Unlike human medicine, our patients are unable to let us know how they are feeling, or getting on with their exercises, or if they have developed a new niggle as a result of the changing weight bearing patterns we have introduced to them. Therefore, at the start of every session we always conduct both a static and dynmaic assessment. By looking at the way animals stand and move, gives us a picture of how they are feeling such as if they are favoring weight bearing on one specifc limb, or if they are more willing to flex their limbs to a greater extent than the last session. Static and dynamic assessments are a small bridge of communication between humans and animals to give us an insight on how they are progressing in their treatment.
Veterinary consent
When it comes to the treatment of animals, there is a veterinary team that work together to ensure the highest level of welfare and care for the animals. This is composed of the Veterinary Surgeon in the chiefs position with several other important figures including the Veterinary Nurse, Veterinary Technicians and the Veterinary Physiotherapists. To ensure we work effectively as a team, its essential that we abide by the legislation stating that we must work under the consent of a veterinarian.
As a vet physio we are unable to make any clinical diagnosis ourselves, therefore this consent is required alongside a detailed description of the animals case history to ensure our treatment plans take all factors into consideration. Alongside this, within my own personal practice I like to make communication with the vet before any initial visit to any animal. I understand my place in the veterinary team and the vets may have some important information in relation to past injuries, even if they are no longer a present issue.
Building the case history
A case history is when a compile of information that as a vet physio we generate to get a picture of the animals current condition, previous conditions and in my case the future goals. This first starts at the veterinary refferal as they send all of the relevent medical information with the currect sitiation and other opposiing factors that could contribute to them.
Then when I meet with the client themselves we can get a more personal case history. I build this by asking questions such as the animals career, how often they are ridden, their normal behaviour and the overall end goal of rehabilitation. Knowing whats normal for that specific animal and where we want to end up helps make an overall plan for the rehabilitation process.
Meeting the patient
When meeting the patient all of the information we have compiled from the case history are in the fore-front of my mind. We want to evaluate any signs of pain, any changes in their general personality in which we would have discussed whats normal for them with the owner when making the case history. Overall, when we first approch a patient we want to assess for any signs of obvious pain or discomfort in themselves generally or even how their environment is impacting them and their condition. For example, some horses on box rest can get quite stressed causing box walking, so assessment of bedding distribution can give us an indication on how they are feeling!
Static assessment
My first form of assessment after saying hello, is a static assesment. This is an assesment of their overall posture. How they are standing can give us large clues as to where they are painful and where we should target our treatment. However, especially for horses they are very good at hiding the painful areas and they may not follow the basic text book offloading, this is why its essential to complete a full assessment before any treatment proceeds.
A static assessment is best completed while the animal is stood square on a flat and hard surface. This ensures there are no external factors that are influcing the way the animal is standing, giving us the most accurate representation of their posture.
Dynamic assessment
The dynamic assessment always follows on from the static assessment. This is an assessment of them moving, often known as a trot up in the horsey world. This is also conducted on a flat surface to limit other variables that may influence a lameness looking gait.
It can dependent on the type of injury the animal has on what surface is better to show the lameness. Most commonly, trot ups are done on hard surfaces as this increases the concussive forces through the limb which ultimatly make the lameness look worse so its more easy to identify. However, for injuries to soft tissues such as tendons and ligament, hard ground reduces the impact on the supportive soft tissues, therefore the animal can present as more sound than they actually are. If a soft tissue inury is speceted they are often conducted on a soft ground, due to the reduced stability, tendons and ligaments will have to act in order to support joints, increasing the stress through soft tissues often making lameness more apparent.
Additional dynamic assessments we can conduct are circles and backing up. Circles place more strain on the inside limb which can make a lameness look worse, however some conditions such as proximal suspensory desmitis can look worse when the affected limb is on the outside circle. Backing up encourgaes a larger degree of flexion in most joiints, therefore is the animal consistely resistst backing up in a straight line and favors going in a certain direction, this can also indicate a pain/ lameness in a certain limb.
Palpation assessment
A palpation assessment is when we begin to get hands-on with the animal. During this stage, we are not intending to make any changes to the muscles; instead, we are assessing their overall condition and health. This gives us a starting point and helps us identify which areas may require the most attention during treatment.
Palpation is conducted using our fingertips to feel over the superficial muscles, assessing factors such as muscle mass and muscle tone.
Muscle mass refers to the physical size and amount of muscle tissue present, whereas muscle tone relates to the level of tension within the muscle at rest.
When an animal has reduced muscle mass, this is known as muscle atrophy. This can indicate that a muscle is not being used to its full potential, which may be associated with discomfort, pain or reduced use of a limb. As the animal adapts, another area may show an increase in muscle mass or tone as it works harder to compensate for the reduced contribution from the affected muscle.
Muscle tone refers to the baseline level of tension within a muscle. When a muscle has good, healthy tone, it is often described as feeling like butter. Imagine room-temperature butter: when you press your fingers into it, it feels soft and pliable, while still providing a small amount of resistance. This is similar to how a healthy muscle should feel on palpation.
In contrast, muscles with increased tone can feel firm, bandy or fibrous. This can indicate that the muscle is maintaining a higher level of tension than it should, meaning the contractile tissues are under increased load even when the muscle should be relaxed.
