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Journal of Bodywork and Movement Therapies (2006) 10, 317–327

Bodywork and

Journal of

Movement Therapies

1360-8592/$ - sdoi:10.1016/j.j

www.intl.elsevierhealth.com/journals/jbmt

REVIEW

Animal physiotherapy

Penny Veenman, BAppSc, M.Sc., MCSP

Bradiford House, Barnstaple, Devon EX314DP, UK

Received 11 October 2005; received in revised form 20 February 2006; accepted 21 March 2006

KEYWORDSVeterinary;Animalphysiotherapy;Equine;Canine;Mobilization;Rehabilitation

ee front matter & 2006bmt.2006.03.004

Summary Animal physiotherapy is a field of growth in the UK due to factorsincluding increasing client (owner) awareness and demand. Advances in veterinarydiagnostic and treatment technology have lead to increasingly sophisticated andintegrated veterinary management of both companion and performance animals,and overall increases in animal longevity.

Using human physiotherapy techniques to manage similar problems in veterinarypatients is not a new phenomenon however. Animal physiotherapy can trace its originsback to at least the early 20th century in the UK. Specific legislation citing theapplication of ‘Physiotherapy’ in veterinary medicine first appeared over 40 years ago(Veterinary Surgeons Exemptions Order, 1962). The Association of CharteredPhysiotherapists in Animal Therapy (ACPAT) was founded as special interest group ofthe Chartered Society of Physiotherapists (CSP) in 1985, and has a growing membership(to date has over 150 fully qualified Category A members in the UK).

In 2000, the first intake of students where enrolled on the M.Sc./Post-GraduateDiploma in Veterinary Physiotherapy at the Royal Veterinary College, London. Thisprogram of part time study was developed to provide chartered physiotherapists withthe ability to apply their professional knowledge, experience and practical therapy skillsto the treatment of animal patients. M.Sc. students are required to complete an originalresearch project, contributing to the development of a much-needed scientificevidence base for veterinary physiotherapy.

This article aims to provide an overview of the treatment of animals withphysiotherapy from the perspective of an ACPAT physiotherapist. Some understandingof human manual therapy principles and nomenclature is assumed.& 2006 Elsevier Ltd. All rights reserved.

Why do animals need physiotherapy?

The reasons for animals requiring physiotherapy aremuch the same as why people need and benefitfrom it including:

�

Optimizing recovery from illness and injury.

Elsevier Ltd. All rights reserv

�

ed.

Managing musculoskeletal problems caused byfaulty biomechanics, less than optimum physicalfitness, demands of lifestyle or faulty ergonomics.

� Enhancing athletic performance in sport

whether amateur or elite.

� Minimizing dysfunction and disability in degen-

erative conditions.

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What animals/conditions are commonlyseen?

Horses and dogs are the most common animals seenin veterinary physiotherapy practice, althoughagricultural animals such as cows, sheep, goatsand alpacas and companion animals such as catsand rabbits are infrequently referred. Principles oftreatment can be applied to more exotic or wildanimals, including birds and reptiles, although ofcourse additional species-specific knowledge ofanatomy, physiology, biomechanics, behaviour andhusbandry/handling is required. Some interestinganatomical anomalies do arise. For example, whilemost mammals and birds have ossified patellae intheir stifles (knees), these are absent in redkangaroos and certain wallaby species (Holladayet al., 1990).

Examples of cases commonly seen by veterinaryphysiotherapists include:

�

Dogs for rehabilitation after orthopaedic/neuro-logical surgery such as canine cranial (anterior)cruciate repair or spinal decompression for disclesions (Figs. 1–3).

Figure 2 Upper cervical spine palpation in sitting.

� Horses with muscular tension/spasm/irritabil-ity/wasting/imbalance caused by poor fittingsaddlery/unbalanced riders/compensating forlower leg biomechanical problems. Commonlypresent as poor performance or behaviouralproblems such as bucking under the saddle. � Dogs with degenerative joint disease compli-

cated by obesity and a sedentary lifestyle(Fig. 4).

� Horses used in equestrian sport where a minor

benefit to performance can mean the differencebetween winning and finishing out of theplacings in a competition or race. This will have

Figure 1 Palpation of hind legs in standing.

