Introduction to Animal Physiotherapy
- 1 Introduction
- 2 History
- 3 Transferring knowledge of human physiotherapy to other species
- 4 The Role and Scope of Animal Physiotherapists
- 5 Evidence to Support the Use of Physiotherapy in Animals
- 6 Differences between humans and animals
- 7 Human-Animal Dyad
- 8 Terminology
- 9 Summary
- 10 References
Physiotherapy is defined as: "the therapeutic use of physical agents or means, such as massage or exercises, to treat disease or injury". The primary purpose of physiotherapy is to restore mobility, function and quality of life to patients. This is achieved by stimulating the healing process to:
- restore injured tissues
- improve injured tissues' strength and balance
- stabilise cardiorespiratory, neurological, and musculoskeletal systems
The first record of animal physiotherapy being practised comes from 1939 when Lord Luis Mountbatten asked the Royal physiotherapist, Sir Charles Strong, to treat his horses. Animal physiotherapy evolved as a profession from this point onwards. The first official animal physiotherapy association, the Association of Chartered Physiotherapists in Animal Therapy (ACPAT), was formed in the United Kingdom in 1985. Then, in 2011, animal physiotherapy was recognised as an official subgroup of the World Confederation of Physical Therapy (WCPT).
Transferring knowledge of human physiotherapy to other species
In order for physiotherapists to be able to successfully transfer their assessment and treatment skills to animals, there must be sufficient similarities in structure, function and physiology across species. There is a growing evidence base to support the notion that these similarities exist:
It has, for instance, been found that spontaneous canine cancers have a similar pathophysiology and clinical presentation to the equivalent human cancers. There are also similarities in terms of the disease progression of osteochondrosis in humans, horses and pigs, including:
- Clinical presentation
- Changes on MRI and x-ray
- Histological appearance of the end-stage lesion
- Locations affected
Moreover, some knowledge relevant to human physiotherapy has come from animal research. Horses are considered to be appropriate models for research on osteoarthritis of the knee. Dogs are the animal model of choice for total hip joint replacements.
The Role and Scope of Animal Physiotherapists
Animal physiotherapy is continuing to grow and develop as a profession. Animal physiotherapists work alongside a multidisciplinary team, just as they do in conventional physiotherapy. However, in most countries, animal physiotherapists do not have first-line practitioner status. They generally work on referral from a veterinarian. Thus, there is a requirement that animal physiotherapists communicate with the veterinarian who is in charge of managing the animal patient.
There also needs to be a positive relationship with the animal’s carers. In the case of horses, this may be a large group, including the horse’s owner, rider, trainer, riding instructor, grooms and stableyard manager. There tends to be fewer carers involved in small animal care, but it is still important that each carer’s role in looking after the pet is understood.
- NB: There are different legal frameworks for animal physiotherapy across the world. If you are interested in this area of practice, it is essential to understand the legal requirements to practise this sort of physiotherapy in your country
Physiotherapy can be beneficial for animals with a wide range of conditions. It is often indicated post-operatively to correct complications that can occur as a result of surgery. The demand for post-operative animal physiotherapy has kept pace with the growing number of surgical options for small animal patients.
Like conventional physiotherapy, animal physiotherapy is divided into a wide variety of specialities. In animal physiotherapy, the divisions are:
- Sports medicine
- Elderly care / geriatrics
- Developmental problems
Injuries or dysfunctions in this area include: soft-tissue injuries, such as sprains / strains or ruptures of ligaments, tendons or muscles; bursitis and bone or joint disease, such as osteochondritis dissecans. Injuries may occur following trauma or be caused by overuse.
- Manage secretions
- Prevent pressure sores
- Prevent atelectasis
- Reduce the work of breathing
- Optimise the ventilation / perfusion ratios
Techniques include positioning, manual techniques (i.e. percussion or vibrations to remove secretions), neuromuscular techniques, and manual hyperinflation or bagging.
Post-operative animal physiotherapy can help to enhance a patient's outcomes following surgery. The physiotherapist should have a good understanding of a surgeon's protocol prior to commencing a rehabilitation plan (including the animal's weight-bearing status and when specific exercises should be introduced).
