Click on the PDF below to read about the effects of osteopathic manipulative treatment on Parkinson’s disease related symptoms in animals.

Kendra Byers

Click on the PDF below to read an outstanding analysis of biofluids and heat transfer methods in the usefulness of thermal imaging in canine osteopathy.

Tori is based in NSW Central Coast, Australia, and runs Canine Body Balance. To learn more about her work or to get in touch, click here

Recognizing signs of pain in dogs, especially in your canine osteopathic patients, is invaluable. Signs may manifest only at home, at home and in the office, or only in the office during treatment. It is of the utmost importance to recognize when your patient hurts.

Acknowledging areas of pain helps guide your therapy and provides a means to monitor progress. Track pain response and progress over time and provide owners with monitoring tools at home to help in therapy.

Painful dogs can show a wide variety of signs. They fall on a broad spectrum of severity. Sometimes very stoic animals do not appear painful at all yet may have a severe injury. While others, sometimes specific breeds, huskies, for example, are a bit more melodramatic and more apt to demonstrate overt signs of pain, even with only mild disease.

Erica Tramuta-Drobnis (2020) notes that the following are good indicators that the patient has pain.

It is critical to remember that even the sweetest dog may bite when painful!

Make slow and deliberate movements. Talking to the dog while treating assures that the pet always knows you are there. Make sure you make them aware of your touch and that they are ok with it before proceeding with any type of manipulation or treatment.

Your patient may be coming to you because of an abnormal gait, poor performance in agility, or for other reasons. But always remember that underlying causes may not be specific to the limbs or musculoskeletal system.

Pain can occur from abdominal organs such as the pancreas in pancreatitis or the bladder because of urinary tract infections or bladder stones. The pet may have severe dental disease or chronic ear infections. These may have led them to carry their head differently or use muscles differently, creating a musculoskeletal manifestation of a systemic problem.

So, as a canine osteopathic practitioner, you must be mindful of other underlying diseases. These core conditions can contribute to discomfort in various body systems. This can cause higher levels of pain than the problem that brought them to you may dictate.

It is your job to educate the owner. Inform them that pain WILL DELAY healing. We want adequately controlled pain. For many patients, canine osteopathy may provide sufficient pain management and resolution. Still, pain medication or canine physical therapy, AKA canine rehabilitation exercises, may also be warranted. Finally, modalities such as laser or ultrasound therapy, heat, or ice therapy, may need to be considered.

So, we must know how the pet does at home with the treatment. If our treatment is not enough, we need to intervene. Perhaps just modifying your protocol will be sufficient. Still, it may require a veterinarian’s advice and interventions to enable thorough treatment of the pet.

As animal osteopaths, tracking patient progress is essential. Using several methods can be helpful, including detailed patient notes from one session to another and the inclusion of at-home observations by the owner. You can develop a pain assessment check sheet or a handout to give your owners. Use something with information showing signs of pain. Provide a record format for the owner to use at home. For example consider this checklist option from the International Veterinary Academy of Pain Management.

Feel free to use this as a template listing signs of pain for which  your owners should be on the look out. Modify it to fit your needs. Regardless, have your owner record a journal of findings throughout the interval between appointments. Have them note when the last appointment was, findings the night of treatment, and over several days, then again, following the next appointment. This allows your clients to be part of the treatment process. Encourage them to monitor and participate in their pet’s care.

https://tripawds.com/wp-content/blogs.dir/1/files/2016/09/Is-My-Dog-in-Pain-IVAPM.pdf

Pet owner observations will help you to

Make sure your pet owners know how to monitor for future signs of pain. Sometimes osteopathy alone can treat an injury or medical problem. But it is often one tool out of many to treat and support long-term conditions, such as arthritis

The goal is, of course, a cure. But that is not always feasible. So, we need to ensure owners have the tools to monitor for subtle signs of pain. This will allow them to be proactive with their dog’s care in the future. Ensure owners recognize that seeing subtle changes suggestive of pain is important. We want owners to seek intervention and re-evaluation before the pet becomes too painful, chronic pain occurs, or wind-up develops.

