Journal of Feline Medicine and Surgery (2012) 14, 622632

CLINICAL REVIEW

FELINE PHYSIOTHERAPY
AND REHABILITATION
1. Principles and potential
Brian Sharp

Practical relevance: The rise of animal physiotherapy

Physiotherapy is highly valued
within human medicine and Physiotherapy (or physical therapy) is concerned with physical func-
relatively well established for tion, and considers the value of movement and the optimisation of
canine patients. Despite a physical potential as being core to the health and wellbeing of individ-
popular misconception that feline uals. Although often perceived as an alternative therapy, physiothera-
patients will not cooperate with such py is actually complementary and best used in conjunction with
treatment, physiotherapy is now increasingly being conventional veterinary treatment. The practice of physiotherapy
performed with cats. With cat ownership increasing involves a range of physical modalities used to treat and prevent
in many countries, and an emergence of specialist injuries, restore movement and maximise physical function. For
physiotherapy practitioners, there is demand for humans, the benefits of physiotherapeutic intervention have been well
effective postoperative and post-injury rehabilitation documented within the realms of health promotion, prevention, treat-
for any cat with compromised physical function ment and rehabilitation.1,2 Physiotherapists form an important part
due to injury, surgery or disease. of the human health care team, using problem solving and clinical
Clinical challenges: While physiotherapy and reasoning skills, supported by a sound evidence base, to provide high
rehabilitation are potentially beneficial for cats, due levels of clinical care to ensure optimum outcomes for patients follow-
to their independent nature feline patients certainly ing injury, surgery or disease.
present a greater challenge in the pursuit of In recent years, physiothera- Many techniques, treatments
effective therapy than their canine counterparts. py for animals has enjoyed
Audience: This two-part review article is directed an explosion of interest among and rehabilitation regimens
at the primary care veterinary team. The benefits of the veterinary profession and
physiotherapy and the various treatment modalities
successfully used on human
the pet-owning public. While
available to the qualified veterinary physiotherapist, as research into the benefits of patients have been readily
well as the non-specialist veterinarian and veterinary physiotherapy for animals is
nurse or technician, are examined in this first part. still in its infancy, many tech- adapted for use in animals.
Evidence base: The benefits of human niques, treatments and rehabili-
physiotherapeutic intervention are well documented, tation regimens successfully
and there is good evidence for the effectiveness of used on human patients have been readily adapted for use in animals,
most treatment modalities. Animal studies are still and some preliminary animal studies have shown good results.35
in their infancy, although some preliminary studies In the UK, the practice of physiotherapy on animals is governed
in dogs have shown good results. by the Veterinary Surgery (Exemptions) Order 1962, which permits the
treatment of an animal by physiotherapy as long as that treatment is
provided under the direction of a veterinary surgeon who has exam-
ined the animal and has prescribed the treatment of that animal by
physiotherapy. It is the responsibility, therefore, of the veterinarian to
Part 2 ensure that physiotherapy is carried out by someone fully trained and
Part 2 describes the clinical application of qualified to do so. Recognised qualifications relating to the practice of
a variety of physiotherapy modalities in the
rehabilitation of cats with various orthopaedic
physiotherapy on animals are not legally defined in most countries, so
and neurological conditions. It also discusses
considerations for recumbent and obese cats,
those with compromised respiratory function Brian J Sharp
and those in the intensive care unit. MSc(VetPhys) BSc(Phys) BSc(Biol) PGCertEd
Part 2 appears on pages 633645 of this PGDipHealthEd MCSP HPCReg MACPAT
issue of J Feline Med Surg and at The Queen Mother Hospital for Animals,
DOI: 10.1177/1098612X12458210 Royal Veterinary College,
Hawkshead Lane, North Mymms,
Hatfield, Hertfordshire AL9 7TA, UK
Email: caninephysio@yahoo.co.uk

622 JFMS CLINICAL PRACTICE

DOI: 10.1177/1098612X12458209
ISFM and AAFP 2012
 R E V I E W / Physiotherapy and rehabilitation 1

The success of physiotherapy with cats demands a good understanding

of feline behaviour, coupled with excellent handling skills.

