Laurie's Blogs.

 

08
Jul 2013

Fibrotic Myopathy... Question of the Week!

Hi Laurie,

I am getting a new referral for a shepherd with fibrotic myopathy.

Any new developments that you know of for treatment for these guys?

Haven't seen him yet, but I assume that US, deep tissue work and stretching are the biggies for treatment?

Any prognostics you can provide for the efficacy of rehab?...and any other suggestions for treatment?

UWTM useful for AROM, or is that a waste of resources?

Any input would be great!

Thanks!

k

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Hey K,

So, it all boils down to suspected cause:

Idiopathic ones - just don't get better

Neurologic ones - just don't get better

Traumatic ones - can improve with stretching... I JUST e-mailed another practitioner about this... I'm going to get lazy & just cut and paste the story I told her...

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I think that most of the time we see very progressive fibrotic myopathy because 'regular owners' don't notice it until it gets that bad.  Some show people may notice it but bury their head in the sand thinking it is simply a movement fault that they could work out and/or some genetic fault.  And so really, the performance people are the ones most likely to pick it up early.

So next, we have to realize that there are different forms - Idiopathic (which I've never had success in treating), Neurologic (which don't improve either), and Traumatic (which you can think of as  trauma which led to scar tissue build up.)  So, if we have a traumatic form - we treat / address the muscle issue / scar tissue issue - and the prognosis can be good. 

I have had one of these in my career - and she did great.  Owners described a wobble in the hocks when transitioning from walk to trot and vice versa.  It seemed to come about after some issue about a year previously.  We tried ultrasound, (didn't have a laser then - or I'd have used it), dry needling (but I was new to that and a bit timid), e-stim, and eventually VERY aggressive stretching (I didn't start with this - but we had tried it all... 3 sets of aggressive 10 second stretches while the poor dog cried)... and it worked! 

So I would recommend starting slow (stretches, laser, ultrasound (I think you said you had that - or had tried it), dry needling, thigh building exercises - hill work), and if you need to you can throw the aggressive stretches out there once the owner has come to trust in your decisions & plan... (and / or be upfront that the other things will be your first line of attack - but if they don't work, you have something a bit nastier up your sleeve... but you don't want to start with it.)

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And if you have one that is idiopathic - then you just work on function... in which case the UWT might be useful... but you may have to provide the owner with some reasonably reduced expectations.  Of course they don't want to hear that right away - so you could 'try'... for a bit... and then bring them around to your way of seeing it.  The idiopathic ones aren't painful.  The trauma induced ones are only painful initially and then they aren't either.  So all in all it just ends up being a mechanical restriction.

Fingers crossed!  Good luck!

Laurie



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