Veterinary Medical Manipulation Erica Johnson, DVM, CVMM S - - PowerPoint PPT Presentation

S

Veterinary Medical Manipulation

Erica Johnson, DVM, CVMM

Chiropractic vs. VMM

S Chiropractors perform manipulations on humans and have

the letters DC (Doctor of Chiropractic) after their names

S A veterinarian that is licensed for manipulation is NOT a

• chiropractor. Chiropractic is a human specific term.

S CVMM’s cannot perform manipulations on humans and

DC’s should not manipulate a dog or cat without the appropriate training. Do not allow your chiropractor to adjust your dog or cat unless they have had the proper training.

The Activator

S Common tool used by human chiropractors S This tool is not recommended in the

veterinary practice of manipulation

S It can be set for different strengths but has

too much force for companion animals

S Do not recommend allowing this tool to be

used on companion animals.

S Anyone can get certified to use this tool

Who needs VMM?

Everyone!!!!

Terms to Know

S

Subluxation: This is the manipulable lesion (the area that is “out of place or out”) – lack of range of motion

S HVLA: Type of thrust that we use to manipulate (High

Velocity Low Amplitude)

S Listing: Descriptive name for the restriction – diagnosis S Hypomobility: Decreased movement felt with palpation S Hypermobility: Increased movement felt with palpation

Effects of Restrictions

S

The effects of restrictions can be divided into 3 categories:

S

• 1. Local effects

S

• A. Cartilage degeneration

S

• B. Adhesions

S

• C. Circulation (decreased)

S

• 2. Nervous system effects

S

Decrease in cortical stimulation

S

Decrease in sympathetic and pain inhibition

S

Pain

S

Peripheral nerve function S

Compensatory effects

S

Adjacent motion units

S

Muscles

S

Tendons

Conditions That Need Spinal Manipulation

S

Spondylosis

S

Grade 1 and 2 medial patellar luxation

S

Osteoarthritis

S

IVDD (once things are calmed down)

S

Agility dogs

S

Trauma

S

Lick granulomas

S

Idiopathic epilepsy (reduce frequency)

Lick Granulomas

S Most lick granulomas are due to

restrictions of the vertebrae

S Based on where they are licking

can determine the exact nerve that is affected and its associated vertebrae

S Instead of using a conventional

medication we should perform medical manipulation to see if that resolves the issue

What To Expect During The First Session

S Get an attainable goal in line for your pet S Watch them walk around outside, in the room, see how they

sit and naturally carry themselves

S Perform physical exam and motion palpation S Depending on what is felt may perform k-laser, cold laser or

acupuncture prior to manipulation

S Perform the manipulation/adjustment

The Manipulation Process *Pelvis and Sacrum*

S Start with the pelvis and sacrum S Pelvis can be posterior or anterior

S

Palpating the anterior part of the pelvis can be painful. They may vocalize or turn with touching this

• area. Iliopsoas in this area as well.

S Sacrum has a base and apex

S

Base: Dorsal, right or left

S

Apex: Right or left

The Manipulation Process *Lumbar Spine*

S Lumbar spine has 7 vertebrae S Lumbar vertebrae can be

dorsal, right or left

S This is where most dogs have

spondylosis.

S Support system of the

lumbar vertebrae is all muscle!!

The Manipulation Process *Thoracic Vertebrae and Ribs*

S

13 Thoracic vertebrae

S

13 associated ribs pairs

S

Thoracic vertebrae can be dorsal, right or left

S

Ribs can be dorsal, cranial or caudal

S

12 ribs have cartilage connecting them (sternum) and the 13th rib free floating

S

Ribs can be painful with palpation and manipulation. Be prepared for a reaction.

The Manipulation Process *Cervical Vertebrae*

S

7 cervical vertebrae

S

C1 is the atlas

S

Atlas is cranial or dorsal

S

C2 is the axis

S

C3-C5 typical vertebrae

S

C6 and C7 are transitional segments

S

C2-C7 are either body left or right

The Manipulation Process *Thoracic Limb*

S Scapula S Humerus S Radius S Ulna S Accessory carpal bone/Carpal bones S Metacarpals S Digits

The Manipulation Process *Pelvic Limb*

S Femur S Tibia and Fibula S Calcaneous S Metatarsals S Digits

The TMJ

S The most important joint in the body! S It has very important

sensory/proprioceptive value as it has more neurologic receptors than any

• ther joint in the body!

S Periodontal ligaments are innervated

and give constant feedback about position of the mandible and head

S

Need to be adjusting all pets after dental procedures especially with extractions as we have completely altered their feedback system

The TMJ

S This can be a painful location to manipulate! S Typically not going to do an HVLA

manipulation but more traction because of the pain and sensory input in this area

S TMJ has a few listings:

S

Dorsal compartment left or right (lateral movement)

S

Ventral compartment rostral or caudal (open/close)

The TMJ –Most Predisposed Patients to TMJ Issues

S Animals with dental disease and/or

recent dental procedure

S Animals with little or no remaining

teeth

S Working dogs that train to bite or are

using a tug/chew/ball (agility)

S Previous trauma to the TMJ/Mandible

Nails, Nails, Nails!

S Nail length is the #1 most

important thing that we can control to prevent arthritis

S If the nails are too long will

alter their gate completely. This leads to issues up the limb and into the spine.

S It also weakens the flexor and

tendons leading to tendon laxity

S Keep nails trimmed!!! Atrium

can help!!

Additional Modalities

S

K-laser

S

Cold laser

S

Acupuncture

S

Tu-ina (massage)

S

Assisi loop

S

Hemp Rx

S

Herbals/Homeopathics

Therapeutic Laser

S Typically will use this prior to

manipulation especially with tight and spasming musculature

S Uses:

S

Wound healing

S

Analgesia

S

Edema

S

Inflammation

S

Muscle spasm

S

Increases circulation

Assisi Loops

S PEMF (Pulsed Electromagnetic Field) S Causes nitric oxide release which causes

immediate anti-inflammatory effects and decreases edema

S Improves wound and tendon healing S More rapid neovascularization (increases

circulation)

S Do 2-4 treatments per day!

HempRx

S

Extracted from the hemp plant and is the purest form of hemp oil (better than CBD)

S

Use liquid CO2 extraction so purify the product of heavy metals, solvents or pesticides

S

Used for pain control, seizures, nausea, stress, anxiety and cancer symptoms.

S

No side effects with proper dosing and safe for patients with organ dysfunction

S

NASC seal!!! Do not use products without this seal

Herbals/Hemeopathics

S Body Sore S Devcor mobility S Mobility Flex S T-relief S Essential Oil Blend

S Lavendar + Copaiba

Additional Support

S

Acupuncture

S

Conventional Medication

S

Rimadyl or Metacam

S

Gabapentin

S

Tramadol

S

Methocarbamol S

Rehab with Kathy and Allyson

S

Tu-ina

S

Exercise and strength conditioning plan

S

Therapeutic Ultrasound

S

UWTM

Agility Gone Wrong

S https://www.youtube.com/watch?v=A4N7G29GWQI

Questions?