Sports Injury Rehabilitation Table Topic (AAEP 2011)

The Sports Injury Rehabilitation Strategies table topic session at the American Association of Equine Practitioners (AAEP) Annual Meeting, held Nov. 18-22 in San Antonio, Texas, opened with an update on the requirements for eligibility to sit the certification exam for the ACVSMR (American College of Veterinary Sports Medicine and Rehabilitation). The requirements are available at The first board exam will take place in May 2012. Application for the exam has closed with 33 qualified applicants; however, interested members were directed to the table topic the following day specifically outlining the future process.

A brief discussion followed regarding the new AAEP online forum discussions and the expected improvement for future communication among interested members compared with the rehabilitation list serve previously in place.

Participants selected specific case types to discuss, including distal limb soft tissue injuries, joint injuries both post-operative and post-trauma with specific mention of the stifle joint, osteopathies, disorders of the axial skeleton including neck and back pain and sacroiliac (pelvic area) issues, foot balance considerations during rehabilitation and respiratory rehabilitation for post-operative and post-disease process cases.

Regarding soft tissue and joint injuries, attendees discussed MRI and ultrasonography's value for diagnosing soft tissue and joint injuries, with MRI providing more global information and ultrasonography providing tissue architecture detail and repeatability for monitoring the healing process.

Veterinarians brought up various protocols for treatment and exercise following distal limb soft tissue injuries, with most participants reporting using controlled exercise schedules. They also discussed the conflict between client desire for a quick return to athletic use and the known time required for soft tissue injuries to heal. The majority of participants used frequent (every 4-8 weeks) clinical and ultrasonographic monitoring to determine exercise levels for the horse.

Several treatment modalities were subject to varying opinions. Hyperbaric oxygen therapy, for instance, has recently been reported to be ineffective for skin graft healing and endotoxemia; however, there were anecdotal discussions indicating its value for treating equine burn patients, clostridial myositis (muscle inflammation), cellulitis (skin inflammation), and lymphangitis (inflammation of the lymph vessels) cases as well as upper airway post-operative healing.

Attendees also discussed aquatic therapies such saltwater spa, underwater treadmill, and water exerciser, observing that horses hyperflex their limbs, especially the hind limbs, during water exercise. Thus, such exercise might be harmful for hind limb suspensory ligament injuries or in the early stages of any flexor rehabilitation unless depth of water impact on degree of flexion is well understood and addressed in the rehabilitation regime. Concerns about free swimming included colic, "tying-up," and further injury.

Attendees reported limited but promising experience with other treatment modalities such as vibration floors and electrical muscle stimulation. Chiropractic adjustment and acupuncture were often either used by participants as adjunct therapy or referred to a colleague with expertise in these modalities. Physical therapy such as stretching and using various "gait aids" was discussed as emerging but controversial with more questions raised than answers given, indicating the need for more controlled study and reporting to disseminate information.

Overall consensus was that equine rehabilitation is firmly established as an "art" but needs more "science." It is hoped that ACVSMR members will be active in this arena going forward in the future.

This Table Topic was moderated by Carol Gillis, DVM, PhD, out of Aiken, S.C., and Kathleen Anderson, DVM, a practitioner in Elkton, Md.

About the Author

Carol Gillis, DVM, PhD, Dipl. ACVSMR

Carol Gillis, DVM, PhD, Dipl. ACVSMR, is a graduate of UC Davis School of Veterinary Medicine. She was the owner of a sport horse practice for 8 years during which time she became one of the first equine practitioners to perform ultrasound examinations on the musculoskeletal system of horses. Dr. Gillis returned for an equine surgery residency at UC Davis. Following completion of the residency, she obtained a PhD in equine tendon and ligament pathophysiology. Concurrently she established the equine ultrasound service at UC Davis, pioneering ultrasound of the musculoskeletal system at the University, and developing courses and wet labs to train terinary students, residents and veterinarians how to perform and interpret ultrasonographic examinations. She is the author of over 50 scientific publications in journals such as the American Journal of Veterinary Research and the Journal of the American Veterinary Medical Association on the subject of equine soft tissue injury diagnosis and treatment, and recently was an author of Equine Sports Medicine and Surgery, the definitive reference book on the topic. Clinically, Dr. Gillis has performed more than 22,000 ultrasound examinations of the horse and subsequently guided treatment of problems identified.

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