ABSTRACT: In recent years, there has been a growing interest in the roles that rehabilitation and physiotherapy can play within small animal practice. This article examines a new qualification that has been set up for veterinary nurses, to allow them to develop skills in physiotherapy and rehabilitation. It looks at the content and structure of the course, the new skills that can be developed and how they can benefit patients, the veterinary nurse and the veterinary practice.

In recent years, there has been a growing interest in the role that rehabilitation and physiotherapy can play within small animal practice. A number of practices are now seeing the benefits that it brings to their patients, including an improved recovery rate and faster return to function.

Veterinary nurses are in an ideal position to carry out the rehabilitative care of patients and many already perform such techniques as ‘icing’ or passive movements postoperatively. However, training of the VN in this line of work is often minimal.

With this in mind, a new qualification, the Veterinary Nurse Rehabilitation Therapist (VNRT) has been set up so that the VN can develop her or his skills in this discipline.

Qualifying as a VNRT

Having completed an introductory course in physiotherapy, I knew that this was the career path that I wanted to pursue; so I undertook some research in order to find a course that would best fulfil my needs and give me a suitable qualification.

There are several courses available in physiotherapy, massage and rehabilitation; however, I found that entry to these courses was often open to ‘anybody’ and some were run by non-physiotherapists, who did not appear to have the appropriate qualifications for a course of this type.

The reason I chose to undertake the VNRT course was that it aimed specifically at qualified VNs and it is taught by a chartered veterinary physiotherapist and an orthopaedic veterinary surgeon.

I qualified with a Diploma VNRT in August 2012 after completing my final piece of coursework. The course structure is excellent and consists of a series of seven modules (Table 1).

There is coursework associated with each module and an examination consisting of a two-hour written paper and a 30-minute practical exam. Each module consists of a taught element over two days; and as well as the theory, there is also plenty of opportunity to develop practical and decision-making skills (Table 2).

Putting it all into practice

Without doubt you need the support of the veterinary surgeons with whom you work. My practice has supported me throughout the qualification and my colleagues are happy to integrate my new skills into the practice protocol. They can see the benefits that the qualification brings, both to the patients and the practice.

I have a regular ‘clinic day’ and it is not unusual for it to be booked up with a series of appointments. All of the orthopaedic cases are now referred to me postoperatively, as well as arthritic patients needing help with their mobility and neurological and critical care in-patients.

My appointment times can be anything from 30 minutes to one hour, depending on whether it is a postoperative check or a full assessment (Figure 1). After the patient assessment, I will spend time with the clients talking to them about their pets condition and determining an appropriate treatment plan for them.

Figure 1: Measuring the angle of the stifle joint using a goniometer

Each client is given a comprehensive plan which details the modalities and exercises that I have prescribed. These are always demonstrated to the owners and they are given an opportunity to ‘practise’ them before they leave the clinic.

Some patients come to the practice on a regular basis for a treatment session. Typically I might start by warming the patients muscles and then performing some massage, and introducing passive movements, stretches and proprioceptive exercises. This has had a very positive response and several now come back on a weekly basis because they can see the benefit to their pet.

In the hospital setting, patients are assessed and treatment plans are made in which everybody can get involved.

Marley – a case in point

A recent case that we had was Marley, a three-year-old Labrador retriever who had been involved in a road traffic accident (RTA). He suffered multiple traumas – a fractured femur, haemothorax, pulmonary contusions and a brachial plexus injury. The rehabilitation care that we were able to include in his nursing care plan greatly contributed to his recovery and included appropriate positioning for his chest care, ‘icing’, massage, passive movements, weight shifts, appropriate active exercises and neuromuscular electrical stimulation (NMES) (Figures 2 & 3).

Figure 2: Marley receiving NMES to his forelimb muscles, damaged as a result of the brachial plexus injury 

Figure 3: Marley undergoing a treatment session which included 'icing', passive movements, stretches and weight shifts

He is now an outpatient and is doing really well. He comes in regularly so that I can evaluate his progress and determine his next set of exercises.

Essential support

During the time that I have been completing the course, I have had the full support of the course leader, an ACPAT physiotherapist. This has allowed me to have ongoing support whenever I have had a difficult case in practice and needed help and advice.

For example, Flute, a cross-breed who suffered an FCE (fibrocartilagenous embolism), is one such case. Learning all of the practical skills required to support a neurological case such as Flute is one thing, putting them into practice is quite another! By working with the course leader, I have gained confidence and now feel I am making a positive contribution towards the dogs recovery.

I have been visiting her on a regular basis for her treatment sessions, which include stimulating her muscles by massage and quick stretches; utilising reflexes, bicycling, standing and proprioceptive exercises with the aid of a ‘physio roll’ (a peanut-shaped gym ball) and re-educating her in how to walk, sit and stand.

Flute has made a great recovery and the team approach to her care has undoubtedly influenced this.


The VNRT course requires hard work and determination. However, during training and once qualified there are many benefits for both the VN and the practice.

I charge initial and follow-up consultation fees, as well as treatment fees for hospitalised patients that require a large input of nursing care. The VNRT qualification has definitely contributed to the practice financial intake and provides an additional service for our clients, which helps to bond them to the practice.

I am really pleased that I chose to become a VNRT. I am continuing to see new cases every week, have developed my own client base and feel that I am making a real difference to my patients (Figure 4). This is only the starting point though, as I still have a great deal to learn; so to have the continued support from the course leader is very reassuring.

Figure 4: Balance work on the wobble cushion to challenge balance and proprioception on Poppy who suffered from a spinal injury

I would recommend that any VN who has an interest in rehabilitation should consider undertaking a qualification in this discipline.

If you would like any more information, you would be more than welcome to contact me by e-mail at: sarah.whittaker@henleyvets.co.uk


Sarah Whittaker Dip AVN(Surg) VN

Sarah Whittaker qualified in 1990. Since then she has worked in a variety of small animal practices. She holds the Diploma AVN (Surg) and is currently head nurse in a small animal practice in Henley- on-Thames. Her main interests are surgical and critical care nursing and, of course, rehabilitation.

To cite this article use either

DOI: 10.1111/j.2045-0648.2012.00216.x or Veterinary Nursing Journal Vol 27 pp 347-349

Veterinary Nursing Journal • VOL 27 • September 2012