Manual Therapy in Post-Surgical Rehab: Where’s the Line Between Help and Harm?

Post-surgical rehabilitation plays a vital role in helping animals return to function, reduce pain, and strengthen musculoskeletal integrity. Among the tools employed, manual therapy – ranging from passive range-of-motion to massage and joint mobilisation – holds promise. Yet, as with any intervention, its use must be grounded in evidence, guided by physiology, and tailored to individual patient needs to avoid harm.

The Physiological Framework

Healing after surgery follows a predictable sequence: inflammation, proliferation, and remodeling. Manual therapy can support recovery, for instance, through gentle joint mobilisation to restore range of motion or massage to mitigate edema and pain, but only when the tissue is past the fragile inflammatory phase (1, 2). As the Veterinary Surgery consensus notes, therapists should reassess frequently and progress treatment based on the individual’s tissue healing and functional status (1).

Benefits of Manual Techniques

  • Passive range-of-motion (PROM) enhances joint mobility and reduces stiffness, supported by studies in Labradors with osteoarthritis (3).
  • Soft-tissue massage can ease pain, boost lymphatic flow, and promote relaxation: core goals in post-op care (4).
  • Hydrotherapy combined with manual support, such as underwater treadmills, is evidenced to accelerate strength and functional recovery after procedures like cruciate ligament repair (2).

Potential Risks and Contraindications

Manual therapy isn’t universally safe post-surgery. Techniques involving thrusts or excessive force can worsen injuries or delay healing, particularly risky in the presence of fractures, implants, or weakened tissues (5). Massage or mobilisation directly over surgical sites during the early inflammatory stage may exacerbate swelling or disrupt tissue repair (6).

Finding the Safe Zone

Timing matters: Initiate manual techniques after the inflammatory phase has subsided, typically days to weeks post-operatively, based on tissue type and healing phase (1)(4).

Client-specific plans: Rehab programs must be individualised, adjusting as healing progresses, aligned with Veterinary Surgery principles (1).

Scope of practice: Veterinarians and Certified Canine Rehabilitation Therapists (CCRTs) or physiotherapists should decide which techniques are appropriate, ensuring they complement diagnostics and overall care (2).

Integrate modalities: Combining manual therapy with therapeutic exercises and modalities like laser or TENS enhances outcomes more than single techniques (7).

When Manual Therapy Crosses the Line

Applying joint manipulation or aggressive soft-tissue work too early.

Treating surgical sites without vet input on healing progress.

Using high-force techniques where gentle methods suffice or where tissue remains vulnerable.

Practicing without ongoing reassessment of risks as healing evolves.

The Role of Osteopathy in Post-Surgical Recovery

Osteopathy, with its emphasis on tissue tension, circulation, and the body’s self-regulating mechanisms, can play a valuable role in post-surgical rehabilitation when applied judiciously. Rather than focusing on symptom relief alone, osteopathic practitioners assess the broader mechanical and physiological context, recognising how surgical trauma may alter fascial dynamics, joint loading, and visceral motion.

Techniques such as gentle myofascial release, balanced ligamentous tension, or craniosacral work may support recovery by improving local circulation, reducing compensatory strain, and enhancing neuromuscular coordination. However, as with any manual approach, timing, pressure, and patient selection are critical. Osteopathy should never be seen as a replacement for veterinary oversight, but as a complementary modality that can help restore functional harmony during and after rehabilitation

Final Thoughts

Manual therapy holds a valuable, evidence-based role in post-surgical reha, but only when applied with clinical acumen. The key lies in respecting physiological timelines, customising care to patient recovery, collaborating across disciplines, and avoiding premature or forceful applications. In that balance, manual therapy transitions from a helpful adjunct to a potential hazard.

Resources for Further Reading

Kirkby Shaw et al., 2019 – Fundamental Principles of Rehabilitation and Musculoskeletal Tissue Healing, Veterinary Surgery. Review of tissue-healing phases and rehab guidelines. Full text available via PubMed Central: https://pubmed.ncbi.nlm.nih.gov/31271225/ animalphysionz.com+4PubMed+4ResearchGate+4

Monk ML, Preston CA, McGowan CM, 2006 – Effects of Early Intensive Postoperative Physiotherapy on Limb Function after TPLOAm J Vet Res. Demonstrated that early physiotherapy improves thigh circumference and joint ROM after surgery. PDF available: https://dogrehabworks.com/ResearchArticles/POCruciateAmJVetRes2006.pdf avmajournals.avma.org+4dogrehabworks.com+4arccarticles.s3.amazonaws.com+4

Pedersen A et al., 2023 – Effect of TENS on Gait Parameters in DogsActa Veterinaria Scandinavica. Showed improved weight-bearing in arthritic dogs after TENS therapy. Full paper: https://www.mdpi.com/2076-2615/14/11/1626

Michael C. Petty, DVM, 2025 – Rehab Therapy in the Post‑op PatientVeterinary Practice News (Jan 24, 2025). A clear overview of multimodal post-op rehabilitation, including laser, massage, and exercise: https://www.veterinarypracticenews.com/post-operative-rehabilitation/

[1]: https://pmc.ncbi.nlm.nih.gov/articles/PMC6973127 “Fundamental principles of rehabilitation and musculoskeletal tissue …”

[2]: https://www.aescparker.com/blog/physical-rehabilitation-to-improve-surgical-recovery  “Physical Rehabilitation to Improve Surgical Recovery – Parker (AESC)”

[4]: https://www.advancesinsmallanimalcare.com/article/S2666-450X(21)00012-2/abstract  “[PDF] Manual Therapy in Small Animal Rehabilitation”

[5]: https://www.merckvetmanual.com/therapeutics/integrative-complementary-and-alternative-veterinary-medicine/manual-therapy-in-veterinary-patients “Manual Therapy in Veterinary Patients – Therapeutics”

[6]: https://pmc.ncbi.nlm.nih.gov/articles/PMC9303706/ “Systematic review of postoperative rehabilitation interventions after …”

[7]: https://www.veterinarypracticenews.com/post-operative-rehabilitation/ “Rehab therapy in the post-op patient – Veterinary Practice News”

What Does ‘Holistic’ Really Mean

Unpacking Misuse in the Animal Health World

“Holistic” is one of those words that sounds inherently good: caring, whole, thorough. It pops up in everything from grooming products to dog food, massage to medicine. But in the world of animal health, its use is often vague or, worse, misleading.

So, what does it actually mean to take a holistic approach to animal care? And how do we separate meaningful practice from marketing spin?

A Whole-System Approach – Not a Wild Guess

At its core, a holistic approach looks at the whole animal, not just isolated symptoms or body parts. It recognises that systems interact: a restriction in the musculoskeletal system might influence behaviour; chronic pain might stem from visceral dysfunction or stress. A holistic therapist asks not just “where does it hurt?” but “why now?”“what else changed?”, and “how does this relate to the bigger picture?”

Importantly, holistic doesn’t mean unscientific. Done properly, it relies on clinical reasoning, careful observation, and a deep understanding of anatomy, physiology, and pathology. It’s not a catch-all for “alternative” or “natural”; it’s a way of thinking.

When ‘Holistic’ Gets Hijacked

The problem is, holistic has become a marketing term. It’s often used to imply care that is gentler, safer, or more “natural”, regardless of whether the practice is supported by evidence or even basic anatomy.

For example, some products or therapies described as holistic may:

  • Lack any proven mechanism of action
  • Make broad health claims without clinical backing
  • Promote unverified protocols as stand-alone treatments while discouraging veterinary input, a practice that can compromise animal safety

That’s not holistic. That’s opportunistic.

