Module 5: Physio and Your Pet – Assessment

In this module, physical therapy gets personal as we

consider the needs of pets with different types of

movement problems. Of course, physiotherapy is

about healing rather than doing harm, so it’s

important to recognize when a pet is in pain so that

you can stop and reassess the situation.

5.1 The Rules of Physical Therapy

5.2 Safety

5.3 Is Your Pet in Pain?

5.4 Your Pet’s Problems

5.5.1 Arthritis

5.5.2 Get moving after prolonged rest

5.5.3 Elbow problems

5.5.4 Sore hips

5.5.5 Knee problems

5.5.6 Neck and back problems

5.5.7 Older pets

5.1 The Rules of Physical Therapy

Let’s remind us why you’re bothering to dedicate time and trouble giving your pet physical

therapy at home.

When done correctly, physiotherapy offers your pet-pal the following benefits:

Increased muscle strength

Relief from pain

Better balance

Help injuries to heal

Improved joint mobility

A brighter mental outlook

…which all adds up to a better quality of life for your beloved fur-friend.

To achieve these aims the most appropriate therapies and, those you are most likely to use

at home, are:

Massage

Therapeutic exercises

Heat therapy

[Also see Module 5which covers how to go about giving you pet massage and also lists

general exercises that strengthen muscles and improve body condition.]

Before you start, check the following to make sure you have a GREEN light to go ahead:

A diagnosis from your veterinarian as to what the problem is

A therapy plan from a veterinary physiotherapist

A good-natured pet

Make sure there are no RED lights, in which case do not proceed. These include:

The pet has cancer

There is an open wound, or the pet has an infection

Pregnancy

Your pet has a bad attitude

Remember, physical therapy is about healing and rehabilitation in a gentle and enjoyable

way (for both you and your fur friend). Expect to start easy and build up the number of

repetitions slowly over time. It is essential that you stop the session if your pet becomes

distressed, anxious, or is in pain. Then the next time, start more gently, in a less intense way,

and with fewer repetitions to make sure your pet has a positive experience.

5.2 Safety

The chances are if your pet needs physio then, they are recovering from an injury, have

arthritis, or are sore in some way. Animals have limited ways to tell us when they are in pain

but lashing out is one of them. Also, some pets learn to anticipate pain and react before they

feel they it. If you’ve ever gone to pick up your dog and he squeaked or yelped before you

touched him, this is what’s happening. The implication of this is that when you go to massage

a certain area, your dog may snap in anticipation of the discomfort.

Keep yourself safe and be aware of this protective anticipatory reflex. The following

suggestions may help:

Avoid harsh restraints: You want your fur-friend to co-operate willingly. If he’s really

not happy then something’s wrong so don’t force the point.

Never force the pet into position: Move him gently so that he’s less fearful of pain.

If necessary, consider learning how to lure him into position. [The use of targeting and

reward-based training are covered in Holly and Hugo’s course: Dog Behavior and

Training.]

Ask a friend to help: If you aren’t sure how your canine companion or a feline friend

are going to react, ask a friend along to hold them. Gentle restraint can help the pet

feel secure and keep you safe.

Move slowly: Make your moves in a slow but sure manner, so your pet can anticipate

what happens next. If he looks anxious, just stroke the area first to help him relax,

before applying massage pressure.

Reward him: Use liberal amounts of praise and treats (if weight loss diets permit)

when he is calm and relaxed. The golden rule is to reward the behaviour you want

and ignore the bad stuff. [Again, the Dog Behavior course can help you with this.]

5.3 Is Your Pet in Pain?

Animals can’t talk but they do communicate - if you know

what to look for.

Their spoken language might not be English, but they do

tell us how they’re feeling with their body postures, facial

expression, pupil size, and vocalization.

Learning to read those signs is a vital skill for any pet parent or someone who works with

animals.

5.3.1 Signs of Pain in the Dog

In his day-to-day life if your canine companion is in pain, he’ll give you certain clues. These

include:

Poor appetite

Being listless or restless

Being reluctant to move, for example, he declines to get up and greet you as normal

Whimpering or crying for no apparent reason

Repetitive licking of a part of his body

Drooling saliva

Grumpiness when you go to touch part of his body

Limping (Lameness is a sign of pain, do not ignore it.)

