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

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)

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/

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.

Osteoarthritis in Horses and Dogs

Osteoarthritis in Horses and Dogs: Understanding the Condition and Supporting Long-Term Wellness

May is Arthritis Awareness Month, a time to shed light on one of the most common, and often misunderstood, degenerative conditions affecting animals: osteoarthritis (OA). Whether it’s an aging Labrador struggling to get up or a sport horse becoming subtly uneven under saddle, OA affects quality of life, performance, and comfort in profound ways.

What Is Osteoarthritis?

Osteoarthritis, also known as degenerative joint disease, is a chronic, progressive condition characterised by:

  • Cartilage degeneration
  • Bone remodeling
  • Synovial inflammation
  • Joint capsule fibrosis

Unlike inflammatory arthritis (e.g., immune-mediated conditions), OA is primarily mechanical and degenerative in nature, though inflammation plays a role in its progression [1,2].

Causes of Osteoarthritis in Horses and Dogs

OA typically develops due to a combination of mechanical stress and biological changes. The most common contributing factors include:

In Horses:

  • Wear and tear from repetitive loading (especially in sport horses)
  • Joint trauma (e.g., from poor footing, falls, or intense training)
  • Conformational abnormalities
  • Developmental joint diseases (e.g., OCD, physitis) [3,4]

In Dogs:

  • Hip or elbow dysplasia
  • Cruciate ligament injury (common precursor to stifle OA)
  • Obesity (increased joint load)
  • Poor conformation
  • Aging and general wear [5,6]

In both species, early-life joint stress and inadequate rehabilitation after injury are key contributors [7].

Clinical Signs to Watch For

The signs of OA can be subtle at first, gradually becoming more obvious as the disease progresses:

In Horses:

  • Stiffness when starting work
  • Reduced performance or reluctance to work
  • Changes in movement quality or asymmetry
  • Behavioral changes (e.g., resistance, ear pinning under saddle)
  • Swelling or thickening around joints [8,9]

In Dogs:

  • Reluctance to jump, climb stairs, or get up
  • Lameness or stiffness, especially after rest
  • Decreased activity or play
  • Changes in gait or posture
  • Muscle loss (especially hind limbs) [10,11]

Because OA often progresses slowly, early signs may be dismissed as “just aging”, but early intervention can significantly improve long-term outcomes.

Veterinary Management of Osteoarthritis

Veterinary treatment aims to reduce pain, slow disease progression, and improve function. Key options include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – First-line for pain management.
  • Disease-modifying osteoarthritis drugs (DMOADs) – Including PSGAGs (e.g., Adequan or Cartrophen)
  • Intra-articular therapies – Such as corticosteroids, hyaluronic acid, or regenerative options like PRP and stem cell therapy.Weight management – Essential in dogs.
  • Surgical options – In severe or end-stage cases (e.g., joint replacement, arthrodesis) [12–15].

Regular veterinary check-ups are essential to monitor progression and adjust the plan accordingly.

How Osteopathy and Rehab Therapies Help

Osteopathy offers a gentle, holistic approach to managing osteoarthritis by addressing compensatory patterns, biomechanical stress, and neurovascular imbalances that arise due to chronic joint dysfunction.

Osteopathic Approaches May Include:

  • Myofascial release to reduce tension in surrounding tissues
  • Joint mobilisation to maintain range of motion in unaffected or adjacent joints
  • Visceral and craniosacral techniques where systemic strain is contributing to dysfunction
  • Postural rebalancing to offload affected joints [16,17]

In dogs, osteopathic treatment may focus on pelvic alignment and lumbar strain, particularly in cases involving hip or stifle OA. In horses, attention is often placed on lumbo-sacral compensation, shoulder mechanics, and pelvic symmetry [18].

