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The Latin breakdown: “Arthro” = Joint “Itis” = Inflammation Osteoarthritis (OA) is a common, degenerative, painful disease with chronic onset and acute flare-ups . This means it most commonly takes a long time to develop, but will also have periods of increased sensitivity and pain (acute flare-ups). This disease involves the whole synovial structure – which is one of the reasons it is difficult to prevent and to manage. The synovial structure includes the attached connective tissue that covers tendons, muscles, bones and enclosed joints… which means it can majorly affect movement. The smooth articular surfaces become injured and inflamed, which result in lameness and compensation. The primary and secondary problems associated with managing arthritis are numerous. Layers of a joint: A: shows what a normal bone/joint looks like, B: diagram representing cartilage and the outer most edge of bone, C: demonstrates normal cartilage and subchondral bone, and D represents damaged cartilage and subchondral bone which is indicative of arthritis. Features of joints and arthritis 1. The articular surface (the surface between two bones) is made of smooth and softer cartilage. This allows frictionless motion between bones at the joint. 2. Between these surfaces is a thick fluid made of hyaluronic acid and other chemicals which provide a frictionless and shock-absorptive liquid to cushion the joint ends. 3. The gradient of cells and tissues which develop from the core of the bone to the articular cartilage surface is highly interwoven . This means it’s not distinct and the relation from the bone to the end of the joint is extensive. This gradient also represents a change in the elasticity/“softness” of the levels. This is marginal but does provide for some of the shock-absorptive properties of joints. 4. The “cracking” and loss of smooth surface observed in damaged tissue, and the loss of an even distribution of cells and tissue across the layers of joint tissue indicates arthritis. This alters the frictionless, smooth surface effectively, and becomes a downward cycle which increases joint inflammation and damage in turn. Effects of/evidence of arthritis include : - Narrowing of joint space - Osteophyte formation (joint mice, also known as little bony spurs that grow in or around the joint cavity). - Subchondral sclerosis – This is the thickening of bone ends just under the cartilage - Subchondral cyst – a fluid-filled space which appears at the end of a bone as a result of arthritis. - Reduction in cartilage mineral density in early phases of arthritis Chondrocytes are cartilage-producing cells. Losing them reduces the ability of the joint to repair and produce cartilage. Chondrocytes decrease in activity as the animal ages; however increased strain, damage and pressure to the joints, which could cause these microscopic fragments of cartilage to break, will increase the “wear and tear” associated with aging animals. Âge -> cartilage degeneration Increased workload -> cartilage degeneration Cartilage degeneration -> increased joint damage, inflammation and pain Joint damage and pain -> biomechanical compensations and discomfort https://www.drwilliamhatten.com/blog/2017/6/2/lets-talk-more-about-oa Causes of arthritis are not easily defined; 1. As a chronic disease, the precise moment that it starts happening is nearly impossible to define. However, some metabolic and physiological changes have been linked to early stages of OA. 2. As an acute onset, direct damage to cartilage in a sudden injury can result in a string of events which cause arthritis too. A very brief overview of factors that can increase arthritis onset: 1. Joint conditioning when young - Studies shown that growing and moving young horses “primes” their joints for good cartilage layers at their joints, and that these joints are better prepared for increased pressure later in life. Injury - Joint injury, soft tissue, bone fractures, - Overcompensation (increased pressure on other joints) 2. Poor conformation - Straight hocks (check out the blog: ) 3. Discipline - Racing, showjumping, cross country, dressage… all have different predisposition to arthritis in particular joints 4. Location of the joint - Interestingly, different joints have been categorized in various studies to be far more prone to problems (sometimes labelled “radiographic lesions”). Bones of the distal limb, aka the Phalanges, are short, compact bones that appear to have evolved to take the brunt of force applied to limbs when moving . Because of this function, these joints are exposed to the greatest force, and most likely to suffer arthritic changes as a result. Common locations: (for those who paid attention, this would be the answer to the question posed on my social media this week!) - The coffin joint of the forelimbs are the most commonly affected with arthritis. This is associated with the high level of force these joints absorb as the first point of contact with the ground. - Hocks are the second most affected – this is so commonly related to conformation, back problems and as a result saddle and training problems. - Hindlimb fetlocks are also highly affected, likely as a result of compensation from other problems. Treating arthritis NO TREATMENT WILL REVERSE THE EFFECTS OF ARTHRITIS, NOR SAVE THE JOINT ENTIRELY. TREATMENT OF ARTHRITIS MEANS TREATMENT OF SYMPTOMS. THIS MEANS ADDRESSING PAIN AND COMPENSATION, WHICH INVOLVES A VARIETY OF APPROACHES. Treating arthritis at the level of the joint space and surface is reserved for the Veterinarian. Joint injections in the form of Hyaluronic acid and corticosteroids are commonly used to address inflammation (remember inflammation itself can and does cause pain and further problems) in the joint directly, and to aid in “plumping” the joint fluid already there: this is the Veterinarian’s domain. Pain management and lameness work-ups should all be used in the diagnosis and management of this chronic disease, particularly if you’re expecting your horse to work hard and compete. Treatment by the Veterinary Physiotherapist is in support of the comfort and functionality of the horse, and to reduce pain caused by the acute flare-ups. Target 1: The pain. This is a wide-ranging target for this disease. Pain is likely to be in the affected joint… this will however be followed by that dark shadow that follows pain: compensation. This is likely to be causing pain elsewhere. Increased bracing activity of muscles in other limbs, or bracing the limb itself mean muscles are prone to fatigue quickly: causing further injury risk, discomfort and pain. On top of that, the increased muscle activity elsewhere is likely to increase the pressure on their associated joints, tendons and muscles, which can cause pain and even increase the rate of arthritis onset. Furthermore, and I can’t stress this enough, pain will hinder muscle development and strengthening. If your horse’s pain and comfort levels are not being adequately managed, your training will be an uphill battle. Training is hard enough as it is. Monitor your horse’s comfort and improve your awareness of their indicators of fatigue. LASER: is a fantastic tool for addressing painful and inflamed sites. This means muscle knots resulting from fatigue can be addressed without too much manual force. This is an advantage as chronic diseases can heighten the pain felt in the body. Horses with increased pain sensation rarely enjoy manual pressure and handling, therefore using a LASER to very effectively treat pain on a biochemical level, which can then improve the sensation and allow manual handling afterwards makes it a powerful tool for these cases. Manual therapy: Massage, myofascial release and stretching offer release of the tight muscles developing from compensation, plus an element of strengthening and improved suppleness when the time is right. Increased blood flow, soft manipulation of tight muscles, movement of lymphatic fluid and gentle, physical treatment of muscle knots and tension all benefit the heightened state of discomfort the horse will be feeling. Target 2: The joint. Reducing further inflammation and maintaining the condition of the joint remaining is crucial. This is where the Vet’s involvement and direction is crucial. However, there are some powerful modalities a Veterinary Physiotherapist can offer to help your horse LASER has been shown to increase the rate of production by chondrocytes: meaning increased cartilage production. This makes this an excellent choice to use at joint articulation sites, as it may help to power the chondrocytes that are remaining at the damaged joints. CRYOTHERAPY: Ice applied to an inflamed joint after work reduces heat and the further damage that can cause. Ice further acts as a local mild painkiller after a certain period. It should not be applied for more than 20 minutes duration after work. Arthritic joints generally don’t like moving or being moved; so applying ice prior to work is not ideal, for pre-work preparation, HEAT therapy is more beneficial to these cases. Heat will increase the blood flow and lymphatic fluid movement to the joint, increasing its comfort and functionality in preparation for work. Target 3: Maintaining and improving function. Treating to maintain and improve function will increase the strength and condition of muscles, which should hopefully reduce the severity of acute flare-ups. Massage, stretching, myofascial release accompanied by a targeted remedial exercise program of controlled exercises will then allow strengthening of the body. As mentioned previously, pain hinders correct development and strengthening of muscles... improving muscle condition will improve comfort. H wave is a powerful muscle stimulation tool which can create muscle contractions without fatigue. Increased blood flow, contraction and relaxation of whole muscles and lymphatic fluid movement vastly improve the biochemical concentrations of sore muscles. In addition, a direct reduction in pain sensation has also been recorded. Pain causes compensation which causes faulty muscle contraction sequences. Forcibly activating contraction in targeted muscles gives your Physiotherapist a powerful tool to re-train muscles which have changed their sequence, as well as bringing the horse’s attention to those muscles being treated. H-wave is also useful in neurological cases, and while arthritic horses hopefully are not suffering neurological symptoms, bringing their attention to the contraction of what are likely to be poorly used or dysfunctional muscles, could help them to improve the neurological pathways and therefore retrain the movement patterns… reducing the extensive compensations. LASER can be applied similarly to target pain: muscle fatigue, knots, tension and pain will all greatly benefit this treatment. Stretches target increased (or maintained) Range of Motion of joints, increase flexibility and the strengthening of muscles. These should be prescribed and performed on a case-by-case basis. All the science aside, two of the most important approaches to managing arthritis and or injuries that I have learned over several experiences: Patience and confidence. YOUR HORSE WILL NOT FORGET THEIR TRAINING JUST BECAUSE YOU GIVE THEM AN EASY DAY WHEN THEY FEEL STIFF OR SORE. Give them the benefit of the doubt. Your training is good enough, your horse remembers enough, you will get more out of training on the days they feel good if you let them recover effectively on the days they don’t. Thanks for reading! there‘s so much more that can be written about arthritis, hopefully this fits as an introduction. Let us know your experiences in managing arthritis! Take care! Genevieve Xx Apologies for the lack of reference list; uploading this from my iPad means I cant make the reference list yet, however it will be updated by the end of the weekend!
