Drooling & Gulping - Is that a physio problem?

29 Sep 2018

Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT

So, what do you think when you hear that your next patient is drooling more or gulping and clearing his throat more, perhaps even sneezing?  Well, this blog will give you one more differential to put into your list of things to think about!

Recently, I had an interesting case.  It was an older dog who had recently seemed to develop allergies.  He would sneeze near the hay, sneeze in the barn, and generally was having issues that would necessitate him swallowing more often, gulping, and clearing his throat.  He had been scoped and put on Prednisone, which just gave him diarrhea.  So, he was then also put on Metronidazole.  All in all, here it was 5 days later, and while in the clinic for his regular physio session, he was gulping and hacking.  

I decided to treat him as if he had laryngeal paralysis (despite his scope to look at his larynx had revealed nothing).  I did acupuncture for the upper cervical spine and laser to the same region.  But midway through the treatment, as nothing was settling down the gulping, I thought about checking C1.  His C1 was rotated to the right.  I mobilized it, which was a bit uncomfortable for him.  However, when I finished, so had the gulping!!  I admit to having been amazed, and so was the owner!

At lunch, I was telling the story to some of my coworkers.  One staff member had remarked that it was a few years ago that she had noted her dog was drooling more than usual.  She had asked one of the therapists to check the dog.  On her we also found a C1 dysfunction.  It was mobilized and miraculously, the drooling stopped! 

FASCINATING!

Now, if you do a bit of a search (just to remind yourself naturally) about what C1 supplies, Wikipedia can remind us!

The cervical spinal nerve 1 (C1) is a spinal nerve of the cervical segment. C1 is unique in that all other spinal nerves have both sensory and motor fibres, whereas C1 carries only motor fibres and also a small meningeal branch that supplies some parts of the floor of foramen magnum (via hypoglossal nerve).  It originates from the spinal column from above the cervical vertebra 1 (C1).

Muscles innervated by this nerve are: geniohyoid, rectus capitis anterior & posterior, longus capitus, rectus capitis lateralis, splenius cervicis, levator scapulae, thyrohyoid, omohyoid, and sternohyoid muscles.  

Then when you look up about C2, here’s an interesting little tidbit from Steven D. Waldman MD, JD, in Atlas of Uncommon Pain Syndromes (Third Edition), 2014.

The pain of neck-tongue syndrome is in the distribution of the C2 nerve root. It is intermittent, but is reproducible with certain neck movements. The physical findings associated with this pain are ill defined, with some patients with neck-tongue syndrome exhibiting a decreased range of motion of the cervical spine or tenderness of the upper paraspinous musculature. The main objective finding in neck-tongue syndrome is decreased sensation of the ipsilateral half of the tongue.  Often associated with this finding are pseudoathetoid movements of the tongue resulting from an impairment of the proprioceptive fibers.

So, in both cases, drooling and gulping make sense to be coming from the C1-2 region.  Fascinating.  As a caveat, this is not to say that all drooling and gulping is a C1-2 issue.  But from now on, I hope you at least check there too!