Scope of Practice: Which professional provides what care and when

Understanding the reality of equine MSK care

The growth in equine musculoskeletal (MSK) therapies has created a complex clinical landscape. Owners now have access to physiotherapists, osteopaths, chiropractors, massage therapists and other paraprofessionals alongside veterinary services.

However, this expansion has also increased confusion around who can do what, and when.

Clear understanding of scope of practice is essential for:

• Clinical safety

• Legal compliance

• Appropriate referral pathways

• Optimal patient outcomes

This article outlines the functional and legal distinctions between veterinary surgeons, veterinary physiotherapists and paraprofessional MSK therapists.

1. Veterinary surgeons: primary clinical authority

Veterinary surgeons sit at the centre of equine clinical care.

Under UK legislation, the diagnosis of disease, injury or pathological conditions and the prescription of treatment are acts of veterinary surgery.

This includes:

• Clinical examination and diagnosis

• Lameness workups and imaging interpretation

• Prescription of treatment plans

• Medical and surgical intervention

• Delegation of MSK therapy within a clinical case

Key scope characteristics

• Full legal responsibility for clinical decision-making

• Can treat all disease and injury

• Can authorise and supervise rehabilitation plans

• Responsible for referral governance and patient safety

In practice, all structured rehabilitation following injury or pathology should be vet-led or vet-directed.

2. Veterinary physiotherapists: Advanced skillsets within a vet-led framework

Veterinary physiotherapists operate as allied professionals within a delegated clinical model.

As outlined in UK guidance, MSK therapists work:

• Following veterinary examination

• Under veterinary referral for clinical cases

• Within a defined rehabilitation plan

Core scope of practice

Veterinary physiotherapists focus on:

• Restoration of movement and function

• Pain-related movement dysfunction

• Post-injury and post-operative rehabilitation

• Neuromuscular re-education

• Performance optimisation

Interventions may include:

• Manual therapy (soft tissue work, joint mobilisation)

• Therapeutic exercise prescription

• Electrotherapy modalities

• Functional movement re-training

Important boundary

Veterinary physiotherapists do not diagnose primary pathology. If new injury, disease or deterioration is identified, the case must return to the attending veterinary surgeon.

This reflects the legal framework described in UK legislation and professional guidance, where MSK therapy is an adjunct to veterinary diagnosis and oversight rather than an independent diagnostic service.

3. Paraprofessional MSK therapists: maintenance and adjunctive care

Or delegated practice within veterinary direction

This group includes a wide range of practitioners such as:

• Equine massage therapists

• Bodyworkers

• Some manual therapy practitioners without veterinary or physiotherapy qualifications

Scope characteristics

Typically focused on:

• Maintenance of muscle tone and comfort

• Relaxation and soft tissue work in non-clinical animals

• Supportive bodywork in horses without diagnosed pathology

Paraprofessional MSK therapists may work on animals presenting with injury, disease or dysfunction when operating under the direction of a veterinary surgeon. In these circumstances, treatment is delivered as part of a veterinary-led clinical plan and within defined parameters set by the referring vet.

Clinical governance and referral reality

In practice, access to paraprofessional input varies significantly. Many veterinary surgeons choose to:

• Refer only within structured rehabilitation pathways

• Work with practitioners holding higher-level qualifications

• Prefer members of recognised professional associations, eg NAVP or ACPAT

• Select therapists listed on voluntary regulatory registers, eg RAMP or AHPR

This reflects a risk-managed approach to clinical governance, ensuring that any delegated therapy is delivered by practitioners with appropriate training, documentation standards and accountability frameworks.

Key limitation

While paraprofessional therapists may contribute meaningfully to case management under veterinary direction, they:

• Do not hold responsibility for diagnosis

• Must operate strictly within the scope defined by the referring veterinary surgeon

• Must escalate concerns if clinical presentation changes or falls outside agreed parameters

As highlighted in professional guidance, this distinction is critical: once pain, injury or dysfunction is suspected, the case moves from maintenance care into veterinary territory. The defining principle is not exclusion from clinical cases, but dependence on veterinary oversight and case-specific delegation to ensure safe and appropriate intervention.

4. The overlap and why confusion exists

The boundaries between roles often appear blurred in practice due to:

• Similar manual techniques used across professions

• Variation in terminology (physio, bodyworker, therapist)

• Lack of statutory regulation in animal MSK therapy

• Owner-driven access without veterinary referral in some cases

As highlighted in Equilibre’s guidance on therapist selection, terminology such as “veterinary physiotherapist” is not uniformly protected in law, meaning title alone does not guarantee scope, training or regulatory status.

This makes clinical governance and referral pathways more important than job titles.

5. Practical decision framework for owners and referring vets

A simplified clinical hierarchy can be applied:

Step 1: Is there pain, lameness or performance change?

• Yes → veterinary assessment required

• No → maintenance work may be appropriate

Step 2: Is a diagnosis present or suspected?

• Yes → veterinary-led rehabilitation pathway

• No → consider preventative or maintenance MSK input

Step 3: What is the therapeutic goal?

• Diagnosis and treatment → veterinary surgeon

• Rehabilitation and function → veterinary physiotherapist within referral framework

Maintenance and soft tissue support → veterinary physiotherapist or paraprofessional MSK therapist (where appropriate)

6. Key clinical principle: delegation does not remove responsibility

Even where MSK therapy is delegated, the veterinary surgeon retains responsibility for:

• Case oversight

• Clinical governance

• Determining appropriateness of continued therapy

• Withdrawal of delegation if pathology changes

Similarly, therapists must operate within their competence and cease treatment if clinical red flags emerge.

Conclusion

Equine musculoskeletal care is most effective when delivered as a structured, vet-led, multidisciplinary system rather than a collection of independent modalities.

• Veterinary surgeons provide diagnosis and clinical authority

• Veterinary physiotherapists deliver targeted rehabilitation within that framework

The distinction is not about hierarchy. It is about clinical responsibility, legal scope and patient safety.

A clear understanding of these roles improves:

• Welfare outcomes

• Treatment efficiency

• Inter-professional collaboration

• Owner decision-making

Effective rehabilitation is not defined merely by modality, but by appropriate clinical governance and integration.