FourFront 2025:11th Edition

Four Front

The Magazine of the Professionals in Animal Therapy 11th

Evidence, Experience, and Evolving Landscapes Edition

Association of Chartered Physiotherapists in Animal Therapy w w w. a c p a t .o r g

Contents Editors notes/ Contact Details..........................................................................................................................................p4 Precision in Photobiomodulation: How Laser Parameters Shape Clinical Success Emily Ashdown RVN, ISFMCert, CSMC, Animal Dip Phys, L3 Cert Canine Hydro, L3 AET, VMLSO, RAMP, MIRVAP(VP/ICH)....................................................................................................................... p5 Considerations for the Menopausal Rider Louise Towl Chartered Physiotherapist & Veterinary Physiotherapist BSc (Hons) MCSP PG Dip Vet Phys ACPAT RAMP...................................................................................................... p12 Five Scent work Solutions for Clinicians Dealing with Anxious Dogs Jack Fenton The Dorset Dog Trainer, Nose-work and Reactivity specialist......................................................... p16 A Case Study of Unresolved Equine Hindlimb Lameness- Is the Sciatic Nerve Often Overlooked?

Cara McKinnon Chartered Physiotherapist & Veterinary Physiotherapist MSc BSc HCPC CSP RAMP........ p19 Early Conservative Physiotherapy Management of Pectus Excavatum in a Neonatal Labrador Retriever: A Longitudinal Case Report Charlotte Barton MCSP BSc (Hons) Physiotherapy MSc Vet Physio, ACPAT Cat A, RAMP.............................p22 Dougie: A Case Study on Recognising and Managing Canine Hypermobility Claire Johnston Veterinary Physiotherapist, Human Sports Massage Therapist BSc Hons, IRVAP, AHRP, SMA, PEP.....................................................................................................................................................p26 Stronger together: Implementing Physiotherapy into an Independent Vet Practice Connie Griffin Chartered Physiotherapist & Veterinary Physiotherapist .............................................................. p31 CPD Review: Equine Myofascial Kinetic lines Lisa Emerson Chartered Physiotherapist & Veterinary Physiotherapist MCSP, HCPC, MSc, ACPAT CAT A.................................................................................................................................. p34 Member Research.............................................................................................................................................................. p36 Research Digest.................................................................................................................................................................. p44 A View from the Chair Fiona Dove, BSc (Hons) Physiotherapy MSc Veterinary Physiotherapy, MCSP, HCPC, ACPAT..................... p48

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Evidence, Experience, and Evolving Landscapes In veterinary physiotherapy and rehabilitation, we often stand at the intersection of science, story, and shifting systems. This year’s FourFront Journal reflects that tension and the opportunity it brings.

We begin by championing research. Physiotherapy is no longer a peripheral service; it’s a clinical discipline grounded in biomechanics, neuroplasticity, and recovery science. Yet, to truly embed our work within veterinary decision-making, we must continue to build and share the evidence base. That means not only citing studies, but contributing to them through collaborative trials, literature reviews, and yes, case reports.

Which brings us to experience. Case studies remain one of the most powerful tools for learning, especially in a field where species, presentations, and contexts vary so widely. This year, we advocate for the sharing of all outcomes, not just the polished successes but the unexpected turns, the stalled recoveries, the ethical dilemmas. These are the stories that teach. They remind us that clinical reasoning is iterative, and that growth often comes from reflection, not perfection.

And finally, we acknowledge the shifting veterinary landscape. As corporate consolidation reshapes practice structures, physiotherapists may find themselves navigating new hierarchies, referral pathways, and perceptions. But our value remains constant. Whether embedded in a multidisciplinary team or working independently, our role in improving mobility, reducing pain, and enhancing quality of life is irrefutable. The challenge- and the opportunity- is to communicate that value clearly, consistently, and collaboratively.

This edition of FourFront is a testament to that mission.

It brings together research, reflection, and real-world insight from across the veterinary spectrum. We hope it inspires you to contribute, to question, and to keep building bridges- between evidence and experience, between disciplines, and between the past and the future of veterinary care. ............................................................................................................

Rebecca Wyatt, Editor, FourFront Journal.

Contact Details Journal Editor: Rebecca Wyatt Email: committee@acpat.org Please mark all communications as “FAO Journal Team”

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Precision in Photobiomodulation: How Laser Parameters Shape Clinical Success

Emily Ashdown RVN, ISFMCert, CSMC, Animal Dip Phys, L3 Cert Canine Hydro, L3 AET, VMLSO, RAMP, MIRVAP(VP/ICH) Founder of Precision Animal Laser Academy /Precision Pet Academy / Precision Animal Therapy.

Email: ea.ashdown@gmail.com

Laser therapy is increasingly used in veterinary rehabilitation, but misconceptions about parameters limit its potential.

Over-emphasis on power has historically restricted clinicians’ understanding of light–tissue interactions and has contributed to variable outcomes across practice (Hamblin, 2016; Jenkins & Carroll, 2011). This has led to the development of the CWIDER framework (Class, Wavelength, Irradiance, Deep Tissue, Emission, Research) designed to simplify the parameters essential for patient response and wellbeing.

From Adjunct to Essential: Why Laser Therapy Matters Photobiomodulation (PBM) influences mitochondrial activity by stimulating cytochrome c-oxidase, increasing adenosine triphosphate (ATP) production, reducing oxidative stress, and modulating inflammatory signalling pathways (Karu, 1999; de Freitas & Hamblin, 2016). PBM also enhances circulation and microvascular perfusion via nitric oxide release (Karu & Pyatibrat, 2011; Chung et al., 2012).

These biological changes support physiotherapy goals by improving tissue quality, reducing pain, accelerating recovery, and supporting musculoskeletal health (Huang

et al., 2009; Hamblin, 2018). When delivered with correct parameters, laser therapy reduces barriers to movement and enhances the effectiveness of every rehabilitation session.

CWIDER: A More Complete Understanding of Laser Therapy Clinical limitations often stem from focusing on a single parameter, usually power, which provides minimal insight into the dose the tissue receives (Jenkins & Carroll, 2011; Hashmi et al., 2010). CWIDER provides a structured, clinically meaningful method of understanding these variables and therefore results in more accurate and clinically significant application of laser therapy parameters.

By breaking down the parameters, we can see how our protocols may differ from patient to patient instead of a one style-fits-all approach. The importance of parameter reporting has been emphasised in PBM literature for over a decade. A Harvard review on light parameters highlighted the inconsistency in reporting irradiance, dose, wavelength, and emission mode, and how these omissions contribute to contradictory study outcomes (Chung et al., 2012). This study is a true testament to CWIDER, we need the whole range to be in place for most effective clinical response.

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Parameter

Meaning

Explanation

Key References

Safety classification of the laser

Class reflects hazard level, not clinical effectiveness. A Class 4 laser is anything over 0.5 W, meaning devices with different average outputs (e.g., 1 W, 5 W, 15 W) are all “Class 4” despite functioning very differently in clinical use.

Determines absorption & penetration

Different wavelengths interact uniquely with chromophores such as melanin, haemoglobin, and water. Correct wavelength selection ensures targeted absorption and desired biological effects.

I – Irradiance (W/cm²)

Light intensity over a given area

Irradiance increases the closer the handpiece is to the tissue. Spot size, distance, and beam profile strongly influence the amount of energy delivered to the cells.

D – Deep Tissue (Dose & Delivery)

Ability to reach deeper tissues through correct dose and delivery technique

Deeper tissues require appropriate dose rate and delivery techniques to ensure sufficient energy reaches the targeted area. Tissue depth, patient variability, and device output all influence dosing success.

Hashmi, J.T. et al. (2010) ‘Role of Dose and Penetration in Photobiomodulation Therapy’, Photomedicine and Laser Surgery, 28(S1), pp.

S147–S156.

Anders, J.J., Lanzafame, R.J. and Arany, P.R. (2016) ‘Comparative analysis of tissue transmission of continuous-wave versus super-pulsed light’, Photomedicine and Laser Surgery, 34(12), pp. 1–7.

E – Emission

How the beam is delivered (CW, pulsed, super pulsed)

Emission mode influences heat profile, dosing, and cellular response. Research shows pulsing does not inherently increase penetration. Anders et al.

(2016) demonstrated that continuouswave 810 nm light penetrated deeper than super pulsed 904 nm.

R – Research

Evidence-based practice & species-specific protocols

Device variability means settings must be grounded in evidence-based protocols tailored to species, tissues, and clinical goals. PBM is not “one setting fits all.”

C – Class

W – Wavelength

IEC (2014) Safety of Laser Products – Part 1: Equipment Classification and Requirements.

International Electrotechnical Commission.

Hamblin, M.R. (2016) Handbook of Low-Level Laser Therapy. CRC Press.

Karu, T. (1999) ‘Primary and secondary mechanisms of action of visible to near-IR radiation on cells’, Journal of Photochemistry and Photobiology B: Biology, 49(1), pp. 1–17.

Chung, H. et al. (2012) ‘The Nuts and Bolts of Low-Level Laser (Light) Therapy’, Annals of Biomedical Engineering, 40(2), pp. 516–533.

Jenkins, P.A. and Carroll, J.D. (2011) ‘How to Report Low-Level Laser Therapy (LLLT) Dose Parameters’, Photomedicine and Laser Surgery, 29(12), pp. 785–787

Joensen, J. et al. (2012) ‘Depth of penetration of 810 and 904 nm lasers in a rat model’, Lasers in Medical Science, 27(2), pp. 373–378.

Laakso, L., Cramond, T. and Richardson, C. (1994) ‘Pain scores and side effects in response to low-level laser therapy (LLLT) for myofascial trigger points’, Physiotherapy Research International, 1(2), pp. 97–105.

Hamblin, M.R. (2018) ‘Mechanisms and DoseResponse of Photobiomodulation Therapy’, Photochemistry and Photobiology, 94(2), pp.

199–212.

Riegel, R.J. and Godbold, J.C. (2017) Laser Therapy in Veterinary Medicine: Photo

Table 1: Defining CWIDER. In the Veterinary world, our patients come in all shapes and sizes with a much wider variability in terms of patient characteristics such as coat and skin colour, tissue density and length of fur.

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Why CWIDER Matters More Than Power

Study Highlight: CWIDER in Practice

Power alone does not determine tissue response. Without the correct wavelength, irradiance, dose, emission, and delivery technique, a Class 4 device may perform no more effectively than a Class 3B laser (Hamblin, 2016; Anders et al., 2016). Coat colour, fur length, tissue density, and patient morphology further influence penetration and dose (Mordon et al., 1999; Kolari, 1985).

A retrospective clinical review by Miller et al. (2020) evaluated dogs diagnosed with Degenerative Myelopathy (DM), a progressive neurodegenerative disease, who were undergoing multimodal physical rehabilitation.

Alongside their rehabilitation programme, each dog received one of two distinct PBM protocols, allowing comparison of outcomes based on treatment parameters and delivery method.

Laser therapy becomes inconsistent and potentially ineffective when protocols ignore these variables.

Parameter

Protocol A (PTCL-A)

Protocol B (PTCL-B)

Sample size

6 dogs

14 dogs

Wavelength

~904 nm

~980 nm

Power Output

~0.5 W

6–12 W

Irradiance

~0.5 W/cm²

~1.2–2.4 W/cm²

Dose (Energy Density)

~8 J/cm²

~14–21 J/cm²

Treatment Area

650–1000 cm²

650–1000 cm²

Emission

Pulsed

CW (continuous wave)

Delivery Technique

Point-to-point grid

Continuously moving grid (1–3 in/sec)

Session Duration

~5 min 20 sec

~25–26 min

Table 2: PBM Protocol (PTCL) Comparison of the PTCL’s used from Miller et al. (2020)

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Study Limitations The authors acknowledge several limitations, of which these factors should be considered when interpreting the results before applying in clinical practice: ■ Retrospective design (no randomisation) ■ Non-blinded treatment and outcome assessment ■ Some dogs had a presumptive diagnosis of DM without histopathology confirmation ■ Variability in disease progression inherent to DM

CWIDER relevance The two PBM protocols in the Miller et al., 2020 paper differed substantially in wavelength, power, irradiance, energy density, delivery technique, and duration. These CWIDER components were associated with dramatically different outcomes: ■ Protocol A (low power, lower dose, short duration, pulsed, point-to-point delivery) resulted in survival times consistent with the typical natural course of DM (~11 months).

Rehabilitation Programme (Both Groups) All dogs received: ■ Twice-weekly in-clinic rehabilitation sessions ■ Range of motion (ROM), stretching ■ Proprioceptive and stabilisation/ core work ■ Underwater treadmill therapy ■ Home exercise programmes This ensured that the PBM protocol, not the rehabilitation plan, was the primary differentiating factor between the two groups.

Clinical Outcomes ■ Survival time (start of treatment → euthanasia) ■ PTCL-B: Mean 38.2 ± 14.67 months ■ PTCL-A: Mean 11.09 ± 2.68 months ■ Time to non-ambulatory paresis/ paralysis

■ Protocol B (higher irradiance, higher dosage, extended treatment time, CW and moving grid technique) was associated with markedly improved survival and ambulatory duration (~38 months).

This study illustrates a core CWIDER principle which optimised parameters and effective delivery matter, further reinforcing PBM outcomes are not universal, but protocol dependent.

Practical Guidance: Better PBM Results Tomorrow Improving PBM outcomes doesn’t require new equipment, it requires better reasoning and understanding of your device’s capabilities/ limitations. By applying the CWIDER framework, clinicians can make immediate improvements in treatment effectiveness, consistency, and clinical outcomes.

Below is a practical example demonstrating how a CWIDER-informed approach can look.

Example Case Condition: Stifle effusion

■ PTCL-B: Mean 31.76 ± 12.53 months

Patient: 20 kg black-coated, short-haired crossbreed dog

■ PTCL-A: Mean 8.79 ± 1.60 months

Goal: Reduce inflammation, improve comfort, support improved ROM

■ Statistical significance Kaplan–Meier analysis demonstrated a significantly longer time to non-ambulatory status in PTCL-B compared with PTCL-A and with historical controls.

(This is an example only for demonstrative purposes, the individual clinician should calculate based on patient and device parameter capability, per condition and per patient).

■ PTCL Group B had an average survival time of 38 months compared to 11 months in PCTL Group A.

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Typical Pre-Programmed Setting

CWIDER-Informed Setting (Reasoned Approach)

Why It Matters (with references)

Class 4 device but limitations in individual device output e.g., 1 W. Average power may be significantly lower when pulsed/super pulsed (e.g., 0.025 W actual).

Class 4 device continuous wave at 15 W (meaning average output is also 15 W).

Class determines safety category and power, not clinical effectiveness. Higher average power increases irradiance at depth when delivered safely (IEC, 2014; Hamblin, 2016).

905 nm for pulsing

Prioritise 810 nm for depth; 980 nm due to surface heating risk in dark coats.

810 nm penetrates deeper with less melanin absorption, while 980 nm interacts more strongly with water/melanin (Karu, 1999; Chung et al., 2012).

Irradiance (W/cm²)

Outdated “high watt” setting used (e.g., 1 W/cm²)

High surface irradiance resulting in moderate deeper irradiance (e.g., 10+ W/cm²).

Appropriate irradiance promotes deeper photon delivery and chromophore saturation; distance and intensity strongly influence penetration (Jenkins & Carroll, 2011; Hashmi et al., 2010).

Dose (J/cm²)

Outdated “high dose” (6–8 J/cm²) used for deep tissue; pulsed devices may deliver even less.

12–16 J/cm² delivered to account for coat, depth, and inflammation phase.

PBM is dose-dependent; correct energy density supports inflammatory modulation while avoiding inhibitory effects (Chung et al., 2012; Hamblin, 2018).

Delivery Technique

Point-to-point treatment.

Controlled contact technique (unless contraindicated).

Contact reduces reflection, increases penetration, and ensures even dosing across tissues (Hode & Tuner, 2014; Riegel & Godbold, 2017).

Treatment Duration

15–20 minutes if covering whole region; often 5–10 minutes treating specific points only.

6–8 minutes depending on true average output and target tissue.

Adequate time is required for energy absorption; insufficient duration leads to under-dosing despite appropriate settings (Hashmi et al., 2010; Joensen et al., 2012).

Documentation

Notes recorded as: “Laser – stifle – programme used.”

Full CWIDER recorded: class, wavelength, irradiance, dose, delivery, emission, reasoning.

Detailed parameter documentation increases repeatability, accuracy, audit quality, and clinical consistency (Jenkins & Carroll, 2011; Riegel & Godbold, 2017).

