Laurie's Blogs.

What to notice when asking a dog about pain.

That might sound like a funny way to put it.  You can’t literally ask a dog where it has pain.  This is an argument I’ve heard from some animal physiotherapy deniers in the past.  However, anyone that has worked with animals or owns and animal will tell you that they most certainly can communicate that they are in pain.  This is no different than working with infants, young children, or non-verbal adults.  

So, when doing a physical rehab assessment, how do you assess for pain?

1.  Posture and Gait.  While alterations in posture or gait don’t correlate 100% with pain, they are a good place to start.  Limping is usually pain related.  Off-loading a limb is usually pain related.  Shifting weight forwards or backwards might be an indication of pain.  So, posture and gait observations are always a good place to start.

2.  Licking, chewing, and porphyrin staining.  These things might indicate that a dog is irritated by a certain area or trying to self soothe a painful region.  Pay attention to these, both locally (i.e. directly under the area in question), or proximally (i.e. following the dermatomal distribution of a nerve).

3.   During palpation, watch the dog’s reaction.  Here’s where I believe the ‘art of assessment’ lies.  

     a.  Test the dog’s reaction on a presumed non-painful area to see how the dog reacts to  non-painful but firm palpation.

     b.  Know exactly what structure you are on.

     c.  Palpate firmly and with intention – poke or strum the structure as appropriate.

     d.  Watch for a change in ear position, a drop in body position, holding of breath, turning of head, sudden ‘paying attention’ to what you are doing.

     e.  Notice skin twitching and reaction of the body to what you are doing.

     f.  Note anything obvious – rubor, calor, tumor… (redness, heat, swelling).

     g.  With range of motion, be sure to try to get an end feel so as to also evaluate if there is pain at the end of range (noting the dog’s reactions).

Now, the next part of the ‘art of assessment’, is to take your time so that the dog feels somewhat comfortable in the situation.  Just petting or perhaps a treat can win friends and influence canines!  The other thing I do is have the owners at the head of the animal so that they can provide some support.  If I think I’m going to hit on something I believe will be sore, I warn the owners.  I also talk through the assessment so that the owner knows what I’m doing and is prepared as well.  My dialogue sounds a bit like this, “Okay now Kujo, I’m just going to poke this spot over here.  You let me know nicely now if that hurts.”  This way, the tone of my voice can add to the calming ‘vibes’ and it also lets the owner know what I’m doing.  

The acknowledgment(s) and apology / apologies are important as well.  Whenever I find a sore spot, I give the dog a little rub and thank them for telling me.  I tell them, “Good job.  Good telling.”  If it’s very sore, I apologize, “Oh honey, I’m so sorry.  Good telling.”  If I’m unsure of a response or I feel it’s important to retest, I give the dog a ‘heads up’ by saying, “Good job, now I just have to ask about that spot again.”  If it’s painful twice, then I really do need to apologize and maybe even deliver a cookie after that poke or prod!  This technique, which may sound a bit silly, really does make a difference, and I urge you to give it a try.  

It's also important to note that some dogs (very stoic types) will only show you pain once.  So be fully cognizant of what you are doing and what structure you are on the first time round with these pups!

There are so many tips… I almost forgot this one.  If you can do a certain test in the position the dog wants to be in, then do so.  If lying a dog down is stressful, then assess what you can in standing or sitting.  Invent new ways to do the same thing!    I like testing for patellar luxations in standing.  I can evaluate a medial shoulder instability in standing as well.  I even had a family of Weimaraner that would come in and lay on their backs, impossible to keep standing.  So I learned to do SIJ and spine assessments and mobilizations with the dogs in supine position!

This is only a blog.  I’m sure I’m missing some tips and of course a variety of scenarios… but hopefully this adds to your thought processing or confirms what you have been doing!

Until next time…

Cheers!  Laurie