Laurie's Blogs.

I was scrolling through last month’s research articles of interest and came upon a review paper on exactly this subject.  Unfortunately, I was unable to access the full paper, but the abstract gives us enough information to have a conversation about this topic and see if it might have an impact on our canine caseloads as well!



So, here’s the paper.



Lafrance S, Ouellet P, Alaoui R, Roy JS, Lewis J, Christiansen DH, Dubois B, Langevin P, Desmeules F. Motor Control Exercises Compared to Strengthening Exercises for Upper- and Lower-Extremity Musculoskeletal Disorders: A Systematic Review With Meta-Analyses of Randomized Controlled Trials. Phys Ther. 2021 Jul 1;101(7):pzab072. 

The short version, is that the authors included 21 RCTs that included 1244 patients.  All papers selected looked at the efficacy of Motor Control Exercises (MCEs) compared to strengthening exercises for adults with upper- or lower-extremity musculoskeletal disorders.

And what did they determine?



Conclusions: “MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve [Osteoarthritis] OA. Inclusion of new trials might modify these conclusions.”  (Because the results were inconclusive for OA disorders.)

What does this mean for us?



Firstly, let’s ensure that we are on the same page when it comes to WHAT IS A MOTOR CONTROL EXERCISE?

  

Motor control exercise is a popular form of exercise that aims to restore co‐ordinated and efficient use of the muscles that control and support the spine. Patients are initially guided by a therapist to practise normal use of the muscles during simple tasks.

Here’s one I use often.  Three Leg Stands with Abdominal Stimulation

Start with your dog standing squarely on all four legs. With one hand poke into the abdominals and vigorously wiggle your fingers so as to get a contraction of the abdominals and a rounding of the back, then slowly slide one hind leg backwards until it is no longer touching the ground. (Maintain the muscle poking throughout the exercise.) Hold for 2 - 3 seconds. Replace & repeat.

I did a video on this topic ages ago and put a link up on YouTube so that I could share it over and over again.  I’ll post the link here:  https://youtu.be/CtvzyPWxpio 

The video is of a dog after a spay surgery who is demonstrating loss of motor control, and the abdominal stimulation trick I use to address this issue.  I find this trick is needed for back pain dogs, some hip pain dogs, and many stifle injury dogs (usually cruciate cases).  

How does this apply to the Forelimb cases?  

Well, in those cases, I don’t usually see a chest drop or significant issues in balancing on 3-legs.  So, I tend to think of 3-leg balancing instead with activation/stimulation of smaller stabilizing muscles.

Here’s an example.

Start with your dog standing squarely on all four legs. Loop a piece of theraband around the affected limb (above the elbow).  Then slowly lift the opposite front leg off the ground. Pull slow and steady or rhythmically on the theraband.

Okay, so now we have some ideas for how we translate Motor Control Exercises to the canine patient. Great!  However, I do think it’s important to note that the review paper above does not mean that strengthening exercises are not of value.  Not at all!  In fact, your program should likely include some of both.  One thing to highlight was that the conclusions drawn were for the SHORT TERM.  We know that if we want a full return to function for the LONG TERM, you will need strengthening exercises as well.  Also, important to note that osteoarthritis cases did not see the same benefits as other MSK cases… so those are the ones that you might be better off to START with strengthening exercises.

It’s all food for thought and highlights the importance of really thinking about what you are doing and why you are doing it when you prescribe an exercise!

On that note, have a fantastic week ahead!



Cheers,  Laurie