Being Prepared

 

Milly is a 7 year old Maltipoo (with a bit of Bichon Frise) who is due to have a cruciate operation on her right knee in the summer.   She currently has Grade II medial patella luxation in her right hind and Grade I to II medial patella luxation in her left hind legs. 

Her Mum wanted to book a session to learn how Milly could be helped now – to get her in top condition prior to surgery – and then to carry on the therapy for her post-operation rehabilitation.  What a considerate Mum!

Milly was initially a little uncomfortable with any touch near her rear end, understandably as she had been holding that area tight and scrunched.

But touching her anywhere else generated a smile, soft eyes and resting ears – she loved all of that and we knew we were onto a winner with on-going therapy for Milly.

We went through an appropriate set of massage techniques and leg strengthening exercises that would suit Milly now to make sure all her muscles are healthy and toned, but could be adapted later for rehabilitation.

By the end of the session, Milly was lying down on the mat allowing us both to work with her anywhere on her body – she’d started to understand the difference between therapeutic touch and petting.

 

Best Feedback

Bobi and Pixie have a lovely sunny garden which is ideal for safe working. The dogs get their massage and heat therapy which is a double bonus. 

Both love their sessions enthusiastically – sometimes over keen. One minute Pixie can be purring contentedly in my arms and the next she is off racing round the garden showing her new flexibility. 

But she comes back. Equally Bobi can be lying on the ground smiling his oh-so handsome goofy smile and then he’s off in a wrigglefest. But the end result is always the same – two sparko dogs relaxed for the remainder of the day as in these pictures. 
 
We really can’t ask for better feedback.

New Best Friend

Sometimes, you meet a dog for the first time and they immediately decide that you are to be their Best Friend Forever – and it is reciprocated. 

Meet 3 year old Golden Retriever Archie. A big goofy soppy cuddly fluff ball. We worked in the garden and he simply sat on me – for 45 minutes. My legs had totally gone to sleep by the end but Archie was not going to miss one millisecond of his therapy. 

He had been displaying stiffness in his back. He greeted me through the front gate with the biggest smile “Oh hi…you’re Dr Les. I love you already” before sitting on me as I made myself comfy on the lawn. 

As soon as I touched his lower back, he just threw his head up with a huge grin – that was the spot. Heat came from the area, his eyes rolled in bliss and his smile reached his ears. 
 
The tension had worked itself up his spine into his neck. He adored all the attention and help. 

After a while he turned over and gave an enormous stretch on his back – a stretch that went all the way from his neck to his tail. No tension there now. I said to his Mum to look at the stretch, when he huge looked up at me and stretched his front legs even further – just to show us both that he could. So many times, when talking about a dog with their Mum or Dad during a session, the dog seems to listen and display what we are talking about. In Archie’s case, it meant a l-o-n-g dog.

He even managed to have a darn good scratch at the end, which he hadn’t been able to do. 

When he walked off he had his Retriever mince back, his fur was positively flowing around his like a prize Afghan Hound and he was soooo happy. 

An amazing boy and my latest BFF.

Job done

I hadn’t seen handsome collie Bob for a couple of years. Recently he had an operation with some uncomfortable post-surgical complications requiring restriction of his mobility and wearing a collar so he couldn’t get to the wound site. 

All this made Bob an unhappy boy. His Mum rightly asked if I could go over to give him a check over before he resumes normal Bob Duties. 

When I last visited, Bob kept his toy ball in his mouth throughout. This time it was a deer antler. Things don’t change – just the comforter. At the first session, he was a textbook dog to work with. At that time, I imagined the conversation in his collie head going something like : 

“Ok…that was lovely but I’ll just go for a walk round the sofa” 

“And hello I’m back” 

“Ok…I’ll go for a walk again” 

“And bring back my toy to hold” 

“Ok…I’ll go and sit by Mum and rest against the sofa” 

“Oh this is nice, I’ll just close my eyes” 

“Hmm…I’m sliding down onto the floor” 

“Ok, I’ll just stay here and sleep” 

“I feel like a stretch….oooooo… l-o-n-g stretch” 

“And I’ll do another one – ‘coz I can now” 

Still nothing changes. The script was exactly the same except we were in a different room and he couldn’t get round the sofa. Otherwise it was lots of “oohs and ahhs” interspersed with “I have to walk away for a moment – but I’ll be back”. It was as if he had speech bubbles coming out of his mouth his reactions were so clear. 

