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What does a dog physiotherapist actually do?

We get asked this a lot, so I thought it would be worthwhile explaining some of the key elements of a veterinary physiotherapy programme, whether for dogs, horses or other animals. As i've said before its not rocket science, but a good animal physiotherapist needs to bring together a detailed knowledge of anatomy and physiology, have a trained eye, great palpation skills, and a huge amount of empathy, for both the patient and the owners. I also believe a canine physiotherapist really has to be able to think outside the box in terms of rehabilitation exercises, because most dogs are pretty much guaranteed to not want to sit around and let a physiotherapist do their job - one such client called Luna is a prime example, and you can read about her journey here.

Lets put it in human terms

To better understand the context, lets talk in human terms to begin with. Imagine you are unlucky enough to suffer a major car accident. Thankfully you only have a few broken bones, some cuts and bruises and no-one else was hurt. You are however going to need a a few days in the hospital to recover and then bed rest for a considerabe period of time.

Whilst you are being taken care of by our incredible NHS a couple of important things are happening. Firstly your body is going to be throwing down a huge amount of new tissue to heal all the damage - bone included, which is great from a healing perspective, but it comes at a price. Bone is the only system in our body that will regain its pre-accident strength, usually after a period of about 12 weeks. However everything else is going to be repaired with scar tissue, which is like the bodies polyfilla, plugging the gaps ready to be painted over. The problem is, scar tissue doesnt function like normal tissue - its all just bits of collagen haphazardly deposited in the quickest way possible. Which means when you do finally get out of bed again, things that used to move freely probably wont.

Use it or lose it...

The second thing that's happening is what I call the bodies "use it or lose it" response. Anyone that's a regular gym goer will tell you of the frustrations of having an injury, meaning you can't train for a few weeks, and how quickly all of your past efforts have seemingly disappeared. You see, as well as being incredibly efficient at healing, the body is almost too efficient at getting rid of stuff we don't use. Not walking around as much? dont need all of that leg muscle then. Havent been bench pressing lately? you dont need all that pectoral muscle sitting there, we'll recycle it for something useful.

The same goes for joints and flexibility - if you are not walking around as much, you dont need all that flexibility in your tendons, oh and by the way all the lovely fluid in your knees that keeps them lubricated - its now starting to look like engine oil from a 20 year old taxi. Anything else you are not using at the moment? - oh you dont need to be as conscious of your surroundings as you are not wandering around, so lets turn down your proprioception a little bit (how the body understands where it is in time and space). Whilst we are there, lets start to decrease some of this tension in your ligaments, you are just sitting around doing nothing, dont need that any more... Pretty incredible right?

We are all constructed from the same materials

Ok so you get the general idea, now lets talk in dog terms. Take a dog that has to have cruciate ligament surgery (you can read about what this entails here). Its pretty invasive, involves general anaesthetic, and will normally require at least 6 weeks of crate rest at home to recover. Sadly it also means that there is a 50% chance that the second knee will need to be operated on in the future (and vets dont do 2 for the price of one).

After surgery, exactly the same process is going to happen to the dog that goes on in human patients. Muscle mass is going to reduce, tendons will start to shorten, ligaments will lose some of their integral strength and proprioception will deteriorate. Add in the fact that you have an animal that doesnt understand why it has to stay in a crate for 6 weeks, and is getting frustrated and bored, and its usually a pretty stressful time for both the dog and the owner alike. Horses have exactly the same issue - tendon injury? Lets box rest for 6 months....

Hydrotherapy is not the only solution

Hopefully, at the same time as discussing surgery, a veterinarian is going to talk about the importance of rehabilitation during the recovery. Some will discuss the need for post-surgical hydrotherapy which is great, but in my opinion doesn't start soon enough (as you can see here). A really good veterinarian will recommend a veterinary physiotherapist, for all of the reasons discussed in lots of our previous posts, and we can get to work within 24 to 48hrs of surgery. The first practical thing we will do is assist with pain management. Generally dogs will have pain killers for a really short period of time after surgery - sometimes 48hrs only, sometimes up to 7 days. Think about that for a moment - you've just had major surgery and the doctor says you will get painkillers for two days - hell no! Give me the good stuff and keep it coming...The dog will also be given anti-inflammatories, again usually for a short period of time, but there is a really good reason for that. Inflammation is a vital part of the bodies repair process, so we need it - just not too much of it. There are some really simple ways that animal physiotherapists can help to control it, either with ice packs, but also low level laser therapy, which has the added advantage of that it promotes healing at the wound site.

