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Understanding the connection in dogs

The link between pain and behaviour has long been neglected, but now we have a new, groundbreaking book that shines a light on this important subject, which has such an impact on the lives of our dogs.

Written by Dr Patrick Blättler-Monnier, who specialises in orthopaedics and pain patients, and Katrien Lismont, a specialist in behaviour training, they examine and evaluate the subtle signs – both physical and mental – which indicate that a dog is in pain. 

They provide detailed case histories, using videos accessed by QR codes, to illustrate their findings. Starting with the patient, they share the journey from first consultations, the struggles for diagnosis, and the path to finding the correct treatment and, ultimately, to successful outcomes.

Here they answer questions about their work:

Q. How did you become interested in the subject of pain in dogs, and its link with behaviour?

PBM: I have been a veterinarian for more than three decades. I started my career working with farm animals and horses, and it was there that I learnt to truly read movement: to distinguish between supporting-limb and swinging-limb lameness, to interpret compensatory patterns and to use methods, such as flexion tests and nerve blocks, to localise pain. 

When I later shifted my focus to dogs, I realised that the same biomechanical principles applied, but that we were lacking tools to analyse them properly. Traditional imaging techniques, such as X-ray, CT and MRI, are invaluable, but they only show structure, not function.

This insight led me to develop my own gait-analysis system, LupoGait, which allows us to objectively measure movement and visualise functional changes in real time. Through this work, the link between orthopaedic function, pain perception and behaviour became impossible to ignore. In many cases, behavioural changes were the first sign of subtle lameness or chronic discomfort. 

Today, my research goes even further. Together with a partner company, we are exploring ways to visualise pain through brain-wave activity, combining it with gait-analysis data to create a new therapeutic tool for monitoring and guiding treatment.

KL: I started my dog training career with Tellington TTouch Education, where multiple learning units are devoted to observing dog’s postures and movement, and behaviour issues that are linked to them. This is the foundation that every dog trainer should aspire to; it is forever intertwined with my way of checking out a dog, especially when I see it for the first time. 

Over time, working as a behaviourist and analysing my caseload, I reached the conclusion that almost every dog that was presented to me with behaviour issues, had, in some way or another, something going on in its body. Initially, I tried to push these concerns to the back of my mind as I noticed caregivers were often reluctant to admit there may be a physical cause to the problem. In so many cases, I felt the behaviour issue improved, but we it was not rock solid. We were still missing something. 

It was only when I started linking my work with detailed physical examinations, that we started to make progress. Treated in this way, we could be confident that dogs were free from pain and discomfort and therefore able to assimilate further training, effectively changing their behaviour for the better.

Q. Was there a particular patient/patients who deepened your understanding?

PBM: Every patient teaches us something new. Over the years, countless cases have deepened my understanding of how pain manifests, not only in the body but also in behaviour.

One of the most formative experiences was with a Border Collie who suffered from chronic, recurring lameness for years. Despite extensive imaging, including MRI and CT, no structural cause could be found. Only through detailed gait analysis and neurokinematic observation did we uncover a complex functional disorder involving the shoulder and carpal joint – something that traditional diagnostics had missed entirely. This case reaffirmed my conviction that function often reveals what structure conceals.

Another milestone came this April, when we performed the first brainwave measurement, in combination with gait analysis, at my orthoVet practice. For the first time, we were able to visualise neural activity associated with movement and pain response It was a groundbreaking moment – a glimpse into how the brain perceives pain, and how it changes as therapy progresses. These insights are shaping the next generation of diagnostic tools: systems that don’t just see pain, but measure and monitor it objectively, over time.

KL: It was my own dog, Ilios, who shaped me into a seasoned ‘dog meets dog’ trainer. This was because of his intense reactivity towards other dogs, and also towards humans.

I looked at every aspect: genetics, training, poor socialisation, hidden diseases, and I tried everything: allopathic, homoeopathic and energetic treatments – but nothing improved the situation. However, we did grow together as a team and as a family. We knew his weaknesses, triggers and reactions, so we were able to protect him from potential trouble. He was an angel within his own home but, once we set foot outside, he was hypervigilant and highly-strung. 