Make sure your owners understand that we want to treat pain in the initial stages. Letting it go too long can lead to chronic inflammation, chronic pain, weaken the immune system, and increase stress to the body. Osteopathy may be sufficient but advise clients they may need a combination of manual therapy, pain medications, exercises, even other treatments to help the pet.

Untreated pain can lead to wind-up pain or central sensitization. This is the body becoming overly sensitized to pain to the point where the brain perceives non-painful stimuli as a threat. This, in turn, makes the pain worse and creates a vicious cycle that can be hard to break, negatively affecting the patient’s overall quality of life.

With central sensitization, the spine and brain are constantly flooded with noxious (painful) stimuli without pain management. So, say you lightly graze your toe against a table leg; it may feel like you broke it rather than just grazed it. Even just a light pet to the dog could be translated by the brain as painful rather than pleasurable. This increases anxiety, stress, pain and can occur in as short as one hour. So it doesn’t even require chronicity to develop (Mills, 2018).

Wind-up, thus, describes “the increased ease of transmission of impulses as they travel through the pain pathways to the brain” (Hudson, 2018).  Therefore, teaching owners to recognize signs of pain, initiate intervention rapidly, and seek re-evaluation is critical. This lessens the chance the dog will develop wind-up pain and minimizes the pet’s pain and suffering

For those working in veterinary medicine in any capacity, recognizing signs of pain is a crucial part of the job. We need to both understand canine body language and communication cues and recognize pain to help minimize it and improve our patient’s quality of life.

Recognizing Canine Communication

Additionally, we need to recognize the signs of pain because just a gait abnormality or a tense muscle alone may not be the whole picture. If the patient demonstrates signs of pain, this may indicate

• additional disease processes
• additional areas needing treatment

Additionally, recognizing pain may serve as a means of caution – it means you must be careful when treating painful areas. Ensure you are not causing more pain. Safeguard that the animal does not react with biting, aggression, or other changes that could be harmful to you, your staff, or the patient.

Remember, pain delays healing. Pain unchecked leads to a cascade of problems, causing the frequent release of stress hormones and worsening your patient’s life quality. Additionally, do all you can to minimize wind-up pain and ensure owners understand how to prevent it.

Ensuring owner education is critical. You and your owners need to understand pain signs, continue to monitor patient progress over time, and recognize that pain can lead to aggression or erratic behavior.

Always strive in your practice to make certain you, your staff, and your owners recognize signs of pain in dogs. While treating your canine osteopathy patients, make certain that you are always vigilant for signs of pain, changing behaviors, and communication cues. This will ensure you and all involved remain safe, and that the pet gets the best benefit from your osteopathic therapy.

Figure 1. The canine “prayer position” suggestive of abdominal pain. Borrowed from

https://www.wikihow.com/Cure-a-Dog%27s-Stomach-Ache#/Image:Cure-a-Dog%27s-Stomach-Ache-Step-13.jpg

Figure 2.The Playful dog. The “play bow”. Borrowed from https://www.canva.com/

Hudson, D. (2018,September 20). Analgesia Without Opioids. VIN.Com. Southwest Veterinary

Symposium 2018.

https://www.vin.com/members/cms/project/defaultadv1.aspx?id=8669934&pid=21982&

Mills,A. (2018, June 28). Pain Management: Start to Finish. VIN.Com. Pacific Veterinary Conference

2018, San Francisco, CA.

https://www.vin.com/members/cms/project/defaultadv1.aspx?id=8550828&pid=20885&

Tramuta-Drobnis, E. (2020, July 13). How Long Can a Dog Live With Arthritis—The Animalista—

Animal Vitals. The Animalista.https://theanimalista.com/how-long-can-a-dog-live-with-arthritis/

Intervertebral disc disease, or IVDD, is one of the most common spinal disorders seen in canine patients. These patients will commonly present with back or neck pain on physical exam. However, often owners do not actually appreciate this pain. Instead, owners see the pet hesitating to jump, not wanting to walk as far, or not wanting to play. Owners may miss a slightly off head carriage or an intermittent limp. They may not realize the different ways back, or neck pain can manifest. But they recognize that something is off, triggering them to take the pet to the veterinarian or osteopath for evaluation.

