Review of Manual Therapy Techniques in Equine Practice

Effects of osteopathic manual therapy on the autonomic and immune systems and the hypothalamus-pituitary-adrenal axis in the horse

Manual therapies, physiotherapy, and modalities are often used as a treatment and prophylactic method for preventing various injuries, as well as a rehabilitation tool in the post-operative, traumatic period for horses. Significant results have been achieved with these therapies: increased joint range of motion, tissue extensibility, and reduced pain and inflammation. This study evaluated the effect of osteopathic manual therapy (OMT) on the nervous and immune systems, as well as on the hypothalamus-pituitary-adrenal (HPA) axis. To assess changes in these systems, non-invasive biomarkers were chosen: the heart rate (HR), respiratory rate (RR), temperature (T), as well as objective measurements: blood serum cortisol (BSC) concentration and white blood cell (WBC) count. A total of 30 thoroughbred horses were randomly divided into an experimental group (n = 15) and a control group (n = 15). Blood samples and physiological indicator measurements such as HR, RR, T, BSC and WBC were taken before (p0), after (p1) and one hour after (p2) the OMT treatment for the experimental group. Analogical sequence was performed for the control group without OMT. A significant increase of BSC by 0.94 µg/dl after OMT suggest a direct influence on the HPA axis. Also, a substantial decrease of WBC by 0.57 × 109/l indicates the immune system’s response to the treatment. Moreover, an observed significant decrease in HR and RR shows that the autonomic nervous system was affected by activating the parasympathetic nervous system. Based on the results obtained, it is concluded that OMT has an effect on the HPA axis and on the nervous and immune systems.

A Systematic Review of Musculoskeletal Mobilization and Manipulation Techniques Used in Veterinary Medicine

Simple Summary

Neck and back pain are common ailments in animals. While there are medical and surgical treatment options available for select patients, conservative care is the most common form of management of pain, stiffness and muscle spasms. Physical therapists, osteopaths and chiropractors use mobilization and manipulation techniques to evaluate and treat muscle and joint problems in both humans and animals, but there seems to be little scientific evidence available to support their use in veterinary medicine. This study reviews the scientific literature with the goal of identifying the clinical indications, dosages, outcome parameters, and efficacy of mobilization and manipulation techniques in dogs and horses. Fourteen articles were included in this review of which 13 were equine and one was a canine study. There was a large variability in the quality of evidence that supports the use of joint mobilization or manipulation in treating pain, stiffness and muscle hypertonicity in horses. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Future studies need to establish standardized methods to evaluate the optimal dosages of mobilization and manipulation for use in animals.

Abstract

Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization (n = 5) or manipulation (n = 8) of the axial skeleton. Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

Equine Rehabilitation: A Scoping Review of the Literature

Simple Summary

When a horse is diagnosed with a locomotor disorder, the veterinarian treats the specific injury to restore the horse to soundness. Even after the injury has healed, however, the horse may not be fully functional due to persistent limitations in movement or strength in specific areas of the body. As in people, rehabilitation seeks to optimize function and reduce any existing disability using a variety of methods including manual therapy, the use of physical and mechanical agents, and specialized exercise regimes. This study has reviewed the scientific literature with the goal of identifying which types of physical therapy have been described in horses over the past 20 years. The most frequently reported techniques were exercise, electrotherapy, and hydrotherapy but there are relatively few publications describing details of their use and outcomes in clinical cases. This study reviews the methodology and outcomes of rehabilitation in clinical cases. The results highlight the paucity of clinically-based reports on the practical applications of equine rehabilitation and physical therapy.

