Veterinary Physiotherapy – What’s it about and who should you use?

What is Veterinary Physiotherapy?

Veterinary Physiotherapy identifies movement dysfunction, musculoskeletal and/or neurological conditions in animals.  Physiotherapy involves static, dynamic and thorough “hands on” assessment combined with anatomy and physiology knowledge to enable identification and treatment of any problems or potential problems using a variety of techniques.

Why Physiotherapy?

Animals, like people respond to physiotherapy.  The purpose of physiotherapy is to restore and maintain mobility, function, suppleness wellbeing and performance.  Regular check-ups enable the detection of any weaknesses or potential problems before they manifest to achieve the best possible outcome and maintain peak performance long term.

Which Therapist Should I Use?

There are numerous different types of practitioner or “back person” available to treat your animal and choosing who to use can be difficult.  Word of mouth is always helpful when making a decision but you should still check the qualifications of your chosen practitioner whichever background they have come from.

Veterinary Physiotherapists specialise in assessing movement and muscle function.  They assess the animal statically, observing conformation and muscle development and then dynamically to identify any abnormalities.   Following this the animal is then palpated to consolidate the observations and localise any areas of pain or tension.  If there are any concerns the animal may need to be referred back to the vet but if not then a treatment program will be devised and discussed with you to help address these issues using physiotherapy techniques and remedial exercise.  The animal is looked at as a whole and all involved professionals are consulted and kept informed to enable the best possible outcome.

Currently the title Veterinary Physiotherapist is not protected, this means that anyone can call themselves a Vet Physio and treat animals with little or no training.

When choosing a therapist, you should check what qualifications they carry, ideally you are looking for a Postgraduate qualification such as a Postgraduate Diploma (PgD) or Masters (MSc) Veterinary Physiotherapy.  Practitioners who have taken this route will have been through extensive training to gain this qualification including academic and practical skills.

Chartered Veterinary Physiotherapists studied human physiotherapy and gained an undergraduate degree before completing a PgD or MSc Veterinary Physiotherapy.  Only human trained Physiotherapists can use the protected term “Chartered” and will be ACPAT members.  ACPAT Physiotherapists are highly skilled professionals who have undergone human training initially however, there are now other, equally skilled Veterinary Physiotherapists who have undertaken extensive training at Postgraduate level to become a Veterinary Physiotherapist.

Veterinary Physiotherapists who carry a postgraduate qualification have purely studied animal physiotherapy and usually have prior industry experience and an animal science or veterinary/vet nursing degree before commencing the Postgraduate course.  During their training they will have covered anatomy, physiology and disease modules,  as well as physiotherapy and rehabilitation modules.  Alongside the extensive academic side there is also a large practical element which involves hands on teaching and placements with practicing Veterinary Physiotherapists.

Alongside checking the qualifications of your chosen therapist you can also see if they belong to a governing body which indicates that the practitioner is not only qualified but also insured to give extra security.  Recommended sites include:

  • National Association of Veterinary Physiotherapists (NAVP)
  • Association of Chartered Physiotherapists (ACPAT)
  • Institute of Registered Veterinary and Animal Physiotherapists (IRVAP)

Canine Cranial Cruciate Disease

Cranial cruciate ligament injuries are a common orthopaedic condition in dogs (Budras et al., 2007).  The cranial cruciate ligament runs between the femur and tibia and stabilises the stifle joint by preventing the femur from sliding forwards during weight-bearing.  The cranial cruciate ligament also limits medial rotation of the tibia when the stifle joint is flexed (Evans and deLahunta, 1996).

Cranial cruciate ligament rupture is one of the most common orthopaedic conditions in dogs (Budras et al., 2007).  Cranial cruciate ligament rupture or tearing can be extremely painful and if untreated can cause meniscal tears and potentially osteoarthritis (OA) (Beetem, 2012).  There is vast research on the contributing factors and recommended treatments.

Certain breeds appear to be more susceptible than others, one paper which looked at 426 dogs found that the breeds most commonly presenting with cranial cruciate ligament disease were Labrador Retrievers, 16%, Rottweilers, 15%, Golden Retrievers 12% and Boxers, 9% (Guthrie et al., 2012).  Another study found that there were cellular differences between the cranial cruciate ligament in Labrador Retrievers who are prone to cruciate injuries and Greyhounds who are not (Smith et al., 2012).

Another contributing factor to cranial cruciate ligament injuries is conformation.  Dogs with cow hocks and/straight hindlimb conformation (reduced stifle and hock angle when viewed from the side – image below) are predisposed to cruciate ruptures (Roush, 2013).

Straight leg.jpg

When rehabilitating cruciate injuries it is important to increase the muscles that surround the stifle joint.  Building these muscles can also help as a preventative measure to reduce the strain on the cruciate ligaments.  There are studies to support this theory which show a correlation between decreased quadriceps muscle mass and cruciate disease (Mostafa et al., 2010; Adrian et al., 2013).

If you are concerned about your dog, consult your veterinary surgeon who will be able to advise you.