Bone is made of a mix of inorganic minerals and organic material including collagen (mainly type 1), which creates a highly responsive and adaptable compound (1). For those interested, the mineral is a hydroxyapatite component, made of Calcium and Phosphorus, and it is laid down into the collagen (1). For those uninterested, suffice to say Calcium and Phosphorus provide the major mineral/non-living contents. Bones provide the valuable levers for the locomotor system in all vertebrate animals. It is also a crucial reservoir of minerals, providing a buffering system for the body in times of growth/repair/response (1, 4). Bone tissue consists of cortical bone (a.k.a compact) and Trabecular bone (a.k.a cancellous). https://www.youtube.com/watch?v=Ei4seya3dOg -> This video, (up to the 2-minute mark) offers a clear explanation of the structure of long bones in the body. Bone is essentially a tube of cortical bone with bone marrow (+trabecular bone) on the inside, covered by growth-plates, more bone and cartilage, enclosing each end. The surface of bones is covered by a tissue called periosteum... this is what connects/is continuous with tendon tissue and muscles. Consider this: If you roll up a piece of paper in to the shape of a cylinder and stand it up next to a folded cube of paper... the cylinder will be a lot harder to crush than the square, which is one of the many beauties of the structure of ours, and our horses' bones. Crucial built-in safety margins have evolved in the structure of bones: weight of the distal limb is minimised to reduce momentum and therefore excess force applied to the limb during movement, even the alignment of the bone cells intentionally offers effective support of weight and force (1). Bones are subject to a constant balance of RESORPTION and DEPOSITION, performed by osteoclasts (resorption) and osteoblasts (building/deposition). As a mineral bank, sometimes resorption occurs at a greater rate than deposition, which frees required minerals to the body (3). Alternatively, increased mineral deposition occurs in order to strengthen the bones under stress or to adjust for a surplus and maintain mineral homeostasis (3). Bone is a piezoelectric material, which means when physical stresses are applied, it responds and signals for increased deposition to occur in order to maintain safety margins and full function (4). The response of bone can be short-term or long-term, making it highly adaptive (1). Short-term response is activated by mechanical pressure, which despite not being completely understood could be likened to the muscle “swell” that comes with a workout. Despite these safety mechanisms, a level of damage is expected to occur, and surprisingly is necessary to increase bone density (2). Training and improvement generally occurs outside of a comfort zone… How far outside that comfort zone you can go depends on the following, and even then there are physiological limits: a) your horse’s conditioned fitness (are they in full work or box rest?) b) your horse’s technical ability/training knowledge c) their natural strength/predispositions (referring to conformation etc.). Big injuries occur outside of that small range outside of that comfort zone. In the instance of bone, too many microfractures as a result of a sharp increase in workload or work on a surface that was too hard can overwhelm the precious damage-repair cycle of bone, and could result in a major fracture instead (1). (5): https://europepmc.org/article/PMC/3743123 In short this picture demonstrates the comfort zone, which sort of sits in the “physiological window”. This shows the increased mechanical loading which eventually results in overload and failure. Expected/common micro-damage is caused by repetitive, cyclical loading (as found in repetitive loading of the limb during movement) (1). Damaged portions of bone will be targeted by osteoclasts and will be resorbed into the matrix; to be followed by osteoblasts laying down the new bone in the same arrangement as the osteons found in fresh/undamaged bone (1). It takes a few weeks for extensive mineralisation to occur to regain strength and density to the affected area (1). If none of my words made any sense, they are essentially summarised by this picture: picture A = bone that has adapted to exercise conditioning, B = bone that has not had exercise applied. In summary: bone is highly responsive, it can increase density under increased load, or stay the same and even reduce under reduced load. Too much load and it may be unable to maintain function/structural integrity and will break. picture credit: (1) Now consider this: The cardiovascular system undergoes a significant loss of fitness after 4-6 weeks of rest (2). Bone density takes 12 weeks of reduced rest to result in significant loss (2). Severe injuries commonly require a lengthy period of box-rest/hand-walking (though obviously varying lengths between type and severity of injury); however, bone density is rarely mentioned as a target of the rehabilitation process (personal experience as well as research)… The old english methods of “legging up” horses by trotting them on hard ground is a great way to stimulate osteoblast activity and increase bone density. With a huge word of CAUTION that this should not be done for more than a couple of minutes at a time, a couple of times per week. Otherwise you risk tipping the delicate balance against your favour and causing increased damage. QUESTION: Have you ever considered bone remodelling/density/strength in your training and/or rehabilitation program? Do you think you should? Bone remodelling can occur not only in the length of the bone, but also in the tuberosities at the ends of bones, which can and do change with pressures. The difference with this remodelling is that the pressures from other bones come in to play, as well as the behaviour of cartilage. As such the directional behaviour of the joint can become affected or can affect the new bone remodelling. This plays a role with osteoarthritis, which is a huge topic on its own and should be gracing your screens in 2 weeks’ time ;) AS always, comments and ideas are welcome! Thanks for reading! References:  A. E. Goodship and R. K. Smith, "Skeletal Physiology: responses to exercise and training, Role of SKeleton," in Musculoskeletal System, Elsevier, 2004, p. 81.  A. J. Kaneps, "Practical Rehabilitation and Physical Therapy for the General Equine Practitioner," Veterinary Clinics of North America: Equine Practice, vol. 32, pp. 167-180, 2016.  P. Katsimbri, "The biology of normal bone remodelling," European Journal of Cancer Care, vol. 26, no. 6, 2017.  P. Yu, C. Ning, Y. Zhang, G. Tan, Z. Lin, S. Liu, X. Wang, H. Yang, K. Li, X. Yi, Y. Zhu and C. Mao, "Bone-Inspired Spatially Specific Piezoelectricity Induces Bone Regenration," Theranostics, vol. 7, no. 13, pp. 3387-3397, 2017.  A. Robling and C. Turner, "Mechanical signaling for bone modeling and remodeling," Critical Reviews in Eukaryotic Gene Expression, vol. 19, no. 4, pp. 319-338, 2009.
