What We Now Understand About Knee Problems

by Dr. Deva Khalsa on July 28, 2011


The Skinnny on Anterior Cruciate Problems

Your dog’s knee is an complex joint. To add stability to the joint, there are strong ligaments. Two of these are attached in a crosswise fashion and they are called the anterior and posterior cruciate ligaments. These ligaments act together with two outer bands of fibrous ligament, the lateral collateral ligaments, and the kneecap to maintain your dog’s knee stability through a wide range of motion.

Cruciate ligament damage is seen much more frequently in overweight, neutered, middle-aged dogs, while a very small group of dogs get torn cruciates as a true sports injury. These are dogs that test the physical limits of their bodies through over-exertion such as Frisbee catching. Veterinarians used to think of cruciate tears as a relatively simple and straightforward problem – the dog made a sudden incorrect move that tore the ligament. But recent research has shown that cruciate problems are anything but simple and straightforward in their cause and treatment.

As an example, dogs over 4 years old that are spayed or neutered are considerably more likely to suffer cruciate tears than dogs that remain sexually intact. Do not neuter or spay your dogs early because sex hormones are involved in the development of bone, tendon and muscle. Early neutering and spaying is pushed by SPCAs because they want to halt the pet overpopulation problem. For almost 30 years In my practice I recommended restraining from neutering male dogs because I felt that they stayed stronger and healthier if they were not neutered. At that time the normal approach was to neuter and avoiding prostatic cancer was one rationalization for this surgery. In fact, prostatic cancer occurs just as commonly in neutered dogs as it does in intact dogs and as there are far more neutered male dogs it is seen more in neutered dogs. A similar reasoning for spaying female dogs is to avoid mammary cancer. While the hormones that will activate the cells to create mammary cancer are nipped in the bud with early spaying, this early removal of the sex organs results in many more medical problems. In fact, I never saw one case of mammary cancer develop in my long term patients that practiced holistic treatment under my guidance but I did see mammary cancer in new patients that had not practiced long term holistic care for their pets.

It was once thought that cruciate problem appeared suddenly – after a sudden twisting movement or due to jumping up or out of an elevated location. It’s actually not so and inflammation and weakness in the area can precede and contribute to injury. Whatever the cause or causes, something more than a simple accident is occurring because it’s very common for the pet’s second knee to go out sometime after the first one. Another group of dogs that suffer from this disease are those receiving corticosteroid medications for long periods. It is uncertain if these pets develop the problem because they gain weight or because corticosteroids decrease the ligaments strength.

X-rays will not detect the damaged ligaments in your pet when they occur, but they will pick up later degenerative changes as they develop in the unstable joint. It is also quite common for cruciate ligament damage to be incorrectly diagnosed as a hip problem. One of the things I look for is a tiptoe type of walking when your dog first gets up. This goes on for the first several steps and then the walk begins to get more normal. Sometimes you can pick up the laxity on the joint as you stretch and move it.

Certain homeopathic remedies are excellent for this problem. One of them is Ruta grav 6x or 30x. This is a remedy that is specific for ligament injuries and it is also specific for the knee joint. With an acute injury, give Ruta together with the remedy Arnica, dosing it several times a day. If there is stiffness after a walk or exercise you can also give the remedy Bryonia. If there is much stiffness after resting when first getting up you can give the remedy Rhus tox. But always give the remedy Ruta grav. The remedy Gelsemium is also a handy remedy to give with knee problems. The potency choice would be 6c, 6c, 30x or 30c given several times a day.

For many years I used acupuncture and chiropracit routinely for ACL problems. Today my treatment of choice for resistive cases would be prolotherapy. I became certified in a course that was given by Dr. De Haan

The following is an excerpt from an article I wrote for Dog Fancy.

Fortunately, many veterinarians are now learning how to do a procedure called Prolotherapy. Webster’s New Collegiate dictionary defines Prolotherapy as: “the rehabilitations of an incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells”. Injections of a specific mixture are made into the ligaments around the joint and if needed into the joint itself. This stimulates the ligaments to regenerate and also stimulates new cartilage growth in joints. In the hands of a holistic minded veterinarian, this therapy is key to stimulating the growth and repair of collagen, ligaments and connective tissue.

One such veterinarian is Dr. Roger De Haan, DVM, who has pioneered Prolotherapy within the veterinary field. Dr. De Haan says, “I call Prolotherapy my ‘silver bullet’ therapy for ligament degeneration. In the past 20 years, I have treated hundreds of hips, backs, and joints, including ACL degeneration with approximately a 90% success rate. It is gratifying to see an agility dog, or any dog for that matter, move from discomfort and pain and return to normality. Recently, I treated Andy who had been lying around for weeks with no energy. One treatment and Andy was a totally different dog, now excited and running 3 miles daily.

To balance this picture, last year I treated Sarge, who had ligament degeneration in both knee joints, both hips, the lumbar area of his spine and the left front elbow. Drugs were not working any more. The primary vet had given up and told them to contact me. After the sixth treatment, Sarge was a normal, active, happy dog. One year later, Sarge is still one happy camper, not to mention his loving family, the Hovan’s.”

Prolotherapy is a few decades old but few healing traditions are as old as acupuncture and Traditional Chinese Herbal Medicine, both are a part of a remarkably sophisticated and accurate science of healing developed in ancient China. The principles of Chinese medicine, for instance, published in the period of 400-200 B.C., included a discussion of how the heart controlled blood flow through the body; something only accepted by Western medicine when William Harvey made the same “discovery” 2,000 years later.

Dr. Xie is the founder and President of the Chi Institute of Chinese Medicine. Veterinarians come to the Chi Institute from all over the world to become certified acupuncturist and to learn traditional Chinese herbal medicine. Dr. Xie is a third generation practitioner, and is now an Associate Professor in the Alternative Medicine Department at the University of Florida School of Veterinary Medicine. As President of Jing Tang Herbal, Dr. Xie has developed many herbal formulas including one named Body Sore which is excellent for canine athletes. Body Sore can be ordered by your veterinarian and you can use it both preventively and if your dog is in pain. Ligament Repair is another formula that is excellent for ligament injuries. Dr. Xie states, “I believe that the complementary and alternative Veterinary Medicine including herbs and acupuncture play a very important role in treating clinical conditions related to sport injuries, and even more importantly preventing the injuries.”

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