Parameter

Class

Wavelength

Table 3: Applying the CWIDER Framework to a hypothetical clinical scenario

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How to Improve Your PBM Outcomes Immediately 1. Look beyond power.

Tissue response is determined by wavelength, irradiance, and dose, not wattage alone (Hashmi et al., 2010).

2. Match wavelength to depth.

Near-infrared wavelengths (810- 860 nm) penetrate deeper with reduced melanin absorption compared to 980 nm (Karu, 1999; Joensen et al., 2012).

3. Treat the whole region.

Inflammatory changes and compensations extend beyond a single point (Riegel & Godbold, 2017).

4. Use contact technique where appropriate.

Contact increases penetration by reducing reflection losses by up to 30% (Brondon et al., 2005).

5. Document full CWIDER parameters.

Accurate parameter documentation improves treatment repeatability and case auditing (Jenkins & Carroll, 2011).

Using CWIDER transforms PBM from a “push the button and hope” modality into an intentional, evidence-driven clinical tool. Even one treatment planned with CWIDER will be safer, more consistent, and more effective.

Training & Standardisation: Elevating the Modality Historically, practitioners relied on short manufacturer-led training sessions, often focused more on product features than on clinical reasoning or safe, evidence-based application. This is now changing. With Ofqual-regulated qualifications, such as the Level 4 Award in Principles of Animal Laser Therapies and the Level 4 Certificate in Animal Laser Applications, practitioners can finally access training which provides the depth, structure, and scientific rigour required on in safe photobiomodulation application.

This shift is critical not only for elevating professional standards, but also for animal welfare, ensuring treatments are delivered safely, consistently, and with clear therapeutic intent. Formalised education supports practitioners in applying the CWIDER framework, so that treatments are no longer generic or device-led, but purposeful, replicable, and clinically effective.

By embedding CWIDER-informed decision making into daily practice, practitioners improve treatment accuracy, enhance outcomes, reduce risk, and strengthen the overall quality of rehabilitation programmes. Ultimately, this level of training ensures laser therapy is applied not as a pre-programmed button-press modality, but as a truly evidence-based clinical tool giving you the confidence to widen your usage of the modality.

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Conclusion: Precision in Practice Laser therapy is defined not by the device, but by the practitioner’s ability to apply accurate, evidence-based parameters. The CWIDER framework offers Veterinary Physiotherapists a structured, clinically grounded, and research-aligned guideline for safe and effective treatment. By understanding how CWIDER interacts, practitioners can move beyond assumptions, presets, or manufacturer defaults and instead deliver treatments with intention, consistency, and therapeutic relevance.

Hamblin, M.R. (2016) Handbook of Low-Level Laser Therapy. Boca Raton, FL: CRC Press.

Hamblin, M.R. (2018) ‘Mechanisms and dose–response of photobiomodulation therapy’, Photochemistry and Photobiology, 94(2), pp. 199–212.

Hawkins, D. & Abrahamse, H. (2006) ‘Effect of multiple exposures of low-level laser therapy on the cellular responses of wounded human skin fibroblasts’, Photomedicine and Laser Surgery, 24(6), pp. 705–714.

CWIDER empowers Veterinary Physiotherapists to deliver PBM that is safer, more consistent, and more effective, ultimately improving outcomes and enhancing animal welfare. As formalised education becomes embedded across the profession, laser therapy progresses from a simple adjunct to a core component of modern veterinary rehabilitation practice.

Hashmi, J.T., Huang, Y.Y., Sharma, S.K., Kurup, D.B., De Taboada, L., Carroll, J.D. & Hamblin, M.R. (2010) ‘Role of dose and penetration depth in photobiomodulation therapy’, Photomedicine and Laser Surgery, 28(S1), pp.

S147–S156.

For practitioners wishing to deepen their clinical reasoning and refine parameter-based decision making, further resources and training can be found at:

Huang, Y.Y., Chen, A.C., Carroll, J.D. & Hamblin, M.R. (2009) ‘Biphasic dose response in low level light therapy’, Dose-Response, 7(4), pp. 358–383.

Precision Animal Laser Academy (Level 4 OFQUAL Qualifications & CPD)

IEC (2014) Safety of Laser Products – Part 1: Equipment Classification and Requirements. Geneva: International Electrotechnical Commission.

Social Education - @EmilyAshdown-TheLaserTrainer

Hode, L. & Tuner, J. (2014) The New Laser Therapy Handbook. Grängesberg: Prima Books.

By integrating CWIDER into everyday practice, you ensure each treatment is delivered with precision, purpose, and best-practice clinical standards.

Jenkins, P.A. & Carroll, J.D. (2011) ‘How to report low-level laser therapy (LLLT) dose parameters’, Photomedicine and Laser Surgery, 29(12), pp. 785–787.

References

Joensen, J., Demmink, J.H., Johnson, M.I. & Iversen, V.V. (2012) ‘The depth of penetration of 810 and 904 nm lasers in a rat model’, Lasers in Medical Science, 27(2), pp.

373–378.

Anders, J.J., Lanzafame, R.J. & Arany, P.R. (2016) ‘Comparison of light penetration of continuous wave 810 nm and superpulsed 904 nm laser light through soft tissues’, Photomedicine and Laser Surgery, 34(8), pp.

418–424.

Anders, J.J., Wu, X., Taboada, L.D. & Santiago, L.Y. (2016) ‘Comparison of light penetration of continuous wave 810 nm and superpulsed 904 nm laser light through animal tissue’, Photomedicine and Laser Surgery, 34(9), pp.

418–424.

Brondon, P., Stadler, I. & Lanzafame, R.J. (2005) ‘Bacterial infrared laser penetration enhanced by skin contact’, Lasers in Surgery and Medicine, 36(2), pp. 159–164.

Chung, H., Dai, T., Sharma, S.K., Huang, Y.Y., Carroll, J.D. & Hamblin, M.R. (2012) ‘The nuts and bolts of low-level laser (light) therapy’, Annals of Biomedical Engineering, 40(2), pp. 516–533.

Karu, T.I. (1999) ‘Primary and secondary mechanisms of action of visible to near-IR radiation on cells’, Journal of Photochemistry and Photobiology B: Biology, 49(1), pp.

1–17.

Karu, T.I. & Pyatibrat, L.V. (2011) ‘Cellular membranes in photobiomodulation’, Photochemistry and Photobiology, 87(5), pp. 1233–1243.

Kolari, P.J. (1985) ‘Penetration of unfocused laser light into the skin’, Lasers in Surgery and Medicine, 5(1), pp. 49–55.

Miller, E., et al. (2020) ‘Photobiomodulation therapy protocols and outcome in canine degenerative myelopathy: a retrospective analysis’, Journal of the American Veterinary Medical Association.

Coates, J.R. (2006) ‘Cold laser therapy in veterinary medicine’, Veterinary Clinics of North America: Small Animal Practice, 36(6), pp. 1207–1220.

Mordon, S., Brisot, D. & Fournier, N. (1999) ‘Using laserinduced autofluorescence to predict the efficiency of laser treatments: influence of skin pigmentation’, Lasers in Surgery and Medicine, 25(3), pp. 288–293.

de Freitas, L.F. & Hamblin, M.R. (2016) ‘Photobiomodulation and mitochondria’, Photochemistry and Photobiology, 92(2), pp. 256–261.

Riegel, R.J. & Godbold, J.C. (2017) Laser Therapy in Veterinary Medicine: Photobiomodulation. Hoboken, NJ: Wiley Blackwell.

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Considerations for the Menopausal Rider

Louise Towl Chartered Physiotherapist & Veterinary Physiotherapist BSc (Hons) MCSP PG Dip Vet Phys ACPAT RAMP louise@louisetowlvetphysio.co.uk

Introduction Horse riding is a female dominated pastime; according to the British Equestrian State of the Nation report 2023, 88% of regular riders, and 81% of occasional riders are female. Whilst 16 - 24-year-olds have the highest rate of participation, rates remain consistent up to the age of 65. Overall, the female body remains significantly under researched compared to the male body. This gap in knowledge can have wide ranging consequencesparticularly relevant here when considering the impact of hormonal changes across puberty, menstruation, and the transition from perimenopause to post menopause.

Despite the huge progress in understanding rider biomechanics, the lack of research into the shortand long-term effects of the menopause means the potential issues which arise for female riders are currently unknown and unexplored. Unpublished data from Bradley, S, (2024), highlights the potentially significant emotional and psychological impact of the perimenopause on riders. Whilst pain was reported as the biggest concern in the 1600 riders surveyed, anxiety and loss of confidence were the next more reported issues. 68% of respondents reported a dip in motivation to ride, and 33% stopped riding temporarily or permanently due to menopausal symptoms.

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Hobbs, S.J., et al (2014) have also identified riders become more asymmetric with increasing experience and years spent riding. This is thought to be due to the body’s compensation strategies when absorbing forces transmitted up from the horse to the rider’s seat. It is therefore reasonable to assume the more experienced and older female riders will encounter more challenges than their male counterparts, likely due to the contribution of menopause-related changes posing as a factor. As Physiotherapists working closely with – and often having a longstanding relationship with- riders, we are well placed to investigate, advise and assist female riders through this time.

The content of this article is a summary of the key learning points of the author’s personal continued professional development aimed at improving service provision, and areas which require our greatest attention.

What is the menopause, and what happens The menopause is defined as the point in a women’s life when periods stop due to the reduction and loss of ‘Ovarian Reproductive Function’ and is when periods have been absent for 1 year. The average age for this is 51years old. The time leading up to this is defined as the perimenopause, which may last between 6 and 10 years across individuals.

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Early menopause occurs between the ages of 40 and 45, with premature menopause occurring before the age of 40. The post-menopausal years are all the years after the menopause has occurred, which for many women now can be around 30- 40 years, or 1/3 of a lifetime. During the perimenopause, the female hormones of reproduction – Oestrogen, Progesterone, and to a lesser degree Testosterone- begin to lower in levels of production, until this ceases entirely and menstruation stops.

The roles of these reproductive hormones are huge and varying, affecting most – if not all– functions of the body.

Oestrogen is a hormone of growth, and has roles in: ■ Muscle strength and mass ■ Collagen content/ tensile strength

Other, less obvious effects, and symptoms which can be misattributed to other conditions- require our attention.

Physiotherapeutic Considerations Musculoskeletal factors Within the musculoskeletal system, loss of muscle mass results in weakness. The combination of this with pain and stiffness are commonly reported, and a misdiagnosis of Osteoarthritis is not unusual, due to symptom crossover.

Balance may also be affected, owing to alterations in vestibular function as well as reduced muscle mass. This, combined with bone density reducing at a reported rate of 2% a year, increases the risk of fractures in the event of falls.

It is important to be aware of the impact of eating disorders in younger women on later-life bone density, with Anorexia in teenage years linked to an increased incidence of Osteoporosis. In perimenopausal women, RED-S (Relative Energy Deficiency in Sport) is a risk, due to the changes in the menstrual cycle hormones producing similar symptoms to RED-S, and in some cases amplifying RED-S. It therefore makes it harder to identify the causes of symptoms which a rider may present to a physiotherapist with.

■ Bone health ■ Brain health ■ Cardio-protection ■ Anti-inflammatory ■ Pain moderation ■ Tissue hydration Progesterone is a hormone of moderation, and has roles such as:

Cardiovascular factors

■ Smooth muscle relaxation

Cardiovascular changes include raised blood pressure due to the loss of the vasodilative effects of oestrogen, raised cholesterol, and reduced nitric oxide. Blood vessel elasticity is also reduced, due to changes in smooth muscle elasticity.

■ Raising body temperature ■ Sedative ■ Improving visual memory ■ Improving mood

The result is that heart disease risk increases, and aside from causes linked to dementia, is the leading cause of death in women worldwide. As these changes are not directly linked to lifestyle, women may be unaware of the risks they face during menopause, or that they are able to take action to minimise the impact on their health.

■ Supporting Thyroid function ■ Increasing formation of new bone cells ■ Mild anti-anxiety effect In addition, Testosterone contributes to: ■ Bone density

Emotional wellbeing

■ Muscle mass ■ Cardio health ■ Energy levels ■ Cognitive function The function of the Thyroid also needs to be considered, because underactivity can mimic menopausal symptoms, and reducing oestrogen levels can impact on its function.

Hormone levels will also fluctuate significantly during perimenopause, resulting in varying and inconsistent symptoms. The combined effect of the reduction in these hormones is therefore widespread across body systems.

Well known symptoms include hot flashes, weight gain, poor sleep, anxiety and poor memory/ brain fog. Less well known are symptoms such as tingling extremities, electric shock sensations, itchy scalp, and changes in body odour.

Wellbeing may be severely impacted during the perimenopausal years, often exacerbated by sleep disturbance. In turn, sleep disturbance increases cortisol levels, which increases the ‘fight or flight’ response. A misdiagnosis of depression is not unusual, meaning affected women are treated ineffectively. Pain, stiffness, and pelvic floor dysfunction can all exacerbate anxiety related issues. These clients may not present to physiotherapy until their symptoms have become chronic, due to the lack of exploration of potential physical contributors to emotional wellbeing. These cases can still be assisted successfully with appropriate intervention.

Pelvic health Pelvic health may be severely altered for some women due to changes in strength of the pelvic floor muscles

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and thinning of tissue, causing pain due to friction and an increased risk of urinary tract infections (UTIs). Regardless of child-bearing status, all women going through menopausal hormone changes will find their pelvic floor strength is reduced, alongside all other muscle groups.

increase in asymmetry as identified by Hobbs, S.J., et al ( 2014). The female rider’s body may be placed in a position of increased asymmetry, whilst experiencing greater difficulty in maintaining the strength to absorb the forces being transmitted from the horse.

At the time of writing this article, there is no research into pelvic health in riders, although a survey is currently in development. However, there are anecdotal reported cases of teenage trampolinists with pelvic floor dysfunction, linked to the high loads experienced during the bounce cycle. When considering the immense workload through the lumbo-pelvic area of riders, specifically force absorption, it could be the case that riders are prone to similar challenges. Likewise, the pelvic floor muscles of women who jump at higher levels are potentially experiencing similar loading patterns to trampolinists.

Accordingly, this is an area where all Physiotherapists working with female riders should be inquiring about with their clients, even if onward referral is then required where scope of practice may be a factor.

This can not only make the physical act of riding more difficult, but with the potential for increased emotional stress, riders may feel less able to deal with the challenges and goals they are dealing with, as identified by Bradley, S (2024).

What is the best approach for assisting riders at this stage of life?

Without doubt, education is the most important first step, ideally starting with women in their 30s and even 20s.

The more awareness there is of the ‘silent’ but negative impacts on the female body, the earlier women can start to make changes to their lifestyle. Proactivity and knowledge is empowerment.

Hormone Replacement Therapy (HRT) and other drug treatments are beneficial and widely used, but exercise is increasingly seen as an integral part of short and long term management. Exercise is systemically catabolic, and therefore has a global benefit on muscle mass, as well as having mild anti-inflammatory and mood-enhancing effects.

Targeted exercise is key for managing muscle and bone mass, as well as balance and cardiovascular changes.

Load, through use of weights or body weight is essential, although all exercise needs to consider pain levels and pelvic floor health. High Intensity Interval Training (HIIT) is thought to be inadvisable, however Exeter University is currently running a 5 year study into various combinations of exercises in menopausal women.

For riders, increased time focusing on strength through the lumbar spine, pelvis and hips (i.e. the seat) is likely to be particularly beneficial to aid in force absorption. In depth assessment of symmetry is advisable; changes in collagen tensile strength and reduced pain tolerance can cause old injuries to become more problematic, further adding to the likelihood of increased asymmetry. Incorporating pelvic floor exercises, teaching relaxation as well as correct contraction, is an integral part of this.

A perfect storm for female riders?

Considering all this information together, it is clear the female body is significantly and negatively impacted by hormonal changes occurring during the menopause. A key message here is this is the case for all women, not just those with symptoms.

Of significance to riders, is that these physical changes are potentially occurring at around the same time as the

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Advice on saddle fit for the rider, not just the horse, can be life changing for some women. However, a close look at clothing may be enough; loose fitting clothing made of natural fibres is recognised as providing the optimum environment for pH levels in the pelvic area. Unfortunately, most riding clothes contain a high proportion of synthetic fibres, and are of course, close fitting. The direct pressure on the vulva and urethra in this environment has the potential to increase the risk of UTIs, so shortening the time in the saddle may be necessary. Protective layers, such as cycling shorts and unscented creams may be enough to provide relief in some cases.