And he slid down on the floor in front of the sofa – just as I told his Mum he would. Which is where he stayed. 

His lack of activity plus discomfort had scrunched him up – tight neck and back. Just touching them started to make him longer and release the heat from the restricted fascia. I could see how long he was getting by the space he was taking up in front of the sofa. 

At the end, he got up, did an enormous Dog Yoga stretch one way and then the other. Big shake. And dropped the antler as though it were a Mic Drop! Very dramatic Bob. 

I think that was a Job Done moment.

It’s all about the intention.

Lexi is a 6 year old Portuguese Podengo cross with long legs rescued by Karen from Helping Paws and has been living for the past 3 years in her Forever Home with her new Mum and Dad. 

She has never really been completely settled with her Dad indoors. She doesn’t bark or cower, she just prefers to move away. This behaviour is not as bad when outdoors, but even then, she seems to prefer her Mum. It’s not just her Dad though, she reacts in a similar way with other men. They don’t think she was mistreated before rescue but believe she lived on her own with an elderly lady – maybe not getting much socialisation. She was certainly housetrained although she didn’t know how to play with toys. (That has now been rectified as she has a vast toybox full of things!) 

Overall, she is simply timid. She will accept a hand touch, stroke and may even lick the back of her Dad’s leg in a café. Just not a lot. 

The aim for the session was to try and create a better bond between Lexi and her Dad by intentional touch. AchyPaw Massage is all about intention. You need the dog to know that they are your focus. It’s not petting. It’s intentional. It’s beneficial. It has a purpose. 

We don’t force therapy on any dog – they come at their own speed. At the start of the session, Lexi was upstairs, so I sat on floor by the massage mat while her Mum brought her down. She soon sat on the mat, with her back to me. But close enough to let me gently touch her. As I was working, she didn’t move away but just glanced at me over her shoulder making sure I was an OK person. She even let me perform some massage. Guess I was Ok! 

I spent 15 minutes with her helping her feel comfortable. I then asked her Dad to take my place on the floor. I told him to feel rather than pet. We held our breath. Lexi did not resist or move away. After 10 minutes, we all had to breathe again as we were going rather blue from lack of oxygen! 

That was Lexi’s cue to get up on the sofa. I asked her Dad if that was what he expected to get out of the training session. He replied ”Yes but not within 30 minutes…….”. There were lots of smiles. 

As we were on a roll, I got him to shuffle over to her where she allowed him to perform a full one side body massage. Lots more smiles – even from Lexi this time whose head was slowly slumping down as she relaxed. 

Her Dad stayed on the floor while her Mum took over as we wanted Lexi to feel she could go to either carer. Again, no protestations from Lexi – just a ‘bring it on’ look. After an hour, we got her Dad to stand up (many creaking joint noises from us as we had hardly dared move a muscle), walk away and then come back. This would typically have been Lexi’s signal to go. But she didn’t. She stayed on the sofa and let him put his hands back on her and she relaxed her head even further. He said “She has never felt this relaxed with me touching her”. We say it all the time….intention….intention….intention. Lexi was now being touched with a purpose, with benefits. Petting your dog is fine, they will enjoy it. But if you touch them AND help their tight muscles to relax, how much more enjoyable will that be to the dog? 

I think we have won Lexi around to her Dad touching her and hopefully that bond will strengthen with every massage session.

Homework and caregiver involvement

When set from school or colleges, homework could be a chore. But as an ex-academic now, I try to make the homework that we set our dog carers, more fun, informative and useful. 

As well as treating the dogs we work with, we also treat the carers. Not physically (although some have come to Chris for a holistic massage session) but educationally. During a session, the carer is often so involved with watching how their dog responds to the physical therapy that they forget all the things we discovered and showed them about their dog. 

This is perfectly understandable. We make sure that a treatment session doesn’t end without ensuring that the carer has been made aware of where the aches and strains were on their dog, how to help them with massage and rehabilitation exercises and characteristics to monitor so they can monitor progress or change. 