True holistic care doesn’t ignore conventional medicine; it integrates it. It values referrals, diagnostics, and collaborative thinking. If your “whole-animal” approach involves ignoring a red flag or skipping a vet check, it’s not holistic. It’s risky.

Holistic ≠ Alternative

There’s a common assumption that holistic means “alternative.” But this sets up a false divide between conventional and complementary care.

Animal osteopaths, physiotherapists, and integrative vets often practise holistically without being “alternative” at all. They use hands-on assessment, understand the interconnectedness of body systems, and work with other professionals to support the whole animal. That’s the essence of a good holistic approach: joined-up thinking backed by real skill.

What Animal Owners Deserve

Animal caregivers are more informed than ever, but also more vulnerable to misinformation. Using the term “holistic” should come with responsibility. Therapists, educators, and brands must be clear about what they mean, what their method involves, and where the boundaries are.

Let’s keep “holistic” meaningful by grounding it in science, collaboration, and clinical clarity, not vague promises or pseudoscience. Our animals deserve no less.

Resources

  1. American Holistic Veterinary Medical Association (AHVMA) – “What is Holistic Veterinary Medicine?” https://www.ahvma.org/what-is-holistic-veterinary-medicine/
  2. Royal College of Veterinary Surgeons – Code of Professional Conduct for Veterinary Surgeons https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/
  3. National Institutes of Health – Complementary, Alternative, or Integrative Health: What’s In a Name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name
  4. Australian Veterinary Association – Integrative Veterinary Medicine
    https://www.ava.com.au/library-resources/clinical-resources/integrative-medicine/
  5. VCA Animal Hospitals – What is Integrative Veterinary Medicine?
    https://vcahospitals.com/encina/specialty/departments/integrative-medicine#:~:text=The%20holistic%20approach%20to%20veterinary,Chiropractic%20treatments
  6. Open Veterinary Journal – “Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum” (2016).https://pmc.ncbi.nlm.nih.gov/articles/PMC4824037/
  7. Merck Veterinary Manual – “Overview of Integrative (Complementary and Alternative) Veterinary Medicine” (revised Sept 2024).https://www.merckvetmanual.com/therapeutics/integrative-complementary-and-alternative-veterinary-medicine/overview-of-integrative-veterinary-medicine
  8. VMA Policy – “Integrative veterinary medicine” from the American Veterinary Medical Associationhttps://www.avma.org/resources-tools/avma-policies/integrative-veterinary-medicine
  9. SGU’s School of Veterinary Medicine Blog – “What Is Holistic Veterinary Care?” featuring Dr. Krause’s viewpoint. https://www.sgu.edu/school-of-veterinary-medicine/blog/what-is-holistic-veterinary-care/

“The Fascia Frontier” A Look at Fascia in Animal Osteopathy

Chris Bates M.Ost DipAOs

In the world of animal therapies and human therapies alike, there is a tissue that has until recent times remained poorly understood. Fascia plays a role in a variety of functions of the body and could also be responsible for some of the positive effects of therapies that we hadn’t even anticipated. Let us take a deeper dive into fascia and discuss the possibilities surrounding this enigmatic tissue.

What is Fascia?

Sometimes referred to as the internal scaffolding of the body, fascia is a thin connective tissue that envelops muscles, tendons, ligaments, nerves, bones, and blood vessels. This wrapping provides structural support for the various tissues of the body and acts as a tensegrity structure (see our previous article, “Tensegrity in Animal Osteopathy”) that dynamically responds to forces to maintain this support.

Fascia is composed of layers. These layers are collagen and elastin fibers with a fluid between them called hyaluronan (hyaluronic acid). This configuration allows for the fascia to move and stretch as you do. There are reasons that fascia can become sticky and fibrous leading to restrictions but we will talk about that later. Healthy fascia is smooth and flexible.

There are different types of fascia:

Superficial fascia – This is the more loosely packed collagen and elastic fibers found directly under the skin and within the superficial adipose layers. These areas of fascia often include contractile muscle fibers too, and include the cutaneous musculature such as the platysma and cutaneous trunci.

Deep Fascia – This type has a more fibrous consistency and is rich in hyaluronan fluid. Deep fascia wraps the nerves, muscles and even sometimes blends with the tendinous attachment to bone. This layer is highly vascularised and also contains developed lymphatic channels making its relevance in Osteopathy clear when we consider our principles of practice.

Aponeurotic fascia – These pearlescent white fibrous sheets of tissue provide wide areas of attachment of muscles and muscle groups. This is a thicker type of fascia that takes higher loads of force than some others, providing broad structural attachment support. Areas, such as the thoracolumbar fascia and some of the limb fascia are aponeurosis.

Epimysial fascia – This is a thinner layer of muscle wrapping fascia that envelops large muscle groups and has septa that delve into the muscle layers, acting as a scaffolding and communicator of forces.

Visceral fascia – Surrounds the organs, such as the pleura of the lungs and the pericardium of the heart.

Parietal fascia – This lines the walls of body cavities.

Fascial tissue is innervated by sensory nerves that supply a range of information. In fact the Deep fascia particularly is innervated with nociceptors, chemoreceptors, thermoreceptors and mechanoreceptors which evidences the tissue playing a vital role in sensory feedback to the central nervous system.

Why does it matter?

Fascia is a reactive tissue, just like the rest of the body. There will be changes in the fascia depending on the forces upon it. In Osteopathy, we seek to balance the forces to allow tissues and systems to reach a place of homeostasis and equilibrium. In the same way that muscle, bone or growths can present a barrier to fluid and neural flow, fascia can create the same problems.

There can be a variety of reasons for fascia to lose its healthy properties and become restrictive. If there is localised trauma, inflammation, or poor fluid transfer, then the fascia can become less flexible and tighten. This could be a secondary issue in relation to another barrier stopping the fascia from getting its adequate input and output, be that fluid transfer or neural.

The animals we treat may be displaying signs of restriction and or discomfort, but there may not be a lameness that the Vet can diagnose. It is not uncommon to find owners calling their Osteopathic practitioners for problems that nobody seems to be able to pin down a cause for. In fact, within the horse industry, veterinary visual assessment interreliability of lameness has been measured as at or below chance level (Starke and Ooosterlinck, 2018).

The signs of fascial dysfunction that owners may notice in their animal could be very subtle, but this is where the owner’s deeper understanding of that animal and their individual personality and behaviours is paramount.

Walking the dog or riding their horse, owners may find that the dysfunction is not enough to be obviously classified as a pain reaction, but simply an alteration from the normal. Dogs may only show signs of fascial disturbance in ranges of movement that are beyond the normal range of usual gait assessment.

This is because canine fascia has been shown in dissection and histology studies to be quite similar to human fascia in that it is looser and less dense than equine fascia (Ahmed et al, 2019).

This development is perhaps due to the wider range of movement that canines have and a greater degree of flexibility. Therefore, while the vet may not find anything by observing them walk, the owner might find that their dog has changed their usual sleeping position for example.

We often see dogs curl into a sleeping position that alters the spinal curves and mechanics of the body beyond their range for normal walking and trotting; this could show dysfunction only when they attempt those positions.

The potential for fascia to be a factor in a more progressive dysfunction is clearly high, as it may not be spotted early and could progress to wider effects throughout the body before being given the attention it needs.

There is also the possibility that fascia becomes a maintaining factor in a pre-existing condition or injury. Fascia may be a part of the dysfunction, but another important factor is that it could be our “way in” when treating as well.

Osteopathy and Fascia

Osteopathy has always been ahead of the curve when considering a more open-minded approach and holistic view of healthcare. Fascia had been previously seen as a rather insignificant tissue by many professionals and considered to be inconsequential to injury or pathology.

