Physiotherapy, which is common place in human medicine following an injury or surgery, is becoming more popular in equine rehabilitation as well. It includes various forms of manual manipulation, electrotherapy, exercise prescription and other treatments that can benefit both equine athletes and weekend warriors affected by minor lameness issues or undergoing major recoveries.
“The key area of physiotherapy, applicable to horses, is the study of the musculoskeletal system. This involves assessment, treatment and rehabilitation of neuromuscular and musculoskeletal disorders. Functional biomechanics, neuromotor control and exercise physiology are the prime sciences supporting the profession,” explained London, Ontario based registered physiotherapist and certified equine rehabilitation therapist, Andrea L. Scott.
“Physiotherapists provide a functional assessment to identify pain and loss of function/performance caused by a physical injury, disorder or disability,” said Scott. “Once the cause or causes have been determined, we provide a range of treatment techniques specifically designed to restore movement and function, to allow the horse to return to its optimal performance.
There are a growing number of physiotherapists in Canada, licensed by provincial governing bodies to treat people, who are expanding their practices to include horses. Under current legislation, however, physiotherapists are not licensed to offer independent care, and must work in collaboration and through the direction and supervision of a veterinarian. Equine patients must be referred to physiotherapy services through their veterinarians, and owners can request a referral if they notice unexplained lameness or a change in their horse’s performance, for example. “Once I have completed a full assessment of the patient, the assessment findings and plan of treatment is relayed to the veterinarian. Communication is kept open and current with regular updates with respect to progress and any concerns,” said Scott.
INDICATIONS FOR PHYSIOTHERAPY
Scott said the most common problems she sees in her practice are those associated with loss of quality of movement or unresolved lameness issues. She described a common scenario, in which the owner notices their horse is not moving properly, or is not balanced, and cannot find a specific reason for the change. “The complaints range from the horse being “stiff” or having a reluctance to bend through the body or flex through the neck, to an inability to take or maintain the proper lead. The owner may express concerns that the horse lacks the ability to drive from the hind end, or simply that the performance is poor.” This situation can arise from any one or more of the following:
Poor saddle/tack fit: Ill-fitting tack can result in the horse shifting or moving away from the pressure/painful spots. This can create poor movement patterns that stress joints and muscles and create pain in other areas.
Rider influence: A riding/training error or injury to a rider that changes balance and movement in the seat can also affect the horse. A rider’s pain can change the effectiveness of her aids and her ability to move the horse properly with balance and control. As such, total rehabilitation of the horse should involve an assessment of the horse-rider unit.
Repetitive stress: Training the same way day in and day out, can lead to muscles working in ways they were not designed to, or for longer periods than they are able to. Poor training techniques and over training can also stress joints. Repetitive stress can also be caused by poor training surfaces.
Conformational faults: There is a strong association between conformation and predisposition to movement dysfunction and lameness. It is important, however, not to overemphasize conformation as a cause of lameness.
Trimming/shoeing problem: Poor trimming that affects the shape and angles of the hoof can lead to stress on joints as well as tendons and ligaments. If a horse is experiencing hoof pain, it can affect his movement, leading to stress and potential injury.
Prolonged stall rest: Periods of stall rest are often required to allow an injury to heal. During stall rest, however, the horse will shift his weight and move in a certain way to take the stress off the painful area. This can cause certain muscles to atrophy or waste, decreasing in size and, therefore, strength. Other muscles will work harder to stabilize the horse’s body and hold him upright. Over time, these muscles will hypertrophy, increase in size/tone and become tight. They may eventually fatigue because they are being required to do more work than they were initially designed to do and to work in patterns that are abnormal. Once the muscle imbalance has been created, the movement pattern will be altered and stress will be placed on certain joints and eventually create pain.
Other injuries seen by physiotherapists include injury or trauma to tendons, ligaments and muscle; injury causing stiffness and pain in the neck, thorax, low back, and pelvis; stifle joint problems; injury to nerves and wound care.
COMMON TYPES OF THERAPY
Treatment techniques include manual therapy such as joint mobilization and manipulations, muscle re-education through stretching and strengthening and proper movement patterning exercises. Modalities can include ultrasound, laser, electrical muscle stimulation (EMS), transcutaneous electrical nerve stimulation (TENS) and acupuncture. “Most importantly,” added Scott, “a program tailored to the functional requirements of each horse is designed. The ultimate goal is to educate the horse owner in the well-being and maintenance of their equine partner.”
Manual therapy (or manipulative therapy) refers to the practice within musculoskeletal physiotherapy of therapist-applied passive or assisted active movement techniques for the management of pain and impairments in the mobility of joints, muscles and neural tissue. Joint mobilization and manipulation is performed by several professional groups including physiotherapists, chiropractors, and osteopathic physicians.
Joint mobilization consists of slow, small, passive movements applied to individual joints and surrounding soft tissue, with the purpose of increasing joint range of motion. Joint manipulation, on the other hand, involves a high-velocity, low-amplitude thrust performed at the limit of the joint’s range, with the purpose of increasing joint range of motion. Both techniques are designed to reduce pain and spasm.
Other manual therapy techniques include various types of massage, myofascial release and active release therapy. These are hands-on techniques applied to muscle and surrounding connective tissue to alleviate spasm and pain and to help restore motion.
Electrotherapy is an umbrella term used to identify a range of treatments including electrostimulation of muscles and nerves, as well as the use of sound waves (ultrasound) and light (laser) to treat physical injuries.