- Scratching the surface of tendon injury and rehabilitation
In early 2017 I made an ambitious 12-month competition plan with Pokemon for that year. The goal was Under 25 Grand Prix for my last year in the category, with (what would obviously be…🤔) a seamless move into the Senior classes as our even more ambitious goal… 🤣 The #SilverPrince in full glory at Keysoe Premier League, 2017 In late 2017 he tore his Gastrocnemius tendon (equivalent to the equine Achilles' tendon, crucial for weight bearing, not ideal to damage!). He was treated with a PRP injection to the affected area and then prescribed a 12-month rehab plan, and a disclaimer of sorts from the Vet that the odds of him competing higher than Medium level again were heavily stacked against him. I tore up my plan and indulged a big cry. It wasn’t the first time I had faced disappointment, but it was the closest I had ever been to achieving the magical Inter 2/Grand Prix transition, and Pokemon is an incredibly special soul to me. No matter what level you’re working towards as a rider, the setback of injury, no matter how severe, is a heavy blow to deal with. Muscles of the horse, demonstrating location of the Gastrocnemius muscle. (http://infovets.com/books/equine/A/A028.htm ) Firstly, Structure of the tendon: A tendon is predominantly made up of one of the universe's most incredible materials: Collagen. There are several types of collagen known; type I is associated with tendons and ligaments. Collagen molecules arrange in to bands/tubes called microfibrils, which arrange in to fibrils, then fibres then fascicles, as shown in the image below. These fibres are arranged in a parallel pattern, which is most energy efficient and the strongest formation applicable. The collagen bonds in these fibrils create a molecular-level crimp pattern which is suggested to play a role in the stretch available in tendons (7). Structure of a tendon (https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13331) Unlike what many simplified diagrams lead people to believe: tendon material is continuous with muscles and bones. This makes it a much stronger connection between bones and muscles, which is obviously a benefit considering the force that is transferred through these tissues. There are very few cells and no blood supply found in tendons (1); which is one of the reasons their injury and healing process is a long one (6). Blood supply offers drainage and delivery of helpful inflammatory products (2). Interestingly, the particularly avascular zones of tendons are prone to greater risk of damage and/or injury (2). Functions of the tendon: 1. Tendons consist of connective tissue between muscles and bones (4). This provides support and stability to joints and a connection for the movement produced by the muscle contraction. 2. The tendon behaves like an elastic band and stores energy, which when released provides movement at a highly energy-efficient rate. The repetitive stretch and recoil of the tendons is created by muscular contraction resulting in tension (4). 3. Tendons are able to be stretched extensively and will return to original form when released; they are capable of withstanding a large tensile force. This property does diminish over time, and under certain conditions (such as heat and excess tension). Injury to the tendon: Injury to a tendon can be referred to by different titles, depending on the type of damage. These titles are often used interchangeably in wrong ways, clarity on them may help understand the injuries. 1. Tendinitis = inflammation of the tendon 2. Tendinosis = tiny tears of the tendon including degeneration of collagen in the tendon a. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/ this article explains the differences. 3. Tendinopathy = umbrella for non-rupture damage to a tendon (damage to the collagen in the tendon) https://www.jospt.org/doi/full/10.2519/jospt.2015.5884 Tendon injury is one of the most common reasons for decreases in performance and even retirement from work/competition careers (6). Not only does the initial injury cut into competition and training plans, but the risk of re-injury is incredibly high (between 48-58% and up to 80% depending on the source (6)). Re-injury is high due to a weakened tendon which in itself is predisposed to further damage as well as the compensation that results from protecting it. Tendon injury generally results from overload of some kind. This can either be from a repetitive loading cycle where not enough recovery time is accounted for, or from an acute/sudden overload injury which stretches the tissues too far in a motion. This overload is even possible from muscles that are stronger and contract harder than what the integral strength of the tendon can manage. (check out https://www.germanjournalsportsmedicine.com/archiv/archiv-2019/issue-4/functional-adaptation-of-connective-tissue-by-training/ for further explanation of this). Tendons have a low rate of cellular turnover and regeneration which means that healing occurs by scar tissue formation, NOT tendon regeneration (4), which is how bones repair. This is a problem because scar tissue has a far more random structure of collagen compared to tendons, which greatly reduces its ability to withstand tension. This often means that the limb with damage will always be weaker and that the horse is likely to compensate and offload from it. In contrast to tendons, scar tissue is initially a highly vascularised tissue (necessary for the healing process) and these blood vessels have been questioned to play a role in the cause/effect of the poor collagen fibril alignment that occurs in tendon injury repair (4, 5). Rehabilitation of a tendon injury: Depending on the level of damage, tendon injury can take 3 months or up to/over 18 months to “heal” (6). Because of the nature of scar tissue, a tendon will never return to its former strength, because the biological processes are unable to regenerate the perfection that is the intact tendon, therefore it is hard to say this actually “heals”. This means that it is almost always going to be something that needs to be monitored and managed with workload and treatments, and will always be a weakness in the horse. Box-rest, controlled re-introduction of exercise and regular check-ups to assess healing of the site are crucial for optimal outcome. Muscle strength and bone density are lost throughout the lengthy rehabilitation period and are part of the reason for controlled exercise. This should reflect back on the balance that is necessary between muscle - tendon - bone strength. Box rest is a vital stage of rehabilitation in a variety of cases. This gives the injury site time to mobilise inflammation factors and reduce movement there. A fresh tendon injury means a portion of the tendon is unable to bear weight/tension properly, which means that the other collagen fibres of that tendon will be compensating. Movement of the tendon increases strain on the remaining fibres and is also extremely painful, so limiting this in the early acute stages of damage is important. The fact that a very long rehabilitation process is required to get an injured tendon to a less-than-perfect state makes it a difficult diagnosis to cope with. The remodelling capacity of bones is far greater, and therefore usually (excluding extreme circumstances) an easier diagnosis to receive. Tendon rehabilitation takes a LOOONG time… It is a rollercoaster involving moments of great hope when they look sound; great anxiety not knowing what point the new maximum will be that you get to ride/compete at; the disappointment during the 3 steps forward, 2 steps back process that seems intertwined with rehabilitation… Like when you start trotting after months of walking and they feel more broken than when you first received diagnosis? We know that feeling all too well. I tried to start a running program at the same time as Pokemon’s rehabilitation program. I had full-time University as well as two other horses to ride, so it was an inconsistent program at best, but I definitely developed an appreciation and sympathy for Pokemon on the days I felt sore and less able to go as far or as comfortably. Surely they experience the same! Rehabilitation is a prime example of a marathon, not a sprint. Pokemon enjoying a light "wellness" massage during his clinic visit. The good news is that there is science and technology that is ever improving for your horse’s benefit... Physiotherapy being one of them! Shock-wave therapy, ultrasound therapy, LASER therapy, H-wave, Stretching, massage, controlled strengthening exercises… a variety of options are available to maintain comfort, muscle mass, joint health as well as tendon and ligament function. The rehabilitation road is a long and exhausting one; but it can be fascinating and important. Every time I have had to rehabilitate one of my horses, I have come out the other side with a better execution of their basics of Dressage, and a greater appreciation of what the good riding days become. Good luck with your rehab, I haven’t met you but I have my fingers crossed for you! Let me know if I can help! 😉 Did you know: The half-life (length of time it would take for half of the material to disintegrate) of collagen in mature equine tendons is estimated to be around 200 years?! (3) Some really interesting links for those interested. "Inside Nature's Giants: The Racehorse" is an impressively informative video, however DISCLAIMER it is not for the faint-hearted/weak-stomached! A limb cadaver is used to demonstrate the pressure a tendon can withstand. The tendon info starts around the 15:50 mark, but I can thoroughly recommend the whole lot for anyone who wants to know more about how incredible horses are from a physiology perspective. https://www.youtube.com/watch?v=feAj2aspkIE&list=PLP68rPoaxoUlnliNc2uj38tRPFnmAWBkH Description published by the British Equine Veterinary Association on Microdamage in tendons: https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.13331 Information on the tendon vs. muscle strength training: https://www.germanjournalsportsmedicine.com/archiv/archiv-2019/issue-4/functional-adaptation-of-connective-tissue-by-training/ and the links I used and quoted throughout this: 1: https://pubmed.ncbi.nlm.nih.gov/17450305/ 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650849/ Tempfer 3: Aspartic acid recematization and collagen degradation markers reveal an accumulation of damage in tendon collagen that is enhanced with ageing. Journal of Biological Chemistry. Thorpe et al. 2010. 4: Comparative study of the characteristics and properties of tendinocytes derived from three tendons in the equine forelimb. Journal of Tissue and Cell. 2009. Hosaka et al. 5: . Presence of lymphatics in a rat tendon lesion model. Histochemical Cell biology. 2015. Tempfer et al. 6: Evaluation of Return Rates to Races in Racehorses After Tendon Injuries: Lesion-Related Parameters Journal of Equine Veterinary Science. 2020. Kan Gulsum et al. 7: Mechanical and functional properties of the equine superficial digital flexor tendon. The Veterinary Journal. 2005. B.A. Dowling, A.J. Dart *
- Step 1. Balance.
