Page 140 - Veterinary Laser Therapy in Small Animal Practice

126 Veterinary Laser Therapy in Small Animal Practice

Spine
To help you know what vertebral space you are working
over, remember that with the dog standing up, if the
last rib is followed dorsally, perpendicular to the spine,
you will locate L2–L3. And a change in the direction
of the spinous processes can be easily felt at T10/T11.
You can also locate the lumbosacral junction and count
cranially.
Check for tenderness just cranial to the wing of
the ilium; the iliocostalis lumborum may contain a
trigger point here. Include the epaxial muscles on both
sides. It will be more comfortable for the patient to
follow the muscles longitudinally, especially if there Figure 9.14 Treatment of the caudal cervical spine.
is any contracture. Angle the hand-piece to get the
beam perpendicular and pointing lateromedially. To
try to align the beam with the articular facets, angle it important in patients with epilepsy and other CNS
perpendicular in the caudal thoracic spine (from T10/ diseases, in which LT is contraindicated (although
T11) and lumbar spine. Cranial to T10, the angle is 45° increasing blood flow to the brain can be indicated in
(Fig 9.13). other CNS conditions).
In the caudal cervical spine, pulling the shoulder When dealing with appendicular joint disorders,
caudally (Fig. 9.14) will help you access caudal cervi- treating the associated spinal roots can be a good strat-
cal vertebrae better. Consider that treating deep tissue egy, especially in chronic painful conditions, since they
conditions in the cervical area often requires a rela- will develop a certain neuropathic pain component. So
tively high dose and power (because of the thick muscle most chronic hips and stifles, for instance, will benefit
layers), and the treatment may affect blood flow to the from treating the lumbar area.
head, especially over the carotid area. This is especially
Hip joint
To work from the lateral aspect of this area we locate
three anatomical landmarks: the crest of the ilium, the
greater trochanter of the femur, and the tuber ischi-
adicum (see Fig. 9.9). A screening of the area delimited
from the upper third of the femur dorsally to the ilium
and caudally to the tuber ischiadicum can be the first
approach. Then, more emphasis can be given to the
greater trochanter area and along the path of the sciatic
nerve, following the caudal aspect of the greater tro-
chanter and down between the biceps femoris and sem-
itendinosus muscles. Palpate the quadriceps muscle to
check for a trigger point.
When working over the lateral aspect of wing of the
ilium, we are directly over the gluteal muscles. In acute
conditions, they will likely be reactive and tender (the
gluteus medius is another frequent place for a trigger
point). In chronic pain, they will likely feel depressed,
atrophic, and the reactivity, although it may be present,
will be less. It is actually easier to deal with a contracted
muscle than with an atrophic one, but in the first case
the pressure tolerated will be less.
Figure 9.13 Treating T3–L3 segment. Also consider treating from the medial side (Fig.

REDONDO PRINT (4-COL BLEED).indd 126 08/08/2019 09:48