Although he was monitored by several veterinarians during his life, we never really achieved a state of self-controlled and calm behaviour outside the home. Only in his last days, when he had been treated with appropriate painkillers because of partial paralysis in the hindquarters, he became soft, gentle and calm towards his unknown helpers. He was even described as an “adorable pup”, which I found heartbreaking. 

I swore to myself that I would do whatever it took to make sure that this would never happen again on my watch – neither to my own dogs, nor to my clients’ dogs. And here I am.

Q. Why has it taken health professionals – and caregivers – so long to recognise the link between pain and behaviour?

PBM: For decades, veterinary medicine has focused primarily on what can be seen, on structural changes visible through X-rays or MRI. If no pathology appeared on the image, the assumption was often that the dog must be physically ok. But pain doesn’t always leave a visible trace.

Functional disorders – those affecting co-ordination, symmetry or muscle balance– can cause significant discomfort long before any structural damage develops. It has taken time, technology, and a shift in perspective, for us to realise that behaviour itself can be one of the most sensitive diagnostic indicators of pain. We are only now beginning to connect the dots between movement, neurology and emotion, in a measurable way.

KL: In the world of training and behaviour, the same bias existed. For a long time, dogs were seen as obedient or disobedient, dominant or submissive – never as individuals possibly suffering from pain. 

The idea that a dog refusing to sit, or avoiding touch, could be doing so out of discomfort was rarely considered. Trainers were taught to correct behaviour, not to question its cause. Only as more evidence emerged from orthopaedics and neuroscience did we begin to understand that behaviour is communication. When we fail to listen to it, we risk suppressing a symptom rather than resolving its origin.

We want to see a limp, because that is what we do when our back or our hip hurts. We want to hear vocalisations of pain, because that is what we do when suffering is unbearable. Equally, stressed dogs showing uncontrolled, sometime frenetic movement are misunderstood because we expect a dog who is in pain to be inhibited. 

In our book, we explain that this is not the case in a very large portion of the canine population. It takes time – and profound insight in behaviour analysis – to find out what is going on. Sadly, this is not within the job description of the medical professional.

Shared comment: The separation between body and behaviour has been cultural, rooted in how we educate, diagnose and train. But the reality is that movement, emotion and pain are deeply intertwined. The moment we start looking at the whole dog, not just the symptoms, everything changes – for us as professionals, and for the animals we care for.

Q. Do dogs try to mask the pain they experience?

PBM: Yes, and often remarkably well. From an evolutionary perspective, a pack animal who shows pain can mean showing weakness. Dogs, like many other species, have learnt to compensate rather than display discomfort.

In my clinical work, I see this every day. Dogs with significant orthopaedic problems are still running, jumping and wagging their tails, because movement and social interaction are part of their survival strategy. What they cannot mask, however, are the functional changes that occur subconsciously: subtle asymmetries in gait, shifts in weight distribution, small delays in limb movement. These patterns often appear long before a visible limp or vocalisation, which is why objective gait analysis is so valuable. It captures what the eye may miss, even when the dog seems ‘normal’.

Dogs do not fake wellness out of deceit; they simply adapt. Their bodies find ways to keep functioning, despite pain, until compensation becomes exhaustion, or secondary injury. Recognising these adaptations early is key to preventing chronic suffering, and to truly understanding the silent language of pain.

KL: They do, desperately so. I suppose it is an evolutionary aspect of their behaviour package. Those who show weakness do not stand a good chance of survival. This is particularly noticeable in households where there is more than one dog.

Q. How can we tell if a dog is in pain? Are there telltale physical signs to look for?

PBM: Pain rarely announces itself in a single, obvious way. The signs are often subtle, found in movement, not just in expression. Changes in gait symmetry, shortened stride length, stiffness after rest, or a dog who no longer sits square can all be indicators. The same applies to changes in posture, which could involve a hollowed back, a shift in weight in distribution, or a dog who constantly changes position when lying down. Muscle tension patterns are also revealing; we often see localised contractions, uneven muscle tone, or early asymmetry in the shoulder or pelvic girdle.

Modern gait analysis allows us to quantify these micro-changes long before overt lameness appears. This is essential, because chronic pain often develops silently, with the dog adapting until compensation itself becomes pathological. Recognising these early deviations gives us a chance to intervene before irreversible structural damage occurs.

