I have a couple questions if I may.
When do you start tractions, spinal mobilizations, ROM, and rib movement? One - Some patients are quite painful right after disc injury. Two – The usual recommendations are cage confinement and zero movement for first few days.
Do you wait until patients are more comfortable? (i.e. offer laser and pain meds first?)
Can you worsen the symptoms with ROM, mobilizations, and rib movement if you start too soon or if you are not gentle?
Use of modalities to increase circulation – do you worry about increasing “bad” inflammation?
Is there any benefit from heat therapy in increasing circulation in the disc case? Do you have owners apply heat to your patients at home?
Thank you for your time. Your website/members area is great.
Thank you for your questions!
As for the acute patients... GENTLE movements, mobs, or traction can be pain relieving - as long as it is grade 1 (tiny movements)... maybe grade 2 within the next couple of days (larger movement at the beginning of range). That’s why technique, feeling for, and understanding of the different ’ways’ to mobilize, traction, and even do ROM is so important. (For example, take a painful neck dog that is unwilling to move his/her head... getting the dog to follow a treat up-down & side to side just an inch or so can help with pain, circulation, and reduce ’pain centralization / wind-up phenomenon)... but trying to go as far as possible in any direction will lead to more pain.
So in your acute patient, you could do gentle neck traction or tail traction, you could mobilize adjacent (non-painful segments) with grade 1 or 2 mobs, and or the ribs (adjacent or directly correlating if not uncomfortable... but it has to be grade 1 (- 2) as your goal is pain relief. I would do these in conjunction with the laser, meds, PEMF, maybe TENS or microcurrent, acupuncture (distal points only) and definitely meds.
Keeping the dog quiet is important... but there is so much that rehab can do in the early stages for pain!
And yes, you can worsen the pain if your mobs / traction etc is too aggressive.
With modalities I don’t want to use anything that specifically heats (i.e. direct heat or continuous ultrasound). Laser may have an indirect heating effect but doesn’t usually increase target tissue temperature by even 1degree Celcius... so I don’t worry about creating ’bad inflammation’ with laser... but you could do that with continuous ultrasound... pulsed would be okay - but then we engage in a dialogue about ’where is the inflammation and can ultrasound reach it?’ (To which I think it cannot.)
I don’t ever use passive heat - unless I am alternating hot-cold-hot-cold. I would far rather use ice if given a choice of one over the other... from a therapy standpoint - ice is far superior. I do worry about passive heating causing ’bad inflammation’, which icing won’t do... (even with a ’rebound vasodilation’ after icing slows blood flow originally, when it kicks back in it doesn’t exceed the original flow... so it’s perfect actually... pain relief, vasoconstriction, and then a gentle ’flushing’ of the area afterwards.)
So my rule of thumb is that if there is heat, swelling, or inflammation - go with ice.
If it’s a stiffness issues - go with heat (or other therapies that will directly target the root of the problem).
I hope this helps!