Fig. 3 Hand positioning for lumbar spine mobilization(Note: technique similar to Maitland thoracic spinetreatment in humans).

consequences for a professional rider/trainer’slivelihood, sponsorship deal or chance of teamselection. The British Equestrian Federationpresently employs two Association of CharteredPhysiotherapists in Animal Therapy (ACPAT)physiotherapists to assist in the management ofequine athletes in Eventing, Dressage andShowjumping disciplines representing Britain atthe international level (Figs. 5a and b).

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Figure 5 (a) Eventing (or horsetrials) is an equestriansport where equine and human athletes are at risk ofconsiderable musculoskeletal trauma. (b) This mareappears to have recovered remarkably from the fall (a)

Figure 4 Elderly, overweight dogs are prone to multiplemusculoskeletal problems. This Labrador cross showsstanding posture typical of degenerative hip disease.

Animal Physiotherapy 319

Legal and professional framework

In the UK, treating animals with physiotherapy ismore restricted than treating humans. Under theProtection of Animals Act (1911) owners can legallytreat their own animals with any non-invasiveprocedure or technique that does not compromisethe animal’s welfare.

However, the Veterinary surgeon’s act (1966)states that with certain exceptions that only aVeterinary Surgeon (Veterinarian) may carry outVeterinary Surgery on animals. Veterinary Surgery isso defined by the act as to include:

sustained a month previously. However, ridden assess-ment revealed subtle problems such as tension in her

�

neck and difficulty engaging her hind-quarter properly. A The making of a diagnosis. � deterioration in performance post-fall prompted her The carrying out of tests for diagnostic purposes.

owner to seek physiotherapy attention.

� Medical and surgical treatment.

Of the exemptions created by the VeterinarySurgeon’s (Exemptions) Order (1962), one permitsthe treatment of an animal by ‘physiotherapy’,provided such treatment is given by a person actingunder the directions of a veterinarian who hasexamined the animal and has prescribed thetreatment of the animal by physiotherapy.

‘Physiotherapy’ is interpreted as:

�

Including all kinds of manipulative therapyincluding osteopathy and chiropractic. � Not including acupuncture, homeopathy or

aromatherapy.

Therefore, in the veterinary field, UK phy-siotherapists do not have professional autonomyand cannot act as sole contact practitioners ordiagnose conditions. The documented consent of ananimal’s veterinarian is required before any phy-

siotherapy treatment, in addition to the consent ofits owner. Certain techniques (most notably acu-puncture) cannot legally be performed on animalsexcept by a veterinary surgeon, regardless of theexperience and qualifications the therapist mayhave in human medicine.

ACPAT members are required to take out supple-mentary professional liability insurance to coverthe treatment of animals. Failure to complywith the terms of the Veterinary Surgeon’s actrenders this insurance invalid, and breaches pro-fessional conduct, making them liable to disciplin-ary action from the CSP.

Unfortunately, as in the human field, unquali-fied/unregistered (and uninsured) practitioners aremore inclined to work in breach of the presentlegislation, and outside the scope of professionalregulation. Clients need to be educated on the

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potential pitfalls of using the services of unquali-fied practitioners, especially in the limited scopefor recompense in situations of alleged negligenceor malpractice, which in turn may be more likelydue to lack of appropriate training on pathology/contraindications.

The legal and professional position of a humantherapist looking to begin treating animals willdiffer considerably depending on local nationaland/or state legislation. In some states of the USA‘treatment’ of animals is illegal if performed byanyone other than a qualified veterinary surgeon,while ‘rehabilitation’ may be permissible. InAustralia, a formal post-graduate program of study(Master of animal studies/animal physiotherapy)has recently been developed at the University ofQueensland, although physiotherapists can pre-sently treat animals referred by veterinariansbefore having gained these qualifications. Irelanddoes not have an equivalent of ACPAT, although arecent paper reports 92% of responding Irishveterinarians would support the establishment ofa register of animal physiotherapists, and 64% agreethat post-graduate training is an appropriate careerpath (Doyle and Horgan, 2006).