A change in his behaviour or character, such as he no longer jumps up onto his favourite

chair or he loses interest in a favourite toy

Overall posture is hunched, and he may be protective of the sore area

In addition, study his face; Signs of pain include:

A worried facial expression

His brows drawn up and together

Darting eyes

His pupils may be dilated

Ears are drawn down

Signs of aggression such as curling a lip or growling

If a specific place hurts, when you go to touch it he may react unpredictably; he may flinch

and pull away, or he may lunge and snap. Again, he may also cry or whine before you touch

the area, in a warning that it’s going to hurt if you touch him. It is best to respect that warning

sign and back off and seek advice from those in your team.

5.3.2 Is Your Cat in Pain?

Cats go to great lengths to avoid showing they are in pain. For centuries they were wrongly

labelled as having a high pain threshold, simply because it took a lot for them to display signs

of discomfort. However, modern testing methods that measure levels of stress and pain

hormones in the bloodstream, proves they feel pain in just the same way you and I do.

In his day to day life, general signs you have a painful cat include:

Lack of grooming: The coat becomes progressively more dull and matted

Excessive sleeping (difficult to assess for sure!) and not shifting position

Growling, hissing or tensing up when stroked

Non-stop purring (Confusing isn’t it! Cats however purr to comfort themselves, not just

when they’re happy)

Obsessive licking

Becoming reclusive or hiding away

Poor appetite

Again, looking more closely and studying her face you might see:

Flattened whiskers

Dilated eyes

Tense facial expression

The cat is also more likely to growl when stroked in a non-painful area (as well as painful –

obviously).

5.4 Your Pet’s Problems

It’s interesting to look in a bit more detail at the common ailments that afflict our pets, and

how physical therapy can assist. (Again, this is for general interest only. Each animal is an

individual with their own health issues and complications. Assessment by a vet and a trained

therapist prior to starting a physio program are essential.)

5.4.1 Arthritis

Osteoarthritis is common in both our cats and dogs. It is caused by inflammation of the joint

lining, which causes pain. In addition, the cartilage lining the joints wears thin, the bone

erodes away, and new bone is laid down but, in the wrong places. As well as the pain and

stiffness linked to these changes, an animal with arthritis gets caught in a vicious circle where

pain stops them moving, leading to stiffness, and a worsening of the signs. It is this vicious

circle's physical therapy aims to halt.

Basic Action:

a) Pain relief: Speak to your vet about pain relief. There are some excellent NSAIDs (non-

steroidal anti-inflammatory drugs) that have high safety margins and are proven to ease

discomfort. These will help keep the pet moving. [See also Module 6.]

b) Weight loss: If you pet is overweight, put them on a diet. [See Holly and Hugo’s Pet

Nutrition course] Carrying less weight puts less strain on the joints, making movement easier.

c) Home adaptations: See Module 6 of this course for strategies to help your pet move

around in the home, and also information on nutraceutical use.

Physical Therapy:

For arthritic patients the aim of physiotherapy is:

Decrease inflammation within the joint (which reduces pain)

Increase muscle strength (which supports the joints and improves mobility)

Therapy you can do at home includes:

a) Heat therapy: Just like a cold car engine, the joints don’t want to work after being idle

for a while. Apply heat to the joints as soon as the animal wakes, and this helps gets things

going. Warm a wheat bag or hot pack to a comfortable heat, then lay it over the sore joint.

Be careful the heat doesn’t burn the skin, so take care of the temperature or place a towel

between the bag and the skin. Leave in place for 5 – 10minutes then remove.

b) Passive Exercises: This is like an athlete warming up before a race, only you do the

work for the dog. All you do is bend and flex each joint for around 15-20 slow repetitions.

Take care not to force the joint, and work within the range that is comfortable for your four-

legged. (Be observant for signs of pain.)

c) Low Impact Exercise: Little and often is the answer! Three 10 minute walks a day are

much better than one half-hour walk.

d) Massage (See Module 5.1)

Also, consider speaking to your vet about:

Hydrotherapy: The buoyancy of the water takes the stress off the joints, and the

heated water is also soothing

Acupuncture: For extra pain control

Cold laser therapy: A course of treatment can greatly increase the patient’s comfort

levels

Therapeutic ultrasound: As for the cold laser

5.5.2 Get moving after Prolonged Rest

This isn’t a long lie-in type rest, but the enforced inactivity a pet

experiences to recovery from surgery or illness. That period of not

moving around causes muscle wastage, and when they are allowed

to exercise once again, the patient is often generally weak. Their

cardiovascular fitness may also have slipped, meaning they tire

easily and get out of breath. If this animal overdoes things, they could

trigger a new injury or cause complications with the first, so physical

therapy is an excellent idea.

