Laurie's Blogs.

This past week I had a client come in.  She had been to her vet earlier in the week as one of her Bernese Mountain Dogs was having episodes of crying pain and not wanting to move when it happened (most recently when getting out of a vehicle), unwillingness to get into the vehicle, and apprehension to get onto the couch.  The owner told me that her vet had said, “I think its IVDD but see what Laurie thinks when you see her”, knowing that the dog had an appointment with me on Saturday.   

I told the owner, sounds like lumbosacral disc disease signs and symptoms.  Let’s see what we find.

Sure enough, the dog was painful at L6 and L7, her pelvis was asymmetrical with pain on the right piriformis and SIJ, and her placing reflex on the right was slightly delayed.  So I concluded that lumbosacral disc disease was the most probable root of the problem.  Here’s my deductive reasoning for that:

• Large breed dog and sudden onset of symptoms (less likely to be a Type 1 disc lesion, and too quick to be a Type 2 disc lesion, and not neurologic enough to be ANNPE, HNPE, FCE).
• Unilateral placing reflex deficit puts the lesion in the caudal L/S most likely.
• Avoidance of extension activities.
• Transient pain resulting in crying and unwillingness to move.
• Physical findings that correlate, both pain at L6 & L7, as well as a sacroiliac joint dysfunction, which (as I have found over my years) can have a negative impact on the lumbosacral environment / positioning / nerve root ‘happiness’.

I’ve actually been seeing quite a few cases similar to this recently, and many others over the years.  My treatment strategy (and rationale) has been to treat from the outside in and inside out.  Successful treatment looks like this:

• Mobilize the sacroiliac joint(s), and mobilize L7 and L6.  The specifics are “whatever is needed” for the SIJ, and L6 and L7 should be mobilized (in my hands at least) in such a way as to ‘open’ the facet and nerve root environment on the most painful side / most affected side.
• Modalities and therapies directed at reducing pain and inflammation at the L7 nerve root.  Photobiomodulation (laser therapy), shockwave, acupuncture are all good therapies to select in this regard.
• Home program should include tail pull traction (which can theoretically increase blood flow to the L7S1 region and open up the facet joint space and nerve root environment).
• As the area is settling down, it is wise to avoid extension activities (i.e. jumping into the vehicle, onto the couch, or doing much stairs or hill walking).  I prescribe pelvic tilts in sternal as an exercise to introduce a safe amount of extension (it seems to acclimatize the area to extension, and I speculate could also be helping improve blood flow locally as well).
• Then for the inside out aspect, I advise the clients to either discuss with their veterinarian a good option for an NSAID (if they are not already on one), or to continue giving an NSAID (if one has been prescribed), or to try a herbal / natural anti-inflammatory product (my favourite at this time is Voltrex by Gold Standard Herbs – we are really liking this line of products, just FYI).

And thus far, I’ve been fairly happy with this approach for my lumbosacral disc disease cases.  SOME have needed cortisone shots into the L-S area, those that have been more severe.  However, these mild cases seem to resolve, and the chronic cases that yo-yo in and out of being symptomatic seem to keep injections or surgery at bay with this protocol.  (The addition of the herbal anti-inflammatory has been a game changer, in my opinion.)

I’m hoping that this train of thought and rationale might be useful for others as well.

Until next time, 

Cheers!  Laurie