This article lists contact details of internationalorganizations associated with animal physiotherapyas sources of further information. Individuals areadvised to check their individual local circum-stances before embarking on any form of animaltreatment.

Consideration should be given to the following:

�

State/national law concerning animal welfareand veterinary practice. � Professional/Registration body (human)—does it

recognize animal treatment to be within yourscope of practice and/or impose any restric-tions/requirements related to animal practice?

� Professional and public liability insurance—will

it cover animal treatment and are the limitsadequate to cover potential liabilities (considerthe potentially high value of some animals beingtreated such as racehorses/stud animals).

� Personal injury insurance/income protection

insurance—will you be covered if injured whiletreating an animal?

Transferring human therapy skills toanimals

All ACPAT animal physiotherapists are required tofirst train and gain experience working as humanphysiotherapists, acquiring knowledge of anatomy,physiology, pathology, pharmacology, and skills in

assessment and treatment with manual therapy,electrotherapy and exercise therapy. Learning toevaluate and progress treatment regimes anddevelop communication skill with patients/carersand other members of the healthcare team isconsidered as important as is encountering a widevariety of clinical cases.

Animal physiotherapy training focuses on devel-oping an understanding of anatomical, physiologi-cal and biomechanical differences between humansand animals, and how to adapt assessment andtreatment methods accordingly. The focus is onquadrupedal mammals and on the anatomical,biomechanical and behavioural differences be-tween carnivores (dog model) and cursorial orgrazing mammals (horse model). Even in a givenspecies significant variation can be seen, pre-disposing to different musculoskeletal pathologies(example: compare the size and shape of a GreatDane to a Dachshund). Different individuals of agiven breed will also have slightly differentstructural anatomy or conformation. Animal phy-siotherapists need to become highly skilled inevaluating an individual animal’s conformationand movement/gait patterns, with a view to bothmanaging presenting problems and preventingfuture problems.

Most animal therapists gravitate to the jobbecause of a background of interest and involve-ment with animals, particularly horses or dogs.Although it is possible to be a successful veterinaryphysiotherapist without having been ‘born in thesaddle’ or ‘raised by wolves’, a level of confidenceand competency in handling small and largeanimals is required, as well as a knowledge ofanimal behaviour and husbandry.

Comprehending and appropriately using thejargon/nomenclature relevant to the animal andits use is essential. This is particularly evident inequine and canine sporting disciplines such asdressage, show jumping, eventing, horse and grey-hound racing and canine agility. An understandingof the discipline specific athletic requirements ofsporting animals is also essential in formulatingtreatment plans and gaining optimal compliancefrom owners/riders/trainers. Present ACPAT train-ing requires members to become competent intreating both horses and dogs, rather than focusingon a single species.

Challenges of assessment—locating theproblem

As no one besides a veterinary practitioner candiagnose specific pathology in animals, therapists

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Animal Physiotherapy 321

concentrate on identifying specific functional pro-blems on assessment that can be treated and thenre-evaluated. Even where a clear, known pathologyexists (e.g. a specific muscle strain), individualassessment is required to identify potential pre-disposing factors as well as specific problems andgoals that influence a treatment regime.

One of the biggest perceived challenges toextrapolating human physiotherapy skills to ani-mals is that ‘they can’t tell you where it hurts’.However, consider how frequently in human prac-tice that subjective perception of the area andnature of pain is different to the location of theprimary problem, and how relying solely onsubjective information can be misleading.

Subjective assessment involves questioning thehuman ‘client’ who presents with the animal to betreated for specific clues as to the underlyingbiomechanical problems, as well as backgroundinformation that will help to arrive at mutuallyagreed functional goals. The subjective assessmentis therefore similar to third person assessmentswhere a parent or carer answers for a patient whois unable to communicate. As with human sub-jective assessment, ‘filtered’ information mayprove highly useful or otherwise. Subjective assess-ment also enables the therapist to evaluate therelationship between the client and their animal,which may give clues as to behavioural aspects tothe presenting problem. Dogs are particularlyadept at exploiting owners if their initially pain-related signs and symptoms are met with ongoingrewards, for example night-time whimpering beingassociated with human attention, a walk andpossibly even an edible treat.