Increasing Hindlimb Strength

When walking, many dogs will pull themselves along with their chest and front legs which results in the back legs doing less work.  Over time, the back end loses strength and the front end gains strength making the dog even less likely to recruit the muscles of the pelvic limb which could increase the strain on the joints, tendons and ligaments.  A simple way of encouraging your dog to use his backend is to walk him slowly.  If your dog pulls on the lead this will also increase the weight carried on the front legs and reduce the weight carried behind, to address this, the use of a headcollar or harness rather than a collar may help.  Slow lead walking doesn’t sound like hard work but it is likely that when you walk your dog, he is trotting which is easier than walking.  During trot each limb spends less time on the ground and momentum carries them forwards.  Slowing the pace to a walk means that each limb has to be in contact with the ground individually and therefore take more weight which will increase muscle strength over time!

Another simple exercise that you can add into your walks is a sit to stand transition.  Going from a sit to stand requires the muscles that support the joints to work particularly the gluteals, hamstrings and quadriceps which support the joints of the pelvic limb.  When performing this exercise it is important that the dog sits with both legs tucked under his bottom, not with one leg out to the side.  If your dog tends to sit consistently with one leg out it may be worth monitoring and if it continues getting your vet to have a look.

Adding these two simple exercises into your dog’s routine will help to build muscle over his back legs to reduce strain on his joints and his front legs.  If you have any concerns/queries ask your vet or contact your local veterinary physiotherapist who can give you specific advice for your dog.





Adrian, C.P. Hausseler, K.K, Kawcak, C. Reiser, R.F. Riegger-Krugh, C. Palmer, R.H. McIlwraith, C.W. Taylor, R.A. 2013. The Role of Muscle Activation in Cruciate Disease. Veterinary Surgery. 42 765-773

Beetem, J. 2012. Canine Rehabilitation: Getting Orthopaedic Patients Back on Their Feet. Firstline. dvm360.com

Budras, K.D. McCarthy, P.H. Fricke, W. Richter, R. 2007. Anatomy of the Dog. 5th Edition. Hannover, Germany, Schlutersche

Evans, H.E. deLahunta, A. 1996. Miller’s Guide to the Dissection of the Dog. 4th Edition. Philadelphia, US. W.B. Saunders Company

Guthrie, J.W. Keeley, B.J. Maddock, E. Bright, S.R. May, C. 2012. Effect of Signalment on the Presentation of Canine Patients Suffering From Cranial Cruciate Ligament Disease. Journal of Small Animal Practice. 53 273-277

Mostafa, A.A. Griffon, D.J. Thomas, M.W. Constable, P.D. 2010. Morphometric Characteristics of the Pelvic Limb Musculature of Labrador Retrievers with and without Cranial Cruciate Ligament Deficiency. Veterinary Surgery. 39 380-389

Roush, J.K. 2013. Canine Cranial Cruciate Disease. Today’s Veterinary Practice.

Smith, K.D. Vaughn-Thomas, A. Spiller, D.G. Clegg, P.D. Innes, J.F. Comerford, E.J. 2012. Variations in Cell Morphology in the Canine Cruciate Ligament Complex. The Veterinary Journal. 193 561-566

Kissing Spines and Core Strength

Equine Conditions – Kissing Spines

Dorsal spinous process (DSP) impingement also known as Kissing Spines is the most common cause of back pain in horses (Coomer, 2013; Jeffcott, 1980).

Looking at the anatomy of the horse’s spine helps understanding of this condition (see Fig 1).  The horse’s spine is divided into 5 regions:

  • Cervical
  • Thoracic
  • Lumbar
  • Sacral
  • Caudal

Each of these sections has a number of vertebrae that are different shapes depending on their location and role.  There are:

  • 7 cervical vertebrae
  • 18 thoracic vertebrae
  • 6 lumbar vertebrae
  • 5 sacral vertebrae
  • 15-25 caudal (coccygeal) vertebrae


                                               Figure 1

The thoracic, lumbar and sacral vertebrae have dorsal spinous processes for muscle attachment, the thoracic vertebrae have the tallest spines (DSPs) which should have equal spacing between them.  In horses with kissing spines there is a narrowing of this space in mild cases progressing to the spines touching or even overlapping or fusing causing pain in severe cases (Fig 2)


Figure 2

The area most commonly affected in the thoracic region, under the saddle (T11-18) but it does occur in other areas of the spine.

It has been found that 39% of horses have kissing spines (Turner, 2011) but many of these do not display signs and are clinically normal (Erichsen et al., 2003).  Symptoms of kissing spines range in severity from loss of performance to extreme behavioural issues (Zimmerman et al., 2012).

Diagnosis is normally a combination of symptoms displayed, reduced spinal movement, X-Ray and/or scintigraphy.

There are several treatment options available, the least invasive and usually attempted first is rest and physiotherapy depending on the extent of the symptoms.  The next (more common) step is steroid injections into the interspinous spaces affected to control pain and inflammation usually alongside physiotherapy to assist pain management and reduce muscle spasm (Walmsley et al., 2002).  If these methods are not successful or do not last long term the next step is surgery.

