Harry is a 20 month old black Labrador, who was referred to me by his vet after being diagnosed with elbow dysplasia.
What is Elbow Dysplasia?
This is a condition which describes abnormal development of the elbow joint while a puppy is growing. The abnormality can be mild or severe and it can occur in one or both elbows. The elbow joint is where the humerus (the bone coming from the shoulder), meets with the radius and ulna. There are three main sites within this joint where elbow dysplasia can occur – dogs can have one problematic area or all three, depending on the severity of the abnormality. The abnormality within the joint causes instability, inflammation and pain. Over time, arthritis can also develop.
Harry was diagnosed with mild elbow dysplasia in his left elbow.
Symptoms of Elbow Dysplasia
The main symptoms of elbow dysplasia are:
· Limping and/or stiffness. This might be exacerbated by exercise, though might be more difficult to spot if both elbows are effected
· Reluctant to play or go for walks (due to the pain)
· The front paws may start pointing outwards, rather than straight ahead when the dog is standing still. This is to try to offload some of the weight from the elbows.
· Elbows may be held at a strange angle (to try to reduce the pain)
· Elbows can become puffy or swollen
Harry’s main symptoms were stiffness and intermittent limping, with some mild swelling around the effected elbow joint.
When do these symptoms begin to appear?
It is different for each dog and the severity of the dysplasia. Symptoms can begin from 5 months and are usually spotted by 18 months but very mild cases might not become evident until later when arthritis has also started to impact the joint.
Harry’s symptoms began at approximately 12 months old.
Compensatory Problems
When pain effects one area of the body, we begin to use our bodies differently to try to reduce the load on that area, for example, you may limp if you’ve hurt your leg. Dogs are no different and in the wild, this adaptation to gait is what would have kept them alive. However, when animals (and humans) adapt their gait or stance to avoid loading certain areas, it means they are overloading other muscles, joints and structures. Over time, this overloading can cause secondary problems as the muscles, joints and structures are overused. This is why it is really important to treat and support musculoskeletal conditions if long term functionality and comfort are to be achieved.
Harry had some mild-moderate compensations. The muscles around his right shoulder were overdeveloped, suggesting that his right forelimb had been bearing more of his weight. This suggests that his right elbow and shoulder joints have been working a bit harder than we would have liked. His muscles also felt ‘hypertonic’, meaning that they felt hard and tight. When muscles feel this way it often tells us they are working hard and becoming fatigued. This is problematic because fatigued muscles loose flexibility and strength, making them more prone to injury. Harry also had some sore areas in the muscles which surrounded his spine, directly above his shoulders and further down his back. These areas again indicated that his back and spinal muscles had been overworking to provide stability and reduce the load put through his left forelimb.
Treatment Options
In severe cases, surgery may be required. However, in a lot of cases, elbow dysplasia can be managed with pain relief, controlled exercise (to prevent exuberant movement which can cause further distress), weight management (to reduce the load through the joint) and physiotherapy. It is a lifelong condition , which means owners need to find a way of managing the symptoms in the long term to keep their dogs comfortable.
Harry was initially prescribed pain relief by his vet and then began physiotherapy.
Assessment
On Harry’s first session, I carried out a full assessment and could see that he was intermittently lame on his left forelimb. He also showed reluctance in loading his left forelimb when standing or turning and tried to keep it off the floor when sitting or moving from sit to stand. I also identified the increased muscle mass and tone in his right shoulder and the sore areas in his back that I mentioned above. When I assessed Harry’s range of motion, I found that he was reluctant to fully extend his left elbow joint and had some restriction in the right elbow joint, possibly because of the tightness which was present in the surrounding muscles. Harry’s hindlimb musculature appeared reduced. I measured the circumference of the top of each of his limbs and found that there was a significant difference between the left and right forelimb measurements, supporting the hypothesis that his right limb was doing more work.