many people have taken on the role of the What about cats?
physiotherapist, often with no formal quali- Cat ownership is increasing in many countries,
fications in physiotherapy. Within small yet, despite this, our understanding and treat-
animal practice both the nurse and the veteri- ment of cats by physiotherapy has lagged
narian have often adopted the role as an adjunct behind that of dogs.810 With treatment
to that for which they have been trained. advances and high costs involved in feline
In the UK, an increasing number of veteri- veterinary medicine and surgery, cat owners
nary practices now collaborate with qualified are beginning to expect similar postoperative
veterinary physiotherapists, and in most cases and post-injury care for their pets as their dog-
decisions regarding appropriate physiothera- owning counterparts.
peutic and rehabilitative care are best made Although cats can benefit from the suitable
through a team approach involving the veteri- application of effective physiotherapy tech-
narian, physiotherapist and nurse, to allow niques and appropriately planned and executed
different perspectives to be aired with the aim rehabilitation programmes, compliance with
of achieving optimum outcomes for the treatment is often less predictable than with
patient.6 Veterinary expertise can establish dogs, and the success of therapy with cats
diagnoses and determine appropriate medical demands a good understanding of feline behav-
or surgical interventions; physiotherapy iour, coupled with excellent handling skills.11 As
expertise can identify associated mechanical with dogs, compliance can often be enhanced
dysfunctions and develop appropriate treat- through the provision of enticing rewards
ment plans for restoring physical function.7 (eg, treats, attention, play opportunities).

Benefits of physiotherapy

Many conditions can benefit from physio-

Indications for physiotherapy therapeutic intervention (see box). One major
and rehabilitation application of physiotherapy in animals is
for postoperative management following
Orthopaedic orthopaedic or neurological surgery,12
Postoperative rehabilitation eg, following fracture treatment, joint although it can also benefit other acute and
surgery, luxation repair, arthrodesis, amputation, ligament/tendon chronic disorders in which surgery is not
repair required (eg, muscle, tendon or ligament
Acute and chronic soft tissue injuries involving muscle, tendon, injuries and arthritis).
joint capsule or ligament (conservative care) Postoperatively, physiotherapy helps to:
Degenerative joint disease (long-term management) Control inflammation, swelling and pain;
Hip dysplasia (conservative care) Promote wound healing and ordered scar
Trauma and wound care formation;
Lumbar, thoracic and cervical pain Promote early weightbearing and prevent
the development of compensatory gaits;
Maintain/restore range of motion (ROM)
Neurological and prevent the development of
Postoperative rehabilitation eg, following spinal decompression adhesions, fibrosis and contracture;
surgery Restore muscle properties (strength,
Intervertebral disc disease (conservative care) endurance, speed of activation) and
Central or peripheral nerve injuries eg, brachial plexus avulsion normalise tone following neurological insult;
Fibrocartilaginous embolism Restore balance and proprioception;
Balance/vestibular problems Promote and restore normal movement
patterns and function;
Improve cardiovascular fitness;
Other Prevent the development of hyperalgesia
Respiratory conditions eg, bronchitis, atelectasis, pneumonia and chronic pain;
Care of recumbent/intensive care unit patients
Maintain bronchial hygiene, eliminate
Pain management secretions from airways, re-expand
Obesity atelectatic lung segments, improve
Depression oxygenation and reduce the incidence of
Geriatric care pneumonia;
Return the animal to optimal function.

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Although valuable postoperatively,

