Published in IVIS with the permission of the editor
Physiotherapy for cats and
dogs applied to locomotor
disorders of arthritic origin
Sarah Rivière, DVM, MSc
Scientific Communication, Royal Canin Research Center,
Aimargues, France
Sarah Rivière graduated from the National Veterinary School
of Lyon in 2000. The same year she went to work for the
Breeding and Sports Medicine Unit (Unité de Médecine de
l’Elevage et du Sport) at the Alfort Veterinary School in Paris.
Sarah has worked for five years in canine sports medicine,
developing the use of functional rehabilitation and
physiotherapy for domestic carnivores. Her doctoral thesis,
defended in 2002, dealt with this subject. Sarah Rivière
joined the research team at Royal Canin in September 2005
and is responsible for scientific studies and communication.
Introduction
Over recent years, veterinary medicine has made real
progress in the diagnosis and treatment, both medical
and surgical, of locomotor disorders. However, the
benefits of physiological attention in the pre- and
post-operative periods is a more recent finding.
The positive effects of functional rehabilitation on
man have been accepted worldwide since the 1970s,
suggesting that it could also benefit domestic carni-
vores. Since the 1990s, new techniques that improve
recovery have been used extensively in veterinary
medicine.
32 / / Veterinary Focus / / Vol 17 No 3 / / 2007
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Physiotherapy has positive effects on
the entire locomotor system
The morphology, physiology and metabolism of
the structures involved in locomotion are mainly
determined by mechanical factors related to
movement: cycles of loading/unloading, the direction
and orientation of force. Connective tissue (ligaments,
tendons, muscles, fascias, conjunctive tissue), joint
cartilages and bone adapt to mechanical demands, not
only during juvenile growth but also in adults (1).
Physiological movement is essential to
the good condition of the locomotor system
There are three types of constraints that harm the
locomotor system:
- constraints related to performing supra-physiological
movements or repetitive movements during sporting
activities
- non-physiological constraints generated by postural
disorders (congenital malformation, trauma etc.)
- prolonged immobilization for therapeutic reason,
or caused by the animal’s refusal to move a part of the
locomotor system (pain, mechanical discomfort etc.)
All locomotor organs are subject to change during
non-physiological loading or immobilization (1,2):
- the elasticity and mechanical resistance of joint
cartilage and subchondral bone decreases. Shock
absorption is less effective and the degenerative
mechanisms of arthritis evolve
- bone metabolism is modified: osteoporosis may
develop after a few weeks of immobilization or
poor osteosynthesis
- joint capsules, ligaments and tendons contract and
may become sclerotic, adhesions develop with loss in
joint mobility and proprioceptive deficiency (Figure 1)
PHYSIOTHERAPY FOR CATS AND DOGS APPLIED TO LOCOMOTOR DISORDERS OF ARTHRITIC ORIGIN
- the fleshy body of the muscles undergoes degenera-
tive retraction, even fibrosis and adhesions form
between ligaments and muscle fatigability increases
- cicatrisation processes are disturbed and adhesion
formation favored, since local vascularization is
modified, decreasing the elimination of metabolic
waste
- blood and lymph circulation is impaired, which
may affect major body functions
The harmful effects of non-physiological mobilization
and immobilization explain why orthopedists
agree on the need to bear weight and carry out
physiological movement as early as possible during
the treatment of a locomotor disorder.
The benefits of physiotherapy in the
treatment of locomotor disorders
Definition
Physiotherapy is defined as a therapy using physical
means such as: movement (mobilization, stretching,
exercise, massage), thermal agents (cold, heat), electric
current, sound waves (therapeutic ultrasound), light
(laser), magnetic fields, extra-corporeal shock
waves etc.
Expected effects
These non-invasive techniques, used on cats and dogs,
present multiple therapeutic benefits (1,3). They:
- combat pain
- combat acute and chronic inflammatory processes
- improve blood perfusion and consequently tissue
growth
- prevent adhesions, fibrosis and tissue retraction
- reduce muscle contractions and tension
- strengthen muscles and improve resistance to fatigue
- stimulate the nervous system, prevent neuropraxia
and stunned muscle
- encourage proprioceptive functional rehabilitation
and re-learning of motor patterns
- improve cardio-respiratory capacity
a b
Early stimulation of joints and muscle, together with
careful application of controlled weight during
physiotherapy sessions, improves quality of life and
helps the animal become autonomous, speeding up
functional recovery.
Indications
The principal indication for physiotherapy is post-
operative management of animals having undergone
orthopedic or neurological surgery (4). However it is
also useful before surgery to help fight pain, reduce
inflammation and prepare the animal physically
for surgery (for example: increase muscle mass in
some cases of hip dysplasia).
Physiotherapy also offers the possibility of treating
acute and chronic disorders not requiring surgery
(tendonitis, sprain, muscle pain, arthritis etc.). It can
also be implemented to prevent recurrence or to
prepare sporting dogs (5,6).
