Scooby Doo is an 11-year-old male neutered Australian shepherd mix that presented with a two-year history of stiffness when rising and after play. He was having difficulty getting up and walking for any distance without limping. He had not had an orthopedic examination in the past, but a short course of a nonsteroidal anti-inflammatory had not improved the lameness.
Presentation and physical exam
On presentation, Scooby Doo was bright and alert with an outgoing personality. Initial gait analysis indicated that his stride length was shorter than normal in both rear limbs. He also appeared to have decreased flexion and extension of his thoracolumbar spine when moving. In the examination room, he sat down slowly and with care. His posture was normal.
A physical examination was conducted. Scooby Doo’s temperature, pulse rate and respiratory rate were all within normal limits. The rest of the physical examination was also normal with the exception of the orthopedic and neurologic aspects:
• The orthopedic examination revealed some discomfort on palpation of the paraspinal musculature of the lumbar spine. There was also a general reduction in the flexion and extension of the lumbar spine. A slight reduction in strength was detected in both rear legs as well as the tail. The rest of the orthopedic examination was within normal limits.
• The neurologic examination revealed no problems with the cranial nerves. Mentation was normal. The only abnormality was a slight proprioceptive deficit identified in both rear limbs. Reflexes in all the limbs were normal.
A chiropractic examination was then conducted. The static examination again confirmed there was pain in the paraspinal muscles along the lumbar spine. This area of the lumbar spine was also cool to the touch. The spinous processes of the following vertebrae were found to be in an abnormal position at rest: C1, C2, C5, T3, T6, T7, T11, T13, L2, L3 and L4. In addition, the right tuber coxae was found to be higher than the left tuber coxae, and the sacral apex was found to be left of midline.
The motion of the spine was then assessed through palpation. Reduced movement was identified in all the vertebrae mentioned above. The right tuber coxae would not move ventrally, and the sacral apex could not be moved to the right.
The chiropractic listings for the problems found were ASL, C2BL, T3P, T6PL, T7PL, T11PR, T13PL, L2P, L3P, L4P, Right PI and Sacral Apex Left.
The decision was made to do a chiropractic adjustment on Scooby Doo. Afterwards, the motion palpation was repeated to confirm the chiropractic issues had been resolved. His gait was analyzed and found to have improved. His stride length in the rear limbs had improved and his spinal movement appeared to be more fluid.
Scooby Doo was re-examined ten days later. His owners reported that he seemed more comfortable in general and was more willing to go for longer walks without limping. On examination, he appeared to move well with only a slightly reduced stride length in the rear limbs. He was more willing to sit, with less hesitation than during his first visit. No pain was palpable in the lumbar spine. Strength had improved in both rear limbs as well as the tail. There were no neurologic problems detected.
The chiropractic examination still revealed problems throughout the spine and pelvis. The chiropractic listings found were ASL, C3BL, T5PL, T11P, L2P, L4P, Right PI and Sacral Apex Left. Another chiropractic adjustment was done and Scooby Doo was sent home with no exercise restriction.
A third examination was performed three weeks later. The owners reported an increase in mobility and energy since the previous visit. Gait analysis was normal, and Scooby Doo sat in the exam room with ease. No pain was found on spinal palpation.
The chiropractic examination again identified problems in all parts of the spine and pelvis. The chiropractic listings identified were ASL, C5BR, T11P, L4PR and Sacral Base Posterior. Another chiropractic adjustment was performed and a recheck examination was scheduled for two months later.
The specific chiropractic examination consists of gait analysis, posture analysis, static palpation and motion palpation. The elements of both the chiropractic examination and treatment (adjustment) have been adapted from chiropractic in humans.
1. Gait and posture analysis from a chiropractic standpoint are no different than those used in Western medicine. They allow the practitioner to document deficiencies and help identify potential areas with chiropractic issues.
2. The static examination is simply the palpation of the spine and extremities at rest. Resting spinal morphology and position is assessed as well as any heat, pain or swelling in the spine or extremities. This prepares the practitioner for the most important part of the examination, motion palpation.
3.Motion palpation involves moving each vertebra and the bones of the extremities through their normal range of motion. This requires the doctor to have a knowledge of both normal anatomy as well as what the normal range of motion should be in each area of the spine as well as the extremities. Normal spinal motion involves movement in flexion and extension, lateral flexion, and rotation (three planes of movement). Vertebrae can have an abnormal position at rest (identified during the static examination) with normal movement or abnormal movement, or they can have a normal resting position yet have abnormal movement in one or more planes. The doctor then decides whether these are simply chiropractic problems (chiropractic subluxations – a dis-relationship between bones of the spine) or if they could be more serious orthopedic issues that require further diagnostics.
There are multiple listing systems for describing the problems found during the chiropractic examination. These systems allow for proper record keeping and the communication of abnormalities to owners and colleagues. Some involve describing the abnormalities of the vertebrae at rest, using a reference point, and some describe the abnormalities found based on abnormal spinal movement.
The listing system used for Scooby Doo is an adaptation of the Gonstead System, which uses a reference point for each vertebra to describe its position at rest. In the cervical spine, the reference is the position of the vertebral body itself in relation to the other normal vertebrae. For example, the C3BL listing indicates that C3 was found to be positioned abnormally to the left of the other vertebrae on static palpation. In the thoracic and lumbar spine, the spinous process is the reference point. A listing of T11P indicates that the spinous process of T11 is found to be more posterior (or dorsal) at rest than normal.
Chiropractic adjustment involves manually correcting the subluxations found during the examination. There are over 150 different chiropractic techniques used in humans, and many of these have been adapted for use in animals. The chiropractic adjustment has been defined as a high speed, low amplitude force applied to the spine or extremity in order to restore normal motion.
In summary, chiropractic is a useful physical modality in the treatment of mobility problems. It can also be helpful in the treatment of many internal medical problems. The doctor performing chiropractic should be trained in its use in animals in order to assure the process is both safe and effective.