Journal of Zoo and Wildlife Medicine 2013 (Mar); 44 (1): 181–185 ~ FULL TEXT
Liza I. Dadone, Kevin K. Haussler, Greg Brown,
Melanie Marsden, James Gaynor, Matthew S. Johnston
Palmer College of Chiropractic West,
San Jose, California.
A 2-yr-old male reticulated giraffe (Giraffa camelopardalis reticulata) presented with severe midcervical segmental torticollis upon arrival as an incoming shipment. Despite initial medical management, the giraffe developed marked neck sensitivity, focal muscle spasms, and decreased cervical range of motion. Using operant conditioning to assist patient positioning and tolerance to cervical manipulation, a series of manually applied chiropractic treatments were applied to the affected cervical vertebrae in an effort to restore normal cervical mobility. Laser therapy and cervical range of motion exercises were also used to reduce cervical muscle hypertonicity. The combined application of these nontraditional therapies produced marked clinical improvement. This case highlights the potential benefits of combining traditional medical management with chiropractic treatment and physical therapy techniques for management of severe acute-onset torticollis in a giraffe.
KEYWORDS: Giraffe, Giraffa camelopardalis reticulata, torticollis, low-level laser therapy, chiropractic, physical therapy
From the FULL TEXT Article:
A 2-yr-old captive-borne male reticulated giraffe (Giraffa camelopardalis reticulata), estimated to weigh 450 kg, developed severe torticollis during transport between zoos. The giraffe had been given vitamin E (Emcelle Tocopherol 500 IU/ml, Stuart Products, Bedford, Texas 76022, USA; 2.2 IU/kg p.o. q 24 h for 7 days) and was visually normal when loaded. The giraffe was transported for about 20 hr in a standard shipping crate (2.732.1 33.7 m high) and was reported to have remained calm during transport. Before unloading at the destination, the giraffe had severe left lateral torticollis at C4–C5 with compensatory right lateral torticollis at C3–C4 and superficial bleeding of the ossicones with blood streaks on the inside of the trailer at ossicone height (Fig. 1).
The giraffe unloaded
with no obvious neurologic deficits, did not seem
painful in the cervical region, and started eating
immediately from an elevated feeder. Prophylactically,
the giraffe was given
vitamin E (Bo-Se
Injection, Schering-Plough Animal Health,
Union, New Jersey 07083, USA; 1.1 mg/kg
phenylbutazone (Phenylbute Boluses 1 g,
Phoenix Pharmaceutical, St. Joseph, Missouri
64507, USA; 4.4 mg/kg p.o. loading dose, then
2.2 mg/kg p.o. q 24 h for 2 days), and
(500-mg tablets, Qualitest Pharmaceuticals,
Huntsville, Alabama 35811, USA; 24.4 mg/
kg p.o. q 24 h for 13 wk).
On day 4, the
phenylbutazone was substituted with
(Mobic 15-mg tablets, Boehringer Ingelheim
Pharmaceuticals, Ridgefield, Connecticut 06877,
USA; 0.17 mg/kg p.o. q 24 h for 10 days).
Over the first few weeks, the neck was visibly
straighter except for continued mild lateral deviation
at C3–C5. Target training had been initiated
at 6 days of age; therefore, in an effort to evaluate
and treat the torticollis directly, additional training
was initiated to assist entry into a restraint
chute and to tolerate multiple people standing on
an elevated platform near its neck. Lateral
cervical radiographs, with the giraffe standing
and unsedated, were taken over the first 10 wk and
revealed no obvious osseous pathology. Desensitization
training was initiated to allow palpation
and manipulation of the affected cervical region.
Thirteen weeks after presentation, chiropractic
treatment (i.e., manually applied, high-velocity,
low-amplitude thrusts) was applied to the left C4-
C5 intervertebral articulation in an effort to
restore normal segmental motion and motor
control because of concerns for long-term clinical
deterioration. Gradually increasing manual force
was applied laterally over the left C4–C5 articular
process until firm resistance to the induced
motion was felt (i.e., end range of motion), and
then a lateral-to-medial thrust was applied by a
reinforced hypothenar contact.  In the month
before chiropractic treatment, the neck had visually
straightened. Cervical range of motion
(ROM) was assessed with targeting and directing
the giraffe to move its head and nose laterally and
toward the hip bilaterally. Pronounced muscle
guarding was observed during left lateral bending
(Fig. 2a). Methocarbamol was discontinued 13 wk
after presentation on a trial basis because it was
unclear whether the medication was effective.
Photograph of the giraffe upon
presentation after shipping.
Note the pronounced sigmoid curvature of the
cervical vertebrae at the C3–C5 vertebral levels.
Photographs demonstrating cervical
lateral range of motion (ROM) with the nose directed
toward the hip region.
Fifteen weeks after initial presentation, a second
chiropractic treatment was applied over the
left C3–C4 and right C4–C5 intervertebral articulations.
At this time, there was visibly increased
lateral cervical deviation bilaterally (C3–C4 on
the left side and C4–C5 on the right) and obvious
soft tissue pain on the left side at C4–C5. These
detrimental changes were attributed to the discontinued
use of methocarbamol administration.
Despite resuming methocarbamol (24.4 mg/kg
p.o. q 24 h for 8 wk), keepers reported continued
increased sensitivity along the left side of the
neck. Chiropractic treatments were repeated only
every 4–8 wk because of scheduling conflicts.
