Lameness and Sports Medical Exams

Lameness and sports medical exams are the single most useful diagnostic test there is for determining why your cat or dog is limping.

Most patients present with more than one issue. Pain in one area often causes a shift in posture that over time can causes secondary issues.  Often, the secondary injury becomes more painful that the issue that caused it in the first place. Only by considering the patient as a whole, rather than focus just on what hurts today, can a proper therapeutic plan be devised.

Short Answer

Many patients present with a true lameness, carrying or obviously favouring a specific limb, but some present with more subtle signs, hesitation before jumping into the car or not stretching or shaking as well as before. Addressing issues at this early stage often simplifies treatment.

Similarly, a good lameness exam is part of a comprehensive preventive medicine program, particularly for competition, working, or otherwise athletic dogs. By identifying imbalances and weaknesses early, before they cause serious injury, your pet’s athletic career can be enhanced.

Dr Lane’s lameness exams typically include the following:
  • Static Exam – consideration to body conformation, muscling, posture, etc.
  • Gait Analysis – an assessment of how the patient moves
  • Orthopaedic Exam – assessment of the bones and joints, range of motion, etc.
  • Muscular Exam – palpation of individual muscles for comfort, tone and flexibility
  • Neurologic Exam – assessment of cranial and peripheral nerve function
  • Chiropractic Exam – assess the movement of every vertebrae and their associated structures
  • Acupuncture Exam – use clues from Chinese medicine to aid in diagnosis

Long Answer

Because no anatomic structure works in isolation, lameness or sports medical exams are best approached holistically: the symptom that prompted the appointment may not be the root of the problem, and unless the root is addressed the problem will likely recur.

Different schools of medicine have different perspectives and each may see the same lesion in a different way. Complicated issues often need multiple perspectives in order to find the best solution.

 Every school has its strength:
  • Rehabilitation Medicine works well for assessing muscle groups and how they relate, and evaluating imbalances between them – information that can be used diagnostically and therapeutically.
  • Chiropractic Medicine works well for addressing restricted or painful movement in the vertebral column and its relation to the nervous system. It is the single most useful tool for treating muscular back issues, which are exceedingly common in pets.
  • Western medicine provides the best perspective when surgery or prescription medication is needed.
  • Eastern medicine ties physical and emotional/mental health together, views the patient holistically, and makes use of information that is not considered significant from a western perspective.

 

Most lameness issues did not start with a perfectly healthy pet that suffered a major trauma and is suddenly lame.

Although this does happen, the more common situation is that the pet suffered a microtrauma that caused weakness or imbalance, then another microtrauma that worsened the situation, then another and another until something becomes the final straw1. Although it is important to correct the cause of the lameness, it is also equally important to determine why it happened in the first place, and what can be done to prevent it from happening again.

References

1 Oddly enough, Dr Lane’s favourite example of this involves his wife. Last year she was bucked off a horse and thrown into the metal strut of a building. She was sore, but recovered. A month later, she went to lift the tailgate of her truck (with poor posture) and tweaked her back some more, but recovered just fine. A few months after that, while sitting at the computer for a few hours, her back seized so painfully that she needed to be loaded onto a spinal board to be taken to the hospital.

It doesn’t take a diagnostic genius to wonder if these events aren’t all connected, that even though sitting in a chair isn’t great for the back, this problem really started when she got thrown into a building. Maybe it started even earlier than that. There was an episode involving a mountain bike and a fall from an A-frame… but that’s another story.

In general, the earlier these issues can be caught, the less involved the treatment is. This is why many people, particularly those with athletic and competition dogs, will book preventive or wellness appointments to head off problems before they become debilitating. Asymmetries in movement, something as simple as not being able to stretch one leg as far as the other, can indicate that trouble is brewing. Another simple example is the “wet dog shake”. Normally, it should progress from nose to tail; if it stops part way, or is no longer as vigorous, then something is wrong and should be addressed before it manifests in a worse form.

In the same way that the lameness exam is best served by multiple perspectives, so is the treatment. Anti-inflammatory medication is not a complete treatment. Surgery without a rehabilitation program is not a complete treatment.

Every case is different, but the main topics to consider are:
  • Surgery – is this a surgical situation? If so, then there needs to be a discussion of the pros and cons for each of the different surgical procedures available and of the aftercare with a prediction of the most likely outcome and potential complications. This information should be balanced against the most likely outcome without surgery, and what the non-surgical treatment would be.
  • Soft Tissue Therapy – Is the condition likely to responds to chiropractic and rehabilitation medicine tissue handling techniques, with or without other tools such as lasers, acupuncture etc.
  • Rehabilitation Programs – are always helpful and involve more than just weight control. Therapeutic exercises help build strength and co-ordination, balance muscles, and improve comfort.
  • Prescription Medications – what is available and what are the risks/benefits to each one? How can we find the minimal dose required to have maximal effect?
  • Supplements – are there any nutritional or herbal supplements that have been shown to help?
  • Regenerative Medicine – what options are available, and how are they likely to help?