The teaching of relaxation techniques, particularly

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breathing, can be useful for all riders. There is evidence to suggest that back pain in women has a greater link to poor breathing patterns and pelvic floor dysfunction, than it does to obesity (Hodges, Smith & Russell, 2006). Incorporating breathing techniques which encourage pelvic floor relaxation as well as effective contraction, has the potential to address wellbeing and back pain at the same time.

Symptoms are not permanent, but the effects are…

Whilst many of the changes that occur during the perimenopause are negative, it is important to recognise that for most women, active symptoms are short lived.

Anxiety, hot flashes and sleep disturbance, for example, are likely to improve once hormone levels settle, or with use of HRT. However, the long-term effect of these hormonal changes are truly lifelong, and it is therefore essential that a proactive approach is adopted to reduce the impact of these changes. Whilst we tend to focus on the rider’s body in the saddle, safety on the ground also needs to be considered. Any reduction in balance places anyone handling horses at greater risk of injury and falling, so even if women decide to stop riding, continuing work on factors affecting balance is necessary for their safety around horses.

Currently, there is no specific evidence supporting any particular exercise-based management for menopausal women. Until there is, an awareness of current research into rider-specific biomechanics, combined with an individualised exercise programme which considers the individual need as well as general menopause requirements, is the best that we can offer.

More direct questioning than in a standard Physiotherapy assessment may be required, into areas such as pelvic and mental health. For many women who are struggling with what can be perceived as very private matters, the chance to discuss and find potential routes of management will significantly improve their response to intervention.

References: Bradley S, Unpublished data . Effects of the Perimenopause and Menopause on female riders. 2024 Hobbs SJ et al, Posture, flexibility and grip strength in horse riders. Journal of Human Kinetics, 2014, 42: p.113-25 Hodges, Smith & Russell, Disorders of breathing and continence have a stronger association with back pain then obesity and physical activity. Australian Journal of Physiotherapy 2006; 52 (1): 11-6

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Five Scent Work Solutions for Clinicians Dealing with Anxious Dogs

Jack Fenton, The Dorset Dog Trainer, Nose-work and Reactivity specialist jack@thedorsetdogtrainer.com

Introduction The aim of this article is to provide clinicians with a set of exercises, involving Scent work, to reduce anxiety in the dogs they work with. This includes anxiety in and around the clinician, and anxiety in clinical settings.

Common Barriers: A barrier for clinical work with dogs is anxiety. Concerns can be based around the clinical environment, or the clinician themselves. This can result in a number of shortand long-term issues for all sides.

From a clinician’s perspective, it can limit the interventions they can implement if a dog is unable to enter the environment. Trying to run through basic procedures can prove difficult, providing an inaccurate picture of the dog’s health. The clinicians own welfare could be at risk if the dog’s behaviour escalates into aggression.

From the owner’s perspective, they may be more unlikely to seek intervention for their dog’s needs, due to the anxiety their dog feels. This may lead to a breakdown in the relationship between owner and clinician.

From the dog’s perspective, increased anxiety in clinical settings impacts their quality of life and can exacerbate long term health issues. A dog may also not demonstrate the behaviour needed to diagnose a physical issue. This could lead to a longer-term treatment plan.

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There are several training skills that clinicians can adopt to reduce this friction. These range from the clinician attempting to feed the dog treats, to introducing enrichment toys in a clinical setting. While these are effective in reducing anxiety, they also require comfort the dog must feel safe taking food from the clinician and eat in that space. If the dog does not, this can make these methodologies ineffective.

Evidence and Explanation: Scent work and scent conditioning can be a useful breakthrough skill for these dogs.

By Scent work, we’re referring to the dog finding a ‘target scent’ that we have requested them to look for and performing a behaviour once finding it. For this article, we will primarily be focusing on the dog searching for, and eating, food.

By Scent Conditioning, we’re referring to the act of changing or creating an emotional association with a scent a dog may encounter in their environment.

We know that sniffing is the main way in which our dogs process the world (Kokocińska-Kusiak et al., 2021). We know that their noses have around 250 million olfactory receptors (Berg et al., 2024) , and we know that while certain dog breeds may be more capable of certain types of operational work, all dog breeds are capable of using their nose. Further, studies have shown that breeds

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not presumed to perform well (such as Pugs) have outperformed other breeds (such as German Shepherds) at basic food searches (Hall et al., 2015). On a general level, basic Scent work (searching for food) has also been shown to increase optimism and reduce pessimism in dogs (Duranton & Horowitz, 2019).

Further, Scent work and Scent Conditioning have a number of added benefits to the clinician and owners. There is little training needed to implement the skills effectively. Very little equipment needs to be purchased to perform any of the exercises. Exercises both inside and outside of the practice do not require a major time commitment.

All of this, alongside anecdotal evidence in my own practice, demonstrates untapped potential with Scent work. I have used the five following exercises below to reduce reactivity and anxiety towards people and dogs both in and outside of clinics efficiently.

1. FOOD SEARCHES By a Food Search, we mean tasking a dog to locate multiple food items and eat them, by investigating their environment.

Rather than a typical scatter feed (where the food is just thrown on the floor), the food is placed in a manner that asks the dog to engage in the world around them. For example, placing food under a chair for them to crouch under, or placing it above their head to make them jump up and rest their paws.

In general we’d aim for three-five pieces of food. It is easier if the food can be ‘stuck’ to the environment, such as cheese or meat. However, any type of food will do.

The caregivers can initially practice at home, hiding the food on the sofa or on fences for example. It can also be taken on walks. We’ll cue the behaviour with a specific word, like ‘Find’ or ‘Cheese.’ Searches can be done on or off lead. We recommend a couple of weeks practice, with twice a day searches before bringing it into a clinical practice.

it is common for the dogs to respond negatively to the following: ■ Cleaning products.

■ Clinicians’ clothing.

■ Scents on bedding.

Utilising Food Searches or other methods, we can quickly change the associations to said scents from negative to positive. This can be done by either offering the caregiver some of the above, such as towels/bedding (I recommend the caregiver offers some towels/bedding in return), or by the caregiver purchasing similar products (such as the cleaner used in practice.)

The caregiver, in their own home, can then feed the dog on the towel/bedding to change those scent associations.

They can also use the cleaner around the house to make it more normal. The clinician’s equipment can be left out or paired with food searches.

Exercises such as this can be integrated into the practice environment as well, with those items being placed in areas where the dog will complete a food search.

3. SCENT CONDITIONING (CLINICIAN) The scent of the clinician can also be used as a way of building confidence. The natural scent of the clinician will naturally become positive via other exercises. However, we can condition a scent that the clinician can wear, consistently, to speed this process along.

I tend to recommend lavender, as it is a scent that, anecdotally, people tend to prefer. Any scent can be used, however. The caregiver can apply the scent of lavender to their wrists while doing activities the dog enjoys, such as playing and cuddling.

This will naturally build a strong association with the scent.

The association we are looking for is one of safety, and as such, it is recommended that the scent only be utilised during times when the dog is comfortable.

Once the dog has practiced enough, either the caregiver or clinician can place out these food searches for the dog.

It is recommended that this be the dog’s first introduction to the practice or treatment space.

Just before arrival to the clinic or owner’s home, the clinician can apply the same lavender scent to their own wrists/body. If this remains a consistent scent that is used, the dog will be able to quickly associate the scent of safety with the clinician.

This pattern of behaviour tends to build confidence in the environment quickly. The food and searching are familiar, and the use of food means the dog doesn’t need to be ‘trained’ to find a target odour.

If necessary, the lavender scent can also be applied to different areas of the clinic, so the dog has the same association of safety in the environment. This works beautifully in conjunction with Food Searches.

This can also be used to improve confidence with certain pieces of equipment, such as underwater treadmills, cavaletti poles or balance blocks.

4. RUNAWAYS

2. SCENT CONDITIONING (COMMON SCENTS)

Anxious dogs, in general, feel uncomfortable in enclosed spaces. This is due to their inability to ‘escape’, which can result in escalating aggressive behaviour.

For dogs who have repeated visits to a clinician, changing the emotional association with the common scents in a practice can reduce stress. In my professional experience,

To reduce this anxiety, it is recommended that the dog meets the clinician outside the practice first. This allows the dog to get used to the scent of the clinician, and a Food

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Search can be done in the outside space. Taking from the Nose-work sport of Man-trailing (on-lead search and rescue), a “Runaway” can be a great way of building a strong initial association.

A Runaway is the act of the ‘missing person’ (in this case, the clinician), having something the dog values highly and creating space between the dog and clinician. This tends to involve the ‘missing person’ moving out of sight, but that isn’t always necessary.

The clinician can be given something of high value, such as food or toys, for the dog to find. The clinician then calls the dog’s name and moves away from the dog while the dog watches. The clinician then stops, and the dog is told they can head towards the clinician.

Depending on the dog’s anxiety levels, the dog can either fully approach the clinician to receive the food/ toy or can be stopped a short distance away. At which point, the clinician will deliver the food/ toy by either throwing it towards the dog or leaving it on the floor. The clinician will then leave, and the dog can take the reward.

This works via controlled intensity - the dog builds a strong association between finding the person (building confidence on approach) and then receiving a high value reward.

Despite the overwhelming benefits of the above five activities/exercises seen in practice, there are some elements to keep in mind.

Firstly, the physical condition of the dog must be noted.

Some of the more draining activities (such as Runaways and up high Food Searches) could put undue pressure on joints and muscles. As Hall (2015) argues, certain dog breeds may struggle more with initial Nose-work activities, such as Greyhounds. Extra effort may be needed to increase motivation, such as food games (throwing food for them to chase).

It is worth noting that there should be a delicate balance between asking the dog to do something, and time pressure. Some dogs will require more time and space in order to perform these activities effectively. As such, this may eat into time allocated to the clinical session.

Most activities require effort from the owner outside of the clinical session. This should not be a problem if the owner is compliant with physiotherapy activities, but is worth bearing in mind too.

Conclusion:

Runaways can be repeated into the clinical setting and can be built upon each session. Lots of clinicians, in working alongside myself, do one of these per session to build confidence. The only barrier for this exercise is space - if the clinician works in a busy practice with lots of footfall, it can make it trickier to do. In the event this is impossible, the clinician going on a short walk with the dog outside the clinical space, while the clinician throws food for the dog to search for, can be a useful substitute.

In conclusion, Nose-work can be used to reduce anxiety for dogs across clinical settings. This can be done using food, scents such as lavender, and the clinicians own equipment. Nose-work can be used to increase confidence in the dog, the owner and clinician in achieving their goals in working together.

5. ENRICHMENT CITY

(1) Kokocińska-Kusiak, A., Woszczyło, M. & Niżański, W., 2021. Canine olfaction: physiology, behavior, and possibilities for practical applications. Animals, 11(8), p.2463.

DOI:10.3390/ani11082463.

A final activity which can be performed to massively improve the confidence of anxious dogs in clinical practice is Enrichment City. This involves the owner bringing an assortment of items such as licki-mats, snuffle mats, boxes, cardboard tubes, bathmats etc. to the clinical setting. Both owner and clinician, before the dog gets out of the car, would set up these enrichment items alongside a series of objects/important materials in the clinical setting (scrubs, gloves, caveletti poles etc.)

The area would then be laced with the dog’s favourite food. The dog is then allowed to explore the environment at their own pace, which can benefit the clinician by allowing them to observe the dog’s movements.

This is the most time intensive of the activities, as the dog may take several minutes to clear the area properly. If done correctly, it should take a minimum of ten minutes.

However, this allows for dialogue with the caregiver and an observation of the dog’s movement patterns and function through the environment.

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Drawbacks:

References:

(2) Berg, P., Mappes, T. & Kujala, M., 2024. Olfaction in the canine cognitive and emotional processes: From behavioral and neural viewpoints to measurement possibilities. Neuroscience & Biobehavioral Reviews, 157, p.105527. doi:10.1016/j.neubiorev.2023.105527.

(3) Hall, N.J., Glenn, K., Smith, D.W. & Wynne, C.D.L., 2015.

Performance of Pugs, German Shepherds, and Greyhounds (Canis lupus familiaris) on an odor-discrimination task.

Journal of Comparative Psychology, 129(3), pp.237–246. doi: 10.1037/a0039271.

(4) Duranton, C. & Horowitz, A., 2019. Let me sniff!

Nosework induces positive judgment bias in pet dogs.

Applied Animal Behaviour Science, 211, pp.61–66. doi:10.1016/j.applanim.2019.04.008.

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A Case Study of Unresolved Equine Hindlimb Lameness- Is the Sciatic Nerve Often Overlooked?

Lameness is an abnormal stance or gait caused by locomotor dysfunction, which can be structural or functional in nature (Adams, 2023). One or multiple limbs can be affected, with the lameness being a symptom or presentation of underlying pain, biomechanical restrictions or neuromuscular dysfunction. Forelimb lameness has a higher prevalence than hindlimb lameness and one explanation for this could be the forelimb: hindlimb weight distribution ratio naturally occurring at 58%: 42% (Back and Clayton, 2013) subsequently loading the forelimb anatomical structures more than the hind. Additionally, at certain points of the gait stride cycle, (notably canter and gallop), a single forelimb is weightbearing which can predispose the limb structures to injury (Ross and Dyson, 2011). However, horses training in dressage or jumping activities are likely to present with a higher prevalence of hindlimb lameness, due to the increased load expected on the hindlimb structures during these activities. Veterinarians usually opt for diagnostic analgesics to localise the area causing lameness, and can then choose to x-ray, ultrasound or bone scan to observe integrity of anatomical structures (Ross and Dyson, 2011). These diagnostic methods are useful for identifying bone or soft tissue injuries but will not pick up on nerve injuries or dysfunction. This case study identifies and discusses a horse which had undergone significant diagnostic testing but remained lame, and hence neural involvement was considered.

Quantifiable testing of sensory nerve function in horses isn’t standardised, and there are no tactile sensory thresholds reported in literature, except for the equine face. Veres‐ Nyéki et al. (2020), looked at quantitative sensory testing of the equine face in 34 Warmbloods and identified three areas (nostril, temporomandibular joint and supraorbital foramen) which were the most consistent to obtain sensory thresholds. The question of whether we can quantifiably determine if limb tactile sensation is impaired in healthy equines without being invasive remains to be answered but could be a useful avenue to research.

Cara McKinnon Chartered Physiotherapist & Veterinary Physiotherapist MSc BSc HCPC CSP RAMP cara@firstclassphysiotherapy.co.uk

Figure 1: An illustration showing the anatomy of the sciatic nerve in the equine model. The sciatic nerve is labelled with the number 2 (Brown, 2025).

In equines, the sciatic nerve is the largest nerve in the body with the nerve roots emerging from the spinal cord at L5S2, and the neural path continuing caudally and ventrally before branching into the tibial and common fibular (peroneal) nerves (MacKay, 2011) See figure 1 for an outline of this anatomical neural pathway. The sciatic nerve directly innervates several important hindlimb muscles including semitendinosus, semimembranosus, biceps femoris and adductor magnus, with the tibial and peroneal branches innervating the lower hindlimb (Grönberg, 2011). Therefore, impediment of the sciatic nerve has the potential to affect complete hindlimb biomechanics.

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In humans, sciatic nerve dysfunction is a common cause of pain and disability (Konstantinou and Dunn, 2008), therefore, the similarities in human and equine anatomy could reasonably suggest sciatic nerve pain is a plausible cause of dysfunction in horses. Due to limitations in quantifiable testing, the literature documenting evidence of, or treatment for, sciatic nerve pain in the equine model is very poor.

Veterinary investigations and intervention The horse in this case study, a 5-year-old Warmblood gelding, was five-stage pre-purchase vetted and was declared sound. However, a few weeks after purchase, the horse became lame on the left hind-leg with idiopathic onset. On initial veterinary examination he was 1.5/10 lame trotting in a straight line on the hard, 3/10 lame trotting in a straight line on the soft, becoming increasingly lame when lunged on a circle, whereupon the examination was halted at this point. A hindlimb flexion test was mildly positive on the left hind and an abaxial nerve block was negative.

There were no limb abnormalities noted, and palpation revealed mild hypertonicity and pain response of the lumbosacral region.

Radiographical examinations undertaken of the tarsi and stifle joints were unremarkable, but spinal x-rays revealed the 5th/6th Lumbar (L5/6) were almost fused, with a widened joint space between the 3rd/4th Lumbar (L3/4) vertebrae. The Veterinarian had ruled out any significance from the narrowing of joint space between L5/6, reporting it as a ‘likely old finding and of no clinical relevance’.

