Osteoarthritis is a degenerative joint disease affecting humans and dogs. It is characterised by the loss of articular cartilage in a joint. Joints typically affected are the knee (stifle joint in dogs), hip, and elbow joints.

Canine osteoarthritis can severely affect the dog’s quality of life. Common symptoms include discomfort, which is exacerbated with activity and relieved with rest, restriction of activity, limited ability to perform, impaired proprioception, joint stiffness and enlargement, and loss of strength and limb function.

The causes of canine osteoarthritis are varied and include the dog’s age, genetics and conformation. Lifestyle factors can also contribute to the development and evolution of the disease. These factors include obesity, repetitive stress and joint trauma including surgical interventions.

Treatment goals for canine osteoarthritis

The main goal of treatment for canine osteoarthritis is to improve the dog’s quality of life.

This goal can be achieved by addressing the following:

• Improving the function of the affected joint by maintaining the joint’s range of motion and general health. This measure aims to slow the evolution of osteoarthritis and address gait abnormalities.

• Relieving pain in the joint and addressing muscle spasms caused by compensating for the loss of function in the affected joint.

• Strengthening the muscles that support the joint.

• Addressing proprioceptive defects to restore a normal gait and prevent injury.

• Implementing lifestyle modifications to prevent joint trauma and slow the evolution of the disease.

Conservative treatment of osteoarthritis in dogs may include a range of modalities to achieve the outcomes listed above.

Massage for dogs with arthritis

Human and animal studies have found that massage is effective in relieving pain and restoring function to osteoarthritic joints. Massage therapy is gentle, safe and has few adverse effects. It can also complement pharmacological and surgical treatment of canine osteoarthritis. Massage treatments for humans and dogs involves a range of massage techniques, joint mobilisation, stretching, and passive range of motion exercises.

Massage for pain management

Massage has been shown to be effective in relieving pain in the short and medium term. In musculoskeletal disorders studied in human patients, massage has been shown to be more effective in treating pain than no treatment and active treatments such as exercise. Several human studies investigating the effects of massage and osteoarthritis use the WOMAC (Western Ontario and McMaster Universities Arthritis Index) questionnaire to determine the effect of massage on pain, joint stiffness and function. These studies report significant decrease in pain and stiffness ratings and improvement in function following massage treatments.

In one human study of people with osteoarthritis in the hand, a significant reduction in pain was observed for up to 12 months after receiving low dose massage. In this study, participants received ten (10) massage sessions (including joint mobilisation and stretching) over two weeks followed by four weeks of immobilisation. Six (6) months after the massage treatment, 16/25 participants reported no pain or activity restriction. Similar results were reported at 12 months post treatment, with 10/25 participants still reporting no pain or activity restriction. These results are compared with a group receiving a single corticoid injection. At 12 months after the treatment, 17/25 participants reported their activity was restricted due to pain. This study indicates that massage, joint mobilisation and stretching has a longer term effect on pain and joint function than a single corticoid injection which has more immediate effects.

Similar results in relation to pain management were reported in a study of people with knee osteoarthritis. In this study, participants received two different massage doses (60 minutes once / week or 30 minutes twice weekly). In both massage groups, the improvements in pain, stiffness and functionality were significant compared with the control group (no massage treatment).

In addition to reducing pain, massage is thought to improve patient’s tolerance to pain by promoting a relaxation response and stimulating the parasympathetic nervous system. Massage elicits localised biochemical changes affecting neural activity at the spinal cord and subcortical nuclei associated with reduced anxiety. It stimulates the release of endorphins and serotonin to enhance mood and relaxation. In human studies, massage has been shown to reduce stress and anxiety from pain and promote feelings of wellbeing.

Massage to improve muscle strength and joint function

An important aspect of maintaining a dog’s quality of life is their ability to exercise and participate in family life. While reducing pain and improving mood will increase a dog’s willingness to exercise, an effective treatment model also needs to address muscle strength and joint function.

Muscles and tendons surrounding a joint, store and release elastic strain and therefore have an important role in absorbing impact and preventing further joint injury. In humans with osteoarthritis in the knee, the strength of the quadriceps has been shown to correlate with pain levels and degree of disability. The quadriceps absorb impact on the knee joint especially during eccentric contraction.

Massage has been shown to improve the strength of muscles supporting affected joints. In a human study of patients with knee osteoarthritis, after six massage sessions over two weeks, a significant increase in muscle strength of the knee extensor and flexor muscles was observed. Likewise, in an animal study, a group of rats with an induced muscle injury showed that after 16 days of massage, the injured muscle fibres were fully restored to their pre-injury structure and strength.

In addition to improving muscle strength, massage therapy has been shown to improve joint function. Loss of joint function changes the animal’s gait. Typically, osteoarthritis patients (human and canine) have a reduced gait speed, impaired joint range of motion, and shorter stance period. A human study of patients with knee osteoarthritis analysed the participants’ walking motion. After three weekly massage sessions over a two week period, the study found that the participant’s walking speed increased, their step width (sagittal range of motion i.e. distance from the midline of the knee, hip and ankle) increased during the stance phase, and the total support (stance) percentage of the stride cycle increased. This study concluded that massage has a positive effect on walking ability in human patients. These results may be attributed to a reduction in pain.