The difference between the average test, and the elite test, at least aesthetically (and in my humble opinion), is down to balance. Some horses find this concept easier; some humans find it easier; in the same way some people are clumsy by nature and others are elegant. This does not stop someone from being able to achieve balance on a horse, it can just make it a damn sight easier/harder depending on the natural predisposition of the horse and/or rider. The conformation that has been passionately discussed in the last 2 blogs ( CONFORMATION-The good, the bad, the ugly and No Foot, No Horse... How? ), plays a key role in the moving function of the horse, and therefore in its balance with and without the rider. The biomechanics and art form that this creates is where the everlasting training and improvement that Dressage offers is formed… This hopefully begins to form the bridge, and connection between the Veterinary Physiotherapy and performance aspects, and the horse training considerations horsemen and women require. First, a history lesson. The German training scale was developed in the early 1900s, and is considered the fundamentals for training horses and what riders are judged on at competitions in the present day. The first 3-4 blocs are relatively interchangeable and inter-reliant, the latter 2-3 require the first blocks to be rock solid to be successfully achieved. Balance is only the first step of the German training scale, and yet it is key to every stride, every movement, every training session, every competition, and to every other step in the training scale 1. Rhythm/balance 1. Relaxation 2. Contact/Connection 3. Impulsion 4. Straightness 5. Collection A naturally well built, untrained 3-year-old is likely to have a 60:40 split of weight forehand:hindend, and is probably dominant on its left or right side (out of interest: this can often be spotted by the larger, flatter hoof, and is the hoof that is placed further forwards when grazing since a foal!). This horse also has no muscles or training to effectively carry a rider and is likely to motorbike around corners to compensate for this. In short, this horse struggles to balance. Dressage principles train horses following the German training scale, with the ultimate goal/dream of mastering it, which is what the Grand Prix test entails. OBVIOUSLY, not all horses were created equal, and it would be borderline cruel to attempt this path with some horses. However; as hammered home in conformation blogs, the build of a horse can offer a helping hand towards achieving the balance and eventual collection required. Good conformation offers an even spread of pressure over joints, bones, muscles and tendons around the body. It also offers greater ease of balance and athletic ability. Balance has an effect in a horse standing still, as well as one in motion; an important concept to consider when relating conformation to movement… Imagine you are being pushed by someone; they’re trying to knock you over. If you are steadfast on your feet, can maintain your balance and counter the force applied, you won’t be knocked over. However, if you don’t have the right posture or timing to counter their force, likelihood is you’ll kiss the dirt. This could be true if you are standing still, but it is also true when moving. - Your horse will counter your demands and/or respond to them, as this example demonstrates. How fairly and effectively you ask your aids and how it effects them depends heavily on use of the half-halt and your position. Recently I have been training and guiding Feather’s posture to be more uphill, with her nose more at the vertical and poll at the highest point. This is a pretty classic goal for us lot attempting to Dressage. Because of her lack of strength and fitness from lockdown 1.0, corners are actually an incredibly difficult lesson for us to master at the moment. This sounds ridiculous when she can train piaffe and passage, but there is no point in me pushing those movements if in every corner I feel her barrelling over her inside shoulder, burying her nose down and trying to shoulder punch her way down to Australia. No judge on the planet will be impressed with these moves sadly. I cringe at this picture, but in efforts to educate, here we are. Problems: overflexion of the neck, and a neck thats too low. Falling over the inside shoulder as a result, instead of sitting back on the hindlegs and navigating around the corner in a balanced way. BALANCE has been the key issue, as it usually is, and I realised quite how badly I was interfering with it yesterday. Through each corner, I have been doing my best to use my inside leg to get her in to my outside rein, and encouraging her to keep her head and neck UP, to keep the energy flow UP, through each corner, and not to dive inside, especially on the left rein. This meant my left hand was making a lot of small adjustments. I had one moment, I don’t know what brought it on other than I was thinking to myself: “nothing is changing, and the definition of insanity is doing the same thing over and over again and expecting a different response” Something wasn’t adding up. Feather is smart and well-trained, I know how to ride a corner, she knows how to half-halt… WHY are we barrelling through each corner like a 3-year-old?! I brought it all back to square one. We walked through a corner, I centered my weight over each seat bone and in to each elbow/hand pressure on the reins, and re-imagined the pillars that I like to think attach from her front hooves to my hands, and imagined these being upright, NOT leaning tower of Pisa. Low and behold, ,miraculously, instead of adjusting my left hand towards the middle of her neck as I had been, but keeping it in line with this pillar, taking my reins a bit shorter and making a straighter shape through her neck through these corners… we got better BODY bend (not just an over-flexed, over-bent neck), lift, balance, cadence and posture than I had achieved in the last 3 rides. I rode the damn corner and Feather could make it through it without toppling over herself. a MUCH better example of the balance for a corner... nose at the vertical, upright posture in the rider's position AND the horse's, and no goofy over-bending nor over flexion. (Pic from 2019) YAY for small wins. DOH for forgetting the basics. I had forgotten to balance her. I had bend, I had forwards impulsion and I had her reactive from my aids, I just wasn’t setting her up in the right POSTURE and didn’t have the correct BALANCE. Corners are so telling of training. “Tests are fought and won in corners” is another mantra I have learnt over my years of absorbing all horsey knowledge I can get my ears on, and this was a very telling moment of that. Do not be disheartened, this mare is an international small tour horse and we STILL train corners. It counts a lot to be able to take a step back and consider why something isn’t improving though… chances are there’s a flaw in your basics and you need to reconsider your approach. YOU DO NOT NEED TO BEAT YOURSELF UP AS I WOULD HAVE DONE YEARS AGO. It doesn’t have to be a big deal, it doesn’t have to be difficult… But it can get you a heck of a lot further when you realise the issue! Top tip: 1. If something isn’t changing, aka if your horse isn’t responding: Stop. Take a minute. Break down what you’re trying to fix, and how you are trying to fix it. You may not know how to ride a Grand Prix, but if you break your problem down, and consider the German training scale, or any Dressage basics, chances are logic could deliver you to your solution anyway… And if it doesn’t, find a good trainer who can!
- No foot, no horse... how?