After Leg Surgery

In Module 5.2 we talked about how the anticipation of pain can make a pet aggressive. Well,

the anticipation of pain is one reason why a dog still carries an injured leg, even though the

vet has signed them off as healed after surgery. The dog (or cat) remembers that the leg hurt

a lot, and prefers not to take the risk of placing it down. So, what you need are ways to rebuild

confidence. Get you vet’s approval first, but consider the following:

Praise the dog when you see him putting the leg on the floor. Carry a clicker and treats

with you, and click each time you see him touch the toes down. He’ll soon start

deliberately putting the paw on the floor to get a treat. [Holly and Hugo’s Dog Behavior

and Training course can help you with this.]

Try weaving exercises: No, not weaving as in knitting, but as in winding in and out

between cones. The constant change of direction encourages the dog to shift his weight

and use both sides of his body. Take it slowly at first, at a walk, and build the speed with

time.

Playing games: For dogs that love playing tug, they brace themselves using all four legs,

so this is a sneaky way to get four-on-the-floor. For cats, try a laser pointer, lifting a paw

to squat at that pesky red dot, means the other three legs must be on the ground. (Keep

the chasing round to a minimum speed at first.)

Physiotherapy peanut: Also known as Swiss balls, these are like large exercise balls

but…err…peanut shaped. If the dog is carrying a back leg, place his front end on the

peanut, this encourages him to put both back legs on the floor. (Vice versa for a lazy front

leg.)

After Illness:

This requires rebuilding not only the muscles but cardiovascular fitness.

Slow lead walks. An average of three, ten-minute walks is good.

Increase the time slowly, say an extra five minutes added to each walk,

every week.

Different surfaces: Encourage the dog to walk short distances over

different surfaces such as grass or pebbles, to get the muscles working

even harder.

Treadmill walking: If you have access to a treadmill, use it for the dog

(or cat!) The forward motion of the belt draws the legs forward, which

gives assistance to hips and knees if these have grown especially lazy.

Stair climbing: Guaranteed to condition and get them out of puff. (Just

check with your vet that any bone operations are fully healed before

doing this.)

Also consider sourcing:

o Hydrotherapy sessions

o Underwater treadmills

5.5.3 Elbow Problems

Dogs from breeds such as the Labrador, German shepherd, and Rottweiler, are prone to

developmental problems of the elbow as a result of their genetics. Other elbow problems that

are common in any pet include sprains, strains, old fractures or dislocations, or arthritis.

Home Therapies:

Bend and straighten the elbow joint (see 5.5.1 Arthritis). It may help to warm the joint

first and avoid over straightening or bending. Repeat this 15 – 20 times, before and

after exercise. However, this is a classic example of taking care not to do more harm

than good. If the dog has recently had surgery always take the advice of the surgeon,

and heat is often NOT advisable within two weeks of surgery.

Cavaletti poles: Try walking the dog over cavaletti poles. This encourages the dog to

lift his front paws high, which encourages elbow flexion (see Anatomy

Appendix reference ‘Flexion’).

Swimming: Excellent therapy as they don’t call it ‘doggy paddle’ for nothing. Just don’t

overtire the dog or his muscles will grow fatigued and he’s at greater risk of re-injuring

the joint.

Exercise (Swiss) ball: Select the right size ball and balance the dog front end on the

ball. This encourages him to bend his elbows, which move slightly each time the ball

rocks.

Consider seeking:

Hydrotherapy.

Acupuncture or cold laser therapy if the joint is painful.

5.5.4 Sore Hips

Hip problems are all too common, whether it is arthritis in the hips or problems in younger

dogs caused by hip dysplasia.

The latter is a genetic condition where pups inherited genes from the parents, which increase

the risk of poor hip anatomy. Hip dysplasia refers to an abnormal development of the hip

anatomy, which prevents the ball of the thigh bone from moving smoothly in the socket in the

pelvis (In technical terms this is the ball of the femur and the acetabulum of the pelvis. See

Anatomy Appendix for more technical terms).