Exercise therapy for dogs with osteoarthritis

Another important modality in treating canine osteoarthritis is exercise therapy. The goals of exercise therapy are as follows:

• Strengthen supporting muscles. Strong muscles are required for shock absorption, minimise fatigue related injury and stabilise the affected joint.

• Maintain joint health.

• Improve proprioception.

Implementing a variety of exercise options reduces repetitive joint loading and motion.

Exercise options suitable for dogs with osteoarthritis include the following:

• Walking on softer surfaces like grass or sand.

• Hydrotherapy, swimming and walking in water.

• Hill walking – up, down and across inclines – alters joint loading and strengthens different muscle groups. For more information please see http://www.fullstride.com.au/blog/exercise-to-build-your-dog-muscles

• Cavalettis or low rails for improved joint proprioception.

Lifestyle modifications to slow the evolution of canine osteoarthritis

Implementing modifications to the osteoarthritic dog’s living arrangements can contribute to achieving your overall treatment goal of improving the dog’s quality of life. Lifestyle modifications may include nutrition and changes in housing conditions.

The links between obesity and osteoarthritis in humans and animals is well documented. Obesity decreases dogs’ quality of life, life expectancy and contributes to the development of osteoarthritis. The storage of fatty acids in the dog’s tissues produces a hormone (leptin). In animal studies, leptin is shown to regulate chondrocyte (cartilage) metabolism and therefore plays a key role in the development of osteoarthritis. In a study of overweight dogs with osteoarthritis, a reduction in body weight of 6.2% significantly improved lameness scores.

In addition to changes in the dog’s diet, implementing aids around the house to prevent repetitive strain and joint trauma will also reduce the symptoms of osteoarthritis. Aids that may be considered include the following:

• Non-slip flooring for improved traction and prevent slips. For more on the effects of flooring on gait, please see http://www.fullstride.com.au/blog/are-slippery-floors-safe-for-dogs

• Use of stairs and ramps to assist the dog in the car, around stairs or onto the lounge.

• Use of baby gates to prevent the dog ascending or descending stairs unassisted where a trip or fall is likely.

• Use of a harness to assist the dog standing from rest or when navigating the stairs. Harnesses are particularly helpful if the dog is uncomfortable being touched.

• Ensure the dog’s toenails are kept short so the angle of the metacarpal and metatarsal joints is not compromised. Also ensure that the fur on dog’s paw pads is kept short to avoid slipping.

• Supervise the dog’s play with younger dogs and children to prevent joint trauma.

• Avoid activities where the dog is performing the same movement repetitively. An example of this is ball chasing. For more information please see http://www.fullstride.com.au/blog/is-chasing-a-ball-bad-for-dogs

Benefits of massage for dogs with arthritis

While many studies into the effect of massage on osteoarthritis use human subjects, the disease is similar in both species and the mechanisms of massage appear to also be similar in dogs and humans. Based on this, human study results can be extrapolated to dogs with the condition.

A recognised shortcoming of the massage studies is that pain, stiffness and functionality measurements are typically performed post treatment. The duration and frequency of massage treatments is typically short (several weeks usually) so there is limited data on the longer term effects. However, one human study of people with knee osteoarthritis compared massage “doses” for optimal benefits. The study compared 60 vs 30 minute massage session once per week vs twice a week for one month. After eight (8) weeks, the magnitude of benefits began to plateau however improvements in pain, stiffness and functionality persisted for 4 months post treatment. This study suggests that periodic maintenance doses of massage may sustain the effects over time.

In my practice, dogs with osteoarthritis that receive a 40 – 50 minute treatment every 3 – 4 weeks (sometimes longer for younger dogs) sustain the benefits of massage in terms of pain, stiffness, functionality and ability to exercise.

In human studies, the effect of improving patient’s mood, mental and emotional states is documented. It is thought that improved mood correlates with improved activity levels. Anecdotally, my human clients report that post massage, dogs sleep quality improves, their willingness to interact with other family pets and family members improves, and most importantly, the dog’s exercise tolerance improves.

A final benefit of massage that is noted in some human studies is the benefit of the time spent with the therapist. Although not measured quantitatively, some studies attributed benefit to clients developing a greater understanding of their condition and the types of activities that will cause pain to recur. In my practice, this is certainly a factor in achieving a dog’s treatment goals. Regularly reviewing and reassessing the dog’s lifestyle, exercise regime, diet, as well as joint pain and functionality is critical to maintaining the dog’s quality of life.

By implementing a multi-modal treatment regime, osteoarthritis in dogs can be effectively managed to ensure the dog’s ongoing quality of life.

Full Stride provides remedial canine massage treatments to keep dogs active and pain free. Treatments are provided in my home based clinic in Brisbane’s northern suburbs. Home visits are also offered on the north side of Brisbane.

Until next time, enjoy your dogs.

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