Abstract

Injuries to the locomotor system are a common problem in athletic horses. Veterinarians address these injuries using appropriate medical, surgical, and pharmacological treatments. During or after recovery from the initial injury, horses may be treated for functional locomotor deficits using specific rehabilitation techniques aimed at restoring full athletic performance. This study reviews the literature to identify which rehabilitative techniques have been used most frequently in horses over the past 20 years, the protocols that were used, and the outcomes of the treatments in naturally occurring injuries and diseases. Publications were identified using keyword selection (Equine Athlete OR Equine OR Horse) AND (Rehabilitation OR Physiotherapy OR Physical Therapy). After removing duplicates and screening papers for suitability, 49 manuscripts were included in the study. The majority of publications that met the inclusion criteria were narrative reviews (49%) in which the authors cited the relatively small number of published evidence-based studies supplemented by personal experience. Observational/descriptive studies were also popular (35%). Randomized control trials accounted for only 10%. The most frequently reported rehabilitation techniques were exercise, electrotherapy, and hydrotherapy. The findings highlight the need for further information regarding type of intervention, parameterization, and outcomes of equine rehabilitation in clinical practice.

Effects of Low-Level Laser Therapy and Chiropractic Care on Back Pain in Quarter Horses

Low-level laser therapy has been used clinically to treat musculoskeletal pain; however, there is limited evidence available to support its use in treating back pain in horses. The objective of this study was to evaluate the clinical effectiveness of low-level laser therapy and chiropractic care in treating thoracolumbar pain in competitive western performance horses. The subjects included 61 Quarter Horses actively involved in national western performance competitions judged to have back pain. A randomized, clinical trial was conducted by assigning affected horses to either laser therapy, chiropractic, or combined laser and chiropractic treatment groups. Outcome parameters included a visual analog scale (VAS) of perceived back pain and dysfunction and detailed spinal examinations evaluating pain, muscle tone, and stiffness. Mechanical nociceptive thresholds were measured along the dorsal trunk and values were compared before and after treatment. Repeated measures with post-hoc analysis were used to assess treatment group differences. Low-level laser therapy, as applied in this study, produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness. Combined laser therapy and chiropractic care produced similar reductions, with additional significant decreases in the severity of epaxial muscle hypertonicity and trunk stiffness. Chiropractic treatment by itself did not produce any significant changes in back pain, muscle hypertonicity, or trunk stiffness; however, there were improvements in trunk and pelvic flexion reflexes. The combination of laser therapy and chiropractic care seemed to provide additive effects in treating back pain and trunk stiffness that were not present with chiropractic treatment alone. The results of this study support the concept that a multimodal approach of laser therapy and chiropractic care is beneficial in treating back pain in horses involved in active competition.

Two Multicenter Surveys on Equine Back-Pain 10 Years a Part

Despite back-pain being a common cause of poor performance in sport horses, a tailored diagnostic workflow and a consolidated therapeutic approach are currently lacking in equine medicine. The aim of the study was to assess the evolution in the veterinarian approach to diagnose and treat back-pain over a 10 years period. To investigate this topic, two surveys were addressed to equine veterinarians working in practice throughout Europe 10 years apart (2006 and 2016). The answers were organized in an Excel dataset and analyzed. There were 47 respondents in 2006 and 168 in 2016, from 8 European Countries. The main reasons for examining horses with back-pain were poor performance (76%), behavioral issues (68%), and lameness (50%). When assessing back pain, 97% of respondents applied careful digital pressure over paravertebral muscles, 90% of them used digital back mobilization, and 69% was detecting areas of localized heat. The use of diagnostic analgesia to confirm the source of pain was rarely employed. Radiography and ultrasonography were the most frequent diagnostic imaging modalities used to investigate the causes of back-pain in both surveys. Obtaining a definitive diagnosis in horses with back-pain is considered challenging due to the reduced accessibility of the area and the variability in the pain manifestations. Corticosteroids injections were used for local treatments by 80% of respondents in 2006 and 92% in 2016. Recently, ultrasonography has been extensively used during the injections of the vertebral articular facets and sacroiliac joints region. The use of complementary therapies was restricted to a low percentage of respondents in the first survey (20%) but it increased over the decade. In 2016, a wider percentage of respondents considered osteopathy (40%), kinesiotherapy (29%), and acupuncture (22%) when treating back disorders compared to 2006. The structural differences of the two surveys did not enable a direct data comparison. Based on the results of this surveys, however, veterinarians should be sensitized to the back-pain problems and seek to integrate findings from clinical research studies in their daily practice.