However, as many Osteopaths already knew, the devil is in the details; it is often the most seemingly minuscule of observable disruptions that can create the perfect storm for larger, more “loud” symptoms. The old view of fascia was simply that of ignorance of the actual functions it has.

Models of Osteopathic intervention, such as the Cranial Osteopathy of W.G. Sutherland and techniques like balanced ligamentous tension (BLT), were acting upon the fascia in positive ways before the tissue was fully understood (not that it is fully understood yet).

The methods of balancing tensions through the matrix of interwoven collagen fibers and facilitating the perfusion and hydration of fascia could provide a multitude of positive outcomes if the fascia form part of the configuration of dysfunction (which of course it will as the body functions as a unit). It could be said that Osteopathy was ahead of its time in the understanding and treatment of fascial disruption.

The well-honed skill of palpation, which is a hallmark of Osteopathy, gives a vast amount of information regarding fascia. When other approaches miss this aspect of assessment (or at least miss the depth that Osteopathy teaches), they can lose that vital data that informs their planning.

It can be easy to observe only the big movements and ranges when assessing, this is why Osteopathy trains the eye to seek the smallest of imbalance or asymmetry. This, combined with the Osteopath’s ability to gather a full and holistic history of the animal that considers all aspects of their life, Osteopaths have a great chance of finding the fascial disruption that could have been skipped over otherwise.

In Practice

In human studies (of which there are far more than animal ones), it is seen that lesions of the fascial tissue are highly prevalent in cases of muscular injuries associated with sports (Wilke, Hespanhol, and Behrens, 2019). Sports injuries are really just injuries related to either overexertion or repetitive actions, and these are things that animals will also be at risk of. It would be sensible to consider that fascial injuries would be equally prevalent in animal muscular injury.

Clearly the lines of distortion will be different in the animal models due to quadrupedal morphology. Some interesting models of fascial study have been created for animals to gain a better understanding of the forces transmitted through the tissues and how they may become damaged.

Through the dissection of animal cadavers, animal scientists have discovered that there are continuous connections throughout the body that are similar to those found in humans (The Fascia Guide, 2016). These “lines” as they are described are connections far reaching around the body and create a clear and measurable link between parts of the body that may have seemed too remote to have affected each other.

In horses, lines like the Dorsal line, which spans from the distal phalanx of the hind limbs, through the hamstrings, and attaches along the back to behind the jaw, demonstrate the interconnectedness of structures that owners might perceive as functionally separate. In Osteopathy, however, we use this principle of unity already, and our hypothesis is made upon a whole body assessment that will consider these connections.

In practice it is important to remember that these models are exactly that, “Models”. There is no such thing as a text book perfect animal and the unique variations of each individual are what need to be seen in detail.

If it were as easy as looking at the diagrams of fascial lines and deciding symptom “X” equals diagnosis “Y” then anyone with a text book could do it. The reality in practice is that cases will come to us with other practitioners having failed to resolve the issues because of having stuck to models and not principles.

Why the Principles are Important

The holistic nature of Osteopathy encourages us to see the wider picture. When we are assessing our patients, we can use tools such as the “Osteopathic Sieve,” which allows us to narrow down the presentation to certain tissues and then use that as a road map to find out how those tissues can’t cope with the load upon them.

We can “sieve” the nature of the presentation from its character of pain, biomechanical compensations, time scales of dysfunction, etc. This, combined with the knowledge of the structure and interrelated function of all the tissues and viscera, gives us all the clues to find the tissues causing symptoms.

We can then ascertain to what degree the fascia is impacted. Looking deeply enough, we could theoretically say that the fascia will always be affected to some degree when we consider the holistic functional unit of the body that Osteopathic principles teach.

The previous understanding of fascial lines and models is still very useful as we can visualise the state that one may expect in the fascia and then using clinical assessment we can compare that with what we actually find. This comparison can provide a way to measure the potential level of distortion however we shouldn’t be aiming for a visualised perfect, only a balanced and functional pain free “normal”.

From our Osteopathic philosophy, we can see that the state the fascia is in is the state of the body and not just the fascia. This allows us to create a treatment plan that can treat the entire patient and not just aim to “break down” adhesions or restrictions in fascia.

After all, the adhesions and restrictions are entirely correct for the configuration we have presenting in front of us; if we then deliberately remove those adhesions directly, the body will simply repeat itself or find another potentially more dysfunctional configuration.

With our philosophy guiding our treatment, the approach can be less aggressive on individual tissues, and continual palpation of change leads our technique to avoid unnecessary forces.

Technique in Action

I personally have an experience of treating a horse that perfectly captures the nature of fascia and its importance in Osteopathic intervention. The horse in question was a 16-year-old TB X who had been displaying reduced performance in her flatwork undersaddle.

She had been seen by the vet who had been unable to find a specific cause and was suggesting that this could simply be riding related or overuse strain. The vet did not prescribe any medication or suggest any imaging and instead had referred to an Animal Physiotherapist and the Trainer to work together.

The Physiotherapist could not come up with a hypothesis for the riding problems, and the trainer was convinced that it was behavioural problems. When I was contacted by the owner, they were understandably fatigued by the ongoing problem without any ideas as to why.

I came to see the horse with veterinary permission and full cooperation from the Physiotherapist also. My first meeting with the horse was interesting, while there was clear concern from the owner during my case history taking, there was very little found on initial dynamic assessment so I asked to see her riding as this was when the issues were apparent.

Once the owner mounted, there was an instant change in the horse’s posture and behaviour. While many riding concerns show in a certain pace or with a particular exercise, this was clear from the moment the owner’s weight hit the saddle.

The horse instantly shifted her weight to her left. This can happen when mounting as normal from the near side, but the weight remained there rather than simply adjusting from the mounting. Observing the horse from the front, it was apparent that the head and neck had rotated on the frontal/coronal plan by about 5-10 degrees.

As the horse moved off into walk, I could see that the right bend was restricted (possibly due to the coupled motion it would produce), and there was a tendency to hollow the back and neck when making transitions up or down. Protraction of the forelimb appeared weak and lacked length in the cranial phase of all four limbs.

It was palpation that really informed me what was occurring. On returning to the stable to continue assessment, I palpated at the sternum and withers. I could perceive a sensation of fixation through the fascial diaphragm of the suprapleural membrane.

This dense and fibrous fascial layer separates the neck and thoracic cavity, supporting the regulation of cavity pressures. It could be visualised as the “lid” at the top of the ribcage. In Osteopathic palpation, we can develop the skill to detect the vectors of the distortions, including twist, stretch, compression etc. I could feel a left-sided unilateral distortion of twist and adhesion of the fibres in the suprapleural fascia.

I hypothesised that this was creating a left draw on the lower cervical spine, and when the weight of the rider was placed on top, the cavity pressure changes and exacerbates the pattern.

My treatment was very gentle, and using a form of BLT, I used compression of the tissues between my two hands to find the point of least resistance in that fascial layer. Once this point is achieved and held, there can then be a reorganisation of the tissues by the body itself.

This kind of technique can be learned within our masterclasses and courses at the London College of Animal Osteopathy. This treatment was profound in its effects but very gentle.

After the first treatment I suggested some stretching exercises and a limited riding regime that would allow for the pattern to remain unwound. After just three treatment sessions, the issues had fully resolved and the owner was over the moon.

It is clear that Fascia is equally important as the other tissues when assessing and treating. I could have tried articulating limbs and stretching muscles in a reductionist way, but the pattern creating those other restrictions seemed to stem from this fascial disruption.

Now, as this had been ongoing for a while and the owner couldn’t recall any trauma, we may never know what the initial cause of the pattern was. However, at this point (and in my own opinion) it almost doesn’t matter.

