Mechanisms of aquatic therapy and its potential use in managing equine osteoarthritis

Four Weeks of Incline Water Treadmill Exercise Can Contribute to Increase Epaxial Muscle Profile in Horses

Background

Water treadmill (WT) exercise is a popular modality for the training and rehabilitation of horses. However, evidence-based literature regarding the use of WT exercise, particularly using inclines, is lacking.

Objectives

The aim of this study was to assess the effect of recurring inclined WT sessions on equine epaxial muscle development.

Methods

Six horses completed 24 sessions of 15 minutes of WT activity over four weeks. Horses walked with water at the midcannon level at a treadmill incline of 4%. Back traces were measured at three and seven centimetres ventral to the dorsal midline at T5, T9, T14, and T18, prior to the first session (W0) and weekly for 4 weeks (W1-4).

Results

Overall, the back traces demonstrated progressive increases in muscle development (p < 0.05), starting at W2 up to W4. At three centimetres ventral to the dorsal midline, the most to least significant increases in gross muscle development were at T18, T5, T9, and T14, respectively, and when measured at seven centimetres ventrally, the most to least significant increases were demonstrated at T5, T18, and T14. It was noted that increases in thoracic back profile musculature were mainly observed within two to four weeks of the WT intervention.

Conclusions

It has been concluded that repeated WT exercise on an inclined setting has a significant effect on the rate and size of growth of equine thoracic back profile musculature. Muscle hypertrophy due to resistance training in the WT starts at 2 weeks within the programme, and it progresses as exercise continues to be performed.

Effect of speed and water depth on limb and back kinematics in Thoroughbred horses walking on a water treadmill

Water treadmill (WT) exercise may induce limb and back kinematics that meet specific training and rehabilitation goals. The study aimed to investigate the effects of walk speed, at different water depths (WDs), on limb and back kinematics of six Thoroughbreds exercising on a WT. Horses walked at 2.8/4.3/5.5/6.0 km/h (i.e. 0.8/1.2/1.5/1.7 m/s) at dry, metacarpophalangeal and carpal WD. Videography captured limb movement in the sagittal plane. Motion-capture measured thoracolumbosacral flexion-extension (FE), and lateral bend (LB) ranges of movement (ROM) using skin surface markers on the sixth, tenth, thirteenth, eighteenth thoracic, third and fifth lumbar, and third sacral spinous processes. Inertial-motion-sensors measured poll, withers and pelvic displacements. Following preliminary univariable analyses, multivariable mixed-effects linear-regression analyses were used to examine the relationship between speed, WD and each outcome variable (P < 0.05). Peak metacarpophalangeal, carpal and tarsal joint flexion increased with speed (P ≤ 0.002) and depth combined (P 0.001) while peak metatarsophalangeal flexion increased with WD only (P 0.001). Thoracolumbar FE-ROM between T10 and L3 and hindlimb retraction was increased by speed and WD combined (P 0.001). Hindlimb protraction was increased by speed (P 0.001) while hindlimb retraction was increased by speed and WD combined (P 0.001). Dorsoventral poll displacement was increased by speed (P 0.001) and carpal WD (P = 0.013), craniocaudal poll displacement was increased by speed and WD combined (P 0.001). Pelvic (tubera coxae and sacrum) dorsoventral displacements increased with speed and WD combined (P 0.001). Understanding the effects of speed and WD on limb, back and pelvic kinematics will improve decision making relating to dry and WT exercise within training.

A comparison of stride parameters and carpal and tarsal joint angles during terrestrial and swimming locomotion in domestic dogs

In recent years, canine hydrotherapy has become increasingly popular to treat a range of conditions despite a lack of empirical evidence. It is currently unclear whether joint angles and limb movements performed by dogs during swimming are quantifiably beneficial for healthy animals. This study investigated the swimming kinematics of healthy dogs to establish baseline data for this activity and compare limb kinematics to that of overground locomotion. Kinematic data were recorded from eight healthy dolichocephalic dogs (mean age: 3.4±2.2) of a variety of breeds. Overground data were collected prior to swimming and consisted of dogs trotting on a flat surface. Swimming data were collected using an underwater camera during a standard hydrotherapy session conducted by a trained canine hydrotherapist. Range of motion, primarily due to an increase in flexion, was significantly greater (P<0.005) during swimming than trotting. Stride length (P<0.001) and frequency (P<0.005) were both significantly reduced in swimming compared to trot. Swimming kinematics recorded in this study are consistent with previously published data on canine aquatic locomotion but differ from those previously reported for water treadmill exercise. This study provides an insight into aquatic locomotion in healthy dogs indicating that range of motion exceeds that of terrestrial gaits. It is unclear whether these changes are beneficial for healthy animals and therefore further research is required to develop evidence-based protocols for industry practice.