Neurological physiotherapy is indicated after a neurological injury has occurred. It may involve the rehabilitation of the whole body or just a single limb. One of the most common causes of neurological dysfunction in small animals is intervertebral disc disease. Neurological injuries may be managed conservatively or surgically, but the amount of initial damage can have a major impact on the long-term recovery outcomes. Common treatments for neurological and orthopaedic dysfunction include:
- Passive joint mobilisation
- Neuromuscular electrical stimulation (NMES)
Sometimes animal physiotherapists will need to consider if long-term assistive solutions are required, such as providing an animal with wheels, harnesses or splints. These can enhance the patient's ability to continue to perform activities of daily living.
Animal physiotherapists are also involved in training animals for athletic or sporting activities. Interventions that reduce recovery time and encourage a return to full fitness are vital to protect what are considered “valuable assets”. Animal physiotherapists must also be able to provide guidance to owners about appropriate conditioning programmes (that are specific to both the requirements of the sport and the animal).
Elderly care / geriatrics
Pets, like humans, are living longer, so there are increasing numbers of animals presenting with age-related issues. Appropriate therapeutic interventions can help to slow down conditions such as arthritis and reduce an older pet's discomfort. It is important to remember that these older patients, like their human counterparts, often present with other co-morbidities, which can complicate the rehabilitation process. A holistic management approach, including diet, exercise, environmental considerations, and pain relief, can help to ensure that these animals stay comfortable and maintain their function for longer.
Animal physiotherapists see a large number of young animals with genetic or developmental problems (e.g. hip and elbow dysplasia). Physiotherapy management, including hydrotherapy, can enhance these animals' quality of life and long-term may reduce the likelihood of needing surgery (such as total hip replacements).
Evidence to Support the Use of Physiotherapy in Animals
While there are not many well-designed studies to support the use of physiotherapy in animals, massage is one area that has been researched in more detail. It has been proposed that because of similarities in the physiology and anatomy between humans and other animals, massage may confer similar benefits in animals as it does in people. These benefits include: encouraging relaxation, reducing pain and muscle tension, enhancing venous and lymphatic circulation, and stimulating the nervous system. Several studies have explored these hypotheses and found that:
- Manual lymph drainage can reduce experimentally-induced lymphoedema in rats when compared to a control group
- Massaging the caudal thigh muscles of horses increases range of motion when compared to a sham treatment
- The use of relaxing massage may help to calm and relax racehorses and improve race performance
Differences between humans and animals
Despite the similarities between humans and animals discussed above, there are also many differences. It is essential that animal physiotherapists have a good understanding of the comparative anatomy and biomechanics of each species, so that they are able to establish an effective treatment plan.
The pathogenesis of diseases can be very different between animals and humans, even in shared pathologies or dysfunctions. For example:
- In humans, cruciate ligament ruptures are an acute injury more common in athletes, but in dogs they are the result of chronic disease processes. Therefore, post-operative rehabilitation for cruciate ligament repair in animals occurs in the context of chronic deconditioning
- In humans, there are dynamic fluctuations in intervertebral disc disease, but in dogs (particularly chondrodystrophic (i.e. short legged phenotype) dogs like dachshunds), the disc calcifies and if disc material extrudes, surgery is almost always indicated. As mentioned above, intervertebral disc disease is one of the most common causes of cause of neurological dysfunction in small animals.
The human–animal bond (or dyad) is defined as: "the mutually beneficial and dynamic relationship between humans and other animals, modulated by reciprocal behaviors that are essential to the health and wellbeing of both subjects involved." This dyad can mimic a parent-child relationship. The dog–human attachment bond, for instance, is said to include all four features of attachment bonds that arise in human caregiver-infant relationships:
- Proximity seeking
- Separation related distress
- Safe-haven effect
- Secure base effect
A study by Schöberl and colleagues reinforces this notion of attachment. This study found that dogs who were considered as either a “social partner” or a“meaningful companion” of their owners had lower morning salivary cortisol control values compared to other dogs.
When assessing animal patients, it is important to remember that all of the information about an animal comes directly from the carer. Moreover, the carer's personality and emotions can have a significant impact on the animal. Neuroticism is, for instance, positively associated with pain catastrophising and pain-related anxiety. Owners who display these characteristics are more likely to catastrophise about their animal’s pain levels or disability. A study by Pettersson notes that both dogs' and their carers' oxytocin and cortisol levels are related to the ways in which the owner interacts with the dog and the behaviours that stem from this interaction. Pain neuroscience education for the owner, therefore, plays an important role in the treatment of the animal.
