Rehabilitation has moved steadily from specialty referral centers into general practice, driven by clients who want more for their aging, injured and postoperative pets than medication and surgery alone. The 2022 AAHA Pain Management Guidelines for Dogs and Cats call for proactive, multimodal strategies that combine pharmacologic and nonpharmacologic therapies, and the 2023 AAHA Senior Care Guidelines describe rehabilitation as an excellent option for managing pain and improving mobility and balance in older patients. For a practice that wants to answer that call in-house, the practical question becomes which skills deliver the most clinical value for the training investment.
Narda G. Robinson, DO, DVM, MS, FAAMA, offers a useful perspective on that question. A physician and veterinarian who directed the Colorado State University Center for Comparative and Integrative Pain Medicine, she authored the Merck Veterinary Manual chapters on acupuncture, photomedicine and manual therapy, and her research has consistently pressed the profession to ground physical medicine in anatomy, physiology and honest appraisal of evidence. Her work informs each of the six skills below.
1. Structured Movement and Gait Assessment
Every rehabilitation plan begins with an accurate picture of how the patient moves, and that picture depends on a clinician’s ability to observe posture, weight distribution and gait before laying a hand on the animal. Robinson’s teaching emphasizes restoring the lost art of the physical exam, with unhurried time spent with patients and gentle, informed palpation as the foundation of integrative care. Rehabilitation practitioners add rigor by pairing goniometry, girth measurements and gait analysis with manual assessment to build a problem list and set functional goals for each impairment. The AAHA guidelines also stress capturing owner observations for chronic pain, since owners see patterns at home that a brief exam can’t replicate, and a practice that documents baseline measurements can track progress, adjust plans and show clients results in concrete terms.
2. Myofascial Palpation and Trigger Point Therapy
Myofascial pain is easy to miss in veterinary patients. In her 2012 review “One Medicine, One Acupuncture,” published in Animals, Robinson describes how animals with unrecognized trigger points can undergo costly diagnostics, unnecessary surgery and failed analgesic regimens, and she notes that trigger points in horses can cause recurring lameness, a sore back and loss of flexibility. She also observes that both human and veterinary medical schools offer insufficient education on myofascial dysfunction, which helps explain why so many cases go undiagnosed.
Veterinarians lack the referred pain maps human practitioners rely on, though Robinson points out that anatomy fills much of that gap, since trigger points usually form at the center of muscle bellies and at myotendinous junctions where muscle spindles and Golgi tendon organs concentrate. Her Merck chapter on manual therapy lists sustained compression, dry needling and photonic stimulation with laser or LEDs as ways to release these foci, and she notes that integrative practitioners typically combine more than one technique. Patients tend to show a jump sign or local twitch response when a fingertip or needle finds dysfunctional tissue, which gives the clinician immediate confirmation.
3. Medical Massage and Osteopathic Manual Therapy
Robinson’s Merck chapter defines medical massage as a multimodal soft tissue approach that can draw on Swedish massage, osteopathic techniques and trigger point deactivation, selected after a diagnosis to address the patient’s specific problems. Osteopathic soft tissue methods include direct and indirect myofascial release, ligamentous articular strain and lymphatic pump techniques, and she distinguishes them from Swedish massage by their defined physiologic goals. Evidence from human infants and adults suggests veterinary applications for stress, pain, edema, arthritis, postoperative ileus and intervertebral disc disease, though she acknowledges that well-designed veterinary studies remain limited.
Safety separates trained practitioners from everyone else. Robinson warns that soft tissue work should never be applied directly over infection, acute inflammation, tumors, recent incisions or thromboses, and that excessive abdominal pressure can damage organs or dislodge a catheter. She’s equally direct about high-velocity chiropractic thrusts, noting that such methods have little to no evidence supporting their efficacy and can seriously injure fragile animals, which leads her to recommend soft tissue techniques as the safest choice for geriatric and debilitated patients.