Effects of aquatic conditioning on cartilage and bone metabolism in young horses

While beneficial in rehabilitation, aquatic exercise effects on cartilage and bone metabolism in young, healthy horses has not been well described. Therefore, 30 Quarter Horse yearlings (343 ± 28 kg; 496 ± 12 d of age) were stratified by age, body weight (BW), and sex and randomly assigned to 1 of 3 treatments for 140-d to evaluate effects of aquatic, dry, or no exercise on bone and cartilage metabolism in young horses transitioning to an advanced workload. Treatments included nonexercise control (CON; n = 10), dry treadmill (DRY; n = 10), or aquatic treadmill exercise (H2O; n = 10; water: 60% wither height, WH). Horses were housed individually (3.6 × 3.6 m) from 0600 to 1800 hours, allowed turnout (74 × 70 m) from 1800 to 0600 hours, and fed to meet or exceed requirements. During phase I (days 0 to 112), DRY and H2O walked on treadmills 30 min/d, 5 d/wk. Phase II (days 113 to 140) transitioned to an advanced workload 5 d/wk. Every 14-d, WH, hip height (HH), and BW were recorded. Left third metacarpal radiographs on days 0, 112, and 140 were analyzed for radiographic bone aluminum equivalence (RBAE). Every 28-d, serum samples were analyzed for osteocalcin and C-telopeptide crosslaps of type I collagen (CTX-1), and synovial fluid samples were analyzed for prostaglandin E2, collagenase cleavage neopeptide (C2C), collagenase of type I and type II collagen, and carboxypeptide of type II collagen using ELISAs. All data were analyzed using PROC MIXED of SAS, including random effect of horse within treatment, and repeated effect of day. Baseline treatment differences were accounted for using a covariate. There were treatment × day interactions (P < 0.01) where OC and CTX-1 remained consistent in both exercise groups while inconsistently increasing in CON. There were no treatment differences (P > 0.30) in RBAE, BW, or HH, but all increased over time (P < 0.01). There were no treatment × day interactions of synovial inflammation or markers of cartilage metabolism; however, there was an effect of day for each marker (P<0.03). Changes in biomarkers of cartilage turnover in horses exercised at the walk, whether dry or aquatic, could not be distinguished from horses with access to turnout alone. This study indicates that early forced exercise supports consistent bone metabolism necessary for uniform growth and bone development, and that there are no negative effects of buoyancy on cartilage metabolism in yearlings transitioned from aquatic exercise to a 28-d advanced workload.

Comparing racing performance following arthroscopic surgery of metacarpophalangeal/metatarsophalangeal and carpal joints in Thoroughbred racehorses rehabilitated using conventional and underwater treadmill therapies

BACKGROUND

Rehabilitation of horses using underwater treadmill therapy has been shown to improve joint range of motion, joint mobility, stride length and proprioceptive parameters with experimental studies. However, studies investigating the prognosis and return to function following rehabilitation are lacking.

METHODS

A retrospective study of Thoroughbred racehorses treated with arthroscopic surgery for osteochondral fragments of the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joints or carpal joints undergoing conventional rehabilitation or underwater treadmill assisted rehabilitation at the same facility were included. The objective of the current study was to investigate if underwater treadmill assisted rehabilitation following arthroscopy in the Thoroughbred racehorse was positively associated with returning to racing, time to return to racing and postoperative racing performance including Beyer Speed Figures.

RESULTS

Surgery was performed on 165 horses on 174 surgical occasions; 70 (40.2 per cent) underwent underwater treadmill rehabilitation, with the remainder undergoing conventional rehabilitation. The time to return to racing was a median of 227 (IQR 185-281) days and 239 (IQR 205-303) days for underwater treadmill and conventional rehabilitation, respectively (P=0.16). Of the horses that raced presurgery, 83 per cent (58/70) of underwater treadmill rehabilitated horses and 61 per cent (63/104) of horses undergoing conventional rehabilitation returned to racing following surgery (P=0.02).