In the case of horses, research shows that there is a high degree of emotional contagion. Emotional contagion is defined as: “the phenomenon of an automatic adoption of an emotional state of another person”. In animal physiotherapy, it refers to the animal reflecting the emotional state of conspecifics (i.e. a member of the same species), or of other animals / humans in their environment. Horses have been found to demonstrate emotional contagion when observing human-horse interactions.
Understanding this human-animal dyad, as well as having an awareness of animal behaviour enables the physiotherapist to approach and handle animal patients in a safe and effective way.
Many veterinary anatomical terms are similar to those used in human anatomy, but there are some important terms to know if you are working with animals.
Animals stand on all fours:
- Anterior in humans = ventral in aminals (i.e. directed towards the ground)
- Posterior in humans = dorsal in animals
- Humans – palms face anterior
- Animals – palms face posterior, thus the radius and the first digit are medial
Animals are quadripedal – i.e. their vertebral column is parallel to the ground:
- Head is cranial
- Tail is caudal
- Within the head, rostral refers to structures closer to the nose
Terminology relevant to the limbs:
- Proximal - the parts of the limbs that are nearest to the body
- Distal - the part of a structure that is furthest away from the main mass of tissue
- Front limb - the thoracic or pectoral limb
- Hind limb - the pelvic limb
Terminology referring to the thoracic or forelimb:
- Dorsal – cranial face of the distal part of the forelimb or dorsum of the manus (i.e. the section from the carpus down)
- Palmar (volar) - opposite to the dorsal surface
- Radial – the part of the forearm where the radius is located (medial)
- Ulnar – the part of the forearm in which the ulna is located (lateral)
- Brachium – specifically the region from the shoulder to the elbow
- Axilla – the space between thoracic limb and the thoracic wall
Terminology referring to the pelvic or hind limb:
- Dorsal – anterior face of the distal part of the pelvic limb or dorsum of pes
- Plantar – opposite of the dorsal surface
- Crus – the section of the hindlimb between the knee and the tarsus
- Pes – the section of the hindlimb from the tarsus down
- Tibial – the side of the leg where the tibia is located (medial)
- Fibular – the side of the leg where the fibula is located (lateral)
Terminology to indicate relative distance from the centre of the limb:
- Axis – the centre line of the body or any part of it
- Axial and abaxial refers to, or being relative to the axis (e.g. the axial surface of a digit faces the axis while the abaxial surface faces away from the axis)
Terminology to indicate the relative distance from the surface of the body:
- Superficial – relatively near to the surface of the body or the surface of a solid organ
- Deep – relatively near to the centre of the body or the centre of a solid organ
- External or outer – away from the centre of a hollow organ
- Internal or inner – close to or in the direction of the centre of a hollow organ
Terminology to describe basic movement of the parts of the body:
- Protraction – limb forwards
- Retraction – limb backwards
- Extension – angle increased
- Flexion –angle reduced
- Animal physiotherapy is growing as an area of practice
- While research is limited at present, there is evidence of sufficient interspecies similarities to support the use of human physiotherapy techniques on animals
- The behaviour of an animal, the level of understanding of the owner and their emotions can influence the outcome of physiotherapy interventions
- Prydie D, Hewitt I editors.Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.
- McGowan CM, Stubbs NC, Jull GA. Equine physiotherapy: a comparative view of the science underlying the profession. Equine veterinary journal. 2007 Jan;39(1):90-4.
- McGowan CM. Introduction. In: McGowan CM, Goff L editors. Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals. Wiley-Blackwell, 2016. p.1-2
- Calatayud M. A royal history of animal physiotherapy. Available from: http://history.physio/a-brief-history-of-animal-physiotherapy/ (accessed 2 January 2021)
- Van Der Walt, A. Introduction to Animal Physiotherapy Course. Physioplus, 2021.
- Veenman P. Animal physiotherapy. Journal of Bodywork and Movement Therapies. 2006; 10(4): 317-27.
