In the quest to build better athletes, the human field of physiotherapy/physical therapy (PT) offers up principles, assessment and outcome measures and modalities that can be directly applied to horses with exciting results and benefits. In the human medical field, PT plays an essential role in all aspects of medicine, surgery and sports. PT is often incorporated alongside other allied health professionals to make functional assessments, administer therapies and design rehabilitation plans in a wide scope of cases including those of musculoskeletal, neurologic or cardiopulmonary origin. It has a role in pre and post operative care by improving surgery outcomes and decreasing recover times, and in acute injury, injury prevention and in improving overall athletic performance. Recent advancements in veterinary medicine particularly in the areas of surgery, orthopedics, biomechanics and sports sciences have highlighted a niche for services offered and professionals trained in equine rehabilitation and therapy.
Examples of specific conditions that would benefit from PT include arthritis, stifle disease, radial nerve paralysis, Sweeney, EPM, neck or back pain, tendinitis, generalized stiffness and poor performance.
The principles of equine rehabilitation and therapy involve functional assessments which utilize specialized skills in biomechanics, neurology, pain physiology, topographical anatomy and palpation to identify pain or loss of function caused by a physical injury, disorder or disability and often involve musculoskeletal and neuromuscular systems. A functional assessment should include a history and focus on the key complaint.
Therapists are trained to observe and note posture, conformation, foot and dental balance, limb length, muscle balance and symmetry and will also incorporate a intensive palpation and mobilization of all joints to reveal effusions, heat, increased pulses, irritabilities in soft tissue, restrictions as altered range of motion or glides in joints or fascial tension patterns. Therapists may also incorporate dynamic motion, stability testing and more in depth neurological assessments with keen observation of behavioral responses to detect potential problems before they manifest in overt lameness and diminished performance.
The equine is, by its nature and evolution as a prey species, conditioned to show no weakness or lameness as the case may be, so when overt lameness is apparent often there are significant compensations and soft tissues restrictions causing pathomechanical alteration in normal gait patterns. In addition to the selection pressures of evolution by which they evolved, horses also have anatomical considerations which allow them to evade obvious signs of lameness. Specifically, horses have a highly mobile built in band-aid called fascia. Fascia is not unique to horses, but its broad sheet like anatomical arrangement and its pronounced ability to migrate to areas of instability or injury are. Fascia exists in several states of density as a more normal fluidy or jello-like state to a more restrictive fibrous tough state which is when it contributes to restrictive patterns which negatively affect the normal biomechanics.
These restrictions are often initiated in the large muscle bulk of the shoulders, withers and thoracic sling, the lumbar spine, the sacrum and the haunches and will manifest in symptoms such as joint heat and effusions, arthritis, chip, slab and condylar fractures and injuries to the soft tissues in the distal limb. Restrictive patterns can develop in soft tissue as a result of compensation due to a multitude of circumstances including but not limited to: conformation, dental or shoeing imbalances, rider imbalances, poor saddle fit, changes in surface, repetitive strain patterns, pain, poor core strength, imbalanced training regimes and poor working frames.
PT treatment techniques are used to reduce pain, improve movement and restore normal muscle control, promote strength and endurance for better function and thus performance. Key to treatment success, and vital for maintaining a science based approach, is assessment-reassessment of cases using objective outcome measures such as range of motion in joints, muscle bulk and symmetry, pain scores and biomechanics and gait analysis to determine the effectiveness of treatment, training and rehabilitation strategies. Key to rehabilitation strategies is client involvement doing the stretches, exercises and therapy as required on the ground or incorporating specific work under saddle. In most cases early mobilization is critical for successful outcomes.
Turning horses out for extended periods of time without therapy will often be unrewarding in the long term as many soft tissue problems simply do not fix themselves. PT will work but someone has to do the work. In recent times, many fancy state of the art rehabilitation facilities have been built with expensive machines and equipment to rehab horses.
It has been my experience and education that those modalities are just the icing on the cake and that the bulk of PT can be accomplished with the direction and guidance of a trained professional who has completed a functional assessment, designed a treatment and rehabilitation plan with continued reassessment of outcome parameters utilizing only basic manual therapies and basic facilitated treatment techniques.
Manual therapies include acupuncture or acupressure, massage, body work, energy therapy, myofascial release techniques, sacral occipital therapies, weight shifting exercises, stretching, core strengthening and dynamic stability exercises. There is some basic equipment and facilitated techniques that can also be incorporated into treatment programs including laser, ultrasound and light therapy, taping techniques such as using Kinesio Tape, therapeutic textiles and blankets such as Back on Track products, electrical stimulation,proprioceptive retraining exercises and tactile and sensory stimulation.
The basic principles of PT along with sports specific biomechanical functional assessments and considerations will allow us to pre-emptively design training programs to prevent likely potential injuries associated with specific uses or sports. These principles will also serve to enhance over performance by minimizing the side effects directly or indirectly cause by training, pathology or the specific demands of the sport via repetitive strain or cyclical loading. At the core of prevention based programs is building core strength in our equine athletes and focusing on dynamic stability exercises. Ten minutes of hands on work helping your horse do his sit-ups might prevent a fetlock chip or worse a career ending or catastrophic event.
An ounce of prevention has always been worth a pound of cure and when it comes to building better athletes using PT techniques as prevention is a foundation we can build tremendous machines on.
Dr. Jodie Santarossa BSc. DVM CVA & CERT (elig), BrightSide Vet & Consulting Animal Health Management Solutions