Do you think of animals when you hear the words osteopathy, physical therapist, or physiotherapy? Most people do not. Veterinarians, groomers, horse farriers, dog walkers, farmhands, farmers suggest images of animal-related professionals.
However, what about equine physiologists? Canine physiologists? Canine rehabilitation specialists, animal osteopaths, acupuncturists, and others? Some of these roles may be conducted by a veterinarian. Other times, various professionals provide adjunctive services to pets, working animals, and others with special animal training. Together they collaborate with veterinarians to improve the overall health of varied species.
This article aims to demonstrate the difference between two such animal specialties. We will discuss the differences between animal osteopaths and animal physiotherapists (outside the U.S.) or rehabilitation specialists (in the U.S.). Licensed veterinarians can practice these specialties. Often, they obtain special training and certification via veterinary continuing education courses. Or they may be practiced by other professionals with training in animal applications. They may be required to practice under the direct supervision of a veterinarian.
Before embarking on our journey into these animal practices, let's get some nomenclature clarification under our belts.
"Physical therapy," a term protected by law in the United States, and "physiotherapy," protected by law in the United Kingdom, Canada, and other countries, refer to the same specialty. In human medicine, most will recognize it commonly as "P. T.. "Because these terms are protected, veterinary medicine adopted different terminology in parallel with these terms.
In canine and equine medicine, we refer to treatments and exercises used for physical therapy in patients as "canine or equine rehabilitation" or "veterinary physical rehabilitation. "A veterinary specialty evolved over time in the United States to reflect this. In 2010 the first Diplomates for the "College of Veterinary Sports Medicine and Rehabilitation" emerged. This covers small animals broadly and equine practitioners (Medina, 2019).
Meriam's dictionary defines osteopathy as "a system of medical practice based on a theory that diseases are due chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by therapeutic measures (such as use of drugs or surgery)" (Merriam-Webster,2021).
However, osteopathy is much more than that. Andrew Still, osteopathy's founding father, felt that all body systems need to work together. He thought that when any one system was out of balance, the whole "system" or body was out of balance. He found that treating the musculoskeletal system's dysfunction improved the patient's overall health and well-being (Still, 1899).
As a result of his adapting philosophy, Still branched off from the traditional allopathic medicine and developed a new pathway. In the United States, Doctors of Osteopathy, or D.O.s, are medical physicians. They attend a medical school that incorporates the philosophies of Dr. Still into their teachings and ensures that the system's interconnection remains whole. While in other countries, Doctors of Osteopathy diverged and developed on a separate track apart from medical physicians (DeStefano, 2011, p.3; Robinson, 2015).
Manual therapies include any practice that involves the use of one's hands upon the body, with the intent to provide therapeutic aid. This includes physical therapy/physiotherapy, massage, touch therapies, chiropractic, and osteopathy.
Manual therapies vary in how they produce affect. However, they all utilize varying grades of manual pressure in some fashion and create displacement of the soft tissue or joints. All manual therapies seek to encourage and stimulate healing and repair in the body's neuromuscular structures (Haussler, 2009).
Osteopathic Manual Therapies or OMT are defined as "the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function or support homeostasis that has been altered by somatic dysfunction" (Montrose et al.,2021, as cited by Giusti, 2017).
A variety of manual therapies are utilized by osteopaths and may include techniques that are direct and passive, direct and active, indirect, and passive, or a combination thereof. Various indications such as somatic dysfunction (defined below), decreased range of motion, muscle point tenderness, myofascial (connective tissues) abnormalities, or concerns associated with blocked lymphatics may benefit from an osteopath to improve overall physiologic function and restore the body's balance (Campbell et al.,2019, p. 2 Table 1).
Haussler (2009) helps explain somatic dysfunction. "From an osteopathic perspective, somatic dysfunction relates to impaired or altered function of skeletal, articular, myofascial, and related vascular, lymphatic, and neural elements." OMT use a combination of manipulation and mobilization techniques to address the impaired function of the body's musculoskeletal system and address any somatic dysfunction that may have arisen (p. 851). This technique takes the body both in structure and form and helps make it a holistic approach to care.
Over time, animal osteopathy naturally developed due to the rising need for adjunctive therapies to support veterinary medical interventions. At the time of development, people were searching for a whole-body experience. They wanted a holistic approach to medical concerns.
However, it is not a commonly taught concept in veterinary schools in the United States. Developed in Europe, it was established not by a human physician but by a human osteopathic practitioner.
Vetstream (2021) describes the aims of osteopathic medicine well. Goals include
- Improving a patient's quality of life (QoL) boosts the body's overall range of motion whenever possible.
- To restore or improve function to as close to normal as feasible
- To decrease pain
- To improve both postural control and overall posture
The osteopathic practitioner's treatment is geared towards improving the musculoskeletal system's function and establishing a return to normal overall body function. It is not just treatment of the bones or joints as many may think. Many osteopaths find that the first sign of illness in our animals is simply an abnormal gait or a slight lagging with exercise. So those early signs of illness are often detected by osteopaths even when not looking for something systemic.