Changes in muscle tone can also provide clues about compensation. If a muscle is consistently working harder to support movement or posture, it may develop increased tone as it takes on more of the workload than it would normally be expected to.
During palpation we are always assessing for changing in surface temperature. If there is an area that is hotter than other surrounding tissues this can indicate swelling or inflammation also indicating pain. We always ensure we test for heat within each joint as this can be a large clue for where the animal is experiencing pain. This step is essential before progressing to a range of motion assessment as we dont want to place extra load on already painful limbs.
Range of motion
As previously discussed, a range of motion assessment cannot be conducted until all limbs and joints have first been assessed for heat, swelling or other signs that may indicate pain. It is important that we establish there are no obvious concerns before moving each joint through its available range of motion.
A range of motion (ROM) assessment involves testing the available movement within each joint. Not every joint within a limb has the same range of motion because different joints are designed to move in different ways.
For example, the hock joint is primarily a hinge joint, meaning its main movements are flexion and extension. In comparison, the hip joint is a ball-and-socket joint and has a much wider range of movement. It can flex, extend, abduct, adduct and perform a circular movement known as circumduction.
During a ROM assessment, we lift and assess each limb individually, working systematically from the bottom of the limb upwards. In horses, we begin at the fetlock, while in dogs we begin at the digits (toes).
We assess the flexion and extension of each joint and note whether the available movement appears normal or whether there is any resistance or restriction. A slight resistance during either flexion or extension may indicate changes within the joint itself or within the muscles and other soft tissues associated with that movement.
Some joints, such as the fetlock and carpus (wrist), also have a small amount of medial and lateral movement. These are known as accessory movements. Assessing these movements can provide further information about the integrity of the joint and its supporting structures, including the collateral ligaments.
A ROM assessment therefore gives us valuable information about how freely each joint is able to move and whether there are any restrictions that may need further investigation or consideration when developing the animal's treatment and rehabilitation plan.
Physiotheraputic treatment
Once we have completed the static, dynamic, palpation and range of motion (ROM) assessments, we have a much clearer picture of how the individual animal is feeling.
These assessments give us clues about where an animal may be experiencing pain or discomfort and, importantly, where they may be offloading weight to avoid putting pressure on an uncomfortable area. Animals will often compensate for pain by changing the way they stand or move, which can place additional strain on other muscles and joints.
This information allows us to tailor the treatment to the individual animal on that specific day. Rather than following the exact same treatment routine every time, I can use my assessment findings to decide where massage, stretching and LASER may be most appropriate.
It can be difficult to explain to an animal that what we are doing is ultimately intended to help them! They may not always tolerate hands-on treatment for an extended period of time — especially our canine companions, who seem to have very round bottoms!
Because of this, I always aim to prioritise the areas of highest concern first. Once I have addressed the key areas identified during the assessment, if the animal is still comfortable and happy to continue, I can then move on to the smaller niggles and areas of secondary concern.
Every animal is different, and their needs can change from one appointment to the next. This is why the assessment is such an important part of the treatment — it allows us to adapt the session to what that individual animal needs on that particular day.
Remedial exercise prescription
Completing your remedial exercises is a vital part of the rehabilitation process. An exercise plan is designed specifically for your individual animal, targeting the areas of weakness or dysfunction identified during their assessment. After each session I make a personalised table for your animal and send it over to you. This will show you what exercises should be completed, how often they should be completed and some key things to look out for to see if they are competing them effectively.
The aim is to develop a strong, balanced and well-conditioned animal, which can help improve posture, body awareness and their ability to carry themselves effectively.
When an animal has good form, function and postural control, they are better able to distribute their weight and load their limbs appropriately during movement. This is particularly important because an animal that is able to maintain good balance and has a strong, functional core may place less unnecessary strain on individual limbs and joints.
Remedial exercises are not only beneficial for animals recovering from an injury. They can also be extremely valuable for athletic animals through a prehabilitation programme. By maintaining strength, balance, coordination and good posture, we can help support the animal's physical demands and potentially reduce the risk of injury or reinjury.
Every exercise is prescribed with the individual animal in mind. Their age, breed, activity level, current ability and any previous or ongoing conditions are all considered when creating their programme. As they progress, exercises can then be adapted to continue challenging them appropriately and support their long-term strength and function.
Check ups
Regular physiotherapy can be particularly beneficial for animals with a diagnosed musculoskeletal condition, as well as those regularly taking part in work, sport or other physically demanding activities.
Ongoing assessments allow us to monitor how an animal is moving and feeling over time. Sometimes, we may identify areas of discomfort, weakness or compensation before they develop into a more significant problem that could affect your animal's performance, career or overall wellbeing.
This can be particularly valuable during peak competition seasons, when animals may be experiencing increased physical demands. Regular physiotherapy can help us monitor their musculoskeletal health and ensure that their exercise and rehabilitation programmes continue to meet their individual needs.
As discussed above, prehabilitation is another excellent tool to have in your toolkit. Rather than waiting for an injury to occur, prehabilitation focuses on maintaining strength, balance, mobility and good movement patterns in animals that are regularly working or competing.
By consistently monitoring your animal's musculoskeletal health, we can identify changes over time and adapt their exercise and management accordingly. The aim is to help keep them strong, balanced and physically prepared for the work we ask them to do.
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