Laurie's Blogs.

 

29
Jan 2022

Hyperkyphosis - Thoughts on Treatment

Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT

I came across a journal article on the topic of “Decreasing thoracic hyperkyphosis – What treatments are most effective? A systematic literature review and meta-analysis.” I thought this might be an interesting topic to discuss as it relates to dogs with ‘roached backs’.  What CAN we take away from the human model and what special considerations do we need to think about in regards to a dog (or perhaps any quadruped)?

 

Let’s dive in!

 

So first, the study https://pubmed.ncbi.nlm.nih.gov/34375856/ was a review and analysis of 28 studies. Those studies could be further broken down into treatments and effectiveness in younger populations and in older adults.  What were some of the main findings?

 

  • Structured exercise programs of three-months duration or less are effective in reducing thoracic hyperkyphosis in younger and older populations.
  • Bracing for three months or more is effective in older participants.
  • The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis.

 

Okay!  Can we take this information and make any direct correlations to our canine patients?  Maybe.

 

What this study (and/or these papers) fail to address is whether or not there is a reason for the kyphosis.  In humans, we know that bad posture can cause a rounded back.  Too much time in front of the computer or TV, or not enough physical activity could be the root of kyphosis in a younger population.  Osteoporosis or degenerative discs can cause kyphosis in older adults.

 

In dogs, we can typically blame kyphosis on 1) offloading to the fronts or rears because of orthopaedic issues (think hip dysplasia or elbow arthritis), 2) overloading the front end due to neurologic weakness,  3) acute disc disease (i.e. antalgic posture), or 4) or nerve root irritation at the lumbosacral junction (i.e. tucked under appearance).  I have also spoken out about young dogs with back pain, and commonly sacroiliac joint dysfunctions, causing a roach as well.  Of course, one must also think about congenital malformations (i.e. Pugs, and French Bulldogs), which might manifest as a roached spine.

 

As such, in humans, exercise makes sense in order to change the forces pulling on the spine.  In dogs however, I DO think that treatment needs to be multi-fold.  Here’s how I approach ‘roached backs’ in my canine patients.

  1. Look for an underlying cause that would make a dog offload to the front limbs or the rear limbs.  Check all extremity joints.  Check the Ribs, SIJs, and spine (especially caudal lumbar spine).  Don’t forget the diaphragm!
  2. Assess whether there is pain at the roach?  Could this be an acute disc lesion?
  3. Check reflexes.  Is this a chronic neurologic condition?
  4. If there does not appear to be  any neurologic or disc involvement, then assess the end-feels when you perform dorsoventral pressures in the region of the roach.  Do they feel ‘hard-capsular’, ‘boney’, or ‘elastic’?  

 

Often times, if the roach is compensatory and non-painful, then you might be able to address it with therapy.  You may need to address the reason for an offloading: pain management for hips or elbows; mobilizations to the SIJs; traction for the lumbar spine, etc. Then, to address the ‘roach’, you refer back to the end-feel.  Boney end-feel?  That’s not likely to change.  Elastic end-feel?  That should respond well to exercises.  Hard-capsular end-feel?  That will likely need a combination of exercise, manual therapies, myofascial release, stretching, and postural re-education.

 

Want to go down the rabbit hole further?  Check out these past FourLeg blogs:

 

Dude, What’s with your roach?  https://www.fourleg.com/Search-Results?t=b&id=268 

Kyphosis in a growing dog.  https://www.fourleg.com/Search-Results?t=b&id=42 

Puppy findings. https://www.fourleg.com/Search-Results?t=b&id=353 

Tight hip flexors. Weak glutes.  https://www.fourleg.com/Search-Results?t=b&id=283 

The diaphragm, physio, & the myofascial system. https://www.fourleg.com/Search-Results?t=b&id=372 

 

 

So, I guess really, this blog turned out to be one on Clinical Reasoning (one of my favourite topics)!

 

The next time you see a dog with a roach, you can have a plan for assessment, AND treatment based on what you find!

 

I hope you find this helpful!

 

Until next time…  Cheers!

Laurie

 



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