An equine physical therapist must work in concert with the attending veterinarian. An accurate veterinary diagnosis is necessary for successful treatment with therapy.
Concepts such as progressive resistance and ladder workouts, aerobic and anaerobic muscle fiber conditioning, and the use of specific warm-up and cool-down exercises come from research on human physiological response to training. From these human sports medicine roots grew equine therapy.
Human sports medicine specialists are trained to recognize the location and extent of injury and apply first aid, plan conditioning programs to minimize the risk of injury, and carry out rehabilitation after injury. The tools of rehabilitation include cold, heat, exercise, massage, laser, ultrasound, electrical stimulation, and magnetic fields. The human sports medicine specialist works by referral from a physician. Because equine therapy is practiced largely by untrained individuals, it is essential that a thorough veterinary evaluation precede the use of any therapeutic tool or procedure.
It has been of great concern to veterinarians that many of the people holding themselves out as equine physical therapists have little or no training or educational background in the areas of rehabilitation or sports medicine. As Lexington veterinarian Nancy Cole, DVM, stated in a personal communication, "The profession of equine therapy is in its infancy, and its real value is not totally known or accepted by the veterinary community as a whole. In some instances, the techniques are beneficial; however, the potential for abuse is present with untrained persons and untested techniques."
Both the American Veterinary Medical Association and the American Association of Equine Practitioners define equine physical therapy as the non-invasive rehabilitation of injuries to animals. It is interesting to note that both groups state in their guidelines that the work should be done by a veterinarian. The AVMA also states that the work can be done by a licensed, certified, or registered animal health technician. Unfortunately for the consumer and the horse, neither of these groups receives so much as one day of professional preparation in its educational curriculum for delivering physical therapy techniques and using physical therapy tools. Both definitions go on to say that equine physical therapy can be performed by a non-veterinarian under the supervision of and referral by a licensed veterinarian who is providing concurrent care. This part of these definitions makes good sense, as the successful outcome of physical therapy depends largely on the accuracy of the diagnosis.
Over the past five years, the AVMA and the AAEP have given great attention to therapies termed "alternative." Categorizing equine physical therapy as an alternative always has seemed inappropriate, to me. As James R. Coffman, DVM, past chairman of the AAEP subcommittee on alternative therapies, stated, "Actually, as one develops an analysis of physical therapy, it does not emerge as an alternative therapy. Rather, it is best characterized as a normal part of equine practice which has always existed, but today is poorly understood and decidedly underdeveloped. This is due, in part, to the lack of an orderly educational and licensing process vis-a-vis properly trained individuals and how they should best work in concert with licensed veterinarians."
Presently, there are no college level courses in equine physical therapy and no restrictions on the application of the tools to horses. This makes the close cooperation of veterinarian and therapy specialist even more important.
The dilemma remains as to who is qualified to perform equine physical therapy. I receive an average of eight phone calls and E-mails each week on this question alone. It is my firm belief that equine physical therapy is a health care specialty deserving of college level preparation. Short courses and week-long programs are inadequate preparation for one to gain the knowledge necessary to be a skilled therapist. Until such a curriculum is established, I recommend that one complete course work as a human athletic trainer or physical therapist and combine this with knowledge of equine anatomy and physiology. Unfortunately, many people presently are holding themselves out as equine therapists who do not have an educational background in rehabilitative care or injury recognition. And they are treating horses with equipment for which they have inadequate training.
What To Look For In An Equine Therapist
Equine physical therapy, just like any other health care endeavor, must be applied with clear goals established. These goals include the relief of pain and swelling, restoration of function, and regaining of strength in the injured part. The application of any tool or technique should be preceded by a plan for the outcome of the course of treatment. The equine therapist must be able to discuss the diagnosis with the attending veterinarian and formulate a treatment plan. In most cases, significant improvement in the condition should be evident in one to four treatments. Many conditions, such as laminitis, will not be cured, but the horse should evidence considerable relief from discomfort early in the course of physical therapy treatments.
Injuries to the tendons, particularly those of the horse's lower limbs, have a prolonged healing time. Physical therapy can provide relief from the early symptoms of injury--the heat, swelling, and pain--giving the appearance of complete recovery. If adequate time is not allowed for tendon fiber maturation and strengthening, the tendon will not have developed the tensile strength necessary to withstand the demands of athletics. A horse put back to work without the proper diagnostics to determine the healing status could re-injure the tendon.
In my book Equine Sports Therapy, I have outlined a few of the personal traits that I think are important for an equine therapist to possess. One such quality is the therapist's own personal health. Performing the work of an equine therapist requires energy and vitality. The therapist must be prepared to give full attention to each horse seen during the work day. One must be alert to the movements and body language of the horse during a treatment session and devote full attention to each horse seen as a patient.
