Addressing Frailty Syndrome in Geriatric Dogs

by Susan E. Davis, PT “pull in for a helpful refuel!”  

It’s all about guiding and empowering you to help your pet avoid injury, provide practical solutions and achieve rapid restoration of health and function!   

Pet owners often ask “What is the most important thing I can do to help my dog’s overall health?”  The answer is: “help them achieve and maintain a healthy weight”.

You might assume this refers to pets that are overweight and are at risk for arthritis, loss of mobility, metabolic disease, etc.

While obesity is a common problem with older dogs, there is another condition I will highlight here: frailty in dogs. 

With advances in veterinary medicine, our pets are living longer and may develop issues in their geriatric years that include changes in appetite, dental disease, fluctuation in hormones, reduced blood flow to the brain, slower nerve and balance reactions, etc. When these changes cause lowered body weight, decreased muscle mass (called “atrophy”), thin skin, bone loss, weakness and limited endurance, the pet becomes frail and compromised. Similar changes can occur after extensive surgery or prolonged illness in an older dog.

The term “Frailty Syndrome” is often used to describe this combination of signs and symptoms.

A veterinarian can advise the pet owner about nutrition (percentages of fats, amounts of protein, supplements), dental care, pain management and assessment of cognition for the elderly frail dog. An animal-trained physical therapist can evaluate and treat the dog’s function, mobility, coordination, balance and strength.

Here is a list of items a therapist should look for during the evaluation, along with tips for helping manage and even reverse aspects of Frailty Syndrome.

  1. The Physical Therapy Evaluation will include examination of posture and weight distribution, watching the dog rise and sit or stand from a lying position, balance testing, sensation to touch and pinch, proprioception (the dog’s sense of their body position in space), feeling for areas of pain, swelling, tenderness, measuring limb circumference to assess muscle mass, checking the joints for range of motion, gait analysis, checking reflexes and strength.

  2. What you should tell the physical therapist to help in the evaluation process:  about your home environment (one level, stairs, other pets, type of flooring); changes in behavior you may have noticed (dog paces around the house, seems lost, has a hard time standing still, is falling); how much time they sleep and rest during a 24-hour period, any changes in bowel/bladder function, changes in water and food consumption, how they use their food/water bowls (if the dog is able to stand up or does it sit or lie down to eat and drink).

  3. Types of Physical Therapy interventions may include modalities to decrease pain such as Cold Laser, TENS or PEMF; range of motion exercises (within pain free range), low force strengthening, light functional exercises (to conserve energy), weight shifting in standing (forward and back, diagonally, side to side), paw placement on different surfaces and heights to stimulate balance and awareness of body position.

    Therapists will adapt all exercises to allow for slower speed, zero or very low resistance, fewer reps and longer rest period between exercises. This allows muscle tissue adequate recovery time to avoid painful lactic acid build-up, which is harder for a frail pet to metabolize and eliminate. If the pet has a difficult time standing, the therapist will use physio- rolls, balls, carts or clinic standers (see Eddie’s Wheels for Pets) to assist with weight bearing. Water is also used to assist with standing and walking, via the underwater treadmill, a tub or a pool. Pools can also be used for swimming, with the frail dog wearing a flotation vest, to improve circulation and cardiovascular health.

  4. What you can do at home: follow all preventative measures given by your vet to maintain good dental care of mouth and teeth, maintain proper length of nails and health of paws and pads.  Follow the vet’s advice on nutrition and ensure your dog gets plenty of water and has easy access to food (even if you have to bring it to them). Hydration and food intake are often decreased when there is limited mobility in the frail dog.

    If the dog has difficulty walking, don’t pass on giving them the opportunity to stand up, often, during the day and evening.  Frequent standing: even if only for 20 to 30 seconds and increasing gradually to 1-2 minutes every few hours (ex: 5 times per day) can make a significant difference in cardiovascular health and endurance even if the dog is very frail. If a dog needs assistance to stand, use a sling, harness, or place them over a stack of cushions.  If you have a wheeled cart that your dog will no longer walks in, place them in it just to stand.

    Use toys and treats to keep the dog moving and active, even while lying down.  Engage them in moving their head or limbs by tickling the belly or rubbing lightly across their back or under the chin. Help the nervous system by providing sensory stimulation through petting, light massaging, brushing their coat, rubbing their ears and paws.

    If your dogs can walk, short but frequent walks are best. Three 6-10 minute walks are more beneficial than one 30-minute walk for a frail pet.

    As the dog gains strength, try low impact functional exercises such as “sit to stand” for 6-10 reps. If dog has difficulty with this, place a cushion or step under the rump for a boost. For balance and coordination do leash-guided walking around cones of chairs in a wide circular pattern, on carpet, grass or other non-slippery surface. Challenge balance safely by having dog stand on an inflated mattress, a couch cushion, foam pad.

    For safety, help them gain traction on the floor with the following: Dr. Buzby’s Toe Grips, carpet runners, non-skid booties or socks such as those made by Sticky Pawz or Woodruff Wear, placing non-skid pads on steps, use of ramps with sides, etc.

  5. Precautions and Contraindications: deep tissue massage, stretching, heavy resistance, over-challenging your pet to the point of fatigue. Avoid slippery surfaces such as tile or wood floors; walking the dog up and down hills or steep stairs, activities that include jumping or running.

Frailty can be reversed, even if just partially, through home care and physical therapy. 

In the most severe cases, PT can help maintain the status and prevent it from becoming worse.  In either situation, it is important to ensure safety and maximize your dog’s quality of life.

Despite limited mobility and decline in former levels of function, happiness and high spirits can be achieved by meeting their needs at this new level. Accept your dog as they are, and show joy while providing their care.

If your dog feels special and loved, they will be content in fulfilling their main life purpose: to be your faithful companion.  


Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website , or follow on Twitter @animalPTsue.

Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery 
Physical Therapy Tip Of The Month: Ideas to Chew on - Can Physical Therapy Help with my Dog’s Digestive Problems?
Wrap It Up: Using Soft Supports For Your Dog
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part I) 
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part II) 
Physical Therapy Tip Of The Month: Safe Summer Boating Tips for your Dog 
Physical Therapy Tip Of The Month: Hip Dysplasia - What’s a Dawg Mama to Do?
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part I)
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part II)
Staying in the Loop with Targeted Pulsed Electromagnetic Field Therapy