Vetnews | September 2024 26 « BACK TO CONTENTS The Value of a Veterinary Rehabilitation Practitioner in the Animal Health Team Dr Tanya Grantham I am writing this article from the perspective of a small animal veterinarian who has moved into physical rehabilitation and pain management of dogs and cats. I have been in this field since 2007. During this time, I have learnt so much about body biomechanics (my own and that of the patients), palpation, mobility, and treatments that are not taught to veterinary students. A rehabilitation practitioner has the following skills that can significantly benefit the general veterinary practitioner. I boldly state that this can be extrapolated to horses, production animals and wildlife. Conformation Assessment Dogs are one species. This species has the largest phenotypic variance of any mammalian species on the planet. How do short legs and a long body impact spinal health? Some breeds have upright hind limb angulation, while others are abundantly angulated. How does angulation affect the ability to hold a stance versus the need to cover a vast distance quickly and with minimum effort? Conformation contributes to overall ability, depending on the role the specific breed must fulfil. Poor conformation and imbalance in the regions of the body can predispose an individual to injury. The best therapy can be identified by considering conformation in a patient assessment. By following this approach, the veterinarian’s success is enhanced. Gait Analysis I admit that not being around horses in my youth has presented me with a noticeable disadvantage in the arena of gait analysis. I knew about walking, trotting and galloping. I had yet to learn which was a 3-beat or 4-beat gait, let alone the sequence of footfalls. Upon graduation, I could identify a lameness and, on a few occasions, be bold enough to grade the lameness. That was the total of my ability to analyse the gait of a quadruped. Rehabilitation professionals learn much more than just identifying and grading lameness. Rehab practitioners can assess the different phases of the step (swing and stance) and use this information to identify subtle offloading of a limb. These changes can exist before an injury or assist in recognising an affected limb. These skills are applied to rehabilitation programs, assisting with the choice of therapy and enhancing the outcome. Not only does the dog use the leg, but the leg is being used optimally. Palpation Skills As a new veterinary graduate, and for many years after that, my palpation skills were limited to noting obvious asymmetry, swelling, heat, bone fractures, and possibly reduced range of motion in individual joints. As I delved into manual therapies and my skills improved, I was able to palpate and treat myofascial trigger points. I could feel the presence of intervertebral mobility, and I became familiar with joint end-feels. Manual skills (of which massage is one) are an integral part of the training of a rehab therapist. These skills are compatible with a veterinarian’s diagnostic abilities, resulting in focussing on a particular problem area. The veterinarian’s choice of treatment then becomes accurate and appropriate instead of general. Functional Assessment of Soft Tissues The role of the veterinarian is primarily to diagnose. Once a diagnosis has been established, treatment can be prescribed. My diagnostic training was focused on taking the history, checking normal parameters, establishing a minimum database (urine, faeces, blood), and general palpation (to identify a problem area broadly). This information may lead me to ask for specific imaging, most commonly radiographs or diagnostic ultrasonography. Any musculoskeletal issue not identified on a radiograph (read bone issue) or by specific tests (cranial drawer, Ortolani, etc.) was lumped in the category of soft tissue injury. The patient is given NSAIDs and told to rest for a week and to return if not better. This approach has been particularly frustrating because genuine soft tissue injuries are not resolved in this manner. A rehab therapist is trained to assess the function of soft tissues. The soft tissue assessment and manual skills of the therapist, coupled with the knowledge and experience of the veterinarian, mean that soft tissue injuries can be precisely identified and treated. In this category, I specifically refer to iliopsoas injury, medial shoulder instability, and other causes of front limb lameness. In conclusion, I urge you to begin building a relationship with veterinary physiotherapists in your area. Send them post-surgical patients for rehabilitation. Collaborate with them and build a senior pet care program focused on managing pain and maintaining quality of life. Ask their opinion when faced with a challenging case. Keep an open mind. I think you will be glad you did, and your patients will thank you for it. v
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