Canine rehabilitation: An inside look at a fast-growing market segment
The perception still exists that any veterinarian with some exercise equipment and an underwater treadmill can practice rehabilitation. But the reality is that veterinary rehabilitation is based on an all-new diagnostic algorithm that you need to understand before your patients — and your business — can benefit from this rapidly growing field.
The focus of canine rehabilitation is on soft tissue rather than on bones and joints. Treatment goals are functional, designed to optimize movement and quality of life for the patient. Certified rehabilitation professionals complete many hours of coursework and hands-on training. They perform in-depth evaluations, manage treatment, and objectively measure progress. They use specialized tests to look for tendinopathies and soft-tissue abnormalities, and precise instruments to measure joint rotation and range of motion.
Rehabilitation professionals are highly skilled in manual therapies including joint mobilization, therapeutic stretches and exercise. Physioballs, therapy bands, rocker/wobble boards, Cavaletti poles and treadmills are used routinely to increase strength, coordination and flexibility. Rehab professionals are also trained to use physical modalities such as ultrasound, laser and electrical stimulation. As more practices have invested in therapeutic pools and underwater treadmills, hydrotherapy is also an option for many patients.History of veterinary rehabilitation
Human physical therapy was first widely practiced during World War I when tens of thousands of injured soldiers returned home needing care. The idea that animals could benefit from physical therapy, however, didn't become a reality until the 1960s when equine sporting events grew in popularity, and the number of horses needing treatment for injuries along with it.
Canine rehabilitation had become mainstream in Europe by the 1980s. Interest in the field started to grow in the U.S. by the early 1990s, and the AVMA added "veterinary physical therapy" to its guidelines in 1996. The country's first canine rehabilitation certification program was started the following year. There are now 17 veterinary colleges in the United States that offer canine rehabilitation, and several are planning to offer student electives and clinical rotations.
Practice and politics
Exactly who is qualified to practice veterinary rehabilitation continues to be a hot topic. The two big stakeholders are the AVMA and the American Physical Therapy Association (APTA). These two professional organizations have been exchanging position statements since 1993. The APTA contends that physical therapists are the providers of choice for the provision of physical-therapy services, regardless of the client. The AVMA, on the other hand, suggests that physical therapy should be performed by a licensed veterinarian or physical therapist, educated in non-human animal anatomy and physiology. To further clarify its position, the AVMA added "physical medicine and therapy" to its definition of the practice of veterinary medicine in 2003.
Ultimately, it is not the veterinarians or physical therapists that have the final say in who practices veterinary rehabilitation, but the state practice acts. There is active discussion taking place in several states and in all of the Canadian provinces regarding the role of physical therapists in this field.
A 2004 Nevada practice act revision included a certification process for physical therapists allowing them to practice "animal rehabilitation" if working with a referring veterinarian. In 2007, Colorado passed a bill allowing physical therapists to work with animals. Spelling out the necessary training and practical experience, and the collaboration required between the referring veterinarian and the physical therapist. Officials in both Nevada and Colorado have reported very positive results to date.
On the fast track
Veterinary rehabilitation is widely regarded as the fastest growing area in veterinary medicine. In 2008, more than 300 people were certified by the two U.S. programs. The number of practices offering rehabilitation services continues to grow, and sales figures from rehab-specific equipment manufacturers are on the rise.
What is driving this new field? Public awareness of canine rehabilitation has grown, and pet owners are heading to veterinary hospitals expecting state-of-the-art care for their animals.
This is not unlike the rise of acupuncture in the 1980s, a client-driven demand for a new veterinary service. The growing number of agility and Flyball enthusiasts is also adding to the demand for canine rehabilitation and conditioning. Even local and federal governments are realizing the benefits of rehabilitation therapy for their highly-trained service dogs.
The 5th International Symposium on Veterinary Rehabilitation took place in August of 2008 in Minneapolis. This bi-annual meeting drew nearly 500 people from 29 countries for four days of lectures and laboratories. Organizations sponsoring veterinary meetings in the U.S. have also responded to growing interest in rehabilitation medicine. The ACVS and NAVC have both progressed from a brief mention of rehabilitation to hosting full-day lecture-lab sessions on the topic. There are currently three veterinary rehabilitation certification programs in the U.S. — two canine and one equine. The basic requirements are the same for each — approximately 15 classroom days with exams, reports and internship opportunities rounding out the curriculum.
Practicing veterinary rehabilitation
The first thing to do before adding rehabilitation to your practice is to understand the veterinary and physical therapy practice acts in your state. Keep these in mind when you put together your rehabilitation team, and make sure you choose the right people and that they are trained in veterinary rehabilitation.
A veterinarian should be the leader and responsible for the cases, and a physical therapist should develop the therapeutic programs and administer treatments. Ideally, there should be a veterinary technician to help provide hands-on care and client education, freeing the veterinarian and physical therapist to see additional cases.
When you are finally ready to post that brand-new sign outside your facility, make sure it says you are offering "physical rehabilitation" or "animal rehabilitation."
The terms "physical therapy" and "physiotherapy" are protected in all 50 states so they can only be used by licensed physical therapy professionals to describe their practices.
Is veterinary rehabilitation a viable business? Done correctly, yes. The business models that have been most successful include referral centers that offer surgery and oncology, free-standing rehab-only/referral-only facilities, and specialty centers that emphasize complementary medicine and pain management. I encourage you to do some research and create a business plan that makes sense for you, your practice and your patients.
Regardless of the model you choose, a well-trained team, sound day-to-day management and strategic marketing will all play an important part in your success as a veterinary rehabilitation professional.
Dr. Van Dyke founded the Canine Rehabilitation Institute in 2002 to train and certify veterinarians, physical therapists and veterinary assistants in canine rehabilitation. In addition she teaches classes targeting anatomy, biomechanics, physiology, surgical pathology and developmental disorders. Dr. Van Dyke owns Veterinary Consultants, a referral practice focusing on orthopedic and sports medicine cases in Florida and Colorado. She is a 1981 graduate of the University of Illinois, College of Veterinary Medicine and completed an internship and surgical residency at the Animal Medical Center in New York City in 1984.