Jessie

Pets Age: 
8 year old
Pet Type: 
Female, Chocolate Labrador
Problem: 
Severe hind limb paresis
Treatment: 
A rehabilitation programme on an aquatic treadmill

‘Jessie’ has been with her current owners for nearly three and a half years. She started to attend the Smart Clinic in July 2011 after an acute episode of severe hind limb paresis. At the time she had been given a guarded prognosis. Radiographs had been taken and revealed spondylosis from T13-L4 and at the lumbosacral junction. Osteoarthritis of the hips, particularly the left was also discovered. The radiographs also showed that a metal crimp was present in the right stifle, showing that she must have had cruciate surgery before starting her new life with her current owners. Radiographs taken the previous year had shown arthritic changes affecting the right elbow. Her owners’ main concerns were that although there had been some improvement with the administration of Metacam, her hind limbs appeared weak and her exercise tolerance was low.
 
On initial gait evaluation, the first point noted was that she spent most of the time in recumbency and was not able to stand for more than a few seconds or walk for more than 1-2 minutes. The lateral outline of her spine displayed a marked thoracolumbar lordosis, likely due to her complete lack of abdominal tone and an associated lack of core stability. She displayed bilateral hind limb lameness at an intensity of 2/10 on the left and 4/10 on the right. The right stifle was externally rotated. Her hind limb gait was stilted with very little flexion and extension occurring about both hips leading to a low arc of flight of both hind limbs. Her dynamic and static of centre of gravity had shifted cranially, as a compensatory measure to offload her dysfunctional back and hind limbs. She displayed a lack of core control and stability when moving and very little spinal flexibility when walking on both circles. She also displayed a mild left fore lameness when walking on a circle to the left.
 
On palpation there was a moderate degree of tension in the dorsal cervical musculature. There was slight restriction to lateral flexion of the neck to the right. There was some restriction to flexion and extension of both elbows. There was moderate reactivity along the length of her paraspinal muscles and the hyperaesthesia and allodynia was most intense at the level of T11-T12 and L3-L4. Her abdominal, paraspinal and hind limb musculature lacked tone and bulk. The right hind was more dramatically atrophied than the left.  Medial buttress effect was noted in the right stifle. Mild buttress effect was present on the left. The range of flexion and extension was limited in the right stifle. There was restriction to hip extension bilaterally.
 
A rehabilitation programme was instigated. The main aims of the programme were to alleviate pain and discomfort and patterns of compensatory muscle spasm. This in turn would facilitate our aims of improving hind limb strength and appropriate recruitment during gait, particularly of the right hind. We also aimed to engage her core muscles more appropriately in posture and when moving. This process included exercises and aquatic treadmill work to encourage a subtle caudal shift in her centre of gravity. Although proprioceptive placement testing of the right hind was positive and normal, we needed to work on the proprioceptive awareness of the right hind. It was also important to improve her spinal flexibility in the lateral and rotational places, in order to facilitate a more functional movement pattern in any gait.
 
By six months after treatment, she was able to walk for half an hour, with some of this being off lead. There had been a marked improvement in her core control and stability and her spinal outline had flattened due to the improved abdominal tone associated with this. This core stability started to provide more spinal support against shear forces. This is likely to have slowed the progression of her spondylosis which is often related to wear and tear on the ventral longitudinal ligament of the spine. At the six month mark, there was a mild right hind lameness and slight external rotation at the stifle but her gait pattern was much more functional and the amount of muscle spasm noted on palpation had reduced considerably.
This summer she went on holiday with her owners to the Lake District. This involved hours of walking in hill and dale and a bit of swimming every day. She managed this without additional stiffness in the evenings. She was a little fatigued at her next Smart Clinic appointment but not to any great extent. Of course with any case of polyarthritis, we have to be realistic about our goals but ‘Jessie’ is a good example of a case that is able to enjoy an active, fulfilling, mentally stimulating life.
 
She is currently having monthly appointments at the Smart Clinic. She is on a maintenance programme of physiotherapy exercises and aquatic treadmill work and she continues with her acupuncture sessions. My main findings on examination tend to be that she continues to have some restriction to the range of flexion of her right stifle and that sometimes there is mild allodynia in her lumbar epaxial muscles.  I am constantly impressed by the maintenance of her core stability and the massive reduction in her lameness score. She continues to be on a low dose of Metacam (10kg dose for a dog who weighs around 32kg). We constantly monitor her weight. In an ideal world we would get her down to 30kg. She also has monthly Cartrophen injections. To be realistic we are never going to change the fact that she has osteoarthritis and spondylosis but we have been able to give her the ability to cope with the pathological changes that are present and to slow any further degenerative changes occurring.