A few months ago, a friend of mine came limping up the barn aisle on crutches. She explained sheepishly that she'd taken a tumble off her bicycle, badly spraining an ankle in the process. Her rehab regimen would entail staying off her horse, keeping the ankle in a brace, and making regular visits to a physical therapist for rigorous sessions designed to help the injured tissues heal while restoring the joint's strength and range of motion.

I couldn't help comparing my friend's rehab regimen with that of a horse at the barn, who at that same time was on four months of prescribed stall rest after suffering a soft tissue hindquarter injury. The horse's owner told me that veterinarians had been able to offer few therapeutic suggestions other than "rest him and hope the injury heals with time."

Kevin Haussler, DVM, DC, PhD, of Cornell University's College of Veterinary Medicine in Ithaca, N.Y., finds it frustrating that the field of human physical therapy (PT) is so advanced, and yet PT principles and techniques are largely untapped by the veterinary community. PT incorporates such techniques as the application of heat and cold, massage, stretching, electrostimulation, manipulation, and bodywork, he says--techniques that the horse world might recognize as equine sports massage, the Tellington Touch, and equine chiropractic--but many veterinarians and horse owners regard these and other modalities as so-called "alternative" therapies and not part of mainstream veterinary medicine. He and several like-minded associates, including human physical therapist and soon-to-be veterinary technician Linda McGonagle, MSPT, of Genoa, N.Y., are working to advance the efforts of a new association for veterinary physical therapy. Haussler and McGonagle discussed their hopes of revolutionizing the ways by which equine practitioners help horses reach--or recapture--their athletic potential.

Physical Therapy Defined

Although most people equate PT with injury rehab, the field actually is quite broad, says McGonagle. "The field is not just treatment," she explains. "It also encompasses the evaluation, diagnosis, and prevention of physical impairment and functional limitations. Human physical therapists support the work of physicians, particularly in the areas of musculoskeletal and neuromuscular problems. PTs aid people who have trouble with strength and movement; but we also promote fitness and health, help people improve their quality of life, and address women's health issues."

PT is an established and respected segment of the medical field. According to McGonagle, the practice evolved from efforts to treat injured World War I veterans, as well as polio victims. In the more than 75 years since PT got its start, nearly 160 PT programs have been founded at universities around the United States, and more than 80,000 PTs currently are in practice. PT students complete 2-2 1/2 years of coursework to earn a master's degree, and some go on to earn doctorate degrees in the field. Practitioners must be licensed at the state level. PTs are not physicians (MDs), she says; rather, they are trained specialists with extensive background in anatomy and biomechanics whose in-depth knowledge complements a doctor's training. In certain cases, "Physical therapists can help look past a patient's symptoms and identify the cause of a problem," she says, "then assist in designing a course of treatment that will address that cause, be it a lack of strength, a misalignment, or an injury."

The Veterinary Connection

How does PT relate to horses and to veterinary medicine? According to Haussler, the veterinary community can learn a lot from physical therapists about taking a proactive approach to equine rehab. "The premise among some veterinarians is that animals heal so well on their own that they don't need physical therapy," he says, "but many animals do need PT. If you think about some common equine soft-tissue injuries--such as bowed tendons and pulled suspensory ligaments--veterinarians have developed sophisticated means of diagnosing these injuries, but we generally rely on the horse to heal himself. We turn the horse out to pasture for six months and hope he improves. Contrast that approach with the human physical therapy method: A football player with a knee injury, for example, might work harder to rehabilitate the damaged tissues than he does in regular practice."

Haussler realizes that not all PT methods will translate directly to horses. That injured football player, for instance, might awaken after knee surgery to find the affected joint encased in a machine designed to produce continuous passive motion, thereby promoting increased range of movement and discouraging the formation of painful and movement-limiting adhesions (scar tissue)--a largely impractical technique for horses. Still, he says, possible avenues for using range-of-motion-development techniques on horses exist, such as the use of equine swimming pools and underwater treadmills, which reduce much of the stress on the muscles and joints while allowing the horse to gain strength and endurance.

A knowledge gap between the diagnosis of an injury and a horse's return to full work exists in the veterinary community, Haussler believes. "We need (to conduct) research on how horses heal as well as on how to speed the healing process while increasing the strength and function of the affected area," he says.

McGonagle, herself a horse owner, agrees. She points out that some horse owners turn to "alternative" practitioners when conventional veterinary approaches fail to alleviate their animals' physical problems (See The Horse, May 2000). An owner's search for a cure might turn into a desperate grab at straws, with the horse treated by one type of practitioner after another--usually without communication among the various practitioners.

Emphasizing team-based evaluation, diagnosis, and treatment, she says, PT as an adjunct to regular veterinary care could promote an integrated approach to the practice of equine veterinary medicine by helping pinpoint certain problems more accurately and, as a result, making targeted recommendations as to which therapies would be most effective.

"An equine physical therapist could help in evaluating lameness," McGonagle explains. "The physical therapist's background in anatomy and biomechanics could be very useful in identifying the cause of a hard-to-pinpoint soreness, for example. That same academic background might enable an equine physical therapist to suggest ways of speeding the healing of wounds and soft tissue injuries. Physical therapists also have training in specialized techniques, such as myofascial release and sports massage, that could be very useful in helping a horse realize his athletic potential or recover from an injury."

Wait, don't veterinarians study anatomy and biomechanics and learn about PT-type methods? Yes, but not to the degree that the specialist does, says Haussler, who points out that the required coursework in a four-year veterinary school curriculum leaves little room for specialized study. Veterinary students study anatomy, biomechanics, and related subjects; an equine physical therapist could be like a specialist: someone who goes on to complete additional in-depth targeted coursework with the intention of practicing in that niche of the profession.

