History of Canine Physical Rehabilitation

The authors would like to acknowledge Robert Taylor for his work on the previous edition.

The idea of applying rehabilitation principles and techniques to animals, although not new, has grown appreciably since the mid 1990s. More than 110 facilities providing physical therapy and rehabilitation are now operating in the United States and this number is growing rapidly as veterinarians and physical therapists realize the need and market for these services. Although many of the treatment protocols for humans were developed and continue to be developed using animal models,1–7 a growing number of research studies are being conducted in universities and private practices that look specifically at the benefits of different methods of rehabilitation in animals, especially dogs. Higher owner expectations combined with increased sophistication and technical abilities of veterinary clinicians have resulted in greater interest in physical therapy and rehabilitation.

Interest in the practice of canine rehabilitation in the United States first gained momentum in the late 1980s and throughout the 1990s as a result of the influence of classic texts; sporadic journal articles; national presentations at the American Physical Therapy Association (APTA), American Veterinary Medical Association (AVMA), and the American College of Veterinary Surgeons (ACVS) meetings; and the formation of the Animal Physical Therapist Special Interest Group within the APTA. The International Racing Greyhound Symposium in conjunction with the Eastern States Veterinary Conference (currently the North American Veterinary Conference) in Orlando, Florida, was first started in 1986 and was expanded and renamed the International Canine Sports Medicine Symposium to include all sporting dogs. Rehabilitation was a frequent topic at these annual meetings and numerous articles have been printed in the proceedings of this symposium as well as others during the past 25 years.8–19 Many veterinarians and physical therapists have lectured and presented continuing education and research findings at regional, national, and international human and veterinary conferences.

Many veterinarians have felt a need to improve postoperative patient care, because traditionally preoperative management, diagnostic procedures, and surgical treatment have been emphasized. The results seen with humans undergoing intensive postoperative rehabilitation have caused many veterinarians to rethink patient management strategies, so that postoperative rehabilitation, once overlooked, is now becoming more common in veterinary practice.

The APTA position statement and the AVMA “Guidelines for Alternative and Complementary Veterinary Medicine” have provided some initial guidelines for the field of animal physical therapy. Each professional organization has recognized the other and has published guidelines for collaborative working relationships. The APTA House of Delegates adopted a position statement in June 1993 regarding animal physical therapy, which states that the APTA “endorses the position that physical therapists may establish collaborative, collegial relationships with veterinarians for the purposes of providing physical therapy services or consultation.”²⁰ The “Guidelines for Alternative and Complementary Veterinary Medicine” were adopted in July 1996 by the AVMA House of Delegates.²¹ The document, which defined veterinary physical therapy as “the use of noninvasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries in non-human animals,” established the following guidelines:

New guidelines were adopted by the AVMA House of Delegates in 2001.²² They evaluated several medical approaches described by the terms complementary, alternative, and integrative and collectively described them as complementary and alternative veterinary medicine (CAVM). Examples of CAVM include aromatherapy; Bach flower remedy therapy; energy therapy; low-energy photon therapy; magnetic field therapy; orthomolecular therapy; veterinary acupuncture, acutherapy, and acupressure; veterinary homeopathy; veterinary manual or manipulative therapy (similar to osteopathy, chiropractic, or physical medicine and therapy); veterinary nutraceutical therapy; and veterinary phytotherapy.

The basic concept behind these new guidelines was to emphasize that CAVM should be held to the same standards as traditional veterinary medicine, including validation of safety and efficacy by the scientific method. In addition, the guidelines state, “The AVMA believes veterinarians should ensure that they have the requisite skills and knowledge for any treatment modality they may consider using.” Finally, another pertinent point is, “The quality of studies and reports pertaining to CAVM varies; therefore, it is incumbent on a veterinarian to critically evaluate the literature and other sources of information. Veterinarians and organizations providing or promoting CAVM are encouraged to join with the AVMA in advocating sound research necessary to establish proof of safety and efficacy.” It is encouraging that a number of studies have already indicated its benefit in treating a wide number of conditions.23–34 In addition, other studies have evaluated therapeutic modalities and the responses of tissues to rehabilitation following injury and during repair.^35–97