Physiotherapy as an integral part of a general
functional rehabilitation program
Functional rehabilitation is, above all, an overall and
sensible approach aimed at treating the impaired
function and limiting any repercussions on the body.
When an animal suffers from a locomotor disorder,
it redistributes the forces required for posture and
locomotion onto its valid limbs, which are subject to
supplementary, non-physiological, constraints. Thus,
a locomotor problem is often accompanied by a
cascade of negative effects: voluntary restriction of
physical activity, weight gain, modification in rest
areas, joint stiffness, amyotrophy, increased pain etc.
The vicious circle needs to be broken.
The aim of a functional rehabilitation program is to
ensure and preserve optimal functional recovery as
early as possible. It is based on a careful combination
of physiotherapy techniques, often associated with
other modalities (acupuncture, osteopathy etc.),
Figure 1.
a. Prolonged immobilization of a
limb may result in irreversible
ankylosis of one or several joints.
b. Maximum extension and flexion
of the knee of a Poodle after three
months of immobilization.
Vol 17 No 3 / / 2007 / / Veterinary Focus / / 33
 together with good daily care. It supplements the
effects of medical and surgical treatment. Improved
functional rehabilitation is always observed as soon
as physiotherapy is started (7-11).
To obtain the best results, pet owners are encouraged
to participate in the functional rehabilitation of their
animals by carrying out simple movements regularly.
Physiotherapy in the management of
arthritic patients
The quality of life of arthritic animals is much
impaired. As the clinical signs (pain, joint stiffness)
progress, animals move less and inactivity results
in decreased joint flexibility and muscular atrophy.
The greater the decrease in movement amplitude,
the higher the risk of capsular adherences and
ligament retractions. Pain generates muscle tension,
spontaneous activity decreases and a vicious circle
results. Therapeutic management should slow down
the arthritic process and limit the animals’ discomfort.
A functional rehabilitation program can be combined
with drugs for arthritis, or possibly with surgery
(if necessary) (12). The aims are to:
- relieve pain
- preserve or improve joint function
- increase muscle strength
- stimulate voluntary physical activity (13)
Many physiotherapy techniques are beneficial to
arthritic patients. In this article, we shall limit ourselves
to "manual" techniques, which unlike "instrumental"
techniques require no specific equipment. Manual
techniques are always the basis of any physiotherapy
program, and they can be adapted to the severity of
the animals’ clinical signs by evaluating pain and
functional capacity. There is however one exception to
this rule: in the event of an attack of acute arthritis,
complete restriction of activity is required and
only certain instrumental techniques can be used
(see article by S. Sawaya, page 37).
Passive joint mobilization and stretching
These manipulations preserve or increase flexibility
and amplitude of joint movements and stimulate
muscles and the nervous system.
The animal is laid on its side and should not resist
the movements. Joints and muscles may be previously
heated to obtain better relaxation (14) (see article
34 / / Veterinary Focus / / Vol 17 No 3 / / 2007
by S. Sawaya, page 37). All the joints of the impaired
limb are successively manipulated. Several times a day,
the limb is gently flexed then extended by the therapist
ten or twenty times successively, without causing pain.
If the joint is stiff and there is decreased movement
amplitude, some degree of stretching must be
incorporated: the final extension or flexion position is
maintained for about ten seconds, then repeated
about ten times. One study demonstrated that
twice daily passive mobilization combined with
stretching for 21 days effectively increased the
amplitude of arthritic joint movement in dogs (15).
Here it is clear that the pet owner should be able
to carry out these simple manipulations for the
animal to receive therapy as often as necessary.
These exercises can be completed by mobilizing
the entire limb by a "bicycle" movement which
provides a final, overall action that stimulates the
entire nervous system (3).
Active therapeutic exercises
Active therapeutic exercises are voluntary movements
that are selected and oriented by the therapist
(or owner). They encourage recovery of physiological
weight bearing, stimulate the complete locomotor
system (increased strength and endurance) and
improve cardio-respiratory capacity. They also help
relieve pain and improve activity, as seen for man
in a meta-analysis of publications from 2002 to 2005
concerning the use of active therapeutic exercises
during functional rehabilitation (16).
Active therapeutic exercises should be started as
early as possible, bearing in mind the cicatrisation
phases of impaired tissue. The type, duration,
frequency and intensity of the exercises are
determined from the arthritic animal’s clinical
signs. Short sessions (five to ten minutes) several
times a day are recommended, and difficulties
should be increased gradually.
Assisted therapeutic exercises are also very useful
for animals that cannot move alone correctly. The
principle is to support the cat or dog (using a
harness, a towel etc.) to help and guide it during
simple movements such as walking. Progressively,
throughout sessions, the exercises will be carried
out on different types of ground (grass, sand etc.)
to stimulate the proprioceptive function.
PHYSIOTHERAPY FOR CATS AND DOGS APPLIED TO LOCOMOTOR DISORDERS OF ARTHRITIC ORIGIN
Figure 2.