Equine osteopathy provides pain management therapies, helps prevent injury, improves performance, range of motion, and promotes an animal's overall well-being. It allows horses to perform and function better and stronger by eliminating tense muscles and restricted joints, two commonly seen causes of lameness in horses (Haussler, 2009;OsteoAs Animal Osteopathy, 2019).
Common indications for equine osteopathy (Haussler, 2009;OsteoAs Animal Osteopathy, 2019)
Picture 1. Hand and horse. The power of equine osteopathy. [Digital Photo]. Used with permission by canva.com/design.
- To aid in maintaining soundness for competitions and everyday life
- To assist in both the assessment and treatment of lamenesses
- To assess and treat gait abnormalities
- To aid in the diagnosis and management of arthritis
- To address problems with head carriage
- To address stiffness in various parts of the body (tight ligaments, tendons, muscles, or a combination)
- To address behavioral changes(often abnormal behavior is a sign of pain or underlying disease)
- To provide rehabilitation and improve healing and provide a return to normal function after injuries such as damage to tendons or ligaments
- To improve muscle balance, relieve muscle spasms, and address trigger points, promoting overall muscle health
- To assess for any neurologic imbalances
- To evaluate asymmetry
- To assess for restricted joint movements
- To evaluate for various signs of pain and localize that pain
Techniques used to treat horses, canines, and people include (Haussler, 2009;OsteoAs Animal Osteopathy, 2019)
- Soft tissue releases
- Joint mobilization
- Muscle stretching and or massage
- Joint manipulation
Equine osteopaths form a diagnosis based on a variety of factors. These include the animal's clinical signs, history, general lifestyle (is it a racehorse, a jumper, or a pasture potato). An observational exam will further lead to a diagnosis. This includes having a handler walk, trot and turn the horse in various ways and directions, allowing the osteopath to assess the patient's gait and evaluate soundness. Finally, the practitioner will place a hand on the animal, looking for strains, tension, abnormal musculature, signs of pain, and more (OsteoAs Animal Osteopathy, 2019).
An animal osteopath does much more than evaluate the musculoskeletal system. Because they are well versed in the way the body functions and moves, an osteopath can help identify problems early on before becoming severe (OsteoAs Animal Osteopathy, 2019).
- Back pain
- Neck pain
- Muscular problems including trigger points, muscle tension, and spasms
- Arthritis (hips, elbows, knees); Hip dysplasia (a genetic form of hip arthritis)
- Post-op recovery adjunctive care after orthopedic injuries
- Gait abnormalities
- Stiffness and decreased range of motion
- Myofascial dysfunction(connective tissue) - connects bones, ligaments, tendons, and muscles
- Neurological abnormalities
As an osteopath does with a horse, the canine osteopath will evaluate the patient using a combination of history, visual, and physical assessments to determine the underlying dysfunction and establish a proper treatment plan and course of action. Techniques may include joint mobilization, muscle stretching, range of motion exercises, and even soft tissue release.
Regardless of species, human or animal alike, the goals of rehabilitation (or physical therapy) include (Medina, 2019)
- Decreasing pain
- Restoring the normal body function and biomechanics when feasible or restoring to an improved state
- Promoting wellness
- All in efforts to improve patient's QoL
We commonly use rehabilitation medicine to treat arthritis, muscle, ligament or tendon tears, and myofascial conditions(connective tissue disorders). Sports injuries in working dogs or agility competitors benefit from rehab services. Additionally, painful conditions, both acute and chronic, including spinal diseases, such as intervertebral disc disease(IVDD) or other neurological disorders, may benefit from therapy. Canine Intervertebral Disc Disease (IVDD). Moreover, rehabilitation can be used to help improve the performance of working animals and athletes. Finally, it has an influential role in obesity management in our animals (Gaynor, 2015;Medina, 2019),2019).
Physiotherapy, physical rehabilitation, physical therapy – whatever the jargon may be, the recommendations and practices are universal. While osteopathy is primarily known for hands-on, manipulative therapy, rehabilitation medicine encompasses hands-on and hands-off techniques, incorporating exercise and therapeutic modalities to improve function and QoL.
Manual physical therapy techniques are varied and may include one or a combination of the following, as discussed in Medina (2019)
- Massage: this could be to increase blood flow in the soft tissues. But it can also address trigger points(those knots we all get at times in our muscles that can be very painful and cause pain, refer to other places) and address muscle spasms.
- Joint mobilization: which is the "Gliding of joints in their cranial, caudal, medial and lateral directions to improve joint integrity, joint mobility, and joint lubrication" (2019, p. 2)
- Range of motion exercises
These techniques may also be used in the practice of animal osteopathy.