Objective assessment relies on skilled observa-tion of static posture and movement at the variousgaits, and functional movements such as turning/reversing. Horses may need to be seen ridden orjumping to provoke the specific problem. Access toan alternative rider is always beneficial in caseswhere rider capability or physical impairment issuspected in the presenting problem.

As animals are unable to comply with requests forspecific movements, active joint range and musclestrength assessment are made on the response tofunctional movements and facilitating specificreflexes. Whole body palpation and passive jointrange/muscle length tests are inevitably performedon horses while they are standing. Dogs can beassessed in standing, sitting or lying. Where aneurological deficit is suspected specific neurologi-cal assessment tests are performed. Some thera-pists use electrical modalities such as electricalmuscle stimulation (EMS) to assist in the assessmentof muscle function.

As different species/breeds and individual ani-mals have varying responses to these tests, it is akey skill of the animal physiotherapist to interpretbehavioural feedback in conjunction with thelocal tissue response to palpation to determinepainful regions. Some understanding of the subtle-ties of animal behaviour is required to tactfullyexplore such painful sites while minimizing thechance of the animal needing to give a clearer signthat you need to back off (i.e. by biting or kicking).Although some patients may require additionalrestraint or sedation for assessment and treat-ment to take place safely, most animals tolerateassessment and treatment of painful regionsremarkably well.

Problems identified on assessment may include:

�

Postural asymmetry � Gait asymmetry � Pain � Heat � Oedema � Joint hypomobility � Joint hypermobility � Joint effusion � Soft tissue adhesions/restriction � Muscle trigger points � Muscle spasm/irritability/tightness � Muscle wasting/weakness/paresis � Patterns of muscle imbalance � Sensory/proprioceptive deficit.

Challenges of treatment

Formulating treatment plans

Formulating effective treatment plans depends onidentifying problems for which physiotherapy treat-ment is appropriate and likely to be effective.Prioritizing problems and deciding appropriatetreatment technique selection and dosage will bedetermined using clinical reasoning similar to thatapplied in human practice. In addition the tem-perament and tolerance of the patient and theresources and capacity of the client to affordtreatment and comply with home treatmentregimes need to be considered when settingtreatment goals.

Many problems identified on assessment may besecondary or even tertiary to problems that arebest managed by other members of the veterinarycare team, so good communication links with andtimely referral to farriers, dentists, saddle fitters,behaviour specialists and trainers are essential.

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Treatment methods

Individual therapists have their own preferences,but most use a combination of the following:

�

Manual therapy—stretching, joint/soft tissuemobilization, manipulation using principles ofreflex inhibition, myofascial release, triggerpoint release and massage. � Electrotherapy—ultrasound, laser, electrical

muscle stimulation, TENS, H-wave, static andpulsed magnetic therapy.

�

Figure 7 Hydrotherapy can provide useful non-weight-bearing joint mobilization, as well as muscle strengthen-ing and cardiovascular conditioning.

Exercise therapy—specific training regimes usingobstacle courses/poles, progressive loadingusing alterations of gradient, surface or speedat which exercise is performed, using weightsthat are placed on body or limbs, pulled by asleigh or cart, facilitation of postural/balancereactions including use of wobble boards/gymballs, strapping/taping to alter proprioceptiveinput, hydrotherapy (including water treadmills)(Figs. 6–8).

As with human practice, the technique used maynot be as important as the skill with which it isapplied, and the quality of the clinical reasoningused to arrive at technique selection. For anytreatment to be effective, the right technique, for

Figure 6 Application of TENS for pain relief.

Figure 8 Use of wobble board to challenge propriocep-tion and activate stabilizing muscles.

the right problem at the right dosage for theappropriate stage of healing needs to be applied inthe right place. This requires careful assessmentand reassessment of the patient’s response dur-ing and after treatment and modification, progres-sion and general fine-tuning to ensure the overallresponse is as close to optimum as possible. So,although many ‘physiotherapy’ treatment techni-ques can be used by owners, trainers or para-professionals, veterinary physiotherapists wouldcaution that using these techniques in the absenceof adequate (re)assessment may not achieve thedesired result and may potentially be detrimental.

