Introduction to Animal Physiotherapy

Original Editor - Alan Jit Ho Mak Top Contributors - Alan Jit Ho Mak, Jess Bell, Tarina van der Stockt, Lucinda hampton, Kim Jackson, Ewa Jaraczewska, Rucha Gadgil and Aminat Abolade

Introduction

Physiotherapy for our 4 legged friends

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 patients' mobility, function and quality of life. This is achieved by stimulating the healing process to:

1. Restore injured tissues
2. Improve injured tissues' strength and balance
3. Stabilise cardiorespiratory, neurological, and musculoskeletal systems

Physiotherapy is not only a useful adjunct to medicine for people - it is now seen as a viable rehabilitation option for animals to optimise their performance and prevent injuries.

Animal Rehabilitation (Rehab)/ Physiotherapy is the application of physiotherapy assessment and treatment techniques to the animal patient.  Human Physiotherapists passionate about animal health care obtain advanced education (dependent on country or provincial/state regulations) to translate their skills to specialize in equine, canine, feline, etc.  The goal is to restore and maintain mobility, function, independence and performance.

History

Many people love their four legged friends.

The first record of animal physiotherapy being practised came 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).Animal physiotherapy is currently provided to companion animals, farm animals, and wild, live animal species.

Transferring knowledge of human physiotherapy to other species

Dog X-ray R artificial hip, on L hip dysplasia

For physiotherapists 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.

For instance, it has been found that

• Spontaneous canine cancers have similar pathophysiology and clinical presentation to the equivalent human cancers.
• There are 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 knee osteoarthritis.
• Dogs are the animal model of choice for total hip joint replacements.

The Role and Scope of Animal Physiotherapists

Horse Physiotherapy

Animal physiotherapy is continuing to grow and develop as a profession. Animal physiotherapists work alongside a multidisciplinary team, as they do in conventional physiotherapy. However, animal physiotherapists do not have first-line practitioner status in most countries. 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 stable yard manager. There tend to be fewer carers involved in small animal care, but it is still essential that each carer’s role in looking after the pet is understood.

• NB: There are different legal frameworks for animal physiotherapy worldwide. 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 various specialities. In animal physiotherapy, the divisions are:

• Musculoskeletal
• Respiratory
• Orthopaedics
• Neurological
• Sports medicine
• Elderly care/geriatrics
• Developmental problems

Musculoskeletal

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.

Respiratory

Respiratory physiotherapy for animals is usually required if animals are ventilated or for post-anaesthetic recovery. Respiratory physiotherapy aims to:

• 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.

Orthopaedics

Post-operative animal physiotherapy can help to enhance a patient's outcomes following surgery. The physiotherapist should understand a surgeon's protocol before commencing a rehabilitation plan (including the animal's weight-bearing status and when specific exercises should be introduced).

Neurological

Neurological physiotherapy is indicated after a neurological injury has occurred. It may involve rehabilitating the whole body or just a single limb. Intervertebral disc disease is one of the most common causes of neurological dysfunction in small animals. Neurological injuries may be managed conservatively or surgically, but the amount of initial damage can majorly impact the long-term recovery outcomes. Common treatments for neurological and orthopaedic dysfunction include:

• Massage
• Stretching
• 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 performing daily activities.

Sports medicine

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 is considered “valuable assets”. Animal physiotherapists must also be able to guide owners about appropriate conditioning programmes (specific to both the sport's and the animal's requirements).

Elderly care/geriatrics

Like humans, Pets live longer, so increasing numbers of animals present 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.

Developmental problems

Animal physiotherapists see many 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 not many well-designed studies 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 the range of motion compared to a sham treatment
• Relaxing massage may help 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. Animal physiotherapists must have a good understanding of each species' comparative anatomy and biomechanics 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. Still, in dogs, particularly chondrodystrophic (i.e. short-legged phenotype) dogs like dachshunds, the disc calcifies, and surgery is almost always indicated if disc material extrudes. As mentioned above, intervertebral disc disease is one of the most common causes of the cause of neurological dysfunction in small animals.

Human-Animal Dyad

Dog–human attachment bond

The human–animal bond (or dyad) is "the mutually beneficial and dynamic relationship between humans and other animals, modulated by reciprocal behaviours 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, includes all four features of attachment bonds that arise in human caregiver-infant relationships:

1. Proximity seeking
2. Separation-related distress
3. Safe-haven effect
4. Secure base effect

A study by Schöberl and colleagues reinforces this notion of attachment. This study found that dogs considered as either a “social partners” or a“meaningful companions” of their owners had lower morning salivary cortisol control values than other dogs.

When assessing animal patients, it is important to remember that all the information about an animal comes directly from the carer. Moreover, the carer's personality and emotions can significantly impact 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 animal treatment.

In the case of horses, research shows that there is a high degree of emotional contagion. Emotional contagion is “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 and having an awareness of animal behaviour enables the physiotherapist to approach and handle animal patients safely and effectively.

Summary

• 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