Osteopathy helps us to see the whole and the subtle; it trains the hands to perceive the most hidden of dysfunctions. Fascia is a fascinating tissue to study, and we still have yet to learn its full function. The goal is to remember that we are always students of the body, as A T Still said “Keep digging”.

Bibliography:

Ahmed, W., Kulikowska, M., Ahlmann, T., Berg, L.C., Harrison, A.P. and Elbrønd, V.S. (2019). A comparative multi‐site and whole‐body assessment of fascia in the horse and dog: a detailed histological investigation. Journal of Anatomy, 235(6), pp.1065–1077. doi:https://doi.org/10.1111/joa.13064.

Gatt, A., Agarwal, S. and Zito, P.M. (2020). Anatomy, Fascia Layers. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK526038/.

John Hopkins Medicine (n.d.). Muscle Pain: It May Actually Be Your Fascia. [online] www.hopkinsmedicine.org. Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia.

Starke, S.D. and Oosterlinck, M. (2018). Reliability of equine visual lameness classification as a function of expertise, lameness severity and rater confidence. Veterinary Record, 184(2), pp.63–63. doi:https://doi.org/10.1136/vr.105058.

The Fascia Guide. (2016). Fascia in Horses – Danish veterinary exploring uncharted territory. [online] Available at: https://fasciaguide.com/research/fascia-in-horses/.

Turner, S. (2024). Balanced Ligamentous Tension in Osteopathic Practice. Jessica Kingsley Publishers.

Wilke, J., Hespanhol, L. and Behrens, M. (2019). Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury. Orthopaedic Journal of Sports Medicine, 7(12), p.232596711988850. doi:https://doi.org/10.1177/2325967119888500.

Osteopathy in Animal Palliative Care: A Valuable Integration

By Karen Lithgow – London College of Animal Osteopathy graduate, Animal Osteopath and Veterinary Nurse, LCAO Online Study Group Director

Palliative care is often misunderstood as passive or limited to end-of-life scenarios. In reality, it’s about relieving discomfort, supporting function, and preserving quality of life, especially when curative treatment is no longer an option. Osteopathy offers a powerful, non-invasive complement within this care framework.

At the heart of osteopathic medicine lies the belief that the body is an integrated whole, where structure and function are in constant relationship. In palliative care, this philosophy becomes deeply relevant. Gentle osteopathic techniques, such as articular balancing, cranial therapy, and functional techniques, can help reduce tension, ease restricted motion, and support physiological processes that maintain well-being.

A key player in this process is fascia: the dynamic, intelligent tissue that surrounds and permeates every part of the body. Fascia is more than connective tissue; it acts as a messenger, a protector, and a bridge between systems. It carries neurological receptors, facilitates lymph flow, and plays a vital role in the regulation of pain and proprioception. By engaging with the fascia through touch, osteopaths can support the body’s homeostatic mechanisms, even when disease cannot be reversed.

In ageing or chronically unwell animals, dysfunction often develops silently. Owners may report vague changes, such as their animal seeming less engaged, more withdrawn, or wary of being touched. These subtle signs can reflect deeper systemic imbalances. Osteopathy allows practitioners to assess the body manually, identifying areas of restriction, asymmetry, or altered tissue tone; often before these translate into overt pain.

The impact of treatment isn’t confined to the animal. There is a profound emotional dimension to palliative care, and the sense of relief owners feel when they see their animal more comfortable cannot be underestimated. That improved comfort can lead to renewed appetite, mobility, even playfulness; all meaningful outcomes when quality of life is the priority.

Crucially, osteopathy doesn’t compete with veterinary medicine; it supports it. When integrated into a collaborative care plan, it can reduce the burden on pharmacological management, enhance movement, and help regulate internal systems, including the nervous, endocrine, and lymphatic networks.

Osteopathy in palliative care is not about curing. It’s about easing. It’s about noticing what’s been lost and gently helping the body reclaim what it can. It’s a hands-on reminder that even in decline, there can be dignity, comfort, and connection

Not Just a Hose Job: The Right Way to Cool Dogs and Horses in Hot Weather

1 Sep 2025 Canine, Equine

Some myths are hard to kill. Every summer, they resurface, usually in Facebook threads with 150 comments and rising tension.

“Never hose a horse’s back!”

“Don’t pour water on dogs; it traps the heat!”

You’ve probably seen it. Maybe even argued it. So let’s cut through the noise and get down to what actually works, what doesn’t, and when the stakes are high enough to call the vet.

First: Heat Kills, Fast

Hyperthermia isn’t a vague risk. It’s a medical emergency. In dogs, a body temperature above 39.5°C (103.1°F) is considered abnormal, and above 41°C (105.8°F) is classified as heatstroke, with a high risk of organ damage, coagulopathies, and CNS dysfunction (1)(2).

Horses follow a similar pattern. Heatstroke is generally diagnosed when body temperatures exceed 41.5°C (106.7°F), with neurological signs and cellular injury likely to follow soon after (3).

So no, this isn’t just about comfort.

Signs You’re in Trouble

Whether it’s a dog or a horse, these are red flags:

  • Rapid, shallow breathing
  • Bright red (or very pale) gums
  • Weakness, wobbliness, or collapse
  • Vomiting (dogs), diarrhea (sometimes bloody)
  • Seizures or confusion
  • No longer sweating (in horses) despite high effort
  • Red gums/tongue (dogs & cats)
  • Panting (dogs & cats)
  • Drooling (dogs & cats) (9)
  • Collapse

If you’re seeing these? This is not the time to “let them rest in the shade” and reassess later. Call a vet immediately. Start cooling while you wait.

Cool Fast, Cool Properly

Let’s talk methods. Because yes, how you cool matters, but probably not in the way you’ve heard.

Horses: The Continuous Cold Water Debate

Here’s the short version: hosing is good. Repeated hosing with cold water is better. Scraping? Optional. And no, cold water doesn’t cause shock.

A number of studies have confirmed what we now know works: cold water applied continuously and repeatedly is one of the most effective ways to lower core body temperature in horses after exercise in hot conditions (4)(8). And no, you don’t have to avoid the large muscles or scrape between rounds. In fact, scraping actually slows the cooling process.

What to do:

  • Move the horse into the shade
  • Hose cold water over the entire body
  • Repeat continuously until rectal temp drops below 38.5°C
  • Use fans if you have them

Stop scraping. It’s not doing what you think it is. Scraping was useful when water was scarce or hot; today, it just slows you down.

Dogs: Water Is Not the Enemy

The claim that water “traps heat” on dogs? It’s a misinterpretation of evaporative cooling. Sure, if you pour water on and leave it without airflow, it won’t help much. But if you’re using cold water and creating airflow (with a fan, breeze, or toweling), it’s effective (5).

What to do:

  • Get them into shade or air con
  • Soak with cool water: belly, armpits, paws
  • Use a fan or breeze to promote evaporation
  • Offer water to drink (but don’t force it)
  • If temp >40°C (104°F), get to a vet now
  • Cool water immersion if the dog is otherwise young and healthy (9)
  • Hosing with cool water (ensure it is running cool before applying)

Don’t wrap them in wet towels. That insulates heat unless you repeatedly change them. Other methods, such as those listed above, are more effective. And don’t wait for panting to “settle”; panting alone doesn’t cool enough in high humidity. If in any doubt, call your vet immediately as further intervention may be necessary.

Common Myths (And Why They Stick Around)

Some of these beliefs have been around for decades. Let’s unpack a few:

“Cold water causes shock.”
This comes from confusion with immersion shock in humans. Animals don’t respond the same way. Gradual cooling doesn’t increase the risk of shock; it reduces the risk of organ damage.

“Scraping water is essential.”
Only if you’ve got gallons of hot water and no breeze, otherwise, keep spraying (4).