Logistical challenges

Treatments can take place anywhere from amodern veterinary hospital to a muddy field withno light, shelter or hard standing, Horses and large

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Figure 9 Assessing passive range of hip extension inlying.

Animal Physiotherapy 323

animals (unless under general anaesthesia) aretreated standing, so the therapist is always workingwith a baseline level of postural tone. A greatervariation in starting position and repertoire oftechniques is possible in smaller animals (e.g.physiological lumbar rotation lying see Fig. 9).The spinal anatomy and relative mobility ofcarnivores lends itself to localized physiologicaland accessory joint mobilization techniques thatare not directly transferable to the equine thor-acolumbar spine. Equine spinal ‘manipulation’ aspractised by most veterinary physiotherapists is asoft tissue technique based on principles of reflexinhibition. Other techniques, such as pelvic myo-fascial release/ischial compression provide thehorse with an opportunity to use its own strengthto push into a barrier provided by the therapist’shand/body. Forces encountered using such techni-ques can be quite high, although they are usuallydeveloped gradually. Physiotherapists treatinglarge animals therefore need to be physically fit,and be careful that techniques selected areappropriate to their immediate physical capacity.However, many techniques require minimal force,and animals do have some anatomical advantagesfor efficient therapy technique delivery. Tailsprovide an excellent lever to apply mechanicalforces to the sacrum, including traction anddistraction forces. It can also be used to facilitatepostural reactions for assessment and treatment(Fig. 9).

Two cases are discussed with a view to illustrat-ing some of the issues mentioned. Both areneurological cases, which although not necessarilythe commonest seen, shall hopefully give anexample of the varying challenges faced whentreating animals.

Case APatient: 10-year-old uncastrated male miniature

pet dachshund.History of Present Condition (HPC): Acute onset

hindlimb paralysis. Unable to weight-bear onhindlimbs, loss of bladder and bowel control, deeppain sensation intact.

Diagnosis: Mid-thoracic disc prolapse (evident onmyelogram).

Veterinary management:Surgical: Decompression surgery within 48 h of

onset.Medical: IV steroids, then oral anti-inflammatory

medication (NSAIDs).Nursing: Manual bladder expression, strict atten-

tion to hygiene to prevent skin lesion from lack ofurinary control, regular position change to avoidpressure areas.

Social history: Lives with retired lady owner(human nursing background) and 2 other dogs.Insured. Owner committed to do everything possi-ble to help dog. Emotional attachment: high.Physical capacity of owner limited in some aspects,e.g. unable to kneel on floor due to kneeosteoarthritis.

Value of animal: Highly valued ‘family’ member(financial value irrelevant).

Time since onset when referred for physio:3 months.

Temperament/tolerance of patient: Has dis-played aggression to other dogs, tolerated allveterinary assessment/handling to date with noissues.

Case BAnimal: 8-year-old warmblood gelding, affiliated

eventer (novice or ‘one star’ level) (note for ed:info on what this means/entails can be obtainedfrom British eventing website—link added below).

History of present conditionHPC(defined above): Fell in a ditch while hunt-

ing. Able to rise and continue, but not jumping wellafter accident. Progressive deterioration and wor-sening bilateral hindlimb weakness/propriocep-tive/sensory deficit develop over the next hour.Bladder and bowel function unaffected.

Diagnosis: Spinal cord injury cranial lumbarspine. Soft tissue injury diagnosed, but unable torule out fracture as X-ray inappropriate (cost andlogistics—would require general anaesthetic andrecovery from the same likely to worsen condition).

Veterinary management: conservative-oral ster-oids 48 h, then NSAIDs. Inpatient for 2 weeks, thendischarge home for 3 months box rest.

Social history: Recent purchase to sell on byprofessional rider, running busy competition yard.Not insured. Owner concerned for horse’s welfare,

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Figure 10 Case B: Wasting of spinal longissimus andmusculature of the hind-quarters. Prominent spinousprocess of L1/L2 region indicated.

P. Veenman324

but pragmatic as resources and time need to bedirected to other priorities. Physical capacity andskill of owner high.

Value of animal: Estimated £8000 pre-injury.Time since onset when referred for physio: 2

weeks.Temperament/tolerance of patient: Not owned/

known long enough to predict with certainty,tolerant of procedures/handling to date.

