How to choose your musculoskeletal therapist

No horse owner can have missed the exponential rise of musculoskeletal (MSK) therapists over the last two decades and beyond. This progression can only be a good thing for the welfare of the animals that we love. But how do we decide whether to choose a physiotherapist, a chiropractor, an osteopath, or somebody else, like a massage therapist? And how do we choose which practitioner – are they all the same? How important are qualifications? Is everybody in practice appropriately trained and qualified? Read on to find out more.

Career

Musculoskeletal therapy

First things first, there are no statutory regulations for MSK therapists. Anybody can call themselves an equine physiotherapist, chiropractor or osteopath, without any training, experience or even insurance. Whilst in the human medical field the terms physiotherapist, chiropractor and osteopath are reserved exclusively for those with specific and appropriately recognised qualifications, in the animal world, so long as the prefix equine- or animal- is used, these professional terms aren’t protected. Even, and perhaps most surprisingly, the word veterinary is not protected. Many veterinary physiotherapists are of course incredibly well qualified and credible practitioners, however the name, sadly, means nothing – anybody can use it, regardless of their veterinary training.

To skip the details and just read the conclusions, click here.

The legislation

The Veterinary Surgeons Act 1966 ensures that animals are treated by only those who are qualified to do so. This means that the diagnosis and treatment of animals, including the giving of advice based on this, and performance of surgical operations, are ALL are considered acts of veterinary surgery, to be performed ONLY by veterinary surgeons.

The Veterinary Surgeons Exemption Order 2015 allows MSK therapists to work as part of a vet-led team. This requires delegation by a veterinary surgeon who has already examined the animal and prescribed the treatment to include MSK therapy. It is the veterinary surgeon’s responsibility to ensure the therapist is appropriately qualified and competent. Only if the MSK therapy is for maintenance of a healthy animal, rather than treatment, can an MSK therapist practise without prior referral from a veterinary surgeon. In this instance, the veterinary surgeon will likely not get involved with authorising, recommending or overseeing the therapy provided. The owner must do this for themselves.

In practical terms this means that any MSK therapist must cease provision of therapy at the first sign of injury, disease or pathology and refer back to the animal's veterinary surgeon. If your therapist does not do this, they are practising illegally and outside of the scope of their practice, therefore invalidating any insurance held. But most crucially, they are putting your horse at risk through potentially inappropriate or ill-timed treatment. It may be frustrating for owners when MSK therapists refer back to or seek permission from your vet, but it is always a good sign that they are practising within their remit and prioritising the welfare of your horse.

Which equine musculoskeletal therapy

This is the first question that must be answered. Often an owner will have a specific idea or will be responding to a specific recommendation. If referred by the patient’s veterinary surgeon, many vets will have their own preference based on the animal’s condition and previous experience with local therapists. Broadly speaking, vets will typically work most closely with animal physiotherapists, but this does not mean other modalities are not useful.

Animal physiotherapy aims to restore or maximise movement and function through specific physical therapy. This may include manual techniques such as joint mobilisations, massage and myofascial release, use of electrotherapies and prescription of a series of exercises for rehabilitation or enhancement of function and performance. Physiotherapy considers the whole horse, including the entire musculoskeletal system, bones, muscles, ligaments, tendons and joints.

Animal chiropractors use chiropractic techniques that have been adapted from human medicine to treat primarily spinal problems as well as other joints. Adjustments are made to spinal areas with decreased range of motion (vertebral subluxation complexes) to induce a therapeutic response. (McTimoney chiropractic is a specific branch of gentle chiropractic treatment, see below regarding training).

Animal osteopathy similarly uses manual techniques adapted from human osteopathy to manipulate and strengthen the musculoskeletal framework, improving mobility and therefore function. Osteopathy utilises an integrated approach; whilst the techniques primarily focus on the joints, muscles and spine, they work on the basis that the whole body is connected with links (chain-logic) between the body’s organs and the musculoskeletal system.

Animal massage therapy, bodywork and myofascial release are overlapping and complimentary manual techniques which manipulate the soft tissue structures (primarily muscle and fascia) beneath the animal’s skin to promote healing and restore function. They are most typically used for maintenance of musculoskeletal function or as an adjunct to more in-depth physiotherapy, chiropractic or osteopathic treatment.

