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If a dog has a lack of mobility through illness, muscular or skeletal pain, or postoperatively, this will also cause a reduction in muscle tone. Such reduction will occur much less rapidly, and is due to a reduction of neural stimulation rather than compromised neural stimulation. Massage and passive movement (see Chapter 4) can help to retain the neural communications and improve the circulation, so as to reduce the occurrence of a chronic state of atrophy.
Knowing how muscles are phased and having good palpation skills are extremely important when assessing the condition of a muscle or muscle group (see Chapter 3). This is crucial when trying to ascertain whether a muscle is toned, thixotrophic, stretched, damaged, or in spasm. Experience enables the practitioner to learn how muscle behaves in different situations and conditions, and to differentiate between a well-developed and healthy muscle and one that is unhealthy. Good palpation and assessment skills are essential for identifying the site of injury caused by a chronic insult, as surrounding muscles and fascia can provide misleading information. An accurate assessment can only be made by an experienced practitioner (see Chapter 6).
Fascia
Fascia is a fibrous connective tissue that permeates and interpenetrates tissues, enveloping the entire body. It forms a continuous network that is responsible for the supporting structure, form, and intercellular communication, all of which are needed to aid tissue repair. Fascia is uninterrupted, and because it extends through muscle, bones, nerves, and blood vessels, it forms an extremely effective communication matrix spanning the whole body. It also assists tissue repair through the complex intercellular communication network. Through its physical construction and connective properties, it also supports and aids protection for internal organs. Due to these continuous
and contiguous properties, it enables us to view the body as a system of continuous networks of tissues, and not merely an assembly of separate parts.
In veterinary research, fascial connections are still fairly unexplored. Even within human scientific research, the study of fascia as an organ of support has been largely neglected, and its role in musculoskeletal function and dysfunction has received relatively little attention. This may be due to fascia’s far-reaching effects, which make it difficult to study; it cannot be easily divided into units and subunits.
Even within the fields of dissection and surgery, fascia has always been viewed as obscuring the anatomical structures of interest, such as muscles, nerves, and blood vessels. However, we must remember that the tissue removed is responsible for the support, connection, separation, and, most importantly, the interdependence of the structures being investigated (26). We can only look to human research to see how bodies are connected by these fascial chains; this can help us to answer many questions when treating dogs. Thus, it is necessary to think of fascia as a complete supportive system. Tracing and linking the muscles by following the chain of these fascial connections to an original point of injury is an important skill for a practitioner.
Anatomy of fascia
The two main areas of fascia that are relevant are superficial and deep:
•Superficial fascia – lies just below the skin in most of the body.
The superficial fascia of the trunk corresponds to the subcutis, envelopes the cutaneous muscles, and lies directly under the skin of most regions of the body. It contains mainly areolar and adipose connective tissue, and therefore can support and store fat, providing insulation and protection. It also supports blood, lymph, and nerve vessels.
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•Deep fascia – encloses individual muscles. It forms loose connections with adjacent muscles, forms attachments to bone, directs muscle contraction, and supports and secures internal organs. It is a dense fibrous connective tissue that permeates muscles, and separates groups. It provides physical connection and neural communication between the muscles through fascial linking
of tendons and fascial attachments called aponeuroses. These are
wide fibrous, tendon-like structures that increase the area of muscle attachment and the anchorage of muscle to bone. These fascial attachments form uninterrupted chains supporting much of the body. This continuous network has an active role in cellular innervation, which regulates activity. It is also a matrix for these highly organized structures, including pathways
for nerves, capillaries, and lymphatic vessels that serve the muscle.
26 Fascial bands separating the hamstring group of muscles in a leg of lamb.1: Fascial bands.
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Thus, the practitioner must not view muscular functions individually, but think more of interrelations and connections between one muscle and another, and the fascial relationship between them. This continuous structure, when damaged, can
cause either far-reaching or local problems, forming adhesions to adjacent structures. When damaged, fascia can rupture, tear, or become inflamed and painful. It has a smaller blood supply than many tissues, which can lead to poor healing.
CASE STUDY 1
Tia, an extremely active Border Collie that competed at a high level in agility, suffered an accident that led to pelvic limb ataxia during exercise. Her handler took her to her veterinary surgeon, but by this time she was regaining limited movement of her pelvic limbs. She was then referred for a magnetic resonance imaging (MRI) scan, but it gave no explanation for her condition. Therefore, no solution could be offered. Tia was then sent for myotherapy treatment 4 weeks post-accident. She presented as a dog that had the look of a jack-knifing lorry: her front end was moving forwards and her back end was following its own disunited course. Following palpation by the Galen myotherapist, a tear was found within the fascial connection of the left side of m. latissimus dorsi; the tear was about
1.5 inches (3.5 cm) wide and presented like a circular indent with raised edges. Could this have been the reason for the temporary loss of use of the limbs? More importantly, could this be the reason for her lack of pelvic stability (27)? The m. latissimus dorsi joins the thoracic limb to the pelvis through the thoracolumbar fascial plane, and therefore has a stabilizing role.
After 5 months, Tia is following a course of rehabilitation exercises (see Chapter 5) and regular treatment from a myotherapist; the scar tissue is being managed and her core stability is being enhanced. Her quality of life is very good, but she obviously misses her agility classes.