However, after a discussion with the Veterinarian, it was agreed the narrow vertebral space could have an impact on the sciatic nerve. Whilst the physical, narrowed structure of the vertebral joint could not be changed, it was felt an steroid injection into the Lumbar joint space might relieve any potential neural inflammation at spinal level.

Ultrasound of the pelvis revealed swelling around the Coxofemoral joint and enlargement of the deep gluteal muscle, suggestive of a potential pelvic fracture. Ultrasound of both stifle joints found no abnormalities. Box rest was undertaken for three weeks but this did not improve the lameness, therefore a bone scan was performed. This showed very mild radioactive uptake in both hocks and mild to moderate uptake in the left Coxofemoral joint, but no pelvic fracture. A trot up was performed whilst the horse was under mild sedation which made the left hind lameness worse. It was concluded the horse likely fell in the field causing deep soft tissue injury to the left Coxofemoral area, and subsequent advice of restricted turnout with light walk work followed.

After reassessment one month later the hindlimb lameness had improved, although a stilted and abnormal abducting gait of the left hind was observed. The owner continued walk work for a further month, but as soon as trot work was introduced, the left hindlimb lameness became worse again. The horse was turned away in a field for eight weeks whereafter physiotherapy intervention was requested.

Physiotherapy assessment and intervention After eight weeks of field rest, gait assessment identified a 3/10 left hindlimb lameness which was worse on turning.

When turning a tight circle, the hindlimbs both abducted

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excessively with poor limb placement. Stepping backwards was very difficult, and the horse wanted to abduct the hindlimbs in preference to flexing.

The horse was reluctant to pick up the hindlimbs, but when passively moved had no physical restriction to limb range of motion in any plane. Proprioceptive testing involved excessively crossing one limb in front of the other and placing the hoof to the floor. The horse exhibited a very delayed response to correct the hindlimb placement bilaterally (more than 10 seconds for each hindlimb) but corrected the limb placement in under one second when repeated on the forelimbs.

Palpation revealed mild hypertonicity through the base of brachiocephalicus bilaterally and mild hypertonicity through the Lumbar expaxials and gluteals bilaterally. The right gluteals were hypertrophied indicative of prolonged compensation for the left hind lameness, and the hamstrings were atrophied bilaterally. Global topline musculature was atrophied, likely where the horse had been turned away.

No pain response was found with dorsoventral pressure on either tuber coxae, or with compression or distraction of the tuber sacrale, indicative of no pelvic or Sacroiliac pain.

The Lumbar rounding reflex with bilateral stimulation was intact but restricted, and the lateral spinal flexion reflex with unilateral stimulation was intact, but with an overall reduced lateral spinal range of motion.

Physiotherapy directed treatment involved using soft tissue and myofascial release techniques on the muscle hypertonicities, with lateral flexion spinal mobilisations to the Thoracic and Lumbar spine. Manual therapy was used with the aim of decreasing pain and increasing Thoracic and Lumbar spine range of motion (Memon and Xie, 2023).

H-Wave electrotherapy was applied bilaterally at a 2Hz frequency for 10 minutes with two pads on the longissimus dorsi (approximately T11 level) and two pads on the medial gluteal muscles. H-Wave uses a biphasic exponentially decaying waveform which mimics the Hoffman reflex, a monosynaptic stretch reflex. It has been found to be noninvasive, pain-relieving and can increase return to function in humans (Blum et al. 2008) but currently has no published evidence supporting its use on horses.

The owner was advised to perform a caudal traction exercise, adhering to the protocol used by Long, McGowan and Hyytiäinen (2020), with the aim of distracting the vertebrae and increasing mechanical nociceptive threshold in the Lumbar region. The owner was also advised to perform dynamic mobilisation exercises in accordance with the methodology of Stubbs et al., (2011) to hypertrophy multifidus and mobilise the spine.

Discussion The reluctance to pick up hindlegs on assessment could be reasoned as due to altered sensation, but this is difficult to quantifiably measure. In the instance of this case study, the behavioural response (or lack of) to limb handling was used to deduce a possibility of impaired sensory processing.

In addition, the observation of atrophied hamstrings supported the hypothesis of sciatic nerve impairment, because neural impairment leads to atrophy of innervated muscles (Valberg, 1999).

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Further indication of neural impairment was determined by the reduced response to lumbar rounding reflexes, and the delayed response to abnormal hindlimb placement during proprioceptive testing. The response time of correcting the limb varies in individual horses, and the testing can be considered subjective (Thal, 2014). However, when comparing the response time of the hindlimbs to the forelimbs and noting the horse was alert at the time of testing, it was apparent the hindlimb response time was delayed and thus indicative of a neurological impairment.

The importance of using proprioceptive testing as part of physiotherapy assessment was highlighted in this case because it enabled possible detection of neurological involvement. In the author’s own clinical retrospect, there have been previous clinical cases observed where horses have presented with a hindlimb lameness and been subsequently treated with steroid joint injections.

These horses often responded positively post-injection but sometimes didn’t return to full soundness or function.

In future, it would be sensible to consider whether neural dysfunction as a possible presenting and contributing factor to lameness in these types of cases.

A Veterinary and Physiotherapy review were due to be conducted, but in the interim prior to the spinal injections, the owner reported the horse was still lame and appeared to be getting weaker. It is stipulated the horse subsequently spooked in the school when loose, broke into canter for a few strides and then struggled to stop. Before further evaluation or treatment was carried out, the owner decided to euthanise the horse.

Despite not seeing the horse for review, the plan following discussion with the Veterinarian had been to try and replicate a sciatic neural glide mobilisation as used in humans, to ‘floss’ or tension the nerve along its length and mobilise it within the nerve sheath, as detailed

by Coppieters et al., (2015). This treatment idea was considered because in human fields, study reviews have found sciatic nerve mobilisation is effective in treating piriformis syndrome and reducing sciatic nerve pain (Ahmad and Dadgal, 2022). There is currently no published evidence investigating the method or effect that a neural gliding technique might have in equines but based on the use and effectiveness in the human field, it would be a logical idea to investigate and develop for use in practice.

Conclusion In this case study, the exact reasoning for the hindlimb lameness will remain unknown. Nevertheless, although the horse in this case study was euthanised before further treatment, having assessed this horse with the symptoms he exhibited, impingement, inflammation or damage to the sciatic nerve is a plausible explanation. Often in the hindlimb, bony, ligamentous or muscular structures are pinned as lameness cause, with anecdotally neural tissue involvement frequently being overlooked. However, given the importance of sciatic nerve structure, its location and the prevalence of dysfunction in humans, sciatic nerve involvement in equine hindlimb lameness cases should be considered. Though subjective, proprioceptive testing should be incorporated into most equine physiotherapy assessments, given it is quick to perform and can identify

the need to investigate neural impairment. Fully assessing neural function in horses can be difficult and pose safety risks, but it would be a future scope for dissection studies investigating relevant structures alongside the development of quantifiable limb sensory testing. This, along with devising equine neural glide techniques, would help develop a practical approach to considering the impact and treatment the sciatic nerve in equine hindlimb lameness cases would be beneficial to veterinary physiotherapy practice.

References Adams, S. (2023). Overview of Lameness in Horses. [online] MSD Veterinary Manual. Available at: https://www. msdvetmanual.com/musculoskeletal-system/lameness-inhorses-overview-and-examination/overview-of-lameness-inhorses [Accessed 14 Nov. 2015] Ahmad Siraj, S. and Dadgal, R. (2022). Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release. Cureus, [online] 14(12). doi:https://doi. org/10.7759/cureus.32952 Blum, K., Chen, A.L., Chen, T.J., Prihoda, T.J., Schoolfield, J., DiNubile, N., Waite, R.L., Arcuri, V., Kerner, M., Braverman, E.R., Rhoades, P. and Tung, H. (2008). The H-Wave® Device is an Effective and Safe Non-pharmacological Analgesic for Chronic Pain: A Meta-analysis. Advances in Therapy, [online] 25(7), pp.644–657. doi:https://doi.org/10.1007/s12325-0080073-3 Brown, A. (2025). Part 2: Proximal Pelvic Limb. [online] University of Minnesota- Dissection Lab Guide for Ungulate Anatomy. Available at: https://pressbooks.umn.edu/ ungulateanatomylabguide/chapter/part-2-proximal-pelviclimb/ [Accessed 19 Nov. 2025] Coppieters, M.W., Andersen, L.S., Johansen, R., Giskegjerde, P.K., Høivik, M., Vestre, S. and Nee, R.J. (2015).

Excursion of the Sciatic Nerve During Nerve Mobilization Exercises: An In Vivo Cross-sectional Study Using Dynamic Ultrasound Imaging. The Journal of orthopaedic and sports physical therapy, [online] 45(10), pp.731–7. doi:https://doi. org/10.2519/jospt.2015.5743 Konstantinou, K. and Dunn, K.M. (2008). Sciatica- Review of Epidemiological Studies and Prevalence Estimates. Spine, [online] 33(22), pp.2464–2472. doi:https://doi.org/10.1097/ brs.0b013e318183a4a2 Long, K., McGowan, C. and Hyytiäinen, H. (2020). Effect of Caudal Traction on Mechanical Nociceptive Thresholds of Epaxial and Pelvic Musculature on a Group of Horses With Signs of Back Pain. Journal of Equine Veterinary Science, [online] 93. doi:https://doi.org/10.1016/j.jevs.2020.103197 MacKay, R.J. (2011). Peripheral Nerve Injury. In: Equine Surgery . [online] Elsevier BV, pp.720–727. doi:https://doi. org/10.1016/b978-1-4377-0867-7.00054-5 Memon, M.A. and Xie, H. (2023). Integrative Veterinary Medicine. [online] John Wiley & Sons, pp.63–64. Available at: https://books.google.co.uk/

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Early Conservative Physiotherapy Management of Pectus Excavatum in a Neonatal Labrador Retriever: A Longitudinal Case Report

Charlotte Barton MCSP BSc (Hons) Physiotherapy MSc Vet Physio, ACPAT Cat A, RAMP thelionclinicphysio@gmail.com

www.thelionclinic.com

Summary and Introduction

Background

Pectus excavatum (PE) is a congenital deformity of the canine thoracic wall characterised by dorsal deviation of the sternum and altered costal conformation. Severity ranges from mild cosmetic change to life-threatening cardiopulmonary compromise. Early detection and intervention are essential, as the neonatal thorax is highly malleable and responsive to external shaping, splinting, and targeted physiotherapy.

Pectus excavatum is an uncommon congenital thoracic wall deformity in dogs, most frequently recognised in neonates or rapidly growing puppies. The compliant cartilage and pliable sternum during the first weeks of life make early intervention particularly effective. Conservative management, which typically involves external splinting, positioning, and physiotherapy, is recommended for mild to moderate deformities where there is no severe respiratory or cardiac compromise.

This case report describes the conservative management of “Toni”, a female Labrador Retriever puppy bred for future assistance-dog work, who developed moderate pectus excavatum alongside early feeding challenges and an acute neonatal event that significantly worsened her thoracic shape. Management included manual thoracic shaping, assisted positioning, customised splinting using littermate anatomical templates, and structured neuromotor development activities.

Over an eight-week period, Toni progressed from marked sternal depression and rib flare to near-normal thoracic conformation without surgery. This case highlights the value of early physiotherapy involvement, owner / breeder collaboration, and adaptive splinting strategies in neonatal thoracic deformities.

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Toni, a chocolate Labrador Retriever puppy, was referred at two weeks of age. She was part of a purpose-bred litter for an assistance-dog charity, where optimal musculoskeletal development and functional robustness are essential for future working roles. Her breeder had already identified a thoracic abnormality and trialled early splint ideas but sought physiotherapy guidance due to progression of deformity, early feeding challenges, and an episode of neck/chest swelling that temporarily prevented splint use.

This case provides valuable learning due to its neonatal start point, fluctuating clinical progression, owner-led management, and the need for staged, responsive clinical reasoning in a rapidly changing young puppy.

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Case Presentation (Timeline) 5 September – Age 2 weeks (Initial Physiotherapy Assessment) Moderate pectus excavatum with rib flare, poor sternal lift, and a large ventral cervical swelling. Manual shaping and positioning commenced.

9 September – Age 2.5 weeks On day three of course of antibiotics, swelling is reducing.

Manual shaping and adjustment of sleeping/resting positions with neoprene roll and towels 12 September – Age 3 weeks

Investigations / Diagnostics

Swelling resolved. Splinting resumed using thermoplastic materials. Walking and growth improved.

Diagnosis was clinical and based on: ■ Ventral sternal depression of moderate degree ■ Rib flare laterally, initially more pronounced on the left ■ Palpable thoracic asymmetry with flattening during unsupported sternal recumbency ■ Reduced thoracic lift during feeding attempts ■ Normal respiratory rate and pattern

20 September – Age 4.5 weeks Significant improvement. Ongoing splint used, re-moulded.

Mild imbalance with fatigue. Ribcage nearing normal.

3 October – Age 7 weeks Splint slipping; re-moulded using littermate Steffi with deeper chest. Fur irritation managed.

■ Postural findings: abducted forelimbs, difficulty sustaining midline alignment

11 October – Age 8 weeks

No radiographs were obtained due to adequate clinical assessment and the absence of respiratory compromise.

Differential diagnoses considered included pectus carinatum, congenital sternal segment anomalies, and trauma.

23 October – Age 9 weeks (with puppy walker)

Early Neonatal History and Contributing Factors

Splint only used at night time

Splint to be discontinued. Chest shape clinically normal with trace asymmetry.

31 October – Age 10 weeks Stopped using splint. No obvious change in chest shape.

Toni’s early development was influenced by two important neonatal events: 1. Birth and early feeding concerns Toni was born small, dry, and without an intact umbilical cord which raised suspicion of shared placental vasculature with a littermate. She displayed early difficulty maintaining effective nursing posture, likely secondary to emerging pectus deformity.

At two weeks she refused bottle supplementation, necessitating the introduction of Royal Canin Puppy Mousse to support her caloric intake and growth trajectory.

2. Critical event at 1 week + 2 days During an overnight fading episode affecting a littermate, Toni was discovered early the next morning stuck on her abdomen on vinyl flooring, unable to reposition herself due to poor thoracic strength. This prolonged ventral compression likely accelerated progression of pectus excavatum. She demonstrated retarded growth after this incident.

Problem list and SMART Goals ■ Ventral sternal depression – Achieve neutral profile within 6 weeks ■ Rib flare/asymmetry – Normalise contour by 8 weeks ■ Feeding inefficiency – Restore strong sternal lift within 2 weeks ■ Respiratory risk – Maintain normal RR throughout ■ Hindlimb awareness delay – Improve stepping accuracy by 10 weeks ■ Splint slippage – Optimise fit within 7 days

Please refer to Table 1-, and Table 2.

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Problem

Evidence / Clinical Signs

Impact / Clinical Relevance

Pectus excavatum (mild–moderate at presentation)

Flattened sternum, lateral rib flare, reduced thoracic lift

Risk of respiratory compromise, impaired thoracic development

Reduced motor control / delayed early mobility

Slower to walk than littermates, difficulty pushing up from sternum

May affect feeding, growth, neuromuscular development

Swelling around neck/jaw (early phase)

Firm swelling, resolved with antibiotics

Temporarily prevented splint use; affected feeding and comfort

Growth lag vs. littermates

200–500 g behind siblings at key stages

Impacted by feeding difficulty + overnight collapse

Slipping, rotation, dorsal tape irritation

Required multiple redesigns and refitting

Occasional bunny-hop, balance loss when tired

Expected puppy development but requires strengthening

Mild right-sided dip/flare

No current functional impact but requires monitoring

Splint fit challenges Mild persistent hindlimb weakness / wobbliness Residual costal asymmetry

Table 1: Identified Problem List

Goal

SpecificSigns

Measurable

Achievable

Relevant

Time-bound

Improve thoracic shape

Maintain sternum in corrected alignment using splint

Ribcage palpation + visual symmetry

Yes

Prevent long-term deformity

2–4 weeks

Support normal motor development

Allow periods of free movement without splint

Ability to stand, walk, righting reflex

Yes

Essential for working-dog development

Ongoing over 4–6 weeks

Achieve normal respiratory function

Monitor for no increased effort

RR, pattern, absence of noise

Yes

Key prognostic factor

Weekly checks

Progress weight trajectory

Promote effective feeding and mobility

Weekly weight gain

Yes

Addresses early lag in growth

Weekly

Improve hindlimb awareness

Introduce play-based proprioceptive tasks

Ability to step over obstacles, controlled stance

Yes

Supports balanced development

4–6 weeks

Table 2: SMART Goals

Treatment Delivered

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■ Manual Thoracic Shaping & Positioning

■ Neuromotor & Developmental Strengthening

■ Gentle lateral rib compression, sternal guidance, sternal recumbency with foam supports.

