Battling chronic pain in dogs, with first helping them at home

Youtube audio link - https://youtu.be/76A4ttsDJPQ?si=cBt4AyBWB39OAIgw
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As a continuation of last week's blog on adapting environments and being supported by professionals such as vets to do so, this week I am exploring part two.

The study that I referred to last week: Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis referred to the possibility of further support from professionals such as vets to come and visit the patients home to identify areas which need amending or changing to aid the patient in their recovery or management of their condition. Is this something you would want from your vet? (Mille, McClement and Lauer, 2022)

Many of us are familiar with the vets telling us that our dog needs to be on crate rest for a period of time for recovery from an illness or injury. However it is not widely known that for an osteoarthritis diagnosis for a dog, the complete opposite has to be done. Movement can aid the healing process and the maintenance of the synovial fluid to be properly diffused through the cartilage to manage the arthritis and the symptoms that arthritis causes. (Kiviranta et al., 1988)

What we tend to see as professionals and have fed back to us, is that the dog is extremely frustrated in being confined to a crate, on top of the initial ailment we may then begin to see additional behaviours that haven't been seen before by the guardian and a decline in the dogs mental health, self harm can occur such as chewing their paws, focusing on one area to chew, OCD behaviours in constant digging, chasing their tail, spinning, pacing, barking.

We also see a decline in the mental health of the guardian who feels at a loss, they cannot bear to see their dog struggling, they want to follow the vet's advice so that their dog recovers as fast as possible but they can also not cope with the decline that they are seeing in their dog.

I have also had cases where the dog is resident in a multidog home, everyone got along until the crate confinement and upon reintegration back into the home with no confinement, sudden fights and lack of tolerance towards one another.

Guardians then feel under even more pressure and of course feedback to the vets as they are quite rightly extremely worried, to be told to go and find a behaviourist. Which of course is not all vets at all, but has occurred in some instances.

The guardian then does not feel comfortable with working with the vet and or asking questions for their consult history evaluation because they feel that they have been pushed away and told to deal with this problem themselves with no help or support from their dog's physician.

So then we as behaviourists then see a further breakdown in the relationship between guardian and vet, mental health decline for both guardian and dogs involved and a very fraught situation building in some cases.

So by addressing the pyramid level 2 and embracing low level impact activities, scored with the dogs body weight, injury, treatment, surgery and outcome of the medical model we can then see guardians who are not experiencing such a decline because of their dog being placed on crate rest. (Millis and Levine, 1997)

The third level of the pyramid model is home exercises.

Home exercises complement clinical treatments for osteoarthritis (OA) but have limitations due to guardians' lack of anatomical knowledge. (Millis and Levine, 1997)

This is where the treatment of an holistic approach can fall down as the guardian only has access to the hydrotherapy or Physio clinic during their allotted appointments. However, being taught properly how to do additional exercises at home can help the guardian to have the knowledge to aid their dogs' healing and recovery journey. Such as coaches like myself qualified in canine conditioning to help with targeting specific muscles utilising different categories.

Regular home exercises, such as strengthening, proprioceptive, and balance exercises, and massage, can improve compliance and outcomes when tailored to the dog's and guardians needs. Adequate pain management and proper exercise execution are crucial. This means that a multidisciplinary approach is needed, all of the professionals involved in your dog's healing must be in contact with one another so that if pain medication is required then all of the professionals can work around the agreed exercises, the intensity and also the changes that are planned ahead of time for the dog to be supported physiologically from all angles.

Muscle strengthening is vital for OA management, improving stability, proprioception, and reducing pain. For dogs, exercises like sit-to-stand, resistance training, and regular walking on varied terrains are recommended to enhance muscle strength, aerobic capacity, and weight control. Strengthening should be progressive and continuous for long-term benefits. (Millis and Levine, 2014)

Controlled joint motion is essential for joint health. Passive range of motion exercises, performed without muscle contraction, can improve flexibility and joint health. While not central to physiotherapy protocols, they are useful as complementary techniques alongside active exercises. (Salter et al., 1980)

Balance and proprioceptive training are important for maintaining functionality and stability in OA patients. These exercises help improve balance, reduce pain, and enhance muscle coordination, though their specific effects on osteoarthritic dogs need further study.(Saussac A, 2019)

Massage therapy can increase blood circulation, reduce muscle tension, and improve joint flexibility. In dogs, it is often used to relax and relieve pain. Guardians can learn basic massage techniques to apply at home, there are some great books and online courses available for guardians and professionals alike!

Aquatic therapy we know as hydrotherapy, including swimming and underwater treadmill exercises, offers high-intensity, low-impact exercise options for dogs with OA. This can help improve muscle strength and joint range of motion, especially in overweight dogs and dogs experiencing heightened pain who would not be good candidates for home exercises. (Millis and Levine, 2014)

Pyramid Level 4: Treatment by Physiotherapist refers to the
Physiotherapists evaluate the patient and their environment, develop a treatment plan, and integrate it into daily life. They act as consultants, working with both the patient and the guardian.

