Maintaining Joint Health – options you might not have considered

With the cold, wet autumn weather approaching, you can expect clients to have a higher awareness of arthritis and joining health more generally. Your arthritic clients might well be feeling stiffer and sorer, and this can be an “in” to discuss their pet’s joint health as well. This month, we decided at Lintbells to take a slightly different approach. In addition to supplements and medical interventions, what other options are there that you can recommend to your clients to support their pets’ joint health?

Exacerbation avoidance strategies

Arthritis is a waxing and waning condition; as such, it can be difficult to identify specific exacerbating factors that are responsible for the commonly seen “flare-up” (1) of clinical signs. However, it is widely accepted that there are specific risk factors for an acute exacerbation of the underlying condition:

  • Sudden increases in exercise intensity
  • Overextension or hyperflexion of affected joint(s)
  • Possibly cold and/or wet weather (2)

While the impact of weather on pain in humans is still debated, there is experimental data in rodents suggesting an increase in inflammatory markers in cloudy and wet weather (3). That said, there is relatively little we or the dog’s or cat’s owners can do about the weather – although a warm, draught-free environment does seem to be valuable in minimising acute pain, and possibly chronic pain components as well.

You are doubtless already advising your clients to maintain a steady exercise regime, rather than sudden increases or decreases.

However, it is worth considering again the home environment of the patient. Surfaces that are likely to trigger slipping or tripping are more likely to result in increased joint stress and thus an acute flare up. Even more importantly, irregular surfaces are likely to be a high risk for causing joint overextension or hyperflexion – for example, rabbit holes in the park or garden – and this is more severe at higher speeds. So wherever the client allows their dog to run off the lead, it’s worth advising them to make sure that it is as level as possible with an even surface.

 

Home physiotherapy

While any physiotherapy needs to be used appropriately, there are two techniques that can easily be taught to owners to perform at home.

 

Massage

Massage, either in the practice by an RVN or practitioner, or at home, can be effective for:

  • Increasing venous and lymphatic drainage and reducing oedema
  • Breaking down adhesions to help reduce pain
  • Improving mobility (4)

In addition, it may serve to:

  • Relieve muscular tension and improve muscle tone (e.g. from compensation)
  • Interrupt the pain cycle from overstimulated nociceptors (5)

Demonstration by a member of staff – this is a good opportunity for an arthritis nurse-led clinic, by the way! – followed by massage at home can be a useful way to engage clients with their pet’s care.

 

Passive Range of Motion exercises

Also known as “PROM” exercises, these aim to maintain joint health through circulation of joint fluid (impaired in osteoarthritis, hence the stiffness when rising from rest), and to stretch and condition ligamentous structures around the joints. This is something clients can easily do at home, once the importance of maintaining the movements within the joint’s “comfort zone” is emphasised (4). Overenthusiastic manipulation can, of course, be a trigger for an acute flare up, so again, demonstration followed by supervision is wise, before the client is sent home with their list of exercises.

 

Therapeutic exercise

One of the major complications with osteoarthritis is the issue of compensation elsewhere in the musculoskeletal system, which may cause other abnormalities of gait, as well as eccentric muscular hypertrophy or atrophy (6). A tailored home exercise programme, also known as therapeutic exercise, can help to manage these problems.

While this is not something that can be put together by the client, the vet, RVN and ideally a suitably trained physiotherapist can collaborate to develop a suitable programme of exercise. This should ideally incorporate moderate exercise, but act to build up the atrophying musculature and restore musculoskeletal equilibrium, thus supporting the affected joint(s) (7)(4).

 

Communication with your clients

Managing arthritis is, of course, a multimodal exercise. However, it’s very important not to oversell any one intervention as a “miracle cure” (8). Remember, if the client is presenting the patient, there is a good chance that they are currently in an acute flare-phase, and so this must be managed (1) – but the underlying condition will still be there even after your prescribed analgesic has had its effect. This is a great opportunity to utilise your nursing staff as well, as RVN led arthritis clinics can be really effective in supporting clients and patients long term (9).

By incorporating some of these “newer” approaches, we can effectively support the client and maximise the patient’s joint health.

 

 

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