International Survey Regarding the Use of Rehabilitation Modalities in Horses

To define which biologic, electrophysical and other modalities are used in horses for injury or performance issues, a questionnaire regarding 38 modalities was distributed to eight veterinary groups. A total of 305 complete or partial responses were obtained from over 10 geographic regions; 75.4% from private equine practice or regional private equine referral hospitals, 14.1% from university teaching hospitals or satellite clinics, 8.2% from private mixed animal practice, and 2.3% from veterinary rehabilitation centers. The majority of respondents were located in the USA (60%), Europe (25.6%), and Canada (5.6%). Respondents reported working with athletic horses primarily in the disciplines of hunter-jumper (26.9%), dressage (16.0%), and pleasure riding (14.7%), followed by Western riding, track racing, and eventing. Warmbloods (39.7%) were the predominant breed presenting to respondents, followed by Thoroughbreds (20.3%) and Quarter Horses (17.3%) ahead of other breeds. All 38 modalities were used by respondents. The 10 most prominently utilized were controlled hand walking (97.3%), therapeutic shoeing (96.1%), ice (95.2%), compression bandaging (89.5%), platelet rich plasma (PRP; 86.5%), therapeutic exercises (84.3%), interleukin-1 receptor antagonist protein therapy (IRAP; 81.4%), stretching (83.3%), and cold water hydrotherapy (82.9%). Heat (77.6%), massage (69.0%), and acupuncture (68.3%) were also commonly utilized. The least prominently used modalities were hyperbaric oxygen therapy (9.4%), cytowave (8.3%), and radiofrequency (6.4%). Injectable modalities (IRAP, PRP, mesotherapy, stem cells) were almost solely administered by veterinarians; other modalities were variably applied by veterinarians, technicians, veterinary assistants, farriers, physical therapists, trainers, and other entities. A total of 33% of respondents reported working collaboratively with physical therapists on equine patients. Findings indicate that a broad range of invasive and non-invasive modalities are used in equine patients to address a variety of rehabilitation and performance needs, and that personnel with varying levels of expertise are involved in their administration. This suggests that further investigation to better define the delivery, efficacy and any negative effects of many of these modalities is important.

The deep fascia and retinacula of the equine forelimb - structure and innervation

Recent advances in human fascia research have shed new light on the role of the fascial network in movement perception and coordination, transmission of muscle force, and integrative function in body biomechanics. Evolutionary adaptations of equine musculoskeletal apparatus that assure effective terrestrial locomotion are employed in equestrianism, resulting in the wide variety of movements in performing horses, from sophisticated dressage to jumping and high-speed racing. The high importance of horse motion efficiency in the present-day equine industry indicates the significance of scientific knowledge of the structure and physiology of equine fasciae. In this study, we investigated the structure and innervation of the deep fascia of the equine forelimb by means of anatomical dissection, histology and immunohistochemistry. Macroscopically, the deep fascia appears as a dense, glossy and whitish lamina of connective tissue continuous with its fibrous reinforcements represented by extensor and flexor retinacula. According to the results of our histological examination, the general structure of the equine forelimb fascia corresponds to the characteristics of the human deep fasciae of the limbs. Although we did find specific features in all sample types, the general composition of all examined fascial tissues follows roughly the same scheme. It is composed of dense, closely packed collagen fibers organized in layers of thick fibrous bundles with sparse elastic fibers. This compact tissue is covered from both internal and external sides by loosely woven laminae of areolar connective tissue where elastic fibers are mixed with collagen. Numerous blood vessels running within the loose connective tissue contribute to the formation of regular vascular network throughout the compact layer of the deep fascia and retinacula. We found nerve fibers of different calibers in all samples analyzed. The fibers are numerous in the areolar connective tissue and near the blood vessels but scarce in the compact layers of collagen. We did not observe any Ruffini, Pacini or Golgi-Mazzoni corpuscles. In conclusion, the multilayered composition of compact bundles of collagen, sparse elastic fibers in the deep fascia and continuous transition into retinacula probably facilitate resistance to gravitational forces and volume changes during muscle contraction as well as transmission of muscle force during movement. However, further research focused on innervation is needed to clarify whether the deep fascia of the equine forelimb plays a role in proprioception and movement coordination.