In IVDD, the intervertebral disc material in the spine ruptures, affecting the pet’s spinal cord. Think of the intervertebral discs as the cushions for the spine. Intervertebral discs, found between the bones (vertebrae) in the spine, act as shock absorbers helping to stabilize the spinal column (Béraud,2015; “IVDD In Dogs,” 2020).

The disc material or nucleus pulposus under healthy conditions is flexible and easily compresses to aid in the body’s movement. However, over time the material can become inflexible and brittle. Normally, bending with movement, these abnormal discs will bulge or rupture, putting pressure on the spinal cord’s nerves, causing various signs from mild pain to complete paralysis (“IVDD In Dogs,” 2020). While the disease progresses slowly over time, acute trauma to the spinal cord can suddenly cause this disc material to explode out of the space, sending the disc material fragments to the cord. This concussive action triggers the clinical signs (Béraud,2015).

Similar to when a human herniates a disc or ruptures a disc, IVDD affects various parts of the dog’s spine.

Brooks (2019) reports that 15% of all disc herniations occur at the cervical spine level (neck). 80% of these cervical herniations (most commonly between C2-C3) occur in “dachshunds, beagles, or poodles” (para 8).

Brooks (2019) notes that T11-T12 and L2-L3 are the most seen sights of herniation. However, we also commonly see low back pain L4-S2 in dogs. Extrusions in this area account for 15% of all cases of Type I IVDD in dogs. Continue reading for a review of the types of IVDD. In clinical practice, the author generally appreciates pain in 3 general locations: the neck region(cervical), around T13-L2, and the lumbosacral area (near the tail).

In many cases, we have no idea what actually triggers the disc change at a specific moment. Owners may report that the dog fell off the couch or tripped down the stairs several days ago but had seemed fine. A day or even a week later started to limp or show other signs of pain or lameness.

Sometimes owners will report an episode where they heard the dog cry out. They may even have seen the dog limp for a day or two, and then it seemed to resolve on its own. But most of the time, we do not appreciate a specific incident to truly demonstrate a direct cause and effect.

Because dogs tend to tolerate pain differently from people, they often show it differently and may initially mask it.  Perhaps there was a full resolution of clinical signs. Or maybe they simply didn’t start showing signs of pain until it became serious enough to cause them to do so.

In osteopathy, we look at the whole patient. Knowing what risk factors your patient possesses from the get-go, including any known injuries or traumas, recognizing the breed predisposition, and any previous history of the disease, all help improve your diagnosis and treatment plan development moving forward.

Any dog of any body type at any age can develop IVDD. That being said, there are some poster children that veterinarians and veterinary professionals automatically think of when discussing this disease.

Chondrodysplasia, a genetic abnormality secondary to abnormal cartilage growth, is common in several breeds. The bones grow at different rates leading to limb deformities and shortening of the limbs. These dogs can be disproportionately dwarfed in stature secondary to this abnormal growth. They can have additional abnormalities to various skeleton parts, including the ribs and spine (Cruz-Rincon, 2017,p.; Vetstream, n.d.). See Figures1b, 1d, and 1e for examples.

Classically many think of chondrodysplastic breeds first when they picture IVDD. While their confirmation alone can increase these types of dogs’ risk for IVDD, some dogs also have a genetic mutation. This mutation causes changes to the intervertebral disc’s metabolism, leading to early disc degeneration (Thomas, 2014).

These breeds often have long bodies on very short stubby legs with additional conformational issues that predispose them to IVDD. Dachshunds, Lhasa Apsos, Pekingeses, and Basset Hounds, for example, fit into this classification (“IVDD In Dogs,” 2020).