KL: From a behavioural perspective, the body language of pain can be even more telling. Dogs may become restless or, on the contrary, unusually still. They might seek distance, avoid touch, or show what guardians describe as “sudden stubbornness” – reluctance to jump into the car, climb stairs or lie in certain positions. Some develop repetitive behaviours, such as licking or scratching specific areas, or they overreact to minor triggers because their overall stress level is already elevated by pain. Even subtle shifts – a different sleeping position, reluctance to settle, increased irritability – are worth noting.

Behaviour changes are often the first sign that something inside the body is no longer in balance. When we connect these signs to what we see in movement and physiology, the picture becomes complete.

A dull coat, with lots of whirls, or even changes in pigmentation, can be a marker of pain underlying these changes. 

I have collated a number of photos which show the facial expressions of dogs who are in pain, and when the pain has gone. Typically, facial muscles relax, the eyes become larger and rounder, mouths are not so tight, and ear-set changes. It is amazing!

PBM: Yes, these patterns are among the most telling. If we know how to read them.

For example, changes in the coat can reveal long-standing asymmetries: areas of rough, dull, or thinned-out hair often correspond to zones of muscular tension or altered circulation, caused by uneven weight-bearing. A dog who constantly loads one side of the body will show subtle muscular hypertrophy in this area, and the opposing side may appear flatter or less defined.

In terms of gait, we often see shortened stance phases, reduced range of motion in one joint, or a slightly shifted line of gravity. 

Some dogs consistently ‘favour’ one resting position, always lying on the same side, curling with one leg tucked in, or avoiding deep flexion of a joint. These are protective postures – unconscious strategies to reduce pressure or pain. When we document and analyse them, over time, we can actually map the functional evolution of pain.

KL: Caregivers notice these patterns every day without realising their diagnostic value.

A dog who always lies with his back to you, stops rolling over, or refuses to stretch after waking, is communicating discomfort. Even grooming changes – a dog who no longer grooms one area, or that licks one spot obsessively – can mirror underlying pain or numbness.

When we combine these small, physical observations with behavioural context, the truth emerges. Pain leaves traces everywhere: in movement, in the coat, in how a dog chooses to rest or interact. The art is learning to see what the body has been saying all along. 

I ask clients to provide older photos in order to compare coat patterns, facial expressions and sitting postures. In addition, at the beginning and at the end of a training week I take photos of the dog’s face to monitor the extent to which training has reduced their stress.

Q. How can we identify whether a dog is stressed by external, environmental factors, or whether the stress is caused by pain and discomfort?

PBM: From a physiological point of view, the body does not distinguish between stress from the environment and stress from pain: the same hormonal systems are activated. What makes the difference is what triggers the response, and how long it lasts. 

Environmental stress tends to be situational and reversible. Once the trigger is removed, the dog’s heart rate, breathing and posture normalise. Pain-related stress, on the other hand, becomes chronic. We see sustained elevations in muscle tone, increased sympathetic activation, and a shift in how the dog moves – subtle rigidity, reduced joint amplitude, or altered breathing patterns, even in calm environments. These physiological traces remain, even when nothing ‘stressful’ is happening externally.

KL: The underlying cause of stress is not always clear – superficially, the signs may look the same. However, I would make the distinction that dogs who are ‘just’ stressed because of change, or as a result of former experiences, will be able to learn to accommodate to the situations with time, effective and respectful training, and repetition. Dogs who show stress behaviour resulting from pain tend to be slow in training. It is important to identify the signs of pain in behaviour and to connect the dots.

Shared comment: Pain is, in itself, a powerful internal stressor, often invisible, but constantly active. The key is to observe not only what stresses a dog, but how long the stress persists and when it occurs. True understanding comes when we evaluate behaviour, physiology and movement together. Only then can we see whether the dog is reacting to the world around it, or to the pain within.

Q. How might training, or general responsiveness, be affected if a dog is experiencing pain?

PBM: Pain changes how the nervous system processes information. When a dog is in discomfort, its brain prioritises survival, not learning. The pathways that normally integrate sensory input, co-ordination and emotional regulation become dominated by pain signals. This shifts the entire neurophysiological balance: attention span decreases, reaction thresholds lower, and the dog becomes more reactive or disengaged. 

