Physical rehab in vet med

By Deana Cappucci, LVT, CCRVN, CCMT, VTS (Physical Rehabilitation), FFCP

For millions of people in the United States, pets are not just members of the household; they are considered family, and pet owners are willing to provide the care needed for their animals to live long, healthy lives. According to the American Pet Products Association and National Industry Report, 94 million people own at least one pet—a 56 percent increase since 1988.^1,2

Additionally, pet-related spending reached more than $150 billion in 2024, demonstrating how much pet owners prioritize wellness and care for their
animal companions.^1,2

As owners continue to seek out advanced care for their beloved companions, veterinary rehabilitation has become increasingly popular, with an estimated market projection of $3 billion USD by 2034.³

Physical rehabilitation in the practice

Physical rehabilitation in veterinary medicine refers to the management of conditions related to injury or illness that affect the neurologic or musculoskeletal systems.⁴ The goals of physical rehabilitation are to restore tissue function while reducing pain and to promote healing.^5-7 Additionally, physical rehabilitation helps improve strength, balance, and coordination, benefiting patients recovering from surgery, managing chronic diseases, such as osteoarthritis, or facilitating recovery from neurological conditions and tendinopathies.^5,7-9 Physical rehabilitation can also help improve the patient's overall quality of life, which could be why owners are choosing to seek out alternative medicine options for their pets.¹⁰

A physical rehabilitation exam differs from a general exam, where the certified therapist assesses overall function, including strength, flexibility, range of motion, transitional patterns, gait analysis, pain, and functional independence. Every patient receives an individualized plan tailored to their specific therapeutic goals and functional limitations.

Common techniques and modalities

There are many modalities used in physical rehabilitation that help restore function and improve mobility following an injury or chronic condition (Table 1).⁴

Table 1: Common rehabilitation modalities and their benefits

Core rehabilitation modalities include therapeutic exercise and hydrotherapy, which help improve strength and restore mobility. Advanced modalities, such as shockwave and regenerative medicine, address chronic conditions and promote tissue healing.^11,12 Although laser therapy, also known as photobiomodulation, is a common modality used in physical rehabilitation to support tissue healing and reduce pain,¹³ the true art of helping patients through recovery and functional improvement lies in manual therapy techniques performed by skilled professionals who have completed extensive training and certification in animal rehabilitation.¹⁴

Evidence-based practices

Research in veterinary rehabilitation continues to expand across orthopedic, neurologic, soft tissue, and chronic pain conditions. This allows clinicians to select modalities with documented effectiveness for specific conditions.

Post-surgery stabilization

One of the most studied areas of veterinary rehab is cranial cruciate ligament disease (CCLD). Rehabilitation following surgical stabilization of the stifle has been shown to accelerate recovery, reduce pain, and improve long-term function.^15,16 More recently, Rafla et al. (2025) highlighted the value of adjunctive rehabilitation modalities, including hydrotherapy and cold compression, in reducing pain and promoting functional recovery after cranial cruciate ligament (CCL) surgery.¹⁷

Neurologic recovery

Rehabilitation also plays a vital role in neurologic recovery. Martins et al. (2021) demonstrated that intensive neurorehabilitation, comprising locomotor training, electrical stimulation, and pharmaceutical therapy, enabled 99.4 percent of deep pain perception (DPP) positive dogs, and 58.5 percent of DPP negative dogs to regain ambulation post intervertebral disc extrusion surgery. Additionally, the more severe DPP negative cases achieved spinal reflex locomotion within 90 days, which highlights the potential of structured neurorehabilitation to restore movement and some function, even in challenging cases.¹⁸

Orthopedic recovery

Underwater treadmill (UWTM) therapy has been well supported as a rehabilitation modality for orthopedic recovery. In dogs recovering from CCL surgery, researchers found that patients walking in water at or above the stifle significantly increased stifle and hip range of motion and improved gait phase compared to land-based walking.¹⁹ Further studies concluded that adjusting water levels can significantly improve joint range of motion.^20,21

Tissue healing and chronic pain management

Extracorporeal shockwave therapy (ESWT) is commonly applied in cases of tendinopathies, fractures, and osteoarthritis (OA). It has been shown to play a significant role in managing chronic musculoskeletal conditions by promoting tissue healing and alleviating pain.^12,22

OA is among the most widely studied areas of veterinary medicine, and research continues to support multimodal approaches to managing it.²³ OA affects nearly 40 percent of canines²⁴ and 90 percent of cats older than 12 years,²⁵ and is the leading cause of pain in companion animals, affecting their quality of life.²⁶ Physical rehabilitation plays a critical role in managing OA by focusing on reducing pain, strengthening musculature, and preserving joint function.^5,27

Though this review does not encompass all the research on conditions and modalities, ongoing studies in veterinary medicine will continue to broaden the evidence for therapeutic interventions in veterinary rehabilitation.

