Re: Re: Shoulder extension problem

[Guest guest]

Hi Jeff - We do a good deal of soft tissue diagnosis in the Head to Tail class I teach. This is honestly, the part the veterinarians have the most difficult time with. PTs are trained to focus on the muscles and their actions and how they relate to movement. It is such an imperative part of an examination. I read a statistic a few months ago indicating that approximately 40% of people seen are diagnosed with a muscular injury by their orthopedists. That should relate over to dogs - but do we really see those diagnoses? Of course, a lot of it is related to our ability to point to an area and help discern with muscle testing.

Cheers!

Deb

Debbie Gross Saunders, MSPT, OCS, CCRPWizard of Paws Physical Rehabilitation for Animals, LLCwww.wizardofpaws.netGas prices getting you down? Search AOL Autos for fuel-efficient used cars.

[Guest guest]

Hi All,

Well coming for a RVT background and then taking the rehab course.. I

have always been pretty strict when speaking with clients that have

been referred for rehab without an exact diagnosis or with an open

one... Most recently, I had a greyhound set over with a referral form

stating " forelimb lameness, suspect biceps problem " ... As soon as I

saw the dog, I noticed the odd gait, but more importantly I noticed

the dog was carrying his head funny...very very tense along cervical

area... I had my vet look the dog over and I sent the dog back to the

rDVM for further workup... It was shipped over to the Atlantic Vet

College for a ruptured disc at c5 I believe.. I have not seen the

paperwork yet.. The owner called and thanked us for asking for more

workup before proceeding.

Just my two sense..

Kim RVT, CCRT

Petworks Vet Hospital

www.petworks.ca

[Guest guest]

Hi Jeff,

At CRI, I go extensively into diagnosis from a PT perspective in

our Therapist Module. The Therapist module builds on the skills and concepts from

the Intro and having a better feel for localizing each tendon, muscle etc, and

beginning to look at anatomy from a functional perspective. As an instructor,

I don’t feel comfortable expounding upon the curricula and it’s benefits

further, however, since we have had several students go through, and students

that have taken both programs, I would say to those to feel free to discuss the

curricular devotion to the subject of soft tissue diagnosis and such within the

programs.

And yes, I do believe that the soft tissue diagnosis that are

being recognized now are largely in part due to the PT injection into this

field. And the fact that PT are teaching generalist vets and vet surgeons who

are in turn spreading the word beyond our rehab borders.

All the best to you!

Laurie Edge-, BScPT, Master in Animal Studies (in Animal

Physiotherapy), CAFCI, CCRT

From: VetRehab

[mailto:VetRehab ] On Behalf Of Jeff Bowra

Sent: Tuesday, June 24, 2008 10:48 AM

To: VetRehab

Subject: Re: Re: Shoulder extension problem

This is an excellent and ongoing discussion. I am not

sure where the current rehab certification courses are these days with respect

to diagnosing lameness but this is an area where I feel that we have come

a long way in the last few years. Iliopsoas, Teres etc. Shoulder instability.These

seem to have become more recognized in the last few years. Perhaps it is due in

part to the participation of PTs in our profession? Anyways I would love to

spend more time on lameness diagnosis and I think that there should be more

time spent on this. There are many text books on the subject in equine medicine

but very little in K9. To be a good equine vet you have to be a great lamness

diagnostician and there is much less availability of equine referral and fancy

daignostics. Once you have the diagnosis the treatment is easy (HAHA) So are

NES or CRI offering any specific lameness diagnosis courses. I would be willing

to travel a very long distance and spend a great deal of time to deal with

this!!! But if they spend any more than 15 minutes on cruciates I'm not coming.

Jeff Bowra DVM

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[Guest guest]

I wish that Sherman's post could be a letter to the editor in every veterinary publication in the country. This list is the most integrative exchange of any I belong to with an evident intention of providing the best possible care for patients and education for ALL. I want to thank everyone that contributes, for their generosity, open-mindedness, and for transcending terriitoriality and aggression for the good of all.Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

To: VetRehab From: scanapp@...Date: Wed, 25 Jun 2008 03:24:05 +0000Subject: Re: Shoulder extension problem