To preface this blog, farriery and horse hooves are something that I find extremely interesting, however, also very perplexing. This is very much a “starter” article for this topic, I have done a lot of research but there are always different opinions and concepts around it (some to follow, some to ignore!). I am not a farrier, but I have observed a lot of work, a lot of hooves and my dissertation covered hoof shape analysis compared to saddle positions… so I have done some research! Before we start, the following picture offers a brief recap of the limb’s anatomy. (Distal phalanx = P3 or coffin bone): “No foot, no horse” I first heard echoed over 10 years ago… My trainer was discussing the shape of her horse’s hooves, and at the time I had truly minimal appreciation of the hoof’s anatomy/function and even less idea as to what shape they should be. I thought this horse’s hooves looked just fine, but I was aware that “just fine” was probably not quite enough for a Grand Prix horse! A very perplexed me took this little mantra on as gospel, with hopes to one day actually understand the message. The last few weeks I have felt the difference that X rays and remedial farriery can have on your horse’s performance… and this little mantra took on a life of its own. Yesterday I posted a video of my mare who has had a summer of a sore back due to no riding during COVID. I decided to go back to basics because nothing really seemed to be working (Physio, veterinary treatments etc), and that niggling mantra “no foot, no horse” was ringing in my head. Gratefully, it seems to be working as she is starting to do harder work, with greater wase, developing muscle that she lost throughout the year and her body is recovering faster and faster from the increased workload. These are all great indicators of a horse that is comfortable. If there is anything that my dissertation explained to me, it is that the hoof, and its interaction with the distal limb is a phenomenal feat of engineering. This interface is responsible for communicating between the muscles, tendons and bones of the horse’s legs which are ever moving, and the hard, immovable exterior it collides with 24/7. The hoof capsule “holds” the skeleton by Laminae. Laminae exist as thousands upon thousands of interlocking folds of tissue, which connect the coffin bone to the hoof capsule. These folds, and the hoof wall, stretch and absorb energy as the hoof capsule hits the ground with each stride. As much as it is powerful, this structure is sensitive; which is why diseases such as laminitis (inflammation of these folds) and problems like abscesses cause so much pain. Finally, the weight of your horse is actually held almost suspended by these folds of tissue, which allow their weight to be transferred and actually supported by their fingernails/hoof wall. Furthermore, this wall is a living and growing structure which can and does adapt to the different pressures applied to it (which is one of the reasons why hooves change shape over a lifespan). A hoof’s heel and toe angles should be parallel and should match the hoof pastern axis, which should be approximately 45-55° (Lesniak, et al., 2017) (Clements, et al., 2019!). This angle in theory represents optimal bone, tendon, ligament and joint alignment for function and comfort. CAUTION is warned: Just because the limb looks normal from the outside, does not mean serious deviations from this axis aren’t occurring… This is where X-rays are extremely useful! A broken back HPA is associated with a lower heel, longer toe and generally coincides with a lower coffin bone angle. This broken back axis and lower coffin bone angle has been increasingly associated with greater risk of injury (Dyson, et al., 2011). An interesting description for this which I heard recently is this angle causes the tendons/limb to be “pre-pushed” … Imagine standing on the ground and lifting your weight on to your toes for several reps (flexing your calves). It is tiring, but easily manageable. Now do it with your toes on an elevated surface (for example, the edge of a step) … This becomes much harder. The step mimics a pre-pushed posture and mimics the broken back axis. This increases the distance that your muscles need to work over, to pull your heels up to the same point. Fatigue increases with this broken back posture, and again, flashback to the first blog posts, fatigue is an effective precursor to injury. MANY sources have found different statistics and observations which highlight just how negative the effects of a broken-back HPA can have. A few of these are mentioned… - Function and condition of the Deep digital flexor tendon (DDFT) and the navicular bone (NB) are dependent on heel angle. Low heels increase the distance over which the DDFT has to pass to reach its insertion on the coffin bone. This means greater strain on the tendon, and greater pressure on the structures underneath it, such as the navicular bone. (Eliashar, et al., 2004) (Dyson, et al., 2011) (Clements, et al., 2019!) - Coffin bone angles: o Optimal = 5° (wedge from the ground) (Clements, et al., 2019!) o Raised 1° ((2) on image) = 4% DECREASE of peak pressure on NB (Eliashar, et al., 2004) (Dyson, et al., 2011) o Dropped 1° ((3) on image) = 20% INCREASE of peak pressure through the first moments of hoof contact with the ground. (Lesniak, et al., 2017) These are related to the heel angle, and one of the reasons low, collapsed heels are not desired! - Length of toe: o 1cm excess of toe, adds about 50kg strain to the tendons (Murray, 2020) This causes additional pressure at breakover. Increased length of toe increases the distance the tendons and muscles must contract and travel over in order to rotate and lift the limb (kind of like the pre-pushed posture discussed earlier!). Again, excess strain increases risk of injury. - The angle of the coronet band of the hindlimbs should draw a line directly to the back of the knee of the forelimb. This should indicate correct conformation! These are all factors somewhat out of control of a veterinary physiotherapist. So, what is the relevance? Firstly, all of the above should indicate the hoof shape can cause internal tendon and joint problems, and these certainly are applicable to a VP. These problems are likely to cause compensations and secondary problems. These CAN be addressed by Veterinary Physiotherapy and complementary services. First and foremost, Veterinary diagnostics (especially X-rays, and ultrasound if necessary), and farrier intervention will be necessary to address fixing the conformation, if there are problems. Secondly, pain and compensation require rehabilitation and remedial exercises. This is because your horse will stop moving their bodies in an efficient and correct manner, in order to offload the painful pressures. Rehabilitation will help limit more damage to these tissues, while maintaining form and function. Your Vet Physio can help make your horse more comfortable both during and after the appropriate farrier and veterinary interventions have been made. Ice therapy, heat therapy, manual therapies and some electrotherapies could absolutely benefit your horse! A Veterinary Physiotherapist should coordinate treatment alongside your veterinarian and farrier, so if you have any queries about what we can do to help, what you should be expecting at any stage, or any questions about anything mentioned, please do get in contact! References Clements, P., Handel, I., McKane, S. & Coomer, R., 2019!. An investigation into the association between plantar distal phalanx angle and hindlimb lameness in a UK population of horses. Equine Veterinary Education, Volume NEED VOLUME AND ISSUE, pp. 1-8. Dyson, S. et al., 2011. An investigation og the relationships between angles and shapes of the hoof capsule and the distal phalanx. Equine Veterinary Journal, 43(3), pp. 295-301. Eliashar, E., McGuigan, M. & Wilson, A., 2004. Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot. Equine Veterinary Journal, 36(5), pp. 431-435. Lesniak, K., Willians, J., Kuznik, K. & Douglas, P., 2017. Does a 4-6 week shoeing interval promote optimal foot balance in the Working Equine?. Animals, 7(29), pp. 1-14. Murray, D. R., 2020. Risk factors for injury in sport horses. Newmarket, VetFest 2020.
- CONFORMATION - the good, the bad, the ugly.
