fourleg.com

hello Laurie, 
I have been studying your videos and reading your articles as well as getting more practice with my exams....this is all so amazing.....thank you so much for everything that you do.....ok, so I do have a question....
so when I am doing my exam of the spine and I am applying DV pressure either bilateral or unilateral and pressure along the spinous process (and even doing a cervical side glide), how can I know if flinching and an obvious pain response such as moving away and yelping (I felt so bad when the pup yelped when I attempted a side glide of C6/ C7; his muscle were tense and I really tried not to dig too hard) is the result of the a pinched nerve/nerve root entrapment or facet joint dysfunction vs muscle tightness? 
For example, I think the paraspinals can be tense and painful because they are overworked..... say the pup is shifting weight forward or there is lordosis present.....I presume that these change will eventually put pressure on the vertebrae as you suggest for a dog with lordosis; then we will see both problems....
I am just wondering because this may affect my treatment choice! 
I hope this question makes sense! 

I do hope to be able to make it to Santa Barbara this year to see you!! Cross my fingers!! 
Thanks so much,
J.

Hi J,

Okay… So, you factor into equation the degree of pain.
Facet joints are far less painful than a disc (degenerative disc or a disc protrusion).
Firm pressure on a totally normal joint (spinous process or transverse process or articular pillar) does not yield a twitch or fasciculation.
When there is an exaggerated response (i.e. full on muscle spasm or the dog buckles in pain) then I think disc.
If the pain is bilateral, I lean towards disc (super reactive, I think acute disc;  moderately reactive, I think DDD).
You then factor in muscle tone:  bilateral changes in muscle tone, I think disc (and either too much or too little).  Too much tone, I think acute disc, hypotonicity I think DDD.

In the L/S or T/S an acute disc won’t take to much of any direct manual therapy.  You can do it in the neck - gently.
When I go in on C6 & 7, especially on a small dog, I always go super slow, because if there’s anything there, you can get a yelp.  But if you go slow, it’s usually a scared yelp as compared to a pain yelp (if that makes sense).

Go to the Articles section and then the Differential Diagnosis section.  That might help a bit.  I used to have a document - Thinking like a Physical Therapist - that I would give to the vets when I was teaching with CRI.  Let me see if I can find it.
Found it… but I’ve not checked it / updated it.  The differential diagnosis documents might be better… but these are all a start.

Oh, and overuse from a weak or neuro dog pulling itself up - I expect them to have Thoracic Spine pain (secondary… but it responds well to manual therapies - but not DV pressures).
and the lordosis in the LS - those do well with manual therapy - but again, not DV pressures.


I hope this helps!

Laurie

Thank you so much, Laurie!
So the level of pain is key!!& knowing that pressure on the transverse & spinous process should not produce fasciculations in a normal joint really helps!!
J