Four Front Journal 2023: Research & Collaboration by ACPAT

Four Front

The Magazine of the Professionals in Animal Therapy

10th Edition: Research & Collaboration

Association of Chartered Physiotherapists in Animal Therapy w w w. a c p a t .o r g

12th IAVRPT Symposium 2024 | 31 October – 3 November 2024

31 October – 3 November 2024

Lord Charles Hotel, Somerset West, Western Cape, South Africa

Save the Date More information: www.iavrpt.org Cape Town

12th IAVRPT SYMPOSIUM 2024 The 12th Symposium for the International Association of Veterinary Rehabilitation and Physical Therapy to be held between Thursday 31 October – 1 November 2024 in Somerset West, in the Western Cape Province of South Africa. We will also be offering a virtual experience to delegates who are unable to attend in person. The International Association of Veterinary Rehabilitation and Physical Therapy (IAVRPT) is an organisation bringing together scientists, educators, clinicians, and policy makers to stimulate and support the study of veterinary rehabilitation and physical therapy, and to translate that knowledge into improved animal rehabilitation worldwide. The IAVRPT Symposium is held in partnershp with SAAPRA, the South African Animal Physical Rehabilitation Association (www.saapra.co.za) With 3 days of world class lectures with small animal and equine streams running side by side, this symposium will serve as a strong networking platform to build and foster collaborative research and enhance communication between the academic field and clinical practice. Presymposium Equine and Canine wetlabs will also be available on the 30 October 2024 for anyone wishing to extend their visit in this beautiful city. Historically, the symposium has attracted in the region of 300 attendees from around the world, and with the added audience attending virtually, we anticipate this number to be matched or exceeded. This symposium provides a perfect platform to sponsors who have a key market in the veterinary rehabilitation and physical therapy arena.

About the Venue Situated at the foothills of the Helderberg mountains on 22 acres of idyllic landscaping, the iconic Lord Charles Hotel is proud to welcome guests back. The refurbished hotel maintains its classic flair, but with a contemporary twist. Guests can enjoy traditional luxury in our newly upgraded rooms, and resort style amenities featuring tennis courts, swimming pools, spa and fitness facilities, a revitalized feature dam, and mouth-watering dining options. For those travellers looking to explore beyond the gates, the property’s unique location caters to an eclectic range of interests. From white sand beaches and world-renowned golf courses, to wine tasting at local farms or retail therapy at Cape Town’s V&A Waterfront, the Lord Charles Hotel makes an ideal base for the ultimate getaway.

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Contents Editor’s notes / Contact details........................................................................................................................................p4 Physiotherapy; A Profession, not a technique ACPAT Editorial...................................................................................................................................................................... p5 Comparison of Subjective and Objective Gait Analysis Methods in Equine Lameness Evaluations: A Narrative Review Alysia Ball, BSc (Hons) MSc HCPC MCSP ACPAT Cat A, University of Liverpool.................................................p7 A Case Report of Bilateral Hind Limb Flexural Deformity in a Foal: A Physiotherapist’s Perspective and Management Celia Cohen, BSc Hons Phys, MSc Veterinary Physiotherapy, MCSP, HCPC, ACPAT Cat A............................ p13 The Effect of LASER Dosage on Mechanical Nociceptive Thresholds in the Equine Thoracolumbar Spine Alice Frampton, MSc Veterinary Physiotherapy, MNAVP, RAMP............................................................................. p18 Harmonious Horsemanship: Book extracts Sue Dyson, Vet MB, PhD; and Sue Palmer, MCSP, IHRT, ACPAT, RAMP, Chartered Physiotherapist............p22 Article Abstracts from the Australian Physiotherapy Conference Annette Bowen, BSc Phys Dist., MSc Vet. Phys., APAM, PhD Student................................................................. p27 Q&A with the President of The Register of Animal Musculoskeletal Practitioners (RAMP) Jo Paul, MCSP, RAMP, ACPAT cat A, BHSAI.................................................................................................................p30 Canine Case report: Early Stage Management of Gastrocnemius Musculotendinopathy in a Border Collie Ellen Goldsmith, BSc(Hons) Phys., PGDip Vet.Phys., PGDip Sport and Exer Rehab., MCSP, HCPC, ACPAT Cat A, RAMP........................................................................................................................................................... p32 Collaboration focus: Hydrotherapy Case Review of Hydrotherapy Treatment for a 4-Month-Old Puppy with Polyradiculoneuritis Laura Haywood, RVN, Registered Canine Hydrotherapist, NARCH...................................................................... p36 Hydrotherapy Treatment as part of a Multidisciplinary Team Approach: A Case Report of a Labrador Retriever with Right Hind Lameness Abigail Heald, L3Dip SA Hydro....................................................................................................................................... p38 Burnout and Stress in the Animal Healthcare Professional: Collaborative Working and Management Strategies Rebecca Wyatt, BSc Hons Phys., PGdip Vet. Phys., MCSP, HCPC, ACPAT Cat A, RAMP................................. p41 MSc student research: Hartpury University Research Poster Presentations................................................. p44 Research Digest..................................................................................................................................................................p52 A View From The Chair Fiona Dove, Vice Chair of ACPAT, MSc Vet Phys, BSc Hons Physio, MCSP, HCPC, ACPAT, RAMP..............p56

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Editors notes As 2023 ends, I am proud to bring readers the 10th Edition of the ACPAT publication Four Front. This year’s journal comes at a time where ACPAT members are in the middle of renewing their membership, confirming their continuing professional development records, and preparing for the ever-looming festive period. The theme for this year’s journal is Research and Collaboration, bringing together content across several associations and professions, as well as giving some of our student members a platform to showcase their work. The journal takes a different format this year, going fully green, and therefore being an online only edition. This is very much a trial on our part but is something we hope will be received well and will pave the way for future editions to follow suit. Any feedback is always welcome and can be directed to the Journal team via the contact details below. As always, we are thankful for everyone who contributes to Four Front and would like to extend gratitude not only to our authors and advertisers, but also to all of those in the wider teams who facilitated contact, as well as our new designers, Path Marketing. ............................................................................................................ Rebecca Wyatt, Four Front Journal Editor.

Contact Details Journal Editor: Rebecca Wyatt Assistant Editor: Ellen Goldsmith Email: committee@acpat.org Please mark all communications as “FAO Journal Team”

Four Front I The magazine of the Professionals in Animal Therapy

Physiotherapy; Physiotherapy;

A profession, not a technique.

A profession, not a technique

Overview Overview

qualifications are also available which ensure a high level of training and professionalism within the field of Animal physiotherapists are highly skilled members of the Animal physiotherapists are highly skilled members of the veterinary multidisciplinary veterinary physiotherapy. However, there are a wideteam veterinary multidisciplinary team (MDT). Understanding range of other approach, veterinary physiotherapy courses (MDT). how toapproach, harness theasmultidisciplinary as well as the available how toUnderstanding harness the multidisciplinary as well with varying standards. the importance of developing close working relationships

importance of developing close working relationships with veterinarians, are key to with veterinarians, are key to enabling potentially lifeenabling potentially life-changing intervention. Regulation changing intervention.

The Veterinary Surgeons Exemptions Order (2015) allows an animal to be treated by a veterinary physiotherapist on referral by a veterinarian providing specific conditions are Physiotherapy is a degree or postgraduate level, sciencesatisfied. In addition,profession the BEVA 2016that guidelines Physiotherapy is a degree or postgraduate level, science-based aims‘Working to based profession that aims to restore movement and with Allied Professionals’ states that maintenance functionmovement following an injury, or disability. The title an injury, illness or disability. The title restore andillness function following physiotherapy without veterinary direction is appropriate ‘Physiotherapist’ is protected under the Royal Charter for ‘Physiotherapist’ is protected under the Royal Charter forthe Physiotherapists and thetrained Health providing treating therapist is sufficiently to Physiotherapists and the Health Care and Professions recognise when veterinary intervention is required Care and Professions Council (HCPC) and can only be used by qualified and registered Council (HCPC) and can only be used by qualified and and suitably regulated to protect both the animal and registered physiotherapists, with only members ofof the physiotherapists, with only members the Chartered Society of Physiotherapists allowed owner. There are numerous governing bodies within of Physiotherapists allowed to use toChartered use theSociety title ‘Chartered Physiotherapist’. However, there is no protection of the title the veterinary physiotherapy profession with varying the title ‘Chartered Physiotherapist’. However, there standards required to join of these organisations. veterinary physiotherapist which can be used by anyone regardless their level of Veterinary training. is no protection of the title veterinary physiotherapist physiotherapists who are registered with ACPAT and/or can a be3-year used by anyone regardless of degree their level is required to qualify as a chartered In which the UK undergraduate the ‘Register of Animal Musculoskeletal Practitioners’ of training. In the UK a 3-year undergraduate degree physiotherapist followed by a minimum of 2 years Masters level post-graduate training to (RAMP) must hold an appropriate undergraduate degree is required to qualify as a chartered physiotherapist or A Masters level qualification. Furthermore, membership become and category member of the Association of followed a byveterinary a minimum of physiotherapist 2 years Masters level postof these regulatory bodies requires the member to graduate training to become a veterinary physiotherapist Chartered Physiotherapists in Animal Therapy (ACPAT). Other degree and postgraduate possess adequate professional and public liability and category A member of the Association of Chartered level veterinary physiotherapy qualifications are also available which ensure a high level of insurance. Physiotherapists in Animal Therapy (ACPAT). Other

Qualification Qualification

training and professionalism within the field of veterinary physiotherapy. However, there degree and postgraduate level veterinary physiotherapy are a wide range of other veterinary physiotherapy courses available with varying standards. The magazine of the Professionals in Animal Therapy I Four Front

Scope of Practice

Multidisciplinary approach

The HCPC regulates the physiotherapy profession and to maintain registration physiotherapists must work within their scope of practice. Prior to commencing assessment or treatment, physiotherapists will perform a personal risk assessment that considers their scope of practice in relation to an individual animal and their circumstances. In doing so, the physiotherapist demonstrates an understanding of the scope of the profession of physiotherapy, identifies the limits of their own practice and illustrates an awareness of other professionals expertise. A physiotherapist’s recognition of their scope of practice combined with effective communication with the MDT helps to ensure that the animal receives the correct input from the most appropriate professional in an efficient manner. Scope of practice in practical terms encompasses all elements that form a clinical intervention including risk assessment, clinical assessment, treatment goals and plan, together with advice and training for the owner

Within human medicine physiotherapists are an integral part of the multidisciplinary team and a close working relationship usually exists between the medical team and healthcare professionals. This ensures a holistic approach to patient care that aims to optimise patient well-being and outcome. This multidisciplinary approach also offers great benefit to our veterinary patients with collaboration between vets, nurses, physiotherapists and other paraprofessionals helping to provide a full care package to facilitate maximal health-care benefit to our patients.

Benefits of physiotherapy Physiotherapy involves a thorough clinical assessment to identify any musculoskeletal, neurological, cardiorespiratory and/or biomechanical dysfunction that could potentially limit optimal function and performance. Experience in human physiotherapy develops skills which are largely transferable to animal physiotherapy; ACPAT members specialise in diverse areas of physiotherapy allowing highly specialised intervention. Following assessment, a treatment plan is determined consisting of evidence-based interventions including manual therapy, electrotherapy, exercise therapy, education and advice to facilitate optimal rehabilitation.

Many veterinary physiotherapists have a close working relationship with first opinion and referral veterinarians and many veterinary practices and hospitals offer inhouse physiotherapy and rehabilitation facilities.

Importance of referral Physiotherapy is not a technique or a specific treatment, it is a profession that requires degree and post-graduate degree level qualifications. It is distinct from medicine or veterinary science and is not a technique to be learnt in a CPD course. Physiotherapists are experts in anatomy, biomechanics and neuromusculoskeletal disorders and are widely involved in research and teaching across the medical and veterinary professions. Chartered physiotherapists are highly respected autonomous practitioners who assess, diagnose and treat. However, veterinary physiotherapists are not permitted to diagnose and require, by law, veterinary consent to treat. By giving consent for the treatment of an animal by a suitably qualified and regulated veterinary physiotherapist, vets allow their patients to receive potentially life-changing intervention by a highly skilled clinician.

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Comparison of Subjective and Objective Gait Analysis Methods in Equine Lameness Evaluations: A Narrative Review Alysia Ball BSc (Hons) MSc HCPC MCSP ACPAT Cat A Literature review submitted in accordance with requirements of the University of Liverpool for the degree of Master’s in Veterinary Physiotherapy, January 2023

Introduction

Subjective Gait Analysis Methods

Defined as abnormal motion due to structural or functional deficit, lameness is a common health and welfare concern in the equine population and accurate assessment is critical for successful treatment and rehabilitation (Keegan et al., 2007; Crecan et al., 2022). A fundamental part of any equine lameness assessment, gait analysis allows the observer to identify the presence of any gait abnormalities and determine the nature and severity as well as evaluate the efficacy of attempts to localise or treat the lameness (Davidson, 2018). Yet, with the progressive improvement in practicality and reliability of objective gait analysis methods, the role of subjective objective gait analysis methods as standard clinical practice has been questioned (Keegan, 2019).

Despite considerable developments in the accuracy and accessibility of technology in the clinical setting, visual assessment continues to have a prominent role in equine lameness evaluations. However, there is no ‘gold standard’ systematic protocol proposed for the completion of visual gait analysis (Keegan, 2007). Grading scales aim to characterise the severity of the lameness and permit monitoring of a horse’s response to treatment. However, there is little research evidence examining the validity and reliability of such subjective scoring systems specific to horses (reviewed by Dyson, 2011). Although frequently used for both research and clinical purposes, rating scales such as the 6-point scale of the American Association of Equine Practitioners (AAEP; Table 1) have been reported to demonstrate variable inter-observer reliability for assessing lameness severity and there is no universally accepted scale at present (Fuller et al., 2006; Hewetson et al., 2006; Hardeman et al., 2016). One study compared the use of a visual analogue scale, Obel score and a clinical grading system (adapted from Taylor, Hood and Wagner, 2002) between equine veterinarians and final year veterinary students (Viñuela-Fernández et al., 2011). Intra-observer reliability was higher than inter-observer reliability for all scoring systems in both student and veterinarian groups, suggesting differing interpretations of lameness severity and gradings (Viñuela-Fernández et al., 2011). However, the sample size was relatively small (12 participants in each group), and the study population was limited to horses presenting with laminitis and thus findings may not be generalisable to other clinical presentations.

