CHIROPRACTIC CARE FOR THE VETERINARY PATIENT Cathleen Lombardi DVM, CVA Certified in Animal Chiropractic IVCA Associate Veterinarian, The Oaks Equine and Farm Services Adjunct Professor, TCC Veterinary Technology •Chiropractic is a manual therapy that •What is chiropractic utilizes the spine to influence the •History of animal chiropractic nervous system •Chiropractic philosophy •It IS NOT a replacement for •Indications for chiropractic WHAT IS traditional veterinary care OVERVIEW •The chiropractic exam and adjustment CHIROPRACTIC •Chiropractic falls under the category •Education, licensing, and regulation of integrative medicine and works •Controversy and research best when used in combination with •Questions traditional veterinary care Traction Soft tissue work •Palmer School of Chiropractic (early Stretching 1900) had animal chiropractic treatment center. Offered DVC (Doctor of Rehabilitation exercises HISTORY OF Chiropractic Veterinary) Kinesiotape •Sharon Willoughby DVM, DC – after 13 Lasers/PEMF ** ANIMAL years of mixed animal practice she Diet and lifestyle advice, supplements, CHIROPRACTIC attended chiropractic school acupuncture, etc. ** •Dr. Willoughby founded the first animal chiropractic school in 1989 which eventually became Options for Animals **Scope of practice issues for DC 1 •Body has an innate capacity to heal •Nervous system controls and coordinates •Subluxation - ”Bone out of place” all other system functions •Misalignment •Nerve dysfunction occurs when the spine •Old model, too simplistic CHIROPRACTIC becomes dysfunctional WHAT DO •When the vertebral joints do not have CHIROPRACTORS PHILOSOPHY normal motion, the function of the nervous •Vertebral subluxation complex (VSC) system is affected TREAT? •Decreased motion within the normal •Chiropractic adjustments restore normal range of motion functioning of the spine which allows the nervous system to return to normal •AKA “stuck” functioning Trauma Poor riding Poor fitting tack Conformation Aging Chiropractors look for motion units CAUSES OF VSC Birth that are hypomobile (lack normal Poor or recent dental care (horses) range of motion) and perform an Poor hoof care adjustment to help restore normal Confinement movement Lameness Repetitive movement Emotional stress •The intervertebral motion unit is richly supplied with proprioceptive (mechanoreceptors) and nocicoceptive (noxious stimuli) structures THE •Abnormal spinal movement may result in alteration of normal CHIROPRACTIC mechanoreception and/or ADJUSTMENT nociception •Chiropractic adjustment ”resets” the sensory input going to the CNS 2 The adjustment is a short lever, specific contact, specific line of correction, high velocity, low amplitude (depth), controlled forceful thrust into the paraphysiological space THE CHIROPRACTIC ADJUSTMENT •Restore normal range of motion •Relief of pain CLINICAL GOALS •Optimize health and performance OF •Improve biomechanics CHIROPRACTIC •Optimize nervous and CARE musculoskeletal system for injury prevention INDICATIONS FOR CHIROPRACTIC CARE Pain Bucking Girthy or saddling issues Cold backed behavior Issues with leads Head tossing Performance issues Head or poll shy Post foaling/surgery/stall rest Gait abnormality/lameness 3 Pain while petting or grooming Difficulty rising, jumping or Reproductive issues climbing Performance issues Urinary issues Gait abnormality/lameness Hind end paralysis/paresis This Photo by Unknown Author is licensed under CC BY-SA •Acute trauma •Neoplasia •Early and late pregnancy Use caution in emaciated animals and sedated animals CONTRAINDICATIONS CONTRAINDICATIONS Chiropractic care should never cause a delay in appropriate traditional vet care in serious medical conditions ** Chiropractic is extremely safe if performed by skilled and qualified individuals** •History •Chief Complaint •Diagnostics •Medications or other treatments •Exam •Posture analysis CHIROPRACTIC •Static palpation exam EXAM •Gait analysis •Motion palpation •Neurologic exam/Lameness exam •Diagnosis •Adjust or referral back to primary care vet or proceed with traditional veterinary care or a combination 4 MOTION PALPATION ANIMAL CHIROPRACTIC TRAINING WHO SHOULD ADJUST ANIMALS? •Options for Animals •Healing Oasis Wellness Center •Laypeople? EDUCATION, •Parker University EDUCATION, •Doctors of Chiropractic with no animal training? CERTIFICATION, •ACES CERTIFICATION, •Doctors of Chiropractic with animal •Health Pioneers Institute AND AND training? •Veterinary Chiropractic Learning Centre- REGULATION REGULATION •Veterinarians with no chiropractic Canada training? •Integrative Veterinary Medicine Institute •Veterinarians with chiropractic training? - DVM ONLY and SPECIES SPECIFIC – (Veterinary Medical Manipulation) (119 •IVCA/AVCA certified? hours – others are 200+) WHO