Which therapist

Choosing an MSK therapist is a very personal decision and everybody will have their own unique requirements. Things to consider include: what you are trying to achieve, the therapist’s experience, training, ethos, local reputation and personal recommendation. Your therapist may have complementary skills and experience that may be particularly important for you. Of course, your budget will be important too. Practitioners with higher level training and experience will charge more, but you will in turn benefit from that extra experience and this may be cost effective in the long run.

As previously mentioned, there are no statutory regulations for animal musculoskeletal therapy and there is a huge range in levels of training and experience. Some training courses for massage therapy involve only a few hours or days of training and therefore therapy sessions are often cheaper. If you don’t require more in-depth therapy, but would like your horse to benefit from a great massage, there is no point paying for somebody’s higher level of training. The most rigorous training for physiotherapy, osteopathy and chiropractic can only be completed over several years and hundreds, even thousands, of hours of training. Level 5 courses include diploma programmes, level 6 courses include bachelor degrees, whilst level 7 courses include both postgraduate diplomas and masters level qualifications.

Professional regulation

There is no mandatory regulation for Animal MSK practitioners, however, if they are suitably qualified, they can choose to join the Register of Animal Musculoskeletal Therapists (RAMP). In doing so practitioners will benefit from being part of large body of highly qualified professionals and animal owners are protected by cross industry standards and competence, (similar to the statutory human regulators: the Health and Care Professions Council (HCPC), the General Chiropractic Council (GCC) and the General Osteopathic Council (GOsC)).

RAMP – the Register of Animal Musculoskeletal Therapists:

RAMP is a voluntary, independent, self-regulatory body, which is BEVA recognised and, from November 2023, is also officially DEFRA recognised. RAMP demonstrate a strict eligibility criteria ensuring all registrants hold suitable higher level qualifications, backed up with significant practical experience. In total, RAMP members must demonstrate a minimum of 3600 hours of eligible education via an assessed or recognised educational provider. All members must adhere to a professional code of conduct, maintain continuing professional development, hold professional indemnity and public liability insurance and demonstrate an intention to work under the referral of the animal's veterinary surgeon. Following approval, all RAMP registrants are of equal status (physiotherapy, osteopathy and chiropractic) and RAMP makes no distinctions between these different forms of professional training. Members are categorised on their website according to their therapeutic technique. Horse owners and referring veterinary surgeons can be confident that their chosen practitioner has appropriate qualifications, exemplary professional skills and works within a framework of ethical clinical practice. Read more about RAMP in our Equilibre blog post here.

It is highly recommended that MSK therapists are chosen from the RAMP register to ensure the most rigorous calibre has been met. However there are always exceptions and some excellent therapists are not on the register - this may be because they are newly qualified (some pathways require additional evidence of practical hours), their level of training excludes them, or they have made a conscious decision to not join a regulatory body. If you choose a therapist without regulation, it is important to check their qualifications, credentials and insurance yourself.

Professional associations

Each individual profession also has associations specific to their modality and they generally also require a high degree of training evidence before admitting members. Membership to these associations is also voluntary but demonstrates a commitment from practitioners to their profession, their clients and the animals they treat.

Physiotherapy

NAVP – the National Association of Veterinary Physiotherapists:

Only open to veterinary physiotherapy graduates from a select list of Veterinary Physiotherapy university validated BSc, PGDip, MVetPhys and MSc degree courses, all of which are a minimum of level 6 or 7 qualifications. NAVP members are required to work in accordance with current legislation as part of a vet-led team, and also collaborate with other industry professionals such as farriers, saddle fitters and nutritionists. All members hold appropriate professional insurance, work ethically bound by a professional code of conduct and commit to maintaining and enhancing their skills through continued professional development. Read more about NAVP in our Equilibre blog post here.

ACPAT – the Association of Chartered Physiotherapists in Animal Therapy:

Some human physiotherapists have made a choice to diversify into the animal sector after previously training and working in the human physiotherapy field. ACPAT, provides postgraduate level 7 training in animal physiotherapy to human physiotherapists and maintains a register of these professionals. The association is a professional network of the Chartered Society of Physiotherapy (CSP), and as such all members are regulated through a separate human-focused professional body. Similar to RAMP and NAVP, ACPAT members have demonstrated rigorous high level training and are bound by a strict code of professional conduct. Eligibiliity for ACPAT includes only physiotherapists (not other disciplines) and is restricted to only those who have progressed through this human professional pathway.

