By Matt Scott, Veterinary Physiotherapist BSc (Hons), MNAVP

It is a common misconception amongst owners and even those within the veterinary industry that cats do not tolerate physiotherapy. Whilst there may be certain individuals that do not tolerate manipulation by anyone, these patients can still benefit from owner education on home exercise and environment management strategies. There are however many cats that can tolerate, and even enjoy, physiotherapy and in some circumstances, hydrotherapy. However, they are not just small dogs and they have different considerations, different anatomy, and different behaviours and therefore they require a different approach to dogs.

Anatomical differences

There are many musculoskeletal differences in cats that allow for better adaption to their specific environment and behaviours. These include being more flexible through their spine and having more range of motion (ROM) through the appendicular skeleton (Lorinson et al., 2019). Therefore, when rehabilitating cats that have a ROM restriction, this must be taken into account as they may require a larger range to regain full function than dogs do.

Cats have retractable claws which retract via the dorsal elastic ligaments between the middle and distal phalanges. Additionally, cats do not have sacrotuberous or nuchal ligaments but they do have soleus and gluteofemoralis muscles, which are both absent in the dog (Pasquini et al., 2007).

Within cat’s muscles, there is a higher percentage of fast-twitch fibres, which may influence decision making and exercise selection throughout rehabilitation, relying more on power-based exercises including ballistic/ plyometric in late-stage rehab to achieve full return to function (Maxwell et al., 1977). Another difference is the presence of a small clavicle bone which is absent in a lot of species we commonly treat, although it does not attach to any other bones (Tozzi et al., 2020).

It has been reported that the cranial cruciate ligament (CCL) in cats is thicker than the caudal counterpart (the opposite to what is noted in dogs) which may explain the reason CCL ruptures are less common in cats (Harasen, 2009).
There are also many other anatomical differences that should be acknowledged before commencing treatment with a cat, in order to be most effective. Cats do have some differences in movement and gait patterns as well. For example, pacing can be considered a normal walking gait, and so can loading both pelvic limbs simultaneously during a gallop (Tozzi et al., 2020).

Behaviour

Cat behaviour is perhaps one of the most obvious differences between them and dogs as patients, and understanding their behaviour could make or break a rehabilitation programme. Cats can behave as both predator and prey.
Their hunting/predator instincts can be utilised within an exercise programme, whilst their prey instincts mean they naturally require hiding places and/or perches. Therefore, providing a designated area for the patient to hide in at times during a session is a good idea to improve compliance and reduce stress levels, provided it is not too difficult to retrieve them from this space when needed (Vinke et al., 2014).

Other ways to reduce stress in feline patients include the use of pheromone diffusers, allowing the patient to explore the environment before commencing assessment, and have the owner bring in items with familiar scents including favourite bedding, toys, and/or treats.
When it comes to the assessment and treatment, cats may not always tolerate their limbs taken through a ROM assessment and they also tend to have less patience than dogs (Tozzi et al., 2020). Therefore, the assessment and treatment may have to be conducted in more of a “stop-start” fashion than usual, in order to make sure the cat does not completely lose patience and treatment remains possible.
Often cats will show signs of losing patience before they vocalise or swipe/bite and so it is vital to understand these behavioural signals to improve compliance as well as from a safety point of view. These signals may include tail swishing, tense whiskers, flattened ears, raised hackles, or attempting to escape to their hiding area (Tozzi et al., 2020).
Cats will also have certain behavioural cues that can indicate pain. However, these can be even more subtle than in dogs, particularly with regards to chronic pain. There are some pain scales available that have been validated for the use in cats.

For acute pain and medical conditions, there is the Glasgow Composite Measures Pain Scale-Feline (CMPS-Feline) (Campoli and Vettorato, 2018). There are several available for chronic pain but one example would be the Feline Musculoskeletal Pain Index (FMPI) (Perry, 2020).
Chronic pain behaviours in cats that both the owner and therapist should be aware of include; incessantly licking an area, reluctance to play or hunt, reduced social interactions, reduced frequency of jumping/reluctance to jump, changes in standing or sitting posture, changes in toileting habits, avoiding use of the cat flap, and no longer grooming particular areas of their body (Perry, 2020; Tozzi et al., 2020).

Due to cats having lower patience and tolerance for manipulation in addition to them generally receiving less training than dogs, therapeutic exercise prescription can be one of the most challenging aspects of feline rehabilitation. However, we can use cat’s natural behaviour to encourage and reinforce certain movement patterns that we desire for rehabilitation of different injuries. This will be detailed further in Part 2.

Home and exercise considerations

When treating cats, there are a number of different aspects that must be taken into account during the history/ background assessment in order to provide an effective and appropriate rehabilitation plan. The therapist should attempt to gain an understanding of the individual cat’s home environment as well as their daily activity levels.
They must also consider the cats age and what is considered “normal” for them in behavioural terms, making sure to note if there are changes between when the cat is solely around the owner(s) and when the therapist is present.

There will likely be further changes in behaviour if the cat is being treated in a clinic versus within their own environment as most cats will be more nervous and quieter outside of their own environment (Tozzi et al., 2020). With regards to daily activity levels, it will also be important to know if a cat is generally an indoor or outdoor cat, and whether the owner has an expectation of what they would like their cat to be able to do once they have undergone rehabilitation.
Indoor cats will differ from outdoor in that they will likely have worse muscular and cardio-pulmonary conditioning as well as potentially being more at risk from obesity.

Having some idea of a cat’s normal personality, behaviour, activity levels, and what they like to do/what their interests are, will help when formulating a treatment plan and allow more flexibility with exercise selection.