Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II)

 by Susan E. Davis, PT

There exist common pain patterns and body areas where myofascial pain with MTrPs can occur in animals.

The hip, along the sides of the lumbar spine, the front thigh, the shoulder blade and upper forelimb, etc. Specific muscles in those areas that often have trigger points are the psoas, quadriceps, gracilis, ileocostal lumborum, infraspinatus, triceps, etc. These muscles will feel shortened, tender and hypertrophied (enlarged or engorged) to the therapist’s touch, along with the presence of hard spots (MTrPs).

The dog may yelp or flinch when the MTrPs are touched and pressed, along with lameness—to the point of total non-weight bearing in some cases—such as walking. 

There may be head bobbing during walking, reluctance to walk or climb steps and rounded posture with the head positioned downward or the rear end slumped and tucked in.

The dog may stand with one shoulder higher than the other, or a hip hiked upward, indicating the side involved with having active tripper points.

Treatment of this condition is best performed by clinicians having a high degree of knowledge in muscle anatomy with good palpation skills: such as physical therapists, myofascial therapists, massage therapists, and chiropractors.

Treatment of MTrPs involves massage, myofascial release, electrical stimulation, stretching (and a unique technique called “Spray and Stretch”), as well as dry needling and trigger point injection.

1. Massage

For trigger points, a special type of massage is used to reduce or deactivate the hardened nodule.  Cross Friction is used with the hands moving in a perpendicular direction to the muscle fibers and other times the therapist uses their knuckles or elbow is used to defuse the barrier (called Prudden technique).

Myofascial release is also a form of treatment which is performed with the hands in a light gliding motion to help unlock barriers in the fascia and with deeper pressure to mobilize muscle fibers and other soft tissues.

2. Electrical Stimulation

TENS (Transcutaneous Electrical Nerve Stimulation) and Interferential current are used with electrodes placed on the skin (pets with thick or long coats must be shaved) directly over the trigger points and including the areas of referred pain, to reduce the pain sensations.

The basis behind this treatment is “Gate Theory”:  electrical impulses from the stimulator block the animal’s nerve pain signals at the spinal cord, and prevent them from reaching the brain, so that the sensation of pain is decreased. This is similar to a human’s instinct to vigorously rub their elbow or foot is it is accidentally struck or stubbed. The rubbing provides a distraction and pain-blocking sensation.

3. Stretching 

Stretching to the muscle where the MTrPs are located helps elongate and physically break the pain cycle within the interlocking muscle fibers. The stretches are done initially by the therapist and can subsequently be taught to the pet owner.

4. Spray and Stretch

For those stubborn muscles that just don’t seem to relax or yield to stretching, a special technique using an aerosol spray is used. This technique was originally developed in the 1950s by Dr. Janet Travell and is still used today with humans and animals!

TetraFluropethane or PentaFluropropane are non-flammable and non-ozone-depleting topical anesthetics that are actually sprayed at an acute angle, 12-18 inch distance from the skin and speed of 4-5 inches per second, along the affected muscle while the therapist elongates it. The thin spray is a bit cold but most pets are able to relax during the short treatment if they are spoken to gently and held firmly.

5. Dry Needling

Though sometimes confused for acupuncture, dry needling it is very different in procedure and purpose.

A thin filament needle (the same type that is used in acupuncture treatment) is inserted into the affected muscle and trigger point area, at a depth of 5-10mm, held for 30 seconds or so, sometimes “giggled” or vibrated slightly, for the purpose of mechanical disruption of knots. This needling procedure is usually repeated 5-6 times at each treatment session. This is not a form of ancient Chinese medicine, not used to treat disease, and does not use linear meridian pathways nor acupuncture points. Veterinarians can perform dry needling as well as physical therapists that practice in U.S. states or countries that allow them to use needles.

No medication is injected into the tissue and dry needling serves only to mechanically diffuse the trigger point.

Effectiveness of Dry Needling for Myofascial Pain, September 2013, Volume 43,Number 9, Journal of Orthopedic and Sports Physical Therapy

6.  Trigger Point Injections

Veterinarians can perform direct injection of trigger points with pain reducing and/or anti-inflammatory medication. In human practice, medications used for this purpose include Dexamethasone, Lidocaine, Saline and Botulin Toxin. In the veterinary field the type of medication used for soft tissue injections varies, and your vet determines which is best.
    
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Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 

The Challenge Of Degenerative Myelopathy (DM): Knowledge Is Power (Part I)
Degenerative Myelopathy (DM): Top 10 Management Suggestions (Part II) 
Great (Or Not So Great) Expectations with Femoral Head Osteotomy (FHO) Part (I) 
Great (Or Not So Great) Expectations with Femoral Head Osteotomy (FHO) Part (II)

It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery