The practice of treating animals by physical therapists has grown nationwide since the late 1970s, but not without political controversy. This article is based on a presentation by Kirk Peck at the 2019 FSBPT Annual Meeting.
My interest in both physical therapy and animals extends decades. Before I attended PT school, I worked at a zoo where I trained birds of prey and other exotic animals for educational purposes. I also worked with a raptor recovery program in Kansas City. While I was in PT school, I spent weekends working at an emergency veterinary clinic that focused on small animal care. After I graduated, I continued to volunteer at zoos, which lead to my involvement in the APTA’s Animal Rehab Special Interest Group. I am now licensed in Nebraska to treat both humans and animals. I am certified to treat both canine and equine clients and I teach in the equine rehabilitation certification program in Knoxville, Tennessee.
As I straddled both the veterinary and PT worlds, I learned that state regulatory rules in the area of animal practice needed a lot of work. Therefore, I coordinated with Nebraska’s Board of Veterinary Medicine and Surgery for eight years to establish more formal guidelines. I soon realized that when attempting to change regulatory language, negotiations needed to occur with two licensing boards and two health professions. Therefore, this process was not without its political hurdles. I have learned many lessons that can help others seek a path forward as they negotiate formal language in their own jurisdictions.
There is a common misconception that PTs working with animals is a new area of practice, but it actually goes back decades. The Queen of England knighted Sir Charles Strong in 1974 for his outstanding work as a physiotherapist treating thoroughbred horses in the 1940s and 50s. In 1978 Ann Downer, a PT, published the first book on physical therapy for animals in the United States. In 1985, another physical therapist named Jack Meagher published a book entitled Beating Muscle Injuries for Horses. Since the mid-eighties there have been over twenty additional books written on the subject by both PTs and veterinarians.
Unfortunately, the educational opportunities to learn about animal physical therapy are still minimal. In the United States, there is no recognized academic degree, but there are four certifications available from three different institutions:
While the exact requirements vary, in general students complete about 120 hours of didactic work that covers topics such as anatomy, physiology, pathology, differential diagnosis, biomechanics, restraint and handling, and infection control. Students are also generally required to complete an internship and conduct case studies and pass comprehensive exams to become fully certified.
APTA formed the APTA Animal Physical Therapy Special Interest Group in 1998, which now represents more than 430 PTs and PTAs across the country. While not all PTs believe that PTs should treat animals, APTA officially supports it:
“The American Physical Therapy Association (APTA) acknowledges the collaborative relationships of physical therapists and veterinarians and the evolution of specialized practice by physical therapists in animal rehabilitation. Consistent with the Mission Statement Fulfillment adopted by the House of Delegates to enable physical therapists to improve their knowledge and skills in the interest of furthering the profession where allowable by law and regulation, the practice of animal rehabilitation by physical therapists is permissible.”
Working with veterinarians is not like dealing with medical doctors for humans, it is like dealing with a different breed (pun intended). To be clear, the majority of the vets I work with are fantastic and willing to collaborate. However, there are generalities that are important to keep in mind, even if they obviously are not true for every veterinarian.
In the veterinary world, the education process usually follows a patho-medical model of training. In physical therapy, it is patho-biomechanical. For example, one time, I was co-evaluating a horse with a lameness complaint along with an Olympic veterinarian. I suggested we talk aloud as we conducted simultaneous evaluations. Once we finished, I turned to him and said, “We didn't even look at the same horse, did we?!” We had completely different perspectives on assessing the same horse and our clinical reasoning followed two separate paths.
Additionally, as physical therapists, we are used to working in interdisciplinary teams. It is a concept we are all accustomed to—doctors, nurses, respiratory therapists, speech therapists, occupational therapists, etc., all play different roles on the same team. While veterinarians do sometimes consult with other doctors on specific issues, historically, they work independently. However, in the veterinary world many practitioners are themselves becoming certified rehab experts. This makes them both the medical provider and the rehabilitation expert, which is a lot for one provider. In contrast, medical doctors rarely go back to school to acquire a DPT degree.
Because of differing perspectives, when PTs jump into the veterinary world, we may automatically assume that vets are okay with team care. However, they are less familiar with that approach. Therefore, it can be a challenge to convince veterinarians that, from both a political and a practice perspective, we need to work as a team. This is how animals will benefit the most.
It is important to keep in mind that vets are also very sensitive to encroachment from non-licensed professionals. This is not without reason. Unfortunately, there is a history of encroachment in various areas, such as dog groomers dabbling in medical conditions and unlicensed dental work occurring in the equine industry, that can potentially cause serious, detrimental issues for animals. Similar to these encroachments, vets may also view PTs as competitors. This can be particularly true for veterinarians who are certified in animal rehabilitation.
