THE SUCCESSFUL USE OF VETERINARY PHYSIOTHERAPY IN THE MANAGEMENT OF INTERVERTEBRAL DISC DISEASE IN AN ATAXIC COCKER SPANIEL Barbara Houlding MScVetPhys MCSP FIRVAP Summary A 2 year old male Cocker Spaniel with pelvic limb ataxia was referred for veterinary physiotherapy and hydrotherapy following multiple intervertebral disc degenerations in the thoraco-lumbar region. Following a full veterinary physiotherapy assessment, a prioritized problem list led to treatment goal planning and agreement with the dog’s owners to commence a course of treatment including a range of land and water based treatment strategies. Functional outcome measures demonstrated a significant improvement in the dog’s core stability, pelvic limb strength and gait patterning in walk, trot and gallop. Keywords: veterinary physiotherapy, aqua and hydrotherapy, intervertebral disc disease, pelvic limb ataxia, thoraco-lumbar IVDD Introduction Intervertebral disc disease (IVDD) is where herniated material that lies beneath or adjacent to the spinal cord extrudes or protrudes, resulting in compression of the spinal cord, leading to variable clinical signs that are dependent on lesion severity and location. Intervertebral disc protrusion (Hansen’s Type II IVDD) in the thoraco-lumbar region is a common neurological spinal disorder with clinical signs that include a slowly progressive pelvic limb weakness, reluctance to rise or jump and problems with climbing stairs. Hyperaesthesia of the paraspinals may be present. Conservative management is indicated in dogs with early onset of Hansens Type II and mild neurological deficits.
Physiotherapy has a recognized key role in the effective management of neurological diseases in humans, as well as being central to minimizing and effectively addressing the problems of disuse, immobilisation and poor movement patterning of the musculo-skeletal system. This aims to maximize the functional recovery of the biped or quadruped. However, the organization of canine motor patterning is very different to human motion, with the dog using quadruped biomechanics linked to form and function. Small animal veterinary physiotherapists are specialists able to effectively employ a range of assessment and treatment tools to deliver an individual programme, meeting the needs of their canine client and owner. Case History A 2 year old male (entire) blue roan Cocker Spaniel presented to Dick White’s Referral Clinic from Wangford Veterinary Surgery for further investigation of acute pelvic limb ataxia with reluctance to walk, jump or climb stairs. On presentation to the referral clinic, a full physical and neurological assessment was performed. This revealed mild pelvic limb ataxia with mild thoraco-lumbar hyperaesethesia. Neuro-anatomical localization was consistent with a T3L3 myelopathy. Further investigations included hematology, biochemistry and electrolytes, with results being unremarkable. An MRI scan revealed multiple intervertebral disc degenerations with mild protrusion in the thoraco-lumbar area. Conservative management was recommended with a view to surgical
decompression if there was a poor response to treatment. Management consisted of Gabapentin (Neurontin, Pfizer) 100mg – every eight hours (the dog weighed 13.2kg). Hydrotherapy at least once weekly was recommended along with instructions for rest initially consisting of 5 to 10 minutes lead walks for the first two weeks (then slowly increasing over the following two weeks) to four or five times a daily for toileting purposes. Following this, lead exercise only was directed for four to eight weeks. Reexamination was arranged for four weeks or earlier in the case of any deterioration. Wangford Veterinary Surgery then sent a referral to K9 Hydro Services. A full veterinary physiotherapy assessment was performed. The history highlighted that the Spaniel slept curled up in a rigid plastic bed, was reluctant to climb stairs in the owners second home, could no longer jump into their 4 x 4 car and was exercised on an extendable lead, constantly leaning and pulling ahead of the owner at all times. His owners reported that his mentation had altered and he was withdrawn, quiet and depressed. Observation at rest, functional transfers and gait identified that only a walk gait pattern in a straight line was achievable as the dog collapsed if attempted to trot, turn or circle. In walk the nose was in contact with the ground at all times and the dorsum of the left pelvic limb scuffed consistently. Transfers showed poor core stability and dynamic control as the dog collapsed, using thoracic limbs to attain stance from sit, and sit from lying. In sitting posture the left pelvic limb was held cranial and abducted at all times.
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