Manual therapy ideas for severe hip dysplasia

[Elizabeth24]

Hello, I am asking the forum members whether they have had any successes with joint mobilizations in cases of severe hip dysplasia. I just saw an 11 yr old MN, lab mix, 68 lbs (body condition 7/9) with x-ray and clinical diagnosis of the severe condition of both hips. There is so much bony remodeling and periarticular fibrosis that even under sedation for x-rays, we got very poor hip extension. His gait is more of a short-striped side to side pelvic and lumbar wiggle, and he bunny-hops to get up stairs.

He is on an NSAID and glucosamine supplement already, and I also plan to add gabapentin. He has not had any formal rehabilitation program, and I plan to start one for him. I know controlling pain is a primary goal, and I was wondering if using Grade I and II Maitland mobilizations on his hips in caudal hip glides would have any effect on reducing pain. The cranial hip glides would be next if he tolerated the caudal ones. I was also thinking of just gentle hip distractions. I think there is also benefit of hip “scouring” but was not sure how to apply it if there is very little hip extension.

I appreciate this forum for the opportunity to see different ideas, and I look forward to any interactions here.

[lehughes]

Hey Elizabeth,

I'm sure this dog will do great with any additions you make.

So, in regards to mobilizations, I'd stick with lateral distractions and joint compressions in various stages of extension (as able). And grade 2 would be my goal for these as well. I'm not a fan of cranial or caudal glides... pretty much because you can't really create any movement in the hip joint with those directions, being that it's fairly 'packed in' as a 'ball and socket' joint, and secondly because there's so much fibrosis and remodelling, there would be even less available mobility.

However... I've had some really nasty hip OA cases that just don't do well at all with mobilizations or stretches. In these cases, I have 100% stuck with pain management. My favourites are laser, shockwave, PEMF, acupuncture (and/or dry needling into the deep gluteal muscle), massage and myofascial release techniques (mostly directed at the glutes). Some focus on secondary sites of pain / discomfort (iliopsoas, sartorius, lumbar spine, and/or the SIJ). For ROM, I might prescribe 'loving on the stairs' (front feet up on a step or stair number one, while the owner gives praise, attention, or treats). Just keep it simple... the hips didn't get that way overnight, so they won't improve quickly (or maybe not ever... in regards to ROM). I find it easier to remind myself of this, rather than beat myself up for not seeing improvements in ROM.

Getting pain management sorted from a medical and/or nutraceutical perspective is key as well. Oh yes and weight loss.
So, any sort of easy and fun exercises to simply get the dog moving are great. Don't worry too much just yet about 'gluteal specific' exercises, think global exercise. Overall wellbeing and general health... which will help with pain management, which helps with limb use, and so on.

Best of luck!

Laurie

[Elizabeth24]

Hi Laurie,
I do appreciate your advice. The distraction mobilizations do sound more doable and practical vs glides in these joints with minimal mobility already. I do plan to add laser treatments, and that great iliopsoas article you posted in your newsletter will be helpful also. He walks around in lumbar spine and hip flexion, and his iliopsoas and deep spinal flexors are in constant use.

As far as massage, I was thinking of warming up the area with gentle heat prior. I was going to ask a question about use of a hydrocollator for longer and better heat penetration vs warm moist towels that cool off too quickly. I know from human experience that warm tissues feel better for massage if the area is painful to begin with. Does anyone here use hydrocollators in practice, and if so, what precautions do they take as far as minimum towel layers between the dog and the hot pack. I know the dog’s age and body condition would matter also as far as tissue heating.
I appreciate this forum and the oppportunity to ask some basic questions!

[lehughes]

Hot and Cold is an interesting topic in canine practice. The hair can change what actually happens below the tissues significantly. You could likely think of greyhound or whippet hair coat to be almost human in penetration, but other dogs, the hair acts as an environmental barrier. So we don't really know how much the heat penetrates. There are no studies.

So, to be honest, before massage, I wouldn't worry too too much about heat. It might just be one of those steps that in a dog doesn't translate much. Try it without before adding in an extra step.

Best of luck!

Laurie

[Elizabeth24]

I hadn’t thought too much about the hair coat as insulation against heat or cold penetration, so thank you for that reminder.
As far as the case I was going to work on goes, he suddenly had a seizure-like event and was then unable to move his back legs and he had labored breathing. He died on the way to the emergency veterinary hospital. We don’t know what happened as there was no necropsy. I am always suspicious of cancer and something suddenly hemorrhaging in cases like this.

I will at least now have more ideas for the next severe hip dysplasia case I see, and I thank you for that.

Elizabeth

[lehughes]

Oh gosh! That's too bad Elizabeth.
I'm sorry for everyone involved.

Laurie