Nonpharmacologic management of canine osteoarthritis: Part 1

Approximately 40% of dogs experience osteoarthritis (OA)-induced pain.¹ Proactive and multimodal management of OA should include nonpharmaceutical techniques recognized by the 2022 American Animal Hospital Association Pain Management Guidelines for Dogs and Cats.²

Part 1 of this 2-part article series focuses on the roles of weight management and exercise—both strategies are first-line/tier 1 recommendations for OA management.² Part 2 will review therapies that fall in second and third tiers, including therapeutic modalities, manual therapy, oral joint supplements, and intra-articular injections.

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Weight management

An estimated 60% of dogs are overweight or obese, and excessive body fat predisposes dogs to numerous life-threatening conditions, including OA.³ Maintenance of a lean body condition can reduce the development and severity of OA.⁴ Caloric restriction is the most effective method of weight loss, and feeding sufficient calories to maintain a lean (4.5/9) body condition score (BCS) is recommended.⁵

In a series of articles known as the “Purina Life Span Study,” investigators reported the outcomes of life-long caloric restriction in 48 Labrador retrievers genetically at risk of developing OA. At age 8 years, 10% of dogs that were maintained at a BCS of 4.5/9 through caloric restriction had radiographic OA in at least 2 joints, whereas 77% of dogs that had a BCS of 6.5/9 had OA. The dogs with a BCS of 4.5/9 also lived on average 2 years longer than the overweight dogs.^4,6,7

Other studies have documented improvement in OA symptoms following weight loss in client-owned dogs with the disease. Reduced symptoms of OA can be seen with as little as 6% to 18% weight loss in overweight dogs with hip or elbow OA.^8,9

Exercise

Exercise has been shown to reduce inflammation and decrease pain in humans with OA and animal models of chronic pain through actions on the opioid, serotonin, and dopamine pain modulation systems.^10-13 Exercise also improves function of an arthritic limb through improved muscle strength, proprioception, joint stability, and range of motion.

Regular, controlled, low-impact exercise is recommended for dogs with OA.^14,15 One study found that in a group of Labrador retrievers with hip OA, dogs that exercised for more than 60 minutes per day had significantly lower lameness scores compared with dogs that exercised less than 20 minutes per day.¹⁶ Although the results of this study may not apply to the management of OA in other joints and should not be taken as an immediate prescription of 60 minutes of daily exercise for all dogs, it does offer evidence in support of daily exercise for dogs with the condition.

The addition of exercise, especially with underwater treadmill therapy, to a diet-based program can assist with weight loss and help preserve lean muscle.¹⁷ One of the most important aspects of a weight loss program is regular weigh-ins to monitor adherence, which is often achieved when dogs are enrolled in an in-clinic exercise or rehabilitation program.^18,19

Therapeutic exercise

The foundation of veterinary rehabilitation is therapeutic exercise. Therapeutic exercises are those prescribed with a specific goal in mind, such as increasing gluteal muscle activation or improving active range of motion of the elbow. Therapeutic exercises can often be performed by dog owners at home, though there are benefits to therapist-guided exercises performed in a rehabilitation clinic, including improved adherence and real-time exercise modifications appropriate for the patient. Supervised exercise has been shown to be more effective than unsupervised exercise in humans with OA, which may translate to pets.²⁰ A veterinary rehabilitation professional should ideally be consulted to develop customized exercise programs for dogs with OA.

Hydrotherapy

Hydrotherapy can be considered a form of therapeutic exercise when utilized in the rehabilitation setting. Both swimming and underwater treadmill therapy can help improve strength, range of motion, and fitness while offering support to animals that may be weak or in pain.^17,21,22 Benefits of hydrotherapy for dogs with OA include the following:

• Buoyancy: The support of water often allows animals that are weak and/or in pain to exercise longer than they could on land. The amount of force placed on arthritic joints is also reduced, thereby reducing pain when moving the joint.
• Resistance: Swimming or walking through water requires more effort than moving the body or limbs through air; this provides the opportunity to strengthen muscles that support arthritic joints.
• Range of motion: Swimming has been shown to improve elbow range of motion in dogs with elbow OA.²¹ Another study found reduced lameness, improved joint mobility and weight bearing, and reduced pain on palpation in dogs with hip OA following an 8-week swimming program.²² The height of water can be changed in an underwater treadmill to improve range of motion of different joints.

Conclusion

Weight management and regular, controlled exercise are integral to effective OA management. Dogs with OA should be maintained at a BCS of 4.5/9 primarily through caloric restriction. Daily exercise, including leash walks and therapeutic exercises, should be recommended, with specific plans tailored to the individual dog.²

Kristin Kirkby Shaw, DVM, PhD, MS, DACVS, DACVSMR, is a small animal surgeon and rehabilitation specialist whose career has focused on bridging the gap between these 2 disciplines, with specific emphasis on treatment of arthritis. Shaw received her DVM, PhD, and MS degrees, and completed a small animal surgical residency at the University of Florida (UF) in Gainesville. She spent 2 years as a clinical instructor at UF and 9 years in referral practice in Seattle, WA. Shaw currently works for Zoetis as a specialist in pain management and osteoarthritis.

References

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