In gait analysis, we often see that even subtle pain alters rhythm and timing, and that same disruption extends to mental processing. It’s not that the dog “doesn’t want to cooperate”; it simply cannot perform in a normal cognitive state while the pain signal is active.

KL: From a behavioural point of view, pain can look like poor training progress, stubbornness or lack of focus, but it’s actually a lack of capacity – not willingness.

Many clients say to me: “my dog is not very clever” … “he reminds of an autistic child” … “I think he has learning disabilities”. 

These are typical comments from caregivers when their dogs are experiencing pain. The dogs can learn, but they need more repetitions. They will have good days and bad days (on bad days nothing works), and when the pain is acute (especially headache), they will avoid contact with their caregiver. Their system is switched to survival mode, which is the opposite of co-operation.

When pain is addressed, it’s astonishing how quickly learning returns. Responsiveness, motivation and calmness all reappear, sometimes within days. It reminds us that the foundation of every effective training plan is physical comfort – without that, learning simply cannot take place.

Q. Can dogs get headaches? How can you tell?

PBM: Yes, absolutely. Dogs can experience headaches, although they rarely show them in ways we would recognise. The difficulty lies in the fact that we cannot ask them how they are feeling and describe what they are experiencing. Instead, we have to rely on indirect signs and neurophysiological understanding. 

The canine brain has the same pain receptors and vascular structures as the human brain. This means that any process causing pressure, inflammation or altered blood flow – such as cervical tension, sinus inflammation, dental issues or even changes in intracranial pressure – can trigger headache-like pain.

Clinically, we see dogs with subtle but consistent signs: a lowered head carriage, sensitivity when the neck or head is touched, squinting, changes in facial expression, or an unusual reluctance to move quickly or play. Some dogs avoid light, seek dark corners, or become reactive to sound and touch. These are all compensatory behaviours to minimise sensory input.

Interestingly, many of these dogs show marked improvement after targeted treatment. This could include relieving cervical muscle tension, adjusting the neck’s range of motion, or treating dental or sinus issues. We have even observed measurable changes in gait symmetry and cortical activity in early brainwave recordings, suggesting that headache pain alters not only behaviour, but also movement co-ordination.

So yes, dogs get headaches. They simply don’t hold their heads and tell us – their body does.

KL: In training and in handling, I have observed behaviours that indicate headache. This could include moments of appearing absent-minded, and a failure to co-operate – behaviours that have no function, other than allowing the dog to ‘check out’ mentally. 

Dogs experiencing headache may struggle when the sun is shining brightly, and while they may avoid being touched on the head, they enjoy soft stroking movements over the skull. Sometimes a dog will push his head into pillows or under blankets. Facial expressions are very tense and, in some dogs, the bony structure of the skull is more pronounced.

Q. Do dogs respond to pain in different ways depending on their individual personality, breed type?

PBM: Yes, without question. Pain perception and reaction vary enormously between individuals, and breed type also plays a role – but not in the way people often think. 

Some breeds have higher muscular tension, or a more reactive sympathetic nervous system, meaning they show physical signs of pain sooner. Others, particularly those bred for endurance or work, tend to suppress outward signs and continue functioning despite discomfort. Within the same breed, we also see clear individual differences in pain thresholds, largely influenced by genetic factors, hormonal balance and previous experiences.

At a neurological level, pain isn’t just a signal: it’s a network response. The brain’s limbic system, which processes both emotion and pain, interacts differently in every dog. That is why a soft-tempered Labrador Retriever might withdraw quietly, while a high-drive Border Collie might react explosively, to the same intensity of pain. Recognising these individual profiles is essential for accurate diagnosis and ethical treatment.

KL: From a behavioural standpoint, personality, and coping style, make all the difference. Some dogs externalise pain through restlessness, barking, irritability, and even aggressive behaviour. Others internalise it, becoming still, detached, or overly compliant. It’s easy to misread those quiet dogs as “well-behaved”, when in fact they have simply shut down. 