physiotherapy can also have a useful role in Although valuable postoperatively,
preoperative rehabilitation.7,13 In this context
physiotherapy can also have a useful role
it can be used to:
Prepare the animal physically for the in preoperative rehabilitation.
forthcoming surgery (improving muscle
strength and joint stability, ROM, balance
and proprioception); Manual therapy
Familiarise the animal (and owner) with
the exercises required following surgery; There are many manual therapies that can be
Provide the owner with a sense of used on cats. To achieve the most beneficial
involvement and a good feel for the effects they all demand a degree of calmness
commitment that is going to be required and cooperation on the part of the cat so that tis-
following surgery. sues are relaxed during treatment. Cats that are
In some cases, the animal may improve fearful or stressed are likely to benefit less from
to such a degree that surgery is no longer these techniques, although in many cases relax-
required. ation can be achieved as an effect of the tech-
nique itself. Some of the basic techniques
Modalities used in physiotherapy (such as massage, passive movements, stretches
and heat/cold therapy) can be readily learnt by
The techniques and modalities used in veterinarians and veterinary nurses, following
physiotherapy are numerous and varied. suitable CPD training, and incorporated into
Physiotherapists select, prescribe and imple- daily practice. Many other techniques, howev-
ment appropriate modalities when the er, demand specialised physiotherapy training.
examination findings, diagnosis and progno-
sis indicate the use of specific approaches. Joint mobilisations and manipulations
Often a combination of modalities is used, Physiological joint movements (such as
coupled with expert advice (to owners and shoulder flexion, extension, abduction, adduc-
fellow veterinary professionals), to maximise tion, medial and lateral rotation) are routinely
outcomes and return the patient more quickly tested in respect of ROM, pain and laxity.
to optimal function. Although essential for normal physiological
The primary techniques fall into three cat- movements to occur, the so-called accessory
egories: manual therapy, electrophysical and movements (such as the spins, slides and
thermal treatments, and therapeutic exercise. glides that occur between joint surfaces) are
The benefits of these are discussed in turn in rarely tested, yet can often be the cause of joint
the following sections. Importantly, the per- restriction and pain. Accessory movements
formance of any of these techniques demands are unique to each individual joint. Physio-
a thorough understanding of the respective therapists assess these movements and treat
indications, contraindications, physiological any identified dysfunctions to ensure pain-free
effects and practical application. It is outside movement is achieved. Treatment comprises
the scope of this article to cover all these the techniques of mobilisation and manipula-
elements in detail, but further information tion, which should only be performed by
regarding the use of these modalities with someone specifically trained and experienced
animals (together with their contraindica- in using them.
tions) is readily available in other texts.7,9,14,15 Mobilisations are passive movements made
to joints, and are used to reduce pain and
improve ROM (Figure 1). They are performed
mainly as oscillatory movements in either the
physiological or accessory range of a joint.1618
Mobilisations can be performed as low or high
amplitude movements in the direction of the
joint line or to achieve compression or
distraction of the joint surfaces. Joints may be
mobilised individually or synchronously as a
group, as would occur with many traction
techniques. Some techniques allow
mobilisations to be performed alongside
active movements of the joint.
Manipulations are low amplitude, high
velocity thrusts that are performed at the end
Figure 1 Mobilisations of the joint range, and are likewise used to
performed on the cervical
spine for pain relief reduce pain and improve ROM.

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Soft tissue techniques

A wide range of techniques are used to
General effects of massage
mobilise and restore extensibility to tissues,
improve circulation, reduce swelling and pain, Mechanical
and provide sensory stimulation. These include Mobilisation of skin and tissues
massage, soft tissue release, acupressure, Management of scar tissue
myofascial release, trigger pointing, passive Loosening of secretions
movements, stretches, neural mobilisations,
reciprocal innervation, and proprioceptive
neuromuscular facilitation (PNF) techniques. Physiological
Massage is the most commonly used Drainage of venous blood and lymph
technique and involves the therapeutic Afferent input sedative or stimulatory
manipulation of soft tissues and muscle by Pain control via
stroking, kneading and/or percussion. The The pain gate
effects of massage are achieved via various Removal of noxious chemicals (circulatory effect)
mechanical, physiological and psychological Release of endorphins
means (see box). Different types of massage Effects on musculoskeletal system
will achieve very different effects (Tables 1 Reduction of muscle fatigue and delayed onset muscle
and 2), and basic massage techniques can be soreness (DOMS)
easily learnt and used by veterinary staff and
owners. Selection of appropriate techniques
should be based on the individual Psychological
requirements of the animal (ie, desired effect, Reduced tension and anxiety
size of animal and area requiring treatment, Improved relaxation
any pertinent contraindications, etc) (Figure
2). In humans, massage reduces stress and
creates a relaxed state, as well as providing
positive tactile stimulation. In animals, the
effects are largely undocumented to date, benefit most from massage (the frightened
but massage remains useful as a benign, and anxious ones) can find the physical
non-invasive and inexpensive clinical contact involved threatening and
intervention that is generally well tolerated intimidating.19 Nevertheless, in patients with
by cats. Paradoxically, those cats that could restricted mobility, massage is an indispensable

