Currently, it is common for veterinary rehabilitation therapists to run their own practices, working from the referrals of multiple veterinarians for a limited number of conditions. Some veterinary practices, however, have embraced physiotherapy, adding a rehabilitation therapist to the practice team. In this way, they optimise the skills, knowledge and effects of both the veterinarian and the physiotherapist, and bring about the best possible result for every patient.
The primary reason to employ an in-house rehabilitation therapist is for improved pain control in all patients experiencing pain. Additional reasons include improved quality of life and life expectancy of patients with degenerative conditions, improved post-op recovery, support of competitive animals in injury prevention and recovery, improved client services and increased revenue for the practice.
Let’s discuss some of the biggest benefits of adding an inhouse veterinary rehabilitation therapist to a veterinary practice:
The first benefit of an in-house rehab therapist corresponds directly to our very first goal with the majority of our patients: pain control. Rehabilitation therapists and their modalities can significantly improve pain control for a number of conditions, thus reducing the use of medications such as opioids and non-steroidal drugs. This applies to pre-surgical cases, post-surgery cases, to chronic arthritis, soft tissue injuries, abnormal gait patterns, compensatory pain, overuse injuries, neurological injuries … the list goes on. If a patient is experiencing pain, chances are that far better control will be attained by taking a multimodal approach that includes rehabilitation therapy.
In a randomised, double blind placebo-controlled clinical trial on dogs with elbow osteoarthritis, photobiomodulation – one of the modalities employed by veterinary rehabilitation therapists – was shown to reduce pain scores and improve lameness scores, and resulted in an 82% decrease in the NSAID dose that patients were receiving over a six-week period (Looney, et al., 2018).
Back pain is a common occurrence in our patients, both equine and canine, and can occur secondarily to a multitude of conditions. A study evaluating caudal traction in a population of horses with back pain showed an immediate improvement in their pain thresholds before and after this manual therapy treatment intervention (Shakeshaft & Tabor, 2020).
The addition of a veterinary rehabilitation therapist to your team will mean expanded options of treatment for degenerative conditions, such as hip dysplasia, elbow dysplasia and arthritis. These chronic, debilitating conditions are best managed with a multimodal and multidisciplinary approach, which will improve pain, mobility, strength and functionality, slowing down degeneration and improving both quality and length of life for patients (Dycus, et al., 2017).
Rehab therapists not only work with animals in-clinic, but give owners the tools to manage conditions safely over time, consulting on home modifications, diet changes, regular targeted exercise, stretching protocols (Crook, et al., 2007) and more to ensure that the need for chronic medication is reduced or eliminated for as long as possible. This provides the client with a sense of control and confidence in their ability to keep their pet healthy and pain free, as well as making them more aware of the day-to-day condition of their pet. This means that when a flare-up occurs, they will be quick to recognise it and respond appropriately with a visit to their healthcare team or primary veterinarian.
Degenerative conditions such as degenerative myelopathy have been shown to respond positively to rehabilitation interventions, with improved function, slowed progression of neurological degeneration, and an increase in life expectancy from diagnosis to euthanasia of as much as 30 months (Miller, et al., 2020).
The incorporation of physiotherapy techniques into the day-to-day post-operative procedures for animals will improve outcomes in all surgical cases. This is especially true for orthopaedic and neurological cases; treatments applied according to the specific procedure and requirements of each patient will reduce pain, lower the risk of complications, and facilitate a faster, fuller recovery.
There is evidence that the use of cryotherapy after cranial cruciate ligament surgery can reduce pain and swelling and increase range of motion, while long-term rehabilitation interventions will result in improved range of motion, increased muscle mass and greater limb use in these patients (Cartlidge, 2014).
Sporting and Competitive Animals
Veterinary rehabilitation therapy is advantageous to sporting and competitive animals, providing support right through the competitive season and keeping them in the best possible condition. In these cases, rehabilitation is focused on injury prevention and the early detection of injuries.
In the event of an injury, a rehabilitation programme catered to the individual will ensure the best possible chance of a return to competition. These programmes incorporate knowledge of exercise physiology to prevent detraining during rest periods, a gradual progression of exercise to ensure that the healing timelines are closely monitored, and additional stress placed on healing tissues at appropriate times.
