What Can We Do for Mobility Issues?
Whether your pet is just starting to get a little creaky in the mornings or is suffering from more advanced musculoskeletal or neurological impairment, we put together a list of some ideas to support them. It is by no means complete, but it’s a good start.
Regular exercise. If you know me, then you know I had to rank this one high on the list. Everyone wants the magic pill or injection, herb, laying on of hands, whatever. But getting regular low impact exercise, like walking, is one of the best forms of medicine for your aging companion (and you). It helps to maintain muscle mass, a healthy body weight, joint health, cardiovascular health, and improves cognitive function. Swimming and underwater treadmill therapy are also great exercise for older joints. If your pet is too debilitated for even a short walk, consider a consult with a veterinarian to discuss modifications and/or a referral to a rehabilitation specialist. For a list of outdoor activities to do with your older pet, click here and here for indoor activities. Read more about exercise and osteoarthritis in dogs here.
Balanced diet to maintain a healthy weight. Again, not the favorite answer, but it’s one of the best. Being a healthy weight improves mobility as well or better than pain medications such as NSAIDs and increases longevity by more than 2 years. And I’m not going to recommend a magic, expensive diet, like raw eggs and sushi and grain free organic sweet potato and duck. A good, balanced senior food manufactured by a pet food company with a reputation for strong long term research and quality control (ie, Purina, Science Diet, Royal Canin, Eukanuba) will do just fine as long as it’s an appropriate calorie count.
Supplements. We could have a whole paper on joint supplements, but here are the guidelines:
Look for a product that has undergone independent testing through the NASC or is made by a reputable manufacturer with US sourced ingredients.
Make sure the ingredients are actually listed in a language you can read. Beware of “proprietary ingredients.”
Consult with your veterinarian to make sure the supplement or neutraceutical doesn’t interact with any of your pets other meds and isn’t contraindicated based on species or other health conditions.
That said, most joint supplements are some kind of anti-oxidant and work by reducing cellular damage and free radicals which cause inflammation. Some have some decent evidence for use, such as high levels of Omega-3 fatty acids (Hill’s J/D), hyaluronic acid, and green lipped mussel. Some have less evidence but seem fairly safe, such as glucosamine, chondroitin, turmeric, Boswelia, etc. In general, I think it’s ok to use these as long as they don’t cause any appetite issues or other side effects, and it’s not a financial burden for people (because they aren’t cheap).
4. Massage and acupuncture. Its really two but they work well together. When our body isn’t moving correctly or normally, we overuse some muscles and develop restrictions, muscle knots, that cause changes in blood flow and nerve function, known as myofascial pain syndrome. Think of those knots you get in your shoulders and neck, which can give you a headache and make you hunch your shoulders. Both massage and acupuncture can help release these tight knots, sometimes called trigger points. They also help improve blood flow and return nerves to normal function. Sometimes we use them together, and sometimes one modality seems to work better for certain patients or conditions. More information on myofascial pain here and acupuncture here.
5. Traction. Just like supportive footwear for people, providing good traction helps pets who are already unstable on their feet get up and around and parents them from slipping and falling. Stairs and corners, which require changes in direction are especially important. Old yoga mats, throw rugs, runners are good options. For homes where this isn’t feasible, toe grips are a great alternative. Pawfriction can be helpful for some patients too. In general, keeping the hair around the feet trimmed, and nails trimmed also helps with traction.
6. Mobility Support Devices. Harnesses and slings such as the Help Em Up harness or the Walk About can improve confidence and help less stable patients navigate stairs and uneven ground, getting in and out of the car, or managing a short walk to stretch their legs without falling or killing your back. Ruffwear makes a good supportive harness for smaller dogs with a handle on the back to help lift and carry them when needed. These can be helpful for severely debilitated pets, but implementing them sooner will help maintain mobility for longer and allow pets to get accustomed to their use. Other devices such as the Biko brace, other joint support braces, and even carts can be helpful for specific conditions and patients.
7. Environmental modifications. Consider ramps and stairs to help pets who can’t jump up anymore, and elevated food and water bowls. Dog doors might need extra traction and a slightly elevated area on either side to make stepping through easier. For cats, consider using less litter, about 1 inch, and shorter sides or a cut out or small ramp in the litter box to make getting in and out easier. Heated beds are also nice, especially for cats, as long as they are still mobile enough to move out of the heat if they get too warm. Being able to get a good night of sleep improves pain, mental and emotional health, and allows time for the body to rest and repair.
8. Protective devices. Feet and toes are especially vulnerable to abnormal wear in pets with decreased sensation or neurological weaknesses. Neopaws, Muttluks, and Pawz booties are a few examples of ways to protect toes from scuffing and dragging. Elbows and hocks can also suffer from pressure sores and ulcers in debilitated pets who spend more time laying down and have less subcutaneous fat padding and thinner skin. Soft bedding with conforming padding like memory foam help prevent pressure sores. Absorbent and washable are also good qualities for a dog bed. Dogleggs makes several products to provide extra padding. Again, prevention is key here. Once the skin is ulcerated, more intensive care and bandaging may be needed to allow for healing.
9. Pharmaceutical pain control. We often do too little too late. Starting appropriate pain medications before the pain becomes debilitating and is limiting mobility helps with exercise, and thus, weight control. It’s use it or lose it when it comes to mobility, and if it hurts, you’re not going to use it as much or as well. If your pet has limited mobility, chances are they have some form of pain, even if pain isn’t the cause of their mobility issues. If you aren’t sure, you can reference some pain scales and discuss with a veterinarian whether or not your pets condition might be painful. Keep in mind not all pain is the same, and we have different types of pain medications for different types of pain. Non steroidal anti inflammatory drugs (NSAIDs) are often the first line of treatment and you can read more here.
10. Mental and emotional health. Last but not least. Because if you don’t have a reason to get up everyday, then, well, you don’t want to get up. Providing puzzle toys, chew toys, opportunities for socialization, regular human contact and petting, and whatever else they enjoy helps to maintain a positive attitude. Underlying anxieties and fears should be managed with behavioral modification, pharmaceuticals, neutraceuticals, and pheromones. Pain, fear, and anxiety are interwoven in our nervous system, which controls all bodily functions, including mobility. It’s no surprise that some of the medications we use for chronic pain are psychopharmaceuticals.
Every pet and family is different and deserves an individualized treatment plan which is regularly reassessed and adjusted to meet their changing needs. Read more about osteoarthritis and management here.
Knowing how disease will likely progress and what to expect will help you to anticipate needs and be prepared to make adjustments or institute changes. As with all palliative care, it is vital to be honest with yourself and your medical team about your expectations, abilities, and resources