Dr Michele Broadhurst DC,ICCSP, FIAMA,CCRP,IVCA,
Dr Broadhurst graduated from Chiropractic College (DIT) at the end of 2003. She learned about myofascial dry needling in her third year at university and used it extensively in her two-year residency. After graduating from chiropractic college Dr Broadhurst went on to study further and was awarded her diploma as an Internationally Certified Chiropractic Sports Physician from the International Federation of Chiropractic Sports.
Dr Broadhurst joined Dr Angus and his West Coast Chiropractic team in 2005. Dr Broadhurst branched out in 2006 and went over to the USA to Options for Animals and certified with them and the International Veterinary Chiropractic Association as an Animal Chiropractor. The practice continued to flourish and grow with many families, ranging from babies to those nearing a century, athletes, chronic pain sufferers, dogs and cats visited the practice expectant of pain relief. Dr Broadhurst built an exceptionally busy and prominent small and large animal practice, specialising in stud, racehorses and canines. She was one of the first animal chiropractors to practice in South Africa and has mentored some of the animal chiropractors that have subsequently started practicing in SA.
In 2018 Dr Broadhurst moved to the USA where she currently resides. She qualified under Dr John Amaro (IAMA) as a Chiropractic acupuncturist and certified as a Canine Rehabilitative Practitioner through the University of Tennessee, she is one of only four chiropractors worldwide who hold that certification as a DC – Doctor of Chiropractic.
Dr Broadhurst kindly agreed to answer the following questions:
What are your feelings on how we currently manage this common debilitating condition in dogs?
Osteoarthritis is the most common cause of chronic pain in dogs. It affects 4 out of 5 dogs over middle age irrespective of the breed. It is caused by the degeneration of the articular cartilage and normal bony structures of a joint. This results in pain and a decrease use of the joint, weakening of muscles, ligaments and tendons, and compensations in other areas of the body due to offloading due to pain. It is a disabling and progressive disease for which there is no cure or fix, which ultimately affects the entire body and significantly affects the animal and their owner’s quality of life.
In veterinary medicine we focus strongly on managing the pain element of this disease via pharmaceuticals and it is incredibly important. However, I have concerns that not enough is done to treat the compensations caused by negative inhibition that result in physical manifestations, such as myofascial pain syndromes, myalgia, biomechanical compensations and myofascial trigger points.
As a veterinary rehabilitator what do you feel is essential for managing canine arthritis effectively?
Chronic osteoarthritis creates compensatory changes that activate and perpetuate myofascial trigger points in various muscles. Moderate to severe osteoarthritis of the coxofemoral joint activates and perpetuates myofascial trigger points in the functional muscles of the coxofemoral joint, hind limb flexors (including iliopsoas), adductors, and extensors. The cranial shift in weight overloads the infraspinatus, deltoid, and the long head of the triceps brachii. Lateral flexion of the spine occurs, which assists in ambulation by advancing the pelvis and pelvic limb while limiting coxofemoral flexion and extension, resulting in overloading of the iliocostalis lumborum.
A dog that presents with a non-weight bearing pelvic limb lameness, has a hopping action in the contralateral pelvic limb. This results in eccentric contractions of the coxofemoral and stifle extensors in an attempt to limit flexion. Lumbar paraspinal muscles become overloaded, as their job shifts from being purely spinal stabilisation to assisting with ambulation. The iliopsoas develops myofascial trigger points, and this results in a kyphotic posture.
In the case of osteoarthritis, myofascial pain syndromes occur, and myofascial trigger points form because of sustained low-level contractions in a muscle or a group of muscles. When a muscle needs to perform a low-level contraction, only a few muscle fibres are enlisted for that action.
When these low-level contractions occur, the same few muscle fibres are always used, and even if they become exhausted, no other muscle fibres attempt to help out and work. This has been referred to as the “Cinderella hypothesis.” The rest of the muscle, just like Cinderella’s sisters, never do the work: the same fibres are the first to activate, do all the work on their own and are the last ones to retire.
If you want to understand this better, pick up a plate and hold it in your hand, extending your arm out in front of you. It probably weighs only a few grams or ounces. Within several minutes your muscles will begin to ache and eventually it will fatigue, and you can’t hold it up.
Now think about doing bicep curls in the gym, where you might be curling 20 pounds or more and not feeling the same degree of exhaustion as you just felt with the plate. That’s because the entire muscle is working together to help you do that curl not just individual muscle fibres.
The first example with the plate is similar to what a dog with a painful limb will experience, but the pain of putting full weight on the limb is often less than the pain of the “muscle cramp” that comes about from protecting the injured leg by keeping it non-weight bearing. Eventually these constantly cramped and exhausted muscle fibres develop myofascial trigger points and the dog is constantly in pain.
Ultimately these few muscle fibres become permanently contracted. There is a lack of adenosine triphosphate (ATP), which is necessary for the sarcomere within this taut band of muscle to relax. We always think of muscles needing energy to contract, but the opposite is also true, they need it to relax.
When this hypertonia occurs, the entire muscle shortens, the joint is compressed from the constant contraction, causing dysfunction in the joint dynamics. So not only is there muscle pain, but there is a reduction in joint space, causing increased wear and tear on the joint. This then leads to abnormal biomechanics, hyper or hypomobility and other joint compensations elsewhere that need to be addressed and treated so that they too do not become arthritic. This can be rectified with chiropractic adjustments, mobilisations and other manual therapies.
The insertion of a needle (myofascial dry needling) results in the relaxation of the taut band of muscle by utilising a spinal reflex pathway that bypasses the ATP cascade.
Other methods include cold laser therapy, extracorporeal shock wave and massage (to name but a few), which increase blood flow to the affected area, thereby allowing for the mitochondrial production of ATP and the relaxation of the sarcomere.
How do you see treatment options for arthritis progressing over the next ten years?
We need to focus on the neuromusculoskeletal compensations that occur due to joint degeneration. In my opinion, much of the pain and dysfunction that a dog experiences with moderate to severe OA is due to the fascial and muscular trigger points that form as a compensation to joint dysfunction. An active trigger point creates referred pain to other areas away from the focal lesion. This leads to biomechanical changes and negative feedback loops, which alter posture, muscle tonicity and biomechanics. There needs to be more focus on treating the compensatory mechanisms that arise from OA, in addition to treating the dysfunctional joint itself. I believe in an integrated treatment protocol, which includes veterinarians, physical therapists, chiropractors, rehabilitation and other professionals that work together for the good of the patient to get the best results. Just as in human medicine, veterinary will divide into sub-specialities that will span across, not just veterinarians, but physical therapists, chiropractors, DO’s and many others, so that the patient can get the best care possible.
If you could have the opportunity to give one tip/piece of advice to an owner with a dog suffering from arthritis what would it be?
Build a tribe of professionals who are experts in their fields who are willing to collaborate for the good of your animal. I have seen amazing results with inter-professional collaboration, and it is imperative in these cases.
If you are interested in myofascial pain and how to treat it effectively “A clinicians guide to myofascial pain in the canine patient” is now available on amazon or at www.drmicheleb.com and a full course on myofascial pain will be available through north east seminars in 2021.