Chiropractic

BVCA – the British Veterinary Chiropractic Association:

Only open to veterinary surgeons with additional post-graduate chiropractic training, or human chiropractors with additional post-graduate veterinary chiropractic training, and have passed independent certification by the ICVA, International Veterinary Chiropractic Association.

IVCA – the International Veterinary Chiropractic Association:

An international non-profit organisation promoting high standards of veterinary chiropractic, only open to qualified veterinary surgeons or human chiropractors who have completed approved postgraduate training. THE IVCA accredits European courses.

IAVC – the International Academy of Veterinary Chiropractic:

A private educational institution founded to provide high quality post-graduate level courses to veterinary surgeons and human chiropractors. Entry level courses include five modules consisting of 210 hours teaching and examinations. The IAVC offers courses in England and Germany.

McTimoney Animal Association – the professional body for McTimoney animal practitioners:

Open to MvTimoney practitioners who have neither a veterinary nor chiropractic background but have trained specifically in the McTimoney technique.

Osteopathy

AAO – the Association of Animal Osteopaths:

An association created to support practitioners who use osteopathic techniques, however it should be noted that the AAO does not endorse their members as qualifications and laws are so variable between countries.

IREO – the International Register for Equine Osteopaths:

A register of equine osteopaths who have completed an accredited pathway acknowledged by IREO. Senior EDOs are those that have completed ten, four-day modules and already hold a veterinary, osteopathy, chiropractic or other therapy-based degree. Junior EDOs are all other certified therapists and bodyworkers who have completed an additional four, four-day modules prior to the ten, four-day modules. There is a further progression pathway to become a senior EDO.

Other MSK therapists

IRVAP – the Institute of Registered Veterinary & Animal Physiotherapists:

The IRVAP is a voluntary register with members including veterinary physiotherapists, animal musculoskeletal practitioners, canine hydrotherapists, animal massage therapists and TTouch practitioners who are holders of animal therapy qualifications. Accreditation is via a panel and qualifications depend on type of therapist. For veterinary physiotherapy membership, all practitioners must be qualified with a level 6 or 7 degree from a recognised educational provider. Manual therapists and canine hydrotherapists must hold a minimum level 3 accredited animal therapy qualification (equivalent to A level, certificate or diploma).

AHPR – the Animal Health Professions' Register:

The AHPR is a voluntary register of four animal health subgroups: animal chiropractic and manipulation; small animal hydrotherapy; animal/veterinary physiotherapy; animal sports therapy and massage. Therapists typically hold a level 3 or 4 diploma or higher education for an accredited pathway but there is also a recognition of prior learning pathway which involves demonstration of other qualifications, experience and competence.

IAAT – the International Association of Animal Therapists:

The IAAT is a membership organisation for animal therapists in practice. Registered therapies include: physiotherapy, osteopathy, manipulation, massage therapy, hydrotherapy and maintenance therapies (which inlude reiki, emmett, applied herbal choices, zoopharmacognosy, laser therapy, shiatsu, behaviour and nutrition).

IAVRPT – the International Association of Veterinary Rehabilitation and Physical Therapy:

The IAVRPT is an association providing membership benefits including professional support, access to conferences and a biannual symposium, networking, leadership opportunities and evidence based updates. It does not provide a searchable register for animal owners.

Conclusions

In conclusion, our top tips to choosing a musculoskeletal therapist:
1. Decide on what you are trying to achieve (if your horse is lame or in pain - contact your vet first)
2. Choose which type of therapy is most appropriate: physiotherapy, chiropractic, osteopathy, massage therapy
3. Ask your vet or somebody experienced, who you trust, for recommendations
4. Check the RAMP register or the relevant professional associations, eg NAVP for veterinary physiotherapists, ACPAT for chartered (human) animal physiotherapists
5. Check the therapist’s training, qualifications, experience and professional memberships
6. Make contact with the therapist to find out more and see if they are the right fit