The vet has diagnosed arthritis. You go home with painkillers, the advice to keep your dog lean and the sentence "try to keep him moving". So there you are. Physiotherapy for a dog sounds like something for canine athletes, while it is really meant for the old dog on the bed. This guide sets out what it involves, what it costs and when it is worth it.

What a canine physiotherapist does

A canine physiotherapist works on movement: strengthening the muscles around a worn joint so the joint takes less of a beating. The toolkit is wider than most people expect.

• Massage and mobilisation. Releasing knots and taking joints gently through their range of motion. In a dog who has been guarding himself for months, half the stiffness often sits in the muscle rather than the joint.
• Exercise therapy. Walking over cavaletti poles, balance cushions, controlled sit-to-stands. Dull to watch, effective in practice.
• Hydrotherapy. Swimming or an underwater treadmill. The water carries the weight, so your dog can move without loading the joints.
• Equipment. Laser, TENS, ultrasound or shockwave, depending on the practice and the complaint.
• Homework. Two or three exercises you do at home every day. This is the part that decides the result.

When physio for a dog with arthritis is worth it

Physio for dog arthritis is the most common question in this corner. The answer is usually yes. With chronic wear the gain sits in preserving muscle. A dog who moves less loses muscle mass, so the joint takes more of the load, so he moves even less. Physiotherapy breaks that spiral.

It also clearly pays off for:

• rehabilitation after cruciate ligament or hip surgery;
• hip dysplasia and elbow dysplasia;
• back problems and disc disease, including after surgery;
• visible muscle loss in an older dog;
• dogs who are overweight and cannot walk far enough to lose it.

Where to expect less: acute pain without a diagnosis, behavioural problems and progressive conditions such as degenerative myelopathy. In that last case physio can improve the quality of the time left, just not change the course. An honest therapist will say so up front.

What physiotherapy for a dog costs

Expect the figures below. Prices vary a lot per practice and per region, so always ask in advance.

A typical arthritis programme starts with four to six sessions. After that you move to a maintenance rhythm of once a month or once every two months. So for the first block you are quickly looking at 300 to 500 euro.

Reimbursement hangs on two conditions

Many pet insurers cover physiotherapy in full or in part. In the Netherlands two hard conditions almost always apply. There is a referral from the vet and the therapist is registered with the professional association NVFD. Miss either one and you pay yourself.

That referral is not only an insurance matter. Under Dutch law an animal physiotherapist may treat a diagnosed condition only on referral from a vet. Preventive work with a healthy animal is allowed without one. In Belgium, check your policy wording, because the rules differ per insurer.

What a programme looks like

The intake takes longest, usually an hour to an hour and a half. The therapist watches how your dog stands, walks, turns and gets up, feels the muscles and reads the vet's report. A treatment plan comes out of that.

Then come sessions of thirty to forty-five minutes, once or twice a week at first. As soon as things improve that gets tapered off. Do not expect a miracle in week one. Most owners notice a difference in the getting-up after three or four sessions.

The homework is not a side note. Two five-minute exercises a day do more than one weekly session with the therapist. Skip it and you pay for half a result.

How to spot a good therapist

Not everyone working with animals and movement holds a protected title, so ask questions. Watch for these points:

• There is a proper animal physiotherapy training behind it, not a weekend course.
• The therapist is affiliated with a professional association.
• Findings are reported back to your own vet.
• You get a treatment plan with a goal and a number of sessions, not an open ending.
• No promises of a cure are made. Arthritis does not go away.

What to sort out at home before you start

This gets skipped often and it costs you money. Your dog trains one hour a week with the therapist. The other 167 hours he is standing on your floor.

On parquet, laminate or tiles a dog in pain places his paws differently: short steps, toes spread, muscles braced so he does not slide out. That is exactly the movement pattern the therapist is trying to unlearn. Grip under the paws takes that brake off. Our non-slip dog socks are not a treatment, they simply let your dog dare to load his legs between sessions. The right size is based on the width of the spread paw print, which the size calculator works out for you.

Still not sure whether your dog is actually struggling? The quiet signals are set out in recognising pain in your dog. What else you can adapt at home for joint wear is covered in arthritis in dogs: what helps at home.

The trade-off in short

Physiotherapy is neither a luxury nor a miracle cure. It is an investment in muscle mass. In an old dog, muscle mass is the only thing that takes load off the joint. Start with an intake and four sessions, do the homework daily and judge after six weeks whether you see a difference in the getting-up and on the stairs. See nothing? Then stop and discuss another route with your vet.

Frequently asked questions

How many sessions does my dog need?

For chronic wear a programme usually starts with four to six sessions, then maintenance once a month to once every two months. After surgery it runs higher: eight to twelve sessions is common. A therapist who will not name a number after the intake is a reason to look further.

Is physiotherapy not too much for an old dog?

No, as long as it is adapted. The whole idea is that your dog moves without overloading the joint. That works just as well at thirteen as at three. The exercises are simply shorter and calmer. With heart problems or serious breathlessness the therapist checks with your vet first.

There is no physiotherapist near me. What then?

Many therapists do home visits, though you pay travel costs. A middle road is one intake with a detailed homework programme that you then run yourself at home and have adjusted every six to eight weeks. That is cheaper than driving weekly and it works better than doing nothing.