Research And Development

McGonagle laughs when asked about being on the cutting edge of a burgeoning veterinary specialty. "Physical therapy for animals is actually not new," she says. "The field has been around since the 1940s. It's been developing in the U.K. for 30 to 40 years; in the U.S., physical therapists have been working in the animal field for more than twenty years. Back in 1978, an American physical therapist by the name of Ann Downer wrote a book entitled Physical Therapy for Animals: Selected Techniques. Many horse people are familiar with Jack Meagher's 1985 book, Beating Muscle Injuries for Horses, which helped launch the practice of equine sports massage in this country; what they may not realize is that Jack was a physical therapist. In addition, The New Equine Sports Therapy draws from author Mimi Porter's experience in human sports medicine. But the veterinary community, like any other scientific community, tends to be cautious in embracing new ideas, and it's only been recently that many veterinarians have begun exploring animal physical therapy."

Explore they have, and Haussler looks forward to the day that introductory physical therapy coursework is added to veterinary school curricula, with specialized animal PT study offered at the post-graduate level. He hopes that research grants will be made available so he and others can learn how to apply human PT principles to horses and other animals.

"I'm interested in anything that will help animals and reduce their pain and suffering," he explains, adding that, given his own training as a doctor of chiropractic, he's particularly interested in learning better ways of healing equine back injuries, of relieving back spasms, and of reducing the pain caused by interfering spinous processes--the so-called "kissing spines"--as well as in discovering new ways of treating soft-tissue leg injuries and similar frustrating conditions. "It's hard to study some of these things because injuries can be of such a unique nature," he says of equine injuries and lamenesses. "Perhaps we'll be able to use force plates (floor-implanted panels that measure weight and directional forces as they're stepped on) and other devices to help assess injuries, movement, and the healing progression."

Some researchers, such as noted equine biomechanics expert Hilary Clayton, BVMS, PhD, have begun doing just that. The McPhail Dressage Chairholder at Michigan State University, Clayton is using force plates, video cameras, and other sophisticated equipment in ongoing research projects that almost certainly will be of interest in the equine PT field. (For more on Clayton's work see The Horse of May 2000.)

Other potential applications of equine PT? "One possibility is iontophoresis, or the use of electrostimulation to drive a drug into a joint," says Haussler. "Some studies have shown that the technique doesn't penetrate a horse's skin, but the potential exists that it someday could replace joint injections as a method of combating degenerative joint disease (arthritis). Phonophoresis is a similar technique, except that ultrasound is used instead of electric current. The veterinarian would mix the medications right in with the gel that's applied to the area to facilitate getting a good contact with the scanning wand."

McGonagle predicts that, one day, equine rehabilitation centers will exist across the country. She envisions some as part of university veterinary schools like Cornell, and others as privately run facilities. "A side benefit of having human physical therapists affiliated with such programs is that a human PT can identify and address rider issues at the same time that he or she is helping the horse," she says. "Some riders are one-sided in their muscular development--one side is dominant and therefore is stronger than the other--or one leg is shorter than the other, or they have some other form of imbalance. In such cases, the horse almost always ends up being similarly uneven or crooked, and that lack of equal strength and flexibility can lead to lameness and discomfort. A physical therapist can design a program of stretches and exercises to help the rider become more balanced at the same time that he or she is helping the horse to become more even."

The ideal scenario for a truly holistic veterinary care approach, says McGonagle, is a team effort. "The veterinarian, the physical therapist, the veterinary technician, the PT assistant, the farrier, the rider, perhaps a chiropractor or an acupuncturist or a saddle fitter--all have to work together to achieve the best results for horse and rider," she stresses. If the experts fail to communicate, or if an insufficient variety of experts is consulted, the result will be piecemeal--and likely less effective.

Formal Organizational Efforts

A lifelong animal lover with 15 years of human PT experience, McGonagle is excited about the prospect of taking her professional background in a new direction. She is enrolled at the State University of New York-Delhi to pursue an associate's degree in veterinary technology, and she expects to graduate in May of this year. When she and Haussler were interviewed about this article, both were hopeful that McGonagle would be able to join the Cornell veterinary faculty university and work with Haussler and others to develop an animal PT program--a sort of homecoming for the physical therapist, who earned her undergraduate degree in animal science from the university.

A few other fledgling animal PT efforts also are underway in the United States. According to McGonagle, David Levine, PhD, PT, and his colleagues at the University of Tennessee-Chattanooga have begun researching canine rehabilitation. Last year, the First International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine was held at Oregon State University in Corvallis. "The international conference was very exciting," says McGonagle. "It was the first time veterinarians and physical therapists had gotten together formally." One goal set forth at the symposium was the formation of the International Association for Veterinary Physical Therapy and Rehabilitation, which McGonagle expects will be fully operational within the next year or two. The organization, the first such international level group, will offer training and support research in the field of animal PT, she says.

McGonagle, Haussler, and their contemporaries represent a new direction in veterinary care, for companion animals as well as horses. There are proponents of the integration of human medical advances, veterinary knowledge, and concern for animals' welfare and unique health problems to discover innovative approaches and treatments that could change the way we diagnose and treat lameness and injuries. That would be good news for horses and horse owners alike.

About the Author

Jennifer O. Bryant

Jennifer O. Bryant is editor-at-large of the U.S. Dressage Federation's magazine, USDF Connection. An independent writer and editor, Bryant contributes to many equestrian publications, has edited numerous books, and authored Olympic Equestrian. More information about Jennifer can be found on her site, www.jenniferbryant.net.

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