Working with musculoskeletal allied professionals
There are a myriad of different organisations and individuals offering musculoskeletal (MSK) therapies for horses, which causes much confusion amongst horse-owners and veterinary surgeons alike. BEVA has compiled a list of Frequently Asked Questions for veterinary surgeons in an attempt to clarify the situation.
Q. Are all musculoskeletal therapists equally qualified?
A. Many musculoskeletal therapists hold a qualification but there is a wide variation in the required depth of knowledge and experience. Some qualifications demand independently accredited degrees and post graduate training whereas others are awarded following short part-time courses.
Q. What do the different musculoskeletal therapy titles mean?
A. The titles “Chiropractor,” “Osteopath” and “Chartered Physiotherapist” are legally protected and can only be used by regulated practitioners of chiropractic (commonly using spinal manipulation/chiropractic adjustment), osteopathy (commonly using physical manipulation, stretching and massage), and physiotherapy (commonly using manual therapy, specific movements and therapeutic exercises)
These titles provide assurance that the individuals are professionals who have undergone (and passed) degree-level training in their subject, have the depth of knowledge and the level of skills for them to legally treat human patients, are independently regulated, and carry professional indemnity insurance.
However, prefixing titles with words such as ‘animal’, ‘veterinary’ or ‘equine’ (e.g. ‘equine physiotherapist’) renders them unprotected; anyone can call themselves a ‘veterinary physiotherapist’ whether they have received any sort of training or not.
Q, Why are there so many different Associations?
A. Within the musculoskeletal therapy field there are many overlapping philosophies regarding how animal injuries should be best approached and what level of knowledge, training and skills are necessary in order to safely provide treatment. These differing philosophies have resulted in the formation of many different associations, each of which seeks to promote and protect their own views.
Membership of some groups/associations is only open to independently regulated professionals e.g. The Society of Osteopaths in Animal Practice (SOAP) The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) , McTimoney Chiropractic Association Animal Group (MCA), The British Veterinary Chiropractic Association (BVCA)
Q. How are Musculoskeletal Therapists Regulated?
There is no legal requirement for a musculoskeletal therapist to be regulated in the UK. This potentially puts horses, their owners, and any referring vet at risk in the event that something should go wrong during treatment.
An independent professional regulator, like the RCVS, ensures a high level of educational standards and provides complaints and disciplinary processes to ensure that professionals are accountable for their actions. Chiropractors, osteopaths and chartered physiotherapists are all independently regulated in the UK; other musculoskeletal therapists, including non-chartered physiotherapists, are not.
Some associations of musculoskeletal therapists provide a degree of self-regulation, but this is fundamentally different from independent regulation.
BEVA considers that independent regulation provides the greatest level of protection for horse and owner.
Q. How do I know if a Musculoskeletal Therapist is Independently Regulated?
A. Therapist’s names (or registration numbers if they have provided these) can be quickly and easily checked against the registers on the regulators’ websites: the General Chiropractic Council at gcc-uk.org, the General Osteopathic Council at osteopathy.org.uk, or the Chartered Society of Physiotherapy, via the Health and Care Professions Council at hcpc-uk.org.
I have received a request from a musculoskeletal therapist asking for my consent for them to treat to a horse that is registered with the practice. Should I sign it?
The Veterinary Surgeons Act 1966 (VSA) stipulates that only vets are allowed to diagnose an injury and give advice based on the diagnosis. Therefore, under current legislation, a vet should examine the patient, make a diagnosis and decide on a course of action, before any form of therapy is administered. If the proposed therapy is a “physical therapy” it may be administered by any musculoskeletal therapist (regulated or not).
If you have examined the animal, diagnosed the condition, and prescribed a therapeutic approach then providing consent to the therapist is consistent with the letter of the VSA. If you have not examined the horse and diagnosed the condition then BEVA recommends that you do not provide formal consent but try to establish some kind of dialogue with the musculoskeletal therapist and owner to agree what is in the animal’s best interests.
It is worth noting that by signing a consent form you may be deemed to have some level of responsibility for any treatment administered.
Q. What is the difference between musculoskeletal maintenance and treatment?
A. There is a grey area, which vets should be conscious of, relating to the differentiation between physiotherapy for maintenance and physiotherapy for the treatment and resolution of an injury.
The aim of maintenance physiotherapy should be to prevent objectively measurable deterioration in a patient’s condition and to sustain quality of life or performance. It is often used in elite equines to maintain function and optimize quality of movement.
It is common for musculoskeletal therapists to provide maintenance physiotherapy without veterinary direction.
BEVA considers this to be appropriate so long as the therapist is sufficiently well trained to recognize when veterinary intervention is required and sufficiently regulated to protect owner and horse.