CONCLUSION

Underwater treadmill rehabilitation is superior in returning a Thoroughbred racehorse to racing following arthroscopic surgery of the carpus and/or MCP/MTP joints.

The Importance of Subchondral Bone in the Pathophysiology of Osteoarthritis

Subchondral bone plays a critical role in the pathogenesis of osteochondral disease across veterinary species. The subchondral bone is highly adaptable, with the ability to model and remodel in response to loading stresses experienced by the joint. Repetitive stress injuries within the joint can result in primary or secondary pathologic lesions within the subchondral bone, which have been recognized to contribute to the development and progression of osteoarthritis. Recent advances in diagnostic imaging, particularly volumetric imaging modalities have facilitated earlier identification of subchondral bone disease. Despite these advancements, limitations in our knowledge about subchondral bone makes treatment and prevention of these conditions challenging. The purpose of this report is to review our current understanding of subchondral bone and its relationship to osteoarthritis across veterinary species, with a specific focus in the research that has been performed in horses. It can be concluded that our current understanding of subchondral bone is advancing, and future experimental, clinical and pathologic studies will provide additional insight about subchondral bone and its relationship to joint disease.

Effect of water depth on muscle activity of dogs when walking on a water treadmill

Evidence-informed practice is currently lacking in canine hydrotherapy. This study aimed to investigate if the estimated workload of the gluteus medius (GM) and longissimus dorsi (LD) increased in dogs at different water depths when walking on a water treadmill. Seven dogs were walked for 2 min continuously on a water treadmill at depths of no submersion (depth 1), mid-tarsal (depth 2), between lateral malleolus and lateral epicondyle (depth 3) and between the lateral epicondyle and greater trochanter (depth 4). Continuous electromyographic data from the right and left sides of GM and LD were collected simultaneously during exercise. Friedman’s analyses with post-hoc Wilcoxon tests established if significant differences in GM and LD muscle activity occurred between the water depths for mean estimated-workload. Significant differences occurred in estimated-workload in GM and LD between water depths (P<0.05). Mean estimated-workload decreased in the right and left GM between depths 2 (mid-tarsal) and 3 (between lateral malleolus and epicondyle) (P<0.007) and depths 2 and 4 (between lateral epicondyle and greater trochanter) (P<0.001), a pattern which was repeated for left and right LD (P<0.007). Right GM mean estimated-workload increased between depth 1 (no submersion) and depth 2 only (P<0.013). Water depth influences GM and LD activity in dogs walking on a water treadmill. Increasing knowledge of canine locomotion in water treadmills could be used to inform individualised rehabilitation regimes for dogs undertaking hydrotherapy.

Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial

Background

Recovery of balance and walking abilities is important for the rehabilitation of stroke patients.

Objectives

To evaluate the effects of the Bad Ragaz Ring method on functional recovery in chronic stroke patients.

Methods

Twenty-two chronic stroke patients were randomly assigned to two groups: a Bad Ragaz Ring method group (the experimental group) or a control group. Stroke patients in the experimental group underwent Bad Ragaz Ring exercise and comprehensive rehabilitation therapy, whereas patients in the control group underwent comprehensive rehabilitation therapy alone. The participants in both groups received therapy 3 days per week for 6 weeks. Muscle activations, balance indices, and Timed Up and Go test results were assessed before and after the 6-week therapy period.

Results

The experimental group showed significant improvements in activations of tibialis anterior and gastrocnemius muscles, balance index, and Timed Up and Go test results as compared with preintervention results (p < 0.05), whereas the control group showed significant improvement in Timed Up and Go test (p < 0.05). Significant differences in posttraining gains in the activations of tibialis anterior and gastrocnemius muscles and in balance index were observed between the experimental and control groups (p < 0.05). Effect sizes for gains in the experimental and control groups were strong for tibialis anterior and gastrocnemius muscles (effect sizes, 1.04 and 1.45 respectively).

Conclusion

The Bad Ragaz Ring method may be beneficial for improving balance and leg muscle activation of chronic stroke patients.