Veterinary physiotherapists rely on critical information collected from visual gait analysis, using their observational skills and knowledge of equine anatomy and biomechanics to identify functional impairments and movement dysfunctions present, to aid clinical reasoning of an individualised problem list and treatment plan (Goff, 2016). Guidelines state veterinarians should work together and with other professionals in the veterinary team to coordinate the care of animals as part of an inter-disciplinary approach (RCVS, 2023), with veterinary physiotherapists often being consulted in cases of poor performance in current clinical practice (Goff, 2016). However, there appears to be a distinct lack of research into the value and validity of veterinary physiotherapists’ gait analysis in cases of equine lameness. The purpose of this review is to critically evaluate the current evidence base for common gait analysis methods, including both subjective and objective techniques, in addition to the reliability of subjective gait analysis among and between professionals in equine veterinary practice.

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0 Lameness not perceptible under any circumstances 1 Lameness is difficult to observe and is not consistently apparent, regardless or circumstances (e.g. weight-carrying, circling, inclines, hard surfaces etc.) 2 Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under certain circumstances (e.g weight-carrying, circling, inclines, hard surfaces etc.) 3 Lameness is consistently observable at a trot under all circumstances 4 Lameness is obvious at walk 5 Lameness produces minimal weight-bearing in motion and/or at rest or a complete inability to move

Table 1: The American Association of Equine Practitioners (AAEP) lameness scale, rated from 0-5 (AAEP, 1999)

Several factors that may influence visual gait analysis have been identified. These include factors relating to evaluation of the horse in motion such as speed and size of circle and observer-related factors such as expectation bias following diagnostic analgesia (Pfau et al., 2014; Hammarberg et al., 2016). Collectively, these findings support the need for a systematic approach to minimise confounding variables. A recent study using eye-tracking technology found veterinarians consistently observed the head and pelvis when assessing for lameness on a straight line (Starke and May, 2022). However, this consistency was not evident when horses were assessed on a circle, where there were large differences in the order and weighting of selected body regions observed, demonstrating the unsystematic nature of visual gait analysis currently (Starke and May, 2022).

is impractical for daily clinical use (Bragança, Rhodin and van Weeren, 2018). In contrast, ISS utilise a small number of wireless, body-mounted accelerometers to generate objective data regarding gait asymmetry (Figures 1a-c). Although cheaper, more versatile, and more accurate when measuring acceleration than VAMA, ISS is less accurate than VAMA when determining absolute displacement due to potential integration errors within the technology (Bragança, Rhodin and van Weeren, 2018).

Figures 1a-c: Images illustrating wireless sensor positioning for an inertial sensor system (ISS): a) an accelerometer fitted to headcollar via a bonnet at poll; b) an accelerometer attached at the pelvis between the tuber sacrales using an adhesive pad; c) a gyroscope fitted to the dorsal midline of the right forelimb pastern via a material wrap.

Objective Gait Analysis Methods Quantitative gait provides repeatable, unbiased data characterising a horse’s lameness. Numerous objective techniques have been developed over recent decades, permitting unambiguous re-assessment and efficient communication between clinicians (Hardeman et al., 2022). Kinetic methods such as force plate analysis (FPA) evaluate the forces produced during musculoskeletal work and are accurate in detecting lameness via changes in ground reaction forces yet are expensive and timeconsuming to collect data from (Keegan, 2011). Kinematic methods like video-assisted motion analysis (VAMA) and inertial sensor systems (ISS) examine the movement of body segments during gait. Asymmetry of the head in forelimb lameness and of the sacrum or tuber coxae in hindlimb lameness, in particular the vertical displacement of the head and pelvis, have been identified as the most reliable lameness markers in visual gait analysis and these landmarks are generally examined as part of kinematic studies also (Kramer et al., 2004; Rhodin et al., 2013; Davidson, 2018; Serra Bragança et al., 2021). VAMA uses multiple cameras to monitor the position of strategically placed reflective markers and is suggested to be the ‘gold standard’ for three dimensional (3D) kinematic gait analysis, yet like FPA requires costly equipment and

Fig 1 a

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between visual gait analysis and kinematic methods (ISS and VAMA), although agreement between these methods has been shown to vary from moderate to poor and is greatly dependent on the experience of the clinician, with a positive association reported between agreement strength and clinician experience (Keegan et al., 2013; Leelamankong et al., 2019; Donnell et al., 2020; Hardeman et al., 2022). Furthermore, ISS has been shown to be significantly more sensitive when identifying a lame limb compared to subjective evaluations, correctly detecting induced lameness using specialist shoeing at a lower level of sole pressure than veterinarian observers (McCracken et al., 2012). However, only three veterinarians were included in this sample and the study used artificial solar pressure to induce acute lameness, a scenario potentially not representative of a naturally occurring lameness seen in clinical practice (McCracken et al., 2012). Interestingly, another study compared visual gait analysis with ISS and FPA in their abilities to identify and grade lameness, finding significantly greater agreement between visual gait analysis and ISS (fair) than visual gait analysis and FPA (poor) (Donnell et al., 2015). This is in contrast to an earlier study where subjective lameness grading was significantly correlated with FPA parameters (Ishihara, Bertone and Rajala-Schultz, 2005). However, it is thought strong relationships between visual gait analysis and ISS are due to both methods characterising lameness by asymmetries rather than changes to forces, as in FPA (Donnell et al., 2015).

Fig 1 b

Due to ethical concerns, research has largely excluded horses that demonstrated a lameness score exceeding 3/5 on the AAEP scale. One study identified deviations from the linear relationship observed between subjective and objective data when observing a 0.5/5 AAEP lameness score, indicating reduced accuracy of subjective scoring for low-grade lameness (Hardeman et al., 2022). Yet without analysis of a wider range of lameness severities, the results cannot be generalised to all visual gait analysis evaluations. Moreover, numerous studies have compared subjective and objective gait analysis using trotting in a straight line on a hard surface only, which in cases of VAMA is one of the constraints of the technology and is not reflective of a comprehensive lameness evaluation. This is not the case for ISS, which can collect data during non-linear movements, including lunging and soft surface conditions, similar to a subjective lameness evaluation completed by veterinarians in clinical practice (McCracken et al., 2012; Keegan et al., 2013; Donnell et al., 2015; Leelamankong et al., 2019; Hardeman et al., 2022).

Fig 1 a

Comparison of Subjective and Objective Methods Given the increase in accessibility and versatility of objective gait analysis methods, research has looked to evaluate the relationship between subjective and quantitative techniques and to determine the role objective gait analysis may have in daily clinical practice. Recent literature has demonstrated an association

Forelimb lameness is over-represented in the literature, potentially limiting generalisability of results to alternative presentations, particularly regarding hindlimb assessment, which has been argued to be more challenging (Starke, May and Pfau, 2015). However, studies focused solely on forelimb (Donnell et al., 2015) and hindlimb (Leelamankong et al., 2019) lameness both reported strength of agreement between visual gait analysis and ISS to be

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fair, suggesting no differences in fore- and hindlimb evaluations, although it is important to note this was found only in highly experienced veterinarians in the latter study, with the most inexperienced group demonstrating only slight agreement. Current literature examines largely veterinarian and veterinary student samples, with only one recent study including veterinary physiotherapists among their sample of equine professionals, finding no significant correlation between subjective gait analysis and VAMA data (Spoormakers et al., 2021). Nevertheless, it is important to note this study focused solely on assessment of back mobility assessed using a custom-designed, unvalidated outcome measure and the veterinary physiotherapists’ data were pooled with other professional groups, making it impossible to compare results by profession.

Inter-rater Reliability of Subjective Gait Analysis From initial presentation to treatment of lameness, a horse may be examined by a single professional or multiple clinicians across differing time periods. Therefore, determining the inter- and intra-rater reliability is an important consideration when assessing the value of subjective lameness evaluations (Starke and May, 2022). Hardeman et al. (2022) concluded intra-rater reliability in equine veterinarians studied was ‘good’, mirroring the findings of an older study by Fuller et al. (2006), however both forementioned studies analysed extremely small sample sizes (n=4 and n=1, respectively) and no data regarding the experience of the clinicians in the latter study were available and therefore results should be generalised with caution. Studies have demonstrated inter-rater reliability of subjective gait analysis to range from ‘acceptable’ to ‘good’ when identifying the lame limb, yet agreement between clinicians is considerably lower when required to grade lameness severity, despite most studies using the AAEP scale, which is argued to be familiar to most veterinarians (Keegan et al., 2010; Hammarberg et al., 2016; Leelamankong et al., 2020; Hardeman et al., 2021). Interestingly, one study also analysed agreement between clinicians after they were permitted to perform a full lameness evaluation, including lunging and limb flexion tests, yet this did not augment the inter-rater agreement demonstrated (Keegan et al., 2010). Furthermore, agreement on identification and grading of lameness was found to be positively correlated with lameness severity in multiple studies (Keegan et al., 2010; Hammarberg et al., 2016; Starke and Oosterlinck, 2019; Leelamankong et al., 2020). Previous studies have found inter-rater reliability to be higher in forelimb lameness compared to hindlimb or sound presentations (Keegan et al., 2010; Keegan et al., 2013; Hammarberg et al., 2016). This is consistent with a study by Starke and Oosterlinck (2019), who identified greater inaccuracies in hindlimb assessment regardless of clinician experience, although the use of 3D animations

rather than real horses in this study may limit the ability to extrapolate results to the wider population. The influence of clinicians’ experience on agreement between professionals is varied in available literature. Although both Keegan et al. (2010) and Leelamankong et al. (2020) found no significant correlation between clinician experience and inter-rater agreement, a recent study which sampled a relatively larger group of veterinarians (n=86), found agreement between lesser-experienced clinicians to be ‘poor’, in comparison to ‘acceptable’ in higher-experienced veterinarians (defined as those with more than 5 years’ experience in equine orthopaedics) (Hammarberg et al., 2016). It is important to note that the use of video recordings in studies has been shown to negatively impact on the interrater reliability of visual gait analysis, with several papers reporting a lower agreement between professionals when analysing videos compared to live, in-person evaluations, likely due to the lack of depth, dimension and often sound in research video recordings (Keegan et al., 2010; Hammarberg et al., 2016; Leelamankong et al., 2020; Spoormakers et al., 2021). However, Leelamankong et al. (2020) did not blind live assessors to the hindlimb nature of the lameness, thus providing real-time evaluators an advantage over those participants asked to evaluate video recordings. In contrast, it has been argued that the possible influence of expectation bias in live scenarios may impact on the reliability of visual gait analysis. For example, a clinician may be more inclined to observe a positive improvement following treatment in their own clinical cases as opposed to unknown horses viewed via video recording (Hardeman et al., 2022) Despite extensive literature searches, it was not possible to identify research specifically examining inter- or intra-rater agreement in other equine professional groups, such as veterinary physiotherapists, regarding gait analysis.

Conclusion On evaluating the evidence, subjective gait analysis is less sensitive, less consistent, and less accurate when compared to quantitative objective methods, particularly in cases of hindlimb or mild lameness. Objective gait analysis technology has become more practical and versatile in recent years and therefore its role in daily clinical practice is becoming more feasible and is justified when considering the available evidence (Bragança, Rhodin and van Weeren, 2018). As demonstrated, inter-rater reliability of subjective gait analysis greatly varies within literature, yet it has been proposed that a systematic protocol with standardised training and regular practice may improve consistency between veterinarians when completing visual gait analysis (Keegan, 2019). Heterogenous veterinarian-focused study populations, methodologies and often poor reflection of real-world lameness evaluation protocols likely limits extrapolation of findings to the general population. Further research should reflect daily clinical practice in the methodologies used, such as

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including multiple components of a lameness evaluation as opposed to a single trot up in a straight line. Where it is not possible to complete live, in-person gait analysis, studies should ideally use high-resolution cameras to limit poor video quality as a confounding variable. In addition, given the move towards greater inter-professional working in veterinary practice, future research should utilise larger sample sizes including other equine professionals, such as physiotherapists, to determine the value of additional skills they may offer to the inter-disciplinary team (Kinnison, May and Guile, 2014).

Acknowledgement Thank you to Dr Peter Milner for his support and assistance with this literature review and throughout my MSc research project.

References American Association of Equine Practitioners (AAEP) (1999) Guide to Veterinary Services for Horses Shows, 7th ed., American Association of Equine Practitioners, Lexington. Bragança, F.S., Rhodin, M. and van Weeren, P.R. (2018) On the brink of daily clinical application of objective gait analysis: What evidence do we have so far from studies using an induced lameness model?. The Veterinary Journal, 234, pp.11-23. Clayton, H.M. and Schamhardt, H.C. (2013) ‘Measurement techniques for gait analysis’, in Clayton, H.M. and Back, W. (eds). Equine Locomotion. Saunders Elsevier, pp.31-60. Crecan, C.M., Morar, I.A., Lupsan, A.F., Repciuc, C.C., Rus, M.A. and Pestean, C.P. (2022) Development of a Novel Approach for Detection of Equine Lameness Based on Inertial Sensors: A Preliminary Study. Sensors, 22(18), p.7082.

Hammarberg, M., Egenvall, A., Pfau, T. and Rhodin, M. (2016) Rater agreement of visual lameness assessment in horses during lungeing. Equine Veterinary Journal, 48(1), pp.78-82. Hardeman, A.M., Egenvall, A., Serra Bragança, F.M., Swagemakers, J.H., Koene, M.H., Roepstorff, L., van Weeren, P.R. and Byström, A. (2022) Visual lameness assessment in comparison to quantitative gait analysis data in horses. Equine Veterinary Journal, 54(6), pp.10761085. Hewetson, M., Christley, R.M., Hunt, I.D. and Voute, L.C. (2006) Investigations of the reliability of observational gait analysis for the assessment of lameness in horses. The Veterinary Record, 158(25), pp.852-858. Keegan, K.G. (2011) ‘Chapter 22 – Gait Analysis for the Quantification of Lameness’, in Ross, M.W. and Dyson, S. (eds). Diagnosis and Management of Lameness in the Horse. Elsevier/Saunders. pp. 245-251. Keegan, K.G. (2007) Evidence-based lameness detection and quantification. Veterinary Clinics of North America: Equine Practice, 23(2), pp.403-423. Keegan, K.G. (2019) Reliability of equine visual lameness classification. The Veterinary Record, 184(2), p.60. Keegan, K.G., Dent, E.V., Wilson, D.A., Janicek, J., Kramer, J., Lacarrubba, A., Walsh, D.M., Cassells, M.W., Esther, T.M., Schiltz, P. and Frees, K.E. (2010) Repeatability of subjective evaluation of lameness in horses. Equine Veterinary Journal, 42(2), pp.92-97. Keegan, K.G., Wilson, D.A., Kramer, J., Reed, S.K., Yonezawa, Y., Maki, H., Pai, P.F. and Lopes, M.A. (2013) Comparison of a body-mounted inertial sensor system– based method with subjective evaluation for detection of lameness in horses. American Journal of Veterinary Research, 74(1), pp.17-24.

