Do you, or have you, taken your dog to physical therapy / rehabilitation?

[Stella]

I have been a 'human' Physiotherapist for 16 years and a canine rehab professional for five years. I am based in Ontario, Canada and, as is also currently happening in California, the veterinary college here is trying to prevent anyone except Veterinarians from being involved in the care of pets. I'm attaching a copy of the info I sent out to my clients. If you are willing, please go to the OVC website and complete the survey, or email them your thoughts if, like me, you believe you don't have to be a veterinarian to provide rehabilitation. Iypt would also be an idea to contact your local vet college / governing body with similar thoughts, it could be your province / state that is affected next. Please help me to keep non-veterinarian rehab professionals involved in the care of your pet.


The College of Veterinarians of Ontario (CVO) is proposing changes to the Veterinarians Scope of Practice, the changes involve the inclusion of Restricted Act that can only be carried out by a Veterinarian. So far so good, right? Unfortunately not, included in these Restricted Acts are many of the skills offered to you by a suitably qualified rehabilitation professional. If these Acts are passed, it will become illegal for anyone other than a Veterinarian to perform tasks such as:

- Communicating a diagnosis, identifying a disorder or dysfunction
- Performing an assessment to determine the fitness or soundness of an animal
- Performing a procedure below the dermis (this includes acupuncture)
- Applying or ordering the application of a form of energy (this includes low level laser)

These rulings will also have implications on the tasks that can be performed by other canine professionals, including trainers, groomers, dentists, massage therapists and chiropractors.

How can you help? I am attaching a letter of response from the Animal Rehabilitation Division of the Canadian Physiotherapy Association, please read this letter the fully understand the situation. Feel free to print and send this letter to the CVO, or to use it to guide your own letter. There is also a survey to complete on the CVO website, again you can use the letter as a guide with your responses.

http://caninefitness.com/index.php?pid=63

http://cvo.org/For-the-Public/Public-Consultations/Scope-of-Practic...

Currently, canine rehabilitation is an unregulated profession in Ontario. I do believe that changes need to be made to make sure that those practicing canine rehabilitation are suitably qualified, but to eliminate all except those that are veterinarians is not the way to go.

Please share thiswith all of your animal owning friends, also feel free to lobby your veterinarian to ask that they support the inclusion of non-veterinarian rehabilitation practitioners in the Restricted Acts.

[Karen, Jasper and Jackdoodle]

JD does go for physical therapy/rehab every week, as you know, and has for many years. He gets cold laser treatment and does exercises, all administered/supervised by rehab techs who are not vets. He's also had massage done by a rehab tech who specializes in that. 

He also gets acupuncture monthly, which is done by a holistic veterinarian. 

However, his initial diagnosis, a herniated disc (L7-S1) with nerve compression was diagnosed by a veterinary orthopedic specialist via MRI, and I really believe that needed to be done by a veterinarian, lol. The specialist then recommended the therapies. Since then, he is seen regularly by the veterinary physical therapy specialist (a vet)  who oversees his program, checks his progress and adjusts his treatment program as needed. 

I do think that it is important for an actual veterinarian to diagnose any type of physical problem before therapy is initiated. 

[Stella]

Hi Karen. As a 'human' Physiotherapist I am legally allowed to assess and diagnose my human clients. With my canine clients I tend to convey a 'clinical impression'.... "what I think is happening is.....". You are right that specialist veterinary diagnosis is sometimes required. However, most general practice vets know very little about musculoskeletal conditions, in fact many rehab vets take courses that were intiallly written by physiotherapists! In my canine practice I always send an assessment report to the dogs vet, and if I feel it is warranted I tell the owner, and tell the vet, that the dog needs to be seen by their vet for further investigation.

Physiotherapists are rehabilitation specialists, it is what we do all day every day, so it totally makes sense for this to be transferred over to the animal world.

[Karen, Jasper and Jackdoodle]

Here is my question. I know for an absolute fact that many if not most orthopedic issues in both humans and dogs require X-ray, ultrasound, or MRI to be accurately diagnosed. Do physiotherapists do these kinds of tests? I'm not really clear on exactly what a "physiotherapist" is, but physical therapists earn MS degrees (post graduate degrees) and must be certified by the state. They do not and cannot order or read these kinds of tests; those tests have to be ordered by MDs or DVMs. Physical therapists are rehabilitation specialists, and it is what they do every day, but they are not the people responsible for diagnosis. Once a diagnosis has been made by a qualified medical practitioner, they are then responsible for designing and implementing a treatment program, sometimes after surgery, sometimes as a way to avoid surgery. I believe the same should be true for dogs; maybe even more so, because they cannot communicate with us about what they are feeling, and as I'm sure you know, they are very good at hiding pain.. 
I agree that most GP vets are not experts in musculoskeletal disorders, but they can do Xrays and ultrasounds, and they can refer to an orthopedic specialist when warranted. I am very glad that JD's GP vet did that for us, because what looked like arthritis on Xrays turned out to be something very different (and much more serious) when the MRI was done. 

[Stella]

May be it is different in the USA? In Canada and in the U.K., where I originally trained as a Physiotherapist, physios can and do diagnose. In fact they have the legal right to do so. In many cases a skilled physiotherapist can accurately diagnose without the need for expensive imaging. There are certainly cases where imaging is required, and in the U.K. 'Human' physios (with extra post grad training) are able to order X-rays, ultrasound scans, MRI's and bloodwork. This is coming in Canada too, but the wheels of beurocracy turn slowly!! You are right, dogs are different in that they can't tell you a history of when and how their pain started, so imaging may be needed more commonly than in people, but there are also many hands-on clinical tests that have very good specificity.