The effects of OA vary by patient and are influenced by comorbidities and daily activities. Environmental factors, breed, age, and guardian compliance are also considered. A holistic assessment tool like the International Classification of Functioning (ICF) adapted for veterinary use is proposed. (Millis and Levine, 2014)

Based on this assessment, an individualised exercise plan is created. Best practices in human medicine suggest at least 12 supervised sessions with progressive intensity, complemented by a home exercise program. Techniques like manual joint therapy, taping, and stretching are applied by the physiotherapist and are not suitable for home use. (Zinc and Van, 2018).
Exercises must be performed correctly to be effective, requiring specific and appropriate prescriptions. Physiotherapists should monitor and correct movement patterns creatively. Early contact with a physiotherapist is beneficial for optimising at-home and multimodal management strategies. Lifelong support through periodic reassessment ensures the adaptation of treatment as OA progresses. (Kloek et al., 2018)
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A collaborative, multidisciplinary approach involving a veterinarian, physiotherapist, hydrotherapist, canine behaviourist, and canine conditioning coach can provide comprehensive care for a dog patient and support their human caregiver effectively. Here’s how each professional can contribute and how they can work together:
The Veterinarian is the primary medical provider, diagnosing health issues, prescribing medications, and overseeing the overall health of the dog.
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Coordinates with a multidisciplinary team of the guardians choosing the treatment plan, referring to and communicating with other specialists as needed. Monitors the dog's progress and adjusts medical care accordingly.

Physiotherapist develops and implements physical therapy plans to manage pain, improve mobility, and enhance the quality of life for dogs with conditions like osteoarthritis.

Working closely with the veterinarian to ensure the physical therapy plan aligns with the dog's medical needs. Provides the guardian with exercises to perform at home (evaluates the home) and liaises with the hydrotherapist for aquatic therapy integration.

Hydrotherapist, specialises in water-based therapies, using pools or underwater treadmills to provide low-impact exercise that can help with rehabilitation and conditioning.

Coordinates with the physiotherapist to incorporate aquatic exercises into the dog’s overall therapy plan. Communicates progress and any concerns to both the physiotherapist and veterinarian.

Canine Behaviorist addresses any behavioural issues, providing training and behaviour modification strategies to ensure the dog's psychological well-being and mitigate any issues that might interfere with treatment.

Works with the physiotherapist and veterinarian to understand any medical conditions affecting behaviour. Educates the guardian on how to manage the dog’s behaviour, especially during exercises and treatments, ensuring a stress-free environment.

Canine Conditioning Coach, focuses on fitness and conditioning, enhancing the dog’s strength, endurance, and overall physical fitness.

Working alongside the physiotherapist to create a balanced conditioning program that supports rehabilitation goals. Monitors the dog's fitness progress and adjusts routines to ensure they are safe and effective.

A multidisciplinary team should have frequent updates and meetings among all team members to discuss the dog’s progress, challenges, and any adjustments needed in the care plan.

-Developing a unified care plan that integrates medical treatment, physical therapy, behaviour management, and conditioning exercises.

Ensuring the caregiver is well-informed about all aspects of the dog's care, including how to perform exercises, manage behaviour, and recognize signs of pain or discomfort.

Providing a support network for the caregiver, allowing them to reach out to any team member with questions or concerns, ensuring continuity of care.

By combining their expertise, we as professionals can address the dog's physical, medical, and psychological needs comprehensively, enhancing the dog's health and quality of life while providing valuable support to the caregiver.

So when I write a blog explaining the importance of rugs what I am actually explaining is that osteoarthritis in dogs is my area of brain strength and knowledge and that this is just one stitch in a huge tapestry which is your dog's health and wellbeing. This same model could be applied to any illness or ailment.

It is so important that you as the guardian have as much support and knowledge from professionals as possible to be able to understand what it is that your dog is going through, like any family member and that you have the resources and knowledge to access a rehabilitation or care model that aids both you and your dog.

Next week I will be discussing the impact of walking equipment and the physiological impact.

References

Mille, M.A., McClement, J. and Lauer, S. (2022). Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis. Veterinary Sciences, [online] 10(1), p.2. doi:https://doi.org/10.3390/vetsci10010002.
Kiviranta, I., Tammi, M., Jurvelin, J., Säämänen, A.-M. and Helminen, H.J. (1988). Moderate running exercise augments glycosaminoglycans and thickness of articular cartilage in the knee joint of young beagle dogs. Journal of Orthopaedic Research, 6(2), pp.188–195. doi:https://doi.org/10.1002/jor.1100060205.
Millis, D.L. and Levine, D. (1997). The Role of Exercise and Physical Modalities in The Treatment of Osteoarthritis. Veterinary Clinics of North America: Small Animal Practice, 27(4), pp.913–930. doi:https://doi.org/10.1016/s0195-5616(97)50086-6.
Millis, D.L. and Levine, D. (2014). Canine rehabilitation and physical therapy. 2nd ed. St. Louis: Saunders, Cop.
Salter, R.B., Simmonds, D.F., Malcolm, B.W., Rumble, E.J., MacMichael, D. and Clements, N.D. (1980). The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. The Journal of Bone & Joint Surgery, 62(, pp.1232–1251. doi:https://doi.org/10.2106/00004623-198062080-00002.
Saussac A., Sawaya S.G. Impact of a training program with the motorised platform Imoove-Vet in agility dogs; Proceedings of the 6th VEPRA-1st ECVSMR Conference 2019; Ghent, Belgium. 19–21 September 2019; p. 140
Zink, C. and Van, J.B. (2018). Canine Sports Medicine and Rehabilitation. John Wiley & Sons, Inc.
‌Kloek, C.J.J., van Dongen, J.M., de Bakker, D.H., Bossen, D., Dekker, J. and Veenhof, C. (2018). Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomised controlled trial. BMC Public Health, 18(1). doi:https://doi.org/10.1186/s12889-018-5975-7.

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