Osteoarthritis – a chronic mobility problem and the role of a physiotherapist
Being geriatric or aged is not a disease itself, but is an age bracket when certain diseases are likely to develop, such as the onset of musculo-skeletal, neuro-muscular and systemic conditions.
In human patients, the World Health Organisation defines elderly as being 60 to 74 and aged/geriatric as 75 and older! Factors determining ageing in dogs can include genetics, the environment, nutrition, breed type and the extent to which it is a working or non-working dog. Breed type means taking into consideration whether the dog is large or small, mixed or purebred. “Giant” or large breed dogs have a shorter life expectancy than small breeds, so an 8 year old Great Dane would be considered elderly and a Maltese of the same age would not.
The following questions are designed to help you establish how your elderly pet is coping
- Does your dog still do what he/she used to do for fun?
- Has your dog experienced an increase or decrease in weight?
- Has there been a change in attitude or temperament?
- Does your pet seem to be in pain?
- Have you noticed any limping or stiffness after walks?
- Is he/she lagging behind, reluctant to join in or needing more rests?
- Is he/she sleeping a lot more in the day?
- Can your dog
- Position to urinate and pass stools?
- Transfer from lying to sitting, sit to stand and vice versa?
- Roll over?
- Scratch behind the ears?
- Go for a walk?
- Get up and down stairs?
- Get in and out of the car?
- Run or jump?
These types of questions are used by physiotherapists to establish a base-line or overall picture of your dog’s functional health – to assess your dog’s normal process of ageing, quality of life, home environment, nutrition and supplements. This will lead to the formulation of an appropriate exercise programme and establish if mobility aids are required.
When in doubt, ask
If you are eager to optimise the health or quality of life of your elderly dog, here are a few suggestions
- Seek advice – as with people, regular check-ups are advisable as your dog gets older
- Improve your dogs mobility – a physiotherapist is able to treat mobility problems, assess and advise where walking aids are necessary and advise you about exercises to do at home
- Correct home management – physiotherapists can advise you on how to reduce reliance on medications for pain control and discomfort and how to improve your pet’s general quality of life
- Medical conditions – your vet will be able to advise you with regard to medical conditions, which are easier to treat or manage in the long term if detected early
- Veterinary Homeopathy and Acupuncture – are effective modes of treatment in many cases
Like owner, like dog
Common conditions affecting mobility that can be treated by physiotherapists
- Arthritis – affecting the joints of the limbs and/or the spine leading to possible disc disease
- Degenerative radiculomylopathy – neurological disease causing weakness in the back legs, usually associated with German Shepherd dogs
- Fibro-cartilaginous embolism – acute onset of paralysis due to a “spinal stroke”
- Soft tissue injuries – muscle, tendon or ligament sprains
- Treatment after surgery (repair of fractures, ie broken pelvis or limbs after accidents)
- General muscle stiffness
The most common condition – and the main focus of this article – OA is characterised by a progressive loss of cartilage and by reactive changes at the margins of joints and bones. The goal of physiotherapy for patients with degenerative joint disease is to assist in improving the quality of life in the following ways: to relieve pain and associated muscle spasm, to improve and maintain joint range of movement, to improve joint health, strengthen the supporting muscles, to tackle proprioceptive (body awareness) deficits and to provide advice on home management and lifestyle changes.
Help is at hand!
In my experience, owners are often at a loss about how to help their animals with chronic joint problems but they become very actively involved when shown a few simple exercises and massage techniques that will help bring relief from pain or stiffness for their pet. Some of the following areas can be safely implemented by the owner after instruction.
Pain relief can be achieved by the use of electrotherapy modalities such as ultrasound, laser or muscle stimulation. Massage administered on a regular basis has been shown to relieve pain, increase pain tolerance and stimulate the release of endorphins. Owners can be shown by the physiotherapist how to massage a pet correctly as part of a home management regime. Heat and cold are useful in the reduction of pain and can also be administered safely by the owner.
Range of movement can be improved in humans and dogs through manual therapy techniques, including joint mobilisation, stretching and joint traction/distraction. Manual therapy together with exercise has been shown to be more effective than exercise on its own. A physiotherapist trained in manual therapy will be qualified to assess joint movement – the glide and end feel of joint range – and be able to assess the grade of mobilisation required.
Strengthening the supporting muscles assists in shock absorption, aiding mobility and function and limiting fatigue related injuries. This can be achieved by regular, controlled exercise on soft surfaces. For patients with OA, the utilisation of Aquatic Physiotherapy – in a heated pool – has huge advantages because of the absence of repetitive impact and torsional loads which cause so much damage to joint cartilage. Modified exercise is preferred because it improves muscle tone, maintains or improves range of movement and increases circulation.
Being overweight also impacts on OA joints and therefore weight management is an integral part of rehabilitation of the osteoarthritic dog. The correct diet and nutritional supplements need to be incorporated into the general care along with home management advice such as correct flooring ie non-slip surfaces, controlled exercise, avoiding excess play etc. A physiotherapist will reinforce this advice on a one to one basis with the owner during treatment sessions.
A physiotherapist can also assist with walking/mobility aids such as walking harnesses designed for the older dog having difficulty getting up into standing or negotiating steps and also for animals in the early stages of recovering from orthopaedic surgery.
In conclusion, the general health of a joint, the slowing of the degenerative process and general daily function of the animal can therefore be targeted effectively with physiotherapeutic modalities and correct home management.
General home management advice and helpful tips
In addition to owners being actively involved in the above treatment activities, the following factors should also be addressed:
Bedding – does your dog sleep inside or outside? If outside, bedding needs to be in a sheltered place and easily accessible; elderly dogs often find it easier to get on and off firmer bedding such as foam, rather than a deep cushion
Flooring – should ideally be a non-slip surface such as carpet or non-slip matting, which provides better grip for older dogs getting up from the lying down position
Garden access – older dogs suffering from incontinence need easy access to the garden where possible; ramps can provide easier access than steps
Other dogs at home – it is advisable to be aware that younger dogs, which often encourage an older dog to play, may need monitoring to prevent play becoming too rough and causing injury to the older dog
Food – older dogs often require less food but inactivity may lead to weight gain and this adversely affects mobility; the position of the food bowl may need to be raised, as stiffness in the back can make access difficult or the dog may have difficulty standing to eat.