Table 1 Description of various massage techniques

Technique
Stroking Hands glide smoothly over the body, maintaining contact with the
skin. Starts proximally and ends distally when treating the limbs
Effleurage Hands mould to the shape of the limb and maintain pressure
throughout the movement. Starts distally and ends proximally,
moving in the direction of venous and lymphatic drainage
Kneading Tissues are squeezed, compressed and released in a rhythmical
manner. Hands move in a circular motion
Picking-up Muscles are grasped, lifted, squeezed and released
a (squeezing)
Figure 2 (a) Stroking massage is used to calm and relax cats.
(b) Kneading massage to the paravertebral muscles increases
Wringing Hands move in opposite directions across the long axis of the
circulation and relaxes the muscles muscle, stretching the tissues
Skin rolling Fingers and thumb lift the skin, and roll the tissues forwards
or backwards
Frictions Fingers or thumb move superficial tissues over deeper ones, with
increasing pressure
Hacking The ulnar border of the little finger strikes the area being treated.
Hands work alternately (pronation and supination) and fingers are
kept relaxed
Coupage Hands are cupped and wrists are loosely flexed and extended.
(clapping) Hands work alternately and firmly strike the treatment area
Shaking One hand holds the muscle, and vigorously shakes it
Vibrations Hands hold around the area of chest being treated and lightly shake
the chest. Vibrations are performed during the exhalation phase of
b breathing and the hands gradually move cranially

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alternative to active exercise, maintaining Figure 3 Passive

movements in this case,
soft tissue pliability, circulation and sensory to the left shoulder joint
stimulation. into extension. These are
Passive movements are movements of a gentle, safe movements
that just touch onto initial
joint made in a rhythmical manner through resistance or point of
the full pain-free range (Figure 3). Although discomfort

primarily used to maintain or restore joint

range/muscle length, they also aid articular
nutrition, stimulate mechanoreceptors and
reinforce patterns of movement.20 These
techniques are completely passive and
require no active involvement of the animal,
so will not prevent muscle atrophy or
increase strength. They are generally used
to maintain range postoperatively when an
animal is incapable of moving the joint on its
own (following neurological insult or injury) Figure 4 Stretch being
or when active motion may be deleterious applied to the hip flexor
muscles
to the patient. Gait patterning is a form of
passive movement whereby a limb is moved
in a normal walking (bicycling) motion, and
is particularly useful for neurological patients
(see Part 2).
Stretches are also passive movements that
help to improve or restore full range to a joint
or full length to a muscle (Figure 4). Whereas
passive movements create elastic (temporary)
deformation of tissue and maintain normal
length/range, stretches create plastic
(permanent) deformation and an increased
length/range. Long-term effects of stretching
include adding sarcomeres to muscle mass.
Stretching is generally more effective if
preceded by light exercise, massage, heat or therapeutic ultrasound, all of which increase
the extensibility of collagen.
Static stretching utilises a low force that is
Table 2 Benefits of various massage techniques held for a minimum of 30 s (and repeated sev-
eral times). This is a comfortable stretch which
Major benefits Other benefits should not cause tissue damage, and which
Stroking Accustoms cat to touch Useful for starting and finishing allows realignment of collagen fibres. A total
Reduces tension and anxiety massage session treatment time of 2030 mins daily has been
Lowers muscle tone Provides a helpful link between
different techniques
identified as the optimum to achieve improve-
ment.21,22
Effleurage Reduces swelling and Removes chemical by-products
oedema of inflammation
Prolonged mechanical stretching also utilises a
Maintains mobility of soft tissues low intensity stretch with the aid of casts or
Stretches muscle splints (often used serially). This can be con-
Kneading Increase circulation and Remove chemical by-products of tinued for longer periods of time (from 20
Picking-up lymphatic flow inflammation mins to several hours daily).
Wringing Mobilise soft tissues Provide sensory stimulation and Neural mobilisations require detailed
invigoration (fast technique)
Relaxation and lowering of knowledge of the course of nerves, and gentle
muscle tension (slow technique) and precise handling of the limbs to effect
Skin rolling Mobilises skin and scar mobilisation of the required nerve.23 Being
tissue mobile structures, nerves travel through
Frictions Break down adhesions Local hyperaemia various interfaces, and neural mobility can
become compromised through injury, surgery
Hacking Increase circulation
Coupage Sensory stimulation and muscle spasm, which can result in pain
(clapping) Loosen chest secretions and (localised or referred), paraesthesia and a
stimulate coughing (coupage) variety of other sensory aberrations. The
Shaking Increases circulation Provides sensory stimulation successful restoration of adequate neural
Mobilises soft tissues Reduces adhesions mobility has been reported in people using a
Vibrations Loosen chest secretions and combination of joint mobilisations, soft tissue
stimulate coughing treatment and neural mobilisation techniques.