Wheelbarrow
walking
strengthens
forelimbs.
Figure 3.
Mounting stairs
strengthens hind
limbs and
stimulates the
voluntary extension
of knees and hips.
Walking is the simplest and most essential exercise (3).
A slow walk on a lead controls both posture and
weight distribution. A treadmill helps stimulate
certain weight-bearing points refused by the animal,
since the floor moves under its paws it has to use all
four limbs. This apparatus is also beneficial as speed
can be regularly increased to reach a trot. Galloping is
not recommended since weight-bearing points are not
controlled and shocks to the joints are increased.
Other active therapeutic exercises have a more
specific action:
- removal of support from healthy limbs, either by
"wheelbarrow walking" or "dancing" to stimulate
targeted members (Figure 2)
- mounting stairs to induce hip and knee extension
(Figure 3)
- obstacle circuit to obtain limb flexion
- load pulling to strengthen muscles
- "sitting-standing" exercises to strengthen hind limbs
- voluntary flexion/extension of the neck by offering
a ball or food from left to right or up and down
- walking in a circle or an 8 to stimulate the proprio-
ceptive function etc. (3,12).
Hydrotherapy
Walking in water and swimming are very useful active
therapeutic exercises for arthritic animals. They
are particularly recommended where the animal is
overweight or has difficulty in moving. Buoyancy puts
the animal in a state of relative weightlessness which
relieves the locomotor system (17) (Figure 4).
Immersion in water induces constant exteroceptive
stimulation that forces the animal to mobilize its
entire locomotor system to maintain its position.
Heat relaxes tissue and relieves pain, whilst the
viscosity of the medium offers a resistance that
stimulates muscle work. Some movements that are
impossible to make on the ground can be made in
water (18). Hydrotherapy promotes joint work,
muscle development and cardio-respiratory capacity.
Two to three sessions per week of five to twenty
minutes are recommended preferably in an immersed
treadmill in a rehabilitation swimming pool (Figure 5)
or in a natural environment, if the water temperature
is suitable.
Massage
There are many different types of massage which help
the animal to relax, reduce muscle tension and pain,
improve venous and lymphatic circulation, facilitate
metabolic waste elimination, reduce adherences
and stimulate the nervous system. Massage is used
to reduce muscle tension in arthritic animals as a
complement to other techniques. A massage session
must be performed prior to any other physiotherapy
exercises. Heat application at the start and end of the
session will improve relaxation.
For arthritic patients, only superficial techniques
are used and massage is not recommended on places
of acute arthritis.
- the session starts by gentle massage or effleurage
where the therapist makes contact with the
patient by gently stroking the skin.
38% Greater trochanter
of the femur
85% Lateral condyle
of the femur
(©Jean-Michel Labat)
91% Lateral malleolus
of the tibia
Figure 4. The weight borne by the animal (as a % of bodyweight
measured out of the water) as a function of the depth of immersion
in water, as per Levine, et al. (17).
Vol 17 No 3 / / 2007 / / Veterinary Focus / / 35
 PHYSIOTHERAPY FOR CATS AND DOGS APPLIED TO LOCOMOTOR DISORDERS OF ARTHRITIC ORIGIN
Figure 5.
Hydrotherapy
in a rehabilitation
swimming pool in
the Breeding and
Sports Medicine
Unit* – School of
Veterinary
Medicine, Alfort,
France.
- it continues with superficial petrissage: the therapist
takes a skin fold and rolls it. He/she starts at the tail
and works towards the head along the back and from
the distal area towards the proximal area of limbs.
- percussion can also be used: for example, the skin
is tapped gently with the palm or the side of the
hand. Large areas of muscle are treated in this way.
- the session ends by vibrations, either by holding a
group of muscles that are slowly mobilized in a to
and fro movement, or by holding the tip of the
paw to stimulate the whole limb. It is an ideal
technique for the end of a massage session since it
fully relaxes muscles. Eff leurage can also be
performed at the end of a session.
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36 / / Veterinary Focus / / Vol 17 No 3 / / 2007
Weight management
Any excessive load placed on joints may accelerate
the development of arthritis and pain (13). When
assessing an animal before functional rehabilitation,
always assess its ideal weight. If necessary, caloric
restriction is prescribed simultaneously with exercises
to maintain healthy musculature. In veterinary
medicine, as in human medicine, a program of
functional rehabilitation combining weight loss
with physiotherapy was seen to decrease the
symptoms and improve clinical signs (19).
Conclusion
In the framework of integrated multimodal therapy,
a careful combination of various physiotherapy
techniques (manual and instrumental), drugs and
other non-pharmacological therapies such as
acupuncture, osteopathy or homeopathy provide
excellent results.
* The Breeding and Sports Medicine Unit (UMES) was created in
1996 by Professor Dominique Grandjean within the National
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feline professionals and the veterinarians work together. The UMES
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practice is beneficial: a summary of systematic reviews 2002-2005.
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