“Cooling must be slow.”
Nope. Rapid cooling saves lives. Delays kill (1)(4).

Other Factors That Raise Risk

Even well-cared-for animals can overheat. But some are more at risk:

  • Brachycephalic breeds (Pugs, Frenchies, Bulldogs)
  • Horses with anhidrosis (poor/no sweating)
  • Obese or heavily muscled animals
  • Thick-coated breeds in humid weather
  • Older or chronically ill animals

And don’t forget: if they’ve overheated once, they’re more vulnerable next time. Heatstroke causes cumulative damage.

Final Thoughts: Don’t Wait to Be Sure

By the time you’re sure it’s heatstroke, you’re probably already late. When in doubt, cool and call. You won’t regret being wrong, but you will regret being too late.

Resources

1. VCA Animal Hospitals. Heat Stroke in Dogshttps://vcahospitals.com/know-your-pet/heat-stroke-in-dogs

2. Pathophysiology of heatstroke in dogs – revisited. PMC, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800390/

3. Marlin, D.J., & Nankervis, K. (2002). Equine Exercise Physiology. Wiley-Blackwell. Summarised in: AAEP Guidelines on Heat Stress: https://aaep.org/horsehealth/heat-stress-horses

4. Marlin, D.J., Scott, C.M., Roberts, C.A., Casas, I., Holah, G., & Schroter, R.C. (1998). Post exercise cooling strategies in hot, humid conditions. Equine Veterinary Journal, 30(S27), 337–340. https://doi.org/10.1111/j.2042-3306.1998.tb04426.x

5. ACVIM / VETgirl. How to Treat Heatstroke in Dogs. VetGirl Veterinary Continuing Education blog. “Heatstroke is defined as a non‑pyrogenic elevation in core body temperature greater than 105.8 °F (41 °C) along with central nervous system dysfunction.” https://vetgirlontherun.com/how-to-treat-heastroke-in-dogs-vetgirl-veterinary-continuing-education-blog/

6. Veterinary Voices UK. Cool, Icy, Cold or Tepid? What’s Best for Heat Stroke? Myth‑Busting blog post, June 26, 2024. “Pour, hose or if possible immerse the pet in very cold water… Do not drape in towels and leave them in situ.” https://www.vetvoices.co.uk/post/cool-icy-cold-or-tepid

7. VetCompass UK – Heat-Related Illness in Dogs: Risk Factors and Clinical Signs. https://www.vetcompass.org/media/1312/heat-related-illness-dogs.pdf

8.Vet Times (2022). Don’t be afraid of the hosepipe – cold water won’t cause shock in horses. https://www.vettimes.co.uk/news/dont-be-afraid-of-the-hosepipe-cold-water-wont-cause-shock-in-horses/

9. Royal Veterinary College (RVC). Heatstroke in Dogs and Cats: Fact File. Royal Veterinary College Small Animal Department. “Dogs and cats can suffer from heatstroke, a life-threatening condition where the body temperature increases … organ failure and even death can occur.” https://www.rvc.ac.uk/small‑animal‑vet/teaching‑and‑research/fact‑files/heatstroke‑in‑dogs‑and‑cats

Red Flags in Animal Osteopathy That Should Trigger Immediate Veterinary Referral

Accurate assessment is critical in animal osteopathy. Sometimes, the most professional decision is knowing when not to treat. If you notice any of the following red flags during your evaluation, referring the animal promptly to a veterinarian isn’t just recommended; it’s essential for the animal’s safety and well-being.

Sudden-Onset, Non–Weight–Bearing Lameness, Especially with Swelling

Non–weight–bearing lameness (when an animal completely stops using a limb) is often a sign of a serious condition such as a fracture, joint dislocation, or cruciate ligament rupture. Even in the absence of visible injury, swelling and heat around the limb further indicate acute injury or inflammation.

VCA Animal Hospitals notes that sudden lameness in dogs is often due to bone fractures, joint injuries, or soft-tissue damage, and cautions against manual treatment without prior imaging. (1, 2).

Point Grey Veterinary Hospital reinforces that non–non-weight-bearing lameness accompanied by swelling or inability to stand should be treated as emergencies requiring veterinary attention (3).

Neurological Signs: Ataxia, Seizures, Behavioural Changes

Signs such as stumbling (ataxia), tremors, sudden seizures, head tilt, or marked behavior shifts suggest neurological involvement; these Conditions require prompt diagnostic workup.

A PubMed case report described a dog presenting with hindlimb ataxia and generalized seizures due to osmotic demyelination syndrome. Diagnosis and treatment occurred only after referral and specialist workup (4).

Veterinary neurology references describe acute onset seizures or ataxia as potential signs of stroke, encephalitis, or spinal cord injury, underscoring the need for immediate veterinary intervention (5).

Rapid Deterioration in Overall Condition

A swift decline in an animal’s health, not always linked to pain, may indicate serious systemic disease such as toxin exposure, internal hemorrhage, endocrine crisis, or infection.

Emergency veterinary resources highlight how acute systemic presentations (e.g., collapse, sudden weakness, stupor) can reflect life-threatening conditions requiring emergency diagnostics and treatment.

Bladder or Bowel Incontinence

Sudden loss of bladder or bowel control often points to spinal cord compression, acute neurologic disease, or pelvic injuries.

Neurological assessment tools emphasise incontinence as a clinical marker for serious CNS involvement, such as myelopathy or intervertebral disk disease.

Persistent or Unresponsive Pain

If an animal continues to exhibit significant pain that doesn’t align with musculoskeletal findings and doesn’t improve with rest, simple exercises, or prior treatments, deeper pathology should be suspected.

Diagnostic guidelines for gait and pain assessment encourage practitioners to pursue imaging or laboratory analysis when pain is unexplained by physical examination alone (6).

Summary Table

Final Word

When clients bring in an animal with any of these red flags, proceeding with osteopathic techniques could compromise patient safety and potentially delay proper diagnosis and treatment. Early recognition and referral preserve professional integrity and, most importantly, protect the animals in your care.

References

1. Lameness in Dogs. VCA Animal Hospitals. Lameness (collapsed, non-weight-bearing lameness). https://vcahospitals.com/know-your-pet/lameness-in-dogs (peakpeturgentcare.com, vcahospitals.com)

2. When Paws Pause: Understanding Limping in Pets & The Diagnostic Journey. Santa Monica Vet. https://santamonicavet.com/when-paws-pause-understanding-limping-in-pets-the-diagnostic-journey/ (santamonicavet.com)

3. Dog Limping Causes. Point Grey Veterinary Hospital. https://pointgreyvet.com/dog-limping-causes/ (pointgreyvet.com)

4. Hindlimb Ataxia Concurrent With Seizures; Osmotic Demyelination in a Dog. PubMed (Case Report). https://pubmed.ncbi.nlm.nih.gov/35782535/ (pubmed.ncbi.nlm.nih.gov)

5. Case Report: Hindlimb Ataxia Concurrent With Seizures by Presumed ODS. ResearchGate PDF. https://www.researchgate.net/publication/361369519 (researchgate.net)

6. Specific Neurological Disorders in Emergency Medicine. Cambridge Handbook of Emergency Neurology. https://www.cambridge.org/core/books/handbook-of-emergency-neurology/specific-neurological-disorders-in-emergency-medicine/28CD83F61C29405A8FFE13951E04140C (cambridge.org)

7. A Systematic Approach to Diagnosing Canine Pelvic Limb Lameness. DVM360. https://www.dvm360.com/view/a-systematic-approach-to-diagnosing-canine-pelvic-limb-lameness (dvm360.com)

8. Orthopedic Conditions of the Canine Limbs. American Physical Therapy Assn. PDF. (orthopt.org)

Headaches and Headshaking in Equine Patients

25 Aug 2025 Equine

Chris Bates M.Ost, DipAO, EEBW, BHSAI

Owners and riders of horses may, at some point, experience the frustration of not knowing what to do in the event of their horse becoming a “headshaker”. There can be many different reasons for horses to head-shake, and so the most important thing is to work with the Vet and other paraprofessionals to ensure a cause (or likely cause) is found.