Good conformation is fundamentally what is anecdotally or scientifically regarded as the most efficient spread of: - Weight - Force - Energy transfer In your horse. On the whole, the better symmetry within/between/around the horse and their legs, the less chance of injury. Less good for my job, very good for your horse 😉 In theory we want a horse that divides evenly in to 1/3rds, as this indicates an even distribution of weight carrying and weight pushing capacity, good straight joints when looking front on, but well angled shoulders, stifles and hocks when looking from the side. A well-proportioned neck and head complete the picture. In short, achieving correct proportions and conformation indicates correct and balanced distribution of weight, forces applied and movement through the horse. Keeping this in balance reduces the injury risk. This means that there is no obvious asymmetry BETWEEN, or WITHIN limbs and landmarks of the body. Balance front to back: A horse naturally carries at least 60% of its weight on its forehands, and 40% through its hindquarters. One of the aims of Dressage is to encourage greater active weight carriage on the hindlimbs in order to encourage better balance, particularly for the harder movements associated with Grand Prix dressage, as well as an improved expression in the movement. In my limited experience, show jumpers also seem to require a light and nimble balance, in order to get that horse to take off over those ridiculous obstacles 😉 The forelimbs are essentially struts to carry weight, (imagine they function like a pogo stick does – bouncing again and again when you put the power through your body). The head and neck behave as a ballast which can accentuate and aid movement (this is where you start throwing your body forward on the pogo stick to move around) and energy created by the engine: the hindlimbs (your legs which act to create energy and movement in the pogo stick). A match in power versus carrying capacity must be achievable (alongside training designed to aid this), in order for the horse to develop correctly, with good muscles. A horse that naturally achieves this will naturally find training easier compared to those who don’t. The angle of the shoulder indicates the ease with which the forelimbs can be protracted (pulled forwards). The more sloped this angle is, the better protraction power that limb is expected to have (which means better toe flick for your dressage test, or height for your jump 😉) Excessively long pasterns: are increasingly popular as they seem to give horses a very expressive/floaty trot. Something we all have an obsession with I imagine, however, long, thin pasterns reduce the stability with which the whole limb is balanced on… …Imagine Jenga blocks, these represent the bones that make up the pastern and lower limb: your tower gets taller and thinner as you remove blocks and it loses stability. Putting your hand at the top of them helps to stabilise the tower. That act of compressing the blocks creates stability. That same compression can be mimicked by the tendons… These can actively contract and tighten the Jenga blocks (or distal limb bones) together, creating stability. However, this means you increase the tension in tendons before you’ve even asked for increased workload. Increased tendon tension = increased risk of injury = increased risk of breakdown, tears, vet bills and “WHY DO I DO IT” (note: author’s personal experience) 😉 So: Short, wide pasterns provide a good sturdy base for the horse’s large weight, plus you, plus the movements you are demanding. Balance between limbs: Left to right balance encourages symmetry under saddle and reduced likelihood of one being overloaded (and increased risk of injury). Mechanical abnormalities can be mistaken for lameness, which is where experience and understanding biomechanics is crucial to understanding your horse (and trusting practitioners working with your horse!). Increased load on one limb increases the load and strain more than its natural capacity can handle. This can also create training problems (those days when you feel like rigor mortis has set in on one side of your horse sounding familiar?), and injuries, because increased strain does that to living tissues. Balance within limbs is just as crucial: Even spread of weight and pressure thanks to a symmetrical joint means balanced strain on the tendons and ligaments surrounding that joint capsule, and reduced risk of damage and injury to all these structures. If however the joint between two bones is asymmetrical, that difference can create increased compression on one side of the joint, and reduced pressure on the other. This results in greater risk of arthritis and greater strain on tendons, because they can be stretched asymmetrically and have to work harder to compensate for this pattern. Science buffs: An experiment was designed to test this – wedges were placed at the side of hooves (to force asymmetry on joints), and joint mechanics were recorded. Reduced joint flexion was observed as a result: Meaning that tendons and ligaments intervened and actively compensated for the new force being applied. This was to reduce the asymmetrical force applied to the limb, and reduce the abnormal movement which would result, and which would increase risk of injury and pain. This increased tendon strain however… that was likely to damage it long term. Many studies have tested different elements of this to determine similar conclusions: tendons will actively compensate for asymmetry and asymmetrical forces applied, and this definitely exacerbates their risk of damage and deterioration. Straight hocks and stifles: indicate poorer shock absorption, and poorer movement efficiency generated by the hindlimbs. With the amount of power generated in the hindlimb, poor angles (aka straight limbs) means less efficient and effective shock absorption, and a higher likelihood of arthritis. Higher chances of arthritis in the hocks indicates increased pressure on the backs, particular the lumbar back region, and can cause secondary problems with stifles (as mentioned previously with either over-active or underactive quadriceps muscles) and eventually hindlimb tendon pathologies/problems. In summary: Not good. Long backs often create a lovely softer ride, and these horses seem to develop a lovely rhythm (albeit a slow one commonly). However this long back can mean increased strain on the stifles, as they compensate for an unnaturally long wheel base, and the horse finds it harder to push underneath and carry weight behind. Stifle inflammation is likely to occur as a result of overworked quadriceps muscles, or inefficient function of Quadriceps. (Pokemon is a prime example of quite a long back, and I was forever teaching him to sit and weight, strengthening his back and encouraging him to lift his front end.) The lumbar back region is the point of transfer of power from the hind end, along the back to propel the forelimbs forwards. If this is excessively long, instability can occur, resulting in pain and compensations. Furthermore, this part of the back is not supported by a rib cage, and is therefore responsible for supporting a portion of the abdominal cavity “unaided” so to speak. Increased weight and/or increased back length will make this function far more difficult. It can be hard to spot asymmetries, particularly if you’re not trained to do so. Horse hooves can highlight red flags both in terms of confirmation, and movement. Next weeks post will be heavily focussed on hooves. As a precursor, “no hoof no horse” is a common mantra in the horse world, and yet I have only in the last week truly understood and experienced quite how much a difference that can make.
LASER works by using light energy of the visible to near infra-red range to increase the activity in the engine of the cell: the MITOCHONDRIA. These are a ‘sub cell’ of sorts, known as organelles, and are responsible for respiration. Respiration produces the energy for our bodies, in the form of ATP. When an injury is present, a hypoxic environment is created, meaning reduced oxygen is available. This prevents mitochondria from doing their job efficiently and reduces the supply of ATP. LASER provides benefits of: - Pain relief - Reduction of swelling - Blood vessel growth - Improved chemical composition of that area. Within the mitochondria are molecules known as “Chromophores”, these are “photon-acceptors”. A “Photon acceptor” is basically a molecule capable of accepting energy from the LASER. Cytochrome C-Oxidase is and enzyme and the final photon acceptor in the chain of respiration in the Mitochondria and is theorised to be one of the main action sites of the LASER. The absorption spectrum of COX, meaning the wavelengths it is affected by ranges from 500-1110nm; which is important to note with regards to the wavelengths of the LASER/light therapy machine used for treatment (different wavelengths for different purposes). COX is theoretically able to produce Nitric Oxide (NO) from Nitrite… Increasing COX activity through LASER application could increase the release of NO into the body. NO has therapeutic benefits of increasing blood vessel size (vasodilation), which will help revive and re-oxygenate the poorly oxygenated tissues that have suffered from injuries (as previously mentioned). Increasing this activity of COX also increases the ATP production and general mitochondrial activity, which increases the cell’s ability to function. Increasing the cell's function will increase the activity of that area and tissue, and enhance the repair process of the injured area. Combined, this effect increases the delivery of fresh nutrients and oxygenated blood, increases the ATP/energy available to the injured tissue, and results in pain reduction, blood vessel growth, wound healing, reduction in swelling and reduction in pro-inflammatory chemicals… All very good benefits to the healing of the body. The benefits of LASER make it suitable to treat a range of problems: - muscle knots - tendon and ligament problems - swelling - ischaemic tissues - muscle trauma - bone problems (Joint problems, arthritis, fractures) Interestingly, Nitric Oxide can be supplemented by some natural sources: Pumpkin seeds. Alternative, natural supplements are gaining interest, and certainly have made me broaden my approach to supplements. Pumpkin seeds (and pumpkins themselves!) are high in a range of minerals, vitamins (especially A and E, BOTH excellent for muscle function and quality), and importantly Nitric Oxide. For a bit more on this, while we work on some info about natural supplement alternatives: https://thehorse.com/113373/can-horses-eat-pumpkin/ Bibliography  H. B. Cotler, R. T. Chow, M. R. Hamblin and J. Carroll, “The Use of Low Level Laser Therapy for Musculoskeletel Pain,” Orthopeadics and Rheumatology, vol. 2, no. 5, p. 00068, 2015.  M. Flaherty, “Rehabilitation therapy in Perioperative Pain Management,” Veterinary Clinics of North America: Small Animal Practice, vol. 49, pp. 1143-1156, 2019.  X. Fu, J. Dong, S. Wang, M. Yan and M. Yao, “Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound,” Burns and Trauma, vol. 7, no. 1, pp. 1-7, 2019.  L. Hochman, “Photobiomodulation Therapy in Veterinary Medicine: A Review,” Topics in Companion Animal Medicine, vol. 33, pp. 83-88, 2018.  K. C. Kennedy, S. A. Martinez, S. E. Martinez, R. L. Tucker and N. M. Davies, “Effects of low-level laser therapy on bone healing and signs of pain in dogs following tibial plateau leveling osteotomy,” American Journal of Veterinary Research, vol. 79, no. 8, pp. 893-904, 2018.  J. L. Wardlaw, K. M. Gazzola, A. Waqgoner, E. Brinkman, J. Burt, R. Butler, J. M. Gunter and L. H. Senter, “Laser Therapy for incision healing in 9 dogs,” Veterinary Sports Medicine and Physica Rehabilitation, vol. 5, no. 349, pp. 1-24, January 2019.  B. Pryor and D. L. Millis, “Therapeutic Lase in Veterinary Medicine,” Veterinary Clinics of North America: Small Animal Clinics, vol. 45, pp. 45-46, 2015. https://www.discoverymedicine.com/Robert-O-Poyton/2011/02/20/therapeutic-photobiomodulation-nitric-oxide-and-a-novel-function-of-mitochondrial-cytochrome-c-oxidase/
- What are the Electrotherapies used by Veterinary Physiotherapists for?