Wow, what great responses!Judith, I completely agree that a "chiropractic and acupuncture savvy veterinarian" can also result in an accurate diagnosis and treatment program. I commonly refer cases out for chiropractic treatments and actually just had a treatment by my chiropractor this evening (probably TMI). Where I disagree is that just because you are trained in surgery does not mean you understand orthopedics….and just because you were trained in orthopedics does not mean you understand sports medicine……..specialty referral medicine has become extremely sub-specialized and clients non-a-days expect that standard of care (similar to human sub-specialty medicine). This is the problem that we are all running into with this new area of "veterinary rehabilitation therapy"…..attempting to be a "jack of all trades". No offense to the various rehab courses out there but there is only so much you can learn from a few modules on any one particular subject….these modules are simply an introduction to the bigger picture. It is therefore up to us to continue to advance in our field and area of sub-specialty medicine. PTs have years of training on modalities, manual therapy, etc., not a few hour sessions. Surgeons are trained in ortho, neuro, and general surgery….no where is sports medicine or rehabilitation therapy even mentioned in most residency programs. This is the reason I feel so strongly about PTs, veterinary rehabilitation therapists, and sports medicine/orthopedic surgeons working together as a team for the best outcome of the patient. I am constantly learning new techniques/information form our veterinary rehabilitation therapist, veterinary technician rehab assistants, and our PT consultants. The CRI course opened my eyes to soft tissue injury and significantly improved my palpation techniques, however did not mention many of the sports medicine conditions I am currently seeing. I have had to gain that information from other human and veterinary sports medicine guys since the course. So the bottom line is that we must continue to learn following our CCRPs, CCRT, ACVS, etc.Jeff, that being said you are more than welcome to spend a few days/weeks with us at VOSM if you are interested in working with us on objective lameness evaluations, advanced diagnostics, etc (for example you would be able to follow conditions such as MSI through presentation, workup/evaluation, arthroscopic treatment and rehabilitation therapy). We commonly have vets/PTs/techs/students/surgeons perform externships/out-rotations with us due to our intense sports medicine / rehab caseload. I don't know about your learning style, but I learn best by actually seeing clinical cases while having an opportunity for hands-on. I am sure there are other groups around the country that can offer a similar experience. In addition, we will be hosting a sports medicine seminar later this year which will include objective lameness evaluations, advanced diagnostics, etc. We will have patients with challenging conditions such as MSI, JDS, etc at the seminar for demonstration (presentation, physical evaluation, diagnostics, treatments, etc)….I will send out more info on this as we get closer to the time of registration.Cheers,ShermanSherman O. Canapp Jr., DVM, MSDiplomate ACVSVeterinary Orthopedic & Sports Medicine Group10270 Baltimore National PikeEllicott City, MD 21042Phone: Fax: http://www.vosm.org________________________________________--- In VetRehab , Judith Shoemaker wrote:>> Indeed an excellent discussion. I also want to add that referral to a chiropractic and acupuncture savvy veterinarian can also result in an accurate diagnosis and treatment program! Even though I did orthopedic surgery for years, I don't think "the chance to cut is the chance to cure" is always true. And I certainly see plenty post surgically that don't do well until the "hardware" is straightened and the "software" is reprogrammed. And there are many that have done well without surgery that were told it was the only option; and also those that I refer to awesome surgeons like Sherman. Neither chiro or acupuncture are "modalities;" they are analytic and diagnostic systems of medicine that have more depth and proof than is acknowledged by the conventional medicine world. Please don't forget these options when you refer, if you don't know about these medicines how can you know they won't help?> > Also, an old text, somewhat outdated, but still a useful overview for examination and just general knowledge about injury, illness, treatments, etc. might be " Care of the Racing Greyhound-A Guide for Trainers, Breeders and Veterinarians" by L. Blythe, R. Gannon and A. Morrie Craig. I know it has helped me with some pretty "off the wall" and simple diagnoses too, over the years.> > Eventually, I hope to put together a gait analysis/ lameness seminar with the best of the best contributing. Anyone with suggestions or who wants to be a part of this can contact me. Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com> > > To: VetRehab@...: jeffbowra@...: Tue, 24 Jun 2008 09:47:38 -0700Subject: Re: Re: Shoulder extension problem> > > > > > This is an excellent and ongoing discussion. I am not sure where the current rehab certification courses are these days with respect to diagnosing lameness but this is an area where I feel that we have come a long way in the last few years. Iliopsoas, Teres etc. Shoulder instability.These seem to have become more recognized in the last few years. Perhaps it is due in part to the participation of PTs in our profession? Anyways I would love to spend more time on lameness diagnosis and I think that there should be more time spent on this. There are many text books on the subject in equine medicine but very little in K9. To be a good equine vet you have to be a great lamness diagnostician and there is much less availability of equine referral and fancy daignostics. Once you have the diagnosis the treatment is easy (HAHA) So are NES or CRI offering any specific lameness diagnosis courses. I would be willing to travel a very long distance and spend a great deal of time to deal with this!!! But if they spend any more than 15 minutes on cruciates I'm not coming. > Jeff Bowra DVM> > > > > > > > > > __________________________________________________________> Introducing Live Search cashback . It's search that pays you back!> http://search.live.com/cashback/? & pkw=form=MIJAAF/publ=HMTGL/crea=introsrchcashback> Earn cashback on your purchases with Live Search - the search that pays you back! Learn More