At 4 mo, laser therapy (LiteCure, Companion
Therapy Laser, Newark, Delaware 19702, USA)
was applied over the left side of the neck to help
manage soft tissue pain and hypertonicity (Fig. 3).
Moderate epaxial muscle hypertonicity and pain
on palpation were localized to the left C4–C5
region, with milder changes identified over the
right C3–C4 articulation. Laser therapy was
applied twice weekly for 4 wk, with treatments
focused over sites of muscle hypertonicity. The
laser settings included ‘‘edema/swelling’’ (10 W,
1,000 Hz, 4 min/site) and ‘‘arthritic pain’’ (10 W,
continuous wave frequency, 6 min/site). The
giraffe would stand in the restraint chute longer
when laser therapy was applied compared with
regular training sessions without laser therapy.
One month after initiating laser therapy, the
cervical ROM was significantly improved in left
lateral bending, muscle hypertonicity and contracture
were reduced, and the left side of the
neck was less sensitive to palpation. Laser therapy
was then continued once weekly for 9 mo. A
gradual continued increase in left lateral bending
ROM was evident over the next few months.
Photograph of giraffe positioning
in restraint chute for laser therapy treatments.
At 8 mo, the cervical ROM and muscle
hypertonicity continued to improve; however,
mild lateral deviations were noted over the
dorsum of the withers and at the L5–S1 spinal
region. The giraffe was subsequently trained for
the application of laser therapy and chiropractic
treatments at those sites.
One year after initial presentation, the giraffe
had nearly normal cervical ROM but continued to
have mild thoracolumbar scoliosis. Small regions
of muscle hypertonicity continued along the neck,
but were markedly improved. Target training was
initiated to induce active stretching exercises for
the cervical region by placement of the target and
nose near the hip region with a prolonged held
position (10-sec duration, five repetitions s.i.d.)
bilaterally. Because of patient height, the stretching
exercises were not able to be performed within
the restraint chute; however, target training while
free in a paddock was effective after several weeks
One month after initiating consistent stretching
exercises and 14 mo after initial presentation,
cervical ROM was excellent (Fig. 2b), cervical
muscle hypertonicity was minimal, and only mild
torticollis remained. On the basis of clinical
improvement, laser therapy was discontinued.
Two years after presentation, neck stretching
exercises are continued daily, and chiropractic
treatment is applied every 4–8 wk in an effort to
help maintain cervical ROM and muscular stability.
In captive giraffes, cervical injuries and muscle
spasms occur in young animals from unknown
causes,  during immobilizations and recovery,1,5
and as the result of shipping. In two recent cases,
shipment-related cervical injuries have resulted in
spontaneous death or euthanasia within days or
months of onset. In 2009, a 5-yr-old female giraffe
sustained cervical vertebral endplate fractures
during transport and was euthanatized.  In 2010,
a 10-yr-old male giraffe had severely avulsed
cervical vertebral ligaments and was euthanatized
immediately after shipment (Erica Lipanovich,
pers. comm., August 2011). The current case is
unique in that immediate life-threatening injuries
did not occur and conservative treatment approaches
were very effective in restoring cervical
The etiology of transport-related cervical injuries
is unknown, although it is speculated that
trauma-induced malalignment of the cervical
vertebrae and nuchal ligament displacement
could lead to progressive cervical vertebral subluxation,
compressive myelopathy, and paralysis
(Roy Burns, pers. comm., October 2011). In
humans, whiplash-associated injuries and soft
tissue damage are reported with velocity changes
of as little as 6 km/hr.3 The authors speculate that
relatively minor velocity changes during shipment
could likewise cause cervical soft tissue injuries in
giraffes. The giraffe described in this report was
younger at the time of shipment compared with
other reported cases of cervical injuries in giraffes;
therefore, a younger age or a smaller
patient size might have helped minimize the
severity of the injury.
Acquired cervical torticollis has been reported
in horses and an alpaca from parasite migration of
Parelaphostrongylus tenuis within the cervical spinal
cord. [2, 8] However, it is not known whether
giraffe are susceptible to this parasite, and more
cases of spontaneous torticollis without a shipping
history would be expected in captive giraffes
if this were an underlying etiology.
The nontraditional modalities of chiropractic,
laser therapy, and active stretching exercises were
essential for successful management of this case.
Chiropractic treatment and stretching are well-recognized forms of spinal rehabilitation to address
pain, flexibility, and muscle tone in horses. 
To date, these therapies have not been reported in
addressing musculoskeletal issues in exotic animal
species. Laser therapy is increasingly utilized
in exotic pets.  Laser light is considered to
produce photobiostimulation at the cellular level,
which leads to the normalization of cell function,
pain relief, improved circulation, improved nerve
function, accelerated healing, and stimulation of
acupuncture and trigger points.  On the basis of
the positive response to these therapies in this
case, similar forms of treatment should be considered
for managing cervical injuries in giraffes
and in select cases in other zoo species. In
refractory cervical muscle contractures that produce
torticollis, experimental treatment with
botulinum toxin-A (Botoxt) could also be considered
as a possible treatment option because it
is commonly used in humans for the treatment of
cervical dystonia. 
The authors thank Barb
Wolfe, Kay Backues, Erica Lipanovich, Eric
Klaphake, and Andrea Goodnight for consulting
with this case. We also thank Allison Kao for
exceptional work with training the patient, the
veterinary and animal departments for help with
case management, Pike’s Peak Veterinary Clinic
and LiteCure Companion Laser Therapy company
for providing access to equipment, and the
Oakland Zoo staff for starting patient training at
such an early age in this giraffe.
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