Effect of water depth on limb kinematics of the domestic dog (Canis lupus familiaris) during underwater treadmill exercise

Canine hydrotherapy is an increasingly popular modality for the rehabilitation of dogs; however, little evidence exists to support the use of current hydrotherapy protocols. Before data can be meaningfully collected from pathological animals, biomechanical data for healthy animals is required. Kinematic analysis was utilised to observe the effect of increasing water depth on the stride parameters (including duty factor) of dogs exercising on a canine hydrotherapy treadmill. During two sessions, eight clinically sound adult dogs walked on the underwater treadmill at four different water depths (dry, mid-tarsal, between the lateral malleolus and the lateral epicondyle, and between the lateral epicondyle and greater trochanter). Reflective kinematic markers were placed onto anatomical limb landmarks and a video camera was used to record foot contacts at 60 Hz. Data were digitised using video analysis software and stride length, stride frequency and duty factor were subsequently calculated. Data were analysed using the Friedman Test and Wilcoxon post hoc pairwise tests to identify differences between conditions. There was a significant effect of water depth on duty factor (P<0.0005). Hind limb duty factor differed significantly from fore limb duty factor (P<0.0005), except at the depth between the lateral malleolus and the lateral epicondyle where no significant difference was observed. There was a significant effect of water depth on both stride frequency (P<0.0005) and stride length (P<0.0005). In summary, water depth has a significant impact on the stride parameters of dogs exercising on the canine hydrotherapy treadmill and as such is an important consideration when designing underwater treadmill based rehabilitation programs.

Pain: Its Diagnosis and Management in the Rehabilitation of Horses

This article provides a brief overview of pain physiology and its relevance to equine patients. Objective and subjective techniques for assessing pain in the horse are described in depth. Pharmacologic and interventional pain modulation treatments are discussed with a focus on the rehabilitating horse.

Water depth modifies back kinematics of horses during water treadmill exercise

REASONS FOR PERFORMING STUDY

Water treadmill exercise can be incorporated into the rehabilitation programmes of horses recovering from back pathology, yet little is known about the effect of this type of exercise on thoracolumbar movement ranges.

OBJECTIVES

To measure the flexion-extension range of motion (FE ROM) of the thoracolumbar spine and pelvic vertical displacement during water treadmill walking at 3 water depths and compare these with the control condition.

STUDY DESIGN

Within-subject trial using a crossover design in healthy horses.

METHODS

A total of 14 horses walked at 0.8 m/s on a water treadmill for 3 min at each of the following depths; hoof (control), metatarsophalangeal joint (low), tarsal joint (medium) and femoropatellar joint (high). Skin surface markers on T6, T10, T13, T18, L3, L5 and S3 were used to obtain FE ROM and the minimum and maximum angular motion pattern values (AMPmin and AMPmax) for T10, T13, T18, L3 and L5. Markers placed on left and right tuber coxae were used to obtain pelvic vertical displacement. Friedman's tests and post hoc Wilcoxon's signed ranks tests were used to determine the effects of water depth on measured variables.

RESULTS

The FE ROM of T10 (8.4°), T13 (8.1°), T18 (6.9°) and L3 (6.4°) when walking at high depth was significantly greater than control (5.5, 5.7, 5.1 and 5.1°, respectively; P<0.008); T13 AMPmin was significantly lower in high water (-3.0°) than control (0.1°, P = 0.001) and L3 AMPmax significantly greater in high water (-1.9°) than control (-4.8°, P = 0.001). There was no significant association between pelvic vertical displacement and water depth.

CONCLUSIONS

Walking in high water causes cranial thoracic extension and thoracolumbar flexion when compared with walking in water at hoof depth. This postural change should be considered when designing rehabilitation programmes for horses with back and/or hindlimb pathology.

Biomechanical responses of the back of riding horses to water treadmill exercise

There is a lack of evidence for the presumed beneficial effects of water treadmills on the movement of the horse's back. The aim of the study was to evaluate the effects of water treadmill exercise on axial rotation (AR), lateral bending (LB) and pelvic flexion (PF) in horses. The back kinematics of a group of riding horses were studied at the walk in a water treadmill at different depths of water (hoof, fetlock, carpus, elbow and shoulder joint levels) over a period of 10 days. Skin markers were placed at anatomical locations on the back. AR, LB and PF were measured on days 1 and 10 using two high-speed video cameras. There was a significant increase in AR compared to baseline at the level of the carpus and at higher water levels, whereas LB was significantly lower than baseline values at water levels that reached the elbow and shoulder joints. PF was significantly higher than baseline values at each water depth other than hoof water depth. At increasing water depths, there were significant increases in flexion and rotation of the back. At the highest water levels, there was reduced bending of the back. After 10 days, horses exhibited more bending of the back.