4. Therapeutic Exercise and Neuromuscular Re-Education
The 2022 AAHA guidelines describe therapeutic exercise as targeted work aimed at defined goals, including restoring range of motion in arthritic joints, rebuilding muscle after surgery or immobility and retraining proprioception after neurologic injury. The task force noted that the pain-control benefits of exercise are well established in human medicine and highly likely to apply to dogs and cats, while acknowledging that veterinary clinical evidence is still sparse. That combination of strong biologic plausibility and developing data makes exercise prescription a core rehabilitation skill.
Postoperative orthopedic patients illustrate the opportunity. Monk, Preston and McGowan reported in 2006 that dogs receiving early intensive physiotherapy after tibial plateau leveling osteotomy showed improved thigh circumference and stifle range of motion compared with dogs on a home program, though a later Veterinary Evidence review concluded the data were insufficient to prove a benefit in one-year peak vertical force. Clinicians build exercise plans around weight-bearing status, progressing from early weight shifting to functional strengthening, and some use neuromuscular electrical stimulation to produce quadriceps and hamstring co-contractions during the acute phase before joint motion is safe. Structured integrative rehabilitation and physical medicine training teaches that progression alongside manual therapy and modalities so each plan adapts as tissues heal.
5. Photomedicine and Laser Therapy
Robinson’s Merck chapter on photomedicine explains that light alters tissue only when a photoacceptor molecule, such as cytochrome c oxidase in the mitochondrial respiratory chain, absorbs photons and initiates a cascade that can increase ATP production, modulate reactive oxygen species and normalize inflammatory mediators. Treatment effects depend on power, wavelength, spot size, pulsing and dose, and she notes that ideal dosing for specific conditions remains controversial. She also corrects a common misconception by pointing out that Class IV devices routinely heat tissue, which makes the term “cold laser” inaccurate.
The clinical evidence is promising and mixed, and a well-trained clinician needs to understand both sides of it. A 2020 study in BMC Veterinary Research found that dogs receiving perilesional laser therapy within a postoperative rehabilitation protocol after thoracolumbar disk surgery showed improved neurologic status when deep nociception was intact, while a 2017 study in the American Journal of Veterinary Research found no difference in early recovery among dogs receiving photobiomodulation, rehabilitation or sham treatment after hemilaminectomy. Robinson has acknowledged openly that some studies show no benefit, while arguing in Veterinary Practice News that laser therapy “when properly applied and appropriately dosed, provides clinically significant benefits.”
Safety training matters as much as dosing. Robinson lists contraindications including neoplasia, a hyperactive thyroid, active hemorrhage, the retina, a pregnant uterus and patients with lymphoma or on immunosuppressants, and she cautions against higher-powered treatment over long bones in animals under a year old because of possible premature physeal closure. She also warns that infrared light above 760 nm is invisible to the human eye, so devices without a finder beam create a genuine risk of accidental retinal exposure. In a dvm360 interview, she noted that photomedicine attracts considerable hype and sales pressure, which makes vendor-independent photomedicine training a sound investment before a practice buys equipment.
6. Medical Acupuncture and Dry Needling
Acupuncture rounds out a rehabilitation toolkit by addressing pain and neurologic dysfunction through neuromodulation. Robinson’s Merck acupuncture chapter describes needles activating somatic afferent fibers that trigger responses across the local, autonomic and central nervous systems, and she notes that electroacupuncture appears most frequently in scientific studies because its physiologic effects are robust and reliable. Studies in the Journal of the American Veterinary Medical Association have evaluated electroacupuncture for dogs with thoracolumbar intervertebral disk disease, including work by Hayashi and colleagues in 2007 and Joaquim and colleagues in 2010, and Robinson points to that canine research as a case where veterinary findings can inform human spinal cord injury care. Dry needling of trigger points pairs naturally with manual therapy and exercise, and the 2023 AAHA Senior Care Guidelines list acupuncture alongside exercise therapy, hydrotherapy, manual therapy and photobiomodulation as rehabilitation therapies for senior patients.
