What is intervertebral disc disease (IVDD) and how can physio help?
What is intervertebral disc disease (IVDD)?
Between each vertebrae (back bone) is a disc, this is made of a tough fibrous outside filled with a softer squidgy inside, it is often described like a doughnut but in reality is much stronger than this.
In this picture, A shows a normal spine, as when the dog is stood and you are looking at a section through the dog looking from tail end to nose. The tall spine is what you can feel when you run your hand along your dogs back. The spinal cord runs through a gap in the bones (the oval with the butterfly type shape within it) and below this sits the disc. You can see the “jelly” of the doughnut (Nucleus pulposus) and the doughnut itself (Annulus fibrosus).
Intervertebral disc disease is normally divided into 2 categories, these are called Hansen type 1 (Picture B) and Hansen type 2 (Picture c). Simply put type 1 typically affects smaller dogs over the age of about 2. This is normally a sudden onset rather than a gradual decline. The inside of the disc bulges out through a lesion in the fibrous outer ring and generally will press either on the spinal cord itself or on spinal nerves as they leave the spinal column. The signs and symptoms can vary widely from a mild loss of sensation to complete paralysis, it can also be extremely painful.
Type 2 is more regularly seen in older dogs of a medium to large size. The presentation can be gradual or sudden. The inside of the disc does not come out but the outside of the disc bulges, again often causing compression of the spinal cord itself. The outer of the disc can tear and bleeding may occur further compressing the cord. The signs and symptoms vary widely as with a type 1 lesion.
Typically dogs presenting with a type 1 or 2 will need surgery. On occasion when the signs and symptoms are really mild, the vet may try strict rest and medication for a short period to see if it spontaneously resolves.
How can physiotherapy help?
Physiotherapy can help in a number of ways, when in the very early phase of recovery this may be more about assisting with pain relief and scar healing using laser therapy, once the vets are happy for more input therapy will be designed to treat the main signs on assessment. Many dogs lose some sensation in their hind limbs so lots of sensory stimulation would be used, different textures when brushing, using something that vibrates over the area and different temperature sensations. Any weakness would be addressed using specific exercises, these may start as gently as just assisting your dog to stand in a symmetrical position and hold it.
Progressions might include assisting the dog to sit and then stand backup or lifting one hind leg up off of the floor, forcing more use of the opposite side. Progression into more movement and gait re-education will be added over time. Hydrotherapy is not essential but can help either to support for the dog in the early stages or offer resistance for strengthening. Each dog will be reassessed at each session and exercise will progress along with the dog as it recovers.
The level of recovery can vary, some dogs will recover fully, others not so well depending on the level of neurological damage. The dog may need a splint for support of a leg which your physiotherapist can measure for and order (some can make them for you themselves). If the hind limbs do not recover it is possible to get “wheels” for the dog, the dog is placed into the harness, which needs to be carefully measured by the physiotherapist, adjusted for an exact fit and then the dog pulls itself along by its front legs.