[Guest guest]

I feel this is whole topic a double edged sword. Also after having been a PT for many years, I have treated numerous human patients successfully without a definitive or accurate diagnosis...ie the infamous "LBP", which IS a symptom and not a diagnosis. The reality is, we don't always have a definitive diagnosis to work with. On the other hand, I probably hold an unpopular opinion that seeing any problematic client, human or canine, without an evaluation and referral from a Dr/Vet is dicey territory. There are multiple skill levels in our profession and none of us have the ability or expertise to order and accurately asses diagnostic tests, ie MRI, bloodwork, etc., therefore could miss a number of underlying diseases/problems that mimic musculoskeletal ones. ( I am presently treating a beagle for secondary back and RL muscle spasms, however the underlying cause is a kidney infection with e-coli)

However, I also think if you only treat the diagnosis and not the dysfunction you could miss key components of the recovery process. So while I agree strongly that we need an accurate working diagnosis, I feel our job is to be expert at evaluating the resultant dysfunction and treat it...hence the "joint above and joint below" rule in PT. Although it is actually better to look at the whole structure and not limit yourself, esp in dogs.

So I think both are important and by treating the dysfunction we can also evaluate the results in pursuit of a more definitive diagnosis if we don't have one. And even with a diagnosis I often re-evaluate my treatment results and adjust accordinginly as Shari said all patients do not respond the same.

And that is why these discussions are so valuable and why it is so rewarding and satisfying to work together Dr/PT...Vet/PT and collaborate with our complimentary skill sets.

Pavlakos, PT, CCRP

-----Original Message-----From: VetRehab [mailto:VetRehab ]On Behalf Of Shari SpragueSent: Friday, June 27, 2008 10:10 PMTo: VetRehab Subject: Re: Shoulder extension problem

I definitely second that opinion. As a human physical therapist for almost 10 years, I saw a lot of poorly given physical therapy because the therapist did not diagnose the root of the problem and just treated the symptoms. It was sad to me because we are taught to be diagnosticians and can treat clients without a doctor's referral for up to a month, so why not put those skills to good use. It may give the client a quick fix by treating the symptoms, but is not truly treating the long term underlying cause of the actual issue, therefore raising the probability that the symptoms will reoccur in the future. I would get a lot of clients therefore who would be a little sour towards physical therapy because of this but I helped them improve by diagnosing and treating the true problem and they were very thankful for that. Therefore, why wouldn't we want to carry over the same school of thought to our canine clients. If we are only treating their symptoms and not the actual cause of the problem, then we are doing a disservice to them and most likely not helping them in the long run. It is very important to try to diagnose the actual problem and then formulate your treatment plan based on those findings, as well as to think out of the box and not do "cookbook" rehabilitation. Every body is designed uniquely and therefore may respond differently to the same modality/exercise. Best of luck to you all. Keep up the great work. We are all offering an amazing service to these wonderful creatures!

Shari Sprague, MPT

[Guest guest]

Sherman and others,

Great post. I am sure that is why a lot of us that have taken the courses are NOT doing much, if any rehab. I am sure I can put together a rehab program if I made the correct diag. I guess it is what ever I say it is. In my area there are 4-5 surgeons and none are doing sports med. My own golden had acl repair last summer then tore the meniscus and had to be recut. I rehabbed her my self the surgeon was very impressed with her, asked what I had done but no interest beyond that. I am sure a preceptorship would be helpful. Most of my classmates from ARI struggle to make it profitable when it is so time consuming. Lamenesses take on a whole new meaning to me now. Great list.

karen kowalski RN., DVM CVA CincinnatiGas prices getting you down? Search AOL Autos for fuel-efficient used cars.