A quick word of caution here though - what no medical professional has ever managed to do in the history of time is speed up the bodies natural healing process. The body will heal in its own time, which varies between individuals, all we can do is optimise it - give it the best chance of recovering in the quickest possible time, by maximising cellular repair and optimising the bodies naturally healing process.

You cannot speed up the bodies natural healing process

Think of it like a battery that only stays charged for a day or so. You can recharge it, but you can't charge it any more than 100%. You can however optimise it, so that the 100% charge lasts longer and is more effective (in hindsight thats probably a pretty poor analogy, but hopefully you get the point). If we go back to inflammation for a second, the body needs it to clear away all of the waste products and dead cells that are being created at the site of a wound, and will generally be in an inflammatory state for around 72 hrs. If we shorten the process the body hasn't had time to do the job effectively and the wound doesnt heal properly. What we can do is optimise the inflammatory process, so that the body does it as efficiently and effectively as possible, so that it can then move on to the next part of the healing process. If we dont, healing can take much longer, or you start to get uncontrolled inflammation, which is really tricky as the body starts clearing healthy cells away as well as damaged ones. Just as an aside, different tissue in the body need different times to heal. The chart below gives you a really good overview (you can click on it to enlarge)

Image courtesy of prehabguys.com


At the same time as dealing with the inflammation we start to work on the restriction in movement caused by both the surgery, and having to deal with a damaged cruciate for a length of time before this all started. Again, if we want to optimise the bodies natural healing processes we want to encourage new blood flow into the area, and we do that by performing very gentle range of motion exercises. Remember what we said about use it or lose it? If the joint isnt moved (and chances are the dog doesn't want to do it by choice) then things start to shorten and get tight, movement starts to restrict and the healing process becomes longer. Once the inflammatory period has finished we also want to keep on encouraging new blood into the area (again maximising healing) and we do this by increasing the range of motion, using electrotherapies such as a Pulsed Electromagnetic Field, or even just simple heat packs (told you it wasn't rocket science) Funnily enough I have a heat pack on my shoulder as we speak, dealing with a niggling tendon injury. We will also use a range of massage techniques to not only relax the dog, but also relieve pain, help to drain toxins into the lymphatic system, increase blood flow and fluid turnover and maintain tissue plyability.

Image courtesy of companionanimalhealth.com

Usually within around 48-72 hrs post surgery there will be a follow up visit with the vet, and everything is hopefully looking good. Now is when its important to encourage the dog to weight bear on the limb. Dogs are their own worst enemy, so if they can find a way to not use the leg, they will do. This is especailly true with smaller, lighter dogs, who can usually cope really well with wandering around on 3. So we start to introduce simple, gentle weight shifting exercises, to encourage loading in the affected leg. This is all important for healing of the bone as well, as the level of strength in a bone is directly related to the load that is placed through it - its called Wolffs law. Just in case you missed it, let me say that again..

The strength of bone is directly related to the load that is regularly placed through it

Remember what we said about use it or lose it? Now it is a gradual process, but bear in mind if a dog has a cruciate ligament issue, chances are it wont have been weight bearing correctly for a period of time, so the bone WILL have started to lose strength before the surgery, its then generally cut (fractured) as part of the surgery process, and then the dog sits in a crate for 6 weeks... So we need to start loading it as soon as possible, and then increase the loading to build up the integral strength.

Bone is amazing in that its the only tissue in the body that can completely heal and be as strong or stronger than what it was post injury. To help promote fracture healing we can once again use some electrotherapies which encourage the turn over and deposit of new bone. As part of that process we introduce SLOW lead walking to load the limb, encouraging the dog to move around, and again getting vital bloodlfow and nutrients to the wound area. More importantly this helps to slow any loss of proprioception and helps with the dogs mental wellbeing. Around 7-10 days the superficial wound site should have healed, and another vet visit is on the cards. From a veterinary physiotherapy perspective, we now want to start promoting tendon and muscle flexibility, as scar tissue is starting to form, and unless we encourage it to be nice and linear its going to start reducing mobility. So as well as increasing the range of motion that the dogs is using, we start some gentle stretching exercises. Bearing in mind this is all within around two to three weeks of surgery - we wont even go near a hydrotherapy centre for another month or so

As the weeks progress so will the amount of exercise the dog is allowed to do. There will be no off-lead until around week 12, but maintaining movement is vital for recovery and all the benefits we've previously mentioned. At around the 6 week mark there will be another vet visit - this it to check the progression of the healing so will generally involve an x-ray to look for whats called soft-callous closing of the fracture. This means that the bone is now joined, albeit does not yet have full structural integrity. If all is well hydrotherapy is introduced where possible (not every dog can cope with it mentally). Hydrotherapy has a number of benefits, not least of which is that it allows for development of muscle mass with a reduced amount of pressure (caused by bouyancy) through the limb.

