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Information for veterinarians

Orthomanual veterinary medicine

The idea behind orthomanipulation is that many instances of lameness and neurological deficiencies are caused by the misalignment of the vertebrae and joints. Orthomanual manipulation can be described as a direct force, used on an osseous structure of the spine with a malposition or malfunction, using a short lever within a segment in the direction of the natural position of function.

Indications:

  • orthopaedic pati├źnts;
    1. young and old cripple animals (acute or chronic);
    2. animals with arthrosis and Degenerative Joint Disease.
  • neurological patients;
    1. patients with Intervertebral Disc Disease and hernia;
    2. patients with weakness in the fore- or hind limbs;
    3. patients with neck-, back- and lower back pain;
    4. patients with Lumbosacral Stenosis/instability.
  • animals with behavioral problems like restlessness, anxiety and aggression (may be related to pain);
  • orthomanual sport check-up of working- or sporting dogs (preventive);
  • orthomanual puppy check-up and examination (preventive and educative).

A prompt referral is preferred.

In behandeling bij D.Aharon

Misaligned vertebrae

Instability of the spine due to for example intervertebral disc degeneration, congenital disorder or a trauma, can lead to rotation, dislocation or translation of one or more vertebrae.

From the orthomanual perspective, a vertebrae position is considered misaligned when the alignment differs from the longitudinal, ventrodorsal or lateral (dextrosinistral) body axis. Moreover, the vertebrae position is misaligned when the processus transversus are not parallel.A misalignment of skeletal components can cause loss of function, movement limitations and pain. The aim of the Aharon method of orthomanipulation is to correct misaligned vertebrae and joints, thereby restoring the original position and function.

An example

In animals, instability of the lower back and misalignment of vertebrae in the neck (Lumbosacral instability and Wobbler syndrome respectively) appear regularly. Consider Wobbler syndrome, for instance - a neurological problem that is caused by (among other things) malformed vertebrae. An abnormality seen in older Doberman Pinschers and in younger Great Danes is well documented.

Wobbler treatmenyt before

Before and directly after treatment of the Wobbler patient (Cervical Spondylomyelopathy).

Caudal cervical Spondylomyelopathy (CCSM)

In caudal cervical Spondylomyelopathy, neurological symptoms are caused by compression of the cervical spinal cord. This disease most commonly affects large dog breeds, especially the Great Dane and the Doberman Pinscher. The etiology of CCSM is multifactorial and includes: vertebral instability, stenosis and/or malformation, intervertebral disc herniation and degenerative changes in the vertebral facet joints and ligaments. One or a combination of these abnormalities lead to progressive stenosis and compression of the cervical spinal cord. This compression may be dynamic, meaning the degree of compression varies with the position of the neck. Symptoms can occur in very young animals, but may also develop in later life. Typical CCSM signs are wide based pelvic limb ataxia and pseudohypermetria of the thoracic limbs, or unilateral thoracic limb lameness due to nerve root compression (root signature). The treatment options are conservative or surgical. Prognosis is always guarded and recidive of symptoms is common.

From AVOM viewpoint there is a vertebral misalignment in CCSM with ventral and minor cranial displacement along the antero-posterior axis. Correction of this misalignment with orthomanipulation relieves the spinal cord compression and symptoms.

Hernia Nucleus Pulposus (HNP)

HNP is an outdated and essentially incorrect term. In veterinary medicine pathologies of the intervertebral disc are currently referred to as intervertebral disc disease (IVDD). Furthermore, the term cervical disc disease (CDD) is used for lesions in the cervical region, and thoracolumbar disc disease (TLDD) for lesions in the thoracolumbar region. The neurological state based on the neurological examination is classified as follows:

Grade Neurological state Proprioception Bladder control Deep pain perception
I Pain + + +
II Paraparesis - + +
III Paraparalysis - + +
IV Paraparalysis - - +
V Paraparalysis - - -
Dachshund

AVOM presumes that degeneration of the intervertebral disc results in an instability of the vertebra. This instability can cause misalignment of successive vertebrae and as a consequence of this misalignment and disc degeneration, extrusion or protrusion of the nucleus pulposus or the annulus fibrosis results.

The resulting pressure on the spinal cord, or trauma induced by the kinetic energy component of the extruded disc material, may cause pain and neurological dysfunction. It is theorized that correcting the misalignment of the vertebra diminishes the pressure on the intervertebral disc and creates a situation that facilitates an improvement in the neurological state.

In AVOM the recovery of the patient is also assessed on the basis of neurological grading. Full recovery is defined as grade 0, with a completely normal gait and proprioception and without residual paresis. Clinical recovery with some residual motor deficiency (paresis and/or delayed proprioceptive reflexes) is defined as recovery to grade I.

Spondylosis deformans

Spondylosis is a non-inflammatory process associated with degeneration of the annulus fibrosis of the intervertebral disc, in which bony spurs or bridges between adjacent vertebrae are formed. It is assumed that Spondylosis does not give any or only few complaints (sometimes stiffness). A distinction must be made between Spondylosis and DISH (Diffuse Idiopathic Skeletal Hyperostosis). This disease causes certain ligaments and tendons to ossify, which affects both the spine and the limbs.

DISH is best known in humans. In dogs especially Boxers seem to be susceptible. With these dogs, DISH can also occur in combination with spondylosis, but the symptoms of DISH are very serious (pain, neurological deficit, fractures), in contrast to Spondylosis.

From AVOM viewpoint, the bridging is an attempt of the body to compensate for vertebral instability and therefore it is a signal for a possible problem in the back. Spondylosis and DISH have also been associated with adjacent segment disease, because the fusion of two vertebrae causes relative instability of the adjacent vertebrae.

lumbosacral instability before treatment

Lumbosacral Instability, Lumbosacral Stenosis: before treatment.

lumbosacrale instabiliteit after one year

Lumbosacral Instability, Lumbosacral Stenosis: a year after treatment.

Adjacent segment disease

Pathologies of the spine in adjacent areas (caudally and cranially) after spinal surgery. This phenomenon is well known in dogs with cervical Spondylomyelopathy and is one of the major long-term complications after spinal surgery.

From AVOM viewpoint spinal surgery (in TLDD, CDD etc.) causes only local decompression, while AVOM corrects all vertebral misalignments, also addressing areas where subclinical intervertebral disc disease might be present. This results in 'decompression' where appropriate, in different places, so AVOM treatment prevents the adjacent segment disease.

Notes:

  1. Van de Veen et al.; Variance in Manual Treatment of Nonspecific Low Back Pain between Orthomanual Physicians, Manual Therapists, and Chiropractors, Journal of Manipulative and Physiological Therapeutics, 2005; vol. 28.
  2. Oliver and Lorenz: "Handbook of Veterinary Neurology" 2nd ed. W.B. Saunders Company, 1993: pages 180-185.
  3. Morgan J: "Spondylosis deformans in the dog". Acta Orthopaedica Scandinavica Supplementum 1967; vol 96: blz 1-88.