Dachshunds and beagles typically come to mind when thinking of IVDD for most veterinarians, but really IVDD can occur in any breed (Gregory, 2018).

While rarely occurring in dogs younger than1, it can occur at any age. It is often seen in ages 3-7 and then again in the older stages, ages 12 and up. Thus, age alone isn’t enough to suggest the presence or absence of the disease.

The classification of the types of disc changes that occur have varied over the years but currently include Hansen Types I, II, or III.

Hansen Type I IVDD most commonly occurs younger in life and in chondrodystrophic dogs. Since genetics also plays a large role in this type of degeneration, it tends to affect younger to middle age dogs.

Type II IVDD tends to occur in older dogs secondary to normal aging processes and tends to occur in the larger breed dogs.

Type III AKA traumatic disc herniation, non-compressive IVDD, or high-velocity low-volume IVDD occurs at any age and in any breed. It causes the nucleus pulposus to suddenly shoot out a disc fragment into the spinal cord (Béraud,2015).

For a detailed review of the signs of pain in dogs, please review the blog entitled (Recognizing Canine Communication).

Some dogs with IVDD may demonstrate classic generalized signs of pain such as

• Hesitancy to jump onto or off furniture or in going up/downstairs
• Decreased energy or desire to play or exercise
• Change in behavior
• Change in appetite
• Vocalizing – Remember to educate your clients. Inform them that lack of vocalization doesn’t mean they aren’t in a lot of pain. For example, Pitbulls are often very stoic and may not show pain unless severe. On the other hand, Huskies are often wimpy and may stub a toe and behave as if they tore off an entire foot.

Other signs may be more specific or suggestive of back or neck pain. These may vary depending on where the disc abnormality resides in the spine.

Additional signs of pain or spinal cord damage may include

• Holding the tail low, not wagging it normally or as often
• Crouching or hunching postures (can mimic abdominal pain)
• Chewing on the tail or a leg(even to the point of causing trauma)
• Chewing can occur far from the actual injury site. This occurs due to referred pain, neurologic pain, or because it becomes a means for them to handle the pain.
• Merely being more guarded or not normally engaging with the owners or other pets in the home.

Suppose the damage causes compression of the spinal nerve root. In that case, it can cause pain (radicular pain) to be referred from the spine itself down a limb or other areas. Be aware that sometimes back pain presents as lameness in the hind-limb(s) without overt backpain (Rossmeisl, 2013).

• This author’s own dog, Isabelle, a Rhodesian Ridgeback/Labrador mix, didn’t know she was a 4-legged animal. She was active, athletic, in ideal body condition. She was long and lean and loved to stand on 2 legs. For 6 months, she was intermittently lame in her left hindleg. Radiographs were non-remarkable. Her physical exam revealed only muscle changes and tension bands along the spine, left hind leg, and intermittent strains to the iliopsoas muscles in the pelvic/groin area.
• Using a combination of laser therapy, ultrasound, massage, and physical therapy in addition to pain medications, she improved. It wasn’t until 6 months later that she even showed any back pain signs and was only evident with the spine’s deep palpation.
• Then, she responded to therapy and barely had real pain to severe back pain and vocalization overnight. She required surgical intervention and, thankfully, recovered, never looking back.

So, back pain can manifest in many ways. All too often, veterinarians FAIL to evaluate for it. Just because your patient went to the vet and the vet found nothing overtly wrong, make sure that you evaluate their gait and palpate for signs of back pain thoroughly on your physical assessment. Not everyone appreciates subtle signs of pain or thoroughly assesses for back pain, so take care to ensure you do so.

