeutic implications., Journal of the American Veterinary Medical Association Nov 2001, Vol. 219, No. 10, Pages E. J. Valtonen. A double blind trial of methocarbamol versus placebo in painful muscle spasm., Current Medical Research & Opinion 1975, Vol. 3, No. 6, Pages

14 C. Nielsen, G. E. Pluhar, Diagnosis and treatment of hind limb muscle strain injuries in 22 dogs., Veterinary and Comparative Orthopaedics and Traumatology (VCOT) Issue: 2005: Issue Pages: Gro Jamtvedt, Kristin Thuve Dahm, Anne Christie, Rikke H Moe, Espen Haavardsholm, Inger Holm and Kåre B Hagen, Physical Therapy Interventions for Patients Osteoarthritis of the Knee: An Overview of Systematic Reviews. PHYS THER. 2008; 88: Ferreira D.M., Zângaro R.A., Balbin Villaverde A., Cury Y., Frigo L., Picolo G., Longo I., & Barbosa D.G.. Analgesic Effect of He Ne (632.8 nm) Low Level Laser Therapy on Acute Inflammatory Pain, Photomedicine and Laser Surgery. April 2005, 23(2): doi: /pho Bjordal J M, Johnson M I., Iversen V, Aimbire F, & Brandao Lopes Martins R A. Low Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo Controlled Trials Photomedicine and Laser Surgery. April 2006, 24(2): doi: /pho Gur, A, Cosut, A, Sarac, AJ, Cevik, R, Nas, K, & Uyar, A, Efficacy of different therapy regimes of low power laser in painful osteoarthritis of the knee: A double blind and randomized controlled trial. Lasers in Surgery and Medicine, Volume 33, Issue 5, pages , December 2003 Marcos G. Rosemffet, MD, Emilce E. Schneeberger, MD, Gustavo Citera, MD, Marı a E. Sgobba, MD,Claudia Laiz, PT, Haydee Schmulevich, PT, Patricia Artcanuturry, PT, Susana Gagliardi, MD,and Jose A. Maldonado Cocco, MD. Effects of Functional Electrostimulation on Pain, Muscular Strength, and Functional Capacity in Patients With Osteoarthritis of the Knee, JCR: Journal of Clinical Rheumatology, Volume 10, Number 5, October 2004: Richard M. Dubinsky and Janis Miyasaki. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence based review), Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74;173 Neurology 74 January 12,

15 Optimizing Musculoskeletal Health: Benefits of the General Practice Robert L. Gillette, DVM, MSE, DACVSMR Dogs enjoy participating in activities. This exercise benefits them both physically and mentally. It helps to maintain a healthy conditioned state as well as helping to maintain a healthy level of weight. Obesity is a common problem in the pet world. Many times this is associated with nutritional factors. It is important to understand that body condition is a balance of nutritional input and energy utilization. There is a lot of animal nutritional information available but there is minimal animal exercise information. In normal dogs, inactivity has detrimental effects of the body. Physical activity has structural, metabolic and psychological benefits to the overall health of the dogs. This results in healthier and happier dog. Exercising with your dog is beneficial for both you and your dog. Having your dog as a workout companion has been shown to have mutually beneficial effects to both the dog and the owner. The human dog bond is strong to both participants. The domestication of the dog has created a dependency by the dog for human interaction. Tuber, et al. (1996) showed that dogs, when faced with a novel or new environment, had significantly lower glucocorticoid values in the presence of a familiar human than when alone or in the presence of a littermate. Bennet and Rohlf (2007) showed that strategies designed to increase participation in dog training activities and promote canine sociability may have significant benefits for both companion dog owners and their dogs. From the human aspect, Brown (1991) states that physical fitness is an important general component of well being. This also seems to be true for the dog. This information indicates that having a canine workout companion benefits the human, the dog and the human dog relationship. Exercise benefits your Dog Dogs were bred for herding, chasing, smelling, and protection to name a few of the functions. Outside of the toy breeds, most dogs were not selectively bred for a sedentary lifestyle. Inactivity or lack of activity has a negative affect on the body condition which commonly results in obesity or the dog being overweight. As a result, obesity has a negative effect on the health of the dog. In the human health field it is recognized that obesity is associated with a 36% increase in inpatient and outpatient spending and a 77% increase in medication costs. Obesity has been recognized as a growing problem in dogs and cats. Problems associated with obesity in the dog and cat includes orthopedic diseases, diabetes mellitus, abnormal lipid profiles, cardiorespiratory disease and anesthesia complications. Obesity is defined as an accumulation of an excessive amount of adipose tissue in the body. In the normal dog, it is a result of more energy being taken in and stored in the body than being utilized by the body. There are two ways to address body weight, diet restriction or by increasing energy utilization. Diet restriction has shown to have a positive effect on the life span of

