Page 164 - Veterinary Laser Therapy in Small Animal Practice

150 Veterinary Laser Therapy in Small Animal Practice

Case no. 23

M., canine, 8 years old, Border Collie, MNC, 20 kg
• Complaint: chronic right hindlimb lameness and weakness, occasional forelimb lameness.
• History: M. is a very active sports dog who is trained for obedience and has run four World Cups. Four
months ago he presented with 5/5 acute lameness after running over frozen ground. He has improved
since then but still shows abnormal gait. His referring veterinarian has performed ultrasound (no significant
findings, apart from some inflammation in the gastrocnemius) and X-rays, and has diagnosed him with
mild right hip OA and muscle contracture of gastrocnemius and superficial digital flexor muscles. He has
recommended a month of NSAIDs and absolute rest.
• Radiographic findings: right femoral neck thickening, mild change in right coxofemoral angle. No
radiographic changes in stifle and tarsus.
• Physical examination:
• Body condition score 5/9.
• 4/5 right hindlimb lameness, with shortened support phase and internal rotation of the tarsus of the
affected limb during walking. Weight-bearing was significantly decreased during stance.
• Goniometry: mild decrease in the right hindlimb passive ROM.
• Asymmetric hindlimb circumference (right 24 cm and left 27 cm, measured at 70% of thigh).
• No neurological deficits.
• Pain assessment: 5/10 NRS, moderate pain during tarsus and hip manipulation.
• Diagnosis: mild right hip OA and muscle contracture of gastrocnemius and superficial digital flexor muscles.
• Treatment:
• Laser therapy:
2
• 6–8 J/cm over gastrocnemius, superficial digital flexor, and tarsus; 10 J/cm over right hip.
2
• Three times a week for 3 weeks, then twice a week.
• Other physical therapies:
• Three times a week for 3 weeks, then twice a week.
• Ultrasound: pulsed mode 50%, frequency 3.3 MHz, 5 cm probe over gastrocnemius and superficial
digital flexor muscles.
• Manual intervention: massage for 30 min with effleurage, petrissage, and longitudinal friction of
affected limb, passive ROM exercises.
• PMF therapy: 12–20 Hz over the hip area, 100% intensity for 40 min.
• Home exercise program: all techniques were performed with the owners in the clinic to ensure proper
delivery. At home, owners performed them twice a day.
• Local heat for 15 min on gastrocnemius and right hip.
• Massage, passive ROM.
• Owner education: avoid intense or explosive exercise, just walking on leash. Do not train for the moment.
• Outcome:
• Decreased pain on manipulation and improved weight-bearing after 1 week; almost normal after 2 weeks
(1/5 lameness) but some pain persisted at the hip.

Range of motion (degrees)
Hip Knee Tarsus
Flexion 55 45 30
Right
Extension 157 170 170
Flexion 50 42 35
Left
Extension 165 165 170

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