■ Stepping tasks, raised-surface shifts, forepaw lifts, varied-surface exploration.

■ Customised Splinting

■ Owner / Breeder Education

■ Initially moulded on littermate Miranda, later revised using Steffi whose thorax better matched Toni’s anatomy. Overnight use prioritised, daytime free movement encouraged.

■ Breeder and puppy walker trained thoroughly in monitoring and home management.

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Date

Intervention / Findings

5 Sept

Initial assessment; severe sternum flattening; swelling preventing splint use; neoprene sternal roll provided

Started thoracic shaping & supported rest

Custom splinting

Thermoplastic splints modelled on appropriate littermate chest shapes

Maintains sternal lift while allowing thoracic growth

12 Sept

Swelling resolved; splint tolerated; walking improved

Ribcage shape improving; weight 1.17 kg

Supported sternal positioning

Neoprene rolls, egg-box positioning, pipe lagging

Prevents flattening during rest and reduces rib flare

20 Sept

Overnight splint + daytime free movement; splint slipping; mild imbalance

Ribcage nearly symmetrical; growth 1.5 kg

Gentle thoracic shaping

Light manual cues 3–5×/day

Promotes correct alignment during rapid cartilage growth

Improved lateral stability; overnight-only plan

Free movement periods

No splint during active play

Ensures normal neuromuscular development

Thorax functionally normal; focus shifts to conditioning

Balance & proprioception play

Raised standing, stepping over obstacles

Strengthens hindlimbs/ core; prevents compensation patterns

Monitoring & review

Weekly assessment, weight checks, skin monitoring

Ensures splint remains safe, avoids pressure injury

Owner/puppywalker education

Handling guidance, mouthing management

Essential for continuity in long-term assistance dog training

3 Oct

23 Oct

Splint too narrow; remoulded larger splint using Steffi as anatomical model Splint to be discontinued; new puppy walker; mild hindlimb wobble

Progress / Notes

Treatment

Description

Ongoing basis:

Clinical Rationale

Table 3: A summary of Physiotherapy intervention

Outcome and Follow-up Toni achieved a successful physiotherapy-led conservative management outcome: ■ Sternum positioned normally ■ Ribcage symmetrical with minor non-functional variation ■ Normal respiratory effort

Davidson, J.R. and Kerwin, S.C., 2019. ‘Orthopaedic development and musculoskeletal maturation in puppies’, Veterinary Clinics of North America: Small Animal Practice, 49(1), pp.1–18.

Harrington, A.C. and Steiss, J.E., 2019. ‘Early physiotherapeutic intervention in neonatal and juvenile puppies’, Topics in Companion Animal Medicine, 34(4), pp.119–126.

Marcellin-Little, D.J. and Levine, D., 2020. Small Animal Rehabilitation and Physical Therapy. 3rd ed. St Louis: Elsevier.

■ Age-appropriate gait and balance ■ Splint fully discontinued by 10 weeks

References: Ahlström, C., Peura, P., Hielm-Björkman, A. and Lappalainen, A., 2021. Pectus excavatum in dogs: presentation, diagnosis and outcomes of conservative and surgical management. Journal of Small Animal Practice, 62(8), pp.653–662.

Martinez, S.A. and Sacks, A.E., 2017. ‘Splinting and external coaptation for thoracic deformities in neonates: techniques and outcomes’, Journal of Veterinary Orthopaedics, 40(2), pp.45–53.

O’Brien, D. and Baines, S., 2020. ‘Thoracic deformities in juvenile dogs: diagnosis and management’, In Practice, 42(2), pp.70–78.

Baines, S., Renwick, A. and Houlton, J., 2017. BSAVA Manual of Canine and Feline Musculoskeletal Disorders.

Gloucester: BSAVA.

O’Neill, D.G., Church, D.B., McGreevy, P.D., Thomson, P.C. and Brodbelt, D.C., 2020. ‘Longevity and mortality of assistance dogs: implications for early-life musculoskeletal health’, Veterinary Record, 186(12), pp.389–397.

Brown, S.G. and Boston, R.C., 2018. ‘Outcomes of conservative management for canine pectus excavatum diagnosed in early life’, Veterinary Surgery, 47(3), pp.344–352.

Pavia, P.R., Jones, C. and Salt, C., 2019. ‘Motor development in puppies: timelines, biomechanics, and influence of early handling’, Journal of Veterinary Behavior, 33, pp.63–70.

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Dougie: A Case Study on Recognising and Managing Canine Hypermobility Claire Johnston, Veterinary Physiotherapist, Human Sports Massage Therapist BSc Hons, IRVAP, AHRP, SMA, PEP claire@animalrehabpartners.co.uk With kind permission of Dougie’s owner, The Win Clinic and The Renew Centre for their contributions to this case summary.

Introduction Joint hypermobility, commonly recognised in humans, is becoming increasingly important in canine health. Eccles et al., (2012) found individuals with joint hypermobility show differences in the size of the amygdala, a brain region linked to emotions. This heightened interoceptive sensitivity may lead to more intense emotional experiences, with people with hypermobility being up to 16 times more likely to suffer from anxiety disorders.

Similar behavioural patterns may exist in dogs. Bowen et al., (2019) studied over 5,000 assistance dogs and found a link between hip joint hypermobility and excitability. In humans, anxiety disorders are associated with hyperreflexia, where an overactive “fight-or-flight” response increases sensitivity in muscles and reflexes, though this has not yet been explored in dogs.

Further research by Ueda et al., (2018) examined the relationship between patellar luxation, skin hyperextensibility, and collagen structure in dogs. Their study found dogs with patella luxation had greater skin extension (18.5%) compared to normal dogs (8.8%), suggesting a link to joint dysplasia and hyperextensible skin, similar to human Ehlers-Danlos syndrome.

In humans, joint hypermobility is often assessed using the Beighton Scoring System, which evaluates joint movements such as extending the 5th finger backward beyond 90 degrees or extending the elbows and knees beyond normal limits (Hakim & Grahame, 2003). In canine research, Amy Kings at the Win Clinic uses assessments including the Skin Elasticity Index to measure skin extension in the lower back, with values above 14.5% indicating hyperextensibility (Ueda et al., 2018). Shoulder abduction angles are also assessed using a goniometer,

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where angles beyond 36 degrees are considered significant. These assessments are crucial for identifying hypermobility in dogs and improving the management of related health issues.

A Hypermobility Case Study: Dougie This case study follows Dougie, a 2-year-4-monthold Australian Labradoodle who struggled with behavioural challenges during walks, including increased reactivity, heightened nose sensitivity, and an aversion to harnesses. Dougie’s experience highlights the complexities of recognising and managing hypermobility in dogs and underscores the importance of a multidisciplinary care approach.

Dougie’s clinical history includes escalating lead biting and lunging behaviours, which developed gradually and eventually caused bruising to the owner during walks. These behaviours became nearly constant at their worst. Despite extensive training, including puppy and adolescent classes, nose work, and therapy dog training, Dougie’s issues persisted. In December 2023, Gabapentin was introduced for pain management, which significantly reduced the lunging and biting behaviours, nearly eliminating them overnight. “Reconcile”, prescribed for anxiety, provided additional support, improving his condition somewhat.

These treatments, prescribed by a Veterinary Behaviourist, assumed that pain was the primary cause of Dougie’s behaviour. Dougie presented with intermittent bunnyhopping and rear-end discomfort resulting in radiographs being performed. These revealed femoral head flattening but no subluxation, periosteal new bone formation, or hip laxity. Based on these findings, the veterinary team recommended physiotherapy and hydrotherapy to help maintain Dougie’s muscle mass and mobility.

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Image 3: A typical laying position for Dougie

Musculoskeletal assessment revealed forelimb joint laxity with increased stretch in the subscapularis bilaterally, but no pain. Muscle atrophy was noted caudal to the thoracolumbar junction, with size differences between limbs: right hind (36 cm), left hind (31 cm), right fore (24 cm), and left fore (21 cm). Neurological testing showed minimal twitch response in the cutaneous truncii, indicating possible neural pathway issues. Dougie had increased excitability on the left side, with a fast response to left hind knuckling, exaggerated biceps reflex in the left fore, and exaggerated patellar reflex in the left hind, suggesting upper motor neuron dysfunction.

Palpation revealed muscle spasms in the right epaxials and intercostals, more pain in the right iliopsoas, and reluctance to extend his right hip. Strength testing showed better performance on the right fore and hind limbs but difficulty on the left. The Trendelenburg test indicated pelvic drop on the right hind lift, suggesting left gluteal weakness.

Image 1 & 2: Dougie’s ventrodorsal pelvic radiographs taken October 2023.

In summary, Dougie displayed bilateral iliopsoas pain (more severe on the right), muscle asymmetry, and atrophy. His primary concern was left-sided weakness and abnormal reflexes, which may point to a mild neurological condition contributing to his behavioural issues. Physiotherapy directed treatment included manual therapy, trigger point therapy, hip and sacroiliac mobilisations, low grade lateral lumbar mobilisations, and pulsed electromagnetic field (PEMF) therapy.

Owner Update on Dougie (1st March 2024)

Initial Physiotherapy Assessment At his initial physiotherapy consultation in February 2024, while no obvious lameness was observed, circumduction of the right hind limb during canter and a “sloppy puppy sit” suggested hip laxity and weakness. Dougie demonstrated in session abnormal laying positions, which may be indicative of hypermobility.

Dougie had been on a combination of paracetamol, gabapentin, Reconcile, and clonidine for seven weeks, along with regular physiotherapy focused on hip stability, strengthening, and managing muscle tightness flare-ups.

These interventions led to significant improvements in his behaviour. Incidents of lunging and biting ceased, with only a few minor jumping incidents remaining.

Socially, Dougie became more relaxed around visitors, successfully managing a family gathering of 12 without issues. He was receptive to touch and remained calm during

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recent veterinary and physiotherapy appointments, showing no signs of jumping or barking during grooming sessions.

His training approach remained consistent, improving his responsiveness. Dougie participated in online training focused on rewarding disengagement but continued to struggle with excitement around some dogs, particularly in open spaces.

Veterinary Neurological Specialist Consult – March 2024 During this exam, Dougie was alert with no signs of paresis or ataxia. The owner mentioned that the neurologist noted brisk one-sided reflexes, but these were not considered a cause for concern and were not mentioned in Dougie’s report. Mild discomfort was noted in the iliopsoas muscles, but no obvious pain was found elsewhere. The neurologist suggested the episodes might be behavioural or related to mild pain from the iliopsoas muscles, but it was unclear. Paracetamol was discontinued, and gabapentin was tapered.

In March, Dougie was switched to a single dose of gabapentin after stopping paracetamol. He showed high arousal from a busy week of appointments, along with mouthiness and sensitivity, particularly around his hip flexors. Physiotherapy examination revealed improvement in the iliopsoas muscles, though spasms were noted in the internal abdominal obliques. The treatment plan included exercises to maintain a square sitting posture and lumbar and hip mobilisations. Dougie showed progress in sit-to-stand transitions, and muscle tone, especially in the gluteals, increased, though mild hip discomfort remained. By the end of March, after discontinuing gabapentin, Dougie’s biting behaviours returned, but his sitting posture improved. Minimal pain was noted during the examination, with tenderness around the right sacroiliac joint.

In April, Dougie resumed gabapentin and performed well with at-home physiotherapy exercises. However, during the assessment, he showed muscle hypertonicity and pain, particularly in the left latissimus dorsi and hips.

Hydrotherapy was attempted, but Dougie found it stressful, crying throughout the session and resisting the harness.

The session was cut short and deemed unsuitable until his anxiety and discomfort could be better understood.

Veterinary Orthopaedic Specialist Consultation May 2024 On examination, mild resentment during deep palpation of the hypaxial lumbar muscles and during abduction of the hips was found. The remainder of the orthopaedic examination was within normal limits. The specialist recommended starting meloxicam (an NSAID) to determine if pain is causing the aggressive behaviour, with a gradual weaning off gabapentin. The owner was advised that Dougie’s hip arthritis may slowly progress, and advanced

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imaging (e.g., MRI) could be considered if needed.

After a weekend of activity in June, including chasing a ball, Dougie reverted to biting behaviours and displayed muscular tension in several areas. This highlighted a clear link between high-energy exercise, sharp turns, and increased behavioural reactivity and muscular discomfort.

The exercise plan was adjusted to limit play activities and focus on controlled conditioning exercises to better manage his condition.

After a few good days in July 2024, Dougie’s reactivity returned following beach outings. Physical examination during physiotherapy revealed tenderness in the thoracic and lumbar regions, along with epaxial muscle spasms.

Following treatment, his behaviour improved, with no lunging or biting.

The Renew Centre August 2024 Dougie’s assessment with Rachel Richardson at The Renew Centre revealed a normal spine and pelvis. MRI results showed his hips were also normal, with no signs of active inflammation. However, diagnostic ultrasound confirmed bilateral iliopsoas tendinopathy and left-sided sciatic irritation, and hypermobility was suggested as a possible cause. This was the first time a veterinarian had proposed hypermobility as a potential factor contributing to Dougie’s hip and back pain.

To address these issues, a comprehensive treatment plan was developed. It included Shockwave Therapy to alleviate hip and back pain while reducing inflammation in the sciatic nerve and iliopsoas. An exercise program was designed to strengthen Dougie’s postural muscles and fascial network, improving joint support and addressing hypermobility. Pain relief would be provided as needed, with the goal of reducing dependence on pain management through improved strength. The plan also incorporated supplements, such as Nutramed for soft tissue inflammation and Type 2 collagen for joint support.

In Dougie’s first physiotherapy session following the Renew Centre referral and primary shockwave treatment, the owner reported no significant behavioural changes, and a second shockwave treatment was scheduled soon after. Physical findings indicated muscle spasms in his hip flexors and lumbar region, possibly linked to a recent run. Hydrotherapy was carefully reintroduced, focusing on engaging his postural stabilisers through low water walking, as suggested in a study by Parkinson et al., (2018).

Dougie showed improved tolerance during the session, initially displaying some imbalance and lateral swaying, but noticeable improvement was seen by the end.

After Dougie’s second shockwave treatment, his progress was mixed. While he continued to lunge on the lead, improvements in his movement and energy levels were evident. Physical assessments showed increased agility, with Dougie jumping up more enthusiastically. The owner had begun collagen supplements the previous week,

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which may have contributed to these positive changes although this cannot be accurately measured or attributed to this. Further hydrotherapy sessions included targeted exercises to enhance Dougie’s stability, with notable improvements in his lateral swaying, indicating positive progress in his rehabilitation.

Hypermobility Assessment – The Win Clinic September 2024 On September 4th, Dougie underwent a hypermobility assessment with Amy Kings at the Win Clinic, which revealed several significant findings: ■ Shoulder abduction: Left shoulder 67.67°, right shoulder 58.33° (normal range: 30-40°) ■ Elbow extension: Left 188.67°, right 186.67° (normal: approximately 180°) ■ Stifle extension: Left 190°, right 189.67° (normal: around 160°) ■ Tarsal flexion: Left 28.67°, right 29.33° (normal: about 20°) ■ Skin extensibility index (SEI): 16.13% (threshold for hypermobility: 14.5%) These results confirmed Dougie’s marked hypermobility, supporting the theory of significant joint flexibility.

During Dougie’s follow-up physiotherapy appointment, the owner reported significant progress, noting that Dougie had enjoyed a run without lead biting. A physical assessment revealed mild muscle spasms in his left abdomen and hip flexor, but no issues on the right side.

Hydrotherapy sessions showed marked improvements in balance and stability, and Dougie performed sit-to-stand exercises without difficulty. A final shockwave treatment was scheduled at the Renew Centre.

By October, Dougie’s pain behaviours had decreased, though slight discomfort was noted during hip stretches.

A mid-month flare-up led to increased reactivity during palpation of the left hip, likely due to reduced at-home conditioning exercises. Tenderness was found in his left abdomen, quadriceps, and hamstrings. Dougie received LASER therapy, manual treatment, and stability exercises on a rocking board leading to another improvement in his reactivity post session.

brought him in earlier due to a return of lunging, anxiety, and barking, despite no changes in his routine or gabapentin. Examination revealed mild tenderness in the right iliopsoas region, lumbosacral discomfort, and pain during left shoulder adduction, suggesting a potential left deltoid muscle strain. LASER therapy, massage, and mobilizations alleviated the pain and restored shoulder function. Dougie regained stability on wobble cushions after initial unsteadiness. The muscle strain may be linked to his hypermobility syndrome and joint discomfort, with the strain possibly triggering anxiety and imbalance, as seen in hypermobile humans. This emphasizes the need for ongoing care to manage flare-ups, as they can contribute to a regression in behavioural issues for hypermobile patients.