- Schiffman JD, Breen M. Comparative oncology: what dogs and other species can teach us about humans with cancer. Philos Trans R Soc Lond B Biol Sci. 2015; 370(1673): 20140231.
- McCoy AM, Toth F, Dolvik NI, Ekman S, Ellermann J, Olstad K et al. Articular osteochondrosis: a comparison of naturally-occurring human and animal disease. Osteoarthritis Cartilage. 2013; 21(11): 1638-47.
- Skurla CP, Pluhar GE, Frankel DJ, Egger EL, James SP. Assessing the dog as a model for human total hip replacement. Analysis of 38 canine cemented femoral components retrieved at post-mortem. J Bone Joint Surg Br. 2005; 87(1): 120-7
- Price H. Introduction to veterinary physiotherapy. Companion Animal. 2014; 19(3): 130-3.
- Colveiro AC, Rauber JS, Ripplinger A, Wrzesinski M, Schwab ML, Pigatto A, Ferrarin DA, Mazzanti A. Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy. Acta Scientiae Veterinariae. 2020 Oct 13;48.
- Doyle A, Horgan NF. Perceptions of animal physiotherapy amongst Irish veterinary surgeons. Ir Vet J. 2006; 59(2): 85-89.
- Rivière S. Physiotherapy for cats and dogs applied to locomotor disorders of arthritic origin. Veterinary Focus. 2007;17(3):32-6.
- Cottriall S. The geriatric canine and physiotherapy. Companion Animal. 2014; 19: 296-300.
- Preston T, Wills AP. A single hydrotherapy session increases range of motion and stride length in Labrador retrievers diagnosed with elbow dysplasia. The Veterinary Journal. 2018; 234: 105-10.
- Corti L. Massage therapy for dogs and cats. Top Companion Anim Med. 2014; 29(2): 54-7.
- Hill C, Crook T. The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Vet J Suppl. 2010; (38): 683-7.
- Kowalik S, Janczarek I, Kędzierski W, Stachurska A, Wilk I. The effect of relaxing massage on heart rate and heart rate variability in purebred Arabian racehorses. Anim Sci J. 2017; 88(4): 669-77.
- Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg. 2010; 39(4): 399-409.
- Southpaws Specialty Surgery for Animals PTY LTD. Cruciate Disease in Dogs Explained With Animation. Available from: https://www.youtube.com/watch?v=UKXVyNFe31k [last accessed 4/1/2021]
- Southeast Veterinary Neurology. What is Intervertebral Disk Disease(IVDD) in Dogs?. Available from: https://www.youtube.com/watch?v=7OgOSwNL9Qs [last accessed 4/1/2021]
- Scopa C, Contalbrigo L, Greco A, Lanatà A, Scilingo EP, Baragli P. Emotional Transfer in Human-Horse Interaction: New Perspectives on Equine Assisted Interventions. Animals (Basel). 2019; 9(12): 1030.
- Payne E, Bennett PC, McGreevy PD. Current perspectives on attachment and bonding in the dog-human dyad. Psychol Res Behav Manag. 2015; 8: 71-9.
- Schöberl I, Wedl M, Bauer B, Day J, Möstl E, Kotrschal K. Effects of owner-dog relationship and owner personality on cortisol modulation in human-dog dyads. Anthrozoös. 2012; 25(2): 199–214.
- Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLoS One. 2015; 10(4): e0126351.
- Petersson M, Uvnäs-Moberg K, Nilsson A, Gustafson LL, Hydbring-Sandberg E, Handlin L. Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns: An Exploratory Study. Front Psychol. 2017; 8: 1796.
- Singer T, Tusche A. Understanding others: brain mechanisms of theory of mind and empathy. In: Glimcher PW, Fehr E editors. Neuroeconomics: Decision making and the brain. London: Elsevier, 2014. p.513-32
- Trösch M, Pellon S, Cuzol F, Parias C, Nowak R, Calandreau L et al. Horses feel emotions when they watch positive and negative horse-human interactions in a video and transpose what they saw to real life. Anim Cogn. 2020; 23(4): 643-53.
- Rod Allrich. Directional Terms Used in Animal Anatomy. Available from: https://www.youtube.com/watch?v=T8pCS4rdm38 [last accessed 4/1/20201]