To achieve this aim, every carer is sent a personalised and workbook for their own tailored homework. The workbook details : 
• Where the issues were on their dog 
• Massage techniques that could benefit each issue and area 
• How to perform those massage techniques (with explanation and pictures) 
• Pictures and explanation of any appropriate rehabilitation exercises 

The Mums and Dads who do their homework become far more aware of changes in their dog and describe these in terms of gait, ability and muscle tone. It always raises a smile when a carer says things like “Les…I think the right thigh muscle is far less tight now and my dog is standing straighter”. This means they have been watching their dog and paying attention rather than just walking them. 
Our homework seems to go down well and we frequently receive feedback about it : 

 “Many thanks for your email and our homework, we have started following the plan & think that he seems more relaxed & happy already!”

 “I want to add that Les sent me the most amazing run down of what I learnt explaining everything really well to help my terrible memory not to miss anything out! Super happy with this as it is really clear what to do now.”

 “We have exercises to do and detailed information on how to do the most good, which Les sent through pretty much immediately. We saw improvement in our dog’s walking after the session and following exercises believe this will make the difference he needs without pumping him full of drugs. If you are thinking myotherapy could be the way forward, we would 100% recommend and suggest Les at AchyPaw!” 

Hopefully with all this homework, the dogs we help will have a greater and extended quality of life with an informed Mum or Dad. Don’t underestimate caregiver involvement.

 #homeworkcanbefun 

No reason...just because

Most therapists – canine and human – have a list of conditions on their webpage of issues which they believe would benefit from manual therapy. Classics things you’ll find listed include: slowing down, unsteady gait, limping, difficulty getting up, arthritis etc. 

While all these are perfectly valid, what do you do if your dog doesn’t show any of these signs? Will massage therapy still be beneficial? In our opinion, and it’s borne out by a lot of research, yes – most certainly. How many of you have had a massage just to maintain your present condition rather than to ‘fix’ something? 

Maintenance, top-ups, prevention, or ‘just because’ are good reasons to schedule a massage session for you or your dog. And please don’t think I’m talking about pampering. We don’t do ‘pampering’. We deliver professional experienced targetted therapy to make your dog feel and move easier. English 

Bulldog Ralph is an example of benefiting from regular physical therapy to keep him in the stunning condition he is. We’ve been treating him for 6 years now and he has always been fit - he has muscles on his muscles! And his regular massage helps to keep him that way. At 10 years old, his Mum and I want him to stay healthy, mobile and happy. 

After his session, he tends to sleep and snore while I work on his sister, Auntie Pearl. He lies there with a big soppy grin. He does wake up to give me a huge Ralph cuddle when I leave and frequently sits by the front door so I can’t get out. 

Do you need a problem or a mobility issue before you think of massage? No. You can come to us….just because. It will benefit your dog anyway. 

#noreasonjustbecause 

Helping a rescue dog

I’m scheduled for another volunteering session at Arundawn Dog Rescue in a few days. But I saw a recent post from Elaine about Bertie the 10 and a half year old Staffie who was sadly back in kennels at the time – although now is in a wonderful new foster home. 

When I looked at the videos, I felt sure that we could definitely help him – he clearly had issues which would benefit from a physical therapy session. I showed the video to Chris and he agreed. A phone call to Elaine, agreement from their vet and 36 hours later our back expert Chris was with Bertie and his new fosterers to offer a voluntary session. 

Initially Bertie’s coat was quite dull and his fur was very tight – you could see him struggle to get any fluidity in his movement. He was our classic “36 inch chest in a 32 inch coat” dog. This where the fur is so tight it is like you’ve put on your favourite coat after a rather over-indulged Christmas – the buttons pop. We can, at least, tug at our clothes to stretch them. A dog can’t do that – but we can help with plenty of myofascial release. 

Bertie was a dream to work with – all he wanted was attention and touch. As Chris was working with him, he was demonstrating the techniques with Bertie’s new fosterers. They both have monthly massages so fully understand the benefits and didn’t need any convincing that it would help Bertie. 

Chris also left a few suggestions about household adaptations to make things more Bertie Friendly such as following where he walks to see where he might need a carpet runner or two. We offered them support if needed and suggest follow up in a few weeks to check progress. 

At the end of the session, Chris had left behind a new dog who tried to stop him leaving and with a loose shiny coat that actually fitted him. It won’t take Bertie long to become another AchyPaw Massage Diva.

Shedding fur - good thing or not?

“Don’t wear black” Roxy’s Mum said when we confirmed our second visit. 

