Remedial exercise prescription... The part of physio everyone dreads. I know we do as humans from my own personal experiences: casually forgetting and blowing it off with a "there's always tomorrow". So when there is the added effort of not only completing your own remedial exercise prescription but also completing your animal's exercises, it can feel very overwhelming, and I completely resonate with that.
What is remedial exercise prescription?
Remedial Exercise Prescription, or more commonly known as REP, is a set of tailored exercises given to each animal to help them achieve their goals.
Before I begin treatment on any animal, I always aim to ask the owner what their overall goal is. This can be as simple as improving quality of life or returning to soundness, or it may be as ambitious as returning to competition or progressing within their discipline.
Once we are all on the same page about where we want the treatment plan to end up, we can set realistic milestones that can be achieved without causing further damage or muscle fatigue, both of which can slow progress. However, we do have to be honest and acknowledge that even with the most flawless REP, there may still be setbacks as every animal is unique. That is okay; it is something we can overcome together as a team.
Why is REP so Important?
As a veterinary physiotherapist, I often see each patient for around an hour once weekly for injury recovery cases and once every six to eight weeks for maintenance cases. During that contact time, I will always strive to ensure my patients receive all of the hands-on treatment through manual therapies and electrotherapies that they require to help them meet their short- and long-term goals.
My hands-on treatment aims to promote healing, relieve muscle spasm, reduce excessive muscle tone and enhance muscle suppleness. All of these elements are essential parts of the healing process in musculoskeletal conditions, helping the animal move and function properly.
When I leave, the work does not stop there. The animal may feel relief from pain, have more supple muscles and have an improved healing capacity within the soft tissues. However, as my sports therapist at ZRL Sports Therapy says, “a weak muscle is a tight muscle”.
If I have relieved tension within a muscle but little effort is made to strengthen it, the increased tone, muscle spasm and pain response are likely to return. When we reconvene for the next session, we may find ourselves back at square one. Essentially, the hands-on work I perform is foundational; it creates the opportunity for muscles to become stronger. Increased strength can improve resting muscle tone, enhance power and performance and ultimately help us achieve your desired goals.
My Role in REP
Now that I have discussed the importance of completing REP, I feel it is important to explain the role I play within the process.
After each session, I sit down and review the notes I made during treatment, including improvements since the previous session, areas that have remained unchanged and, occasionally, areas that may have worsened. When these findings are considered alongside the goals we have already discussed, I can prescribe specific exercises and repetitions that both I and the current evidence base believe will help strengthen areas of weakness and create a more balanced musculoskeletal system.
At each session, exercises may be adapted to meet changing needs, or existing exercises may be progressed to build additional strength. Although I am not present while the REP is being carried out, I work very hard behind the scenes to ensure every prescription is appropriate for the individual patient and allows progression without excessive fatigue, helping them move towards their goals safely and effectively.
Lets Review the Literature
- A back up exercise targets the glutes and hamstrings, which when increased in strength help enhance the range of motion of the hindlimb including the hock and fetlock (Eldridge et al., 2025).
- Working on a gradient will help shift weight onto the hindlimbs, developing muscles along the back, hamstrings and abdominal muscles to enhance spinal stability (Clayton, 2016 and Castejon-Riber et al., 2017), a useful exercise for horses with kissing spines. Hill work is also beneficial for canine companions to help enhance joint range of motion, improving motor control and balance (Richards et al., 2010). Therefore, beneficial for conditions such as CCL rupture and to train motor control for performance dogs.
- Pole work/Cavetti is useful for both dogs and horses to help enhance both fore- and hindlimb range of motion by strengthening flexors of the limb (Clark and Flood, 2022). Additional benefits include strengthening the core muscles to enhance spinal stability, and progression into raised poles can help balance and coordination (Shaw et al., 2021). Therefore, useful for treating equine kissing spines and canine neurological conditions.
- A sit to stand exercise for canines is beneficial to help enhance the overall range of the hip joint by strengthening the quads and hamstrings (Dycus, Levine and Marcellin, 2017). Beneficial for the rehabilitation of hip dysplasia and patella luxation, and can be performance enhancing by increasing propulsive power from the hindlimbs.
Final Thoughts
To conclude, REP is one of, and perhaps even the most important part of, a veterinary physiotherapy rehabilitation plan when it comes to achieving both your goals and your animal’s goals.
As I mentioned at the start, I know how overwhelming REP can feel for us as humans, let alone when we are also responsible for our animals’ rehabilitation programmes. Alongside discussing your goals, I also take the time to understand your lifestyle. I make it my mission to design your REP so that it fits into your normal daily routine as much as possible, helping it feel a little less daunting and a little easier to maintain consistently.
Next weeks post will be looking more closely at specific exercises and how these can benefit each canine and equine patients.
DISCLAIMER: Although the proposed benefits of certain exercises have been discussed it's vital that you seek advice from a fully qualified veterinary physiotherapist before completion of any exercises as at certain stages in rehabilitation certain exercises can cause more harm than good!
References
Castejon-Riber, C., Riber, C., Rubio, M.D., Agüera, E. and Muñoz, A., 2017. Objectives, principles, and methods of strength training for horses. Journal of Equine Veterinary Science, 56, pp.93-103.
Clark, A. and Flood, D., 2022, June. The effect of the use of ground poles and raised poles on hindlimb range of motion and hindlimb hoof height. In 11th Alltech-Hartpury Student Conference.
Clayton, H.M., 2016. Core training and rehabilitation in horses. Veterinary Clinics: Equine Practice, 32(1), pp.49-71.
Dycus, D.L., Levine, D. and Marcellin-Little, D.J., 2017. Physical rehabilitation for the management of canine hip dysplasia. Veterinary Clinics: Small Animal Practice, 47(4), pp.823-850. DOI: https://doi.org/10.1016/j.cvsm.2017.02.006
Eldridge, F., George, L.S., Chapman, M., Harrison, L., Tabor, G., Uttley, C. and Clayton, H., 2025. A comparison of equine hind limb muscle activation and joint motion between forward and backward walking. Journal of Equine Rehabilitation, p.100036. DOI: https://doi.org/10.1016/j.eqre.2025.100036
Richards, J., Holler, P., Bockstahler, B., Dale, B., Mueller, M., Burston, J., Selfe, J. and Levine, D., 2010. A comparison of human and canine kinematics during level walking, stair ascent, and stair descent. Wien Tierarztl Monatsschr, 97(92), p.100.
Shaw, K., Ursini, T., Levine, D., Richards, J. and Adair, S., 2021. The effect of ground poles and elastic resistance bands on longissimus dorsi and rectus abdominus muscle activity during equine walk and trot. Journal of Equine Veterinary Science, 107, p.103772.
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