Head-shaking can become dangerous in extreme cases by unbalancing the horse, leading to potential falls, secondary trauma through head impact, or potentially injuring a handler or rider. The causes of headshaking can also create learned behaviors that become very hard to decondition.

Headshaking 

The presentation of a head-shaker will vary, but many clinical signs are common. Most head shaking will be up and down on the sagittal plane, while some may twist and rotate at the same time.

Sometimes the actual action of the headshake can help to identify a cause and isolate maintaining factors involved. The action of headshaking is sometimes quite violent and sometimes just a bobbing action; however, even the most light of headshaking will, over time, produce secondary concerns.

Veterinary attention will seek to rule out other causes before concluding a headache. It is important to remember that a headache could arise as a result of another initial cause. Some potential triggers for headshaking could include:

  • Mites (in the ear)
  • Otitis media/interna/externa (ear infections)
  • Ocular conditions
  • Guttural pouch infections
  • Dental issues
  • Rhinitis

The list could go on… (Lane and Mair, 1987)

Obvious signs of infection, both clinically observed and through lab testing, would not discount a headache, as pain could be a secondary factor and maintain or exacerbate the head shaking.

The action of headshaking in horses can often become more noticeable or prevalent during exercise, often showing no signs at rest. There may also be a seasonal difference in symptoms, which may indicate an allergic rhinitis present. Around 60% of headshakers have shown spring/summer seasonal worsening of symptoms (Roberts, 2019).

Headaches

There can be a multitude of factors that lead to headaches in horses. The type of headache will depend on the pathophysiology of the causes, but various types can lead to headshaking behaviours.

Potential causes can include:

  • Dental issues
  • Sinusitis
  • Cervical spine dysfunctions
  • Poll issues
  • Meningitis
  • Space-occupying lesions – Tumours, Abscesses
  • Cranial trauma
  • Neuralgia

Clearly, with some causes, lab testing and veterinary clinical examination can make the definitive diagnosis to allow for treatment. However, sometimes the cause or even causes of the headache can be more elusive, and it may require a process of elimination type approach.

Headache pain can be worse on exertion, and so horses may react more when ridden or driven. Even a mild headache can affect the horse when under saddle or in work, and this impact can often be misconstrued as a behavioural issue. Of course, no amount of training will fix a headache.

Central sensitisation

When we consider the reactions of the horse who is suffering from a headache, they may not seem entirely congruent with the present trigger or obvious trauma/condition. This may be due to the pain sensitivity being “dialed up” internally. Central sensitisation is a state of heightened responsiveness in the central nervous system, which can amplify pain signals.

There may not be present inflammation or tissue damage, but hyper-excitability of the nervous system can signal the same level of pain as if there were severe trauma.

The causes are many and complex, and the study of this Nociplastic pain (as it is now often called) is continuous. Hormonal imbalances are sometimes highlighted as a trigger, as are chronic inflammatory states; however, there can be a genetic predisposition or even psychological influences.

One way to imagine the process taking place is to think of the nervous system like pathways through a dense forest. If someone walks a particular pathway every day, treading down the plants and clearing the route, then the pathway becomes easier to navigate. If a nociceptive (pain) pathway is continuously stimulated, then this same phenomenon could be responsible for the increased sensitivity. In this sense, it is easy to see how even a rider’s or handler’s activities around the horse could lead to sensitivities.

Osteopathy for Headache and Headshakers

As discussed in previous articles, and is always the case, a proper veterinary diagnosis is essential before we, as Osteopaths, aim to assess and treat. Vets often refer to Osteopaths and other paraprofessionals for this kind of condition, as a multi-disciplined approach is often the best course of action.

Osteopathic assessment of the horse may be able to isolate a causative factor and maintain factors within the head and neck, and so treatment may be only regional. However, there may be wider factors that the Osteopath can address. There may be postural concerns that are impacting the horse’s head and neck positioning; these could be a result of spinal restriction, foot and limb balance, or an injury.

If the horse’s head and neck position is affected to the point of making compensatory patterns, then this could, in turn, trigger headache pain. There is also the possibility of jaw alignment or the hyoid apparatus being affected by more distal structures due to large muscle connections with the shoulder and neck. Jaw pain or temporomandibular joint dysfunction could trigger headshaking.

The key factor in a treatment being Osteopathic is that it is guided by the principles and philosophy of Osteopathic medicine. The body functions as an interconnected unit, therefore, the practitioner who is aware of this may find triggers and causes that seem as though they would be far removed from the symptomology. It is a case of tracking what is found in a logical way to the presenting complaint.

With the trigeminal nerve being a major factor in a large number of equine headache cases (Newton, Knottenbelt and Eldridge, 2010), the Osteopath may seek to find areas where the path of that nerve is compromised. This perversion of function could be through compression or stretch of the nerve, for example.

Remember that structure and function are reciprocally interrelated. The compression or malposition of the nerve structure will alter the function, resulting in pain or numbness. Various structures can compromise nerve pathways, including muscle, bone, fluid swelling, and space-occupying lesions like tumors.

If we find that neural pathways are being perverted by muscle tension, then we can apply soft tissue release techniques to alleviate pressure on them. To be complete, however, we may want to ask the question “why is this muscle/muscles doing this?”.

There will be a configuration that requires the muscle to be in this state; our work can then seek to discover why. This configuration could be a postural or traumatic positioning that necessitates it, or it could be environmental, such as horses’ feeding position or tack influences.

While a headache that is caused by temporomandibular joint (TMJ) dysfunction may be treated by articulation of the joints, release of the masseter, temporalis, and pterygoid muscles, the actual reason for the joint dysfunction may be further away.

It might be that the TMJ dysfunction is caused by stress and subsequent jaw clenching and tooth grinding. This could be found within the case history and questioning when the owner mentions the horse is grazed alone and spends time walking the fence line, and calling. The practitioner may suggest a gradual introduction of a field companion to allow for natural behaviour to flourish and reduce stress.

What can we do to avoid headshaking?

There will, of course, be some cases of headache and or headshaking that will be beyond our control to avoid, such as traumatic injury or neoplastic (cancer).

Our role as owners and keepers of horses is to ensure that all possible precautions are taken and that any signs of illness are picked up on as soon as possible.

Much of the time, it is education and awareness that help to improve horse care and welfare. Many owners are not aware of the intricacies of tack fitting, and of course, professionals train for years to become proficient in this. Some simple checks can help, however.

  • Check the pressure of the bridle at key points of contact, such as the poll, nose band (if using one), and around the ears.
  • Ask a professional (saddler or trainer) to help you fit the bridle and ensure that the position of all parts are correct.
  • Check for any sharp or irritating parts of the tack, such as loose stitches, sharp edges, and bulky straps.
  • Try different types of bridle sets up and materials to see what suits your horse best.

If your horse is sensitive to dust and pollen, then you may find that keeping your riding or exercise to times of the day when pollen count or dust is lower is best. You could also investigate the use of nose nets or applying pollen capture gels around their nostrils. Nasal irritation can be a cause for headshaking and so try keeping their nose clean with a soft sponge and clean water to gently clean around the other part of their nostrils.

It is good practice to regularly get your horse’s teeth checked by a vet or equine dental technician. Remember, however, that only vets can perform certain dental procedures. Some younger or older horses may need checking on more regular intervals, around 6 months. Other horses may be able to have their teeth addressed annually. The important thing is to ensure you follow the recommendations from your vet.