Davidson, E.J. (2018) Lameness evaluation of the athletic horse. Veterinary Clinics of North America: Equine Practice, 34(2), pp.181-191.

Kinnison, T., May, S.A. and Guile, D. (2014) Interprofessional practice: from veterinarian to the veterinary team. Journal of Veterinary Medical Education, 41(2), pp.172-178.

Donnell, J.R., Frisbie, D.D., King, M.R., Goodrich, L.R. and Haussler, K.K. (2015) Comparison of subjective lameness evaluation, force platforms and an inertial-sensor system to identify mild lameness in an equine osteoarthritis model. The Veterinary Journal, 206(2), pp.136-142.

Kramer, J., Keegan, K.G., Kelmer, G. and Wilson, D.A. (2004) Objective determination of pelvic movement during hind limb lameness by use of a signal decomposition method and pelvic height differences. American Journal of Veterinary Research, 65(6), pp.741-747.

Dyson, S. (2011) Can lameness be graded reliably?. Equine Veterinary Journal, 43(4), pp.379-382.

Leelamankong, P., Estrada, R., Mählmann, K., Rungsri, P. and Lischer, C. (2020) Agreement among equine veterinarians and between equine veterinarians and inertial sensor system during clinical examination of hindlimb lameness in horses. Equine Veterinary Journal, 52(2), pp.326-331.

Fuller, C.J., Bladon, B.M., Driver, A.J. and Barr, A.R. (2006) The intra-and inter-assessor reliability of measurement of functional outcome by lameness scoring in horses. The Veterinary Journal, 171(2), pp.281-286. Goff, L. (2016) Physiotherapy assessment for the equine athlete. Veterinary Clinics of North America: Equine Practice, 32(1), pp.31-47.

McCracken, M.J., Kramer, J., Keegan, K.G., Lopes, M., Wilson, D.A., Reed, S.K., LaCarrubba, A. and Rasch, M. (2012) Comparison of an inertial sensor system of lameness quantification with subjective lameness

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evaluation. Equine Veterinary Journal, 44(6), pp.652-656. Pfau, T., Spicer-Jenkins, C., Smith, R.K., Bolt, D.M., Fiske-Jackson, A. and Witte, T.H. (2014) Identifying optimal parameters for quantification of changes in pelvic movement symmetry as a response to diagnostic analgesia in the hindlimbs of horses. Equine Veterinary Journal, 46(6), pp.759-763.

Starke, S.D., May, S.A. and Pfau, T. (2015) Understanding hind limb lameness signs in horses using simple rigid body mechanics. Journal of Biomechanics, 48(12), pp.3323-3331.

Rhodin, M., Pfau, T., Roepstorff, L. and Egenvall, A. (2013) Effect of lungeing on head and pelvic movement asymmetry in horses with induced lameness. The Veterinary Journal, 198, pp.e39-e45.

Starke, S.D. and Oosterlinck, M. (2019) Reliability of equine visual lameness classification as a function of expertise, lameness severity and rater confidence. The Veterinary Record, 184(2), pp.63-63.

Royal College of Veterinary Surgeons (2023) Code of Professional Conduct for Veterinary Surgeons. [Online] Available at: https://www.rcvs.org.uk/setting-standards/ advice-and-guidance/code-of-professional-conduct-forveterinary-surgeons/

Taylor, D., Hood, D.M. and Wagner, I.P. (2002) Short-term effect of therapeutic shoeing on severity of lameness in horses with chronic laminitis. American Journal of Veterinary Research, 63(12), pp.1629-1633.

(Accessed: 14th November 2023). Serra Bragança, F.M., Hernlund, E., Thomsen, M.H., Waldern, N.M., Rhodin, M., Byström, A., van Weeren, P.R. and Weishaupt, M.A. (2021) Adaptation strategies of horses with induced forelimb lameness walking on a treadmill. Equine Veterinary Journal, 53(3), pp.600-611.

Starke, S.D. and May, S.A. (2022) Expert visual assessment strategies for equine lameness examinations in a straight line and circle: A mixed methods study using eye tracking. The Veterinary Record, 191(8), pp.e1684.

Viñuela-Fernández, I., Jones, E., Chase-Topping, M.E. and Price, J. (2011) Comparison of subjective scoring systems used to evaluate equine laminitis. The Veterinary Journal, 188(2), pp.171-177.

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A case report of bilateral hind limb flexural deformity in a foal: A Physiotherapist’s perspective & management. Celia Cohen ACPAT(A), BSc hons phys, MSc Vet Phys, HCPC, MCSP. Chartered Physiotherapist Specialising in Veterinary Physiotherapy cjcohens@hotmail.com

Summary Flexural deformities in foals are deviations in the sagittal plane1. They are divided into contractual or hyperextension deformities and can affect the forelimbs or hind limbs or both2. They are congenital or developmental in origin and vary in severity and relatively common limb deformity in neonatal foals. Carpal overextension and weak pasterns/fetlocks are the most common and normally improve in the first few weeks. In the most severe form it results in the foal weight bearing on the plantar/ palmar aspect of the proximal phalanges and fetlock with the toe raised. Severe cases will need intervention.

Background A warmblood colt was born at full term to a primiparous mare. Foaling took place in an indoor environment at an experienced thoroughbred (TB) stud with video surveillance. The mare required some manual assistance with foaling, but it was otherwise a normal successful foaling ensued. The foal stood independently and fed.

Fig.1.A. Day 1 turnout posture & hind limb presentation

Presentation and initial intervention Day 1: Presented with severe hyperextension of the hind fetlocks, rocking onto the bulbs of his heels (Fig.1.A & B). The right was worse than the left. He was put on 1 week of box rest in a deep straw bed. After Veterinary consultation the treatment was remedial farriery3 and restricted exercise as follows: • Glue on shoes with heel extensions were fitted on the 11th may (5 days old) under sedation. • He was then allowed turn out for 10 minutes on a firm sand surface a few times day– his gait when cantering around presented as a hopping, kangaroo like bounce.

Fig 1.B. Day 1 turnout posture & hind limb presentation

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Day 8:

Day 25:

14th of May (8 days old) no change in gait patterns, tendon laxity. He pulled off his shoes a few times however they were replaced without sedation. Under veterinary guidance his free turnout was gradually reducing, and hand walking commenced.

He had repeat glue on extension however it was observed he was now developing hoof wall contracture and sore bulbs of his heels (Fig.2.A). Therefore, the farrier used dental impression material to dissipate load and provide cushion (Fig.2.B), all of which the foal allowed without sedation or force.

A Chartered Physiotherapist (experienced with foals and youngstock, working for the Stud) was contacted by the Stud Veterinary Surgeon for further advice on whether Physiotherapy intervention and support help. This case had a very poor prognosis and very little literature was found to support management with adjunctive therapy other than a mention of hydrotherapy. Following further reading and liaison the Veterinarian referred the foal to physiotherapy. The team at this stage consisted of a Veterinarian, Farrier and the Stud managers/ staff who all liaised with the Physiotherapist on the foal’s progress both physically and mentally.

Ethics/ welfare challenge: As a Physiotherapist I felt it prudent to reflect on the following points. This was a severe case with a very poor prognosis therefore was intervention by me and others warranted and evidenced? Was it in the best interest of the animal? Handling foals is difficult and dangerous, could he tolerate more and possibly longer-term intervention? Was it financially viable? Would hydrotherapy be safe and feasible? In discussion with Team, it was decided on balance to progress treatment with close monitoring.

Following team review and discussion, exercise in the form of controlled hand walking the foal with the mare on a firm flat surface took place for 10 minutes 2-3 times a day. This was a degree of flexibility and risk assessment required for this with respect to whether the mare/ foal could cope with this and was it safe to carry out.

Day 26: Refit of extension shoes.

Day 38: The hoof wall distortion and heel contractures were worsening at this point therefore the glue on extensions were removed and a pair of aluminium ‘skis’ were made and bandaged on to the foot.

Physiotherapy Plan Factors to consider prior to ongoing rehabilitation: The foal tolerated his intervention and controlled exercise. He continued to be sweet and willing to handle and was otherwise healthy and growing well. His mare remained well and coping too. He was very well bred with motivated owners who could support and fund treatment. Upon evaluation, hydrotherapy was deemed unsafe and inappropriate. It was too far to travel, not viable. The frequency of sessions required to have therapeutic advantage alongside the safety aspect made this far too risky for all including the mare and foal. Therefore, a physiotherapy assessment was instructed.

Fig 2.A. Day 25: Contracted hoof capsule & collapsed heels

The effective management of the tissue laxity would likely require an active eccentric and controlled concentric contraction in a closed kinematic chain based on the function and nature of structures involved. As a result, it was deemed land based assisted weight bearing was required.

Day 60: Physiotherapy assessment was undertaken with the following objective assessment findings: • Aluminium skis held on with bandage in situ. Fetlock drop noted when walking. Controlled in hand walking continues.

Fig 2.B. Day 25: glue on shoes, heel extensions & dental impression material

• Without skis- Right hind fetlock severe sink, weight bearing on heel, plantar aspect when walking. Left hind toe up but not as severe. • Sore bulbs of heels but no open sores.

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• Good body condition. Pelvic musculature – no obvious asymmetry or pain. • Hindlimb flexors- lacked tone. • Proprioception – intac. • A Surface Muscle stimulator was used to assess the contraction of the hind limb digital flexors / associated structures to help determine if there was a viable contraction strong enough to lift the fetlocks. This was carried out using a NeuroTrac ® Neuromuscular stimulator with two ports and self-adhesive pads to prevent slipping were used (Fig.3); foals have a thin enough coat which with some conductivity gel results in sufficient connectivity and conduction.

Once a strong yet comfortable contraction was established on one hind limb the electrodes where then strapped in place using crepe bandage to allow set up on the other limb. When both were in place and a strong co-contraction was observed it resulted in a small lift of the fetlocks occuring. It was deemed to be tolerated well and the staff were taught how to apply the device ensuring safety precautions and the muscle stimulator protocol was adhered to with all handlers/ operators. It was decided to use a pre programmed setting that had a pulse duration of 300ms throughout and a varying frequency of 5-75 Hz to allow both recovery and work. This was to increase the capacity to develop increased muscle force over a longer time, to aid muscle health and to improve the tensile properties and support the lower limb. It was decided 20-minute sessions twice a day would be both reasonable for the foal and the staff. He continued with his in-hand walking sessions, of note, short sessions of walking with the muscle stimulator in situ were also recommended but this was not practical alongside the day to day running of the stud. The staff were also shown some basic pelvic stability and weight transference exercises to do when handling him. These were in the form of gentle supported manual pelvic rocks and key point stability, all with the skis in situ and avoiding excessive fetlock sinking. Throughout this part of the rehabilitation process, the team fed back regular updates and reviews via videos with the Physiotherapist.

Day 90: Fig 3. Neuromuscular stimulator in situ

Surface muscle stimulator protocol4:

30 days after starting his Physiotherapy programme his ski shoes were removed followed by a radiographic-assisted remedial trim by the remedial farrier (Fig.4). His fetlocks are now neutral and the fetlock sink on walking was within normal limits (Fig.5).

1. Preparation of the skin- warm water to clean and damped the skin. Gel applied. 2. Repeated handling of the area to ensure the foal could cope. 3. One electrode placed at a time, manually held. 4. The electrodes were placed in the crural region and moved over the respective muscle-bellies until fibres of the deep digital flexor muscle, Flexor digitorum lateralis, soleus and gastrocnemius were recruited. Pulse width: 300ms- a comfortable and muscle recruitment setting. Frequency: 5 Hz-20Hz. Current: Very slowly increased to 5mA, followed by allowing time to accommodate to the sensation, then gradually increased over 5-10 minutes until a very small contraction was seen and tolerated.

Fig.4. X-ray images taken to guide remedial trimming at day 90.

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Key learning points: • There is a lack of evidence base for Physiotherapy input in limb deformities in foals. This case and future cases should be guided by expert opinion. The transfer of skills and knowledge from relevant fields along with the application of biomechanics and muscle physiology is imperative. • The team and effective communication amongst team members is essential. An experienced team in handling mares and foals with the safe and equipped facilities is necessary. A stud with rehabilitation facilities would be advisable if attempting a similar case. • Patient compliance is a game changer. This outcome of this case was only possible due to the lovely nature of the foal and very careful handling of the mare.

References: 1. Clinical Techniques in Equine Practice. Vol 5. Issue4, DEC 2006 PAGES 282-295 Fig.5. Post trim hind foot posture at 90 days old

Day 91+: The foal was turned out in a level paddock for a few hours with this gradually increased according to monitoring of his gait and alignment. The gait pattern in all paces were now normal resulting in a free foal with an exciting future. At this stage he was predicted to fulfil a sporting career as intended. At 6 months old he is weaned and living a normal weanling life in herd (Fig 6.).

2. Diagnosis and Treatment of Limb Deformities in Foals. Annette M McCoy. DVM, MS, PhD, DACVS, University of Illinois College of Veterinary Medicine. 3. Effective farriery treatment of hypoflexion tendons (severe digital hyperextension) in a foal. Equine Veterinary Education/vol 11 issue 5 p256-259. S.J. Curtis, Sarah Stoneham 26 April 2010 4. Wide-pulse-width, high frequency neuromuscular stimulation: implications for functional electrical stimulation. Evans R. Baldwin, Piotr M. Klakowicz, and David F. Collins. Journal of Applied Physiology, American Physiological Society Published online 01 Jul 2006.

Fig.6. The mare and foal now recovered.

