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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.
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