Treatment
Harry was initially treated with a variety of massage techniques to reduce the hypotonicity where his muscles had been over working. These techniques were used to reduce the tension, improve circulation to the muscles and increase the muscle fibre extensibility. This was followed by specialised stretching to realign muscle fibres, improve flexibility and move joints through their full range of motion to help keep them healthy.
I then used my K-Laser on both of Harry’s elbows and on the part of the spine directly above his shoulders, where the nerves which serve the tissues around his elbows connect to the spinal column. Laser was used on his left elbow to reduce pain and to reduce inflammation in the joint. This is important as prolonged periods of inflammation can cause arthritis- if we can keep the inflammation at bay, we can hopefully delay the occurrence of arthritis in the joint. The spinal column/nerves which serve this area were targeted to reduce pain sensations transferred to the brain and therefore increasing the analgesic effect. Harry followed the advised 3-2-1 course of laser treatment, having three treatments the first week, 2 in the second and then 1 in the third and thereafter. This course of treatment provides a boost in the initial stages of pain relief, improved circulation, reduced inflammation and, where required, tissue healing. His right elbow was also treated as we knew that this joint had been working harder and therefore the laser was used to reduce any inflammation which may have occurred from the over work and prevent any possible damage.
Once Harry was feeling more comfortable on his left elbow, he began a progressively challenging program of exercise therapy. This therapy had two aims: to strengthen his core and hindlimb musculature to reduce load on his forelimbs and to encourage him to begin loading his left fore limb correctly again, to keep the muscles and the joint as strong as possible. Harry’s owners were given exercises to practice at home to support Harry’s strengthening and rehabilitation.
Exercise Therapy
Exercise therapy is something I really believe in; the treatments I provide during a physiotherapy session put the musculature in the best place for healing and comfort- it is how they are then used from this point which will build strength and flexibility.
Initially, Harry carried out a range of active stretches to improve his core strength. He also carried out simple exercises which encouraged use of his hind limbs (to build strength here) and to encourage him to use his elbow joints correctly. Once he was comfortable with this, we reduced either his base of support or his stability. This basically means he was required to carry out his exercises with one or two of his paws off the ground and/or he was asked to carry them out on an unstable surface- we used foam pads, wobble cushions, inflatable platforms and eventually ‘the peanut.’ Harry also began to use cavaletti poles, to encourage him to actively take his joints through their range of motion. His exercises steadily progressed over the course of approximately 6 weeks. His progress was monitored so that the right amount of challenge was introduced at the right time.
Time Scale
Harry visited me three times in his first week- once for his assessment and physiotherapy and twice for the additional laser. In his second week, he visited twice- once for full physiotherapy and a second time just for the laser therapy. After that, he visited me weekly for physiotherapy sessions, which included the laser therapy. Over this time, his strength improved, his forelimb muscle mass evened up, his hindlimb muscle mass increased and he was more comfortable and confident to use his left forelimb correctly. By week 4, we started to include off lead exercise into his week- something he hadn’t done for about 9 months. Initially, this was gradual and increased over time.
After six weeks or treatment, with his owners carrying out very regular exercises at home to support his progress, we discussed reducing the regularity of Harry’s appointments. Harry’s owners have played a huge part in his rehabilitation and, without their hard work at home, I am not sure he would have improved so quickly. We are now monitoring Harry’s response as we reduce the frequency of his appointments. As Harry’s owners are so conscientious with their home exercises, Harry is remaining strong and is no longer developing compensations. However, we are still finding that he finds regular K-Laser therapy important to keep him comfortable on his elbow, especially if he over does it from time to time! Every dog is different and there are lots of outside influences which can contribute to a flare up in a condition. Working together, Harry’s owners and I will continue to monitor his progress and his comfort. If there comes a time when I need to refer him back to his vet, this will be done without hesitation. However, at the moment he is doing very well and I am very pleased with his progress.
Huge well done to Harry and his owners for all your hard work.
Here is a picture of Harry practicing his exercises - Star Pupil!
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