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Electrophysical and thermal

treatments There is published evidence to show that
low intensity pulsed ultrasound accelerates
Many electrophysical agents can be used on
animal patients, including laser, ultrasound, fracture healing.
neuromuscular electrical stimulation (NMES)
and transcutaneous electrical nerve stimula-
tion (TENS). These are all non-painful forms
of treatment and cats are generally tolerant of age) benefit most from a 1 MHz frequency
their use. However, all these modalities pos- whereas 3 MHz is used for more superficial
sess inherent dangers and should only be used treatment (2 cm average), although actual lev-
by operators who have received specialised els of penetration depend on the type of tissue
training. By contrast, the basic techniques of being treated. As the ultrasound waves pass
applying heat (thermotherapy) and cold through the body tissues, energy is absorbed,
(cryotherapy) can be readily learned and incor- particularly by tissues with a high collagen
porated into daily practice by veterinary staff. content such as ligament, tendon, fascia, joint
capsule and scar tissue.29,30 Animal hair
Laser therapy absorbs much of the transmitted energy so
The laser is a form of light amplifier, enhanc- clipping and use of a coupling medium is
ing particular properties of light energy. Many always required.31 Coupling can be achieved
different types of laser are available, but for in various ways to suit the requirements of the
therapeutic purposes class 3A or 3B lasers are individual animal: direct contact using ultra-
used with typical wavelengths of 6001000 sound gel; water bag application using a
nm. The treatment device may be a single Figure 5 Laser therapy plastic or rubber bag filled with warm water
emitter (or probe) or a cluster of several emit- is predominantly used for together with ultrasound gel; and water
pain relief and to improve
ters (cluster probe) with a combination of wound healing. The cluster
immersion, whereby the part is treated under
lasers and light-emitting diodes (Figure 5). probe pictured contains a water and water acts as the couplant.32
Much of the laser light energy combination of lasers and Ultrasound can be used to
light-emitting diodes
is absorbed in the superficial produce thermal, as well as
tissues, and penetration is non-thermal, effects to the body
rarely greater than a few milli- tissues. Pulsed or continuous
metres. However, it is believed modes are available, with
that deeper effects can be pulsed modes used for healing
achieved as a secondary conse- purposes and continuous
quence via a chemical mediator modes used for thermal
system whereby the cell mem- effects.32 If used for its thermal
brane acts as the primary effects, ultrasound should not
absorber of the energy, and then be used over metallic surfaces,
generates intracellular effects as this may intensify and pro-
by means of a cascade-type long the heating effects.
response.24 It has been reported Application of ultrasound
in horses that penetration can during the inflammatory, prolif-
be improved following clipping erative and repair phases of tis-
and cleaning of the area.25 sue healing is of value because
Laser application is predominantly it stimulates or enhances the normal
used for its effects on wound healing, sequence of events and thus increases
inflammatory arthropathies and soft the efficiency of the repair process. It
tissue injury, and for the relief of pain. can influence the remodelling of scar
There is a growing body of evidence tissue by enhancing the appropriate
supporting the clinical use of laser orientation of the newly formed colla-
therapy in humans,2628 but, as with gen fibres and also triggering a colla-
many treatment modalities, evidence gen profile change from mainly type
of its value with animals remains III to a more dominant type I construc-
limited at the present time. tion, thus increasing tensile strength
and enhancing scar mobility.33
Therapeutic ultrasound There is published evidence to show
Ultrasound produces mechanical Figure 6 Therapeutic that low intensity pulsed ultrasound
ultrasound can be applied
vibrations that are the same as sound waves using different size
accelerates fracture healing,3436 and can bene-
but at higher frequencies, beyond the range of treatment heads. Coupling fit many bone-related disorders, including
human hearing (Figure 6). In therapy the mediums can include normally healing fractures, stress fractures,
ultrasound gel (pictured),
frequencies used are typically between 1.0 water or a water-filled and delayed and non-unions. Several of these
and 3.0 MHz. Deeper treatments (4 cm aver- coupling cushion (plastic studies have been performed on animals.3739
or rubber bag)