Last time I worked with Roxy, she shed fur. A lot of fur. And she is a Yellow Labrador. As a result, I looked like Chewbacca by the end of that session and her Mum’s vacuum cleaner probably seized up. 

When we work with dogs, shedding fur is one of the ways we can tell that we’re having an effect and doing some good. Imagine if you’re going round with skin that is sticking to you due to anxiety or discomfort. That’s got to be uncomfortable. Manual therapy not only works on the joints and muscles but also on the fur – that’s what our fingers are passing through all the time. Myofascial release techniques assist with this fur lifting. And when you create space between the fur and underlying structures, blood and other nutrients can start to move freely through the body again. Result = looser, softer and more healthy fur. 

I once worked with a very VERY anxious Chihuahua who simply ‘couldn’t be touched’. Well…. guess what, not only did she adore her session ‘being touched’ (in a therapeutic way) with me, but, by the end, we had a pile of Chihuahua fur that could easily have made another dog. Over the months of treating that dog, the fur shedding became less and less as her body became more fluid, softer and supple. The blood and nutrients could move through at last. Also, her anxiety decreased and approachability increased accordingly. 

The same happened this time with Roxy. OK, there was a pile of fur on the floor but it was just a small pile. And my black jeans (I know…..should have worn a different colour!) didn’t look quite so much like I was auditioning for a Pantomime Bear. 

Roxy’s Mum has been doing some homework with her, particularly warming-up her hips and thighs before exercise. Roxy’s insecurities about being massaged have vastly diminished. 30 minutes with no getting up and down. Mind you, despite it being the hottest day of the year so far, Roxy decided she wanted her massage in the sun. And, you’ll remember I was wearing black…when will I listen? As we were both cooking, she did move into the shade for a while but decided that being microwaved was preferable and shifted back into the sun. 

She felt better all over – neck softer, fascial movement possible and muscle tone improved. AND less fur shed. That’s a great result for her, her Mum and for the vacuum cleaner. 

#lessfurshedmoremobility

How old should a dog be to start canine physical therapy?

Some people suggest that massage is only beneficial for senior dogs or canine athletes. The workshops Cathie and I designed recently, focussed on ways that manual therapy, exercises and knowledge can help influence the way that development progresses – from puppyhood to senior years. Of course, physical therapy is especially good for our silver faced chums with all sorts of benefits. But youngsters have a high level of activity – often wiggling and waggling carefree all over the place. 

Moss was a perfect example of this. He is a 5 month old Vizsla/Collie cross with that infectious lust for life puppies have. He’s not worried about warming up, running too far, tripping up, straining muscles – he just wants to see what new and exciting thing is around that corner and if it’s even better than the thing he is currently playing with. 

But this carefree attitude can lead to mobility niggles. In Moss’s case, he was developing a stiff back leg at the end of his walks. Although the walks are kept appropriate puppy length, he does love to play chase in the garden with his older, but still young, sister. At the vet consult before the therapy session, it was found that he was reluctant to fully extend either stifle. 

His Mum had heard of us through Debbie Peters of Schooling 4 Dogs and asked if I could go over to check things out. 

Of course, Moss is a wriggler. He’s a puppy. But we found that there were two ways to keep him still (-ish). One was to allow him to totally wash my face, ears, beard and neck – that way meant that I could work with his hind legs – mind you I could not see a thing. The other was to give him something to chew – preferably not my massage mat. That way I could work all over. 

Between those two distractions, we managed to discover he did, indeed, have very tight thigh muscles – particularly those of the left. It’s likely he simply ‘pulled’ something which had gone undiscovered and unnoticed in general puppy wriggling and enthusiasm. 

In the next hour, in between puppy tongue washes and treat nibbling, Moss received a good massage and his Mum and Dad received education on what is going on under that seething mass of puppy. They learned how to feel him – not pet him and to understand how a normal muscle should feel and what Moss’s tight muscles felt like. 

You don’t need to wait before adding physical therapy into your dog’s growing-up. Armed with their recent knowledge of a massage routine, exercises and our warm-up/cool-down, his Mum and Dad are well equipped to help Moss’s current issues but also to continue that maintenance through his next stages of life. 

Keep enjoying life Moss.

Canine Massage Therapy #123456 - "Being able to chase that dog you've always fancied"

For our latest Double Therapist Day, we worked with senior girls Lyla and Midge. Midge chose Chris while Lyla chose me. 