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260ml of Conductive gel

525

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The effect of Laser dosage on mechanical nociceptive thresholds in the equine thoracolumbar spine Alice Frampton MSc Vet. Physio, MNAVP, RAMP Thesis submitted in partial fulfilment of the requirements for the MSc. Degree in Veterinary Physiotherapy, Harper Adams University May 2019. Email: alicevetphysio@gmail.com

Objective: The purpose of this study was to investigate the effect of dose emitted from Low-level laser therapy (LLLT) on mechanical nociceptive thresholds (MNT) along the equine thoracolumbar spine.

Background: LASER is an acronym standing for Light Amplification by Simulated Emission of Radiation. Low level laser therapy (LLLT) differs from other light sources due to its monochromacity which has been found to be key to therapeutic effect (Moore et al., 2005; Tafur and Mills, 2008). LLLT is commonly used to treat back pain in horses (Kaneps, 2016), however there is little evidence to support its use and provide an accurate measure of dose in horses. Back pain is one of the most common causes of poor performance in horses (Dyson, 2002), LLLT provides a non-invasive, high compliance treatment option with little physical effort required from the therapist (Paterniani and Grolli, 2018). Laser is best absorbed by superficial vascular tissues such as epithelial tissue and skeletal muscle and is widely accepted to have a positive effect on tissue healing, studies support increased inflammatory processes and blocking of reactive oxygen species effects (Rizzi et al., 2006; Albertini et al., 2007; De Souza et al., 2011; Silveira et al., 2013). The energy delivered by Laser disturbs the local electron orbits resulting in production of heat, chemical change, disruption of molecular bonds and production of free radicals as its primary mechanism of action (Chung et al., 2012). Laser helps to improve the microcirculation increasing oxygen to hypoxic cells and removal of waste products, this in turn helps to break the pain and spasm cycle (Uemoto et al., 2013). The electron transport chain has been shown to be photosensitive to red and infrared light, photostimulation has been found to increase

Adenosine Triphosphate (ATP) production and increase reactive oxygen species leading to improved homeostasis and proliferative control (Tafur and Mills, 2008). The Arndt – Schulz law is deemed an appropriate model when determining dose for low level laser therapy (LLLT) under the principle: weak stimuli will exhibit no therapeutic effect, moderate stimuli will have a bio stimulatory effect and high stimuli will have a bio-inhibitory effect (Huang et al., 2009; Chung et al., 2012). Establishing the reliable dosage parameters needed to exhibit therapeutic effect becomes increasingly difficult when dosing is conflicted among research, with most studies comparing only one LLLT fluence with control or comparing two very different dosages without establishing a gradient Rizzie et al., 2006; Liu et al., 2009; De Souza et al., 2011; Renno et al., 2011). Pressure algometry (PA) has proven a useful tool for measuring MNT in horses (Haussler and Erb, 2006a; Haussler and Erb, 2006b; Varcoe-cocks et al., 2006; De Hues et al., 2010), applied perpendicular to the testing area pressure is applied at a steady and constant rate to allow the subject time to respond, when a behavioural response is seen the pressure is stopped and a recording taken (Kinser et al., 2009). High individual variation of MNT in horses has been found, with some studies choosing to use a difference value or percentage change to provide a more accurate comparison of results and utilising each horse as its own control (Haussler and Erb, 2006b; Sullivan, Hill and Haussler, 2008; De Hues et al., 2010). Ridden horses can be exposed to an array of different tack, equipment, rider weight and ability, as well as domestic management practices, all of which can contribute to their musculoskeletal health with high stresses found in the thoracic and lumbar regions, and back pain linked to poor performance (Dyson, 2002; De Cocq et al., 2004; Greve and Dyson, 2013; Wennerstrand

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et al., 2004.). Murray et al, (2010) documented over 25% of horse owners considered their horse as having had a back problem with the majority resolved by a therapist without veterinary intervention. An understanding of modalities that effectively reduce musculoskeletal pain is important to improve performance and welfare in the equine population, this study aims to establish an LLLT dose based relationship for influencing MNT with a view to treating back pain in horses.

T13 Thoracic portion of longissimus dorsi 2cm lateral to the dorsi midline of the 13th thoracic vertebra.

T18 Thoracic portion of longissimus dorsi 2cm lateral to the dorsi midline of the 18th thoracic vertebra.

Method: One hundred horses were divided into 5 study groups (n=20.) LLLT was administered using OMEGA XP Mobile, Class 3B Gallium Aluminium Arsenide Lasers (Omega Laser Systems Limited, Essex UK) together with a single infra-red point probe 0.16W/cm2 (200mW), 820nm, spot size 0.125cm2, at rates shown in table 1. MNT testing was carried out via PA at 6 anatomical locations before and after LLLT or control. Control group received no intervention between pressure algometer readings. A 240s break was taken following the first PA reading before the second PA measurement, this was to keep the time between the first and second PA readings similar across the treatment and control groups, serving as a habituation marker. Anatomical sites at the level of T13, T18 and L3 were chosen for their high repeatability and use in previous studies (De Heus et al., 2010; Haussler and Erb, 2006a, Haussler and Erb, 2006b) as well as their location having the potential to be influenced by tack and ridden activities (Greve and Dyson, 2013). To increase reliability of results and limit the effects of skin marking19, three points of Laser were applied at each location, one point at the anatomical location and a second and third point 3cm left and right on a horizontal gradient.

Group Participants LLLT Dose (J/cm2)

Pulse Factor treated with LLLT

Total points Total Irradiation Time (S)

8 J/cm2

5,000

90s

16 J/cm2

5,000

180s

24 J/cm2

5,000

270s

32 J/cm2

5,000

360s

L3 Mid portion of the Gluteus medius 2cm lateral to the dorsi midline of the 3rd lumbar vertebra.

Figure 1: Anatomical landmarks and descriptions of MNT sites. Adapted from (Ellenberger et al., 1901 and De Heus et al., 2010)

Data Analysis: Raw data was entered into Microsoft Office Excel 2013 to calculate the mean MNT value for horses at each point, overall means and standard deviation for the groups. Mean data was displayed in graphs for descriptive analysis and also later used in statistical analysis. Statistical analysis was completed using GenStat (18th edition VSNI, UK). Data was first tested for normality using the ShapiroWilk test to determine parametric and non-parametric data sets for further statistical analysis. Parametric data was assessed for variance using one way ANOVA with a Tukey post hoc test. Non-parametric data was assessed for variance using the Kruskal-Wallis test and two sample Man-Whitney U test. Left and right variance was assessed using a paired t-test.

Results:

5 20 Control-no N/A 0 0s intervention (1st PA reading taken followed by 240s break from algometry.)

Laser fluence of 16J/cm2 and 24J/cm2 were clinically effective (P < 0.001) at increasing MNT values compared to control immediately after application in horses. Laser applied at 8J/cm2 and 32J/cm2 did not significantly alter MNT values compared to control. Mean increase in MNT throughout the study was calculated at Control 2.7%, 8J/cm2 6.6%, 16J/cm2 23.8%, 24J/cm2 28.4% and 32J/ cm2 7.2%. Coat length, coat colour and skin colour did not significantly influence results in this study, however in-depth analysis was beyond the scope of this study and arguably only applicable after dose parameters have been established.

Table 1: Experiment protocol

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Percentage MNT increase after LLLT 35.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00 -5.00

Percentage %

Figure 2: Percentage MNT increase after LLLT (Authors own, 2019)

T13L

T13R

T18 L

T18 R

L3L

L3R

Group 1

5.68

8 .60

5.22

10.63

3.34

6.11

MEAN 6.60

Group 2

17.67

25.76

29.56

23.23

25.91

20.36

23.75

Group 3

34.68

24.47

29.8 6

24.8 4

30.21

26.17

28.37

Group 4

7.01

8 .99

8.88

5.71

5.43

7.37

7.23

Group 5 (Control)

6.89

4.25

2.98

-0.40

0.30

2.44

2.74

Anatomical location Group 1

Group 2

Discussion: This study supports a therapeutic dose between 16-24J/ cm2 for increasing MNT and reducing pain in the equine thoracolumbar epaxial muscles. This is contradicting to other studies that have found therapeutic effects outside the 16-24J/cm2 range in other species. Several studies found 5J/cm2 effective for treating muscle trauma in rodents (Rizzi et al., 2006, De Souza et al., 2011, Silveira et al 2013) and 72J/cm2 for treating myofascial trigger points in rabbits (Chen et al., 2010). It is therefore essential to consider Laser fluence alongside species, clinical condition, tissue state, and desired tissue response. Following a protocol commonly used in equine practice a gradient of 8J/cm2 was used to establish a dose-based relationship for treating horses. A pulse rate of 5kHz was used under manufacturers’ guidelines although not supported by literature with pulsing parameters largely un-researched aside from evidence that pulsed light has differing effects from continuous (Hashimi et al., 2010). A variety of horses ranging in age, height and breed were used to provide an accurate representation of the general population. The use of anatomical markers allows for greatest repeatability, albeit differing from clinical application when treatment would be tailored to individual findings (Sullivan et al., 2008, Kaneps, 2016). It was assumed some areas of soreness were likely to be present at the anatomical sites used in the current study due to the influence of tack and ridden stresses previously found to occur in this region (De Cocq et al., 2004; Fruehwirth et al, 2004; Greve and Dyson, 2013;), however palpation and hypertonicity were not recorded. Coat length, coat colour and skin colour were recorded but did not appear to have a significant impact on therapeutic effect which is also supported by a previous equine study (Ryan and Smith, 2004) however consideration should also be given to the Laser probe and application when applying through hair. Parting of longer hair and use of a small point probe provided good access

Group 3

Group 4

Group 5 (Control)

to the skin which would not have been possible with the application of a cluster probe and may have produced differing results.

Conclusion: LLLT dose significantly effects MNTs in the equine thoracolumbar epaxial muscles, highlighting the importance of establishing dose-based parameters in order to achieve a therapeutic outcome when using LLLT. This study focused purely on immediate MNT effect with the biological effect of these fluences not recorded. Further research is now needed to determine the longevity of these effects, the influence of a pulsing factor and the effectiveness of Laser for treating horses with clinically diagnosed back pain.

References Albertini, R., Aimbire, F., Villaverde, A., Silva, J. and Costa, M., 2007. COX-2 mRNA expression decreases in the subplantar muscle of rat paw subjected to carrageenaninduced inflammation after low level laser therapy. Inflammation Research, 56(6), pp. 228-229. Chen, K., Hong, C., Hsu, H., Wu, S., Kuo, F. and Hsieh, Y., 2010. Dose-dependent and ceiling effects of therapeutic laser on myofascial trigger spots in rabbit skeletal muscles. Journal of Musculoskeletal Pain, 18(3), pp. 235-245. Chung, H., Dai, T., Sharma, S.K., Huang, Y., Carroll, J.D. and Hamblin, M.R., 2012. The nuts and bolts of low-level laser (light) therapy. Annals of Biomedical Engineering, 40(2), pp. 516-533. De Cocq, P.D., Van Weeren, P. and Back, W., 2004. Effects of girth, saddle and weight on movements of the horse. Equine veterinary journal, 36(8), pp. 758-763. De Heus, P., Van Oossanen, G., Van Dierendonck, M.C. and Back, W., 2010. A pressure algometer is a useful tool

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to objectively monitor the effect of diagnostic palpation by a physiotherapist in warmblood horses. Journal of equine veterinary science, 30(6), pp. 310-321. De Souza, Thais Oricchio Fedri, Mesquita, D.A., Ferrari, R.A.M., Dos Santos Pinto, D., Correa, L., Bussadori, S.K., Fernandes, K.P.S. and Martins, M.D., 2011. Phototherapy with low-level laser affects the remodeling of types I and III collagen in skeletal muscle repair. Lasers in medical science, 26(6), pp. 803. Dyson, S., 2002. Lameness and poor performance in the sport horse: dressage, show jumping and horse trials. Journal of Equine Veterinary Science, 22(4), pp. 145-150. Ellenberger, W., Dittrich, H. and Baum, H., 1901. Handbuch der Anatomie der Tiere für Künstler. Dieterich’sche Verlag. Fruehwirth, B., Peham, C., Scheidl, M. and Schobesberger, H., 2004. Evaluation of pressure distribution under an English saddle at walk, trot and canter. Equine veterinary journal, 36(8), pp. 754-757. Greve, L. and Dyson, S., 2015. Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health. Equine veterinary journal, 47(4), pp. 415-421. Kaneps, A.J., 2016. Practical rehabilitation and physical therapy for the general equine practitioner. Veterinary Clinics: Equine Practice, 32(1), pp. 167-180. Kinser, A.M., Sands, W.A. and Stone, M.H., 2009. Reliability and validity of a pressure algometer. The Journal of Strength & Conditioning Research, 23(1), pp. 312-314.

Omegalaser.co.uk. Available at: http://www.omegalaser. co.uk/veterinary/equine-therapists [Accessed 7 Dec. 2018]. Paterniani, V. and Grolli, S., 2018. Approach and potentiality of low level laser therapy in veterinary medicine, Laser Florence 2017: Advances in Laser Medicine 2018, International Society for Optics and Photonics, pp. 1058205. Renno, A.C.M., Iwama, A.M., Shima, P., Fernandes, K.R., Carvalho, J.G., De Oliveira, P. and Ribeiro, D.A., 2011. Effect of low-level laser therapy (660 nm) on the healing of second-degree skin burns in rats. Journal of Cosmetic and Laser Therapy, 13(5), pp.237-242. Rizzi, C.F., Mauriz, J.L., Freitas Corrêa, D.S., Moreira, A.J., Zettler, C.G., Filippin, L.I., Marroni, N.P. and GonzálezGallego, J., 2006. Effects of low-level laser therapy (LLLT) on the nuclear factor (NF)-κB signaling pathway in traumatized muscle. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery, 38(7), pp. 704-713. Ryan, T. and Smith, R., 2007. An investigation into the depth of penetration of low level laser therapy through the equine tendon in vivo. Irish Veterinary Journal, 60(5), pp. 295. Silveira, P.C.L., Da Silva, L.A., Pinho, C.A., De Souza, P.S., Ronsani, M.M., Da Luz Scheffer, D. and Pinho, R.A., 2013. Effects of low-level laser therapy (GaAs) in an animal model of muscular damage induced by trauma. Lasers in medical Science, 28(2), pp. 431-436.

Haussler, K. and Erb, H., 2006. Mechanical nociceptive thresholds in the axial skeleton of horses. Equine veterinary journal, 38(1), pp. 70-75.

Sullivan, K., Hill, A. and Haussler, K., 2008. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine veterinary journal, 40(1), pp. 14-20.