There are 2 main surgical procedures commonly available, DSP resection and interspinous ligament desmotomy (ISLD).  DSP resection involves the removal of the summits of the affected (touching or close) DSPs.  This surgery is invasive with a prolonged rehabilitation time of around 6 months (Coomer, 2013).  ISLD is less invasive with similar success rates and reduced rehabilitation time (6 weeks) (Coomer et al., 2012, Coomer, 2013).

DSP resection aims to recreate space in the spine to remove pain and ISLD aims to relieve tension on the nerve endings found at the ligament insertion to remove the sensation of pain.  This combined with controlled exercise and physiotherapy to release muscle spasm resolves KS permanently (Coomer et al., 2012).

Lameness is also often associated with KS (Zimmerman et al, 2011) due to the lack of muscle surrounding the spine caused by back pain.  This muscle loss reduces core stability which effects spinal movement and causes gait adaptations in an attempt to relieve the pain (Bromiley, 2009).  These compensations can lead to both forelimb and hindlimb lameness issues including foot related lameness, tendon/ligament and sacroiliac issues (Coomer, 2012). Zimmerman et al., (2012) found that some horses have developed a coping strategy in association with either forelimb or hindlimb lameness (often mild and bilateral) becoming progressively stiffer and more restricted in their movement.

Research suggests that allowing horses with overriding or impinging DSPs time out of work is detrimental due to links between the lack of spinal musculature and KS.

There is research to support the use of core strengthening exercises in horses to help maintain strength and mobility which is not only beneficial for horses with KS but also as a preventative measure and for general wellbeing, strength and suppleness.  Stubbs et al., (2011) found that regular use of baited stretches increases the size of the multifidus muscle which is a spinal stabilizer.  If you have any concerns about your horse, you should consult your Veterinary Surgeon.

Core Strength

The equine athlete needs to learn to use his muscles for mobility but also for stability.  The muscles that support the spine and abdomen need to be recruited to enable the core to support itself which allows the limbs to function correctly without the extra burden of an ill supported core.

There are numerous simple exercises that can be done daily (5 times a week) to assist in building core strength.

Baited stretches are good for horses that are not too food obsessed and likely bite!  Make sure that your horse is stood on a non-slip surface. Stretches should be held for around 5 seconds and repeated 3-5 times (* – both ways)

  1. chin to chest
  2. chin to knees
  3. chin to fetlocks
  4. chin to shoulder (*)
  5. chin to outside of knee (*)
  6. chin to outside of fetlock (*)

Tail pulls are another simple exercise to improve core strength targeting abdominals and pelvis stabilisers.  Ensure that the horse is stood on a non-slip surface, grasp the tail gently but firmly towards the base of the dock and gently pull in the desired direction, be careful not to pull the horse off balance you are aiming to see the abdominal muscles contract without moving the horse.  When releasing the strain do not let go of the tail, gently release the pressure to allow the horse to return to it’s natural balance. Hold for 5 seconds, repeat 3-5 times.

  1. Tail pull to the left
  2. Tail pull to right

Another simple exercise than can be added into your existing routine is transitions, as many as you can do – on your way to/from the field, out hacking and of course when schooling.  Adding these simple exercises to your routine can help make your horse stronger, more supple and agile and reduce wear and tear on the limbs!


Bromiley, M. Rehabilitation. In: Equine Back Pathology: Diagnosis and Treatment. 1st Edition. Oxford, UK. Blackwell Publishing Ltd 249-261

Coomer, R.P.C. McKane, S.A. Smith, Vanderweerd, J.E. 2012. A Controlled Study Evaluating a Novel Surgical Treatment for Kissing Spines in Standing Sedated Horses. Veterinary Surgery. 41 890-897

Coomer, R. 2013. New Surgery for Kissing Spines. Veterinary Times. 43 (21) 20-21

Erichson, C. Eskell, P. Wistrom, C. Roethlisberger Holm, K. Johnson, C. 2003. Scintigraphic Evaluation of the Thoracic Spine in the Asymptomatic Riding Horse. Veterinary Radiology and Ultrasound. 44 330-338

Jeffcott, L.B. 1980. Disorders of Thoracolumbar Spine of the Horse: A Survey of 433 Cases. Equine Veterinary Journal. 12 197-210

Turner, T.A. 2011. Overriding Spinous Processes (Kissing Spines) in Horses: Diagnosis, Treatment and Outcome in 212 Cases. AAEP Proceedings 57 424-430

Stubbs, N.C. Hauptman, J. Clayton, H.M. 2011. Dynamic Mobilisation Exercises Increase Cross Sectional Area of Musculus Multifidus. Equine Veterinary Journal. 40 (1) 14-20

Walmsley, J.P. Petterson, H. Winberg, F. McEvoy, F. 2002. Impingement of the Dorsal Spinous Processes in 215 Horses: Case Selection, Surgical Technique and Results. Equine Veterinary Journal. 34 23-28

Zimmerman, M. Dyson, S. Murray, R. 2012. Close, Impinging and Overriding Spinous Processes in the Thoracolumbar Spine: The Relationship between Radiological and Scintigraphic Findings and Clinical Signs. Equine Veterinary Journal. 44 178-184