Lovely Lyla is a 12 year old Doberman who has a history of stiffness in her forelimbs. Radiographs taken last year showed arthritic changes in both carpi and digits. She is a happy potterer when out walking and her Mum wanted to start maintenance massage to support her through the next stages of her life.

Lyla got over her shyness and realised the benefits by settling down for a full hour. 

The next day her Mum wrote “..OMG!!!! Wow what a difference in the girls, ….. Lyla was walking with a spring in her step not as stiff at all, managed to chase this dog she fancy's….Magic hands uncles a big THANKU XX” Hmm…chasing a dog she fancies. 

Now THAT is a new benefit for canine physical therapy. 

Massage and canine anxiety

Sometimes it not just about the physical issues. 

6 year old Jack Russell/Chihuahua cross Pippa was referred to us by behaviourist Debbie Peters Schooling 4 Dogs. For the past few months, Pippa had been exhibiting anxiety and shaking. Debbie wanted to make sure there were no underlying physical issues causing these behaviour patterns. 

When I met Pippa she came bounding down 3 flights of stairs and back up again – no noticeable issues there - thank you for that Pippa. Then once in the house, Pippa decided I was her latest plaything – bringing me her toys and sitting with me. Again, no obvious signs of physical discomfort or anxiety. 

What was clear though, was her movement when walking across the vinyl floored living room. She is a small dog but she was making teeny tiny deliberate steps from place to place. She also hunched her back while doing so. As soon as she reached a mat or rug, her back visibly lowered and straightened. This had given her quite a stiff back. Stiff backs in us humans can cause a lot of grief and anxiety and it is likely the same in dogs. 

The stiff back was one thing we could help to solve with physical therapy. But there was also the floor – lots of Mobility Islands needed of mats, runners or rugs especially by the water and food bowl so Pippa didn’t have to worry about slipping. 

Then there is bonding. Touch is a language all dogs understand. Using it to help with re-establishing bonding is a powerful tool. We started to build a multi-purpose massage routine that would help to ease Pippa’s overall tension, straighten her back and also to be relaxing. A few minutes a day, a few times a day. 

Massage was on her terms. A bit here, and a bit there. In between getting out more toys, walking round the room but always coming back for more. Until, after 2 hours, we had a breakthrough moment with Pippa demanding more and more from her Mum. Even shifting her body around so nothing was left untouched. 

With massage, household adaptations and some interactive play we can see how Pippa progresses before her behaviour assessment. Her Mum wrote back “Thank you very much for the report, we have already noticed a difference in Pippa and she definitely appears calmer after a little massage and less shaking” so that is a positive start. 

Extra benefits of canine massage

All canine physical therapists have their list of massage benefits. Benefits such as improving mobility and gait, stimulation of the healing process, assisting pain relief and discomfort from stiffness, helping restore muscle tone and so much more. These are the physical benefits. Then there all the emotional and psychological ones. Such as relaxation and bonding,

It’s always good to add to that list. Palliative care is one such addition. This isn’t just for the dog, helping them remain comfortable and calm and as eased as possible, but also for the carer. When our dogs are in distress we all want to do something to help. By giving the carer a gentle but effective massage routine they can do with their dog, they know that they are helping and not just watching. And the dogs love it. 

Then there are the chance benefits such as Floc and her PooGate. She was constipated…very constipated. Her carer asked if massage could help. Couldn’t hurt I said. Lots of gentle massage over the stomach. Next two days….lots of texts from her Mum detailing the vast quantity of her resultant poos. 

And the psychological benefits such as Lord Nelson. When he was rescued he was very anxious and almost withdrawn. Physically he was tight – all over. He’d been confined in a cage too small for him before rescue and his body had simply fit to accommodate. He needed stretching. He joined his rescue brother in his new family. But his brother had his own problems being mildly autistic. He had random behaviours which came out of nowhere but also seemed to find it hard to read other dogs. He preferred to ignore and avoid them. 

Springer Spaniel Lord Nelson quickly learned to defer to his brother – a tactic that lead to a happy, content house. Recently his Dad wrote a couple of posts to me. The first was “Lord Nelson actually sprang over long grass several times on the Downs the other day. He used to just push through any undergrowth. That’s the first time I’ve seen. Amazing how regular therapy has given him a new life, including a much more cheerful character”. So that’s a physical and emotional benefit. 

