The importance of cooperative care for anxious and reactive dogs in Physiotherapy

By Rosie Jackson, November 2026

Majority of dogs have a very positive experience during physiotherapy, however some dogs can find treatment very challenging. Like us, dogs struggle with pain

and biomechanical challenges. Cooperative care is where a dog is encouraged to willingly participate in procedures. In physiotherapy cooperative care focuses on building trust and willingness to participate to reduce fear and reactivity for dogs that need extra support. The more comfortable and confident the patient is, the better outcome for quality of treatment and experience. Some patients can be scared of having a painful area touched and treated, where others may have behavioural challenges and physiotherapy can test that individual limit. It is a duty of care for the physiotherapist to ensure they provide the best care possible. Sometimes, this means going slower initially and helping the dog feel more comfortable. The emotional wellbeing of the patients is just as important as the physical wellbeing. A dog pressured or forced for treatment is likely to have a reduced tolerance for treatment and therefore the practitioner is further limited. Some patients may never be able to tolerate Physiotherapy, where others can surprise you with the right help.

Why cooperative care matters

Cooperative care is when a patient is given the option to opt in or out at of handling and treatment. This allows the dog to be a willing participant in their treatment. Dogs are emotional and sentient beings. Most of us who own dogs understand how deeply this is true, however studies now support and confirm that there are similarities between human and canine emotional circuits within the nervous system, as well as their own additional unique circuits (Skierbiszewska et al, 2024). The dogs anxiety circuit has been proven by MRI to be very similar to humans. A lot of the dogs seen in clinic are older or struggling with debilitating injuries, naturally these dogs are going to have anxiety about a new person approaching them and trying to assess their injury or pain, especially if they have additional behavioural needs. Understanding and recognising signs of stress in dogs is essential to support the individual.

Signs of stress in dogs:

• Lip licking

• Yawning

• Panting

• Whale eye (Showing the white of the eyes)

• Dilated pupils

• Pacing

• Trembling

• Vocalisations

• Ears back

• Posture changes or stiffness

• Displacement behaviours or avoidance such as walking away

• Lunging

• Biting

How can cooperative care be integrated into Physiotherapy sessions?

During assessment, the dogs behaviour is evaluated and taken into consideration when approaching. A more confident dog is more likely to tolerate a full assessment and we can continue straight into treatment. Other dogs may struggle with hands on work due to pain or behavioural reasons. Restraining or pushing a dog here would likely lead to resistance of treatment, thus creating a negative association around physical therapy. With some patients rebuilding after broking trust can be very difficult. If there is plenty of notice before the first session it is always beneficial to encourage the owner to muzzle train so that if needed, a muzzle can be applied with minimal stress. Safety for all involved is always a priority, but we also want to avoid the first muzzle experience to be in the first physiotherapy session where possible. The overall goal is to build safety and confidence in the patient. Most patients come in for the first time in a degree of pain or anxiety. So, where do we start? Every dog is different, but here is a general guidance to beginning work with a nervous or a reactive dog with cooperative care in 6 steps to begin the first session.

Step 1- Support relaxation. Initially ignore the dog entirely and chat to the owner and begin the consult to allow the dog to regulate themselves. Studies show that dogs are excellent at reading human emotions and respond better with calm and communicative cues (Albuquerque and Resende, 2022). When ready help the patient feel good about you, you can throw some treats behind them to search for, regularly calmly talking to the dog can help build relationship and ease anxiety. If a dog appears tense or there are signs of becoming very uncomfortable, ensure you give them the space so they don’t have to react. We want to work within the dogs tolerance even if that window is very small. You can use pheromone diffusers or essential oils if appropriate. Calming music can also create reduce tension in the room. The goal is to help the patient feel good about you and to see that you are a safe space where they can relax.

Step 2- Provide a clear treatment space. Provide a vet bed or use the patients bed as a treatment area. Only work with the dog when they are on this mat or bed. Over the course of time, the patient can associate treatment with the treatment bed. If a patient needs a break, leaving the bed gives them a defined safe space as they learn they will not be treated if out of the designated zone. Other patients love their treatment and will immediately lie down ready for their session. Ensure the treatment room is quiet and any distractions are kept minimal. Have a discussion with the owner beforehand if they are comfortable having people arrive at their home, home sessions can be great for reducing tension in dogs that need more support.

Step 3- Positive reinforcement. Allowing the dog to sniff the area and be allowed to explore initially can be very calming. Using food based rewards or positive verbal cues be very useful. A preference is to not feed or use toys during the actual treatment as this can be distracting and make treatment overstimulating for some dogs, although for some patients this is necessary. Offering food and toys pre-treatment, during assessment and for remedial exercises can be very effective.

Step 4- Gradual introduction to assessment. For some patients there may be a period of socialization sessions before starting treatment to help them adjust. Hands off analysis such as assessing posture, confirmation and movement can begin to paint a picture of whats happening with a dog when we are unable to progress to hands on assessment. We can ask the dog to move through remedial exercises with the handler to further help us build a picture. If the dog is compliant we can feel joint movements and assess the soft tissues for the rest of the assessment.

Step 5- Monitor body language. As you build a relationship with the patient you will learn their start and stop signals. Keeping a check in on body language will help gain information about the dogs experience. Listening to the dogs body language and showing they will be heard can support the trust building process and hopefully allow further treatment. As a handler or practitioner, remember to breathe and be self-aware of what information you are giving the dog about yourself.

Step 6- Begin treatment. This can be hands on or hands of with the use of exercises. If you have a dog who likes to work or is food motivated, starting with exercises allows the dog to engage and relax. The idea being that a positive relationship can be formed before hands on treatment is started. If massage is tolerated I often choose a comfortable area of the dog to begin, thus stimulating the parasympathetic nervous system. This is the part of the nervous system which is responsible for ‘rest and digest’. This is the opposite part from the ‘fight or flight’ system and will help the dog release serotonin and dopamine which reduce stress levels (Teo et al, 2022). If this initial treatment phase is successful, the dog may then allow massage and treatment of more uncomfortable areas.

The key is to take the session at the dogs pace and gradually build confidence over time. The first few sessions may only be 10 minutes and very limited to treatment options, but this can lead to successful treatments later if given the time to adjust.

References

• Albuquerque. N and Resende. B (2022) Dogs functionally respond to and use emotional information from human expressions. Evol human science. 6 (5)

• SKIERBISZEWSKA. K, Borowska. M, Bonecka. J, Turek. B, Jasinski. T and Domino. M (2024) Functional magnetic resonance imaging in research on dog cognition: A systemic review. Applied science. 14 (24)

• Jillian T. Teo, Stuart J. Johnstone, Stephanie S. Römer , Susan J. Thomas (2022) Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review. International journal of Psychophysiology. Vol 180. PP 27-48