Mind and Body

At the intersection where human physical therapy and veterinary rehab converge

An interview with Sue Fiske, a practitioner of both healing arts

Photo by Richard Asinof

Sue Fiske, who works as a physical therapist for humans and a certified canine rehabilitation practitioner.

Photo courtesy of Susan Fiske

Susan Fiske's physical therapy veterinary practice also involves working with horses.

Photo courtesy of Susan Fiske

One of the physical therapies offered for dogs in Susan Fiske's veterinary practice has been a treadmill in water.

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By Richard Asinof
Posted 4/23/18
The convergence of physical therapy for humans and physical therapy for animals has opened up a new career path in connectivity and empathy.
What kinds of lessons can be learned in the treatment of pain through physical therapy working with animals that can be applied to humans? How can the bringing of pets to work change the nature of the workplace moving forward? Are there ways to quantify the evidence-based mutual results in physical therapy for pets – and their owners – in improving health outcomes? Can older humans be taught new tricks?
The increase in cardiovascular activity has been shown to reduce the flood of stress hormones in the human brain. Is there similar evidence-based research that connects the positive relationship between humans and animals as a healing force from trauma?

PROVIDENCE – The boundaries of the workplace keep getting pushed into new directions, breaking down silos. For the first time, a sitting Senator, Tammy Duckworth, was allowed to bring her newborn onto the Senate floor so she could vote, tearing down the kind of artificial barrier that does not seem to make much sense in the 21st century world we live in.

A similar kind of breakdown, or breakthrough, is evident in the new Twitter accounts for employees at the Kaiser Health News, featuring their dogs and cats that are now welcome in the workplace.

The presence of young infants and pets in the workplace seems to be an acknowledgement that makes for a less artificial, more normal, healthier environment.

A similar kind of convergence is taking place in the world of physical therapy, where a new professional career path combines both physical therapy working with humans and veterinary rehabilitation working with animals.

Sue Fiske is both a physical therapist assistant, working with humans, and a certified canine rehabilitation practitioner, working with dogs; she also does physical rehabilitation therapy with horses, as well as hippotherapy, therapy provided to humans with the aid of a horse to improve physical, mental and emotional wellness.

[For purposes of transparency, some 12 years ago, upon the recommendation of a veterinarian, ConvergenceRI took his 11-year-old black Lab to physical therapy with Fiske, to help the dog gain increased range of motion to improve his quality of life. One of the therapies involved putting Buddy on a treadmill in a water tank, providing stability to exercise the dog’s legs without stress.

To this day, members of ConvergenceRI’s extended family still tease him about his decision to provide physical therapy for his aging dog. The answer to such criticism is that it provided Buddy with improved quality of life in his final years, and the fact that he loved going to the therapist.]

A chance encounter on the streets of Providence led to curiosity about how Fiske’s career was progressing, and she and ConvergenceRI recently sat down for an interview.

Here is the ConvergenceRI interview with Sue Fiske, a physical therapist assistant as well as a certified canine rehabilitation practitioner, talking about the lessons learned from both humans and animals in physical therapy, and their potential applications in developing alternative approaches to pain management.

ConvergenceRI: You are at the edge, at the convergence of different worlds of physical therapy and veterinary rehabilitation. How do you define the boundaries, and the need to cross the boundaries in your work?
FISKE:
I have worked in different aspects of health care and physical therapy, as a physical therapist assistant, in the field of physical therapy from pediatrics to geriatrics.

I have also worked in physical rehabilitation with animals. I have always felt this, animals are big part of our lives, and that they deserve and need the care that we give, the same care that humans get.

My favorite quote is: “The greatness of a nation and its moral progress can be judged by the way its animals are treated,” by Mahatma Gandhi.

ConvergenceRI: It may seem an obvious question to ask, but: how are the ways in which we interact with people and how we interact with animals related, when it comes to health care?
FISKE:
What is really important to note is that dogs are becoming more a part of our lives. We’re bringing them to the vets more, and they’re having more invasive surgeries. As veterinary care progresses, it is important to have the physical therapy to help bring them along their most functional level.

ConvergenceRI: Dogs have also become an important part of mental health therapy, in terms of bonding with prisoners or helping humans heal from trauma.
FISKE:
Yes. There is an emotional link, there’s a non-spoken, non-verbal link that an animal can relate to, and a child can relate to, that is beneficial.

ConvergenceRI: Non-spoken and non-verbal? Can you tell me more about what you mean?
FISKE:
I think that animals can communicate with us. The most frequent question I’ve always been asked is this: how can you work on animals if they don’t talk to you. The more time that you are with an animal, you realize that they do talk with you. They just don’t use a spoken language.

They use their body language, they communicate in their actions, but also in the way they [respond].

When we are so busy, wrapped up in our fast-paced world, I think we often miss the opportunity to be more present and to be more responsive [to non-verbal cues].

ConvergenceRI: When asked, I have often said that my dogs taught me many things, the most important of which was to remember to wag my tail when I was happy.
FISKE:
[laughing] But that’s so true. As I think about my 15 years of doing veterinary therapy, each animal I have worked with has taught me something, as well as improving my skills as a professional. They may teach you to be more patient; they may teach you be smarter than them, to be more clever. Or, they may teach you something that maybe you didn’t know was inside of you, or something that you need to develop.

ConvergenceRI: What has working with dogs taught you about working with humans?
FISKE:
I have noticed that people and dogs often have similar problems.

I often will have the dog come to a session, and when I start talking with the owner, it turns out that the owner will often have many of the same issues, whether it is back pain, or knee pain, or issues of overall fitness.

In working with animals, I’ve noticed, over time, as the animal’s health improves, the owner’s health often improves significantly as well.