Additional clinical signs may suggest that your patient has a neurologic component and help you lean to a diagnosis of IVDD. These signs may include

• Varying degrees of paresis (weakness)or paralysis (inability to use a leg/legs)
• Crossing over with a leg when walking
• Stumbling
• Weakness
• Dragging a limb

Thankfully, society is becoming more accepting of adjunctive treatments in the veterinary community and the lay population. Our clients want to avoid medications unnecessarily, and who wants their pet to have surgery if it can be avoided? Finally, these therapies provide a great addition to post-op surgical care.

A combination of the various treatment options available should be employed to properly control pain and improve recovery chances. Sadly, factors including finances, access to services, dog acceptance of therapies, owner perceptions, and expectations play a role in what treatments are ultimately used and the success and failures of those therapies.

A canine osteopath may be the first professional that an owner comes to see. The pet may have an off gait or simply be hesitant to exercise. So, the owner knows something is wrong but cannot discern where the problem lies. An osteopath can perform a physical and visual assessment and determine what parts of the body are painful, and discern probable causes for the problem.

Pain can occur due to disc disease, muscular, bone, meningeal pain (membranes that protect the spine), or radicular pain (travels along the spinal root nerve). So, while discussing IVDD specifically here, make sure to assess the whole patient as there could be more than one area of dysfunction.

IVDD could be the primary problem at, for example, the lumbar spine. But don’t forget to evaluate other areas for possible pain or dysfunction. When a dog attempts to compensate for pain, muscle tension and other biomechanical shifts often lead to pain in other regions of the spine, pelvis, legs, and musculature. These areas must not be forgotten as they too will significantly benefit from manual therapy, such that an osteopath can provide (Rossmeisl, 2013).

There is no single-word answer for this. All cases differ. Various factors play a role in the successful recovery of a patient, including owner expectations, quality of life, remaining neurologic deficits, life-long limitations, or restrictions. Prognosis also depends on the owner’s commitment and willingness to follow strict adherence to the caregivers’ directions and recommendations. This includes the veterinarian, surgeon (if performed),osteopath, rehabilitation veterinarian, and others.

Critical to the patient’s recovery, all owners within a family need to follow all directions.

Some dogs may recovery 100% and never lookback. But many dogs will have a reoccurrence of the disease. Clinically, about 1/3of my patients have had reoccurrence at some point in their life. The presence of neurologic changes, uncontrollable pain, or an owner who fails to follow directions, a full return to function may not always be achievable.

NO MATTER WHAT WE DO, some pets will worsen and require surgical intervention due to clinical signs’ progression, worsening neurological function, or intractable pain.

Yes and no. Some animals are simply predisposed. Short of keeping them in a bubble and not letting them be dogs, well, we can never prevent it 100%.

Obviously, if you see a patient with this disease, we are a bit too late to prevent onset. However, with high reoccurrence rates, while we still want a dog to be a dog, there are a few steps that owners can take to lessen the chance of recurrence (Béraud,2015; “IVDD In Dogs,” 2020).

Provide your owners with handouts. Client handouts are great to remind owners about your recommendations, including any exercise restrictions, at-home exercises, and MOST IMPORTANTLY. It provides something they can refer back to later. Exactly how much each owner retains is unknown, but we know that no one hears everything we say. This means that valuable information gets lost in translation. Additionally, not all family members maybe present at the visit, so the handout can educate them about what is recommended. This handout can help ensure the successful care of the pet.

Dogs with back and neck pain commonly lead owners to visit a veterinarian or canine osteopath. Many owners fail to recognize pain signs and often cannot localize pain to the back or neck. Your job as a canine osteopath includes evaluating the patient and determining via gait analysis, physical exam, history, and clinical signs, what the primary clinical problem may be. The pet’s signalment (age, breed, sex) may aid in your diagnosis. But remember that any breed of dog, at any age, and even an animal with an ideal body condition may present with clinical signs suggestive of IVDD.

Osteopathic therapy compliments the therapy provided by veterinarians, rehabilitation specialists, and surgeons (if surgery is indicated). Osteopathic therapy provides a crucial role in pain management. It can significantly assist your patients’ recovery and prevent further disease reoccurrence.