Haussler, K. and Erb, H., 2006. Pressure algometry for the detection of induced back pain in horses: a preliminary study. Equine veterinary journal, 38(1), pp. 76-81.

Tafur, J. and Mills, P.J., 2008. Low-intensity light therapy: exploring the role of redox mechanisms. Photomedicine and laser surgery, 26(4), pp. 323-328.

Huang, Y., Chen, A.C., Carroll, J.D. and Hamblin, M.R., 2009. Biphasic dose response in low level light therapy. Dose-response, 7(4), pp. dose-response. 09-027. Hamblin.

Uemoto, L., De Azevedo, R.N., Alfaya, T.A., Reis, R.N.J., De Gouvêa, Cresus Vinicius Depes and Garcia, M.A.C., 2013. Myofascial trigger point therapy: laser therapy and dry needling. Current pain and headache reports, 17(9), pp. 357.

Liu, X., Zhou, Y., Liu, T.C. and Yuan, J., 2009. Effects of low-level laser irradiation on rat skeletal muscle injury after eccentric exercise. Photomedicine and Laser Surgery, 27(6), pp. 863-869. Moore, P., Ridgway, T.D., Higbee, R.G., Howard, E.W. and Lucroy, M.D., 2005. Effect of wavelength on low-intensity laser irradiation-stimulated cell proliferation in vitro. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery, 36(1), pp. 8-12. Murray, R.C., Walters, J.M., Snart, H., Dyson, S.J. and Parkin, T.D., 2010. Identification of risk factors for lameness in dressage horses. The Veterinary Journal, 184(1), pp. 27-36. Omega Laser (2018). Equine Therapists. [online]

Varcoe-Cocks, K., Sagar, K., Jeffcott, L. and Mcgowan, C., 2006. Pressure algometry to quantify muscle pain in racehorses with suspected sacroiliac dysfunction. Equine veterinary journal, 38(6), pp. 558-562. Wennerstrand, J., Johnston, C., Roethlisberger-Holm, K., Erichsen, C., Eksell, P. and Drevemo, S., 2004. Kinematic evaluation of the back in the sport horse with back pain. Equine veterinary journal, 36(8), pp. 707-711. Wennerstrand, J., Álvarez, C.G., Meulenbelt, R., Johnston, C., Van Weeren, P., Roethlisberger-Holm, K. and Drevemo, S., 2009. Spinal kinematics in horses with induced back pain. Veterinary and Comparative Orthopaedics and Traumatology, 22(06), pp. 448-454.

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Book Extract: Harmonious Horsemanship With Kind Permission of Sue Dyson and Sue Palmer.

All too often, pain in ridden horses is labelled as ‘bad’ behaviour. The apparently ‘sound’ horse is ‘naughty’, ‘lazy’, ‘difficult’, ‘explosive’, ‘spooky’, ‘nappy’, and more. These labels are wrong. Pain impacts all aspects of a horse’s performance, includ-ing its partnership with the rider, and its potential to progress. It does not always create lameness. Relieving pain can lead to greater potential, a deeper partner-ship, and improved performance. In ‘Harmonious Horsemanship: Use of the Ridden Horse Ethogram to Optimise Potential, Partnership and Performance’, Sue Dyson and Sue Palmer share their professional knowledge and experience. You will learn how to use a list of 24 be-haviours to check for musculoskeletal pain in ridden horses. The book includes a gripping mix of research studies, contributions from industry experts, and real-life case studies. Only by first recognising pain can we then address it through accu-rate assessment, diagnosis, and treatment. This book, full of practical tools and backed by robust science, teaches you how to use ridden behaviour to recognise the subtle signs of pain, even in horses that appear to be sound. It is for anyone who cares about the horse, whether you are an interested amateur owner or an experienced equestrian professional. To-gether, we can make the world a better place for horses.

Chapter 2 (extract) The What: Developing The Ridden Horse Pain Ethogram “The horse, with beauty unsurpassed, strength immeasurable and grace unlike any other, still remains humble enough to carry a man upon his back.” Amber Senti

Case Study: Brio By Hannah Knaebel-Seierstad “Even though I had been doing everything in my power to help her, I felt I was still failing to be the horse owner I wanted to be.”

Hannah bought Brio, a well-bred Connemara cross with high expectations to be her forever horse, to fulfil dreams of galloping cross-country, fun clinics with friends, and trail rides through the woods. However, as Brio’s workload increased, she struggled to perform. “I did everything I could think of to address her resistance: time off, a new saddle, dental evaluations, ulcer treatments, hormone treatments, supplements, groundwork, chiropractic and acupuncture treatment, more time off and another new saddle”, said Hannah. “She was never ‘lame’, and the resistance looked more like training or behavioural issues. Professionals told me it was normal young horse behaviour.” However, there are some common misconceptions amongst horse people about what may be normal responses for a young horse to training. There should be progressive improvement if training methods are correct, and the horse is pain-free. “In the barn, Brio was sweet and affectionate. She excelled at in-hand work and learned quickly. But she was entirely different under saddle: distracted and spooky, inconsistent in the bridle, hard to get forward and even harder to keep on the correct canter lead. The horse I had on the ground was very different from the horse I rode, and that bothered me.” It was watching the Equitopia webinar series on Sue Dyson’s RHpE and the as-sociated research that sharpened Hannah’s vision of what might be behind Brio’s behaviour, but the realisation also brought with it a level of guilt. “I could see my horse, her behaviour, and her expressions through clearer and cleaner eyes. “Even though I had been doing everything in my power to help Brio, I felt I was still failing to be the horse owner I wanted to be. I was hearing two conflicting viewpoints. Firstly, that of the professionals who put the ‘blame’ of Brio’s behaviour on her, or my riding skills. The other viewpoint was from Dr Dyson; that the behav-iour was no one’s fault, but an expression of pain. Of the two opinions, it was Dr Dyson’s that had supportive data that was fact-checked. “There was no more guilt or shame over my skill or her personality. I was going to find the facts that would be unmoved by personal or professional opinion. I could get off the hamster wheel of bouncing from trainer to vet to chiropractor. I was going to find facts, face them realistically, and pursue a solution.” Hannah asked a friend to video her riding Brio doing the movements that Dr Dyson recommends for application of

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the RHpE, including trotting 10-metre di-ameter circles in each direction, transitions, cantering 20-metre diameter circles in each direction. “I watched the video carefully, slowing it down as needed so that I could watch the facial expressions and counting the number of seconds a particu-lar behaviour occurred, and concluded that the RHpE score was 12 out of 24. “When I watched the video, not through training eyes, but via the lens of the RHpE, I felt both happy and sad. I was relieved that our struggles could finally be resolved, but I was disappointed that I hadn’t found Dr Dyson’s work sooner. I was certain that this was the beginning of real change for both Brio and me. “I knew it would take some work to convince my vet to do a lameness evalua-tion on a horse that wasn’t ‘lame’. I showed her Dr Dyson’s research and we talked about the RHpE.” Hannah’s vet assessed Brio in hand, after flexion tests and on the lunge. No lameness was seen in hand and Brio’s movement did not change after flexion tests, but she reacted to the hindlimbs being flexed by pinning her ears – not normal for a pain-free horse. Although she appeared sound on the lunge, Brio was reluctant to go forward, pinning her ears, swishing her tail and kicking out. Hannah then rode Brio for the vet, including circles in trot and canter and tran-sitions. The vet applied the RHpE, agreed the horse was uncomfortable, and then opted to x-ray Brio’s hocks and stifles and to acquire ultrasonographic images of the stifles. In the left stifle there was an increased amount of fluid, indicative of inflamma-tion, and evidence of injury of the distal end of the medial patellar ligament. The right stifle also had increased joint fluid. There was a hypoechoic lesion in the mid-dle patellar ligament, evidence of additional injury at the distal end of the medial patellar ligament, a roughened edge of the medial meniscus close to the medial collateral ligament, and bony proliferation on the medial side of the joint reflecting osteoarthritis. The pain was bilateral, so Brio had never presented as overtly lame on one hindlimb because both hindlimbs hurt. The stifles were ‘blocked’ by injection of local anaesthetic solution, and the flexion, lunge and ridden tests were repeated, with clear improvement. “The big-gest revelation was what I felt when I rode her. With her stifles pain-free, I had an entirely different horse. Brio was forward, happy and attentive. She was steady in the bridle, light off my leg, consistent in a soft uphill frame. Everything I had been struggling with was gone; the resistance, the spooking, the inconsistencies – all gone. She was the horse I knew she had the potential to be. I pulled up to a halt, looked at the vet, and both of us were in tears. A massive weight had lifted off my shoulders. We finally had answers.” Brio underwent arthroscopic surgery to examine and debride the damaged cartilage and remove bone chips. She then began a lengthy rehabilitation process with shockwave therapy, PRP (platelet rich plasma), and

AdequanR (polysulphated glycosaminoglycan). “Brio has continued to make good progress and is gaining strength. She will probably never be my performance horse, but I’m fine with that. The 10 minutes I had with her totally pain-free will be the most influential 10 minutes of my riding career. Never again will I blame the horse’s personality or my skill for behaviours I know from the RHpE are because of pain. The RHpE saved me from years of self-doubt, and Brio from untold pain and frustration. It’s now a regular part of my rid-ing and training programme. “While I am sad that I don’t get the fun of crosscountry jumping or collecting ribbons, Brio has given me something of the most enormous value, which is knowledge. She took me from frustration to clarity. To feel the difference of a pain-free horse means more than any show. Every horse and rider deserve to experi-ence the feeling Brio and I had for those wonderful 10 minutes; happy, connected, and moving with ease.”

Introducing The Ridden Horse Pain Ethogram What is the Ridden Horse Pain Ethogram? The Ridden Horse Pain Ethogram (RHpE) is a list of 24 behaviours, each with strict definitions, that might be seen in a ridden horse. Studies have shown that if a horse displays eight or more of these 24 behaviours, then the horse is likely to have pain or discomfort. It is important to recognise that although there may be a variety of reasons for each of the 24 behaviours, in the context of the RHpE (performance check list) it is the total number of behaviours which is the crux. A horse can only communicate pain or discomfort through its behaviour or per-formance. If a horse has been in discomfort ever since you have known it, then you might not see any changes in that behaviour or performance. This doesn’t mean the problem is not pain related, it simply means that the pain has been there since you first met that horse. We hope that one day, to overcome on-going perfor-mance and behaviour problems, riders, trainers, coaches and all other equestrian professionals will first look for physical problems in a horse, rather than trying to fix the performance problems initially by training the horse or the rider. Only once pain and discomfort have been ruled out, with the RHpE as one of the tools used to do this, should the problem be dealt with through training.

Chapter 3 (extract) The How: Learning To Use The Ridden Horse Pain Ethogram “A horse can lend its rider the speed and strength he or she lacks – but the rider who is wise remembers it is no more than a loan.” Pam Brown

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How to use the Ridden Horse Pain Ethogram “The ethogram is synergistic. The behaviours seen together produce a combined effect greater than the sum of their separate effects. To quote Aristotle, ‘the whole is greater than the sum of their parts’. If one was given the components of a motor vehicle, they would have no value unless they were combined to create a car. A behaviour in isolation does not necessarily denote pain, but behaviours creating a score of eight or more suggest a horse in musculoskeletal pain. I often explain to owners that it’s like your driving test. A certain total of minor errors reaches a threshold at which point it becomes a major error, and that equals a failure.” Jessica Mullard, equine veterinarian involved in the development of the RHpE.

It takes practice In this chapter, we take you step by step through how to use the Ridden Horse Pain Ethogram (RHpE), a performance check list, with your horse. There are plenty of reasons you might want to do this, and we discuss some of the many potential ap-plications of the RHpE in Chapter 4. Like most things, application of the RHpE is a skill that you will get better at with practice. It would be unrealistic to expect to find it easy the first few times, so don’t be put off by having to put in some effort initial-ly. If you use the RHpE regularly, you will soon find that it becomes natural to look out for the 24 behaviours. Not only that, but you will be making a positive contribu-tion to equine welfare by learning to recognise and address pain at an earlier stage.

About the authors Sue Dyson qualified as a veterinarian from the University of Cambridge in 1980. After an internship at the University of Pennsylvania and a year in private equine practice in Pennsylvania, Sue returned to Great Britain to the Animal Health Trust, Newmarket. Sue ran a clinical referral service for lameness and poor performance, attracting clients from all over the United Kingdom, Ireland and continental Europe for 37 years. From 2019 she has worked as an independent consultant, combining her horsemanship skills with her previous veterinary experience, with the aim of maximising performance potential. Sue Palmer has worked in the equestrian industry for over 25 years. During this time, she has been fortunate enough to work with some truly inspiring owners and professionals. With a BSc (Hons) Physiotherapy from Kings College London, a MSc Veterinary Physiotherapy from the Royal Veterinary College, and a BSc (Open) from the Open University, Sue has a solid education. However, the horses are, and always have been, Sue’s best teachers, and she learns more every day. ‘Harmonious Horsemanship: Use of the Ridden Horse Ethogram to Opti-mise Performance, Partnership and Potential’ by Sue Dyson and Sue Palmer is available from

www.harmonioushorsemanship.co.uk, and from all major bookstores.

Publications related to the RHpE Those marked with an asterisk are Open Access and are available via the URL. Any paper can be shared with individuals, please contact sue.dyson@aol.com Berger, J., Bondi, A., Dyson, S., Ellis, A., Lindegaard, C., Martin, C Mullard, J., Pollard, D., Quiney, L., Routh, J., Thomson, K. (2022) Letter to the Editor: Commentary on Ladewig et al. : The value, uses and limitation of the Ridden Horse Pain Ethogram. J. Vet . Behav.: Clin. Appl. Res. 57, 31-34. *Dragelund Garcia, H., Lindegaard, C., Dyson, S. (2023) Application of a Ridden Horse Pain Ethogram in Icelandic Horses: a Pilot Study. Equine Vet. Educ. doi:10.1111/ eve.13803 Dyson, S. (2019) Application of a ridden horse ethogram to horses competing at a 4-star three-day-event: comparison with cross-country performance. Equine Vet. J. 51 (Suppl. 53), 11. Dyson, S. (2020) Unexplained forelimb lameness possibly associated with radiculopathy. Equine Vet. Educ. 32(S10), 92-103. Dyson, S., Berger, J., Ellis, A., Mullard, J. (2017) Can the presence of musculoskeletal pain be determined from the facial expressions of ridden horses (FEReq)? J. Vet. Behav.: Clin. Appl. Res. 19,78-89. Dyson, S., Berger, J., Ellis, A., Mullard, J. (2018) Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J. Vet. Behav.: Clin. Appl. Res. 23, 47-57. Dyson, S., Berger, J., Ellis, A., Mullard, J. (2018) Behavioural observations and comparisons of non-lame horses and lame horses before and after resolution of lameness by diagnostic analgesia. J. Vet. Behav.: Clin. Appl. Res. 26, 64-70. Dyson, S., Ellis, A., Mullard, J., Berger, J. (2018) Response to Gleerup: understanding signals that indicate pain in ridden horses. J. Vet. Behav.: Clin. Appl. Res. 23, 87-90. Dyson, S., Ellis, A., Quiney, L., Douglas, J., Bondi, A., Harris, P. (2018) The influence of rider: horse bodyweight ratio on equine gait, behaviour, response to thoracolumbar palpation and thoracolumbar dimensions: a pilot study. Proceedings of the 14th International Society of Equitation Science Congress, Rome, p120 Dyson, S., Van Dijk, J. (2020) Application of a ridden horse ethogram to video recordings of 21 horses before and after diagnostic analgesia: reduction in behaviour scores. Equine Vet. Educ. 32(S10), 104-111.

