Slipping and Tripping

 

80% of dogs over the age of eight suffer with OA. 80%!!

 

But it is not only geriatric cases that are affected. It is thought that up to 35% of younger dogs are too. This figure is most likely to be even higher amongst the cases we see. That is because orthopaedic injury/surgery or the presence of a developmental orthopaedic condition are both risk factors for OA.

 

The other group to be at higher risk are those who have had a ‘less than perfect upbringing’ in respect to exercise and weight management (this is why we need to be more proactive with prevention education for owners but that’s for another day!)

 

Let’s just stop and think for a minute about what this means for your practice. Looking at those figures above I would go as far as to say that the majority of the cases you see will have some underlying OA and would benefit from mobility nursing/therapy (or have it coming and would benefit from some proactive prevention!).

 

So what is mobility nursing/therapy?

 

Providing mobility clinics/sessions is extremely valuable and can massively increase quality of life for patients with OA. This is a specific service you can offer and marketed well, it can provide a whole new revenue stream for your practice!

 

Over the next few articles, I am going to discuss the areas we need to consider for patients with mobility issues. We are going to start with Slipping and Tripping.

 

Smooth flooring surfaces like wood, laminate, or tile can cause slips and falls for dogs with arthritis. The weaker the dog becomes, the more difficult it is for them to control their limbs over the slippery flooring. This leads to repetitive strain on already inflamed joints as well as risking sprains and strains of the tendons and ligaments.

 

Owner education

 

Part of our job is to help owners understand that just because their dog doesn’t cry out when they slip, it doesn’t mean that they are not in pain. Just because they keep running (in a fashion) around the corner to the door barking when the doorbell goes, slipping all over the place, it doesn’t mean they are not in pain.

 

If you cannot visit the home, then it is essential that you spend a significant amount of time questioning the owner about the home environment and how the dog behaves at home. Sometimes with these cases a very small change can make a big reduction in pain and symptoms and significantly improve quality of life. Cool eh?

 

For example, the strategic placement of a mat might be enough to decrease stress on a particular OA joint that is being insulted multiple times a day. We can see a rapid decrease in pain with seemingly small changes like this.

 

Here is some advice we can give to owners – encourage them to think outside the box:

 

 👉  Provide traction: Use non-slip mats or rugs to cover slippery areas, especially in high-traffic zones like hallways and kitchen floors. (There are actually companies that produce non-slip flooring especially for dogs so if a renovation is in progress then this might be an option)!

 

👉  Paw grip enhancement: Consider using paw wax or non-slip booties to improve traction on smooth surfaces.

 

 👉  Nail maintenance: Keep your dog’s nails trimmed to prevent sliding and improve stability.

 

 👉  Assistive devices: Supportive harnesses can provide stability and help prevent falls.

 

 👉  Environmental modifications: Remove obstacles and clutter to create a safer and more accessible environment.

 

 👉  Home layout adjustments: Rearrange furniture to provide clear and obstacle-free pathways for your dog to navigate.

 

Outside areas

 

It is not just inside the home we need to worry about tripping and falling. Outside can be very hazardous too. Encourage owners to think about the dog’s outside environment. Is there anything that could be moved to make life easier?

 

Paths, patios and decking can become very slippery, especially in winter. Slimy surfaces can be easily fixed with a jet wash but ice can be another issue.

 

A slip on the ice for an OA patient can be catastrophic. It may be that on icy days the dog can be assisted to a grassy patch to toilet or even carried if they are small. Salting pathways is another option but make owners aware that the salt itself can cause a problem for dogs. Ingesting salt can make them very sick, so if owners are using salt to clear ice then they should be aware of this. Also, the salt can lead to sore paws. Boots or balms can help with this.

 

You can see how important it is to spend time talking to the owner and encouraging them to think about all the little things that they might not have considered. This in itself is a very valuable part of offering a mobility service.

 

Why improving traction is not enough?

 

If you read any article written about dogs with OA in the home environment, it usually starts with “improve traction”. It’s the obvious place to start (I started with this too). But I cringe when I see this advice given out without warning. In fact, making this sudden change, without working on muscle strength and joint stability can actually be detrimental in some cases.

 

Sudden change in biomechanics

 

We need to be careful when promoting a sudden change in biomechanics. During turning, when a limb is planted, the body pivots around the limb to a certain degree. It requires optimal muscle strength and neuromotor control to protect the joint during this twisting movement, both of which are usually reduced in patients with OA.

 

This sudden increase in ‘twist’ on the joint can cause injury in some cases.

 

Think skiing injuries. Anterior cruciate ligament (ACL) rupture is a common injury in skiers. An important role of the ACL is to prevent twisting of the knee joint (same as the cranial cruciate ligament in dogs). In a normal movement, as the body turns around the foot, the foot spins around with it. The quads and hamstrings also kick in to provide a ‘brace’ for the knee.

 

If you have ever been skiing, you will know that skis are designed to come off during a tumble. But this doesn’t always happen and this is what leads to so many ACL injuries on the slopes. When the ski remains in place during a fall, the limb is effectively planted in the ground and the body then pivots around this fixed point. Pop goes the ACL!

 

Now this is an extreme scenario but in ‘normal’ daily movement, a strong healthy ligament is capable of managing some of this twist. It is not designed to do it alone though. It needs assistance from the muscles around the joint. They should kick in and help to counter the force.

 

The trouble is, most dogs with OA do not have young healthy ligaments and they do not have strong muscles to support the joint.

 

Furthermore, the brain should receive a warning that the joint is vulnerable and command the muscles to respond appropriately. In these patients, the warning/messaging system is all out of sync so this doesn’t happen either.

 

I would like to be clear that I am not suggesting we don’t make an effort to provide more traction. Non slip flooring, boots, balm etc are all very useful. But I am saying that this is not enough alone and that the dog should also undergo a rehab programme so that we give them the very best chance of regaining safe, functional movement.

 

Slipping

 

Slippy flooring is not the only reason why dogs with OA slide about more than dogs without OA.

 

A dog without OA who has good muscle strength and neuromotor control will use their core strength and deep stability muscles to control their limbs and protect their joints. They will still slip around a bit but they will maintain a better limb position and correct their limbs more easily when they are out of place.

 

As a dog with OA has reduced muscle strength and neuromotor control, they usually have a weak core and poor stability around the joints. This makes their joints very vulnerable. Rehabilitative exercise can counter some of this, by improving core strength, stability, muscle strength and mass.

 

Tripping

 

The main factors that cause tripping are:

 

 👉  Reduced joint range of movement, meaning that the dog does not pick up his limbs as high as is necessary to get over the obstacle.

 

 👉  Pain – it is either painful to fold the joints enough to get over the obstacle or it is painful to bear weight on the limb that needs to stay on the ground – often it is both.

 

 👉  Proprioceptive deficit – proprioception is the awareness of limb position in space. This is almost always altered in cases with OA. Think of this as a dysfunctional brain to body connection. The brain is not aware of exactly where the limb is (or should be) and this often leads to tripping and falling. This also feeds into why dogs with OA are slow to replace their limbs into a safe position from a vulnerable one.

 

An exercise rehabilitation plan for an OA patient will address all of the above 😍