Building Rehabilitation Services on a Scientific Foundation
These six skills reinforce one another, since assessment directs palpation, manual therapy prepares tissue for exercise and modalities such as photomedicine and acupuncture control pain so patients can participate fully in their programs. Robinson’s body of work argues that each one earns its place in practice when it’s taught with anatomical precision, applied within clear safety boundaries and evaluated against the best available evidence. A practice that builds its rehabilitation service on that foundation gains treatment options for postoperative, neurologic, geriatric and chronic pain patients that it can explain, measure and defend.
References
American Animal Hospital Association. (2022). 2022 AAHA pain management guidelines for dogs and cats. https://www.aaha.org/resources/2022-aaha-pain-management-guidelines-for-dogs-and-cats/
American Animal Hospital Association. (2023). 2023 AAHA senior care guidelines for dogs and cats. https://www.aaha.org/resources/2023-aaha-senior-care-guidelines-for-dogs-and-cats/pain-management/
Bennaim, M., Porato, M., Jarleton, A., Hamon, M., Carroll, J. D., Gommeren, K., & Balligand, M. (2017). Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease. American Journal of Veterinary Research, 78(2), 195–206. https://doi.org/10.2460/ajvr.78.2.195
Bruno, E., Canal, S., Antonucci, M., Bernardini, M., Balducci, F., Musella, V., Mussoni, M., & Spinella, G. (2020). Perilesional photobiomodulation therapy and physical rehabilitation in post-operative recovery of dogs surgically treated for thoracolumbar disk extrusion. BMC Veterinary Research, 16(1), 120. https://doi.org/10.1186/s12917-020-02333-3
CuraCore. (n.d.). About. https://curacore.org/about/
Does physical therapy after a TPLO lead to improvement of the 1-year post-operative peak vertical force? (n.d.). Veterinary Evidence. https://veterinaryevidence.org/index.php/ve/article/download/31/80
Hayashi, A. M., Matera, J. M., & Fonseca Pinto, A. C. B. C. (2007). Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. Journal of the American Veterinary Medical Association, 231(6), 913–918. https://doi.org/10.2460/javma.231.6.913
How I treat postop TPLO with physical rehabilitation. (n.d.). Veterinary Information Network. https://vin.com/doc/?id=8896562
Joaquim, J. G., Luna, S. P., Brondani, J. T., Torelli, S. R., Rahal, S. C., & de Paula Freitas, F. (2010). Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. Journal of the American Veterinary Medical Association, 236(11), 1225–1229. https://doi.org/10.2460/javma.236.11.1225
Monk, M. L., Preston, C. A., & McGowan, C. M. (2006). Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. American Journal of Veterinary Research, 67(3), 529–536. https://doi.org/10.2460/ajvr.67.3.529
Robinson, N. G. (n.d.). Let there be light: Why laser therapy is evidence-based medicine. Veterinary Practice News. https://www.veterinarypracticenews.ca/?p=10550
Robinson, N. G. (2012). One medicine, one acupuncture. Animals, 2(3), 395–414. https://doi.org/10.3390/ani2030395
Robinson, N. G. (2018, July 10). Different forms of photomedicine in veterinary medicine [Video]. dvm360. https://www.dvm360.com/view/different-forms-of-photomedicine-in-veterinary-medicine
Robinson, N. G. (2024). Acupuncture in veterinary patients. In Merck Veterinary Manual. Merck & Co. https://www.merckvetmanual.com/therapeutics/integrative-complementary-and-alternative-veterinary-medicine/acupuncture-in-veterinary-patients
Robinson, N. G. (2025). Photomedicine in veterinary patients. In Merck Veterinary Manual. Merck & Co. https://www.merckvetmanual.com/therapeutics/integrative-complementary-and-alternative-veterinary-medicine/photomedicine-in-veterinary-patients
Robinson, N. G. (2026). Manual therapy in veterinary patients. In Merck Veterinary Manual. Merck & Co. https://www.merckvetmanual.com/therapeutics/integrative-complementary-and-alternative-veterinary-medicine/manual-therapy-in-veterinary-patients
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