Hip dysplasia can be worsened if the growing puppy is overfed, which encourages them to

grow too quickly and the blood supply to the developing hips can’t keep pace. In addition,

too much exercise at a young age can lead to too much movement in the hip joint which

chips and damages the delicate lining. The end result is unstable hip joints which are badly

formed and are painful. As time goes by the hips remodel further and the condition worsens,

leading to muscle wastage and even more reduced mobility.

Help at Home

If the dog has muscle wastage and is weak on the back end, take things slowly. Depending

on how bad they are, consider the advice for an arthritic patient, and build them up slowly.

Leash walking on the flat: Three, 15 minute walks a day, increasing by five minutes

each walk a week.

Swimming: Great exercise as the hips don’t have to carry weight. Again, start little and

often and build up, as those muscles are going to tire easily with the unfamiliar exercise.

Sit to stand exercise: This is a sneaky one. Repeatedly ask the dog to “Sit” and then

“Stand”. The repeated effort to push the back end up is a good way to build muscle.

Again, start with a low number of repetitions, and build it up.

Heat therapy: This will bring relief to especially stiff and sore hips.

Bend and straighten the hips (as per the instructions for arthritis):This helps to warm up

the joint fluid and get things moving. Think “athlete warming up” and do it before and

after walks.

Non-slip flooring: Slipping on a laminate floor really wrenches those poor hip joints so

make sure you have plenty of rugs.

Consider more advanced therapies:

Hydrotherapy

If the hips are very painful consider acupuncture, cold laser therapy or one of the other

advanced options.

5.5.5 Knee Problems

For arthritic knees, see Module 5.5.1.

A very common problem with knees is rupture of the cruciate ligament; this is a ligament

which crosses over inside the knee which allows the joint to hinge open and shut, but not

slides backwards and forwards. [See Anatomy Appendix for more detailed anatomy.] The

best outcome is surgical repair, but some dogs remember the pain and even after the surgical

wound has healed, they don’t put the paw down. It takes cruciate surgery several weeks to

heal internally so always be cautious and check in with your vet before attempting any

exercises. If it gets to months down the line, then consider if the strategies in Module 5.5.2

are appropriate for your pet.

Other exercises that can help include:

Cavaletti poles lay on the ground. As the dog walks over them it encourages him

to lift his paws to clear the poles, which encourages bending of the stifle.

Stairs. Walking slowly upstairs shifts the dog’s weight backwards and strengthens

the stifle.

Sit to Stand exercises as mentioned in 5.5.5.

Consider accessing:

An underwater treadmill.

5.5.6 Neck and Back Problems

Neck and back problems are a double-edged

sword. On the one hand you must be incredibly

careful because of the spinal cord; overdo things or

use inappropriate exercises and the dog could be

paralyzed. On the other hand, strong back muscles

are a great ally that can help to support the spine

and reduce the risk of future problems. When in

doubt always seek professional help and work with a physiotherapist.

General fitness and condition all benefit the back, after all the backbends and extends with

every step. Strategies such as balancing the front end on a fitness ball can also help to

strengthen the back muscles, as long as the dog has no history of disc or nerve disease.

As with so many things, swimming is excellent therapy as the dog is relieved of his weight

while swimming.

To encourage flexibility in the neck, try tricks like smearing a bit of peanut butter or cream

cheese (or whatever your pet’s particular favourite delicacy is) into his armpit. The dog will

double over in an attempt to lick the tasty snack.

Also, take a look at Module 5 for ideas on general strengthening exercises and massage

techniques to relieve muscle spasms.

5.5.7 Older Pets

Much of the information in Module 5.5.1 Arthritis applies to older animals, however, they merit

a special mention for the effects on the mind of ageing. Older pets are not so mobile and can

decline into themselves mentally because they don’t get out and about. Physiotherapy, as

well as conditioning the body, also gives them a sense of hope and well-being. They usually

enjoy the mental challenge and thrive on the one-to-one attention with their pet parent.

In addition, in Module 6, we consider strategies to slow up deterioration and to make the

home easier to move around, which helps them to cope and feel more confident about getting

out of bed. Also, don’t underestimate how simple, but fun obedience training, can mentally

stimulate an older dog; so ignore the saying “You can’t teach an old dog new tricks,” and do

the exact opposite because it will lift his mood. Now is the time to teach him ‘High Five’ or to

bark on command, if you haven’t already done so.