A retrospective study of supraspinatus tendinopathies, a common injury in sporting dogs, showed that 74.6% of dogs failed to respond to NSAID treatment, while only 40% of patients failed to respond to rehabilitation. While not yet the kind of outcomes we want for these patients, the addition of rehabilitation into a multi-modal treatment approach can significantly improve the chances of recovery (Canapp, et al., 2016).
Clients often recognise the value of rehabilitation therapy and hydrotherapy, and will request these services. Incorporating them directly into your practice means you keep these clients happy by recognising their needs and providing for them. A physiotherapist will also spend a larger portion of time with clients, improving client relationships and customer loyalty to the entire practice. No small consideration!
According to a survey by Dr Leilani Alvarez, two of the key factors preventing or inhibiting veterinarians from referring patients to rehabilitation were the perceived cost of rehabilitation and the distance for the client to travel to rehabilitation facilities (Alvarez et al., 2016). By incorporating rehabilitation services into the veterinary practice, the travel distance is removed as an obstacle and the perception of high cost can also be removed. Dr Leilani shares some additional information on the cost perception of rehabilitation in a podcast interview about her research.
Simplicity and Efficiency
Having a physiotherapist as a part of your team means you don’t need to refer patients elsewhere for this service, and a referral from the physio back to the vet is a simple matter. Transitions are easy and convenient for all concerned.
The Multi-disciplinary Team
The value of a multi-disciplinary team cannot be overemphasised. When members of a team, each with their own area of expertise and experience, work together with one goal, the knowledge of the entire team deepens and expands. A jack-of-all-trades is a master of none. When a team works together within a practice, diagnoses are more accurate, treatment plans are more complete, and results for the patient are more successful.
What could be more beneficial than a motivated, multidisciplinary team of complementary professionals working together under one roof? The presence of each enhances the work of the others.
Adding an additional service to the offerings of a veterinary practice means adding an additional source of revenue for the practice. This allows the practice to diversify and leverage different avenues of income, and in the long run will aid in overall expansion and growth of the practice.
In human practice, every hospital has a team of physiotherapists, and no orthopaedic surgery is performed without post-op rehabilitation. The discipline is not restricted to post-op recoveries in hospitals; it is used in the successful treatment of geriatric patients, chest conditions, ICU patients, sports injuries and a whole host of other conditions.
In the smaller and more intimate setting of a veterinary hospital, we stand to gain even more from our rehabilitation therapists, since teams are smaller, the work is more focussed and the relationships inevitably become closer and more dynamic.
If you are a veterinarian, I’d love to hear from you. Do you employ the services of an inhouse rehabilitation therapist? If so, how has this impacted your practice? And if you don’t have an inhouse rehabilitation therapist, what is stopping you from taking one on?
- Canapp, S.O., Canapp, D., Cox, C., Carr, B. J. and Barrett, J. G. 2016; Supraspinatus tendinopathy in 327 dogs: A retrospective study.
- Cartlidge, H. 2014. Evidence for the use of post-operative physiotherapy after surgical repair of the cranial cruciate ligament in dogs. https://www.theveterinarynurse.com/review/article/evidence-for-the-use-of-post-operative-physiotherapy-after-surgical-repair-of-the-cranial-cruciate-ligament-in-dogs
- Dycus, D. L., Marcellin-Little, D. and Levine, D. 2017. Physical rehabilitation for the management of canine hip dysplasia
- Looney, A. L., Huntingford, J. L., Blaeser, L. L. and Mann, S. 2018. A randomized blind placebo-controlled trial investigating the effects of photobiomodulation therapy (PBMT) on canine elbow osteoarthritis.
- Miller, L. A., Gross Tarraca, D. and De Boada, L. 2020. Retrospective observational study and analysis of two different photobiomodulation therapy protocols combined with rehabilitation therapy as therapeutic interventions for canine degenerative myelopathy
- Shakeshaft & Tabor. 2020. The effect of a physiotherapy intervention on thoracolumbar posture in horses.