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27 Tia, showing her typical stance, compensating for a lack of structural stability. The arrow indicates the position of the fascial tear.
Fascia and muscle
The role of fascia in relation to muscle tissue is that of constraint, containment, and connection, to allow the
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or, conversely, distributed to surrounding tissues as required by biomechanics. This avoids any power dissipation during activity, through tensile strength and elasticity of the outer fascial sheath. This keeps the muscle in its correct position, whether in contraction or not, and sustains the loose fascial connection with adjacent muscles to maintain alignment and orientation in both situations. Any form of fascial tear will compromise the muscles’ or muscle group’s integrity (see Case study 1).
How do the combinations of muscles and fascial planes impact on the biomechanics of the dog? This can be answered by looking at anatomical trains. Within the human form, anatomical trains, or the myofascial planes, are well documented; considering the similarity of our musculoskeletal system to that of the dog, we can view the dog in the same way. Thus, we can achieve a much more threedimensional feel for body patterns, compensatory effects, and strain distributions; these would otherwise be treated in isolation.
‘The anatomy train is a line of tensional pull, not compressional push – therefore, it must, like any functioning tensile apparatus, follow the most straight lines, both in direction and depth’.
Tom Myers
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Dissection has demonstrated human |
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Myofascial stress
The stresses of movement have a piezoelectric effect on the surrounding molecules, which causes the bonds between them to be stretched. This slight electrical flow is communicated and interpreted by the cells in close proximity, causing them to respond and reorganize the intercellular elements in the area. This includes bone formation and density due to exercise, and the stress lines in each individual (see Skeletal system). This can be affected by the stresses caused through
Superficial back arm line
Superficial back line
Lateral line
Medial aspect
Superficial front line
29 Postulated canine fascial trains (based on human Anatomy Trains™, courtesy of Tom Myers). Not all the trains are featured; all four legs should have four lines each: cranial and caudal for mobilization and lateral and medial for stabilization.
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injury, overuse (especially in puppyhood), or chronic repetitive strain. Osteoblasts lay down new bone anywhere within the periosteum, and osteoclasts are controlled neurologically only to clear new bone that is not piezo-electrically charged. Therefore, over time the stresses caused through a myofascial–skeletal dissonance could have a long-term effect over the stress distribution of bones and, therefore, over joints and their application.
While not overemphasizing their importance in treatment considerations, these possible canine anatomical maps may prove to be the ‘missing link’ in a nonreceptive case of persistent intermittent lameness. In many cases, the release of fascial tension can prove to be a highly successful treatment.
Within the dog’s skin, fascial changes can be clearly felt and assessed. The degree of change can be calculated (especially in a young dog) by the degree of elasticity displayed. When a dog is older (>10 years), the collagen is less elastic; however, there should still be a visible pliability in the skin and in surrounding tissues. If the superficial fascia is not demonstrating pliability, the dog will be displaying symptoms of somatic dysfunction, whatever its age.
Fascia and posture
There are certain specialized forms of deep fascia that stabilize and maintain a dog’s posture during movement (30). They form part of the body’s fascial network (29).
Spinotransverse Cervical
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30 Canine deep fascia involved in posture.
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CASE STUDY 2
Digby, an agility dog damaged the left thoracic palmar surface of his leg on glass, and was left 9/10 lame on this leg. Being a lively dog, this was not going to hold him back, despite being cage rested. When he did have exercise, the activity levels were high. When the leg healed, he was left with a chronic stiffness within the pelvic region. This was not unexpected, due to the compensatory issues he had received, but the unusual factor was that the main problem arose from the same side and not, as is the usual case, from the opposite side to the original injury (compensatory issues tend to cross diagonally or criss-cross the body). Again, this can occur, but the significance was that, when the neck was treated, there was an obvious and major skin reflex that imitated the fascial superficial front line. It travelled at a mid-point in a transverse direction across the ribs where it continued from the iliac crest in a ventral direction to his stifle. After this treatment, all stiffness eased and he resumed his agility career.
CASE STUDY 3
Jess, a 12-year-old Beagle was becoming stiffer (over the whole body) and grumpier with every week that passed. She had been treated in the same way as other successful cases by targeting hypertonic muscles, but to no avail and remained chronically lame. As a last resort the practitioner applied some thorough and very painful skin-rolling. All the skin across the thoracic and pelvic region was adhered, so this process was more than a little uncomfortable; however, a few days later, Jess was a changed dog and resumed being her affectionate self. The stiffness eased to such a point that she could resume walks and did not require any further treatment.
Consider the gravitational and mobility stresses that a dog puts its body through.The twisting, turning, and pivoting by far exceeds most human capability and sustainability (see Chapter 3). This has always been a phenomenon the author has found hard to understand when treating different dogs for various injuries. It can help to consider the skeleton, with the only soft tissue in place
being the ligaments; this is anything but a stable structure against the aforementioned forces. But, then add the muscles, which can be considered to be the struts or cables that connect this bridge-like structure, and then think of a dog performing leaping and twisting movement (31).
The ligaments, cartilage, and bursae of a joint form a very resilient compression