Breeding goals also influence these responses. For example, herding and working dogs will often mask pain until it becomes severe, whereas companion breeds may show discomfort through proximity-seeking or vocalisation. Ultimately, pain always interacts with personality. What we see outwardly is not just the pain itself, but how the individual dog tries to live with it. Our task is to learn that language: physiologically, behaviourally and empathetically.

Q. As a vet, how would you conduct an initial consultation if a dog is struggling, but there is no clear diagnosis?

PBM: When a dog presents with vague or unexplained symptoms, I always start by observing – not touching. Observation is the first diagnostic act: how the dog enters the room, how it distributes weight, how it turns, sits, or lies down. These moments already reveal asymmetries, hesitation, or shifts in balance that tell me where the body is compensating.

Of course, the eye provides an essential subjective first impression, but true diagnostic work requires objectivity. What I perceive must later be measurable, comparable and reproducible. That’s where LupoGait comes in. Using mobile gait analysis, I can convert my clinical impression into data: step patterns, symmetry, range of motion, and stance duration become quantifiable parameters.

I perform at least two measurements per consultation: one before treatment and one immediately afterwards, in order to document change and verify whether the intervention has had a measurable effect. In subsequent visits, I repeat the analysis to evaluate long-term improvement or recurrence. This creates a functional timeline rather than a single snapshot. 

After the initial visual assessment, I perform palpation to feel how the tissues respond under my hands. I am assessing tension, temperature, elasticity and micro-movements. Palpation reveals areas of restriction or hypertonicity that may not yet be visible in motion, but can be clearly confirmed later in the LupoGait data.

For young dogs and preventive work, we now use the LupoGait Puppy module, a software add-on designed to detect early asymmetries during growth; it also calculates a hip dysplasia score. This allows us to monitor development objectively, and to guide movement training before any structural issues arise. If localisation remains uncertain, I sometimes use diagnostic nerve blocks, a technique adapted from equine orthopaedics, to pinpoint the exact source of pain.

In essence, diagnosis, for me, is not a single image or isolated test, it’s a dynamic process of observation, palpation, measurement and comparison. Each step refines the picture until the pattern of dysfunction becomes clear and verifiable, over time.

Q. As a behaviourist, what are you looking for when you take a case history and you suspect underlying pain is an issue?

KL: I have a 12-page questionnaire which I give to all clients, which asks them to describe typical behaviours within the home and outdoors. I want to know all about sleeping habits and postures, eating habits, other medical problems now and in the past. I want to know how the dog responded to former training, and what are his ‘other and less urgent’ behaviour problems. This could involve a desire to be alone, noise sensitivity, inability to relax in the presence of strangers, behaviour when examined by a vet, and conduct on and off the leash. In addition I want to find out if the dog likes to play and, if so, does he end the play himself? How does he manage stairs, surfaces, doors, bridges, narrow places? Have there been biting incidents; if so, how did it happen? 

My aim is to gather all the antecedents I can, in order to find out why the dog might be reacting the way he is. I place these on a timeline and, in the end, I connect the dots.

Q. As caregivers, what can we do to help dogs who are experiencing pain and discomfort?

PBM: Pain recognition begins at home, and in the puppyhood. The earlier we connect what we see in behaviour with what we can measure in movement, the better we can protect a dog’s long-term wellbeing. Movement is life – and life is movement.

KL: The best thing we can do for our dogs is to look at them with awareness rather than assumption. Pain rarely shouts. It whispers through small changes in behaviour, posture, and expression. Caregivers play a vital role because they see their dogs every day. When something changes – a different way of walking, sleeping, playing, or reacting – it marks the moment to listen, not to correct.

Supporting a dog in pain means creating calm, predictable routines and avoiding unnecessary pressure. Movement should be gentle and purposeful, never forced. Observation, empathy and patience often reveal more than immediate action. 

When uncertainty remains, co-operation between caregivers, behaviourists and veterinarians is key. Behaviour can point us toward pain, but only a functional evaluation, including gait and motion analysis, can show how deep it runs and how healing progresses.

As behaviourists, we don’t just work with behaviour. We work with what the behaviour is telling us. When we start to read those signs early, we can prevent so much suffering.

Our advice: Do not wait! Go to the vet, or therapist, and have your dog treated so that the pain is lessened, or removed. Every single month you wait corresponds to seven months in a human life. Imagine…