Having a good grooming routine helps you to investigate your horse’s reaction to touch around the head, check for signs of mites or insect bites, and look for any signs of injuries. Some Osteopaths will suggest scanning with your hands when grooming, as you can pick up things like temperature changes or lumps and bumps. This can often find potential causes of headshaking and headache before they become problematic.

Some owners will keep an equine specific thermometer in their first aid kit, and this can be useful to monitor changes that can occur during infection. Some horses can develop guttural pouch or dental infections, and this can create pain and headshaking.

If you notice signs of swelling around the jaw or face, then this can also be a sign of infection. Other signs to watch out for are general malaise, feeding problems, dehydration, dull coat, and nasal discharge.

Conclusion

There can be very serious health concerns causing horses to head shake. All cases should be checked by the vet first to rule out complications that may need urgent medications or surgery. Even when a serious complication is present, the vet may still recommend the help of an Animal Osteopath. As described above, the best way to avoid this from occurring is generally just good horse husbandry and care. Get to know the horses/’s you care for well and you will notice changes in their behaviour and health very easily.

Bibliography:

LANE, J.G. and MAIR, T.S. (1987). Observations on headshaking in the horse. Equine Veterinary Journal, 19(4), pp.331–336. doi:https://doi.org/10.1111/j.2042-3306.1987.tb01424.x.

Newton, S.A., Knottenbelt, D.C., and Eldridge, P.R. (2010). Headshaking in horses: possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases. Equine Veterinary Journal, 32(3), pp.208–216. doi:https://doi.org/10.2746/042516400776563617.

www.sussexequinehospital.co.uk. (2025). Head Shaking. [online] Available at: https://www.sussexequinehospital.co.uk/en-gb/news-events/factsheets/head-shaking [Accessed 8 May 2025].

Roberts, V. (2019). Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies. Veterinary Medicine: Research and Reports, Volume 10, pp.1–8. doi:https://doi.org/10.2147/vmrr.s163805.

When the Owner Feels Better: Understanding Bias and Placebo Effects in Veterinary Treatment

Exploring Cognitive Bias, Observer Bias, and Non-Specific Treatment Effects in Companion Animal Care

In human healthcare, the placebo effect is well established. But what happens in veterinary care, where the patient can’t speak? While animals may not experience a placebo in the traditional sense, the caregiver placebo effect, observer bias, and non-specific treatment effects all play significant roles in shaping perceptions of success in veterinary treatment.

What is the psychology behind these effects? How they can influence both clinical decision-making and owner satisfaction, and what evidence tells us about reducing bias in animal care.

The Caregiver Placebo Effect: When Owners Perceive Improvement

Animals may not expect a treatment to work, but their caregivers often do — and those expectations can shape what they think they see.

A placebo-controlled study of dogs with osteoarthritis found that while 56% of owners reported improvement in their dog’s condition, only 8% showed objective improvement using force-plate gait analysis (JAVMA, 2012).

This discrepancy highlights how owner belief and hope can lead to overestimation of treatment effectiveness, especially in conditions involving chronic pain or subtle behavioral changes.

Cognitive Biases in Clinical Practice

Veterinary professionals are not immune to bias either. Cognitive biases affect how information is interpreted and can lead to confirmation of what a clinician expects to find.

Key types of bias include:

  • Confirmation bias: The tendency to seek or interpret evidence in ways that affirm pre-existing beliefs
  • Anchoring bias: Relying too heavily on initial impressions or diagnoses, even when new evidence arises

These biases are subtle but powerful. A review by McKenzie (2014) in the Journal of the American Veterinary Medical Association emphasised how they can influence clinical reasoning and lead to overconfidence in unproven interventions (ResearchGate).

Observer Bias in Animal Studies

In studies involving animals, observer bias can lead to misinterpretation of subtle changes in behaviour, gait, or attitude.

A 2014 paper in Applied Animal Behaviour Science showed that observer expectations could significantly distort data collected during behavioral research, especially when outcomes are subjective (ScienceDirect).

Blinding observers to treatment groups is one way to mitigate this, but it’s not always feasible in real-world practice.

Non-Specific Treatment Effects: More Than Just the Medicine

Non-specific effects refer to any improvement not directly caused by the therapeutic agent — for example, the act of doing something, increased attention to the animal, or changes in routine.

A 2017 meta-analysis from BMC Veterinary Research compared conventional veterinary medications with homeopathy and found that non-specific treatment effects contributed significantly to owner-perceived improvements, even when the therapy itself was biologically implausible (PMC).

These findings support the need to separate true treatment efficacy from the “halo” created by the therapeutic encounter itself.

What Can Practitioners Do About It?

Veterinary clinicians and allied professionals can take several steps to minimise bias:

  • Use objective measures: Where possible, rely on tools like force plate analysis, range of motion goniometry, or validated pain scales
  • Blind assessments: Even informal blinding (e.g., different clinicians assessing progress) can reduce bias
  • Manage expectations: Be transparent with clients about expected outcomes and the potential for bias
  • Commit to continuing education: Awareness is the first step toward clinical objectivity

Implications for Canine Practitioners, Equine Specialists, and Animal Osteopaths

Understanding the influence of bias and non-specific effects is especially important for manual therapists like osteopaths, who often work in close partnership with animal owners. In canine and equine osteopathy, treatments typically involve subtle changes in mobility, comfort, and behavior; areas that are inherently difficult to measure objectively and highly susceptible to observational and caregiver bias.

For animal osteopaths:

  • Client education is key. Owners may perceive improvement simply because they believe in the practitioner’s skill or the hands-on nature of treatment. Transparent communication about what signs of change to look for and what timeframes are realistic, helps manage expectations.
  • Objective baselines and reassessment tools, such as video gait analysis, behavioural logs, or validated pain scoring systems, can help practitioners more accurately assess changes over time.
  • Referral and collaboration are vital when progress stalls or red flags appear. Maintaining a clear boundary between manual therapy and medical diagnosis ensures professional integrity and patient safety.

Whether you’re working on a warmblood with sacroiliac pain or a Labrador with lumbosacral discomfort, grounding your practice in evidence and awareness of bias strengthens both outcomes and trust.

While animals don’t experience placebo effects directly, their humans, and sometimes their practitioners, do. Understanding and addressing caregiver placebo, cognitive biases, and observer effects is essential in making veterinary or manual treatment, such as osteopathy, more objective, ethical, and evidence-based.

References

  1. Conzemius, M. G., & Evans, R. B. (2012). Caregiver placebo effect for dogs with lameness from osteoarthritis. Journal of the American Veterinary Medical Association, 241(10), 1314–1319. https://pubmed.ncbi.nlm.nih.gov/23113523/
  2. Brennen A. McKenzie, MA, VMD. (2014). Veterinary clinical decision-making: Cognitive biases, external constraints, and strategies for improvement. Journal of the American Veterinary Medical Association 244(3):271-6 .https://www.researchgate.net/publication/259768660_Veterinary_clinical_decision-making_Cognitive_biases_external_constraints_and_strategies_for_improvement
  3. Sorge, R. E., & Oliver, M. H. (2014). Observer bias in animal behavior research. Applied Animal Behaviour Science, 158, 1–6. https://www.sciencedirect.com/science/article/abs/pii/S000334721400092X
  4. Bergh, A., Lundin, F., & Pettersson, K. (2017). Evidence of placebo effects in veterinary homeopathy: A systematic review and meta-analysis. BMC Veterinary Research, 13, 301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738587/

Beyond the Hips and Elbows: Atypical Presentations of Osteoarthritis in Dogs

18 Aug 2025 Canine

When we think about osteoarthritis (OA) in dogs, our minds often jump straight to the hips and elbows, and with good reason. These are the most commonly affected joints, particularly in breeds predisposed to hip or elbow dysplasia. But OA doesn’t always follow the “classic” patterns. In fact, it can show up in far less obvious places, quietly affecting a dog’s comfort, mobility, and quality of life in ways that are easy to miss if we’re not looking for them.