That being said, if a veterinary physiotherapist is involved from the outset this is usually less of an issue. At home, stretching and range of motion exercises will still be part of the weekly routine, and at this point we might introduce cavaletti poles as part of the rehab process. This kind of exercise is fantastic in that asking the dog to step over an obstacle not only actively increases the range of motion, but also increases weight bearing in individual limbs. It also means the dog has to think about its co-ordination which helps from a proprioceptive point of view.

The magical 12 week vet follow-up appointment

If all is well, at 12 weeks a final follow up is scheduled with the vet for a final x-ray. If the dog has avoided infection, implant failure and a multitude of potential complications then at this point the vet will say that all is well and good, there is hard callous at the fracture, meaning the dog can now have some time off-lead. The good ones will tell you to build it up slowly, the poor ones, possibly not. If a veterinary physiotherapist hasnt been involved up until this time, the chances are the dog will still have a long road ahead for recovery, range of motion will be limited in the joint, tendons will still be tight, muscles will be fatigued and the risk of osteoarthritis increases immeasurably. If a physio has been invloved, healing is 99% done. Off lead is just about topping up on proprioception and fitness. Some of the feedback i've had is that in the majority of cases dogs have come back fitter and stronger than before the surgery, which is magical, especially as it may mean they could avoid that 50% chance of having further surgery on the opposite leg.

So to recap, what does a dog physiotherapist actually do?

They manage pain

They optimise the bodies healing responses

They Increase an animals flexibility and fitness

(Told you it wasnt rocket science)


However, what they ACTUALLY do is:

  • Explain every part of the process to the owner - answer any questions they have about the surgery, describe things generally in more detail than the vet in a way the owner understands, and does everything they can to reassure the owner that the dog will get better.

  • Spends a huge amount of time getting to know the animal. Starting with the history, then the current situation, then developing a bond and understanding with the dog in their care

  • Carry out a range of different assessments at every visit to assess the dogs current stage of healing and musculoskeletal state

  • Provide a range of different manual techniques depending on the needs of the dog, whether its stretching, weight shifting, massaging or exercise, and, more importantly, teach the owner how to do them too.

  • Apply a range of electrical therapies, at settings tailored to the individual dog, at optimum times fo that particlur patient, throughout the healing process

  • Recommend other paraprofessionals to enhance the dogs recovery and wellbeing

  • Offer nutritional advice, as well as practical ways to support the dog through crate rest, and ongoing advice to manage longer term issues

  • Write reports to both the vet and owner, explaining everything that has been done and updates on progress

  • Provide ongoing support throughout the dogs journey, and in many cases (certainly the majority of mine) keep in regular contact with the owners once everything is resolved.

Now the cynics reading this might say that as physios the reason we keep in contact with owners once the case is finished is so we can pounce once again if the dog is unwell. In my case I have to say that I can remember 99% of the dogs that i've worked with, but probably 5% of the owners (sorry!). What that means is as a therapist I do build an emotional attachment to the dogs that I care for, I dont think you can be a really effective therapist without it. But that doesn't just finish when I see them for their last treatment. One of the greatest joys I have is encountering dogs i've worked with when I am out on a walk, or getting pictures of them just being dogs along with updates from owners as to how they are doing. Below is a picture from when I popped in to see a previous client a little while ago (I think he was pleased to see me)

So if you take away all the technical stuff, what a dog physiotherapist actually does is spend at least 4 years or more studying full time to learn how to care for an animal at the time when its needed most. They then spends the rest of their career doing exactly that in the best way possible.

One final thought - as anyone who has ever had a dog undergo cruciate surgery will tell you, its painful, has risks, and is incredibly stressful for both dog and the owner. The client I mentioned at the beginning of this article was facing that same surgery on both legs, starting with one then the second 6 weeks later. Happily we have managed to not only AVOID both surgeries, but she is now stronger, fitter and happier than ever before. You can read about her journey here.

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