Orthopaedic Conditions

Arthritis is characterized by the loss of the smooth cartilage that covers and protects the ends of bones in a synovial joint.
The cartilage has no nerves so that when it touches the cartilage of another bone, there is no pain. But when the cartilage wears away, the bone is exposed, and the bones do have nerves, so when the 2 bone ends in a joint touch each other, it results in pain and inflammation.

Causes

• Ageing – the most common cause of osteoarthritis.
• Congenital joint disorders – developmental disorders such as hip dysplasia, osteochondrosis (OCD), and elbow dysplasia can result in arthritis later in life.
• Trauma – old injuries or repeated trauma to joints.
• Activity level – working dogs and athletic dogs tend to place more stress on their joints and are more likely to incur injuries.
• Obesity – overweight dogs have increased mechanical stress on their joints that leads to arthritis.
• Metabolic diseases – diseases such as Diabetes and Cushing’s disease are associated with early wear of the cartilage and secondary arthritis.

Symptoms

• Altered gait/limping/lameness
• Muscle wastage (atrophy)
• Creaking (crepitus) in joints
• Difficulty getting up and down from lying down, jumping in and out of the car, going up and down stairs
• Change in appetite and behavior (may go off their own more)
• Vocalisation – yelping at certain movements
• Licking or biting a sore area

How massage can help

• Massage can help to ease areas of overcompensation and pain referral.
• Increases flexibility and mobility in joints by stimulating production of synovial fluid.
• Decrease pain and inflammation by the release of endorphins.
• Light massage over the areas affected will relax the muscles supporting those structures by warming them and improving circulation (which in turn delivers more oxygen and nutrients to the affected area).

Spondylosis is a chronic condition in which boney spurs, or osteophytes, form on the spine due to progressive disc degeneration. As the bony spurs grow, they may form bridges from one vertebra to another.
There is no spinal cord compression, but the spine is immobilized in that location. The bony spurs can press on the surrounding tissue, producing pain and discomfort.
Commonly affects T9-T10, L2-L4.

Cause

• Not fully understood – thought to be hereditary
• The condition tends to affect ‘middle age’ dogs
• Typically found around areas of trauma, or bitches with several pregnancies
• Wear and tear of an active dog

Symptoms

• Tenderness over affected area
• Roaching (rounding) of back
• Inflexibility – yelping in pain when turning or twisting in a specific direction
• Nerve deficit and lack of proprioception in hind limbs
• Loss of balance

How massage can help

• Provides comfort and relief from pain by the release of endorphins
• Mobility and flexibility can be promoted by easing the tightness in the surrounding tissues
• Relieves areas of muscular overcompensation
• Can be useful in helping control the referred pain of spondylosis which in dogs may run from the back, down the hind limb due to nerve irritation

This is a condition in which the patella (knee cap) dislocates or moves out of its normal position. There are 4 grades of luxating patella, depending on the stability of the patella.

Cause

• A weak or stretched patella ligament – usually congenital or due to injury.
• The trochlear groove is too shallow – usually congenital.
• The lower attachment of the patella ligament is to far to the inner side of the tibia. This is most common in short legged dogs eg dachshunds.

Symptoms

• Intermittent lameness in the hind leg(s).
• Dog stops and yelps as he’s running, extending the affected leg backwards. The yelp is from the pain caused by the patella sliding across the boney ridges of the femur. Once the patella is out of position, it is no longer painful.
• Dog develops a ‘hop-hop-skip’ action.
• There is lack of normal movement in the stifle joint.

How massage can help

• Depending on the grade of luxation, some dogs will need surgery to correct the anatomical problem. The dog will need approximately 8 weeks to recover, depending on the type of surgery performed.
• Massage will help by ensuring the areas of overcompensation and pain referral are minimized.
• Massage can lengthen the muscles thatinsert around the area – ie the patella interposes with the tendon of insertion of the quadriceps.
• Reduces soreness and stiffness.
• Increase circulation to the affected area, providing oxygen and nutrients to the tissue.

Hip dysplasia is associated with abnormal joint structure and a laxity of the muscles, connective tissue and ligaments that would normally support the joint.
As the laxity develops, the articular surfaces of the 2 bones lose contact with each other – known as subluxation – and this causes wear to the articular surfaces.