Bagley, R. S. (2006).Acute Spinal Disease. Western Veterinary Conference 2006, Las Vegas, NV.

https://www.vin.com/doc/?id=6694882

Béraud, R. (2015, March 30). Intervertebral Disc Disease (IVDD) or Why I Love Dachshunds: Part II.

VIN. Com. 66th Convention of the Canadian Veterinary Medical Association, 2014, Centre

Vétérinaire Laval, Laval, QC, Canada. https://www.vin.com/doc/?id=6700544

Brooks,W. (2019, July 17). Intervertebral Disk Disease in Dogs. Veterinary Partner.

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4953012

Budsberg, S. C., Torres, B. T., Kleine, S. A., Sandberg, G. S., & Berjeski, A. K.(2018). Lack of

effectiveness of tramadolhydrochloride for the treatment of pain and joint dysfunction in dogs

with chronic osteoarthritis. Journal of the American Veterinary Medical Association, 252(4),

427–432.https://doi.org/10.2460/javma.252.4.427

Carrera-Justiz, S. (2020). When the Dog Can’t Walk! (SA257). Western VeterinaryConference 2020, Las

Vegas, NV.https://www.vin.com/doc/?id=9447928

Cruz-Rincon, S. (2017, August 8). Chondrodystrophy in Dogs [Vin.com]. Veterinary Partner.

https://www.vin.com/doc/?id=8156779

Gregory, S. (2018). The Nerve of It! VIN. Com. Wild West Veterinary Conference2018, Reno, NV.

https://www.vin.com/doc/?id=8613867

IVDD In Dogs: What You Need to Know. (2020). Emergency Vet 24/7.

https://emergencyvet247.com/ivdd-in-dogs/

Loria, K. (2017, May 19). Dogs, vets wait for progress on IVDD. Veterinary Practice News.

https://www.veterinarypracticenews.com/dogs-vets-wait-for-progress-on-ivdd/

Muñana, K. R. (2002). Canine & Feline Myelopathies II: Surgical vs. Conservative Management of

Intervertebral Disk Disease in Dogs & Cats. VIN. Com. Western Veterinary Conference 2002.

https://www.vin.com/members/cms/project/defaultadv1.aspx?id=3844478&pid=11136&

Pancotto, T. E. (2020). Integrative Management of the Neurologic Patient: Surgery, Rehabilitation, and

Alternative Medicine. VIN.Com.2020 ACVIM Forum On Demand. https://www.vin.com/doc/?id=9631245

Rossmeisl, J. H. (2013). Approaching the Dog with Low Back Pain. VIN. Com. Western Veterinary

Conference 2013, Las Vegas, NV.https://www.vin.com/doc/?id=6699626

Thomas, B. (2014). VIN Boards—Hindlimb traumatic paralysis and chiropracter[sig] adjustment.

https://www.vin.com/members/boards/discussionviewer.aspx?documentid=8504292&viewfirst=1&findsince=26280000

Vetstream.(n.d.). Chondrodysplasia in dogs. Vetlexicon Canis from Vetstream. Retrieved March 5, 2021,

from https://www.vetstream.com/treat/canis/diseases/chondrodysplasia

Figure 1a. Fotojogodka from Getty Images [Photographer]. Lhasa apso portrait [Digital photo].

Retrieved fromcanva.com/design

Figure 1b.VTLS from Getty Images [Photographer]. Dachshund standing. [Digitalimage]. Retrieved

fromcanva.com/design.

Figure 1c.Ozgurcoskun from Getty Images [Photographer]. Cocker spaniel standingagainst a white

                 background. Retrieved from canva.com/design

Figure 1d.Fotojogodka from Getty Images [Photographer]. Pekingese dog in stand[Digital Photo].

Retrieved fromcanva.com/design

Figure 1e.Studiotrapeza from Getty Images [Photographer]. Dog, basset hound, isolated[Digital Photo].

