Laurie's Blogs.

Part 1 covered recognition: orthostatic tremor (OT) is a high-frequency, stance-locked postural tremor, mainly in young giant- and large-breed dogs, confirmed by conscious standing EMG greater than 12 Hz (Liatis et al., 2022; Lowrie & Garosi, 2016).

Part 2 covers what treatment actually does — and how rehab can help without training the wrong problem.

There are no published clinical trials of physical rehabilitation for canine OT. The recommendations below are extrapolated from the neurology literature, movement-disorder logic, and general canine rehab principles.  

What medical treatment can (and cannot) do

In the 60-case multicenter series, most treated primary OT dogs improved, but complete resolution was uncommon. Improvement occurred in 85% of treated dogs; among those with a graded response, improvement was partial in about 71% and complete in 29% (Liatis et al., 2022).

Medications used with some success include:

•  Gabapentin or pregabalin

•  Phenobarbital or primidone

•  Clonazepam

In that series, gabapentin was the most commonly used first drug (median dose 20 mg/kg PO every 8–12 hours). Phenobarbital was used at a median of 2.5 mg/kg PO every 12 hours. Clonazepam, pregabalin, and primidone were used less often. Treatment with phenobarbital/primidone, gabapentinoids, or clonazepam was associated with a higher chance of remission than miscellaneous other treatments. Retrievers and dogs with later onset appeared less responsive (Liatis et al., 2022).

Early Great Dane reports also described marked reduction in tremor after phenobarbital (Garosi et al., 2005). OT-plus dogs generally improved only partially and still needed management of the concurrent disease (Liatis et al., 2022).

There is no published evidence that surgery, nutraceuticals, or a specific diet treats primary OT. Quality of life can still be good when tremor persists, especially if sit-to-stand is supported and owners understand the condition is not simply “painful weakness” (Burbaitė & Menchetti, 2023; Liatis et al., 2022).

Is there relevance for canine rehab?

Yes — mainly in recognition, activity prescription, and owner coaching, not in abolishing the oscillation with exercise.

1. Do not treat it as simple weakness

These dogs can look weak because they avoid standing still and struggle with transitions. Strengthening programs built around prolonged static standing, long balance-board holds, or “stand square for 30 seconds” drills fight the physiology of the disease. The tremor is triggered by stance, not by lack of muscle mass (Liatis et al., 2022; Lowrie, 2021).

2. Transitions are the functional problem

Nearly half of primary OT dogs are presented for difficulty rising or sitting (Liatis et al., 2022). That is a rehab-relevant impairment. Short, assisted sit-to-stand practice, a ramp or platform to reduce the demand of the transition, and teaching owners how to support the dog through the movement can improve daily function even if the tremor remains.

3. Gait work is usually better tolerated than stance work

Tremor typically disappears once the dog is walking (Garosi et al., 2005; Liatis et al., 2022). Controlled leash walking, underwater treadmill if otherwise appropriate, and movement-based proprioceptive work align better with the condition than long static postural holds. If you use unstable surfaces, keep exposures brief and pair them with movement rather than prolonged quiet stance.

4. Screen for OT-plus and orthopedic comorbidity

Giant-breed dogs also develop Wobbler syndrome, lumbosacral disease, and osteoarthritis. OT does not protect them from those problems. A dog with OT andpain or proprioceptive deficits needs a dual plan. Late-onset tremor, especially in a Retriever, should prompt neurologic work-up rather than an assumption of primary OT (Liatis et al., 2022; Burbaitė & Menchetti, 2023).

5. Owner education prevents the wrong rehab loop

Owners often interpret the tremor as pain, anxiety, or collapsing weakness and then restrict activity or seek ever-more-aggressive “core stability” work. Explaining that the tremor is stance-locked, that walking is usually fine, and that medication may only partially dampen signs reduces frustration and inappropriate rest (Lowrie, 2021).