Journals and books have provided information on animal physical rehabilitation for more than 30 years. However, an article titled “Postsurgical Physical Therapy: The Missing Link,” by Taylor,²³ was one of the first to capture the interest of the veterinary community. Throughout the remainder of the 1990s and continuing to date, the number of publications increased. Topics included cranial cruciate ligament rupture and rehabilitation,^23–34 postoperative management of spinal surgery or spinal cord diseases in the dog,^35–48 orthopedic conditions and osteoarthritis,^49–61 and management considerations for trauma patients.^62,63 Collaboration of veterinarians and physical therapists has increased, resulting in publications regarding physical rehabilitation for the critically ill patient^64–66 and pain relief.^67–70 It is clear that the dissemination of information has strengthened the ties between veterinarians and physical therapists and increased support for the efficacy of rehabilitation approaches in animal care.

Initially, several books helped shape the field of animal physical rehabilitation. Physical Therapy for Animals: Selected Techniques, by Downer,⁷¹ influenced professionals as early as 1978. Canine Sports Medicine and Surgery⁷² added to the growing field of sports medicine and discussed the role of physical rehabilitation in treating injuries of dogs. Originally published in 1994 as Care of the Racing Greyhound⁷⁴ and revised in 2007,⁷³ Care of the Racing and Retired Greyhound outlines rehabilitation guidelines for musculoskeletal injuries sustained in racing and training that are applicable to any athletic dog.⁷⁴ The revised version was expanded to include retired greyhounds. Three recent texts written through the cooperation of veterinarians and physical therapists include Canine Rehabilitation and Physical Therapy (2004) by Millis, Levine, and Taylor⁷⁵; Essential Facts of Physiotherapy (2004) by Bockstahler, Levine, and Millis⁷⁶; and Animal Physiotherapy—Assessment, Treatment and Rehabilitation of Animals (2007) by McGowan, Goff, and Stubbs.⁷⁷ All of these recent texts provide details of examination procedures, intervention, and applications for specific conditions. Multiple articles describe the use of physical therapeutic modalities and orthotics.^78–97

Physical rehabilitation is gaining greater acceptance in veterinary medicine and there are more options for training. Currently, rehabilitation rotations, electives, and instruction are available at a number of veterinary colleges, and rehabilitation lectures and even courses exist as a part of the professional curriculum. A university-based certificate program at the University of Tennessee has over 850 graduates worldwide as of 2012 (www.canineequinerehab.com). Graduates receive the Certified Canine Rehabilitation Practitioner designation. Other continuing education programs are available at conferences and meetings.

In August 1999 the First International Symposium for Physical Therapy and Rehabilitation in Veterinary Medicine was sponsored by and held at Oregon State University. More than 300 participants from 21 countries met during 4 days to present clinical and research findings and to share ideas. This meeting focused entirely on animal physical rehabilitation and brought the professions of veterinary medicine and physical therapy together to exchange information and share ideas. Subsequently, there have been additional symposia in the United States in Knoxville, Tennessee, in 2002; in Raleigh, North Carolina, in 2004; and in Minneapolis, Minnesota, in 2008. The fourth symposium was held in Arnhem, the Netherlands, in 2006 to expand and integrate rehabilitation knowledge, methods, and practices of other countries. In 2010, the sixth symposium was held at Auburn University in Alabama and the Seventh Symposium was in Vienna, Austria. Plans for a meeting in the United States in the summer of 2014 are ongoing.

Worldwide Animal Rehabilitation and Physical Therapy Associations

Veterinarians and physical therapists in many countries have been sharing information and working together for three decades. Physiotherapists have professional organizations for animal physical rehabilitation in at least 11 countries: Australia, Canada, Finland, Germany, the Netherlands, New Zealand, South Africa, Sweden, the United Kingdom, and the United States. In many of these countries, the groups are formally recognized by their respective national physical therapy associations. Box 1-1 provides a brief history of these organizations and contact information.

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