Physiotherapy findings (first contact)Case AObservation: Surgical wounds well healed. Wast-

ing of epaxial spinal muscles caudal to mid-thoracicregion and all hind limb muscles. Some wearing ofnails on both hind feet.

Functional mobility: Independently mobile insideusing forelimbs to propel whole body, with hin-dlimbs trailing passively behind. Unable to standindependently, even if limbs manually placed incorrect position. Unable to sit in normal position,requiring maximal assistance for sit to standtransfer.

Pain: No pain response elicited on palpation.Tone/reflexes/sensation: Increased tone hin-

dlimb flexor and adductor groups. Exaggeratedpatella reflex bilaterally. No evidence of consciousawareness of hindlimb palpation, or response totouch or vibration. Exaggerated flexor withdrawalresponse to deep pain stimulus, with consciousawareness.

Range of motion: Hip abduction and extensionrange reduced due to increased tone. Full rangepossible on slow sustained passive manual stretch.

Case BObservation: Very prominent spinous processes

of L1-2. Wasting of epaxial muscles most evidentcaudal to L1 and gluteals bilaterally (see Fig. 10).

Functional mobility: Able to stand indepen-dently, but often with unusual hind limb position-ing. Very unsteady when turning in box with poorhindlimb control. Unable to stand safely with anylimbs manually lifted of the ground.

Pain: Painful response on light palpation ofepaxial muscles of caudal thoracic spine to L1,reduced pain response caudal to L1.

Tone/reflexes/sensation: No signs of consciousawareness of forceps skin pinching all regions ofboth hind limbs. Some resentment of similar skinstimulus along spine, but this response significantlyreduced caudal to L1 than cranial. Anal tone andreflex normal.

Range of motion: Unsafe to assess. Horse wouldbe at risk of falling if any limb lifted to passivelyevaluate range. Given suspicion of fracture, wouldbe unwise to elicit reflexes than result in spinalmovement at this stage (Fig. 10).

Physiotherapy problems

Case A

Case B

Loss of trunk andhindlimb motorcontrol primarily dueto spinal cord injury,but likely alsosecondary disuseatrophy

Pain from sub-acute softtissue injury with suspicionof bone injury

Hindlimb flexor/adductor increasedtone, impairs ROM/normal movement andrisk of contracturedeveloping

Loss of hindlimb motorcontrol

Compensatorymovement patternswell learnt/established so moredifficult to implement‘normal movement’

Reduced hindlimbsensation/ proprioception

Risk of skin damagedue to loss ofsensation/bladdercontrol andcompensatorymovement strategies

Spinal muscle atrophycould be either due tonerve injury or paininhibition with secondarydisuse less of a factor at 2/52 post-injury

Risk of secondary injurydue to poor hindlimbcontrol, also safety oftherapist/grooms/handlers needs to beconsidered

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Animal Physiotherapy 325

Treatment aims (common to both cases)

�

Optimize conditions for maximal recovery usingunderstood principles of neural plasticity (Dob-kin, 1993; Selzer, 1993). � Prevent disuse atrophy. � Maximize afferent sensory input in areas of

deficit.

� Prevent secondary injury, e.g. use of protective

boots/bandages.

� Encourage normal movement patterns wherever

possible.

Specific to case A

�

Normalize hindlimb tone to prevent contracturesand promote normal range of movement andfunction.

Specific to case B

�

Promote resolution of subacute soft tissue injury. �

Figure 11 Case A: Showing wheeled cart use to aidrehabilitation and functional mobilization.

Provide pain relief.

Goals/plan agreed with owners

Case AOptimistic: To restore normal function, i.e. for a

dog to walk again.Realistic: To ensure dog has a good quality of life

and is free of pain. Compensatory strategies such asa wheeled cart would be considered if optimumgoal not achieved.

Case BOptimistic: To be able to sell as competition

horse.Realistic: Ultimately, the horse needs to be able

to be ridden, if only as a pleasure hack. Will givehorse 3 months. If no improvement in this timeframe will euthanase. If partial improvement, i.e.able to safely go out in a field, will turn out forfurther 6 months and re-evaluate.