Electrotherapies include the machines available to Physiotherapists to target healing in more focussed ways than what our hands alone are capable of. There are several different functions of these machines. These will hopefully be a bit clearer without being too heavy. If you are looking to be weighed down by the science, the next blog is the one! Please let us know if there’s something of real interest for you, so we can include it! LASER LASER works by using light energy to increase the activity in the engine of the cell: the mitochondria. These are part of cells, and are responsible for respiration, which produces the energy used all over ours and our horses’ bodies. When an injury is present, chemicals create bonds within mitochondria, and build up, stopping these mitochondria from doing their job efficiently. LASER helps to break down these bonds and the toxic build-up, which provides beneficial results such as: - Pain relief - Reduction of swelling - Blood vessel growth - Improved chemical composition of that area. LASER is a popular choice of treatment for trigger points (muscle knots), joint pain, swelling and areas of tension that are too painful to attempt other modalities. This provides a non-invasive and well-accepted method of addressing pain in your horse, making it a vital tool. When your back is stiff, the last thing you want is for it to be hammered, consider your horse in the same way… before they teach you to consider it more severely! This also means the vets may not need to prescribe as much pain relief, meaning that your horses’ livers and kidneys will also be VERY grateful! LASER light waves are unlike a standard LED; they produce the same wavelength, do not get spread from the light chamber, and create a uniform wave pattern. This characteristic makes these machines specific, effective… and expensive! Smaller “LASERs” are available on the market for less than £200, where the “proper” conventional class 3B ones are upwards of £1500. That price difference is not purely based on the bag it comes in! If someone is treating your horse with LASER and charging as such, it may be worth having a check on what the details of the machine are. Therapeutic Ultrasound Ultrasound uses soundwaves of energy which create changes in the body’s tissues. Not dissimilar to the concept of LASER in terms of energy delivery to increase the healing power of the treated location, but a different form of energy is delivered. UNLIKE LASER, this machine uses soundwaves, a mechanical form of energy, not light waves. With the different form of energy, come different benefits, different mechanisms of function, as well as different treatment targets. Shockwave therapy works on the same principle as Ultrasound; by also using mechanical waves to effect changes in the tissues. Soundwaves create moments of compression and decompression in the tissues – imagine an accordion stretching in and out. This constant change in pressure seems to create gas bubbles in the treated tissue (cavitation), which then affect nearby cells to vibrate more (acoustic streaming). In tandem, the Ultrasound creates thermal (heating) effects, and non-thermal benefits. It is possible to “overdo” this treatment. So it is CRUCIAL that the settings applied to the injury are appropriate to the healing stage (acute/subacute/chronic… go read that first blog post ;)). The suggested amount of energy delivered per pulse is different for each of these stages, where the setting for a chronic injury could destroy the tissues in acute stages of damage. PEME/PEMF or Pulsed Electromagnetic Field Therapy There is evidence of this modality treating bone fractures, osteoporosis and pain relief, however as with a lot of the research into most of these machines, different settings and machine specifications make it extremely difficult to compare any 2 studies. The basis of function for this machine is the therapeutic benefits that magnets have been associated with. Increased blood flow, pain relief, treatment of swelling and bone problems have all been associated, to varying degrees, with this modality. This machine is particularly popular in the small animal world, as it seems to help the stiffness and pain of small animals getting up in the morning. Some large horse rugs use this technology, however there is not much scientific evidence for how effective these rugs actually are, especially when considered for the hefty price tags attached. Often an anecdotal summary of the product is found as opposed to research studies. Have you used any rugs that claim PEME benefits? (ActivoMed is a big one) What differences, if any, did you notice? I would love to know! H-Wave This is a muscle stimulation machine which is incredibly useful and effective at retraining coordination and maintaining muscle function. Pain has potent abilities to alter the contraction ability of muscles. Compensations, new or old, can start to affect a lifetime of muscle function. Imagine the days you’ve twisted your ankle and you limp for a week. Your other leg hurts and your back hurts from compensating. Imagine the pain and the dysfunction you feel when that twisted ankle hurts continually for weeks on end. Horses may go a long time before we really notice that something is not quite right for them. That means, they may have spent a long time compensating, twisting their pelvis out and clenching their back, to avoid putting full weight on the sore leg. As a result, muscles will have seized up, locked up the painful area and brace the body against using it. The muscle contraction messages could then change, and the muscle function could change as a result. Allowing altered muscle contractions to continue runs the risk of secondary problems, as the body tries to respond to altered posture and muscle because the body starts to alter and respond to the different pressures. H-wave can effectively re-stimulate the correct muscle sequence (with correct handling of it), WITHOUT fatiguing the muscle. The H-wave mimics the natural waveform that the body uses to contract a muscle; meaning it is generally well tolerated as well as effective. The other huge benefit to this machine is that it is capable of contracting the whole muscleas the electrodes are positioned on the muscle motor point, which is where all the nerve fibres enter a muscle and therefore where any contraction starts. The H-wave can also be used to target pain relief, but the wave frequency used for this setting is generally poorly tolerated by horses. The “Muscle pump” function with the lower frequency is well tolerated, and also has a pain-relieving effect (thanks to improving the muscle quality). NMES – Neuromuscular Electrical Stimulation Similar to H-wave, this is a muscle stimulator. Unlike the NMES, this has a slightly sharper wavelength to create contraction, and it DOES cause fatigue in horses. This machine does however maintain and cause increased muscle strength, stamina and treatment of muscular atrophy. With both of the muscle stimulation machines (H wave and NMES), neurologically deficit horses could benefit. These machines are able to artificially contract muscles, maintaining their function, reducing the risk of secondary problems such as contracture. Maintaining muscle function also means that fluid movement, lymph drainage, and delivery of fresh nutrients to the tissues of the muscles and surrounds is artificially maintained. This is hugely beneficial as the toxin build up and lack of drainage can cause pain, stiffness and discomfort secondary to the actual injury that is requiring treatment. Furthermore, a horse unable to work or preparing to recommence work after injury may be able to use muscles correctly from the beginning, if the treatment plan has been committed to. TENS – Trans Cutaneous Electrical stimulation This machine works by interfering with the pain-gate pathways in the body. In theory it is effective at treating pain in the body, though studies show varying lengths of time that relief is actually present for. This machine is often poorly tolerated by horses. As ever, let us know what you’re thinking! - Have your horses ever used any of these machines? - Does your horse’s Veterinary Physiotherapist use them? - Does your Vet believe in them? Some are more popular than others, and it’s always interesting to hear a fresh take/opinion on the effectiveness and experiences people have with them! The next few posts will cover some of these in a deeper scientific way, destined for those with a keen desire to know more about the biological responses that each machine initiates. See you in a week!