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*Dyson, S., Pollard, D. (2020) Application of a Ridden Horse Pain Ethogram and its relationship with gait in a convenience sample of 60 riding horses. Animals 10, 1044. https://doi:10.3390/ani10061044 Dyson, S., Ellis, A., Guire, R., Douglas, J., Bondi, A., Harris, P. (2020) The influence of rider:horse bodyweight ratio and rider-horse-saddle-fit on equine gait and behaviour: a pilot study. Equine Vet. Educ. 32(10), 527-534. https:// doi:10.1111/eve.13085; Dyson, S., Thomson, K., Quiney, L., Bondi, A., Ellis, A. (2020) Can veterinarians reliably apply a whole horse ridden ethogram to differentiate non-lame and lame horses based on live horse assessment of behaviour? Equine Vet. Educ. 32(S10),112-120. https://doi:10.1111/ eve.13104 Dyson, S., Ellis, A. (2022) Application of a Ridden Horse Pain Ethogram to horses competing at 5-star three-dayevents: comparison with performance. Equine Vet. Educ. 34, 306-315. https://doi: 10.1111/eve.13415 Dyson, S. (2020) How to determine the presence of musculoskeletal pain in ridden horses by application of the Ridden Horse Pain Ethogram. Proc. Amer. Assoc. Equine Pract. 66, 334-342 Dyson, S., Bondi, A., Routh, J., Pollard, D. (2022) Gait abnormalities and ridden horse behaviour in a convenience sample of the United Kingdom ridden sports horse and leisure horse population. Equine Vet. Educ. 34, 84-95. https://doi: 10.1111/eve.13395

Animals 11, 1820. https://doi.org/10.3390/ani11061820 Dyson, S. (2021) How to assess the suitability of rider size – height, morphology and weight – for optimal horse welfare and performance: a review. Proc. Amer. Assoc. Equine Pract. 67, 223-230 Dyson, S., Bondi, A., Routh, J., Kydd, J., Pollard, D. (2021) A review of how to recognise signs of abnormal equine behaviour during tacking-up and mounting and to understand their potential clinical significance. Proc. Amer. Assoc. Equine Pract. 67, 231-239 *Dyson, S., Pollard, D. (2022) Application of the Ridden Horse Pain Ethogram to horses competing in British Eventing 90, 100 and Novice one-day events and comparison with performance. Animals 12, 590. https://doi. org/10.3390/ani12050590 Mullard, J., Berger, J., Ellis, A., Dyson, S. (2017) Development of an ethogram to describe facial expressions in ridden horses (FEReq). J. Vet. Behav.: Clin. Appl. Res. 18,7-12. Thomson, K., Chan, C., Dyson, S. (2020) Head tossing behaviour in six horses: idiopathic headshaking or musculoskeletal pain? Equine Vet. Educ. 32(S11), 58-64. Dyson, S. (2022) The Ridden Horse Pain Ethogram and the performance of sports horse: a review. Proc Amer. Assoc. Equine Pract. 68, 316-325.

Dyson, S., Bondi, A., Routh, J., Pollard, D. (2022) Gait abnormalities and ridden horse behaviour in a convenience sample of the United Kingdom ridden sports horse and leisure horse population. Equine Vet. Educ. 34, 84-95. https://doi: 10.1111/eve.13395 Dyson, S., Martin, C., Bondi, A., Ellis, A. (2022) The influence of rider skill on ridden horse behaviour, assessed using the Ridden Horse Pain Ethogram, and gait quality. Equine Vet. Educ. 34(7), e308-e317. https://10.1111/eve.13434 Dyson, S., Bondi, A., Routh, J., Pollard, D., Preston, T., McConnell, C., Kydd, J. (2022) An investigation of behaviour during tacking-up and mounting in ridden sports and leisure horses. Equine Vet. Educ. 34, e258267. https://doi: 10.1111/eve.13432 Dyson, S. (2022) The Ridden Horse Pain Ethogram. Equine Vet. Educ. 34(7), 372-380. https://doi: 10.1111/eve.13468 *Dyson, S., Pollard, D. (2021) Application of the Ridden Horse Pain Ethogram to elite dressage horses competing in World Cup Grand Prix Competitions. Animals 11, 1187. https://doi.org/0.3390/ani11051187 *Dyson, S., Pollard, D. (2021) Application of the Ridden Horse Pain Ethogram to horses competing at the Hickstead-Rotterdam Grand Prix Challenge and the British Dressage Grand Prix National Championship 2020 and comparison with World Cup Grand Prix competitions.

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Abstracts from the Australian Physiotherapy Association (APA) Conference 2023 Annette Bowen, BSc Phys Dist., MSc Vet. Phys., APAM, PhD Student.

KEY MOVEMENTS TO OBSERVE WHEN ASSESSING QUALITY OF MOVEMENT IN HORSES BOWEN, A1., RANDLE, H1., LABENS, R1., TABOR, G2 Animal 2, P 5, October 5, 2023, 1155AM – 1240pm

Aim:

Results:

Outcome measures for movement tasks are lacking in equine physiotherapy. Creating a new outcome measure for quality of movement will improve the ability to monitor treatment efficacy, therefore enhancing evidence-based practice. This study asks, what are the most commonly observed in-hand movements during assessment of horses for performance management and rehabilitation, and how are complex functional movements currently being measured?

Twenty-four in-hand movements were identified as being used more frequently than others. The movements chosen were based on the individual case presentation. Barriers include access to facilities and the training level of the horse and handler. To measure complex functional movements 81.6% agree or strongly agree a modified Patient-Specific Functional Scale would be useful.

Design: Online survey of equine sports medicine veterinarians, physiotherapists and equine allied health professionals.

Method:

Conclusion: Despite challenges in the field, a key group of in-hand movements are routinely used to observe equine quality of movement. Equine clinicians do their best to record changes in movement and have a strong desire for more relevant outcome measures.

A survey, distributed by professional associations, gained responses from 81 equine clinicians. Descriptive statistics, chi squared analysis and ANOVA along with thematic analysis of free-text responses was performed.

Key Practice Points: • There is a strong desire for outcome measures relevant to equine clinicians’ needs. • Challenges to assessment include facilities, handlers and horses training levels. • Equine professionals identified key in-hand movements which will be included in a new outcome measure for quality of movement.

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Developing a scoring system and directives for equine quality of movement BOWEN, A1., RANDLE, H1., LABENS, R1., TABOR, G2 Animal 4, P 5, October 5, 2023, 2:30PM – 3:15PM

Aim:

Results:

An outcome measure is being developed for equine quality of movement during in-hand assessment as part of performance management or rehabilitation. This study looked at selecting a suitable anchor word and scoring system for grading quality of movement in horses. Additionally, aiming to create a list of the most important features to guide scoring of each movement, to be refined into directives.

“Quality of movement” became evident as the preferred anchor word after two survey rounds. The chosen grading words were “optimal, good, mild, moderate, and severe movement dysfunction.” The number of important features was reduced over three rounds, with features reaching >75% agreement used to inform the development of the directives over the subsequent rounds.

Design:

A 5-point word and number scoring system was chosen, however, selecting the most important features and writing directives proved challenging. Achieving specific meaningful guidance needs balancing with concise, generic language. The resulting scoring system and directives will now undergo pilot testing before reliability trials.

Repeated, online survey of an expert panel (three round Delphi process.)

Method: Expert Physiotherapists were invited to be part of the Delphi process. Summary results (descriptive statistics and major themes) were presented back to the panel in subsequent survey rounds.

Conclusion:

Key Practice Points: • Translating observational expertise of practitioners into explicit language is challenging. • The meaning ascribed to directives depends on the task and the experience of the assessor. • A scoring system for quality of movement is being taken forward for pilot testing.

The above abstracts form part of a wider PhD research project and received Best Paper award in the Animal Stream at the 2023 APA Conference. They remain property of the author and reference must credit accordingly. The corresponding infographics overleaf have been provided with kind permission of the Charles Sturt University project supervisors. Questions and enquiries can be directed to the author at: abowen@csu.edu.au

References: Bowen, A.G., Tabor, G., Labens, R., Randle, H., 2023. Visually Assessing Equine Quality of Movement: A Survey to Identify Key Movements and Patient-Specific Measures. Animals 13, 2822. https://doi.org/10.3390/ani13182822 1 School of Agricultural, Environmental and Veterinary Science, Charles Sturt University, 2Hartpury University

Future work by the author: The project has since completed a discussion group and pilot testing. Plans are underway at Charles Sturt University for Reliability and Validity trials with the aim of papers on the Equine Quality of Movement Score (EQoMS) being published in 2024.

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Question & Answer Session with the President of The Register of Animal Musculoskeletal Practitioners, Jo Paul.

The Register of Animal Musculoskeletal Practitioners (RAMP) represents Chiropractors, Osteopaths and Physiotherapists working in Animal Practice. It has recently been recognised by the Department for Environment, Food and Rural Affairs (DEFRA) as a voluntary industry regulator: “Defra see’s RAMP as a voluntary industry regulator as there is currently no statutory regulator for activities undertaken by animal musculoskeletal practitioners either in the Veterinary Surgeons Act 1966 and the Veterinary Surgeons Exemption Order 2015, but it does have provisions in place that mean members are accountable to RAMP in case of malpractice, even if you have no legal powers of enforcement.” This is an important step in the process of moving towards professional autonomy, regulation, and recognition of the skills of our registrants and the wider profession. RAMP have outlined professional standards based on the human statutory regulatory bodies of the Health and Care Professions Council (HCPC), the General Chiropractic Council (GCC) and the General Osteopathic Council (GOC) and educational standards to align with pre-registration courses in human care. RAMP is currently a voluntary regulator and those who are eligible should be willing to volunteer for scrutiny from an independent and impartial industry regulator.

Q1. What is the significance of RAMP being an industry regulator recognised by DEFRA? JP: Anyone can set up an Industry Regulatory Body (IRB). IRB’s set standards, create policies and procedures for the industry to follow ensuring their registrants reach and maintain these standards. The significance of the latest RAMP news is that DEFRA have recognised RAMP as a voluntary regulatory body fulfilling this function. This provides our organisation credibility and encourages other veterinary industry stakeholders to work with RAMP.

Q2. Do professionals have to be a member of RAMP or any other IRB to practice their profession? JP: No, you currently do not need to be a member of RAMP or any IRB as there is no statutory regulation in place within animal care, whereas in human care this already exists. RAMP is a voluntary IRB which means whilst you do not need to be registered, those who choose to are demonstrating they’re willing to have their practice

monitored by an impartial and independent organisation. With more eligible practitioners choosing to join RAMP, the louder the voice of the animal musculoskeletal professions are at government level will become. This can lead to a greater impact on the industry as a whole as we are more likely to affect changes to legislation which ultimately protects animal welfare and allows each profession to flourish.

Q3. If you are a member of a Professional Association (PA) who set standards of practice and audit their members, does that mean you are already regulated? JP: In short, no. PA’s set standards for their own members, providing CPD options, mentoring and networking opportunities. They are there to support you as a practitioner. However, if there was a complaint against you the PA would find it difficult to be both defence and prosecution and any investigation may be seen as biased. An IRB exists to protect the public and any investigation is impartial regardless of what PA you are a member of.

Q4: Can you clarify what RAMP as an IRB does for its registrants? JP: RAMP represents its registrants who come from 12 PA’s. This means RAMP can represent the views of a whole industry of professionals to the Government, as well as the insurance and education industries to improve opportunities for its registrants but also the profession. DEFRA have constantly stated they prefer everyone to work together and by registering with RAMP you support the ambitions of the organisation to improve access for animals to receive safe and competent neuromusculoskeletal (NMSK) care. RAMP provide due diligence for the veterinary industry and owners alike by publishing a register of practitioners who meet a RAMP gold standard to clarify any confusion regarding where that care can be found. RAMP also hosts a complaints function and has a comprehensive investigatory process in place which functions to robustly review all complaints independent of any PA. This provides a platform for members of the public and professionals alike to raise a complaint when it is felt best practice has not been delivered.

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Q5: Why do RAMP only represent the three professions of Chiropractic, Osteopathy and Physiotherapy? Will there be a time when other professions will have an IRB? JP: The honest answer is resources. RAMP is run by a voluntary council on a very tight budget. We simply do not have the resources to include other professions. This does not mean other professions cannot have an IRB it just means presently it is not RAMP. Ultimately there will be little point in RAMP regulating the three professions if the rest of the industry are not regulated in some way. However as and when the Veterinary Surgeons Act is revamped something will need to change, and RAMP do have some thoughts which can be put forward. The best advice I can offer is for the PA’s in other disciplines to collaborate and decide on their own industry standards in anticipation of some sort of regulation.

Q6: What is the relationship between the registrant, their PA and RAMP? RAMP is already aligned with 12 PA’s and has open, dynamic communication channels with them. This enables RAMP to keep the PA’s informed on industry progress, changes to regulation standards as they occur along with any collaboration opportunities when lobbying for change. The industry PA’s can use their relationship with RAMP to feedback the thoughts of their members as well as conveying any issues they would like RAMP to consider. They may also be involved in any complaints processes regarding one of their members alongside any RAMP input. As previously mentioned, PA’s can help with further learning, skills enrichment, and professional practice ultimately supporting you in your career development. RAMP is there to independently audit and verify you reach our minimum industry standards therefore holding you as a professional accountable to at least maintaining these standards. The resultant effect of this promotes confidence to the rest of the veterinary industry stakeholder’s in having regulated NMSK practitioners.