What rehabilitation utilizes that osteopathy does not is the addition of therapeutic therapies. These aid in numerous ways to address multiple types of pain, cause blood vessels to constrict, decrease swelling, and some may even help reduce inflammation. Additionally, some produce muscle relaxation, decrease muscle spasms and provide pain management.
Therapeutic therapies may include a wide array of mechanical and other aids. Some examples include thermotherapy or cryotherapy(the use of cold or heat to improve circulation, decrease pain and decreases welling), therapeutic ultrasound, even hydrotherapy (water therapy like underwater treadmills) (Gaynor, 2015;Granger, 2016; Lewis et al., 2020; Medina, 2019). Note that some of the therapeutic modalities mentioned above, among the various others used in rehabilitation practice, have varying degrees of scientific-based evidence in support or against their use. Contact your local practitioners to see what they are using now. This may change as more studies become available for review.
Finally, exercise is a big part of rehabilitation medicine. The foundation is basic, returning to the simple act of walking! Sounds easy, right? Walking and the structure to the walking will vary depending on the underlying medical condition and where the patient is physically within the treatment program. Walking around the block, up and down hills or stairs, sitting and standing, and then immediately walking, and using unsteady surfaces to improve balance may aid patients in recovery(Medina, 2019). Additional forms of exercise may be utilized as the patient improves throughout therapy.
A word of caution: Many countries, including the United States and the United Kingdom, have laws governing various medical practices as they apply to both animals and people. Make sure you know the laws in the area where you plan to practice.
Many regions of the world DO NOT permit osteopaths or rehabilitation practices to be conducted on animals without direct or indirect supervision by a veterinarian. In other words, a veterinarian must be involved in any care you give. Be cautious, and do not overstep your bounds.
Finally, when in doubt, always contact a veterinarian or refer the patient to a veterinarian. If your physical assessment suggests systemic disease or warrants imaging or other diagnostics before you initiate therapy, make sure to refer them. Always strive to DO NOHARM and have your patients' best interest at heart.
Osteopathic medicine uses manual therapies, the knowledge of the body's biomechanics, form, structure, and physiology, to address the body's problems. Osteopaths focus on the whole body, despite working on muscles, tendons, ligaments, and the body's external reachable workings. Thus, osteopathy is considered a holistic approach (the whole in relation to its parts). The philosophy developed recognizing that if one can maintain good balance structurally, one can return the balance to the entire person or animal (Meta Med, 2021). Thus, treatment includes not just those areas of the body overtly in pain or diseased, but other areas to help support the body as a whole (Franke et al., 2014).
An osteopath considers the patient's mental state (when feasible), underlying health conditions, presenting complaints, and physical exam and gait findings. With this, a treatment plan develops to address the problem areas and the body as a whole, ensuring restoration of whole-body balance. By considering a patient's total health, (mental health, physical health, and where applicable the spiritual health), Dr. Andrew Taylor Still found that one could provide manual therapies that would benefit not just the musculoskeletal system but the whole body as well (Meta Med, 2021).
To demonstrate this holistic approach, Dr. Still created the four main osteopathic principles, as seen in Figure 1.
Manual therapies used in osteopathy include various techniques to balance the body, from joint manipulation to joint mobilization to multiple types of stretching to myofascial release and more. But because of the osteopath's holistic approach, osteopaths have a secondary role. The obvious one is that of pain management and treatment with a known injury or ailment. However, because of the adept ability to detect delicate nuances in the body, osteopaths are also valuable for a more preventative nature.
Because of an osteopath's extensive training with their hands, they are in-tune with the body. They can detect minor strains or other issues before pain presents itself to the patient. This may provide for a better quality of life. Unlike physical therapy, where the patient presents because of an injury or weakness, it can also offer a holistic approach to wellness and preventative care
Both animal osteopathy and veterinary rehabilitation provide adjunct services to pets, performance animals, and working animals for various ailments. They work in conjunction with medications and other common modalities to improve the QoL of multiple species. They differ in scope, but their ultimate goals are similar. Both strive to restore the patient to the previous form returning them to the most normal function attainable. They hope to improve posture, flexibility, range of motion and reduce adverse effects, including pain, inflammation, muscle spasms, and more.
What path you choose depends on your philosophy and your ultimate goals. For animal osteopathy and animal physiotherapy patients, a thorough evaluation to assess body posture, confirmation, structure, and function helps determine where abnormalities arise. Both specialists perform a physical exam and assessment, including gait analysis, muscle evaluation, and taken with the animal's history, develop a working diagnosis and plan of attack.
Both professions strive to improve the QoL of their patients. However, osteopathy goes a bit further by having a holistic outlook and approach. It provides for the ability to not only treat pain and ailments already present. Still, it can provide a means of identifying problems before they arise, helping to give a better balance to one's overall mental and physical well-being.
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