In last month’s Small Animal Research Refresh, I decided to delve into a condition we all see, over and over again – hip dysplasia. The danger with a condition we’re all familiar with is that we become complacent; patients respond well to therapy, we have good results, and therefore we don’t think about it much. We stop digging into the research and we stop asking questions.
Having a dog of my own with hip dysplasia (as I am sure many of you do!), I have been traveling the road of conservative management for the last 7 years. And the truth is, in the last few months nothing I can do works anymore, and I needed to start finding new options to add to my bag of tricks, to manage flare-up after flare-up.
As an Onlinepethealth Member, my first port of call was to dive into all of the webinars we have in the members portal on this subject. I would love to share some of the take home points that I have gained as I have watched these with fresh eyes.
Hip Dysplasia: Treatment from young to old, by David Dycus
True to form, David Dycus covers this topic in detail from beginning to end. He includes a discussion on the differences between treatment for young dogs and for old. The main difference is that in a young dog, the origin of the problem is hip laxity, so that is what we address through our rehab. We need to increase the muscular strength and activation around the hip so that the joint can be held in place more effectively.
In an older dog, we are really treating arthritis and the effects of arthritis on the body.
Throughout the life of the dog, rehabilitation goals may shift, but one thing remains constant and central – we are working to provide the best quality of life we possibly can, for as long as we can. In some cases, surgical intervention can be undertaken early, and in other cases surgical intervention will be a last resort.
Hip Instability, by Sasha Foster
Sasha Foster really opened my eyes to some new ideas and challenged my thinking on a few old ones. Specifically, she added a few modalities to my toolbox that I hadn’t used before, such as Kinesiotape. How would you apply tape to achieve greater hip congruity and activation of the hip stabilisers? I encourage you to watch the webinar for instructions!
In addition, we know that the primary problem in a young dog is joint laxity, and our goal is to strengthen the joint in a reduced position. Sasha looks at some of the exercises we commonly perform that may well be achieving the opposite effect and causing the joint to subluxate, negating any therapeutic effect we may be aiming for. She shares a few ways in which we can ensure we are first reducing the joint, and then strengthening it through our therapeutic exercise routine.
Rehabilitation tools: What, when, where, how, and why to use them, by Lisa Mason
In the years that we have been practising rehab, new research has been emerging on the protocols and dosages of our therapeutic modalities. We have seen a spike in the use of ESWT, tPEMF therapy and laser therapy over the years. In this webinar, Lisa discusses these modalities, their dosages and their effects – not on how they impact a specific condition, but rather their dosage and treatment parameters for multiple conditions.
When it comes to treating hip dysplasia, I have already implemented a few of her suggested new dosages into the treatment protocols for Sasha, with good results.
Physical Rehabilitation for the Management of Canine Hip Dysplasia, by Dycus, Levine and Marcellin-Little (2017)
This is our Research Refresh for June 2020. I decided to dive into this research article because it contains a great overview of our rehabilitation goals through each phase of hip dysplasia, as well as for surgical intervention. The most important point to consider is that every aspect and phase of rehabilitation follows a multimodal, patient-centred approach.
Most of us are pretty well versed in the goals and requirements when it comes to conservative management, so the above webinars will simply add new tools to our toolbox. But are we equally well versed when it comes to surgical rehabilitation work? This Research Refresh focuses on the goals of rehabilitation and how to achieve them for each of the surgical procedures.
Beyond the Basics
The above lectures cover the common tools we use when we work with hip dysplasia, but if you have a client who is sitting in the position I am, then additional tools are needed that go beyond the norm to control pain and address progressive dysfunction.
It’s Alive! Regenerative Medicine in Canine Mobility, with Cameron Black, helped me to investigate the options available in the world of regen med for different phases of hip dysplasia.
Ground Treadmill Therapeutic Exercise, with Robert Porter has opened my eyes to a whole host of ways that I can use a ground treadmill in a very targeted and specific way to address the movement dysfunctions that are a problem for a specific case, in a home exercise environment, taking the home exercise program to a whole new level.
The Long term use of Opioids and the alternatives, with Kenneth Joubert, together with his series on Pain, opened my eyes to the myriad of medical management options available to control pain, and bring a patient through flare-ups without allowing sensitization of the neural system.
Right now I am asking myself the question, ‘Why am I not seeing more hip dysplasia patients?’ I know they are out there in their homes, so where is the gap in getting these patients into a maintenance protocol?
And on top of that, where are the surgical cases? I see them only when there are complications, but according to Dycus et al (2017), ‘Rehabilitation therapy is paramount and, in the authors’ opinion, considered the standard of care after surgery for CHD. Rehabilitation therapy will improve overall comfort, ROM, early usage of the postoperative limb, and facilitate healing.’
So my challenge is to focus on this condition when it comes to my marketing strategies. In letting people know of my services, I aim to achieve three things:
- Educate my referring veterinarians on the role that I can and should play in these patients. I can do this in multiple ways, but the best would be by hosting a CPD evening or, in these Covid times, a webinar might be the better option!
- I need to reach the owners of these dogs, and that can be tricky. Since the signs of hip dysplasia start early in the dog’s life, targeting puppy socialisation classes to educate new owners on recognising early signs can be really effective. When we do this, we’re also hammering home the information to the trainers.
- Educating dog trainers to recognise the signs of hip dysplasia and other conditions in young dogs is invaluable. A trainer will often see dogs through their first year of life on a regular basis, forming a strong relationship with both owner and pet. If they recognise the signs and think something might be wrong, they can advise the owner, who is likely to listen to their advice and pursue an early diagnosis and management protocol.
Of course, there are many other ways to reach owners, such as through Facebook and your social media marketing. The more you ‘niche down’ on hip dysplasia, the more effective these marketing channels will be for you. And if you prefer to focus on a different niche, the listed suggestions should still be helpful!
What is your story?
Do you have a story similar to mine? Do you have a dog that has changed your life for the better, but challenges you in a professional capacity to keep upping your game?
Please tell me about your friend, patient and inspiration in the comments – I will share more about Sasha in the coming weeks.