Complementary Rehab Modalities:

  • Hydrotherapy – Excellent for joint unloading and muscle strengthening
  • Laser therapy – Reduces inflammation and pain
  • Pulsed Electromagnetic Field Therapy (PEMF) – Stimulates cellular repair
  • Therapeutic exercise – Maintains muscle mass and joint support
  • Manual therapies – Including massage, trigger point work, and stretching [19–22]
  • Physiotherapy – including specific rehabilitative exercises

Importantly, rehab should be individualised. What works for one animal may not be appropriate for another, especially in the presence of compensatory injuries.

A Collaborative, Multi-Modal Approach

Osteoarthritis is not curable, but it is manageable. The best outcomes are achieved with an interdisciplinary approach, integrating:

  • Veterinary oversight
  • Bodywork and manual therapy
  • Targeted exercise and rehab
  • Environmental adjustments
  • Owner education and monitoring

Osteopathy fits beautifully into this collaborative model, helping to support biomechanical balance, enhance circulation, and reduce the risk of secondary dysfunctions [23].

Arthritis is not a death sentence, but it is a signal to act. Early recognition, proactive management, and integrated care can help our horses and dogs live more comfortably and remain active well into their senior years.

If you work with animals affected by OA, or have one in your care, consider how your skills and collaboration with veterinary and other animal professionals can make a meaningful difference.

Need help supporting an animal with OA?
Reach out to a qualified animal osteopath or rehab therapist trained to work alongside your veterinary team.

References

  1. Johnston SA. Osteoarthritis: Joint anatomy, physiology, and pathobiology. Vet Clin North Am Small Anim Pract. 1997;27(4):699–723.
  2. McIlwraith CW, Frisbie DD, Kawcak CE. The role of inflammation in equine joint disease. Equine Vet J. 2012;44(2):145–152.
  3. Baxter GM. Adams and Stashak’s Lameness in Horses. 6th ed. Wiley-Blackwell; 2020.
  4. Ross MW, Dyson SJ. Diagnosis and Management of Lameness in the Horse. 2nd ed. Saunders; 2010.
  5. Anderson KL, Zulch H, O’Neill DG. Epidemiology of canine osteoarthritis. Vet Rec. 2020;186(17):564.
  6. Sanderson RO, et al. Systematic review of the management of canine osteoarthritis. Vet Rec. 2009;164(14):418–424.
  7. Innes JF, et al. Pathophysiology and management of canine cruciate ligament disease. Vet J. 2010;184(3):292–297.
  8. Dyson S. Osteoarthritis in the horse. Equine Vet Educ. 2011;23(11):556–567.
  9. Jeffcott LB. Osteoarthritis in the equine carpus. Equine Vet J. 1991;23(1):3–8.
  10. Moreau M, et al. Osteoarthritis in dogs: a review of diagnosis and treatment. Vet Comp Orthop Traumatol. 2010;23(1):1–12.
  11. Mullan RJ, Main DCJ. Behavioural indicators of pain in dogs and cats. J Small Anim Pract. 2006;47(10):535–539.
  12. Vandeweerd JM, et al. Systematic review of efficacy of nutraceuticals in the treatment of osteoarthritis in dogs. J Vet Intern Med. 2012;26(3):448–456.
  13. Caron JP. Intra-articular therapies for osteoarthritis in horses. Vet Clin North Am Equine Pract. 2005;21(3):559–573.
  14. Dycus DL. Medical management of canine osteoarthritis. Vet Clin North Am Small Anim Pract. 2021;51(1):123–143.
  15. Mosley JR. Surgical interventions in canine osteoarthritis. Vet Rec. 2020;186(5):153–154.
  16. Engel BT. Somatic dysfunction and osteopathic manipulative treatment in veterinary medicine. J Am Osteopath Assoc. 2002;102(2):65–69.
  17. Almond AM. Principles of veterinary osteopathy. In: Foundations of Osteopathic Medicine, 3rd ed. Lippincott Williams & Wilkins; 2010.
  18. King JN, et al. Osteopathic approaches to equine performance. J Equine Vet Sci. 2014;34(3):355–361.
  19. Levine D, Marcellin-Little DJ, Millis DL. Canine Rehabilitation and Physical Therapy. 2nd ed. Saunders; 2013.
  20. Clayton HM, Hobbs SJ. The application of biomechanical principles in equine rehabilitation. Vet Clin North Am Equine Pract. 2017;33(1):17–35.
  21. Alves JC, et al. Therapeutic exercise in canine osteoarthritis. Top Companion Anim Med. 2020;39:100432.
  22. Draper WE, et al. Effects of cold laser therapy on pain and inflammation in horses and dogs with OA. Am J Vet Res. 2015;76(9):765–773.
  23. Ricard F, Denoix J-M. Multimodal approach to equine musculoskeletal disorders. Equine Vet Educ. 2016;28(3):139–146.