Conclusion Dougie’s journey through canine hypermobility highlights the importance of a comprehensive, multi-disciplinary approach to care. Despite seeing multiple veterinary professionals from different specialisms, his hypermobility condition was initially missed, demonstrating the need for increased education and awareness about how hypermobility can affect dogs- not only physically, but mentally. Through careful assessment, targeted therapies, and a tailored exercise regimen, significant improvements have been made in both Dougie’s physical capabilities and behaviour. The combination of veterinary physiotherapy, electrotherapy, massage, conditioning, pain management, collagen supplementation, and specialised treatments such as shockwave therapy and hydrotherapy has not only addressed Dougie’s immediate concerns but also contributed to his overall well-being.

This case illustrates the challenges dogs with hypermobility face, including behavioural issues tied to anxiety and discomfort. By recognising and managing these complexities, we can improve the quality of life for affected dogs. Ongoing focus on strengthening Dougie’s postural muscles and supporting joint stability will be crucial in maintaining his progress.

Regular follow-ups will ensure emerging concerns are addressed promptly, fostering long-term health and happiness. Dougie’s case serves as a valuable example for both pet owners and professionals, underscoring the need for proactive management and greater awareness in canine hypermobility.

At the end of October 2024, Dougie showed good mobility and no reactivity during palpation. A scan revealed no fluid in the left iliopsoas, but mild thickening in the right sciatic region. The recommendation was to continue simple exercises to support his recovery.

At his next physiotherapy follow-up, Dougie was calm and actively participated in exercises focused on hip extension and stability. While he initially sat slightly off square, this corrected itself quickly. Emphasis remained on hip stability and conditioning, with a follow-up scheduled in three weeks. However, Dougie’s owner

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Reference list Bowen, J., Fatjó, J., Serpell, J.A., Bulbena-Cabré, A., Leighton, E. and Bulbena, A. (2019). First evidence for an association between joint hypermobility and excitability in a non-human species, the domestic dog. Scientific Reports, [online] 9(1). doi:https://doi.org/10.1038/s41598019-45096-0.

Eccles, J.A., Beacher, F.D.C., Gray, M.A., Jones, C.L., Minati, L., Harrison, N.A. and Critchley, H.D. (2012).

Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms. British Journal of Psychiatry, 200(6), pp.508–509. doi:https://doi. org/10.1192/bjp.bp.111.092460.

Glans, M., Humble, M.B., Elwin, M. and Bejerot, S. (2020).

Self-rated joint hypermobility: the five-part questionnaire evaluated in a Swedish non-clinical adult population.

BMC Musculoskeletal Disorders, 21(1). doi:https://doi. org/10.1186/s12891-020-3067-1.

Hakim, A. and Grahame, R. (2003). Joint hypermobility.

Best Practice & Research Clinical Rheumatology, 17(6), pp.989–1004. doi:https://doi.org/10.1016/j. berh.2003.08.001.

Parkinson, S., Wills, A.P., Tabor, G. and Williams, J.M. (2018). Effect of water depth on muscle activity of dogs when walking on a water treadmill. Comparative Exercise Physiology, 14(2), pp.79–89. doi:https://doi.org/10.3920/ cep170031.

UEDA, K., KAWAI, T., SENOO, H., SHIMIZU, A., ISHIKO, A. and NAGATA, M. (2018). Histopathological and electron microscopic study in dogs with patellar luxation and skin hyperextensibility. Journal of Veterinary Medical Science, 80(8), pp.1309–1316. doi:https://doi.org/10.1292/ jvms.18-0115.

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Stronger together: Implementing Physiotherapy into an Independent Vet Practice

Connie Griffin,Chartered Physiotherapist & Veterinary Physiotherapist Beacon VetCare, Cornwall, UK connie.griffin@beaconvetcare.co.uk

Independent practices thrive on adaptability. When Beacon VetCare in Cornwall introduced an in housephysiotherapist, it was not about adding a luxury service, it was about strengthening the continuity and quality of care, offering the best service possible for the community’s pets.

Beacon VetCare is a family-run independent practice, taking Cornwall by storm, opening its doors in August 2023 offering community, referral, and emergency care. It has now tripled in size operating three sites, with a fourth opening in Spring 2026, expanding from 17 staff to nearly 70.

The business began at Colin and Lizzy Whiting’s (owners of Beacon Vetcare) kitchen table, and this is where decisions are continually made. Originally being a referral client of theirs for my injured Labrador requiring orthopaedic surgery, I immediately knew I wanted to be a part of their

amazing team. It was the mix of authenticity and ambition which drew me in to the practice. The excitement of every team member valued as equal, no hierarchy as such, but an ethos of “we are all on this Beacon adventure together.”

What stood out the most was the transparency and openness of the practice, offering me a tour of the facility they are so proud of, as they do for all their customers.

For the last year, the vet world has been experiencing a period of stagnation, but being welcomed to commence the physiotherapy service for a growing independent practice has been extremely exciting and nerve wracking all at once; nevertheless, I am very grateful for the opportunity!

Earlier in 2025 I had my first day with the team. We weren’t sure how the physiotherapy pathway was going to work,

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or even if it was going to work at all. But as with all the Whiting’s work, it was an idea, possibly a promising idea that had to be trialled. The physiotherapy service launched from a deliberately flexible starting point, with basic equipment, diary access, and a commitment to evaluate and adapt. This allowed the pathway to develop organically in response to clinical need.

Since then, upon reflection it has been a steep learning curve with many positives identified of having an in-house physiotherapy service within an independent practice.

Personalised patient care We pride ourselves on tailoring our care to every animal, through individualised assessments and treatments. This extends further through capitalising on the huge level of skill and knowledge we have available within our team. For example, joint sessions are often undertaken with physio and orthopaedic surgeons, or joint hospital discharge appointments with physio and veterinary nurses. Clinical discussions are often had in the office or in the prep rooms, working out the best plan for the animals. Most recently we had a daschund who wasn’t recovering very well physically following spinal surgery. He presented with bilateral hind limb low tone, no deep pain response and was requiring regular assistance to manage his bladder. During the dog’s hospital stay he received multiple sessions of hands-on physio focusing on hind limb strength and mobility. The added benefit of having the surgeon and nurse team on hand for a dog like this was huge. We completed a multi-disciplinary discharge appointment and advised an ACPAT referral to their local therapist so the rehabilitation could continue.

Supportive and collaborative team environment The ethos of Beacon VetCare is: ‘a friendly welcome and veterinary care designed around your pets’ best interests’.

This is exactly what is delivered throughout all the practices and is down to the nature of the teamwork. Physiotherapy is now embedded within the team with a busy diary comprised of frequent in-house referrals and outpatients (internal and external referrals). Daily support for physio is on hand from the nurses, vets, care assistants, reception staff, media manager etc. Efficient working is evident, for example, vets are on hand for questions around changes in symptoms or bladder management for the outpatient post- spinals. Things are completed in a timely manner, which clients notice and appreciate. Most recently a dog was booked in, a week down the line following tarsus surgery. Around the incision site the wound was beginning to look red, swollen and sore. With having the nurse team accessible, one of them was able to pop into the consult, assess and treat as needed at once. No wait for answers, no return visit for a separate consult appointment, just solid teamwork with the animal and client at the forefront.

Professional autonomy and clinical freedom The physio pathway has been developing and is continuing to do so organically based on service needs and requirements. The clinical freedom is huge, ranging from how much time I can spend with hospital patients, to asking a vet to pop into my outpatient appointment to clarify queries, to having time to complete CPD based on caseload requirements. Not one day at work looks the same.

The service operates with full clinical autonomy, enabling targeted rehabilitation plans, timely follow-ups, and direct communication with veterinary colleagues. This flexibilityfree from financial targets-allows appointments to prioritise patient needs and owner education, which is particularly important for complex or long-term rehabilitation cases.

A recent example involved a 5-year-old English Bull Terrier with hip dysplasia, lumbosacral pain, and carpal strain.

Coordinated management across orthopaedics, pain medicine, onward acupuncture referral, and physiotherapy resulted in marked functional improvement. Consistent communication with the owner, supported by exercise videos and between-appointment updates, was equally vital to progress.

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Direct impact and community connection

Advice for clinicians/practice owners

Colin and Lizzy’s vision is to provide compassionate, independent veterinary care that truly serves local pet owners. Excellent pet care is about more than just checkups and treatments- it is about the community. There are huge benefits in terms of continuity of care to carrying out Physiotherapy appointments in the same place where the surgery took place. Visiting the vet with a poorly or injured animal can be hugely stressful for owners and guardians.

We have found by building relationships with our clients and being able to offer services in house, joint working and a consistent team, helps with this hugely.

■ The prestige of having an in-house physiotherapist goes a long way

More recently I have started outreach visits to local vets, meeting with them to educate around what our physio service offers, referral indications and benefits of physio.

This has increased inter-practice relationships and has broadened the range of referred cases. This supports earlier intervention, more comprehensive rehabilitation plans, and improved community access to physiotherapy.

Focus on quality of care over targets The quality of care is always at the forefront. There are no financial targets, we are just expected to treat our clients as if it was our Granny or our Mum stood in the clinic room with their animal. I have the luxury of managing my own diary to ensure time is well spent with clients, focusing on what really matters. when people are collecting their dog’s following surgery, it can be upsetting, daunting and overwhelming.

The dog that is part of the family is no longer able to join on their beach walks, or the cat that loves cuddles on the sofa is now restricted. When meeting owners following their dog having orthopaedic or spinal surgery, lots of questions are raised around managing at home and the rehab plan, as well as consideration of caring for their non ambulatory, incontinent dog alongside the four children at home too! It can seem like a lot, for anyone, whatever the circumstance.

Joint physio and nurse discharge appointments take place providing the owners with all the information needed to ensure their animal will be cared for in the best way possible, maximising levels of recovery. We give them our time, so they feel happy taking their animal home.

■ There are times where a physiotherapist can see animals instead of veterinarians seeing them, i.e. followup appointments, some post-op checks ■ Clients choosing a particular vet practice because of a physiotherapy service ■ Internal and external referrals accepted which increases community support and inter-practice relationships ■ A broad range of possibilities are made available to clients, i.e. physio clinics, hydrotherapy, electrotherapy adjuncts, fitness classes etc ■ Having an in-house Physiotherapist can result in another team member supporting in clinical and nonclinical duties.

Establishing the physio service at Beacon VetCare has been quite the journey so far, and its not over yet.

Physiotherapy is now routinely embedded into the patient’s journey. Things will continue to adapt and evolve as new premises open and new members of the team join.

Working at Beacon Vetcare is the kind of place where the ideas matter more than their job title, if it’s a good idea it will be considered. Everyone cares so deeply about the clients and the animals, and there is a real sense of ‘we’re building something together’- that kind of environment is rare! If anyone is considering approaching their local veterinarians to provide in-house services, it is most definitely worth considering.

If anyone would like to discuss anything about setting up a similar physio pathway within a vet practice, emails are welcomed. Feel free to contact me on: Connie.griffin@ beaconvetcare.co.uk

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CPD Review: Equine Myofascial Kinetic lines

Lisa Emerson, Chartered Physiotherapist & Veterinary Physiotherapist MCSP, HCPC, MSc, ACPAT CAT A equifitphysio@outlook.com

Course overview

Learning outcomes and relevance to practice

This course was an exciting face-to-face course with a mixture of theory and practical delivered directly by two of the vets that have been extensively researching fascia in equine (and canine) through dissection. The course guided us through how Fascia works in the body, its relevance to function in the equine and the 11 lines that can be mapped out in the horse inspired in the earlier human work ‘Anatomy Trains’ by Thomas Myers. Following the anatomical research, specific assessment and treatment techniques of the myofascial kinetic lines have been developed by the course providers which we had a chance to learn and practice on equine cases.

Completing this course, I gained a completely new skill set in both assessment and treatment. You can assess each fascial line by using a functional test, usually a movement most of us are familiar with, or already use as part of our assessment process, for example, using the rounding reflex assesses restriction of the Superficial Dorsal Line, or flexion of the hind limb to assess the Lateral Lines. In addition to functional tests, “swing tests” can also be used which involve using a swinging movement generated from the horses tail alongside applying touch to specific points along the line been tested. A positive reaction would then mean that the swinging stops, or it is harder to generate a fluid movement from the tail while there is feedback on certain structures. The skeptic in me at first did wonder how much you could bias these tests yourself but then after we were working in pairs touching different parts of the horse while the other generated movement from the tail it did start to become quite fascinating, plus the immediate change to movement following the specific treatments on reassessment was quite remarkable.

A small cohort of 15 students from all over the world and various rehab backgrounds – vets, vet students, physiotherapists, osteopaths and chiropractors- enhanced the learning experience as alongside learning from the course providers, we were able to share knowledge and techniques relating to the equine cases in addition to learning the fascial lines. Plus, it was a fantastic and eye-opening experience to learn about animal therapy constraints, legislation and training routes in other countries.

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The slightly unconventional theme continued when it came to treatment, after identifying a restricted line on

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assessment the whole chain can then be released by using a specific point on the horse, similar to that of an acupuncture or acupressure point. There are various methods of stimulating these points- the preferred method was using an acupuncture needle directly into the point momentarily but as we would not be able to translate this into our UK (and beyond) practice as therapists, instead we were taught to use the vibration on the end of tuning fork. The tuning fork treatments are not only non-invasive and extremely well received by the horses but appear to work instantly to change certain movement patterns on reassessment. The hardest thing was trying to remember the fascial lines including their function, the tests and then the specific treatment points, nothing really changes unless you are pretty accurate.

In addition to the course content, I also came away with new skills learned from the other course participants as we shared knowledge and experience throughout the practical elements. This has sparked an interest in potentially completing further training, particularly on some of the osteopathic and acupressure techniques.

It is now 12 months since I completed this course; I use the assessment and treatment techniques on many of my equine cases and have found it a fantastic addition to my physiotherapy toolbox. I have developed a further working knowledge of certain symptoms of restricted lines that start at the observation and gait assessment and have incorporated some of the functional tests as part of my ‘routine’ palpation assessment. My tuning fork now lives in my pocket and it’s an efficient addition to my practice and the response from some of the horses when you hit the right point is fascinating, often generating various satisfying parasympathetic reactions. It has opened me up to a different approach to treating various movement dysfunction which for some of my cases has provided a missing link or has enhanced the effectiveness of other interventions. It has also given me an appreciation for a ‘less is more’ approach and how effective the gentle techniques can be, emphasising that change doesn’t have to come always through mobilisation or manipulation.

It is important to note, however, that this is an additional skill and not a standalone or miracle treatment. While it has been extremely useful, often the dysfunctions or restrictions we see are more complex than just simply restricted fascia and this can limit the effectiveness of the techniques. It was taught in the course that each point could only be treated twice in one session, if no response was seen then other factors needed to be considered, I continue to use other manual techniques and electrotherapies where appropriate following a ‘whole horse’ assessment.

in creating. There was a good mix of theory and practical elements plus opportunities to learn from other participants.

The course was held in Denmark, which potentially limits its accessibility and there is only a handful of these courses available throughout the year. The providers do have two books now available for purchase which are worth a read, but I will say I struggled to make sense of the book until I had seen it in person, but I am a practical and visual learner.

Conclusion In summary this was a very insightful and useful course that I would highly recommend. The knowledge of the course providers was exceptional and the whole experience was fantastic, not only did it teach completely new skills and concepts, but it also changed my approach to certain cases after been exposed to other professionals, their experience and techniques. I look forward to attending the follow-up course and the canine courses.

References/further reading Course details and books can be found on: www. fasciallines.com Schultz, D., Due, D., Elbrønd, P. and Schultz, V., 2021.

Equine Myofascial Kinetic Lines. Leanders Grafiska AB Kalma.

Due, T., Elbrønd, V.S. and Schultz, R., 2021. Equine Myofascial Kinetic Lines-for professional treatment.

Fascialines. com.

Elbrønd, V.S. and Schultz, R.M., 2015. Myofascia-the unexplored tissue: Myofascial kinetic lines in horses, a model for describing locomotion using comparative dissection studies derived from human lines. Medical Research Archives, (3).

Elbrønd, V.S. and Schultz, R.M., 2018. Equine myofascial lines: Verification and validation of three profound lines– and discovery of a new line. Journal of Bodywork and Movement Therapies, 22(4), p.872.