Client education and involvement

Educating clients on their role in the rehab process is also crucial for optimizing results. Clients can be encouraged to participate in sessions and learn exercises to continue at home, which extends the benefits of rehabilitation beyond the clinic setting.

In one randomized controlled trial of 33 dogs with stifle injury, adding a 12-week progressive home exercise protocol to a standard physical rehabilitation program showed significant improvement in hind limb weight-bearing, reduced pain of the affected limb, and enhanced stifle function compared to rehabilitation alone.²⁸

Beyond exercise, clients are guided on how to recognize signs of pain in their pets and are educated on pharmaceuticals and additional therapies to support comfort and healing. Assisted mobility devices such as slings, harness support, booties, and home modification guidelines are also recommended. Veterinary technicians play a vital role in client education and supporting owners through their pet's rehab journey.

A collaborative effort

Veterinary rehabilitation requires additional training that extends beyond general practice, and some professionals pursue advanced-level board certification.²⁹ Collaboration is vital to achieving successful outcomes. It involves inclusion of a certified veterinary rehabilitation technician or assistant, a veterinary technician specialist (VTS) in Physical Rehabilitation,³⁰ a human physical therapist, or other allied health professionals trained in animal care. Collaboration also extends to primary care and referral clinicians. By working together and maintaining clear communication, coordinated efforts provide medical oversight and specialized training to ensure optimal patient care and recovery. Table 2 reviews the different programs and advanced-level certifications for those interested in pursuing veterinary rehabilitation as their career path.

Table 2: Animal rehabilitation courses and certifications

Table 3: Additional veterinary rehabilitation memberships

The business of veterinary rehabilitation

Clinics that offer physical rehabilitation can generate direct revenue through individual services, such as hydrotherapy, laser, shockwave, and acupuncture, or combine services into comprehensive sessions, which include more than one modality and are often charged based on time.³¹ Additional regenerative modalities, such as platelet-rich plasma (PRP), can also add to the value of hospital revenue, addressing post-surgical, OA, and soft tissue injuries.

As owners seek out more alternative therapies, clinics that offer integrative services are more likely to experience increased client retention and increased demand for complementary supplements that support body wellness and nutritional support.³¹

An industry analysis showed increased visit frequency correlates strongly with annual revenue per patient, more so than high-cost visit fees, suggesting regular structured rehab appointments can contribute to both enhanced patient care and business performance.³²

In summary, veterinary rehabilitation continues to be an emerging field of interest, driven not only by continued research but also by owners seeking additional services to improve the quality of life and extend the longevity of their companions. By embracing innovation, collaboration, and education, the veterinary profession can ensure that physical rehabilitation remains both a science-driven and client-centered part of veterinary medicine.

Clinical case example: Physical rehab at work Duke, a 10.5-year-old male neutered boxer mix, was referred to the West Delray Veterinary Physical Rehabilitation Service located in Delray Beach, Fla., following a suspected acute non-compressive nucleus pulposus extrusion (ANNPE) after becoming acutely non-ambulatory. The MRI report indicated multifocal intervertebral disc protrusions from T12-L4, and there was no evidence of extradural spinal cord compression. Upon presentation, clinical signs revealed non-ambulatory paraparetic with muscle wasting in the pelvic limbs (worse on the left), and Duke was comfortable upon palpation of the spine. The left hind paw had abrasions on the dorsal surface of the digits, so an assistive boot that protects the paw while keeping the digits lifted was applied to prevent Duke from scuffing and exacerbating injury to the digits. Intensive physical rehabilitation was prescribed twice weekly, comprising laser therapy to the spine and affected compensatory muscles. E-stim was applied to atrophied muscles of the left pelvic limb, alternating with the quadriceps, hamstrings, gluteal muscles, and cranial tibialis. Therapeutic exercises were introduced, focusing on proprioceptive neuromuscular facilitation (PNF) training in the pelvic limbs, neurodevelopmental sequencing (NDS), and balance and strengthening exercises to improve core and hind limb muscle strength. Massage and manual therapy techniques were performed on affected muscles and joints to improve flexibility and reduce joint restriction. UWTM was incorporated to assist in gait retraining. Electro-acupuncture was also performed to improve nerve communication. Additionally, a regimented home exercise program was created for the owner to continue between sessions to facilitate a faster recovery. Duke improved in overall functional mobility after eight weeks of therapy and continues to make progress through his recovery. Rehabilitation for ANNPE has been shown to have a direct influence on recovery.33

Deana Cappucci, BS, LVT, CCRVN, CCMT, VTS (Physical Rehab), FFCVP, specializes in canine physical rehabilitation and pain management. Passionate about education, she shares her expertise through peer-reviewed publications, textbooks, and lectures to both the veterinary community and pet parents. Cappucci currently leads the rehabilitation program at West Delray Veterinary in Delray Beach, Fla., and continues to work as an independent consultant and educator within the veterinary community.

References

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