- What is Veterinary Physiotherapy?
Trying to summarise a 4-year degree to an accessible blog post was a lot harder than I gave it credit for! On a literal level, Physiotherapy breaks down to “therapy” meaning “treatment of pain and dysfunction” through “Physio” which translates to “movement”. A Veterinary Physiotherapist addresses the animal as a whole, and works to treat injuries directly (along Veterinary Surgeon guidance) with various modalities, and indirectly by training controlled movement in the form of stretches and exercises, to reduce compensations and inefficient movement. Compensations may have developed from injury, poor conformation or chronic asymmetrical use of the body. These are a problem because the asymmetry that results in the body causes increased load in some areas of the body, and decreased load in others. This asymmetry means excess wear and tear, leading to arthritis or injuries. This is something horsemen and women fight on a constant basis; and something that we Physios do our best to help. In order to support this quest for free-moving and functioning quadrupeds, us Physiotherapists have acquired in-depth knowledge of anatomy, clinical reasoning, modern research and practical applications of treatments. Within this, knowledge of how the body heals and what treatments are appropriate at different stages is used to maximise the safety and path to successful rehabilitation. There is potential for causing a lot of damage if this is done ineffectively, or in the wrong order, which is why fully-qualified and trained Veterinary Physiotherapists are crucial for your horse’s rehabilitation and performance! Clinical reasoning is the process of analysing the presented animal’s symptoms, combined with the clinical historyprovided by the vet and owner. Along with some other puzzle pieces, this is used to determine the appropriate treatment plan with its short- and long-term goals. Part of clinical reasoning is to determine which stage of healing the animal is at. This means ascertaining where the injury is from the following stages: 1. Acute is the initial time period up to approximately 72 hours after an attack on the body. This may be a physical trauma like a kick, or an infection which creates a greater systemic response. 2. Sub-acute is an elusive time between the initial onset of the attack/pain and the acute phase, to the chronic stages indicated by tissue remodelling. 3. Chronic phase can begin anywhere from a few weeks post-initial injury, up to months or even years depending on various factors. This is the remodelling phase of tissues, though it is important to note that not all tissues will ever remodel to their former strength and glory. Once the above has been established, an initial treatment will be delivered. Depending on the presenting symptoms will determine the use of modalities applied. Modalities available to the Veterinary Physiotherapist include Electrotherapies, Manual therapies, and Prescriptive/Remedial Exercises for the strengthening phase. These will be discussed in greater depth in future articles. The huge benefit to these treatments is the non-medicated pain relief available from them. Manual therapies include variations of massage, stretches and myofascial release. These increase circulation and drainage, reduce swelling, relax the animal and importantly offer pain relief… Yes, you riders would benefit from them too, but who am I to tell you to spend money on yourself and NOT your horse! (#beentheredonethat). Stretches are a great strengthening tool for horses, particularly those that are unable to work that much under exercise restrictions. *These should be monitored by a Physiotherapist! * Electrotherapies vary from muscle stimulation machines, LASERs, Ultrasound machines as well as many other ever-evolving products. These offer pain relief, improved muscle function, tendon and ligament treatment, and many others. Due to the wide-ranging benefits, another blog post is in the pipeline devoted entirely to this topic, so keep an eye out! These treatments are able to reduce reliance on painkillers, which means reduced risk of liver and kidney damage (and others),and of course, a financial bonus to avoid regular veterinary visits and drug prescriptions. Furthermore, this means that during those hard training days when your horse is feeling that bit more sore, or you’ve been working up to a competition and you can feel them tiring in their body, there is so much support available to them which doesn’t involve drugs*. *Important disclaimer: Painkillers are effective and necessary, but as advised by your Veterinary surgeon. Veterinary Physiotherapy simply offers a supporting therapy to what is available there Finally, the strengthening exercises that are available are as limitless as your imagination. Poles, weaving and hill-work could be described as the basic platform for remedial exercises, but the variations are endless, and can be tailored to suit your horse exponentially. This may be for the horse who is learning to use a limb again after nerve damage, or the sports horse who is slightly stiffer in one direction compared to others and requires increased suppleness there. There is no elitism when it comes to improving horse welfare. A lot of these elements will be discussed in the future, however, if there is something in particular that sounds of interest, please do get in touch! As always, at your beck and call on every social media platform! Looking forward to hearing from you… And you will be hearing from me this time next week! ❤️ Genevieve
- The Beginning.
I made a bold statement during my placement year at University (roughly 2018) that I was going to start a blog… There’s nothing quite like a good run-up! Now that I have completed my 4 years of Undergraduate study to become a qualified Veterinary Physiotherapist, I feel ready and armed to start the journey. I am still waiting on a final exam board meeting before I can be insured to treat, however, it’s only a matter of time. With that, I am so thrilled to be launching this blog as a precursor to the full business launch! Kirk Equine Performance is borne out of a love for horses and for Biology and represents a combination of expertise and skill. Kirk Equine Performance blends degree-trained Veterinary Physiotherapy with skills and experiences of an International Dressage rider – a rare combination if I may say so myself ;). This will be an all-inclusive service offering training, riding and treating your horse to the best levels achievable. My passion for horses has taken me to many places in the world. I actually think I fell in love with the sport at two years old obsessing over my cousin’s pony in England; I rode my first horse at the age of 5 in Sydney, Australia; got my first pony at 11 in Geneva, Switzerland; competed internationally for the first time in Pompadour, France, competed for my University team in Surrey, England; worked in professional stables for four years in Germany, and most recently made myself at home in the Cotswolds and Shropshire for my degree with my horses Pokemon, Horacio, Feather and most recently Riva! I am now permanently based in the Cotswolds, covering Gloucestershire and surrounds comfortably (including Oxfordshire, Herefordshire, Worcestershire and Wiltshire). Throughout my 4-year degree, including a year placement in clinical settings, I have kept training and competing my horses as much as possible. I competed my top 3 horses Royal Pokemon, Feather and Horacio each at senior international level at Small Tour, with Feather and Horacio both stepping up to this level for the first time in their lives! Managing expectations of myself and my horses, alongside deadlines and a huge workload at university, plus coping with devastating injuries and setbacks along the way with some of these horses tested my resolve and my passion, yet again, and has made me sure of my future ambitions. I became more focussed on pursuing the course of improving horse welfare as best I could with education, rehabilitation/treatment and training. If any of my knowledge is able to help them, to prevent them from any damage or deterioration, or help you as their owners handle those heartbreaking moments, then you’ll find me throwing that information around like it’s my business… ;) During the years of learning about life with horses, I have experienced colic, tendon tears, broken bones, blood clots, and random lameness that seems to just come along with them. A big part of wanting to become a Physio was to help support and fix horses as best we can, and have less heartbreak. I enjoy now knowing more about the science of rehabilitation, having already had plenty of experience with the emotions, the heartache and the practicalities of horse injuries. These blogs will cover anecdotes from life as a Veterinary Physiotherapist, as a competitive rider, as a horse trainer and informative pieces on new and/or interesting research, explanations about treatments and technologies or great questions I’ve been asked… … Which leads perfectly in to, as if I had planned it (😉), GET IN CONTACT! Any questions, any comments, please do get in touch on any of our various platforms! There is a contact form on the website, I’ve linked it, so you don’t even have to open your email tab! Find us on Instagram, Facebook, email, and if you feel nostalgic about the good ol’ days, I’ll even answer the phone! Looking forward to hearing from you, and you’ll be hearing from me this time next week!