16 the dog. Nutrition plays a very important role in body condition. Physical activity has shown to have a beneficial effect on health in people. Activity and Body Condition The body is in an ever changing state. It continually monitors it status and maintains or corrects itself depending on the factors that influence its homeostasis. There are external factors and internal factors that affect the metabolism. Some examples of external factors include temperature, humidity, sunshine, altitude and the external forces of nature. Internal factors include sleep, hormonal fluctuations, feeding, presence of metabolic waste and nervous stimulation. The dog is continually exposed to these factors. Wolfe s law states that every change in the form or function of a bone is followed by adaptive changes in its internal architecture and its external shape. This means that as varying forces are applied to the boney structure the structure will adapt according to these forces. Wolfe s law is generally applied to bone structure, but Davis theory has application to the muscles and soft tissues. Exercise also affects the body s metabolism. As metabolic stresses are continually applied to the body, over time the body will adapt its metabolism to the point that they are no longer stressful. The body now recognizes this state as normal and the external influences are not stressful to the body. In other words the body has adapted itself to the handle the external influences. This application is the basis for most training and conditioning programs. Inactivity has the same influence as exercise but in the reverse fashion. If the body is not presented with any stressors, the systems will balance out their activity to maintain the metabolism at this low activity level. If the body is introduced to any of the previously described factoral extremes the body is not prepared to handle it. The body will react to handle this stimulus and will either handle it or succumb to it. An example of this is the immune system. If the immune system is not exposed to any infectious stimulus or in a physically reduced state, its ability to respond to acute exposure is deficient. The immune system is enhanced by sleep and rest and is impaired by stress. A body that is conditioned and healthy is less likely to be stressed, so it is better able to respond to infectious stimuli. A more active dog is a healthier dog and less affected by the normal stressors of life. It is then important to know what amount and type of activity is beneficial to the dog. There are many factors that influence how activity affects the dog. First we must address the genetic composition of the dog. The wild dogs of Africa were naturally bred over time to run long distances and work as a team. Large dogs similar to the Rottweiler were bred for their size and strength and were utilized by Roman soldiers on the front lines to attack their enemy. Foxhounds were selectively bred to run long distances to handle their hunting activity. Greyhounds were bred for the strength to produce a supramaximal effort over a shorter distance and period of time. Sled dogs were bred to have the strength and endurance to run long distances. Dogs have a phenomenal aerobic capacity when compared to the other species. Their bodies are designed to

17 handle activities and work much better than the human body. Therefore we cannot transfer our concepts of human conditioning limits to the dog. The dog s genetic design helps us to select types of competitive activities for the dog. Greyhounds are best suited to compete in sprint races less than a mile in length. The hound breeds are best suited to compete in long distance activities. This is also true for the sled dogs. German Shepherds, Belgian Malinois, and Rottweilers are better suited for detection and/or protection competitions and work. This is not necessarily true for pleasure activities. Most all dogs can participate with their owner or handler in basic pleasure activities. These activities include walking, jogging, skiing and other activities in which people participate. The key to safely including the dog in the owner s activity, is in proper conditioning. The dog should be introduced to the activity in a manner that does not force too much activity too soon. Proceeding in this manner the activity is beneficial to the dog and not detrimental. There are also psychological benefits to activity participation. Dogs are very excited to perform the activity for which they were bred. Recent studies have shown that the dog benefits psychologically from activity participation. Sled dogs, Labrador Retrievers and Greyhounds were evaluated to determine the metabolic affects related to activity anticipation and exercise. These three population groups were analyzed using an established performance analysis protocol. Three typical highly bred groups trained to perform specific tasks were represented. Physiological parameters were taken at rest, away from the activity site to represent resting parameters. The dogs were taken to the activity site and introduced to the activity 24 hours after the resting values were taken. Pre activity values were taken. The dogs then performed their activity and postactivity values were taken. Variances between the resting and pre activity values were associated with activity anticipation. Variances between pre activity values and postactivity values were associated with activity. There are many types of dog sporting and working activities. Although there are many activities, there are three basic physiological definitions in which these activities can be grouped. The three basic groups are Sprint, Endurance and Strength. References Wells, D. Domestic dogs and human health: An overview. British Journal of Health Psychology, 2007, 12, Kushner, R, Blatner, D, Jewell, D. The PPET study: people and pets exercising together. Obesity, vol 14, no. 10, October 2006.

18 Bergler, R. In Man and Dog: The Psychology of a Relationship, Rheinhold Bergler. Blackwell Scientific Publications, Oxford, Brown, L, Shaw, T, & Kirkland, K. Affection for people as a function of affection for dogs. Psychological Reports, 31, , Sturm, R. The effects of obesity, smoking and drinking on medical problems and costs. Health Affairs. Chevy Chase: Mar/Apr Vol. 21, Iss 2; pg 245 German, A. The growing problem of obesity in dogs and cats. The Journal of Nutrition, 136:1940S 1946S, July 2006 Bach, J, Rozanski, E, Bedenice, D, et al. Association of expiratory airway dysfunction with marked obesity in healthy adult dogs. American Journal of Veterinary Research, Vol 68, No. 6, June 2007, pp Burkholder, W & Toll, P. Obesity. In Hand MS, Thatcher CD, Reimillard RL, Roudebush P, Morris ML, Novotny BJ, editors. Small animal clinical nutrition, 4th edition. Topeka, KS: Mark Morris Institute. 2000; pp Kealy, R, Lawler, D, Ballam, J, et al. Effects of diet restriction on the life span and agerelated changes in dogs. Journal of the American Veterinary Medicine Association, Vol 220, No. 9, May 1, 2002, pp Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, May Lange, T, Perras B, Fehm H, Born J (2003). Sleep Enhances the Human Antibody response to Hepatitis A Vaccination. Psychosomatic Medicine 65: Khansari, D, Murgo A, Faith R (1990). Effects of stress on the immune system. Immunology Today 11: Gillette, R. The canine workout companion. The Athletic and Working Dog Newsletter, 7:1, pp 1 4, Gillette RL, Angle TC, Wakshlag J. Research Design of Nutritional Studies on the Athletic Dog Needs to Take into Account the Effects of Anticipation and Conditioning. Supplement to Compendium on Continuing Education for the Practicing Veterinarian