Elbrønd, V.S. and Schultz, R.M., 2014. Myofascial kinetic lines in horses. Equine Veterinary Journal, 46, pp.40-40.

Elbrønd, V.S. and Schultz, R.M., 2021. Deep myofascial kinetic lines in horses, comparative dissection studies derived from humans. Open Journal of Veterinary Medicine, 11(01), p.14.

Harrison, A.P. and Elbrønd, V.S., 2018. Applied myofascial advances in veterinary medicine and practice. SPG BioMed, 1(2).

Course evaluation The course providers’ expertise was exceptional; they were able to deliver their knowledge based on experience and the evidence base they have been directly involved

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MEMBER RESEARCH

Is the Canine Brief Pain Inventory More Effective than Veterinary Lameness Assessment in Detecting Pain and Functional Impairment in the Management of Canine Osteoarthritis: A Systematic Review.

Kathleen Lott1* BA(Dance), BAppSc(Physio), MPhysioPrac. MVetPhysio (Project Mentor: Cathy McGowan1 BVSc, PhD, University of Liverpool) info@barcphysio.com.au

Abstract Objectives: Canine osteoarthritis (OA) is common, typically characterised by joint pain and reduced function. The literature reports a multitude of outcome measures used to monitor canine OA response to treatment, including the Canine Brief Pain Inventory (CBPI) and veterinary lameness assessment. This study aimed to determine whether the CBPI is more effective than veterinary lameness assessment in detecting pain and functional impairment in the management of canine OA. A second aim was to discover whether the Pain Severity Score (PSS) component of the CBPI detects change in pain more often than the Pain Interference Score (PIS) detects interference as a result of pain.

Methods: The systematic review was completed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. PRISMA is a freely available tool which includes a checklist with clear descriptors of what is required for each section of the systematic review (https://www.prisma-statement.org/). Four databases (PubMed, MEDLINE, Scopus, and Web of Science) were searched in May 2024. After returning 682 papers, duplicates were removed, and the remaining studies were manually screened for inclusion. A total of 22 papers were included in this review. Relevant results were extracted from the papers, risk of bias was analysed, and certainty of evidence was determined.

Results: Twelve papers demonstrated that both the CBPI and veterinary lameness assessment detected improvement in pain and functional impairment at certain time points. Three studies found that neither the CBPI nor

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veterinary lameness assessment detected improvement in pain or functional impairment at any time point. One article revealed that veterinary lameness assessment detected improvement in pain and functional impairment, but the CBPI did not. Conversely, six studies showed that the CBPI detected improvement in pain and functional impairment, but veterinary lameness assessment did not.

Three of these six studies demonstrated that the PSS detected improvement in pain, but the PIS did not detect improvement in functional impairment.

Clinical significance: The results of this study do not provide strong evidence that the CBPI is more effective than veterinary lameness assessment.

Permission statement: This systematic review is part of an MSc project work submission and has the permission of the University of Liverpool to share publicly.

Supplementary Comments This research project was chosen by the author to determine whether an owner completed questionnaire may be a valuable inclusion to the physiotherapy assessment of dogs with osteoarthritis. In human physiotherapy, validated patient questionnaires are widely used to quantify severity of symptoms and to track a patient’s progress throughout their treatment. Therefore, it seems logical as an inclusion for Veterinary Physiotherapists. Limitations to consider when using the CBPI include, the risk of a caregiver placebo effect, inaccurate completion of the questionnaire and a misunderstanding or poor interpretation of pain behaviours. To mitigate some of these risks, it is imperative the Veterinary Physiotherapist provides thoughtful

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education on canine pain behaviours, ensuring the owner understands how to correctly rate each criterion for their dog. The CBPI has an accompanying user guide, which owners and clinicians may find helpful. It is important to remember the risk of human error will always remain, reinforcing that the CBPI should never be a standalone outcome measure, and is best utilised as part of a thorough assessment.

The author has found in her own professional practice the CBPI is a valuable inclusion to physiotherapy assessment in the evaluation of canine osteoarthritis management. It demonstrates change in pain and function not only to the clinician, but also to the owner. It would be beneficial if Veterinarians were to utilise the tool more widely for dogs diagnosed with osteoarthritis. It may assist in improving owner awareness regarding pain behaviours, highlight additional cases benefitting from veterinary physiotherapy input, and serve as a prompt for Veterinarians to refer cases to physiotherapy earlier.

Relevant links: CBPI questionnaire:https://www.vet.upenn.edu/wp-content/ uploads/2025/04/canine-bpi.pdf CBPI user guide: https://assets.elanco.com/0cec44ed3eaa-0009-2029-666567e7e4de/e64824ca-e759-4a9d90fb-9fa484fdfedd/canine-bpi-user%27s-guide-2017-07.pdf

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MEMBER RESEARCH

Clinical Audit of Post-Operative Hospital Processes and Outcomes of Pediculectomy in Dogs Albert Tseng MSc Veterinary Physiotherapy University of Liverpool, supervised by Em Prof. Catherine McGowan and Dr Lesley Goff albert@map.physio

Background I chose this topic because I was curious about postoperative recovery rates of dogs in a local hospital setting and the uptake of rehabilitation services given the relative infancy of the canine rehabilitation industry in Australia.

A clinical audit of a local referral centre was the perfect option for this exercise.

Intervertebral Disc Disease (IVDD) is the most common cause of acute paraplegia in dogs and is commonly treated by surgical techniques such as pediculectomy. The presence of deep pain sensation is a strong prognostic factor for recovery of ambulation with continuity of care and rehabilitation integral to good postoperative outcomes. Despite this, the postoperative processes and outcomes of dogs receiving pediculectomy has not yet been audited at this referral centre.

positive (DPP) dogs). Utilisation of post-operative surgical recheck and physiotherapy treatment targets were set upon discussion with the surgery team. Data was extracted and anonymised from records of dogs that underwent pediculectomy during a 6-month period. Yes/no responses were recorded for each criterion and results were compared to set targets.

Key Findings Of the 95 dogs, 31 were lost to follow up. Post-operative surgical recheck was below target for both groups of dogs as was physiotherapy referral in only the DPN dogs.

Physiotherapy treatment was well below target in both DPP and DPN dogs. All DPP dogs and 40% of DPN dogs recovered ambulation within 8 weeks respectively.

Aim Objectives: 1. To audit postoperative ambulatory outcomes (outcomes audit) 2. To audit the appropriate utilisation of post-operative surgical recheck and physiotherapy treatment (process audit).

Completing the above objectives will lead to quality improvement strategies to improve post-operative outcomes in dogs recovering from surgically managed IVDD.

Methodology A single practice audit was conducted. Ambulation targets were set against rates published in the literature (50% for deep pain negative (DPN) dogs, 100% for deep pain

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Supplementary Material Criterion

Protocol A (PTCL-A)

Target

Dogs undergoing pediculectomy had at least 1 surgical revisit following surgery within 8-weeks post-operatively

All dogs: 1 surgical revisit within 8 weeks target: 90%

Continuity of care promotes the animal receiving its full care requirements in the veterinary environment and at home (Thompson, 2009)

Physiotherapy programme was advised on discharge

Target for deep pain positive dogs: 50% Target for deep pain negative dogs: 100%

Physiotherapy consultation was documented by vet during revisit

Target for deep pain positive dogs: 40%

Dogs underwent at least 3 physiotherapy visits within 8-weeks post-operatively

Target for deep pain positive dogs: 33%

Target for deep pain negative dogs: 80

Target for deep pain negative dogs: 75%

Physiotherapy promotes recovery of function and reduction of post-operative complications; however, it is not commonly prescribed in veterinary medicine (Moore, et al., 2016, Hodgson et al., 2017) To track utilisation of physiotherapy and its documentation by vets to promote interdisciplinary care and communication which in turn improves outcomes (Pantaleon, 2019) At least three rehabilitation visits were utilised in a study where post-operative outcomes were improved over a control group that did not complete rehabilitation (Hodgson et al., 2017)

Deep pain positive dogs recover ambulatory function within 8 weeks post-operatively

100%

To compare ambulatory outcomes to what is reported in the literature-98% of deep pain positive dogs recovered ambulation in a study of 831 dogs (Aikawa et al., 2017)

Deep pain negative dogs recover ambulatory function within 8 weeks post-operatively

50%

To compare ambulatory outcomes to what is reported in the literature-52% of deep pain negative dogs recovered ambulation in a study of 831 dogs (Aikawa et al., 2017)

Table 1: Audit criterion, their targets and rationale behind selection

Criterion

Protocol A (PTCL-A)

Target

Dogs undergoing pediculectomy had at least 1 surgical revisit following surgery within 8-week time frame.

All dogs: 1 surgical revisit within 8 weeks target: 90%

64/95 = 67%

Target for deep pain positive dogs: 50%

Physiotherapy programme was advised on discharge

Target for deep pain negative dogs: 100%

Physiotherapy consultation was documented by vet during revisit

Target for deep pain negative dogs: 80%

Dogs underwent at least 3 physiotherapy visits within 8-weeks post-operatively

Target for deep pain negative dogs: 75%

Target for deep pain positive dogs: 40%

Target for deep pain positive dogs: 33%

Deep pain positive dogs recover ambulatory function within 8-weeks post-operatively

100%

Deep pain negative dogs recover ambulatory function within 8-weeks post-operatively

50%

70/82 = 83% 10/12 = 83% (One dog had unconfirmed deep pain status) 4/82=5% 3/12=25% (One dog had unconfirmed deep pain status) 4/82= 5% 1/12= 8% (One dog had unconfirmed deep pain status) 58/58= 100% 24 unknown 2/5= 40% 7 unknown

Table 2: Audit results

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Critical Reflection The target recovery of ambulation rate for deep pain negative cases within 8 weeks documented was not met.

The 40% recovery rate is lower than the rates referenced in the literature, however this number is skewed heavily by the small available case sample. There were only five cases with sufficient data to draw from in the audit, as given the high clinical severity, deep pain negative dogs formed the minority of cases and had more cases lost to death. Additionally, seven cases were also lost to follow up. Therefore, these findings suggest that a larger deep pain negative-specific outcome and process audit is necessary for the hospital in the future to more effectively evaluate performance and lead to quality improvement specific to this subset of cases. However, another potential barrier to evaluating deep pain negative dogs both clinically and in audit lies in the fact that deep pain testing itself is not always reliable- one case during the audit was documented as having ‘questionable presence of deep pain’ and unable to be categorised (Gorney et al., 2016). Therefore, an additional future consideration for the hospital would be to audit the process of deep pain testing itself amongst its clinicians.

The target recovery of ambulation rate for deep pain positive cases within 8 weeks was met. However, an incidental finding of the high number (24/82=29%) of cases who lacked documentation of follow-up was noted. This formed a major limitation of the audit in assessing the outcomes of the cases.

To address this, it is recommended the hospital establish a blanket policy of follow-up of cases via a stepped process of phone call, then repeat phone call, then email or a physical letter (to include owners who are not adept at technology) at the 2-, 4-, 6- and 8-week timepoints respectively after surgery for owners who fail to present

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their dogs to the hospital for rechecks. A program of telephone follow-up has been shown to lead to detection of treatment side effects and enhancement of supportive care in human cancer patients (Murata, 2023).

Clinical Relevance Running a clinical audit within a hospital or physiotherapy practice setting can identify quality improvement areas that may lead to improved clinical, client and operational outcomes.

Conclusion This clinical audit is the first of its kind for the participating referral hospital and found the process criterion of postoperative service utilisation, particularly physiotherapy utilisation rate, was low. Whilst not intentionally audited as a criterion, the high numbers of dogs lost to follow up reduced the amount of data available to audit. This result highlighted a need for quality improvement strategies such as increased follow-up, education and marketing of owners and surgeons about the benefits of post-operative physiotherapy in their dog’s recovery. Outcome criterion of recovery of ambulation closely matched the literature for deep pain positive dogs, however, the target for deep pain negative dogs was not met, with the data likely to have been skewed by the small sample size. This has flagged a need for a deep-pain-negative specific audit with larger case numbers in the future. This project has completed the measurement and strategy formulation stages, and the audit team plans to progress to strategy implementation and re-audit later in the year when hospital staff are available. This will close the audit cycle loop and lead to quality improvement for the post-operative processes and outcomes of cases receiving spinal surgery at the hospital.

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MEMBER RESEARCH

Towards an Evidence-Based Treatment Plan for Horses Diagnosed with Primary Back Pain

Lynne Harrison BSc (Hons), MSc APA Titled Animal Physiotherapist APAM, MACP, MCSP ACPAT Cat.A lynne.harrison@student.uq.edu.au

Overview Back pain and diseases of the spine are significant problems in sport horses, with diagnosis of the underlying pathology proving a challenge for the clinician. Indeed, veterinary medicine, like human medicine, has historically focused on finding pain generator from the underlying anatomical lesion. However, significant work in human back pain patients has concluded that many back pain presentations have no identifiable lesion on imaging, or the radiographic changes are unrelated to the pain. This has resulted in physiotherapy-led research focusing on the effect of acute, sub-acute and chronic pain on spinal muscles, and indeed, the rehabilitation requirements at each phase. Whether a patient is experiencing acute back pain or chronic back pain, the early-phase rehabilitation goals are pain relief and re-establishing neuromotor control

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of the deep spinal muscles (Hodges & Danneels, 2019).

With regards to this PhD, early-phase rehabilitation of horses with primary back pain will be investigated, with the aim being to provide an evidence-based treatment plan for equine back pain patients. Muscle activation patterns, manual therapy and therapeutic exercises will be investigated across four studies using a variety of equipment and outcome measures.

Time frames: PhD duration: April 2023-September 2026

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Papers in Print: Free to access 2025: Journal of Equine Rehabilitation Title: Functional anatomy of the equine thoracolumbar spine related to equine back rehabilitation Abstract: Back pain and diseases of the spine are prevalent issues in sport horses, with diagnosis of the underlying pathology proving a challenge for the clinician.

Historically, veterinary medicine, like human medicine, has concentrated on identifying the pain generator linked to specific anatomical lesions. However, significant work in human back pain patients has revealed that many cases exhibit no identifiable lesion on imaging, or that changes to images may not correlate with the patient’s pain. This has resulted in physiotherapy-led research focusing on effects of acute, sub-acute and chronic pain on spinal muscles, as well as the implications for rehabilitation. This review aims to summarize existing literature on muscular changes due to back pain in both human and equine patients, while exploring the physiotherapy-led rehabilitation principles tailored to the various stages of back pain. https://doi.org/10.1016/j.eqre.2025.100027

2024: Journal Of Equine Rehabilitation Title: Equine back pain is a diagnostic challenge: A physiotherapist’s perspective Abstract: Back pain syndromes often present with nonspecific signs and may involve multiple different structures as their pain-generator, making a pathoanatomical diagnosis challenging. Diagnosis of back pain requires a multidimensional approach, involving both functional and interventional assessments. Whilst the equine practitioner has a substantial number of assessment tools available, many are not utilized due to time constraints, lack of awareness, and financial implications. The purpose of this review is to summarise the literature on functional and interventional assessment for equine back pain and highlight the challenges faced by clinicians. https://doi.org/10.1016/j.eqre.2024.100017

References: Hodges, P. W., & Danneels, L. (2019). Changes in structure and function of the back muscles in low back pain: Different time points, observations, and mechanisms.

J Orthop Sports Phys Ther, 49(6), 464-476. https://doi. org/10.2519/jospt.2019.8827

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RESEARCH DIGEST

How does cruciate ligament rupture treatment affect range of motion in dogs?

Ellen Goldsmith Pinna, S., Di Benedetto, M. and Tassani, C. (2024). The Veterinary Journal 308, 106253. https://doi.org/10.1016/j.tvjl.2024.106253

Introduction

Results

Cranial Cruciate Ligament (CCL) rupture is one of the most common orthopaedic conditions in dogs. The affected stifle undergoes various changes affecting stability, range of motion (ROM) and development of Osteoarthritis (OA).

Several surgical techniques exist with the primary aim of these to restore the stability of the joint thereby reducing the progression of osteoarthritis. Joint ROM may be used as an assessment tool for evaluating the effectiveness of surgery and rehabilitation as it is an indicator of joint function. Few studies have focused on the changes in passive ROM as the primary goal to determine the effects of CCL rupture and/or surgical treatment correction.

For dogs having a TTA operation 76.8% had an abnormal extension angle which decreased to 61.4% by 6 months.

The flexion angle was abnormal in 69.6% of dogs which increased to 77.3% by 6 months. The sample size was 56 at month 0 and 44 at month 6. The presence of lameness went from 100% at 0 months to 9.1% by 6 months.