SHOULD ADJUST ANIMALS? WHO SHOULD ADJUST ANIMALS? •In some states chiropractic is specifically named under the definition of veterinary EDUCATION, The rules regarding who may EDUCATION, medicine, making it illegal for DCs to CERTIFICATION, perform animal chiropractic are CERTIFICATION, work on animals AND state specific and often vague AND •In some states DCs may work on animals or unclear with certain conditions (direct or indirect REGULATION REGULATION supervision, referral from DVM) •5 states have “Direct Access” laws which allow DCs to work on animals without the direct involvement of a DVM 5 WHO SHOULD ADJUST ANIMALS? WHO SHOULD ADJUST ANIMALS? RULES FOR DCs RULES FOR DCs DIRECT ACCESS: ILLEGAL: EDUCATION, Arkansas EDUCATION, Alabama (DVM only) CERTIFICATION, Colorado CERTIFICATION, Arizona (DVM only) AND Ohio *** AND Iowa (DVM only) New York (DVM only) REGULATION Oklahoma REGULATION West Virginia (DVM only) Utah There is a big movement within the chiropractic community (DC) to move to “direct access” laws WHO SHOULD ADJUST ANIMALS? VIRGINIA RULES FOR DCs Any person shall be deemed to be practicing UNCLEAR/ILLEGAL Pennsylvania (Direct veterinary medicine who performs the diagnosis, supervision?) treatment, correction, change, relief or prevention EDUCATION, Alaska EDUCATION, of animal disease, deformity, defect, injury, or other CERTIFICATION, Connecticut Rhode Island CERTIFICATION, physical or mental conditions; including the South Dakota performance of surgery or dentistry, the AND DC AND prescription or administration of any drug, Hawaii Virginia medicine, biologic, apparatus, application, REGULATION Washington REGULATION anesthetic, or other therapeutic or diagnostic Massachusetts substance or technique, and the use of any manual Montana Wyoming or mechanical procedure for embryo transfer, for testing for pregnancy, or for correcting sterility or Maryland? infertility, or to render advice or recommendation with regard to any of the above. WHY IS IT SO CONFUSING? PROS AND CONS OF DIRECT ACCESS LAWS •Chiropractic boards control what DCs can and can not do. Many of their state Proponents of these laws feel that: practice acts includes the word ”human’ in EDUCATION, the definition of chiropractic EDUCATION, Protect patient welfare CERTIFICATION CERTIFICATION, Relieve the veterinarian of liability •Veterinary boards control veterinarians. AND They have no “domain” over DCs unless the AND associated with supervision or REGULATION DC is practicing veterinary medicine without REGULATION referral a license Allows the state to mandate training and continuing education • The wording of many practice acts is very vague 6 PROS AND CONS OF DIRECT ACCESS LAWS REALITY Critics of these laws feel that: Owners will seek out chiropractic care EDUCATION, Chiropractic is part of the practice of EDUCATION, Often getting referrals from non-DVMs veterinary medicine. CERTIFICATION, CERTIFICATION, DC (both trained and untrained) are AND Animals should be ‘cleared” by a DVM AND adjusting animals before seeing a DC. REGULATION REGULATION LAYPEOPLE (both “trained” and Animals may be harmed by untrained) are adjusting animals chiropractic. My opinion… • Favorable anecdotal articles/case studies, REALITY but limited scientific publications My opinion is: • Lacking in number of overall studies as well as the gold standard of RCTs The best thing is for the animal to have EDUCATION, access to qualified, well trained, RESEARCH AND • All studies have limited data sets. i.e. low LICENSING, AND professionals (DVM or DC) that are group numbers, limited objective measures, required to have specific education in CONTROVERSY etc. REGULATION both chiropractic and veterinary topics. • Chiropractic is an art and has a subjective And get rid of the untrained nature to it professionals and lay people!! • Motion palpation and adjusting is done by “feel” and it is hard to standardize it Chiropractic abnormalities of the lumbar spine Effects of Low-level Laser Therapy and significantly associated with urinary Chiropractic Care on Back Pain in Quarter Horse incontinence and retention in dogs J Equine Vet Science 2020 Mar. Kevin Haussler et J Small Animal Practice 2015 al. Thude TR • 61 QH in national western performance competitions that had back pain • Randomized clinical trial RESEARCH AND • Retrospective study over 6 year period RESEARCH AND • Laser, Chiro, Laser with Chiro • 22 cases • Laser: significant reduction in back pain, epaxial muscle CONTROVERSY • Initially underwent traditional diagnostics and CONTROVERSY hypertonicity, truck stiffness • Chiro: no change in back pain, muscle hypertonicity or trunk treatment for their urinary condition stiffness, were improvements in trunk and pelvic flexion • Urinary patients were significantly more likely