A lot of the time, owners might not want to get care for themselves, but they will bring their animals in. But, as time goes by, and they see the animal’s health improving, they say: this could be good for me, too. And, I would often see them in my human practice in orthopedics.

ConvergenceRI: What kind of practice are you a member of?
FISKE:
I work with a group practice in Franklin, Mass., where I am physical therapist assistant, a member of the team. It is an outpatient orthopedic practice. It is a very busy practice, where we focus on manual, hands-on therapy.

ConvergenceRI: Do you use things like cupping and dry needles?
FISKE:
Many physical therapy practices have been adding new modalities such as cupping and dry needles. We do not perform these services at the present time, but we have just added a Class 4 Laser to our human practice, which has had some great results.

We have used it for years in the veterinary practice, but it is now just becoming more popular in treatments for people. We have used lasers in the treatment of orthopedic injuries in animals for years.

ConvergenceRI: How does the laser work?
FISKE:
The  specific light that is emitted from the Class 4 Laser at the proper wavelength can facilitate the mitochondria in the cell to speed the miotic rate in cell division. It does this through a series of chemical reactions at a cellular level, allowing quicker healing times for both deeper tendon injuries as well as more superficial wounds of the skin.

There are different classes of lasers, according to strength and function. The Class 3b Laser has been utilized in veterinary rehab for quite some time to treat animals successfully. It is great for tendonitis and tendon strains. We started using it with racehorses, which often have common injuries of the lower leg.

A new addition to our human practice is a Class 4 Laser. This more powerful  laser works to speed healing, as with Class 3b Lasers, but it also helps to decrease pain by inhibiting pain pathways and decreasing inflammation in the affected area.

There is some debate over which laser class is more beneficial in veterinary practice. We do want to control inflammation and pain in the animal to prevent suffering, but we recognize that pain is often there for a reason and that it helps animals [and humans, as well] from overdoing it and further stressing damaged soft tissue.

ConvergenceRI: In my coverage of the opioid epidemic in Rhode Island, one of the more surprising things is that there is not yet a clinical alternative pain center as a stand-alone practice in the state. One of the problems, it seems, is the inability to get reimbursed for work that involves yoga and acupuncture as a way to relieve chronic pain. Can you talk about the relationship between relief from pain and physical therapy?
FISKE:
There are a lot of different modalities we use in physical therapy that we assume everyone knows about. We have lasers, we have pulse electro-magnetic field [technology], which is great for fracture healing; it’s been used in animals for a long time.

I also incorporate breathing work and yoga into my physical therapy practice.

People often want to have the quickest fix that they can get [for pain]; they just want to be able to take a pill, or to have an injection.

But, as a physical therapist, we try to get to the root of the problem, to see if we can’t eliminate it through exercise, through better nutrition, which we know plays a huge part, in trying to give our body the building blocks that it needs to heal. And, not to cover up [the pain].

Also, building up muscle strength and endurance as important factors in maintaining fitness.

I think a lot of times, what happens with animals, and with humans, it that we try to push through it, to make it to the next day, instead of really stopping and trying to get to the root cause of the problem.

ConvergenceRI: What is involved in listening to your body?
FISKE:
Our outward appearance will often reflect, a lot of time, what’s going on inside. So, we look at all the systems; you need to look at your skin, you need to look at the cardiac system, you need to look at the pulmonary system, you need to look at muscle tone.

You want to make sure that you have enough cardiac fitness so that you’re not getting exhausted by the activities that you’re doing. You also want to try and eliminate most of the toxins in the environment that you can; some we don’t have any control over, but there are lots of things we do have control over, like what we put in our bodies.

And exercise. Most research has shown that an hour of some form of exercise is beneficial; it doesn’t have to be at a gym, or running on a treadmill. Everyone’s different. I have found, over the years, that you can do the exercise that makes you move, that makes you feel good. It doesn’t have to be the same exercise as the person next to you.

It just has to be something that gets your blood moving, that gets your mind engaged, the circulation to our heart but also to our brain. That’s why exercise is proven so beneficial to preventing a lot of diseases.

There are a lot of preventable diseases in both dogs and in people that you can avoid if you take a little bit of precaution.

ConvergenceRI: In terms of your own work as a physical therapist, is it easier to work on people or on animals?
FISKE:
I love both, and I’m grateful to being doing something that I love, both in the human and in the veterinary world.

In my veterinary clinic, I don’t have a clock. I always work on dog time, which is not the same as human time. I can treat them until I get the response that I want, or until they have had enough.

In some ways, that is easier, not having to be on a human time clock. [In the human practice], the pressure is on to see more and more people in a shorter amount of time, and to be more resourceful.

In the veterinary practice, I can actually work a little more freely on dog time. I always tell my human clients, I try the techniques out on them, and if they respond well, then it will be good for the dogs.

ConvergenceRI: Is the marrying together of physical therapy for humans and for animals a growing career path? Are more people pursuing it?
FISKE:
Yes. The first international symposium for veterinary rehab took place about 20 years ago at a conference in Corvallis, Oregon. It brought together people from all over the world.

Information was shared on a grassroots level about what different people been doing, with the realization, that this could become a profession.

For those looking to begin a career, the logical place to start is at schools that have both physical therapy programs and veterinary programs. There is a certification program at the University of Tennessee, where they are taking people who are already veterinarians and people who are already physical therapists and cross-training them into each other’s professions.

Editor's note: Sources of information for anyone interested in pursuing a careet in this field is the International Association for Veterinary Rehabilitation and Physical Therapy, the American College of Veterinary Sports Medicine and Rehabilitation, as well as the University of Tennessee Certificate Program.

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