Well, the universe just keeps on providing learning opportunities on this subject! This past week, both in terms of cases AND in terms of online education, I am seeing more and more lumbosacral tidbits of information and clinical pearls.
Firstly, I am still waiting to see the ‘kicking’ dog back for a follow up to hear if the L-S treatments prescribed have made a different yet. (Don’t know what I’m talking about? Check out this past blog - https://www.fourleg.com/Blog?b=506 ).
New this week was a Labrador (existing patient) with an acute flare up of L-S irritation. He had tried to climb up a creek bank, but couldn’t, and the owner had to walk all the way around to the other side and encourage him to swim across. He was hunched and sore and the owner had to stop every few steps to let the dog sit before they could take a few more steps, sit again, and so on, in order to get him back to the car. We were able to get the dog in right away at the clinic. He was very sore in his caudal lumbar spine and for therapy I did laser, manual traction, PEMF, and some acupuncture. I encouraged the owner to call her vet and ask about an NSAID as well. She was to do lots of tail pull traction as well. I followed up with the owner 2 days later, and the dog was much improved. I then saw him 5 days after incident, and wow, you wouldn’t have known there had been an issue! Remarkable.
Second case was a follow up of a standard poodle with L-S pain from a few weeks prior. At this point, she was much improved as well. The owner was wondering about return to activity. (This is the part I want to share about THIS case.) I advised that she could go for longer walks, but shorter than her ‘normal’, because you don’t want to end up on the far end of the field or the other side of the block, just to realize that you shouldn’t have gone that far!! So, progress gradually, adding 5 minutes per walk as able. No hills just yet (in other words, NOT the steep ravine near where the owner lives), and no jumping yet (obedience heeling would be okay). The message here is that nerves can settle down but not be 100% back to normal, so, don’t push ‘return to normal’ too quickly.
Lastly, I listened to a fabulous interview of Tom Harcourt-Brown on Canine Arthritis Management. Tom is a veterinary neurologist and has some very sage advice and honest commentary about L-S disease. Check out the full interview here: https://www.facebook.com/CAMarthritis/videos/1925015037659994
Some brilliant take-aways:
- •An MRI is not the be-all and end-all in regards to diagnosing these issues.
- •There is no rush to jump into surgery.
- •Surgery may not be the gold standard for all of these cases anyways.
- •If other therapies are working, then stick with them.
- •Spondylosis can simply mean that the body has been successful in stabilizing an area (and is not a concern in and of itself).
- •Inflamed nerves are painful… normally nerves can be stretched, poked, and pinched without issue. So, the pain the animal is experiencing is often inflammation-related versus damage or compression.
- •Look for atrophy of Biceps Femoris as one of your diagnostic indicators of L7 impingement.
- •The tail-jack / tail-hike test is not definitive, nor is pain on pressure of the sciatic nerve in the lower limb (i.e. behind the stifle).
- •Life can be good even if there is a little bit of pain.
- •One key component to diagnosing L-S disease over other neuro pathologies is the presence of pain. (i.e. there is no pain involved in laryngeal paralysis neurologic sequelae vs. lumbosacral disease).
It was honestly, one of the best things I’ve watched in quite some time. I encourage everyone to find the 1 hour and 40 minutes to watch this!!
Last story: Many years ago we had a patient go in for lumbosacral stabilization surgery. He was sore in his back and had some ataxia / weakness in the rear legs, but he was mobile. He came out paralyzed and remained that way. From that point on, I decided that all L-S dogs should try physio/rehab first and not jump into surgery for this condition except as a last resort. I am happy to hear a veterinary neurologist come close to saying that exact same thing! (Or at least, “Don’t rush into surgery.” I added the physio/rehab part!!!)
There you go! That is the latest on the lumbosacral front!
Keep being awesome guys! And have a great week ahead!
P.S. The follow up video / interview on Canine Arthritis Management featured UK physiotherapist Diane Messum. It’s a great follow up for the physio side. It makes me want to do another blog NEXT week on this topic! Anyways, here’s the link to THAT video: