Massage for dogs is a very large subject so let’s look at a few of the massage modalities that have been proven to work for humans first. Trigger point therapy will be our first subject. I have been practicing massage full time since 1985 and this treatment is one of the most effective treatments I have found to reduce and eliminate pain in humans and I have also seen the effectiveness of this treatment with dogs and cats. A dog is not much different that a human when it comes to the causes and treatments for pain. While a dog can not communicate through words about the amount of pain reduction after a treatment I have seen many a dog who has gained full range of motion to joints and full loading of structure after treatment with trigger point therapy which they could not do before the treatment.
What is a trigger point? As defined by the Taber’s Medical Dictionary a trigger point or trigger zone is “an area of tissue that is tender when compressed and may give rise to referred pain and tenderness”. An active trigger point is ” A trigger point that is painful when the involved muscle is at rest. Palpation will reproduce the patient’s symptoms”. Latent trigger points are ” Trigger points that are not symptomatic when the involved muscle is at rest, but produce pain during palpation. Range of motion and strength may also be affected.”
What causes a trigger point? Trigger points are generally caused by over use of the muscle, trauma to the local muscle cells, and or increased muscle cell metabolism combined with reduced metabolic waste uptake by the vascular system or all of the above in combination. Trigger points have also been found to be active on bones and viscera. A more thorough review of myofascial trigger points can be found in the Journal of Manual & Manipulative Therapy, 2006 article; Myrofascial Trigger Points: An Evidence-Informed Review.
Myofascial trigger points are generally treated by dry needling, stretch and spray, injection therapy, acupuncture, or manual therapy. While trigger points have been widely studied in humans their has been very little research done on trigger points in animals. One study by Luc Janssens, Trigger Points in 48 Dogs with Myofascial Pain Syndromes identified trigger points in the triceps brachii, infraspinatus, adductorpectineus, peroneus longus, gluteus medius, ileocostorum lumborum, and quadriceps femoris muscles in 38 lame dogs. The treatment consisted of weekly stimulation of the trigger points by needling or injection of a local anesthetic. The author states that excellent results and complete recovery were observed in 60% of the treated dogs.
In a presentation to the World Small Animal Veterinary Association Congress-Vancover 2001, Alan Schoen a well respected veterinary acupuncturist stated that “trigger points may also be related to clinical and subclinical degenerative joint disease, intervertebral disc disease, spondylosis, as well as vertebral misalignments.” Trigger points have also been found to correspond to many acupuncture points.
Identifying trigger points in the dog is done through palpation of the tissues. The tissue that contains the trigger point will be indurated and there will be a taut band of fiber present. The novice might identify this as a knot but muscles can not be tied in knots so a more accurate description would be an area of hardened or swollen tissue that may be hotter then the surrounding tissue. The spot might also seem to pulsate and when touched if it is active it will cause pain in the dog which can be identified by the dog pulling away from the pressure, an increase in alertness as we approach the area and the dog will look back at us intensely, whimpering, growling, and the dog might move away from us at this point or start to lick the area insistently. We should always approach a painful area on the dog with gentleness and caution so we don’t hurt the dog or get bitten. If we start the palpation process by doing long gentle petting strokes from head to tail and off of each limb the dog will let us know the areas that are sensitive by pulling away from the stroke in the areas that are sensitive. Once we have found the areas of sensitivity we can slowly move back to the area and lightly rest our palms over the area without moving for a minute or two so that the dog will understand that we will be sensitive and not hurt them. If the area is hypersensitive we might have to just hover our hand over the area for a while and them very gently lower our palms onto the spot. Linda Tellington-Jones the originator of TTouch sometimes uses a feather to lightly stroke a hypersensitive area. Another way to approach a hypersensitive trigger point is to use cryotherapy to help numb the nerves in the area. We can crush some ice and put it in a sturdy zip lock back and gently rest it on the area after letting the dog sniff the bag. We can use a hot water bottle and put some crushed ice in it with water so that the bag will mold around the area. It is better not to apply the ice directly on the body because the dogs coat will get wet and this will alter the effectiveness of the treatment and in small dogs will cause them to shiver to much even after the treatment has stopped. Leave the ice pack on for 15-20 minutes and check the area a few times during the treatment to see how cold the tissue is. A smaller dog will need less time and a larger thicker coated dog will probably need more time. We should check the area part of the way through the treatment to make sure that the dog is not getting frostbite. We do not want the dog to get a frostbite so if the tissue seems really cold to you, stop the treatment. If the dog is uncooperative in lying still we can wrap the ice bag on with some Ace bandages. After the area has been numbed we can then treat the trigger points. For dogs who are in constant pain from a degenerative joint disease, muscle sprain or strains, or nerve compressions you might consider getting a custom made ice holding pack from CanineIcer.com.
Once we have identified the active trigger points we should warm up the surrounding area with moderate pressure compression so that we can get some local blood circulating. The actual treatment of the trigger point will be done with ischemic compression. We can use our thumb pad, a digital pad, or a massage tool that is made for this work or even a rounded crystal. The technique is similar to shiatsu thumb pressure. We should place our thumb over the trigger point, trap the muscle against the bone and gently sink in to a depth that will not make the dog pull away or wince in pain, wait for three to four seconds and then sink in a little deeper for another few seconds and finally sink in even deeper if the dog is receptive. Sinking in is the operative term here, we don’t push in and push past the pain tolerance level. Pushing is aggressive and insisting on change, sinking in is asking and waiting for change. The tissue under your thumb should slowly open up and allow you to sink in deeper if this technique is done right. If you find yourself pushing or if you come to an end feel and keep pushing you will hurt the dog and this will be counter productive because the dog will start to tighten the muscle to guard against the pain. In working with human trigger points the human will identify the feeling that is produced as good pain, or will describe the pain as radiating to a distant area and will describe a feeling of warmth as we slowly release the pressure and the blood flows back into the tissue. We should release our pressure slowly so we don’t jar the nervous system and then move a half thumbs width to an adjacent area of tissue and repeat the thumb pressure until we have covered all of the area surrounding the trigger point. Don’t over treat the point, this will irritate the muscle tissues to much and cause the dog to be sore for the next few days. If we have used cryotherapy over the trigger point or the dog is on pain medication we will have to be extra cautious because the dog can not feel the area very well and can not give us a signal that we are going to deep.
How often should we do this treatment? We should leave at least two-three days between treatments, we might bruise the tissue to much if we over treat if and the local circulation should be given time to remove any metabolic waste or previously damaged cell material from the interstitial fluid. Also in many instances we have put pressure on the local nerve supply and this will need a little time to recover from the pressure that we have applied.
It is a good idea to stretch the muscles that we have worked on so that the connective tissue can become more elastic and pliable and any cross linkages in the fibrotic tissue can be broken down. They are many other positive benefits of stretching after treating trigger points and I will discuss this in another post on the benefits of stretching for animals. How many sessions does it take until we see progress? This depends on the age, vitality, degree of injury, length of time that the trigger point has been active, and how much the dog is using the muscles involved. Some trigger points can be deactivated with one session and some trigger points may take 4-6 treatments. We would also need to have the DVM examine the dog to see if there are boney misalignments that are contributing to the trigger point formation or an underlying physiological problem. Tracing the causes of the trigger point development is best done by a DVM that is trained in canine orthopedic medicine or a canine physical therapist.