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Neuromuscular electrical stimulation

The technique of NMES stimulates the motor
nerves and evidence exists for its strengthen-
ing effect and for its ability to prevent disuse
muscle atrophy.40 This is particularly useful for
animals that cannot generate useful voluntary
contraction on demand, and for those that find
active exercise difficult.41,42 There is no evi-
dence that NMES provides any significant
benefit over active exercise, and the treatment
is generally stopped once the animal is able to
exercise actively. This modality can also be
useful for muscle re-education and facilitation
of muscle control, improving sensory aware-
ness, decreasing spasticity and muscle spasm,
and reducing oedema. In a normal muscle con-
traction, type I (slow twitch) postural muscle
Figure 7 Cold compression units are generally regarded as
fibres tend to be recruited first, followed by more effective than most other forms of cold therapy as they
type II (fast twitch) fibres. With NMES this is combine cold with compression. The sleeve is fitted snugly
around the cats limb and filled with ice-cold water from the
reversed, and so it preferentially prevents atro- container. The hose can be disconnected after filling, and
phy of type II fibres.4345 reconnected after treatment to empty the sleeve
To date there have been no studies deter-
mining optimal parameters for NMES in cats,
though best practice guidelines have been Heat and cold therapy
produced in the medical field.46 The use of Heat can be applied superficially (12 cm) via
NMES requires clipping of fur, cleaning of hot packs, baths/spas and hosing, or more
skin and the use of conductivity gel to max- deeply (4 cm or more) using therapeutic ultra-
imise contact between the electrodes and the sound. In small animal practice, superficial
skin. heating is most commonly used. This is partic-
ularly useful for subacute and chronic condi-
Transcutaneous electrical nerve tions where there is a reduced ROM due to
stimulation stiffness or contracture; to relieve pain; and as
TENS provides symptomatic pain relief by a prelude to passive movements, stretches or
specifically exciting sensory nerves and there- exercise by improving collagen extensibility.
by stimulating the pain gate mechanism Hot packs should be used at a comfortable
and/or the endogenous opioid system. Pain temperature, wrapped in towelling to avoid

involves activation (excitation) of the A sen-

relief by means of the pain gate mechanism burns and should be applied for 1020 mins.
Cold penetrates deeper and lasts longer
sory fibres, and subsequent reduction of than heat and is most effective when used in

fibres. The A fibres respond most effectively

noxious stimuli transmission from the c pain the first few days after trauma (accidental or
surgical). During this acute phase of inflam-
to a relatively high rate of stimulation (90130 mation it provides analgesia, reduces inflam-
Hz). The alternative approach is to stimulate mation and swelling, controls bleeding and
the A fibres, which respond preferentially to reduces muscle spasm. Cold can be applied
a much lower rate of stimulation (25 Hz). using cold packs and cold compression units
This provides pain relief by causing the (Figure 7), and treatment should be limited to
release of an endogenous opiate (encephalin) 1015 min sessions. This can be repeated
in the spinal cord, which in turn reduces the every 2 h if necessary (for severe injuries), but
activation of the noxious sensory pathways.47 for most postoperative/injury applications it
As with NMES, the use of TENS requires is suggested that cold therapy is given every
clipping of fur, cleaning of skin and the use of 34 h. Superficial tissues show the most rapid
gel. TENS electrodes can variously be located cooling and rewarming effects; the deeper
around the painful site, at the relevant nerve intramuscular tissues respond more slowly
root, along the peripheral nerve supplying the and may take as long as 60 mins to return to
painful area, and over trigger/acupuncture baseline temperature after a 10 min applica-
points.48 tion of a cold pack.49

The basic techniques of applying heat and cold can be readily learned
and incorporated into daily practice by veterinary staff.