Electrostimulation (EMS and TENS) is the application of low or medium frequency electrical currents in order to stimulate sensory or motor nerves to produce or facilitate muscle contractions, or to provide pain relief.
Muscle stimulation can be used after injury or surgery where there has been a loss of strength of a muscle or muscle group or when the timing of the firing of the muscle has been altered due to injury. TENS is used to help reduce pain and associated spasm.
Electrodes are applied as needed over the bulk of the muscle; over motor points; over nerves; over acupuncture points, or directly over the painful area. A cool gel is placed under the electrode. This allows the current to pass through more effectively. The horse’s hair should be clipped and cleaned to lower the resistance to the passage of current.
Treatment times vary from 15 minutes up to one hour. They are initially shorter to help familiarize the horse with the sensations associated with stimulation and to reduce anxiety.
Ultrasound is the application of longitudinal sound waves to the body for a therapeutic effect. The sound waves directly affect the cells and stimulate healing. Sound waves are absorbed by connective tissue such as ligaments, joint capsules, tendons, fascia and muscle. The effect is either thermal or non-thermal, depending on the intensity or the pattern of absorption in the tissue.
Promotion of tissue healing is the main goal of ultrasound, and it can be used at any stage of recovery or where healing is delayed. Pain relief as well as reduction of swelling and muscle spasm are parallel effects of this type of therapy.
A cool gel is applied directly over the area of concern and the sound head is moved in a circular pattern. It is painless, and treatment time is generally between seven and 10 minutes long.
Laser (Light Amplification by Stimulated Emission of Radiation) is a form of light energy used to stimulate and improve healing of open wounds, ulcers and soft tissue injuries such as tendonitis. It can also be used to stimulate acupuncture points to relieve musculoskeletal pain. It is sometimes referred to as LEPT (Low Energy Photon Therapy)or LLLT (Low Level Laser Therapy).
The type (red or infrared) and frequency of the wavelength used over the area of injury and the duration of the treatment depends on several factors- and varies for individual patients. Applied by a ‘cold’ laser device, the process is pain-free. It has been shown, however, that the radiation of the laser beam is damaging to the retina of the eye, so it must be used with care and special protective glasses should be worn while administering laser treatment.
Acupuncture is an ancient form of Chinese Medicine involving the insertion of acupuncture needles into the skin at specific points on the body to achieve a therapeutic effect. It is used to encourage natural healing, reduce or relieve pain and improve function of affected areas of the body.
Needles are inserted and left in place for approximately 15 to 30 minutes, and may be manipulated by the therapist to strengthen or reduce the flow of energy. Most horses respond quite well to acupuncture and are not bothered by the needles.
CURRENT RESEARCH IN PHYSIOTHERAPY
“Much of the current research in human, as well as equine rehabilitation is focusing on dynamic stability (the ability to maintain proper positioning during movement) and neuro-motor control (control of nerve impulses on muscles). Studies are looking at how pain, caused by certain injuries and conditions, affects movement,” said Scott.
“Current equine research into the biomechanical (the study of movement) effects of lameness, rider and saddle pressures, head and neck position and muscle recruitment is helping us understand some of the changes and compensations associated with various dysfunction and injury,” said Scott.
“Research looking at how specific nerve endings, called sensory organs, work in our joints, muscles, tendons and ligaments has progressed the way we rehabilitate patients. This is especially true with respect to peripheral joint injury (shoulders, knees, ankles etc.) in humans. When injuries to these tissues occur, these tiny sensory organs within the tissues get damaged as well. These tiny sensory organs give the brain information about joint position and the control of muscles around a joint, called proprioception. Research indicates that this system must be rehabilitated as well in order to maximize performance and reduce future injury to the joint.
“Rehabilitation of this system can be achieved by utilizing aids to facilitate these sensory organs. These aids are applied to the horse’s skin or body and include taping techniques with specialized elastic tape; proprioceptive aids such as light chains, applied to fetlock rings; Theraband (elastic sheet bands) and utilizing certain training aids like the Pessoa lunging system or long-reining techniques.”
PROMOTING GOOD HEALTH
“There are many exercises that can be done to help maintain strength and balance, and to limit the amount of disuse atrophy that a horse can suffer during periods of stall rest. Exercises that mobilize the spine and help strengthen the muscles of the neck, back, abdomen and pelvis are called core strengthening exercises, and are critical to the performance of your horse.”
“The most important exercises you can do with your horse, though, no matter the discipline, are the original “classical” exercises developed centuries ago by the European Masters,” said Scott, “the goal of which was to create horses with strong core muscles to enable them to maintain a “rounded posture” while carrying the weight of the rider. These exercises included arena figures, ground pole and cavaletti work, lateral work/leg yielding, flexion, doubling and untracking, shortening and lengthening of step and stride, transitions through all gaits both up and down, and changes in tempo. They are critical in producing a strong fit healthy body and mind.”
Making healthy lifestyle choices for your horse is also key to preventing injury and maintaining good health, as well as ensuring recovery is as successful as possible. You can do so by:
- maintaining a healthy weight for your horse to reduce impact to joints
- ensuring proper and sufficient nutrition
- recognizing when rest is necessary
- learning what to do should a flare up occur
- not overexerting structures beyond what they have been prepared to do
- matching exertion with conditioning level
- taking time to warm-up and cool-down
- ensuring regular, proper hoof care
- ensuring well-fitted tack
- ensuring safe footing