Q.7: How likely is a change of legislation which would allow autonomous practice for NMSK practitioners in the veterinary industry? JP: RAMP would like to believe it is and we are currently working towards this aim, but only for RAMP regulated practitioners. Our longer term goal is working towards statutory regulation, most likely to involve the RCVS. However, we need to continue to prove we can competently represent the professions in animal care. RAMP have spent the last few years evidencing their standards and policies are fit for purpose regarding competent voluntary regulation. DEFRA acknowledging RAMP filling this space is monumental, but it cannot end here. The next step is to encourage all eligible practitioners to prove they are willing to be regulated by joining RAMP whilst continuing to support their PA’s. A larger, collaborative voice of professionals supports the position that we are a responsible industry and able to be accountable to an industry regulator.

Q.8: Lastly, how would you summarise RAMP’s aims? JP: T o ensure animal welfare by providing a register of professionals who can be trusted to deliver safe and effective care. • To reassure veterinary industry stakeholders that the NMSK professions have an independent IRB with transparent standards and protocols. • To provide competent industry regulation. • To encourage quality education provision to enable graduates to gain RAMP eligibility. • To gain autonomous practitioner status for RAMP regulated practitioners. • To elevate the standards of education and practice. • To gain statutory regulation for the three professions. • To gain protection of title for statutory regulated practitioners. • To empower regulated practitioners to continue to develop the NMSK professions.

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Canine Case report: Early Stage Management of Gastrocnemius Musculotendinopathy in a Border Collie Ellen Goldsmith, BSc(Hons) Phys., PGDip Vet.Phys., PGDip Sport and Exer Rehab., MCSP, HCPC, ACPAT Cat A, RAMP Email: ellen1goldsmith@googlemail.com

Introduction Client A is a 9 yr old, male neutered, Border Collie. He has existing chronic lumbosacral disease for which he was being treated with Librela, Gabapentin and Previcox. Client A had been referred to an orthopaedic specialist by a Primary Care Veterinarian after a right hindlimb lameness failed to improve after a period of rest and medication. The Orthopaedic Specialist found pain on palpation of the right lateral fabella; characteristic of gastrocnemius musculotendinopathy. Radiographic findings were osteophyte formation at the origin of the muscle and the lateral fabella supporting the potential diagnosis. In addition, mild bilateral hip and tarsal osteoarthritic changes were identified but thought to be coincidental. Client A was referred to physiotherapy six weeks after the acute aggravation of a right sided gastrocnemius musculotendinopathy. The gastrocnemius muscle is prone to musculotendinous injury due to its action across two joints; extending the tarsal joint and flexing the stifle joint, its superficial location and equal proportions of type 1 and type 2 muscle fibre types (Bencardino et al. 2000; ). Repeated myotendinous strain during exercise is reported to cause microtrauma to the origin of the gastrocnemius muscle in that the tendon fibres become overstretched,

and some of them tear. The pathology has a close affinity to border collies but is otherwise uncommon. No studies have assessed the effects of physiotherapy nor any prospective treatment protocol on gastrocnemius musculotendinopathy (Markley 2023). This case study covers the first 8 weeks of physiotherapy assessment and treatment.

The physiotherapy assessment A thorough physiotherapy assessment was performed. A problem list was compiled and is shown in table 1. From this SMART goals were drawn up; through discussion with his guardians and clinical reasoning of tendinopathy pathologies. Based on a recent systematic review and the author’s experience of treating tendinopathies these require at least 12 weeks of a targeted loading programme to have an affect (see table 2) (Dizon et al. 2023). Factors limiting the treatment programme were the client living in a bungalow, in a locality that is “as flat as a pancake”, the lack of information available on the rehabilitation of such a pathology and the author’s relative veterinary physiotherapy inexperience. These needed to be taken into account designing an exercise programme (Dycus et al. 2021).

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Problem Number

Problem

1 Right hindlimb decreased stance phase with 5/10 lameness in walk and 7/10 lameness in trot with occasional non-weight bearing. 2

Partially non-weight bearing on the right hindlimb in stance

BCS 6/9

Tendency to sit with right hindlimb in hip abduction and lateral rotation

Decrease right hindlimb protraction at 75% compared to the left side

Decreased right hip extension at 90% and right tarsal flexion at 90% compared to the left side

Minimal withdrawal response on palpation right L5/1S (known lumbosacral disease)

2cm proximal thigh circumference deficit on the right hindlimb

9 Myofascial trigger points and withdrawal response on palpation of the right gastrocnemius muscle belly and insertion. 10 Myofascial trigger points, tightness and spasm in the right thoracolumbar epaxial muscles and right hip flexor muscles 11 Reduced cardiovascular fitness as walking 3 x 20 minutes a day on the lead currently when usually walking 2 x 60 minutes a day off lead; sometimes with all day walking alongside his guardians bird watching.

Table 1

Goal

Problems addressed

Time line

Treatment

Outcome measure

Achieved

Decrease myofascial trigger points and tightness

4,5, 7-10

ongoing

Soft tissue therapy, manual therapy and laser therapy

Palpation, range of movement

ongoing

0/10 lameness in walk

1,2

4 weeks

Progressive loading programme, Soft tissue therapy and laser therapy.

Gait assessment

Week 4

1/10 lameness in trot

1,2,9

8 weeks

Progressive loading programme, Soft tissue therapy and laser therapy

Gait assessment

Week 5

12 weeks

Soft tissue therapy and laser therapy

Range of movement

Week 8

16 weeks

Progressive loading programme and progressive exercise programme

Duration of walks

At 90 minutes at week 8

5 Full right hindlimb protraction comparable to the lefthand side Return to 2 x 60 minute walks daily off lead

3, 10, 11

Table 2

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Physiotherapy Treatment While traditional treatment models of protection, rest and ice; activity modification; and education may be appropriate early in management, key meta-analyses suggest longer-term benefit of active treatment (Dizon et al. 2023). The aim of physio was to restore the tendon’s ability to withstand load. The fundamentals of progressive strengthening, lumbopelvic stability, and endurance training being taken into consideration (Dizon et al. 2023). There was also a need to address the proximal and distal kinetic chain biomechanical abnormalities caused by both concomitant osteoarthritis as well as the musculotendinopathy (von Rickenbach et al. 2021).

Exercise programme Weeks 1-4 Client A had been on Lead exercise at 20 minutes 3 x a day and this was maintained as the lameness was no worse. By week 3 when the lameness in walk had decreased to 1/10 the lead walks started to be increased by 5 minutes per week. Initially, isometric exercises were used to decrease pain (Van Ark et al. 2016). These were baited stretches and forelimb lifts. Baited stretches decrease tightness and spasm in the thoracolumbar spine maintaining a neutral spinal posture and, whilst doing less exercise, engage his brain by providing mental stimulation (Shakeshaft and Tabor 2020). Furthermore, performing these on a 2 inch raised pad encouraged increased hindlimb weight bearing and hip extension. The increase in hip extension would actively release the hip flexors from tightness associated with lameness. The movement of the head and neck would also encourage weight transference onto the respective hindlimbs. By ensuring that he was stood square, starting in the planking position, this would also build lumbopelvic stability (Rizon et al. 2023). These were performed for 1 minute twice daily. Forelimb lifts, similar to the human “superman” exercise, encourages hindlimb weight bearing and core activation. These were started at 5s x 3 twice daily and subsequently increased up to 20s x 3 twice daily according to signs of fatigue. Sit to stands on a flat surface were initiated as these provide concentric and eccentric forces through the gastrocnemius muscle with a greater range of movement than walking, therefore increasing flexibility (Dycus et al. 2021; Yosshikawa et al. 2023). Based on client A’s level of fatigue and having started at 1 set of 10 these were subsequently increased by 1 set week on week up to 3 sets of 10. Having reached this threshold, the exercise was progressed onto standing up to a raised platform of 20 cms. This further increased hindlimb weightbearing and the forces through the gastrocnemius muscle and posterior chain (Dycus et al. 2021). Walking backwards demands increased hip extension and engages the whole posterior chain to a great degree than walking forwards (Cipriani et al. 1995; Dycus et al 2021). More specifically, gastrocnemius acts to decelerate on initial contact therefore working eccentrically. With the greatest strain being through working eccentrically,

or moving from eccentric to concentric, this is an important part of the rehabilitation process (Cipriani et al. 1995). Backing up allowed this to be achieved in a controlled way. Therefore, this was incorporated once client A was walking with 0/10 lameness when the hip, the musculotendinopathy and the tarsal joint were more comfortable (Dycus et al. 2021). Initially this was done over 10 x 1m intervals and subsequently increased week on week until 3 sets was achieved.

Weeks 5 onwards Poles and cones were introduced at a walk for 1 week prior to a trot. A walk initiated a balance and proprioceptive element to the programme; elements known to affect people with OA (Dycus et al. 2021). Introducing a trot engaged a more plyometric element to the programme. The gastrocnemius tendon functions as a coil to store elastic energy to rebound; plyometrics are therefore an important part of the end-stage programme. In addition, trotting down a course of cones, set elbow to floor distance apart from one, another engaged dynamic weight transference. After introducing trotting for 1 week weaving was introduced as well as a controlled fetch of a ball from 5m which introduced increased deceleration forces.

PBM, Manual and Soft tissue therapies Hands-on treatment consisted of gentle soft tissue release, trigger point release, myofascial release and joint mobilisations. Initially the soft tissue techniques were performed with the muscle in an offloaded shortened position with the canine in side lying. Once the trigger points released, the integrity of the muscle and musculotendinous junction were further improved through using soft tissue techniques whilst taking the muscle through its full range of movement as far as was comfortable for the client. No stretches were given to the guardian so to focus on the priority of strengthening and limit the possibility of non-compliance to a minimum by only giving 3 exercises (Henry et al. 1999). Joint mobilisations were performed on the hip and tarsal joints. These joints had osteoarthritis changes identified on CT and reduced range of movement on assessment. Lateral glides where applied to the hip joint as to provide comfort and increase range of movement (Ju et al. 2015) A Chattanooga class 3b laser was used with the therapeutic dosage of 155hz 2.7J/cm2 with a cluster head to the tendon in a lengthened position. This is in line with the World Association for Laser therapy (WALT) recommendations for superficial tendons. For the hip, lumbosacral and tarsal joints continuous 8j/cm2 was used (Dycus et al. 2021). Medial and lateral aspects were treated of both the hip and tarsal joints. Both soft tissue therapy and photobiomodulation was performed weekly as although biweekly may be preferable this was not realistic in a sole-practitioner practice (Dycus et al. 2021)

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Other considerations

References:

Hydrotherapy was not used despite there being a pool in the locality. With the evidence base for land based loading being the mainstay in human treatment, together with committed guardians and an amenable canine towards exercises and not the water, there was no added benefit to client A to add hydrotherapy. Furthermore, no additional gains in posterior chain extension may be gained (Dycus et al. 2021; Bliss et al. 2022).

Allen, P. and Barclay, J. (2022). The Mechanical Properties of in situ canine skeletal muscle. Font. Physiol, 13. https:// www.frontiersin.org/articles/10.3389/fphys.022.862189

Dietary wise the client was fed on a raw diet. With increased body weight associated there may be an increased risk of stifle injury therefore a 15% reduction of food was advised (Markley 2023).

Future Going forwards, the carers often played ball with client A. Usually in the form of him driving a football around a field. With Border Collies being more at risk of agility-type injuries the carers were informed of this. A plan for the future is either his body is made more resilient through a progressive strength and conditioning programme and/ or any ball play is discontinued unless in a controlled wait and retrieve manner (Markley 2023).

Reflection The are several areas that the author identified when reflecting on the case study worthy of discussion. Firstly. when assessing joint range of movement the author could have used a goniometer as well as comparing the range to the other side. A goniometer would have provided a more accurate objective measure of improvement. There are also phone apps, such as Angle Meter, which can make this even easier which the author is going to try. Secondly, although no weighing scales were available client A did have monthly librela injections at a local veterinary surgery and therefore the Canine Arthritis Management calculator could have been used to provide a more effective weight management plan. The author was pleased to have educated carers on how tendons behave and the fundamentals of exercise progression which meant that they could make their own informed decisions whilst on holiday and wanting to do more walking with client A.

Conclusion Gastrocnemius musculotendinopathy is an uncommon injury in dogs. Following 8 weeks of rehabilitation client A had a normal gait pattern and full range of movement in all peripheral limbs. This was beyond the expectations of the author. The combination of manual therapy, soft tissue therapy, PBM and a progressive loading exercise programme proved to be successful in restoring the client to near normal exercise levels; despite concomitant pathologies. The author would consider using the same loading programme again should a similar case present. It would be beneficial to share experiences in treating such pathologies in order to establish best practice.

Bencardino, J., Rosenberg,. Z., Brown, R., Hassankhani, A., Lustrin, E. and Beltran, J. (2000). Traumatic Musculotendinous Injuries of the Knee: Diagnosis with MR Imaging. RadioGraphics, 20:suppl_1, S103-S120 Bliss, M., Terry, J., & de Godoy, R. F. (2022). Limbs kinematics of dogs exercising at different water levels on the underwater treadmill. Veterinary Medicine and Science, 8, 2374–2381. https://doi.org/10.1002/vms3.947 Cipriani, D., Armstrong, C. and Gau, S. (1995). Backward Walking at Three Levels of Treadmill Inclination: An Electromyographic and Kinematic Analysis. Journal of Orthopaedic & Sports Physical Therapy, 22:3, 95-102 Dizon, P.; Jeanfavre, M.; Leff, G.; Norton, R. (2023). Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation. Sports, 11, 53. https:// doi.org/10.3390/sports11030053 Henry, K., Rosemond, C., and Eckert, L. (1999). Effect of Number of Home Exercises on Compliance and Performance in Adults Over 65 Years of Age, Physical Therapy, 79, 3, 1, 270–277, https://doi.org/10.1093/ ptj/79.3.270 Ju, T., Choi, W., Yang, Y. and Lee, S., 2015. Effects of hip mobilization on pain and function for chronic low back pain individuals with limited range of hip joint motion. Indian J Sci Technol, 8(26), pp.10-17485. Markely, A (2023). Management of Injuries in Agility Dogs. Vet Clin Small Anim 53, 829–844. https://doi.org/10.1016/j. cvsm.2023.02.012 Shakeshaft, A. and Tabor, G. (2020). “The Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses” Animals 10, 11: 1977. https://doi.org/10.3390/ ani10111977 van Ark, M. Cook, J., Docking, S. et al., (2016). “Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial,” Journal of Science and Medicine in Sport, 19, 9, pp. 702–706, 2016. von Rickenbach, Kristian J. MD, MS1,2; Borgstrom, H., Tenforde, A., Borg-Stein, J., and McInnis, K. (2021). Achilles Tendinopathy: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports 20(6):p 327-334, | DOI: 10.1249/JSR.0000000000000855 Yoshikawa, K., Kitazawa, T., Sano, T., Ino, T. and Miyasaka, T. (2023). Kinematic characteristics of canine hindlimb movement during sit-to-stand and stand-to-sit motions, Research in Veterinary Science, 162, 104944, ISSN 00345288, https://doi.org/10.1016/j.rvsc.2023.104944.