[Karen, Jasper and Jackdoodle]

I have to say that I would not want to be treated for any physical issue without knowing exactly what it is, and having the appropriate clinical testing done, by which I mean Xrays, MRIs, CAT scans, ultrasounds, bloodwork, etc. nor would I want JD treated without all of that. I want the expensive imaging. Maybe it's the fact that I'm a doctor's daughter, but when it comes to health issues, I want to know exactly what is wrong and I want the proof that I believe only this type of testing can give you. There is no possible way that anyone with any level of education or experience could have known what was wrong with JD prior to his MRI, and in fact, both his GP vet and the orthopedic surgeon guessed wrong, because JD is a quirky dog even when it comes to illness, lol. If surgery can fix something, I want that option every time, and I also want medication where appropriate. (And Dog knows, when I've had an orthopedic issue, I sure needed meds just to move.) So I'm glad that in this country, you need an MD or a DVM to diagnose and treat these things. 

[Stella]

We're getting a bit off topic, all I'm trying to do is make people aware that access to rehabilitation for their pet may become limited if these veterinary Colleges gain exclusivity over these services.

But, continuing off topic (lol) you may find this interesting reading.......

http://coloradoinmotion.com/vomit-victim-medical-imaging/

[Karen, Jasper and Jackdoodle]

My own personal experience with a herniated disc just this past summer strongly contradicts this article (written by a P.T., lol). I won't pursue the point and lead this discussion further off-topic, but I simply don't understand how physical therapy could be started without a clear diagnosis and without proper medication. I couldn't even have driven to the therapy facility without a prior week of anti-inflammatory treatment.

I think that the issue you've posted about here regarding these CVO proposals is exclusive to Canada. Here in the U.S., you already need a referral from a DVM to go to the canine rehab facilities, just as you need a referral from an MD to go to the human rehab facilities. 

[Karen, Jasper and Jackdoodle]

I'm also a bit confused about this part of your post:  "These rulings will also have implications on the tasks that can be performed by other canine professionals, including trainers, groomers, dentists, massage therapists and chiropractors."

I don't think groomers or trainers should be giving advice about health or diet. I've heard a lot of bad advice about nutrition and allergies from peoples' groomers and trainers. I sure wouldn't want them recommending treatments for dogs with orthopedic issues, let alone doing them. 

Dentists are vets, at least here in the U.S. JD's holistic vet also does his chiropractic, and I was strongly advised by his orthopedic surgeon to only ever let a veterinarian do that, as certain kinds of orthopedic conditions can be made much worse with chiropractic "adjustments" or manipulations. Veterinary chiropractic doesn't look anything at all like the human kind, at least not in JD's case. 

I should probably add that while my own degree was not in physical therapy, I did do a lot of rehab/therapy work with my clients. I studied human anatomy and physiology extensively in order to be able to do what I did, and I have to say that very little of that prepared me to work with JD on his physical issues. I don't feel at all well versed in canine anatomy, lol, and since dogs can't tell you "It hurts when I do this", I also don't feel qualified to even guess at what might be causing an orthopedic or movement-related problem. 

[BG and Gavin]

To only guess at your first question...I wonder if they are addressing training centres where they have access to water tubs/swim programs for dogs? In a smaller area like our there is no dedicated physio place for dogs, but a larger training/daycare centre can "make it" by doing double duties and providing pool rehab for a small number dogs as well as their training and daycare. Just guessing...

[Karen, Jasper and Jackdoodle]

I think it would be fine to offer canine water therapy/rehab in a daycare/training facility, under the supervision of a trained canine rehab pro, but I do think it should be a vet making the recommendation for that kind of treatment. 

Just like I had clients whose doctors told them to do some exercise to help correct some physical problem, but when the client came to me, they came with a doctor's orders and a diagnosis that told me what needed strengthening or stretching, and what types of movements were contraindicated. 

I had a client once (a young man who was himself in training to do what I did) whose chiropractor told him that the pain in his neck was due to a whiplash injury. Something didn't seem right about it to me, and when I finally convinced him to see an orthopedic MD, it turned out that he had a tumor the size of a golfball in his neck, pressing against the nerves. It was benign, and removed, but there was permanent nerve damage, and the chiropractic "adjustments" he'd been getting had probably contributed to that. Over the years, I had several clients misdiagnosed by chiropractors, but that was the worst. 
(OT but worth mentioning: If anyone ever tells you that you have bones that are "out of place", go see a real doctor, lol.)

[Stella]

I can tell you that most general practice vets have no idea about musculoskeletal pathologies. Nearly every dog that is hind limb lame gets told they have a CCL tear etc etc. I treated a dog that had a lumbar disc problem that had been diagnosed intially by the vet as an abdominal organ problem - because he was standing roached.

Part of the current problem is that canine rehab is unregulated, the CVO's answer to this is to try and take control of the whole field and say that only vets should he doing this. There are many people offering 'rehab' that are not appropriately trained. So, while I agree that something needs to be done, this is not the answer. Would you want your family practice doctor to do your physiotherapy? No, you would want to see a rehabilitation specialist - a Physiotherapist. Why should it be any different for our pets??

If one province or state passes these laws, others will follow (the same battle is currently being caught in California) and a whole world of rehabilitation expertise will be lost to the canine world.

[Karen, Jasper and Jackdoodle]

No, I would not want my family doctor to do my physical therapy; but I would also not want my physical therapist to diagnose my orthopedic issue, lol. I think the issues should be diagnosed by vets, specialists in most cases, and the treatment performed by therapists, both for humans and for pets.

In the case of the dog you treated who had a lumbar disc problem, how was it determined that that is what he had?