Veterinarians also have several additional concerns related to PTs. They often argue that animal treatment is beyond the scope of PT practice. Veterinarians are also concerned that PTs lack the appropriate knowledge that is needed to treat animals. Additionally, there is a misconception that PTs do not handle human emergencies, so they cannot handle acute emergencies with animals. While vets may view animal treatment as a skill that is beyond the scope of PT practice, additional training can address this concern. However, even with additional education, vets remain concerned that certification programs may not be sufficient. While certification programs do address many competencies in animal therapy, it would be helpful if the profession had more robust educational opportunities.
Finally, veterinarians are not in favor of PTs having direct access to animal care. This is the one negotiating piece right now where there is no give. No state has passed direct access laws for PTs to treat animals. Instead, a referral or medical clearance by a veterinarian is generally considered the safest and most collaborative way for PTs to treat animals.
In light of the history of unlicensed work in other areas and the specific concerns surrounding PTs, some veterinarians are skeptical of PTs treating animals. Therefore, it is very important for PTs to build trust initially with the veterinary profession. While PTs bring a lot of valuable knowledge to the table, they must recognize and respect the knowledge and skills veterinarians possess as medical practitioners. This recognition will help build more collaborative relationships both during political discussions and in various treatment environments.
As regulators, the biggest question to ask is whether any new standardized language allowing PTs to practice on animals should reside in the PT or veterinary regulations and statutes. Veterinarians prefer to have it in their statutes to maintain authority over licensees. While this is not ideal for physical therapists, often a compromise is necessary to move forward. Ironically, allowing the veterinary profession to maintain control of practice standards may help with another unfortunate hurdle: there are still PTs who do not believe the profession should be involved with treating animals.
As you draft regulatory language, keep in mind these necessary components:
The APTA’s special interest group recently completed a practice analysis, which may help guide regulations. There are six primary categories of practice:
Additionally, carefully review the current successful state laws, which can serve as useful guides.
Nevada was one of the first states to address animal rehabilitation by physical therapists and they have had relatively no concerns with their regulations for more than twenty years.
Nevada State Board of Veterinary Medical Examiners REGISTRATION AS AN ANIMAL PHYSICAL THERAPIST
Colorado’s regulations lay out all the competencies PTs need for practice; indicate that competencies do not constitute the practice of veterinary medicine; and clarify that PTs require veterinary medical clearance.
Colorado Revised Statutes 2019, Section: 12-285-116
In Nebraska, the PT board and Nebraska PT Association were not supportive of adding regulatory language to the PT statues. Therefore, I worked directly with the Nebraska veterinarian board to create additional competencies specific to physical therapy practice. PTs have medical clearance via a referral from a licensed veterinarian. The required educational competencies look very similar to what you would acquire through the certification programs. The key is, what you can practice on an animal is limited to what you are qualified to do on a human. The Board of Veterinary Medicine brought together PTs, chiropractors, massage therapists, and acupuncturists to negotiate all the details of statutory and regulatory changes. Working together, collaboratively, is the best way to move forward.
Nebraska Board of Veterinary Medicine and Surgery, Section: 38-3309.01 “Licensed Animal Therapist”
If your state is looking to initiate or expand regulations to allow PTs to treat animals, keep in mind the three “C”s of success”
State policy makers and regulatory agencies have expressed concerns on how jurisdictions define veterinary medicine, scope of practice for physical therapists, physical therapy direct access, and term and title protection. However, with collaboration and effective communication the physical therapy profession is well positioned to address a growing need for physical rehabilitation within the animal kingdom.
Kirk Peck PT, PhD, served two-terms as President of the Nebraska Physical Therapy Association, including twenty years as Chair of the state legislative committee. In addition, he served two terms as President of the Animal Physical Therapy Special Interest Group (ARSIG) of the Orthopaedic Section, American Physical Therapy Association, and he was recently selected to serve on the Federation of State Boards of Physical Therapy Ethics and Legislation Committee. Dr. Peck has consulted with numerous physical therapists nationwide addressing political issues related to animal rehabilitation, and he has presented nationally at the APTA State Government Affairs Forum. Finally, Dr. Peck worked extensively with the Nebraska Board of Veterinary Medicine and Surgery to draft statutes and regulations allowing physical therapists to acquire a professional license to treat animals following completion of additional educational competencies.