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Forms of therapeutic exercise

Strengthening
Strength is the ability of a muscle or muscle
group to produce tension and a resulting
force. Exercises to improve strength create
an increase in the myofibril component of
the muscle, thereby increasing the cross-
sectional area of the muscle. Strengthening
exercises include such activities as running,
slope work (uphill and downhill), use of leg or a b
body weights, dancing, wheelbarrowing and Figure 8 Strengthening exercises such as dancing (a) and wheelbarrowing (b) allow
swimming. limbs to be exercised against the cats bodyweight

Flexibility
Flexibility describes the capacity of the
muscles, tendons and ligaments to stretch,
allowing the joints to have a larger ROM,
and the cat to be able to manoeuvre through
awkward spaces. Flexibility is important for
cats as it also helps to protect against injury.
Flexibility exercises include activities that make
a b
the cat reach or stretch for something, or
encourage crawling under, through or over Figure 9 Flexibility exercises such as baiting (a) and step-overs (b) help restore
or improve ROM to joints. Baiting primarily exercises the spinal joints, and assists
obstacles. balance retraining; step-overs also assist with balance and gait re-education

Balance and proprioception

Balance is the ability to adjust equilibrium at a stance (static balance) or during locomotion (dynamic balance) to take
account of changes in direction or ground surfaces. Proprioception is the unconscious perception of movement and spatial
orientation originating from the body. It is the bodys way of knowing where all its different parts are and what they are doing.
Proprioception diminishes with age, and is also affected by injury or surgery, especially following neurological damage.
All cats need good balance and proprioception to function normally. Balance exercises include activities requiring rapid
responses to changes in supporting surface (eg, wobble cushion, balance pad,
trampoline) and changes of direction when moving, as well as playing with toys, dancing
and standing on a gym ball. Proprioception exercises include weight shifting, walking
in circles or weaving, walking over obstacles of various shapes, height and spacing,
and walking over different terrains.

a b c

Figure 10 Balance is especially important for cats, and exercises to improve static balance include the use of unsteady surfaces such as bean bags,
trampolines or wobble cushions (a). Playing with toys (b) provides dynamic balance training, while treats (c) can be used to offer particular challenges

Endurance
Endurance allows animals to perform activities for prolonged periods of time without tiring. Exercises to improve aerobic
endurance usually target muscle groups for periods exceeding 15 mins, and are repeated several times each week. Long-
term changes occur in muscle, including increased vascularisation, alongside decreased resting heart rate and increased
stroke volume (allowing greater time for ventricular filling), decreased resting blood pressure and increased respiratory
enzymes. Endurance exercises are less relevant to cats, which rely more on stealth and rapid movements to catch prey.

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Therapeutic exercise (Figure 13). Additionally, the presence

Benefits of the owner can often provide confi-
Exercise represents the final element Therapeutic exercise dence and reassurance to nervous cats.
in the process of helping an animal may be used to improve: At no time should any animal be left
Aerobic capacity and endurance
achieve optimum function following unattended during a hydrotherapy ses-
Agility, coordination and balance
injury, surgery or disease and is used sion, because water aspiration and
to: drowning are real risks.
Prevent long-term physical
(static and dynamic)
Gait and locomotion
Postoperatively, hydrotherapy may
Neuromuscular capability and
impairment; be employed as soon as the surgical
Enhance function; incision has established a fibrin seal
Reduce the risk of injury and
movement patterning
Postural stabilisation
(generally 4872 h post-surgery),
Range of motion
re-injury; although in practice most hydrothera-
Optimise overall health; Strength and power
py with dogs is started 23 weeks
Enhance fitness and wellbeing. following surgery.4,5

Types of exercise
Exercise can be divided into four principal
types (see box on page 629):
Strengthening (Figure 8);
Flexibility (suppleness) (Figure 9);
Hydrotherapy should not be
Balance and proprioception (Figure 10); automatically dismissed as an option,
Endurance (stamina).
All therapeutic exercise programmes should as it is certainly achievable with some cats.
be tailored to the animal and comprise a com-
bination of the four types, dependent on the
individuals needs.

Land-based exercise
Land-based exercises should form the major
component of exercise programmes designed
for cats because, being land animals, they
must obviously be able to cope with life on
land. In many cases cats may be more accept-
ing of exercises that involve less manual con-
tact from the therapist (or owner) see Part 2
for examples.