Causes

• Genetics – dysplastic dogs should not be bred from as researchers agree hip dysplasia is a genetic disease.
• Nutrition – obesity, or a diet too rich or too poor in calcium and other minerals.
• Exercise – over exercising young dogs (eg jumping for a frizbee).

Symptoms

• Reduced exercise tolerance.
• Reluctance to jump – into the car/ onto the settee.
• Bunnyhopping gait (where both hind limbs move together rather than independently).
• Limping – worse after exercise.
• Wobbly, staggering gait as hind legs criss cross over when walking.

How massage can help

• Relieves areas of muscular overcompensation – the lower back, shoulders and neck will all be working harder to help keep the dog mobile.
• Relieves tension build up and soreness.
• Helps to improve flexibility of hips by stimulating the production of synovial fluid within the joint.
• Improve circulation, and so oxygen and nutrient delivery to the tissues.
• Improves lymphatic drainage, which reduces inflammation.

Elbow dysplasia describes an abnormal development of the elbow joint. The term includes a number of abnormalities, which affect different sites in the joint, affecting the growth of the cartilage or the structures around it. The most common types are:

1. Osteochondritis dissecans (OCD) – damaged cartilage develops abnormally. Joint fluid enters into the fissures and cracks in the cartilage causing pain.
2. Fragmented or united coronoid process (FCP) – a small piece of bone on the inner side of the ulna breaks off and irritates the cartilage.
3. Ununited anconeal process (UAP) – the UAP doesn’t fuse with the iulna and instead forms a separate piece of bone.

Causes

• Genetic make up – symptoms can become apparent in puppyhood, but some dogs may not appear lame until later in life.
• Growth rate
• Poor diet
• Over exercising when young
• Medium and large breeds are more susceptible.

Symptoms

• Lameness – excessive paddling of the front feet.
• Limping – short, stilted gait when both legs are affected.
• Pain – onset often 4-6 months of age and worse after exercise.
• Pain on flexion or extension of the shoulder.
• Crepitus (creaking) in the joint.
• Muscle atrophy around the joint.

How massage can help

• Pre surgical and post op rehabilitation if an operation is required.
• Relieves soreness in areas of overcompensation.
• Relieves trigger points in lower neck and shoulders.
• Relieves pain by producing endorphins.
• Improve circulation to the affected areas, delivering oxygen and nutrients to the damaged areas.

There are 2 main ligaments within the knee joint that form a X shape (cranial/anterior and caudal/posterior ligaments) with the collateral ligaments around the stifle joint, keeping it stable.

Once they are completely torn, they do not heal. The ligaments have a poor blood supply and no mechanism to repair themselves if ruptured. Partial ruptures may heal without surgery, with strict rest and careful management.
There are 4 degrees of sprain (see ‘sprains’).

Cause

• Running, jumping and twisting, causing a sudden tear (it is a typical footballers injury!).
• But can be gradual, exacerbated by exercise.
• Being overweight makes dogs more prone to injury when they exert themselves.

Symptoms

• Acute lameness (less severe if a partial tear).
• The leg is carried with the stifle bent and just toe tapping.
• Clicking noises and swelling may be present.
• Yelping or crying.
• Sitting with the affected leg abducted (sticking out) to one side.
• Atrophy of the muscles of the hindlimb.

There are several different surgical techniques used to repair a ruptured cruciate ligament, depending on the severity, size and breed of dog and the surgeon’s decision:

1. Intracapsular technique – replaces the ligament with a graft.
2. Extracapsular technique – restoring stability using sutures.
3. Periarticular technique – bone altering procedures – tibial plateau leveling osteotomy (TPLO), is the first and most common technique; tibial tuberosity advancement (TTA); and triple tibial osteotomy (TTO).

How massage can help

• Massage is best left until approximately 4 weeks post operatively, to allow the healing process to take place.
• Massage will relieve areas of muscular overcompensation – the lower back muscles will be overworked because of holding the affected leg up. Neck, shoulder and the other hind limb muscles will also be working harder to maintain balance.
• To improve circulation to the affected area – better oxygen and nutrient delivery.
• Produces endorphins, which help to relieve pain.