Retrieved fromcanva.com/design

‍

By Erica Tramuta-Drobnis, VMD, MPH, CPH

Understanding canine behaviour and communication cues is critical to ensure successful treatment outcomes in canine osteopathy. Osteopathy treatment addresses a wide variety of ailments. These can include orthopaedic injuries, arthritis, chronic pain syndromes, acute trauma, and surgical recovery. However, to effectively provide these management services, practitioners need to practice safe animal handling.

Becoming familiar with canine behaviour and communication cues is critical to your success and safe interactions with your patients. Animals do not talk quite the way we wish they could. However, they speak volumes with their body language. Recognising these cues and understanding what your patients saying can differentiate between a successful treatment or a trip to the emergency room.

All interactions with animals, even by trained professionals, need to occur without harm. How to stay safe and have a mutually acceptable relationship with you and your patient depends upon your ability to recognize cues the dog demonstrates throughout your interactions.

When working with your patient, you may see signals indicating your patient’s different moods or acceptance levels. Acceptance of you, of the situation, and the therapy is critical to your osteopathy plan’s success. Remember that

• You need to evaluate the entire body while assessing the dog’s body language.
• A fine line exists between anxiety and fear signs. Recognizing this is critical to ensure escalation to aggression and harm does not occur.
• Dogs can easily switch from anxiety to fear to aggression to contentment, sometimes with apparent changes in manners, but the change is often very subtle.
• Always ensure you keep an eye on your patient, even if focused on treating a specific part of the body. This allows you to detect changes and respond appropriately (Tramuta-Drobnis,2019a).

Table 1 Discusses common behaviors shown by a relaxed dog. Most people recognize the play bow and the loose tail wag.

Table 1 Signs of a content, calm dog. Adapted from (Tramuta-Drobnis, 2019a & Tramuta-Drobnis, 2019b).

Table 2 Shows various behaviors, and body postures often demonstrated in various degrees suggestive of stress and anxiety. Sometimes these behaviors occur all at once, or you may notice a select few. Once appreciated, take action to minimize the pet’s stress, and you should see the signs abate. If you continue with your treatment despite the signs, they can escalate, putting you and the pet in harm’s way.

Table 2. Behavioral indicators of stress and anxiety. Adapted from (Tramuta-Drobnis, 2019a & Tramuta-Drobnis, 2019b).

In addition to signs of anxiety and stress, fearful dogs may also demonstrate these actions in Table 3.

Table 3:Additional signs of fearful dogs. Adapted from (Tramuta-Drobnis, 2019).

Please see Figure 1 for a visual image of some of the described behaviors.

Figure 1. Body Language of Fear in Dogs. A pictorial image of various signs of stress and anxiety in dogs. Obtained from https://drsophiayin.com Originally adapted from Dr. Sophia Yin,2015.

To discuss what the dog may do alone is to neglect the role you play. To succeed at practicing canine osteopathy, you need to understand canine anatomy and biomechanics. However, you must also understand how to interact with your patients safely and in a non-threateningmanner. Things to consider include

• Standing to the side. Do not face the dog directly; stand with your body turned 45 degrees. This makes youl ess threatening.
• Do not stand over the dog.
• Let the dog initiate contact, coming to you.
• Put your hand out at a lowl evel for them and allow the pet to sniff you. Do not attempt to grab at the dog.
• Avoid direct eye contact, as this can be threatening.
• Avoid reaching over the dog’s head or crossing over their body.
• Move slowly—no sudden movements.
• Do not hug the dog. After a brief interaction, stop and allow the dog to regroup. The dog may seek more affection or may turn away.
• Always watch for signs of stress. If cues suggest stress, walk away, change your position, leave there for a bit, and then reattempt to connect.
• Speak calmly and quietly (Cattett, 2014;Tramuta-Drobnis, 2019a & b; Ziegler, 2009).

When first getting to know your patient,perform a consent test. Start interacting, petting, giving treats, and then stop your initial interactions. See if the dog walks away or solicits additional contact. Allow the dog to be involved in the decision-makingprocess. Do not force the dog to be restrained or force the dog to interact until it is ready.