Water-based exercise
Hydrotherapy is one of the most useful forms
of rehabilitation therapy, and has become a
very popular modality for dogs to help in
the recovery of musculoskeletal and neurolog- Figure 11 Hydrotherapy can be successfully carried out with cats, whether in a pool or a
ical conditions. Water provides an ideal envi- water treadmill. Too weak to support itself on land, this cat is able to mobilise normally in the
treadmill due to the buoyancy provided by the water. Courtesy of Simon Jacobs
ronment for performing non-concussive
active exercise, and through its natural prop-
erties (buoyancy and resistance) can help
improve limb mobility, strength and joint
ROM.50
In practice, hydrotherapy is performed less
often with cats, but it should not be automati-
cally dismissed as an option as it is certainly
achievable in some cases (Figure 11). There are
several forms of hydrotherapy, including
pools and water treadmills. The therapist
should accompany the cat into the water to
provide assistance and reassurance until it is
accustomed to the activity (Figure 12).51 In the
authors experience a cat may be more accept-
ing of water if it is initially introduced to it in Figure 13 Accustoming a cat to the
the home environment (bath or sink), as a normal processes of bathing and
gradual progression from being bathed to Figure 12 Comfort and reassurance can be very drying can aid eventual introduction
beneficial when introducing cats into water. Courtesy of to more formal hydrotherapy
being rehabilitated is often more acceptable Sam Jacobs sessions. Courtesy of Sam Jacobs

630 JFMS CLINICAL PRACTICE

 R E V I E W / Physiotherapy and rehabilitation 1

Exercise considerations
The design of an appropriate exercise programme must take account of the current physical abilities of
the cat, stage of recovery/healing and the desired outcome. If assistance is required for the animal to
perform an exercise, this can be provided manually or with the aid of physio-rolls, slings, harnesses or
carts (Figure 14). Exercises must meet the specific needs of the individual animal, with progression
applied to the programme (increasing the difficulty of the exercise as the animal achieves each stage),
as appropriate.

a b

Figure 14 The use of a physio-roll (a) and harness (b) provides sufficient support to allow the cat to perform exercises and
activities it would otherwise be unable to do

Conclusion
and quality of life after first total knee arthroplasty: a single
The recent surge of interest in physiotherapy and rehabilita- blind randomised controlled study. Arch Phys Med Rehabil 2004;
tion within small animal practice has provided the veteri- 85: 546556.
narian with many challenges and among these is the poten- 3 Millis DL, Levine D and Brumlow M. A preliminary study of
tial to provide therapy to cats. A belief that cats will not early physical therapy following surgery for cranial cruciate
cooperate with therapy is restricting its use and, although ligament rupture in dogs [abstract]. Vet Surg 1997; 26: 434.
evidence of the value of physiotherapy and rehabilitation 4 Marsolais GS, Dvorak G and Conzemius MG. Effects of post-
for cats is limited at present, there is an increasing evidence operative rehabilitation on limb function after cranial cruciate
base in the canine field, and a sound evidence base for the ligament repair in dogs. J Am Vet Med Assoc 2002; 220: 13251330.
use of these modalities in humans. There seems no moral 5 Monk ML, Preston CA and McGowan CM. Effects of early inten-
justification, therefore, in withholding these therapies for sive postoperative physiotherapy on limb function after tibial
cats in the absence of species-specific clinical trials. plateau levelling osteotomy in dogs with deficiency of the
To treat cats effectively and safely requires a good knowl- cranial cruciate ligament. Am J Vet Res 2006; 67: 529536.
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S and Watson P (eds). BSAVA manual of canine and feline rehabil-
Funding itation, supportive and palliative care (case studies in patient
management). Gloucester: BSAVA Publications, 2010, pp 90113.
The author received no specific grant from any funding agency in the 8 Case LP. Felis silvestris to Felis catus: domestication. In: The cat:
public, commercial or not-for-profit sectors for the preparation of this its behavior, nutrition & health. Iowa: Iowa State Press, 2003,
review. pp 311.
9 Millis DL, Levine D and Taylor RA. Canine rehabilitation and
Conflict of interest physical therapy. St Louis: Saunders, 2004.
10 Murray JK, Browne WJ, Roberts MA, Whitmarsh A and Gruffydd-
The author does not have any potential conflicts of interest to declare. Jones TJ. Number and ownership profiles of cats and dogs in the
UK. Vet Rec 2010; 166: 163168.
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