90 Canine Sports Medicine and Rehabilitation
a total dose of approximately 1 g of EPA/DHA
per 10 kg body‐weight is effective (Fritsch et al.,
2010, Roush et al., 2010). Many clients will pre-
fer to supplement with fish oil. The strength
and number of capsules needed differ tremen-
dously, so regular‐strength liquid white fish or
salmon oil that provides approximately 250 mg
of EPA and DHA per gram is advised. One tea-
spoon contains approximately 1 g of EPA/DHA
mixture. Dogs eating a typical over‐the‐counter
adult commercial dog food should receive
about one teaspoon of fish oil per 10 kg body‐
weight to achieve the dose needed for joint
inflammation. Each teaspoon of fish oil contains
approximately 45 kcal, and the food provided
should be adjusted appropriately to avoid
weight gain when multiple teaspoons are being
used. Additionally, this dilutes the nutrient
content of the food provided, therefore a
higher protein food (>28% dry matter) is
recommended.
Freeze dried Perna cannaliculus, also known
as New Zealand green lipped mussel (GLM),
contains glucosamine, chondroitin sulfate, and
long‐chain omega‐3 fatty acids. Two clinical
studies performed using a food enriched with
GLM found improvement of joint crepitus and
joint pain resulting in clinically improved joint
scores when evaluated by veterinary surgeons
(Bui & Bierer, 2001; Pollard et al., 2006). GLM
can be found in a variety of supplements.
However, it is commonly thought that freeze‐
dried GLM is superior as this process preserves
the fatty acid component. A clinically effective
dose of GLM has not been elucidated, but based
on data of GLM incorporated into a commercial
pet food, and a non‐commissioned study,
50–100 mg/kg body‐weight may be an appro-
priate dose (Pollard et al., 2006; Hielm‐Borkman
et al., 2009).
Glucosamine and chondroitin sulfate (a
larger conglomerate of glucosamine mole-
cules) have been extensively studied in human
clinical trials for osteoarthritis. The outcomes
have been varied and the largest clinical trial
in osteoarthritis did not reveal any benefits
for joint pain or range of motion, except for
chondroitin sulfate in the most severe cases of
osteoarthritis (Towheed et al., 2005; Hochberg
& Clegg, 2008; Sawitzke et al., 2010). This sug-
gests that once osteoarthritis is present sup-
plementation has no bearing on pain
associated with the disease. Due to some evi-
dence that glucosamine diminishes cartilage
degeneration over time, it may still be pru-
dent to initiate glucosamine and/or chondroi-
tin sulfate treatment early in the disease
process and continue it indefinitely as it has
been proven safe (Sarzi‐Puttini et al., 2005;
Aragon et al., 2007). The only clinical studies
examining its use in osteoarthritis show
potential for benefits when assessed by clients
and veterinarians, yet there were no differ-
ences in gait or subjective assessment in one
study with placebo control (Moreau et al.,
2003; McCarthy et al., 2007). In the age of evi-
dence‐based medicine there is no clinical evi-
dence for its use. However, many orthopedists
and rehabilitation therapists are proponents
of its use. A range of other nutraceuticals
including elk velvet, resin, curcumin, undena-
tured collagen type II, Bosswelia serrata, and
hyperimmunized cow protein isolates, which
have some clinical evidence supporting their
use, have been reviewed elsewhere (Aragon
et al., 2007).Case Study 4.2 Rehabilitation optimizationSignalment: 12 y.o. M/N 26‐kg Siberian Husky in
good body condition (5/9) with a right cranial
cruciate rupture for over 19 months. Left cranial
cruciate ligament ruptured and clients agreed to
bilateral TTA surgery. Right stifle had chronic pro-
gressing severe osteoarthritis.
Evaluation for rehabilitation: Diet history noted
that patient has been eating 3.5 cups of a senior
dog food with 18% protein, 12% fat and has 375
kcal per cup. Ingredient list shows a chicken meal
base with rice, barley, canola oil, and animal fat.
Diet evaluation reveals that patient is getting only
3.0 g of protein per kg body‐weight, and has no
glucosamine or omega‐3 fatty acids. Client resisted
using therapeutic food due to cost so rehabilitation
therapist looked to commercial over‐the‐counter
products and supplementation. Therapist found a
food that has 32% protein, 16% fat, and 405 kcal
per cup. Feeding the patient approximately 3 cups
per day, provides 4 g of protein per kg body‐weight.
Additional supplementation for inflammatory joint
disease was instituted as fish oil at 2.5 teaspoons
per day and 1000 mg of glucosamine/chondroitin
sulfate mix daily during initiation of this patient’s
rehabilitation plan.