6. Watch medication effects in the gym

Gabapentinoids and phenobarbital can cause sedation or ataxia, which will change how the dog performs balance and gait tasks. Dose timing relative to sessions matters.

7. Quality of life, not tremor abolition, is the rehab goal

Primary OT is described as slowly progressive (Liatis et al., 2022). Many dogs remain active pets. Rehab can help with body-condition management in giant breeds, concurrent joint health, confidence with transitions, and avoidance of secondary disuse — without promising to stop the tremor.

A practical session framework

Use this as a starting point, then individualize:

•  Assess, don’t assume. Confirm the tremor is stance-locked. Ask for video of standing, sitting, lying down, and walking. Note WEBLT response if safe.

•  Train the failing task. Brief, high-quality sit-to-stand practice with support as needed. Stop before the tremor dominates the movement.

•  Prefer movement over stillness. Walking, gentle hills, cavaletti at a walk, and underwater treadmill (if medically appropriate) usually make more sense than prolonged quiet standing.

•  Keep static work short. If you use standing weight-shifting or unstable surfaces, use seconds, not prolonged holds.

•  Protect the giant-breed joints. These patients are still at risk for orthopedic disease. Maintain muscle and body condition without making stance the centerpiece of the program.

•  Coordinate with neurology. Confirm whether MRI is indicated. Align session timing with medication. Report whether tremor, transitions, or both are changing.

•  Measure the right outcomes. Easier sit-to-stand, willingness to stand long enough to eat or be examined, and owner-reported daily function matter more than a silent EMG.

Take-home points for the rehab floor

•  Young giant-breed dog + pelvic-limb “shivering” only while standing + normal gait = think OT.

•  Ask for video of standing still, sitting down, and walking.

•  Try a brief WEBLT if it is safe.

•  Do not prescribe long static standing as the primary treatment.

•  Expect medical management to help most dogs only partially (Liatis et al., 2022).

•  Late onset, especially in Retrievers, or any additional neurologic deficits should prompt work-up for OT-plus or another disease.

•  Success is function and quality of life, not tremor elimination.

Orthostatic tremor is uncommon, but it sits in the overlap between neurology and rehab. Knowing the pattern keeps us from training the wrong problem.

References

Burbaitė, E., & Menchetti, M. (2023). Difficulty walking and trembling in a 10-year-old female Akita Inu. Journal of the American Veterinary Medical Association, 261(6), 926–928. https://doi.org/10.2460/javma.23.01.0029

Garosi, L. S., Rossmeisl, J. H., de Lahunta, A., Shelton, G. D., & Lennox, G. (2005). Primary orthostatic tremor in Great Danes. Journal of Veterinary Internal Medicine, 19(4), 606–609. https://doi.org/10.1892/0891-6640(2005)19[606:potigd]2.0.co;2

Liatis, T., Gutierrez-Quintana, R., Mari, L., Czopowicz, M., Polidoro, D., Bhatti, S. F. M., Cozzi, F., Tirrito, F., Brocal, J., José-López, R., Kaczmarska, A., Cappello, R., Harris, G., Alves, L., Rusbridge, C., & Rossmeisl, J. H. (2022). Primary orthostatic tremor and orthostatic tremor-plus in dogs: 60 cases (2003–2020). Journal of Veterinary Internal Medicine, 36(1), 179–189. https://doi.org/10.1111/jvim.16328

Lowrie, M. (2021). Guide to tremor and twitch syndromes in dogs and cats. In Practice, 43(1), 4–17. https://doi.org/10.1002/inpr.3

Lowrie, M., & Garosi, L. (2016). Classification of involuntary movements in dogs: Tremors and twitches. The Veterinary Journal, 214, 109–116. https://doi.org/10.1016/j.tvjl.2016.05.011

Platt, S. R., De Stefani, A., & Wieczorek, L. (2006). Primary orthostatic tremor in a Scottish deerhound. Veterinary Record, 159(15), 495–496. https://doi.org/10.1136/vr.159.15.495