Joint Problems in Horses: A New Approach from Osteopathy

In recognition of May as Arthritis Prevention Month, Dr. Mario Soriano, DVM and Director of Veterinary Studies at the London College of Animal Osteopathy, explains how incorporating Equine Osteopathy into the maintenance program of sport horses reduces joint injuries, increases recovery rates, and improves the overall well-being of horses.

Valencia, May 5, 2025 — Joint health in horses is undoubtedly one of the most critical issues in modern veterinary medicine, as well as in the sustainability and ethics of equestrian sports disciplines. Joint injuries, inflammation, and degeneration are common causes of pain, poor performance, and, in many cases, early retirement of sport horses.

In this regard, Equine Osteopathy (EO) offers a treatment approach that seeks to understand the animal’s biomechanics as a whole, not merely applying a localized solution to a specific symptom, but also considering what dysfunctions might underlie the pathological processes. Treating the horse as a functional unit through osteopathy allows us to detect joint restrictions that can compromise overall equestrian performance.

Before diving further, let’s first review what osteopathy is and how it works in horses, to better understand how it can support equine joint health.

What is Osteopathy and How Does it Work?

Osteopathy is a manual therapeutic discipline established in 1874 by Andrew Taylor Still, who proposed that structure and function are interrelated in the body, in this case, the horse’s body. EO examines and diagnoses the horse in search of movement disorders in joints, muscles, fascia, and even organs. Its primary aim is to restore balance or homeostasis within the equine body system.

From a neurophysiological perspective, osteopathy works peripherally by directly modulating the autonomic nervous system (ANS) and improving joint proprioception. Studies in humans (Degenhardt et al., 2010) and in animal models such as mice (Licciardone et al., 2012) have shown that osteopathic techniques can reduce inflammation, modulate pain perception, and improve basic vascular trophism.

By acting on neuromuscular reflexes and autonomic regulation, osteopathy in horses achieves systemic effects that directly influence movement quality and pain perception, key factors in managing joint disorders in horses.

In addition, research led by Haavik’s team in humans has shown that spinal manipulations can have a positive effect on the brain’s prefrontal cortex, improving sensory and motor integration. This supports the idea that manual interventions proposed by osteopathy not only have local effects but also influence central nervous system functions, enhancing proprioception and alleviating pain, which is essential when treating horses with joint issues.

Osteopathic manipulations, one of the classic techniques used, restore physiological joint function, improve mobility, reduce capsular stiffness, and facilitate load-bearing mechanics. This, in turn, helps to effectively counteract compensatory overload in other structures that may increase the risk of secondary injuries. This point is crucial, as horses often accumulate many biomechanical compensations over years of training.

How Does Osteopathy Help Manage Joint Conditions in Horses?

EO offers a wide array of techniques and approaches to improve equine joint function. For example, there are techniques that aim to:

  • Restore physiological joint cycles and gait patterns while reducing joint inflammation.
  • Rehabilitate joint proprioceptive functions to improve movement patterns and reduce compensatory strategies that may lead to injury.
  • Stimulate myofascial integration to achieve a more even distribution of mechanical forces.