Let’s take a closer look at the less-talked-about joints, the carpus, hock, digits, and even the spine, and explore how these atypical presentations can subtly change a dog’s movement, behavior, and day-to-day function.

Why Atypical OA Matters

Osteoarthritis is a degenerative joint disease characterised by cartilage breakdown, synovial inflammation, osteophyte formation, and changes in subchondral bone [1]. While large, weight-bearing joints are most often discussed, any synovial joint in the body can be affected. Atypical sites are often overlooked in general practice, especially when signs are mild or masked by compensation.

Carpal OA: The Silent Stiffness

The carpus is vital for shock absorption and flexion during locomotion. Arthritis in this joint may not cause overt lameness early on, but signs may include:

  • Reluctance to jump or go downstairs
  • Reduced range of motion in flexion
  • Stiffness after rest
  • Flattening or “pancaking” of the paw during stance

Radiographic evidence of carpal OA is relatively uncommon compared to hips or elbows, but it does occur, particularly in working dogs or those with a history of repetitive strain or trauma [2].

Hock OA: A Subtle Hind-End Saboteur

The tarsus (hock) is another joint that gets little attention until something goes wrong. Dogs with hock OA may show:

  • Abnormal limb carriage (e.g., toe-touching or inward rotation)
  • Difficulty navigating uneven terrain
  • Decreased propulsion when running or climbing
  • Overdevelopment of compensatory muscles in the lumbar or gluteal region

Hock OA can result from chronic instability, as seen in shelties or collies with tarsal injuries, or post-traumatic arthritis in active breeds [3].

Digits: When the Toes Take the Hit

The interphalangeal joints are small, but they bear significant force with each step. Toe OA often flies under the radar because:

  • Dogs may simply appear “off” without clear lameness
  • Owners may report vague signs like “slowing down”
  • It’s often dismissed as age-related stiffness

Toe OA is particularly common in large breeds, senior dogs, or those with past ligamentous injuries. One study found interphalangeal OA in 13% of dogs undergoing full-body radiographs for unrelated conditions [4].

Axial Joints: Spine and Sacroiliac Involvement

Though technically distinct from appendicular OA, degenerative changes in the spine, including spondylosis deformans and facet joint OA, are increasingly recognised in ageing dogs. These changes can:

  • Mimic hip OA symptoms
  • Cause reluctance to jump or twist
  • Lead to compensatory overload in thoracic limbs

Advanced imaging (CT/MRI) is often required to accurately assess these changes, but clinical suspicion should be high in dogs with back pain, hindlimb weakness, or poor response to traditional OA therapies [5].

Clinical Relevance: What to Watch For

In atypical OA, behavioral and functional changes are often more telling than overt lameness. Watch for:

  • Shifting weight or frequent postural changes
  • Persistent licking or chewing at a limb
  • Avoidance of certain movements (e.g., digging, sharp turns)
  • Reduced performance in working or sporting dogs

Gait analysis, palpation, and range-of-motion testing are essential to pick up subtle deficits. Diagnostic imaging can confirm, but shouldn’t replace clinical insight.

A Multimodal Mindset

Management of atypical OA is similar to classic OA but may require more targeted strategies:

  • Manual therapies (osteopathy, physio, massage) can improve joint mobility and reduce compensatory strain.
  • Low-impact exercise like underwater treadmill therapy helps maintain function without overload.
  • NSAIDs, gabapentin, and disease-modifying osteoarthritis drugs (DMOADs) are often used pharmacologically.
  • Weight management remains critical, especially for distal limb and spinal OA [6].

Final Thoughts

Osteoarthritis in dogs is not always where you expect it, and that’s exactly why we need to stay curious. By widening our clinical lens beyond the hips and elbows, we can catch the quieter forms of OA early and intervene with strategies that truly make a difference.

References

  1. Johnston, S. A. (1997). Osteoarthritis. Joint anatomy, physiology, pathobiology, and basic treatment principlesVeterinary Clinics of North America: Small Animal Practice, 27(4), 699–723. https://doi.org/10.1016/S0195-5616(97)50075-3

  2. Paster, E. R., & Bristol, D. G. (2003). Carpal and Tarsal Joint Disease in Dogs. Compendium on Continuing Education for the Practicing Veterinarian, 25(2), 110–122.
  3. Kapatkin, A. S., et al. (2002). Tarsal osteoarthritis: A retrospective study. Veterinary Surgery, 31(2), 127–132. https://doi.org/10.1053/jvet.2002.31763

  4. Morgan, J. P., et al. (1968). Skeletal dysplasias and arthropathies in the dog. Veterinary Radiology, 9(4), 122–131.
  5. Dewey, C. W., & da Costa, R. C. (2015). Practical Guide to Canine and Feline Neurology. Wiley-Blackwell.
  6. Moreau, M., et al. (2010). Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis. Veterinary Record, 166(3), 72–77. https://doi.org/10.1136/vr.b4713

Celebrating Veterinary Nursing Awareness Month 2025

May marks Veterinary Nursing Awareness Month (VNAM) in the UK, a time dedicated to recognising the invaluable contributions of veterinary nurses. Spearheaded by the British Veterinary Nursing Association (BVNA), this year’s VNAM carries the theme “Progression,” celebrating the evolution and advancement of the veterinary nursing profession over the past 60 years.

The Multifaceted Role of Veterinary Nurses

Veterinary nurses are integral to animal healthcare, performing a wide array of tasks that extend beyond what many might expect. Their responsibilities include:

  • Clinical Expertise: Administering medications, monitoring anaesthesia, assisting in surgeries, and performing diagnostic tests such as X-rays and blood analyses.
  • Preventative Care: Leading clinics focused on nutrition, weight management, vaccinations, and dental health, aiming to prevent illnesses before they arise.
  • Client Education: Acting as a bridge between veterinarians and pet owners, veterinary nurses provide guidance on post-operative care, medication administration, and general pet wellness.
  • Emotional Support: Offering compassion and understanding to pet owners during challenging times, such as dealing with a pet’s illness or end-of-life care.

Celebrating Progress and Dedication

The “Progression” theme not only highlights the expanding roles and responsibilities of veterinary nurses but also underscores the need for continued professional development and recognition. The BVNA encourages the public and veterinary professionals to participate in VNAM by nominating outstanding veterinary nurses or teams as the “diamond in your practice,” celebrating those who exemplify excellence in their field.

The Importance of Recognition

While veterinary nurses are highly skilled professionals, their work often goes unnoticed. A study revealed that although 90.5% of respondents held a positive opinion of veterinary nurses, many lacked a full understanding of their roles. VNAM serves as an opportunity to educate the public about the critical functions these professionals perform daily.(The Veterinary Nurse)

How You Can Participate

  • Share Stories: Use social media to highlight the work of veterinary nurses, using hashtags like #VNAM2025 and #WhatVNsDo.
  • Nominate a Nurse: Participate in the BVNA’s competition by nominating a veterinary nurse or team that has made a significant impact.
  • Educate Yourself and Others: Learn more about the roles of veterinary nurses and share this knowledge within your community.

Veterinary Nursing Awareness Month is a time to acknowledge and celebrate the dedication, skill, and compassion of veterinary nurses. Their contributions are vital to the health and well-being of animals and the peace of mind of pet owners. Let’s take this opportunity to shine a light on their indispensable role in animal healthcare.

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