Having personal experience as an athlete, particularly in equestrian sports, will give the equine therapist personal insight into such concepts as over-use injury and the challenge of rehabilitation. Often the rider's own body mechanics play a role in the over-use injuries of the horse. Equestrian experience will broaden the therapist's ability to offer exercise suggestions to the rider on balance problems or problems with rider fitness or communication with the horse. Also, by engaging in athletic or fitness pursuits, one gains an increased appreciation for the experiences of the horse as an athlete as he must withstand the rigors of daily training.
Important qualities to look for in an equine therapist are compassion and patience. If a therapist truly cares about the horses under his or her care, there will be patience and calm and gentle conduct around those horses.
The equine therapist must possess good horsemanship skills. He must be able to detect subtle lameness or discomfort in the horse. He must be aware of hazardous situations around the barn or stall and do his part in correcting them.
Often I have noticed nails that have worked their way out of stall boards, projecting out into the stall. Snaps on feed tubs or on water buckets that are broken or turned the wrong way (snap facing out) present a danger of catching on a halter or the skin of the face. Having treated injuries inflicted by such hazards, I always make note of these conditions and point them out to the appropriate person.
Certainly the therapist must know enough about horse safety to avoid creating a dangerous situation. Does your therapist park his vehicle in the way of horses moving in and out of the barn? Are extension cords placed where they could be stepped on or tripped over? Is the horse relaxed with the therapist and ready to accept treatment? If therapeutic equipment is used, could the horse step on it or get tangled in electrical cords? Does the therapist have a full understanding of the nature and extent of the injury?
As the horse owner, you have a role to play in creating a good environment for physical therapy treatments. Questions to ask yourself before treatment begins include the following: Is the horse tied in a safe and comfortable manner? Are electrical outlets properly grounded to avoid shock hazard? Is the treatment area clean, dry, and well lighted?
The equine therapist should have a lively intellectual curiosity and a willingness to spend time reading scientific journals and books in several fields to gain knowledge about equine therapy. One must have a working knowledge of equine anatomy and physiology, of exercise physiology and sports medicine, and of rehabilitation medicine. A complete knowledge of the modalities and their effects is basic for the equine therapist. The therapist must have an understanding of the types of modalities available and their therapeutic indications and contraindications.
Finally, the equine therapist must have a sound philosophy or attitude toward his profession. He must believe that what he is doing is worthwhile. Does your therapist offer helpful techniques and information? A competent therapist will avoid giving the impression that he is a diagnostician. A competent therapist can make a vital contribution working within his professional limits and in cooperation with your veterinarian.
Target Tissues For Physical Therapy
The soft tissues--muscle, tendon, ligament--the fascia, nerves, and the lymph and blood circulatory systems are the usual targets for physical therapy. Also, there are many scientific studies indicating that specific electromagnetic wave frequencies can stimulate osteogenesis, promoting bone repair. Let's talk about injuries to the soft tissues, since they are the most common.
The largest mass of soft issue in the horse's body is muscle. Often we overlook the role sore muscles play in decreased athletic performance. Most people think of muscle pain as temporary soreness after a workout. Yet, controlling muscle pain can be the key to avoiding further decrease in athletic performance, and in the prevention of joint injury. The ways in which muscle pain inhibits the athlete, whether horse or human, are discussed with suggested physical therapy solutions.
Problem: Muscle pain is a physical stress. It is a drain of both the physical and the mental energy. When there is pain, the body sets up protective mechanisms, such as muscle contraction, to guard the injured area. The metabolic processes necessary to maintain this chronic muscle tension take their toll on the body's physical energy. Emotional stress is a very real component to muscle pain, as well. Emotional stress is the constant feedback from the pain site, which human therapists think distracts the brain from full concentration on the athletic task at hand.
Solution: Electrical stimulation, magnetic fields, and massage provide relaxation to tense muscles, and the horse's response suggests that there is a state of deep relaxation. This state is vital to the restoration of full muscle function.
Problem: Muscle pain sets up a reflex loop known as the pain-spasm-pain cycle. Spasm is the intense, involuntary contraction of muscle fibers. Muscle spasm is more severe than muscle tension, which can be relieved with rest. Spasm cannot be relieved until the self-perpetuating cycle of pain (leading to more spasm) is broken. When a muscle is in spasm, it feels hard and hyper-reactive on palpation, rather than soft and vibrant. A muscle in spasm has reduced agility and strength. It appears that muscle spasms if allowed to persist, can cause marked loss of function and discomfort to the horse.
Solution: Physical therapy techniques as simple as stretching and ice massage can break into this cycle. The application of electrical stimulation, laser acupuncture, or trigger point acupressure is thought to disrupt this debilitating cycle, allowing muscle fibers to relax and begin to contract in a more functional manner. In future columns, I will be discussing the wide range of benefits from the modalities of electrical stimulation and magnetic fields, as well as the benefits from the other modalities of equine therapy.