Over recent years, the experience of thousands of equine osteopaths worldwide has generated strong empirical, clinical, and case-based evidence for the use of osteopathic techniques in treating joint problems in horses. These outcomes have reinforced the validity of the osteopathic profession in addressing these types of equine issues, as also suggested by studies from Burns, Degenhardt, Kramer, Licciardone, and Cerritelli.

One particularly interesting study by Burns et al. (2011) using horses showed that osteopathic manipulative treatments increased flexibility and improved locomotor patterns as assessed through kinematic analysis.

Research in humans and rodents provides data that can be extended to horses. For example, Degenhardt et al. (2010) found that osteopathic manipulative treatments resulted in lower levels of proinflammatory cytokines like IL-6.

Similarly, Licciardone et al. (2012) demonstrated improved joint function and reduced inflammatory response in mice following osteopathic manipulation. In the realm of joint disorders, research by Kramer in osteopathic rheumatology has shown that combining manual therapy with other osteopathic approaches leads to significant improvements in joint mobility and reductions in inflammation in affected joints.

More recently, studies in humans, such as that by Cerritelli et al. (2020), suggest that osteopathic therapy may alter the expression of inflammation-related genes, opening new avenues for research in veterinary osteopathic medicine.

Conclusion

Equine Osteopathy opens an innovative pathway for managing and preventing joint problems in horses. As discussed, the osteopath’s holistic approach, focusing on proactive mobility, neurophysiological regulation, and proprioceptive enhancement, contributes significantly to improving equine joint health.

While much research still lies ahead, preliminary findings, along with clinical and experiential results, increasingly support the use of Equine Osteopathy as an effective and essential therapy for equine athletes.

For more information:
If you’re interested in the postgraduate programs in Equine Veterinary Osteopathy, Animal Veterinary Osteopathy, or Canine Veterinary Osteopathy offered by the London College of Animal Osteopathy, write to: info@aosteocollege.es for Spanish language programs or info@osteocollege.com for English language programs

Not All Wobbles Need a Wiggle: When NOT to Use Osteopathy in Animals

As animal osteopaths, we pride ourselves on our ability to support the mobility, comfort, and well-being of our clients. But effective care doesn’t always mean hands-on treatment. In fact, sometimes the best decision we can make is not to treat, but instead, refer.

Whether it’s a dog presenting with acute lameness or a horse with neurological signs, recognising when osteopathic intervention is contraindicated is not only ethical, it’s critical. Here we take a look at when to say no, why, and how to navigate that decision with clinical confidence.

Understanding Contraindications in Animal Osteopathy

Just as in human healthcare, animal osteopaths must be aware of absolute and relative contraindications. These are conditions where osteopathic treatment is either dangerous or potentially harmful, particularly if pursued in lieu of appropriate veterinary care.

Absolute Contraindications

These require immediate veterinary referral and preclude osteopathic treatment:

  • Fractures (diagnosed or suspected): Manual therapy over an unstable fracture can worsen the injury or delay appropriate treatment (Fossum, 2023).
  • Neurological compromise (e.g., loss of deep pain sensation): Sudden neurological signs should prompt urgent veterinary assessment (Platt & Olby, 2013).
  • Systemic infections (e.g., discospondylitis, Lyme disease): Manipulation in cases of active infection may exacerbate inflammation or pain (Taylor-Brown et al., 2015).
  • Malignancy: Neoplasia, especially osteolytic lesions, is a red flag for manipulation due to fracture risk and tissue fragility (Withrow et al., 2013).
  • Unexplained systemic illness (fever, weight loss, lethargy): These may indicate serious internal conditions not suited to conservative manual care.

Relative Contraindications

These may permit treatment under specific conditions but require prior veterinary evaluation:

  • Pregnancy: While gentle techniques may be appropriate, certain manipulations are contraindicated, especially in small animals or late gestation (Barrett et al., 2019).
  • Osteopenia or osteoporosis: Animals with reduced bone density (e.g., older animals, racing Greyhounds) are more vulnerable to injury from manipulation (Dunn et al., 2007).
  • Coagulopathies: Animals with bleeding disorders may bruise easily or suffer internal hemorrhage from deep tissue work.
  • IVDD (Intervertebral Disc Disease): While osteopathy may assist in the conservative management of mild or chronic cases, acute or severe cases require imaging and stabilisation before manual work is considered (Brisson, 2010).