The latest post from him was “Now this photo taken on our evening walk on Devil’s Dyke may not look very special to most, but it actually shows Nelson running ahead of Darcy back to me, something he would never do before. He used to totally defer to Darcy in everything. He’s just so much happier since the regular AchyPaw treatment and now a showing new personality, more cheeky, more assertive and so much more happy go lucky. Thank you for the AchyPaw treatment” 

“Being cheeky” and “being assertive” and “happy go lucky” are now added to my list of benefits from physical therapy.

First Massage session in the words of a dog (well...almost!)

Last weekend we had another Double Therapist Saturday with Alfie & Flint. Alfie is a Collie who loves his agility and older brother Flint is a Springer who is a typical bouncy spaniel. Recently Alfie displayed lameness from his rear left leg. 

Alfie can be a wee bit anxious but throughout the 90 minute session he demonstrated a classic “I’m going into the massage zone” routine that we have come to experience so often. 

It went like this (using Alfie’s voice…well…..I think that’s what he would have said) : 

1. “Hmm…I don’t know who you two are so I’ll just stay a little away” 
2. “OK…you haven’t gone away and are just sitting on the floor so I won’t look at you but maybe I’ll sit in your lap Chris” 
3. “Oh…you’re working on my back….oooooo that is nice. I’ll just stay here for a while” 
4. “And now you’re on my shoulder….goodness I’ll stay a little longer” 
5. “I’ll walk away now” 
6. “Nope….I’m coming back with my toy fluffy sheep for you” 
6a. “And my toy fluffy dog” 
6b. “And maybe this toy too” 
7. “Hmm…you’re working on my brother so I’ll go to the other therapist…he looks lonely” 
8. “But I’ll just lie here against the sofa while he works on me” 
…….much later…. 
9. “Excuse me….did I say you could stop touching me Dr Les? I’ll just give you a guiding paw on your arm back to where it belongs on ME” 
10. “Hey…you can’t go….I’m staying here on your mat. You won’t be able to leave now” 
…later still……. 
11. “Zzzzzzzzzzzzzzzzzzzzzzzzzz” 

Responses like that just make what we do the best in the world. Thank you Alfie and Flint for sharing your Saturday with us (before and after pictures below)

It really isn't all about arthritis

Golden Doodles Ronnie & Roo are brothers from the same father and different litter. I worked with Ronnie last year. Since then his Mum has adopted Tripawd Roo. Roo has been a Tripawd since birth so doesn’t know any different. To him, three legs is normal. 

Ronnie is 3, Roo is 2. Ronnie has mild hip subluxation which is being managed conservatively with appropriate exercise, hydrotherapy and massage. When his Mum looked for a friend for him, she wanted a dog who could match his reduced exercise regime. Roo came along at the right time. 

We were invited around before Roo moved in permanently to help Mum assess the suitability of her house. But she already knew of all the things to do – just needed our professional confirmation. Things like carpets in strategic places, harnesses, ramps, joint supplements and garden access. The latter has already had plans approved for a bridge to be built from the patio out to the gate. Now THAT is forethought and equals the bespoke Corkie Stair Lift. 

Roo is a happy smiley playful carefree young lad who adores his brother who, in turn, has assumed a protector role. They have both benefitted from the new brotherly arrangement. 

When I first Ronnie last year, he was initially reticent about massage. This time the massage mat went down with Ronnie on top of it immediately. Sighs came within 5 minutes. The aim with Ronnie is to keep him fit and mobile so that his hip issues don’t become a chronic mobility problem. His Mum had been doing her homework – he felt remarkable. 

The aim with Roo is to make sure his tripawdness doesn’t lead to any long-term aches and strains by the different forces his body is going through. He only has a left fore-leg and moves that into the middle. That’ll cause the outer leg muscles to stretch while the inner muscles will shorten – a bit like a Greyhound who always runs the same direction round the track. Roo will also need maintenance work along his spinal muscles as they are also working extra to keep him mobile. He will be using his rear legs and back more to help him stand up. All these movements will cause compensation issues. Luckily, he loved his massage session – getting straight down on his mat so Chris could start work immediately. 

The brothers are now on our unique double-therapist maintenance programme which, with the hydrotherapy, should help them remain bouncy, contented and untroubled.