Edition 12 - Physiotherapy in osteoarthritis
- zeropainphilosophy
- 1 day ago
- 4 min read
I’ve chosen this paper as a starting point because we are simply not doing enough as vets to recommend mobility and exercise therapy as one of the key components of OA management. Granted, this is not our area of expertise and most of us aren’t sure how to advise our clients. By recognising that skills gap, we can take the opportunity to partner with veterinary physiotherapists to offer our canine OA patients a range of options best suited to them.
The aim of the research roundup is to provide vet professionals with an easy-to-read digest on items of research in pain management which focus on one common subject area.
This research roundups provide a single point of reference for the reader.
Subject
Physiotherapy in osteoarthritis
Title of the paper
Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis
Aims of the paper
· Review the goals of physiotherapy in canine OA
· Illustrate adaptations in lifestyle and environment
· Guide owners in optimizing daily exercise routines and performing simple home exercises
· Detail the role of veterinary physiotherapists in implementing advanced or “expert” exercises and applying therapeutic modalities
Key parts of this paper
The Physiotherapy Pyramid
The Physiotherapy Pyramid described in the paper is a structured framework for managing canine osteoarthritis. It provides clinicians with a clear guideline for recommending modalities in a logical, stepwise manner.
Physiotherapeutic strategies are presented in layers based on practicality, cost-effectiveness, and benefit.
Start at the base with simple, foundational measures (e.g., environmental modifications, weight management, basic exercise).
Progress upward to more advanced interventions (e.g., underwater treadmill, laser therapy, acupuncture) only after the basics are in place.
Ensure patient comfort at every stage.
We recommend you read each section of the paper and have provided these questions for reflection;
3.1 Environmental modification
Which of the recommendations will you include in your information to clients?
How do you feel it is best to present this information to clients?
3.2 Exercise Regimen/Activity
How do you explain the nature of OA as a disease and the importance of exercise?
What is a clear risk factor for OA in dogs?
3.3 Home exercises
How would you summarise the current evidence for home exercises in canine OA and what would you recommend to your clients?
Modalities
The second part of the review considers the evidence for various modalities which provides a useful summary to the vet trying to digest the information ready to impart to our clients. We’ve summarised the common electrotherapies here. The review digs into other less common options which you may wish to familiarise yourself with.
Low-level Laser Therapy
Laser is a painless, non-invasive therapy using near-infrared or infrared light.
One randomized, blinded, placebo-controlled trial showed improved lameness and pain in dogs with elbow OA.
Retrospective study (no control group) reported positive effects on CBPI and VAS scores, with improvement after first session and reduced analgesic medication over time.
Challenges in Comparing Studies:
Variability in laser mode (continuous vs pulsed), wavelength, dosage, and application site (nerves vs joints).
These differences make cross-study comparison and extrapolation difficult.
Wavelength Importance:
Optimal penetration occurs between 650–1350 nm, as absorption by water, melanin, and hemoglobin is lowest in this range.
Joint-specific optimal wavelength remains unknown, highlighting a gap in research.
Despite widespread use and economic significance, therapeutic efficacy for OA remains uncertain, and more controlled studies are needed.
Extracorporeal shock wave therapy
ESWT is a non-invasive modality using high-energy acoustic waves with very high pressure and ultrashort duration. It is used for musculoskeletal disorders: tendinopathies, fasciitis, fracture non-union, avascular necrosis, and OA.
Prospective clinical studies:
Improved lameness in dogs with elbow and hip OA (objective gait analysis).
No significant benefit for stifle OA.
Focused ESWT improved peak vertical force and vertical impulse in elbow OA but only short-term (28 days).
Radial ESWT showed benefits for hip OA up to 3–6 months, but studies were small and lacked randomization/blinding.
Limitations:
Few studies, small sample sizes, short follow-up.
Lack of data on optimal dosing, intensity, and frequency.
Historically, focused ESWT required sedation in dogs; newer technology and gradual intensity increase may reduce this need.
Transcutaneous electrical nerve stimulation
TENS is low-frequency electrotherapeutic modality using mono- or biphasic square-wave pulses. It reportedly works by activating descending inhibitory systems in the CNS to reduce pain. TENS can be applied locally or at the corresponding spinal segment.
Murine studies: Analgesic effect in experimentally induced OA.
Pilot study in dogs:
TENS (70 Hz) improved ground reaction forces immediately after application; effect lasted up to 210 min but not at 4-day recheck.
Clinical trial (29 overweight dogs):
Dogs receiving biweekly TENS + intensive PT had better peak vertical force symmetry than those in standard PT.
No significant difference in pain scores or vertical impulse symmetry.
Unclear if benefit was due to TENS or more intensive PT care.
Empirical recommendation:
High intensity, longer duration: 2–3 sessions/week for 5–6 weeks, 30 min each.
To read next
If you are left thinking you need more information on exercise, or just another view of these modalities then this paper is a good summary
Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis
Pye et al (2024)
The Zero Pain View
It’s encouraging to see greater interest in knowledge sharing on physiotherapy for OA. There is a huge amount of information directed at caregivers and that can result in confusion over the best options. With the information provided in this edition of ZPP Reflect we hope you are equipped to recommend physiotherapy to your clients.
References
Mille MA, McClement J, Lauer S. Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis. Vet Sci. 2022 Dec 21;10(1):2. doi: 10.3390/vetsci10010002. PMID: 36669003; PMCID: PMC9863568.
Pye C, Clark N, Bruniges N, Peffers M, Comerford E. Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis. J Small Anim Pract. 2024 Jan;65(1):3-23. doi: 10.1111/jsap.13670. Epub 2023 Sep 29. PMID: 37776028.
Comments