Problem: When the brain gets a message of pain from a muscle or an injury in some other tissue, an inhibitory loop is set up, preventing the body from using that limb to the extent that it normally would. We say that this is Nature's way of protecting the injured body part. But, reduced muscle force and reduced range of limb movement eventually result in muscle weakness or stiffness. When this situation is allowed to persist, the muscle fibers atrophy and lose their contractile power. Loss of muscle volume can be seen in as little as two to three weeks. This degenerative cycle began with muscle pain.
Solution: Therapeutic ultrasound or high-frequency electrical stimulation can be used to combat restrictions of active range of motion (movement produced by volitional activation of muscle). In a study using humans as the subjects, one group carried out movement exercises designed to increase range of joint motion. These exercises were like the movements required in daily living. The other group carried out the same exercises, but received high-frequency electrical stimulation as well. The subjects in the stimulated group showed increases in extension that averaged 35 degrees, whereas the control subjects' joint extension improved by only eight degrees on average. This study is pertinent to treating the injured horse, which often is turned out into a paddock to let Nature take its course. When faced with the prospects of recovery from injury, the application of physical therapy is most likely better than turnout, which only asks the horse to utilize "movements required of daily living."
Problem: Active acupuncture sites or trigger points develop in sore muscles. A trigger point is a small nodule of degenerated muscle tissue that is highly sensitive to pressure. Trigger points sometimes develop after chronic or acute injury, and they also can result from chronic muscle spasm or muscle tension. An acupuncture point also is a physiological entity in the dermis. Acupuncture points exist where cutaneous nerves emerge from deep fascia or along pathways of major peripheral nerves. Acupuncture points often are found superficial to motor points, sites where a nerve enters a muscle bundle.
Solution: Stimulation from a therapeutic laser can be used to deactivate these points and might provide significant relief from muscle pain. Therapeutic laser or Low Level Light Therapy, as it is sometimes called, is a non-invasive method of deactivating these points. The pain relief achieved from this modality often is long lasting. Research suggests that an endogenous opiate acts to help relieve pain. These pain relieving hormones are produced by the body when the appropriate stimulus is applied. A skilled equine therapist will address muscle pain as a major part of treatment. Sensitive manual palpation of the musculature will reveal sites and the extent of muscle soreness that might not be evident when simply watching the horse move. Often, physical therapy can provide cessation of muscle degeneration and allow the horse to recover more quickly.
When Is Equine Physical Therapy Needed?
Physical therapy often is necessary as preventive medicine to avoid muscle contractures or soft tissue shortening that can accompany physical training. Stretching exercises should be a routine part of the warm-up process before any physical activity to avoid an imbalance in range of motion in opposing limbs or opposing muscle groups. Therapy also is useful following surgery to reduce pain and the stress of an invasive procedure. After surgery, physical therapy can be used to restore function to affected muscles and keep unaffected muscles strong and useful.
In cases of severe or chronic pain, simple relaxation and specific muscle therapy it is felt can be as effective as spinal manipulation or injections.
I have found physical therapy techniques designed to relax the muscles, such as massage, electrical stimulation, and magnetic fields, work well with a strong magnet placed on the horse's forehead to induce profound rest and quieting of the brain functions. This state of deep relaxation is essential to the repair process, allowing chronically tense muscles to relax. When the muscles are tense or in spasm, strengthening exercises can make it worse. Allowing the horse one or two sessions of deep relaxation every day will enable you gradually to begin re-introducing exercise into his daily activities. Equine stretching exercises taught to the owner by the physical therapist will be of great benefit to a horse with muscle pain. These should be carried out after a warm-up so that muscle tissue is in a state of readiness for stretch. If spasm is severe, avoid stretching until the spasm can be reduced by your therapist
The tools of the equine physical therapist--electrical stimulation, therapeutic ultrasound, therapeutic laser, magnetic fields, heat and cold, stretching, and massage--have been studied in controlled laboratory tests and in many clinical trials to assess their effectiveness. It is up to the user to apply them correctly and under the appropriate circumstances. Making the most of your equine therapist involves communication. It is essential that the therapist be able to communicate with your veterinarian. It also is essential to success that the equine therapist communicate the goals of treatment to you.
About the Author
Mimi Porter lives in Lexington, Ky., where she has practiced equine therapy since 1982. Prior to that, she spent 10 years as an athletic trainer at the University of Kentucky. Porter authored The New Equine Sports Therapy, published by Eclipse Press and available at www.exclusivelyequine.com or by calling 800/582-5604.
POLL: University Equine Hospitals