The implications of not having firm evidence ofno bony injury were discussed in depth with theowner and referring vet. Should an undiagnosedfracture be present it will be vulnerable if thesupporting muscle spasm is relieved and the regionmobilized too soon. However, if the horse is nottreated for 3 months, disuse atrophy and adhesionformation may impede progress that could other-wise be gained in time for the crucial 3-month re-evaluation. On balance, all parties were in favourof restrained treatment for 6 weeks (giving a stablefracture reasonable time to reach union) andaggressive treatment thereafter. Should at anystage the neurological state of the horse deterio-

rate, he would be euthanased promptly with noattribution of blame to any party.

Physiotherapy treatment

Case A

�

Hydrotherapy—swimming twice per week. Be-ginning with short duration 1–2min swims andfrequent rest periods, progressing to longerduration (5min) swim times in half hour session. � Sensory input to regions of anaesthesia/para-

sthesia—consisting of massage/stroking/skinrolling/tapping and massage with an electrictoothbrush for the vibratory input. Delegated toowner to perform at least twice daily.

� Slow sustained stretch techniques performed in

lying to regain hip extension and abductionrange. Also performed by owner on regularbasis. Facilitation and encouragement of lyingpostures promoting hip extension/abduction tobecome part of daily life.

� Protective boots to be worn to protect hind paws

when mobilizing outside.

� Regular positioning in normal sitting and stand-

ing postures. Facilitation of normal sit to standtransfer. When independent weight-bearing instanding achieved, progress to weight-bearingwith one forelimb lifted, or forelimbs onunstable surface such as cushion/wobble board.Also encouraging weight transference throughhindlimbs with rhythmic stabilization, tail trac-tion and sway/oscillation.

� Supported mobilizing with hindquarter hand-

held sling and later using wheelchair cart (seeFig. 11).

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P. Veenman326

Case B (2–6 weeks)

�

Figba

Laser therapy at pain relieving dosage to L1-2region.

� H-wave at muscle stimulating dosage to caudal

longissimus, gluteals and quadriceps.

� Advised incorporating sensory stimulation to

areas of anaesthesia/parasthesia into dailystable routine of grooms (methods as per caseA). Also to wear protective bandages/boots asfrequently as possible.

� Rhythmic stabilizations through pelvis and tail,

promoting postural reaction (initially performedby therapist, not delegated until horse morestable and technique safer for handlers).

(After 6 weeks)

�

Short walks in-hand, on flat surface with verywide turns, preferably while wearing ‘bodywrap’ bandage (see Fig. 12) to promote sensoryawareness of hindquarters. � Progression of all early techniques with in-

creased force/speed.

� Challenging balance by lifting initially single

forelimb, then as able single hindlimb.

� Forelimb ROM stretches. � Hindlimb lifting and circling progressing to ROM

stretch as able.

� H-wave at muscle stim and pain relieving

settings to L1-2 region, in addition to caudalthoracic, caudal lumbar, gluteals and quadri-ceps.

� Manual reflex inhibition techniques to areas of

longissimus muscle spasm.

� Lumbosacral spinal reflexes used to encourage

abdominal activity and flexion/side flexion mo-bility of spine.

ure 12 ‘Body wrap’ using elasticated non-adhesivendage to enhance awareness of hind-limb position.

Outcome (to date)Case A

Reduced wasting of trunk and limb musculature.

No skin lesions or contractures. Improved proximaltrunk control evident by the ability to climb upsingle steps of 8 in height. Can stand independentlyfor up to 1min, and owner feels this has con-tributed to improved bladder control (has notneeded to assist bladder expulsion for 6 weeksto date).

Although active movement of hindlimbs can beobserved while swimming and in cart this has nottransferred to useful hind limb control sufficient fornormal walking. Remains perfectly happy, mobiliz-ing with front limb drag technique inside, butenjoys cart outside, and able to keep up with otherdogs using this. Also enjoys the attention it bringsfrom onlookers.

Verdict: Realistic goals achieved, owner satis-fied, although regrets that therapy was notinstigated sooner.

Plan: Ongoing home program, and review asrequired.