Red Flags That Should Prompt Referral

Certain clinical signs should immediately prompt a pause in manual therapy and a referral to veterinary care:

  • Sudden, non-weight-bearing lameness

  • Incontinence or loss of anal tone

  • Acute neurological signs (ataxia, head tilt, seizure)

  • Rapid deterioration or progressive weakness

  • Unexplained pain not reproduced mechanically

  • Pain at rest or night pain (suggests non-mechanical cause)

These signs may indicate serious underlying pathology, such as spinal cord compression, neoplasia, or systemic illness, and fall outside the scope of osteopathic care (Jeffcott, 1980; King & Boag, 2007).

The Practitioner’s Dilemma: When Clients Insist on Treatment

It’s common to encounter well-meaning owners who believe their animal “just needs an adjustment.” But their perception may not reflect the clinical picture. Studies show that owner-assessed improvements are often influenced by bias and expectation (Osterås et al., 2022).

When faced with client pressure:

  • Stay factual: Explain why treatment could be harmful or delay necessary diagnostics.
  • Be transparent: Offer a written summary to present to their vet.
  • Maintain trust: Communicate that your decision is in the animal’s best interest, not an unwillingness to help.

Ethical frameworks (e.g., RCVS Code of Professional Conduct; AAEP Ethical Guidelines) clearly state that practitioners must not treat outside their scope or delay veterinary diagnosis by providing inappropriate care.

The Case for Inter-Professional Collaboration

In regions where osteopathy is regulated as a complementary therapy, it is not a substitute for veterinary medicine. This means:

  • Always working under veterinary referral where required.
  • Proactively collaborating with veterinarians to co-manage chronic conditions.
  • Referring animals for diagnostic workup when red flags arise.

Well-managed collaboration benefits the patient, builds trust with local vets, and elevates the credibility of the osteopathic profession.

A good osteopath doesn’t treat every case. They assess, decide, and refer when necessary. Recognising contraindications and red flags is a hallmark of responsible, ethical practice.

Clients may not always understand why “a quick wiggle” isn’t the right choice, but the animals in our care rely on us to know better.

Because sometimes… not treating is the most powerful treatment of all.

References

Barrett, E. et al. (2019). Veterinary Obstetrics and Genital Diseases. Wiley.

Brisson, B. A. (2010). Intervertebral disc disease in dogs. Veterinary Clinics of North America: Small Animal Practice, 40(5), 829–858.

Dunn, M. E., Colborne, G. R., et al. (2007). Osteoporosis in racing greyhounds. Canadian Veterinary Journal, 48(1), 60–66.

Fossum, T. W. (2023). Small Animal Surgery, 6th ed. Elsevier.

Jeffcott, L. B. (1980). Back problems in the horse – A survey of 443 cases. Equine Veterinary Journal, 12(4), 197–210.

King, L. G., & Boag, A. K. (2007). Advances in emergency and critical care medicine. Veterinary Clinics: Small Animal Practice, 37(6), 1231–1247.

Osterås, O., et al. (2022). Owner satisfaction and expectations in canine rehabilitation. Veterinary Record, 190(6), 123–130.

Platt, S. R., & Olby, N. J. (2013). BSAVA Manual of Canine and Feline Neurology. BSAVA.

Taylor-Brown, F. E., et al. (2015). Discospondylitis in dogs: Review of 123 cases. Journal of Small Animal Practice, 56(7), 457–463.

Withrow, S. J., et al. (2013). Withrow and MacEwen’s Small Animal Clinical Oncology, 5th ed. Saunders.

1 2 3 9

Search

+