When petting the dog, pet

• Under the chin
• The side of the chest behind the shoulder area or
• On the shoulders

Most dogs do not like having someone pet the top of their head directly. Avoid holding/restraining them by the collar or neck alone, and try not to hold the muzzle closed.

Cooperative care is a mutual relationship between you, the practitioner, and the pet. It allows the pet to participate in their care. The pet willingly decides to partake in their osteopathic treatment. This ensures a better outcome both medically and socially for all involved (Jones, 2018). See the resources below for additional information.

If you interact and force a dog to dosomething it does not want to, stress can ensue in both the osteopath and the patient. It can create long-lasting stress long after the situation.

If the pet requires a muzzle, muzzle training at home before the visits may be warranted. Using cooperative care training,the owner can train their dog to readily accept a muzzle and associate it with good things. The pet can then come muzzled or readily allow the owner to muzzlethe pet for safe handling.

Anytime the pet’s behavioral cues escalate,demonstrating an increase in anxiety, take a step back. That pet is saying no.

Have owners monitor the dog even before they get to you for signs of stress. While in the waiting room, if the owner appreciates nose or lip licking, low ears, yawning or whining, even panting,the pet is demonstrating signs of stress. Knowing this ahead of time is key to preventing escalation.

You may not be able to do your canine osteopathy treatments on the first, second, or even 5th session. Owners may have to do some work at home after making the initial osteopathic diagnosis via observation and gait analysis. You may not institute your treatment plan untilt he patient learns to trust you over time. See additional resources below.

At any time, a stressed, anxious, or calm dog can become aggressive. You must always be vigilant, always paying attention to sudden changes in behavior. Monitor for slight changes in ear position, tail posture, and eye changes to ensure you can anticipate the unexpected!

Remember that you need to use your senses too. It is not just one body part that you need to monitor. The individual signs they show are taken collectively with their overall body posture,demeanor, and cooperation or lack thereof.

Never force the dog to do something they don ot want to. Allow the pet to take part in the decision to accept yourt reatment. Remain calm. A painful dog may behave differently than he/she would typically.This may trigger the pet to become stressed sooner rather than later.

Learning to recognize the signs of stress will help you protect yourself and your staff and keep the pet safe and minimize anxiety. By doing all this, you can ensure your treatment is successful and that your osteopathy therapy provides the needed relief the pet and owner seek.

Stay tuned for our next blog, reviewing signs of pain in our furry canine friends. Canine Osteopaths need to understand and recognize signs of pain to properly treat their patients and monitor therapy response.

1.  Muzzle use training: The MuzzleUp Project aims to educate and train on the safe use of muzzles and animal behavior. https://muzzleupproject.com
2. Cooperative Care resources
3. Cooperative Care: Seven Steps to Stress-Free Husbandry, by Deborah Jones Ph.D., ISBN-13: 978-0578423135
4. Cooperative care videos byDeborah Jones, Ph.D., https://www.youtube.com
5.  https://www.seasidesignal.com
6. Clicker training information: https://www.clickertraining.com
7. Understanding your dog’s body language: https://positively.com

Cattett, J. (2014). 5loving ways to pet a dog [Dog Behaviour Website]. Smart Animal TrainingSystems Pet Tutor.https://blog.smartanimaltraining.com

Jones,D. (2018). Cooperative Care: Seven Steps to Stress-Free Husbandry.

Tramuta-Drobnis,E. (2019a). Canine and feline behavior and handling. [Power PointPresentation]. Lehigh Valley County Animal Response Team, Allentown, PA.Unpublished.

Tramuta-Drobnis, E. (2019b). Animal Behavior and Rabies. [Power Point Presentation]. Allentown Bureau ofHealth, Allentown, PA. Unpublished.

Ziegler,T. (2009, September 9). Behavior [Power Point Presentation]. AmericanHumane Society Presentation.