Chapter 22 The Role of Acupuncture and Manipulative Therapy in Canine Rehabilitation 555Chiropractic/manipulative therapy is a
receptor-based therapy. A functional knowl-
edge of neurology is required for the appropri-
ate use of manipulative therapy. Every manual
adjustment affects the nervous system in some
manner, and the manipulative therapist should
understand the neurological impact that an
adjustment might have on the patient.
Anatomy and function
Many patients that present to rehabilitation
therapists are experiencing changes in gait
and/or mobility. Training in neuroanatomy
and neural function as well as honing palpation
and manual skills are critical components of
training in manipulative therapy/chiropractic.
These skills can be tremendously beneficial in
helping to determine the longitudinal level of a
neurological lesion with which a rehabilitation
patient presents (Beck, 2011; Lorenz et al., 2011).
Knowledge of the anatomy and function of
the nervous system is necessary to appropri-
ately diagnose musculoskeletal problems
encountered in rehabilitation patients and to
determine when and how to prescribe and
apply chiropractic and manipulative therapies.
A working knowledge of spinal cord anatomy
and function, including locations of motor and
sensory tract pathways and how afferent infor-
mation is processed and affected by chiropractic
adjustments, can help to improve rehabilitation
diagnosis and subsequent treatments.
The joints formed by the articular facets
of the spine are true synovial (diarthrodial)
joints referred to as zygapophyseal joints, or
Z joints for short. The joint capsules of the Z
joints have a tremendous concentration of sen-
sory innervation, including mechanoreceptors
and nerve endings containing substance P for
nociception (Giles & Taylor, 1987; Yamashita et
al, 1996; Cramer & Darby, 2014). Gapping or
separating of the Z joints and breakdown of
intra-articular adhesions between Z joints have
been hypothesized as a beneficial effect of spinal
adjusting (Cramer et al., 2002). Research has
demonstrated that vertebral hypomobility
results in degenerative changes of the Z joints,
including adhesions in the Z joints themselves,
the amount and severity of which are time-
dependent (Cramer, et al., 2004, 2010).
The anatomic components of a joint, includ-
ing the joint capsules and ligaments, are rich
in mechanoreceptors that provide abundant
afferent information to the CNS about joint
position and proprioception. Sensory informa-
tion (received from both the external environ-
ment and from within the body) is processed
and integrated by the CNS to produce appro-
priate output (Zimny, 1988). An adjustment of a
joint provides sensory input through the motion
imparted on the motion segment.
The intervertebral foramen (IVF) forms a
bony–ligamentous boundary and provides
protection between the central and periph-
eral nervous systems. Intervertebral foramina
are found from the 2nd cervical vertebrae to
the sacrum. The structures that pass through
the IVF are the dorsal root ganglia, spinal
nerve, cerebrospinal fluid (CSF), recurrent
meningeal nerve, dura, veins, arteries, lym-
phatics, transforaminal ligaments, and adi-
pose tissue.
Because discs receive direct nociceptive inner-
vation, an injury to the disc can be a sole cause
of back pain. In addition, an inflamed disc can
compress or entrap a dorsal root exiting the IVF,
and the histamine-like substances that leak from
injured intervertebral discs have been found to
irritate exiting dorsal roots. Both of these situa-
tions cause sharp, stabbing pain known as
radicular pain (Cramer & Darby, 2014).
When performing an adjustment, the goal of
the animal chiropractor/manipulative therapist
is not to return a vertebra or joint back to a spe-
cific position, but to activate or initiate the
homeostatic mechanisms of vertebral or articu-
lar kinesthetics. An adjustment concentrates on
one specific motion segment at a time. Effects of
a local change may have widespread physiolog-
ical effects, so the properly trained manipulative
therapist will have performed a comprehensive
evaluation and established a list of differential
diagnoses for the patient before any adjust-
ments or treatments are undertaken.Functional neurology
and manipulative therapyThe nervous system, composed of the central
and peripheral nervous systems, is a complex
and highly organized system that, when