Cats getting massages? Kitties on underwater treadmills? Rehabilitation for feline patients takes off.
Rehabilitation for dogs has become commonplace in veterinary medicine and has demonstrable health benefits. While rehabilitation for cats has lagged behind, more rehab facilities are seeing feline patients, and the scope of treatments is widening. Knowing what’s available for feline rehabilitation is important, so practitioners can deliver the best care to their cat patients.
In this review, we’ll start by taking a step back and talking about diagnosing and localizing pain in cats; move on to a detailed look at current trends in feline rehabilitation; and end with a discussion of what veterinarians and other pet healthcare professionals can expect in the future.
RECOGNIZING PAIN IN CATS CAN BE TOUGH
For those of us who’ve ever tried to do an orthopedic or neurologic examination on a cat 
in the clinic setting, the encounter often ends with an angry cat and a frustrated veterinarian.
Cats and their owners interact in different ways to dogs and their owners. Most clients don’t walk their cats, or play catch or fetch, activities that in dogs often uncover pain or altered mobility. Veterinarians also can attest to how the stress of simply taking a cat for a veterinary exam can mask pain. But there are tools veterinarians can use to help diagnose pain in their feline patients.
In addition to a physical and/or neurologic exam, questionnaires to assess pain in cats are available for both veterinarians and owners. The Feline Musculoskeletal Pain Screening Checklist (Feline MiPSC) was recently developed as a screening tool to evaluate cats for pain. Once a cat has been screened using this instrument, experts recommend using other questionnaires as a way to monitor efficacy, such as the Feline Musculoskeletal Pain Index (FMPI), the Client-Specific Outcome Measures (CSOM), or the Montreal Instrument for Cat Arthritis Testing (MICAT — there are two surveys, one for caretakers and one for veterinarians). Other questionnaires are also available or in development for veterinarians.
Data suggests these questionnaires are helpful in objectively assessing pain in cats (especially pain associated with osteoarthritis), when used by both veterinarians and cat owners. They’re also great ways for veterinarians to engage with clients as partners in their cats’ healthcare.
Although diagnosis is challenging, owners can look for clinical signs that may point to pain. Interestingly, almost all signs of pain in cats are tied to behavior changes. The most common include:
- Hesitance or avoidance of jumping
- Reluctance to go up or down stairs
- Using a step to get on a surface instead of jumping
- Decreased interactions with owners or other animals
- Increased irritability
- Isolation
- Decreased food and water consumption
- Resentment at being brushed, patted or touched
- Greasy coat and dirty nails
- Elimination accidents — difficulty getting in or out of the litterbox
- Sudden vocalization and running away for no apparent reason
- Suddenly turning to look at a region of the body for no apparent reason
The bottom line for veterinarians is that in cats, unlike dogs, behavior changes are dominant when it comes to pain, especially osteoarthritis-associated discomfort. Unfortunately, some of these signs overlap with other feline diseases such as hyperthyroidism and kidney disease, so it’s important for veterinarians to regard any behavior changes as potential signs of disease, and not simply a product of aging.
PROBLEMS THAT FELINE REHABILITATION CAN ADDRESS
Although developmental orthopedic diseases and injuries are less common in cats than dogs, a growing body of evidence suggests osteoarthritis is more common in cats than previously suspected — with some studies suggesting that >90% of cats have some evidence of osteoarthritis in at least one joint.1-3
Many conditions affecting cats can be treated with rehabilitation and physiotherapy. These include:
- Osteoarthritis
- Post-operative therapy
- Neurologic conditions
- Obesity
HARNESSING NORMAL FELINE BEHAVIOR KEY TO SUCCESS
Cats have short attention spans and tend to dislike restraint. Keeping rehabilitation 
sessions short (only a few minutes at first) is important when starting on a therapy program.
Dr. Stefania Uccheddu, a veterinary behavior specialist at the San Marco Veterinary Clinic and Laboratory in Veggiano, Italy, illustrates this point in a story about one of the first cats they started in their physiotherapy program. The cat came out of the carrier and went back in after only a minute, at which point Dr. Uccheddu announced the session was over.
“The caregiver was surprised,” she says. “However, we had good communication with this person, and eventually, the cat was using the underwater treadmill!”
Cats have strong hunting and stalking instincts that can also be leveraged in rehabilitation programs. For example, Drum et al talk about the use of laser lights to get cats to move in certain directions or engage in specific movements.1
BROAD SCOPE OF MODALITIES AVAILABLE FOR CATS
Many of the same techniques used by human and canine therapists can be used for cats.1-4 A brief overview of techniques follows:
- Massage — A variety of massage techniques has been used successfully in cats. These include effleurage (stroking), petrissage (kneading) and tapotement (rhythmic percussion).
- Range-of-motion (ROM) exercises, including stretching — Both passive and active exercises can be used in cats. Many of the same exercises described for dogs can be used in cats, although cats tend to be less tolerant of passive ROM than dogs.
- Laser therapy — Typically, lasers are used to manage pain and in wound healing. They also can be used in cats but require special equipment and training to keep staff and patients safe.
- Therapeutic ultrasound — This method is used for deep tissue healing. It also requires special equipment and training.
- Electrical stimulation — This technique can be used in cats but must be introduced slowly. Again, electrical stimulation requires specialized equipment and training.
- Use of heat or cold — The application of both heat and cold has been used in cats. These therapies can be easily used by trained hospital staff, and also taught to cat owners.
- Swimming and underwater treadmill — Yes, cats can do this! Just as with dogs, it can be a valuable tool for rehabilitation post-surgery, aid in weight loss, and as therapy for osteoarthritis. The key is to work slowly and keep sessions short until the cat adapts to it.
It’s important to recognize that while many of these modalities are commonly used for feline rehabilitation, few research studies confirm the effectiveness of any single technique.
CURRENT STATE OF THE INDUSTRY
There are no certified feline rehabilitation specialists, but many canine rehabilitation facilities also offer services for feline patients. If you’re considering referral, try a local canine rehabilitation service first.
Some veterinary practices are also beginning to offer rehabilitation and physiotherapy services for feline patients. However, it’s important to ensure you have the proper facilities, expertise, and time to appropriately manage these patients. For most veterinarians, referral is the easiest option.
Rehabilitation and physiotherapy for cats is a growing industry that shows few signs of slowing. It’s important that veterinarians recognize the potential benefits of this therapy for their feline patients.
AUTHOR PROFILE
Dr. Kelly Diehl received her DVM from the University of Tennessee and started her practice career in an emergency clinic in New Jersey. She then completed an internship at the prestigious Animal Medical Center in New York City, after which she moved west, completing a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, she left private practice to pursue a career in medical communication and joined the Morris Animal Foundation team in 2013. Dr. Diehl is a board-certified small animal internal medicine specialist and a Certified Veterinary Journalist.