Aims The authors looked to ascertain as to whether passive stifle ROM was affected by, and, if so, to what extent, in dogs undergoing Tibial Plateau Levelling Osteotomy (TPLO), Tibial Tuberosity Advancement (TTA) and Tight Rope (TR) correction of CCL deficiency.

Methods They retrospectively assessed 114 client-owned dogs who had been operated on at the department of veterinary medicine at the University of Bologna. There was a broad range of breeds, ages, body weights and genders. Stifle flexion and extension measurements were taken using a goniometer with a standardised procedure which included the dogs being sedated and in lateral recumbency whilst the measurements were being taken. Measurements were classified using a Likert scale (0-4) as to the degree of normality/abnormality according to measurements in Jaegger et al., 2002 which were derived in “normal” Labrador Retrievers. Prior to sedation, the dogs were also assessed for lameness, and a 0-4 scale were applied according to the degree of severity. Dogs who were on NSAIDs and/or analgesic mediations were excluded. Data was collected for 1 month pre-op, 1-month post-op and 6-months post-op. Statistical significance was set as p<0.05

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For dogs having a TPLO operation 83.3% had an abnormal extension angle which decreased to 69.6% by 6 months.

The flexion angle was abnormal in 76.2% of dogs which increased to 56.5% by 6 months. The small sample size was 42 at month-0 and 23 at month-6. The presence of lameness went from 100% at 0 months to 4.3% by 6 months. There was an association between extension angle and lameness at 0 months.

For dogs having a TR operation, 68.8% had an abnormal extension angle which decreased to 37.5% by 6 months.

The flexion angle was abnormal in 93.8% of dogs which increased to 50% by 6 months. The sample size was 16 at month 0 and 8 at month 6. The presence of lameness went from 75% at 0 months to 37.5% by 6 months. There was an association between flexion angle and lameness at 0 months and flexion angle and extension angle at month 0 and month 6.

At month 6 the TPLO group showed a significant improvement in extension angle compared to the TTA group. At month 1 the TTA group showed a significant decrease in lameness compared to the TPLO group. No other group comparisons were significant.

Conclusion This study confirmed that a stifle joint with CCL injury has an abnormal ROM and revealed that surgical procedures could additionally influence the ROM. These two facts have clinical relevance and provide useful indications for planning therapy to improve and speed up the postoperative rehabilitation process in dogs.

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RESEARCH DIGEST

Quantifying head and withers movement asymmetry in sound and naturally forelimb lame horses trotting on a circle on hard and soft surfaces Alice Hodgson Taddey, C., Roecken, M., Kreling, K., Cruz, A. (2025) Equine Veterinary Journal Volume 57, Issue 5: SPECIAL FOCUS EDITION: MUSCULOSKELETAL DISORDERS OF THE SPORTSHORSE, Sep 2025, Pages1151-1404 https://doi-org.csplis.idm.oclc.org/10.1111/evj.14430

Introduction Despite lameness being the most common reason for poor performance in horses, there remains to be challenges of identifying the affected limb and the origin of lameness.

Associated compensatory movements such as that of the head and pelvis have been recognised to increase the challenge of this. In order to achieve objective measurements of lameness, computer-based measuring systems have studied head and pelvic displacement asymmetry in horses trotting in straight lines. However, this has not been studied in horses lungeing or on different surfaces.

Aims This study aimed to quantify head movement asymmetry in sound and naturally forelimb lame horses during trotting in a circle on soft and had surfaces to define normality thresholds. It also aimed to demonstrate the relationship between movement asymmetry of the head and withers in sound and naturally forelimb lame horses when moving in a straight line on hard ground and during trotting in a circle on hard and soft grounds, thus determining whether withers movement could be used as a valuable parameter for identification of the affected limb(s).

Methods In this retrospective analysis of clinical data and comparison with control group, one experienced veterinarian subjectively assessed 96 horses on hard ground straight line trot and on different surfaces on the lunge. 41 horses were found to be subjectively lame and were excluded, and 55 horses were included in the sound group. For the lame group, two experienced veterinarians assessed 34 horses presenting with unilateral forelimb lameness, showing the lameness of at least 2 out of 5 using the American Association of Equine Practitioners lameness scale. All horses were trotted in-hand in a straight line and in a small circle with a diameter of 6-8m on a hard surface, then lunged on a soft surface on the left and right reins on a circle of 10-14m, on a loose lunge line. A minimum of 15 continuous strides was considered sufficient

for data analysis. The EquiGait Ltd gait analysis system was used consisting of five inertial measurement unit sensors placed on the poll, wither, sacrum, and left and right tuber coxae to measure movement asymmetry, by measuring differences in displacement minima for head and withers.

Absolute values of symmetry that indicated either left or right asymmetry were obtained from the EquiGait® system and used for Receiver Operating Characteristic (ROC) analysis and descriptive statistics and analysed using SPSS. Linear regression analysis was performed with the value of the minimum difference (MinD) of movement of the head as the independent variable and the value of minimum difference of the movement of the withers as the dependent variable. To find the most appropriate threshold, Youden’s index J was calculated. Effects were considered significant at p < 0.05.

Results Lame horses showed significant correlations between head and withers movement on hard ground straight line. Possible threshold ranges for quantifying head movement asymmetry on hard and soft surfaces on circles were 24.5 to 26.5mm, whilst for hard ground straight line trot the threshold range was 11.15 to 12.5mm. The outer leg lame horses showed no significant correlation on the lunge, whereas inner leg lame horses showed a highly significant correlation between head and withers movement asymmetry.

Conclusions The study was able to quantify movement asymmetry and direction of the head and withers movement by investigating sound and naturally forelimb lame horses for clinical lameness under clinical examination conditions.

The study also quantified the movement asymmetry of the head while trotting on a straight line and circular paths under clinical consideration and defined possible threshold values for the discrimination of sound and lame horses. It demonstrates that the vertical displacement of the withers may be used as an additional parameter for detecting hindlimb lameness.

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RESEARCH DIGEST

Our reference lists are compiled of both interesting papers, as well as papers accessible via our JSAP and EVJ subscriptions available to ACPAT members.

CANINE REFERENCES

hindlimb lameness. BMC Veterinary Research 20 (1), 405.

Anatolitou, AA Krystalli, AA., Epaminondas, D., Papaefthymiou, SK., Adamama Moraitou, KK. and Prassinos, NN. (2024). A successful outcome in four puppies sustained swimmer puppy syndrome. Veterinary Research Communications, 1-8

Pye, C., Clark, N., Bruniges, N., Peffers, M. and Comerford, E. (2024), Current evidence for non-pharmaceutical, nonsurgical treatments of canine osteoarthritis. J Small Anim Pract, 65: 3-23. https://doi.org/10.1111/jsap.13670

Brookes, W., Payne, R. and Lea, R. (2024). Reporting outcome measures in veterinary physiotherapy with particular reference to the treatment of canine and equine joint cases in the UK. Veterinary Record 194 (6) Danciu, C.G., Formoso Prado, S. and Fitzgerald, E. (2024), Imaging features of occipito-atlanto-axial joint malformation in a young dog. J Small Anim Pract, 65: 413-413. https://doi. org/10.1111/jsap.13720 da Silva Rauber, J., Chaves, JHF., Wrzesinski, MR., Sekita, AMT., da Silva Soares, T., Beckmann, DV. And Mazzanti, A. (2024). Physiotherapy in the Recovery of Paraplegic Dogs without Nociception Due to Thoracolumbar Intervertebral Disc Extrusion Treated Surgically. Animals 14 (18), 2648.

Davis, SE. (2024). Medial Patellar Luxation and Use of a Manual 3D patellar repositioning technique: Updates.

Orthopaedic Practice, 36 (1), p. 67-68 Doeven, L., Cardy, T. and Crawford, A.H. (2024), Investigation of neutering status and age of neutering in female Dachshunds with thoracolumbar intervertebral disc extrusion. J Small Anim Pract, 65: 637-641. https://doi. org/10.1111/jsap.13733 Fisher, C., Seferidis, N., Zilli, J., Roberts, T. and HarcourtBrown, T. (2024), Insights into the clinical presentation, diagnostics and outcome in dogs presenting with neurological signs secondary to infection with Neospora caninum: 41 cases (2014-2023). J Small Anim Pract, 65: 582-588. https://doi.org/10.1111/jsap.13702 Hutchings, V.C. and Rutherford, S. (2024), Computed tomographic re-evaluation of skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissure: 12 cases (2018-2022). J Small Anim Pract, 65: 817821. https://doi.org/10.1111/jsap.13768 Michael, HE., McGowan, CM. and Hyytiäinen, HK. (2024).

Posture and postural dysfunction in dogs: implications for veterinary physiotherapy. The Veterinary Journal, 106107.

Park, C., Sawyere, DM., Pancotto, TE., Lanz, OI. And Were, SR. (2024). Characterization of spatiotemporal and kinetic gait variables in dogs with hindlimb ataxia and bilateral

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Pye, C.R., Green, D.C., Anderson, J.R., Phelan, M.M., Fitzgerald, M.M., Comerford, E.J. and Peffers, M.J. (2024), Determining predictive metabolomic biomarkers of meniscal injury in dogs with cranial cruciate ligament rupture. J Small Anim Pract, 65: 90-103. https://doi. org/10.1111/jsap.13688 Smedberg, K., Lundbeck, E ., Roman, E., Eriksson, JW., Spörndly-Nees, S., Kallings, LV., Bergh, A. and Söder, J. (2024). A pilot study of a joint outdoor exercise program for dog owners and dogs. Scientific Reports 14 (1), 14321.

Tsai Frank C. and Alvarez Leilani X. (2024). Outcome of eight working dogs with fibrotic myopathy following extracorporeal shockwave and rehabilitation therapy: a case series. Frontiers in Veterinary Science, 10. https://www.frontiersin.org/journals/veterinary-science/ articles/10.3389/fvets.2023.1258319 Volz, f., Schmutterer, JM., Vockrodt, TS., Zablotski, Y. and Lauer, SK. (2024). Inter-rater reliability in performing stifle goniometry in normal and cranial cruciate ligament disease affected dogs: a prospective randomized controlled study.

BMC Veterinary Research 20 (1), 339.

Volz, F., Eberle, D., Kornmayer, M., Zablotski, Y. and MeyerLindenberg, A. (2024), Effect of intra-articular platelet-rich plasma or hyaluronic acid on limb function recovery in dogs with TPLO for cranial cruciate ligament rupture: a randomised controlled trial. J Small Anim Pract, 65: 223233. https://doi.org/10.1111/jsap.13704

EQUINE REFERENCES: Patrico, C.R., Winter, G.H. and Garbade, P. (2024) ‘Spinal Articular Dysfunction is Common in Athletic Horses’, Equine Veterinary Journal, 57(5), pp. 1357-1362.

Pluim, M., Heier, A., Plomp, S., Boshuizen, B., Grone, A., Van Weeren, R., Vanderperren, K., Martens, A., Dewulf, J., Chantziaras, I., Koene, M., Luciani, A., Oosterlinck, M., Van Brantegen, L., Delesalle, C. (2022) ‘Histological Tissue Healing Following High- Power Laser Treatment in a Model of Suspensory Ligament Branch Injury’, Equine Veterinary Journal, 54(6) pp. 1114-1122.

Four Front I The magazine of the Professionals in Animal Therapy

Pfau, T., Simons, V., Rombach, N., Stubbs, N. and Weller, R., (2017) ‘Effect of a 4-week Elastic Resistance Band Training Regimen on Back Kinematics in Horses Trotting In-Hand and on the Lunge’, Equine Veterinary Journal, 49(6), pp.829-835.

Scott, R., Nankervis, K., Stringer, C., Westcott, K. and Marlin, D. (2010) ‘The Effect of Water Height on Stride Frequency, Stride Length and Heart Rate During Water Treadmill Exercise’, Equine Veterinary Journal, 42(s38), pp.662–664.

Walker, V., MacKechnie-Guire, R., Leedham, C., Tabor, G., Deckers, I., Paddison, J. and Maddock, C., 2025. ‘Effects of a 6-week Dynamic Mobilisation Exercise Programme on Thoracolumbosacral Kinematics in Sports Horses’, Equine Veterinary Journal, 00, pp.1-16.

Malekipour, F., Whitton, R.C. & Lee, P.V.S. (2024) Advancements in subchondral bone biomechanics: insights from computed tomography and micro computed tomography imaging in equine models. Current Osteoporosis Reports, 22, pp. 544–552.

Baudisch, N. et al. (2024) Influence of surgical intervention at the level of the dorsal spinous processes on the biomechanics of the equine thoracolumbar spine. Equine Veterinary Journal.

Lang, J.J. et al. (2024) Numerical evaluation of internal femur osteosynthesis based on a biomechanical model of the loading in the proximal equine hindlimb. BMC Veterinary Research, 20, Article 188.

Smit, I.H. et al. (2024) Adaptation strategies of the Icelandic horse with induced forelimb lameness at walk, trot and tölt.

SLU Publication Database.

Bartlett, E., Blackwell, E.J., Cameron, L. & Hockenhull, J. (2024) Are we on the same page? A review of horse training approaches, terminology use and method reporting within the scientific literature. International Journal of Equine Science, 3(2), pp. 88–99.

Bartlett, E. et al. (2024) Exploring the relationship between horse owner attributes and their approach to horse training. University of Bristol Research Portal.

CAFRE (2025) Equine research round up: what recent studies tell us. CAFRE Technical Resources.

World Horse Welfare (2025) Results of the largest and most in depth study into UK public attitudes towards horse sport and equine welfare. World Horse Welfare.

Blake, R. & Marlin, D. (2025) From biomechanics to welfare: integrative advances in equine sports medicine and rehabilitation. Animals, 15(18), Article 2706.

Alves, J., Andersen, P.H. & Gade, R. (2025) Read My Ears!

Horse ear movement detection for equine affective state assessment. Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition Workshops, pp.

5718–5726.

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A VIEW FROM THE CHAIR

Evidence, experience, and evolving landscapes Fiona Dove, BSc (Hons) Physiotherapy MSc Veterinary Physiotherapy, MCSP, HCPC, ACPAT. chair@acpat.org

ACPAT is run by an amazing team of volunteers keeping the organisation evolving, evidenced based and current in the ever-evolving landscape that this industry so desperately needs.

Thank you to Rebecca Wyatt, for putting together this journal with contributions from the committee, ACPAT members and many peers in the industry. I would like to extend my gratitude to all involved for continuing to promote our profession and the positive work in which we are all involved in.

During my first year as chair, I have seen the landscape in which we work evolve significantly. As we all know our profession is ever changing, and certainly that had a significant contributing factor into the decision-making for me to become a Physiotherapist. A profession that is fast paced and vibrant, with the potential to provide us with a career that can take us in any direction we choose at a moment’s notice, and that’s why I love it.

This year has seen the continuation of talks surrounding legislation within our industry, we have strengthened our links with the Universities providing education, collaborated with other professional organisations to develop educational standards, national frameworks, and supported the delivery of ongoing and varied evidencebased learning to our membership. The ACPAT Committee continue to provide courses and professional development options and are looking to evolve this process to allow it to be more accessible, practical and relevant for our membership’s clinical practice.

ACPAT are committed to giving back to the membership.

This year we have subsidised the in-person seminar costs to enhance participation with in-person learning and facilitate collaboration between our organisation and

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leading speakers in the industry. In addition to this we have lobbied for the CSP to provide us with journal access to the Equine Veterinary Journal (EVJ), and ACPAT have paid for a subscription to the Journal of Small Animal Practice (JSAP) for the small animal members.

My role as Chair of ACPAT has developed me in ways I could never have imagined. My non-clinical, organisational and strategic skills have been tested, alongside my communication skills. I had always prided in this as a strength and attribute of mine and I have enjoyed developing further through engaging and working with such a variety of people.

2025 marks 20 years since I qualified as a Physiotherapist.

I remember discussing my hopes and dreams for my future career in a coffee room as a junior member of staff in the NHS, hoping that one day I might make a small change the landscape for Veterinary Physiotherapy. We are certainly a long way from the end goal but with the legacy of chairs before me we are at least a little closer.

The last 20 years has taught me if we’re passionate about what we believe in, have clear strategic goals and continue to strive for improvement, then progress is possible. This is our moment of opportunity to influence the industry in which we are working in to facilitate progress for the Physiotherapists of the future, and I am so privileged to work alongside the rest of the Committee and our members in doing this. We will eventually see the changes that this industry so desperately needs.

Four Front I The magazine of the Professionals in Animal Therapy

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