Joint Mobilization and Manipulation for the Equine Athlete

Joint mobilization and manipulation provide important diagnostic and therapeutic approaches for addressing musculoskeletal issues in veterinary medicine. Soft tissue and joint mobilization are used to assess the quality and quantity of joint range of motion and as a primary means of treating musculoskeletal disorders. Spinal manipulation was shown to be effective for reducing pain, improving flexibility, reducing muscle tone, and improving symmetry of spinal kinematics in horses. Because of potential misuse and safety issues, joint mobilization and manipulative therapies should be provided only by specially trained veterinarians or licensed human manual therapists.

The effect of relaxing massage on heart rate and heart rate variability in purebred Arabian racehorses

The objective of this study was to assess the effect of relaxing massage on the heart rate (HR) and heart rate variability (HRV) in young racehorses during their first racing season. In the study, 72 Purebred Arabian racehorses were included. The study was implemented during the full race season. The horses from control and experimental groups were included in regular race training 6 days a week. The horses from the experimental group were additionally subject to the relaxing massage 3 days a week during the whole study. HR and HRV were assumed as indicators of the emotional state of the horses. The measurements were taken six times, every 4-5 weeks. The HRV parameters were measured at rest, during grooming and saddling the horse and during warm-up walking under a rider. The changes of the parameters throughout the season suggest that the relaxing massage may be effectively used to make the racehorses more relaxed and calm. Moreover, the horses from the experimental group had better race performance records.

Dynamic mobilisation exercises increase cross sectional area of musculus multifidus

REASON FOR PERFORMING STUDY

In human subjects with back pain, the deep spinal stabiliser m. multifidus is inhibited ipsilaterally leading to atrophy, asymmetry and intervertebral instability. Specific physiotherapeutic exercises are required to reactivate m. multifidus. This study assesses the effect of dynamic mobilisation exercises on size and symmetry of m. multifidus in the equine caudal thoracic and lumbar spine.

HYPOTHESES

Regular performance of dynamic mobilisation exercises over a period of 3 months increases cross sectional area (CSA) and left-right symmetry of m. multifidus muscles in the caudal thoracic and lumbar spine.

METHODS

Eight horses performed dynamic mobilisation exercises (3 cervical flexions, one cervical extension and 3 lateral bending exercises to the left and right sides) with 5 repetitions/exercise/day on 5 days/week for 3 months during which time they were not ridden. Left and right m. multifidus CSA was measured ultrasonographically at 6 levels from T10 to L5 at the start (initial evaluation) and end (final evaluation) of the 3 month study. Changes in CSA of the right and left m. multifidus muscles and symmetry of m. multifidus CSA on the right and left sides between the 2 evaluations were sought using analysis of variance (P<0.05).

RESULTS

Between the initial evaluation and final evaluation m. multifidus CSA increased significantly at all 6 spinal levels on both right and left sides. Asymmetries in m. multifidus CSA between the right and left sides decreased between the initial and final evaluations.

CONCLUSIONS

Hypertrophy of multifidus occurred over a 3 month period during which dynamic mobilisation exercises were the only exercise performed.

POTENTIAL RELEVANCE

Dynamic mobilisation exercises maybe a useful rehabilitative technique for horses in which m. multifidus has atrophied in response to back pain.