Case BAt the time of writing, this patient has not yet

reached 3 months post-injury. He is progressingwell with no further muscle wastage and gradualreturn of normal responses to sensation and reflextests is progressing in a cranial to caudal andproximal to distal fashion. He has become so‘fed up’ with confinement that the in-hand exercisehas become very exuberant, and may have to becurtailed on safety grounds.

Verdict: Too soon to say, has improved enough todate to achieve the 6 month extension.

Plan: Will be turned out in a field as soon asground conditions allow, and will be managed withrehabilitative exercises as much as time andresources permit.

Conclusion

Many ACPAT physiotherapists combine animal andhuman practice and most would agree that theirhuman treatment skills have been enhanced byworking with animals, particularly in the areasof observation/gait analysis and manual assessmentand treatment skills.

Animal cases can provide unique challenges thattest problem-solving skills and creativity, as atpresent standard treatment regimes have not beenvalidated for all presenting conditions. Hopefully,when the established post-graduate programs ofstudy begin to produce quality research the

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Animal Physiotherapy 327

scientific evidence base for animal physiotherapywill broaden and strengthen, ultimately enhancingthe quality of overall veterinary care.

References

Dobkin, B.H., 1993. Neuroplasticity. Key to recovery aftercentral nervous system injury. Western Journal of Medicine159 (1), 56–60.

Doyle, A., Horgan, N.F., 2006. Perceptions of animal physiother-apy amongst Irish veterinary surgeons. Irish VeterinaryJournal 59 (2), 85–89.

Holladay, S.D., Smallwood, J.E., Hudson, L.C., 1990. Absence ofan osseous patella and other observations in macropodidaestifle. Anatomical Record 222 (1), 112–114.

Selzer, M.E., 1993. A scientific basis for neurological rehabilita-tion. Western Journal of Medicine 159 (1), 91–92.

Further information-useful websites:

UK;Association of Chartered Physiotherapists in Animal Therapy(ACPAT), www.acpat.org; Royal Veterinary College, London,www.rvc.ac.uk; British Eventing, www.britisheventing.com

USA;Animal Physical Therapist Special Interest Group, Orthopae-dic Section, APTA, www.orthopt.org/sig-apt.php

Canada;Canadian Horse and Animal Physical Therapists Association,www.animalptcanada.com

Australia;Animal Physiotherapy Group (APG), Special Interest Group ofAustralian Physiotherapy Association, www.apa.advsol.co-m.au/join/nsg/animal; University of Queensland- Animalphysiotherapy, Master of Animal Studies program, www.u-q.edu.au.

South Africa;SAAPAT South African Association of Physiotherapists inAnimal Therapy, www.physiosa.org.za.

Italy;www.idioscuri.com

Ireland;No formalized group. Some ACPAT members work in Irelandand are listed on UK ACPATwebsite www.veterinaryireland.ie

Further reading (books)

Bromiley, M., 1991. Physiotherapy in Veterinary Practice. Black-well Scientific, Oxford.

Denoix, Pailloux, 2001. Physical Therapy and Massage for theHorse. Manson publishing.

Millis, Levine, Taylor, 2004. Canine Physical Therapy andRehabilitation. Elsevier, USA.

Sutton, A., 2001. The Injury Free Horse. David and Charles.Sutton, A., 2003. The Injured Horse. David and Charles.

Articles

Moser-Kats, L., Veenman, P., 2004. Veterinary physiotherapy—anintroduction to a complementary treatment option. UK Vet 9(3), 42–43.

Moser-Kats, L., Veenman, P., 2004. Management of secondarymechanical spinal dysfunction and pain. Part 1: Musclebalance. UK Vet 9 (8), 82–86.

Veenman, P., Moser-Kats, L., 2004. Veterinary physiothera-py—indications for physiotherapy in veterinary practice. UKVet 9 (5), 67–70.

Veenman, P., Moser-Kats, L., 2005. Management of secondarymechanical spinal dysfunction and pain. Part 2: Musclespasm. UK Vet 10 (2), 23–27.

Veenman, P., Watson, T., 2005. A physiotherapy perspective onpain management. UK Vet 10 (8), 87–91.