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Case Review of Hydrotherapy Treatment for a 4 month old Puppy with Polyradiculoneuritis: Laura Haywood, RVN, Registered Canine Hydrotherapist Email: laurah_bcc@outlook.com

Summary/Introduction:

Case Presentation:

This review focuses on hydrotherapy management for a polyradiculoneuritis case, but also aims to demonstrate the benefits of working alongside other members of the multidisciplinary team (in this case an ACPAT physiotherapist) for optimal results. The case in question has been a steep learning curve and emotive in nature, but ultimately overall the desired results have been achieved.

On presentation, when I assessed this client at 5 weeks following symptom onset, she was bright alert and keen to interact with centre staff.

Background: This case discusses a female, 15- week- old German Short Haired Pointer with suspected polyradiculoneuritis. She was initially reviewed by our ACPAT physiotherapist before attending her first hydrotherapy assessment appointment. Hydrotherapy in an UWTM was identified as having the potential to be a key part of her treatment plan, alongside regular physiotherapy reviews and a home treatment programme to aim for optimal recovery for the patient.

Investigations/Diagnostics: Prior to my involvement with the patient, she was treated at Langford Referrals, after developing acute onset of tetraparesis/tetraplegia, which presented shortly after her 2nd vaccination. She underwent numerous investigations, including bloods tests and lumbar cerebrospinal fluid analysis, to determine the cause as she was previously a healthy puppy with no known health concerns. It was determined the most likely cause of this presentation was immune mediated polyradiculoneuritis. She remained an inpatient of Langford Referrals, receiving intensive care including physiotherapy and some underwater treadmill (UWTM) sessions., At the time of discharge from Langford the client was ambulatory but still needing some sling support due to residual paresis.

She presented with a body condition score (BCS) of 2/5, with globally reduced muscle bulk especially over her hindquarters. There was very mild ataxia noted during gait assessment, with intermittent knuckling most prominent in the pelvic limb paws. She demonstrated a cranial pelvic tilt and narrow base of support through her hind limbs, increased effort through transfers was also noted. There was a very mild delay in conscious proprioception through all four limbs, but she could correct herself without support from the clinician. No abnormality was evident when assessing her withdrawal reflex. On palpation there was notable tenderness through her hip flexors.

Problem List: • Ataxic gait • Intermittent knuckling of all four paws • Globally reduced muscle bulk, especially through pelvic limbs. • Reduced propulsion through pelvic limbs. • Increased posterior pelvic tilt. • Tenderness through hip flexors and lumbar region. • Reduced exercise tolerance/ fitness levels Client specific goals were to improve fitness and ability to function as a young puppy. They wished for their pet to be able to build strength to enable her to fit in with their active lifestyle.

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Treatment Delivered: Throughout the treatment process I worked very closely alongside our ACPAT physiotherapist and clinical director to provide an optimal management programme. I was also involved in assisting with a few of her physiotherapy sessions, which then allowed me to tailor her hydrotherapy treatment even further. As mentioned previously the client had received UWTM treatment at Langford Referrals, however on handover of the case we learned she had been quite anxious during those first few sessions. There were a few variables to consider as to why this may have occurred, including the owner not being present and the fact she was non-ambulatory. With this in mind, I focused initially on confidence building and acclimatisation taking into consideration her young age (and therefore her immature nature behaviourally, mentally and physically) and it was important to build a positive association to treatment. Her first session involved, as described above, lots of positive reinforcement and confidence building using the owner for lots of encouragement. By the end of session one I had achieved what I set out to which was to build her confidence with my handling and the centre as well as gently introducing her treatment. Over the next few sessions, I started to work further on correcting her gait and posture as well as proprioceptive awareness. The client attended weekly for 9 weeks, then fortnightly for 2-3 sessions. This involved the use of various alignment techniques, facilitation of her gait and some scrunchies to further encourage correct gait patterning and reducing knuckling of her paws through her pelvic limbs. Her neurological presentation improved fairly quickly after 3-4 sessions; however, she became more wary of the UWTM (more specifically belt movement) so I was more reliant on being quite imaginative with static work e.g. aquatic massage to work on the problematic areas such as tenderness through her hip flexors. Throughout treatment I continued to reassess her neurological status as well as observing transfers, gait, posture and objective markers such as muscle bulk. As part of ongoing care hydrotherapy sessions will reduce to monthly for maintenance.

Outcome/Follow Up: Thankfully we progressed well through treatment, with an improvement noted each session. However, this patient became more resistant as time went on to treatment in the UWTM despite best efforts and the use of treats/ owner encouragement/ toys, so following liaison with the physiotherapist, after the 7th appointment we decided to acclimatise her to the pool which has since proved to be far more successful in this case. This again took a few sessions, but we now are seeing a little improvement each session. The only residual issue at the time of writing this report appeared to be tenderness through her hip flexors which can mean she has reduced hind limb propulsion

initially, with some attempts to abduct her left pelvic limb. During hydrotherapy with correct alignment techniques (examples of these include asymmetrical and symmetrical alignment positioning aiming to activate latissimus dorsi and facilitate core stability) and careful encouragement of hind limb engagement she improves extension wise by the end of each treatment. Active physiotherapy management of this issue alongside hydrotherapy consisted of soft tissue massage, phototherapy and active stretches such as raise forelimbs on a peanut ball. This client was signed off from physiotherapy treatment at week 24, but she continued to attend hydrotherapy every 2-3 weeks to facilitate further strengthening, encourage increased global fitness and monitor progress.

Discussion/Reflection: There are many learning points to take away from this case and certainly whilst there has been a positive outcome for both the patient herself, and equally for the owners in terms of their treatment expectations and longterm goals, this case pushed me to think outside the box. There were some challenges which became apparent during the assessment/treatment process, and we have had to adapt across sessions based on patient response and tolerance levels along with the functional outcomes of treatment. One of our biggest challenges was working within the physical and mental capacity levels of a very young growing puppy who required a slow, steady introduction to treatment and required a slightly different approach to keep her engaged in each session. In an ideal world it would have been favourable to continue UWTM treatment for optimal gait re-education and postural adaptation, however as treatment progressed, she became increasingly resistant to this modality prompting the need for a different approach which sat within her tolerance levels. Pool therapy has turned out to suit this particular case better, it has been such a satisfying outcome to what has been a challenging case- especially considering the emotional pressure for the owners caring for such a young puppy navigating a severe condition that could well have not had such a wonderful outcome. I have learned a lot from treating this case, and it has been excellent for my professional development to be involved with a team managed client which has not been straightforward and challenged my thinking outside of the box.

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Hydrotherapy treatment as part of a multidisciplinary team approach: A case report of a Labrador Retriever with right hind lameness Abigail Heald L3Dip SA Hydro - Email: Abigailheald1@gmail.com

Simple summary A multidisciplinary team (MDT) can be invaluable when addressing a musculoskeletal injury, disorder and/or disease, this is to ensure the best rehabilitation programme possible in order to return the patient to full function as each individual skilled practitioner is able to provide different contribution factors to improve and support their diagnosis. This case report provides an overview of the effects and benefits of working effectively as a part of the MDT. From experience it is increasingly found that growth of the rehabilitation industry is having a greater effect on the care and evaluation of lameness in the canine patient, with collaborative working being suggested as the catalyst of this (RCVS, 2023). This case report aims to outline the role of the MDT from the viewpoint of a hydrotherapist with respect to the management of a client with recurring hind limb lameness.

Introduction There are multiple professionals who work alongside hydrotherapists to complement treatment and provide an overall improved management programme. This can include but is not limited to: • primary or first opinion veterinary surgeons; they are the first contact practitioners who the individual pets are registered with. They provide their regular treatment and inoculations and are also who they’d visit if unwell or presenting with injury/lameness. • referral/specialist veterinary surgeons; they become part of the team when the primary vet refers a case to a referral practice in response to a problem they have identified as needing further expertise and work up. • veterinary physiotherapists can also be involved in the MDT process. This can involve the assessment and treatment of musculoskeletal and/or neurological conditions in animals leading to the formulation of robust management programmes.

The roles of members in the Multidisciplinary Team A primary veterinarian provides the initial referral to the appropriate professional, to direct the plan regarding a conservative or surgical treatment approach. Additionally, they can dispense prescription medication, such as painkillers and NSAIDs, as well as advise on nonprescription nutraceuticals such as joint supplements. Primary vets are familiar with the animal’s entire medical history and can provide valuable guidance and advice to the owners, as they have built a good veterinarian-clientpatient relationship. Following a referral, they can supply the hydrotherapist with all the information required to understand the animal’s condition. This allows hydrotherapists to assess and adapt their programme in a specifically tailored way to meet the overall goal of an individual pet’s and owner’s needs whilst considering possible limitations. As a hydrotherapist, it is important to discuss a client’s progression with their vet so that adjustments can be made to their treatment plans appropriately. Referral and second opinion veterinary surgeons can offer advanced knowledge and skills in a variety of disciplines, they have access to specialist diagnostics/treatments such as MRI and CT scanners which can provide more detailed information regarding a pet’s condition. This in turn will assist hydrotherapy by providing deeper insight to a condition, for example where their pain is located and a specific diagnosis, leading to improved overall programmes and tailored treatment. Veterinary Physiotherapy programmes are made from a combination of movement analysis an in-depth knowledge of the anatomy of the neuro-muscular system to identify potential problems. As many physios do home appointments, they can provide useful insight regarding the animal’s environment, as well as any adaptions they have suggested to owners. This is useful when planning their program as it is more individual to their situation

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and can help them reach their full potential. Veterinary Physiotherapists also have access to electrotherapeutic machines, such as laser therapy, EMS machine, ultrasound, electromagnetic therapy and TENS. These can assist in healing, pain relief and strengthening of muscles, which will affect the hydrotherapy program, as it can facilitate changes that sometimes we may not have otherwise been able to achieve in hydrotherapy.

Case Background A 5-year-old neutered male Labrador Retriever was initially presented to the vets after owners noticed an abnormal gait and altered posture. Of note in his medical history, he previously had a period of lameness during adolescence on the right pelvic limb, which was managed with Metacam, nutritional adjustments and joint supplements. This improved the historic lameness but at present day the owner was still concerned the pet was tentative in sitting. More recently he was struggling to rise and was further offloading his right pelvic limb.

Programme progression After several home adaptions being put in place, restricted exercise and five weekly hydrotherapy sessions, the owner reported some improvement including more fluid gait and self-correction on placement of right pelvic limb. An additional stance analyser measurement was taken on completion of their fifth session. While still noting muscle atrophy, limited ROM and abnormal posture, with owners’ collaboration I recommended a referral to a Veterinary Physiotherapist. The therapist noted mild asymmetry in proximal muscle mass of pelvic limbs with reduced circumference on the right. Transitions to sitting and lying highlighted caudal pelvic tilt with external rotation and abduction of the pelvic limbs being more consistent on the right, active spinal flexion identified stiffness in the cranial thoracic region. Palpation identified reluctance of the left elbow joint line along with combined movements of flexion and internal rotation, stiffness through the cranial thoracic region with reactivity on dorsoventral pressure of T10, T13 and lumbosacral junction. Stress signals were present with hip extension and internal rotation of the right hind with overactivity in the hamstring and adductor muscle groups. He was then treated by the therapist with soft tissue techniques, class 3B laser and sent home with a range of targeted exercises. This all had the aim to help promote postural control, strength and proprioception.

Initial presentation After an initial period of lameness and discomfort of right pelvic limb the patient was put on a pain trial of meloxicam for a 10-day period. With no significant changes, following the guidance of the Veterinarian radiographs were completed showing no irregularities including no signs of dysplasia or osteophytes. As well as knuckling correction and withdrawal response within normal parameters. They were subsequently referred to Hydrotherapy initially, for treatment of suspected muscle strain. During the first session he was noted with active placement of right pelvic limb in abduction and external rotation as well as mild lordosis in the thoracolumbar.

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Discussion Since having a previous issue early on in their development, the Veterinarian originally wanted to refer the patient to an Orthopaedic specialist for further investigation. This was in order to get a definite diagnosis to better understand their condition and assist in their treatment. I think the Vet was very supportive when it came to the owner’s decision regarding their choice for an alternative treatment method before completing scans and investigations. This is key as without their support no other member of the MDT would have been able to complete their individual manipulative therapy (Veterinary Surgeons Act 1966). The combined treatments of Physiotherapy and Hydrotherapy were necessary when treating a suspected muscle strain like this. As Physiotherapy can helped to strengthen muscles and improve his mobility with targeted exercises. Hydrotherapy complimented this as the warm water can help to relieve pain and tightness which further reduces muscle spasms. (Protexin Veterinary, 2019) In my opinion, although the clinical signs justified the intervention of some method, I believe that having a confirmed diagnosis would have been beneficial. It could not be ruled out if there was a neurological issue or if it was purely an orthopaedic issue as originally suspected.

In addition to this, although the NSAIDs made minimal to no effect on his gait prior to attending both Hydrotherapy and Physiotherapy, I believe they would have been of beneficial support to continue during the treatments. There is often an element of pain linked to gait abnormalities and this can often be a factor in the progression and their ability to return to full function. At the time of writing this case report, the client remained an active client, continuing with both Hydrotherapy and Physiotherapy with the addition of prescribed home exercises for ongoing support.

References Veterinary Surgeons Act 1966 Exemptions Order 2018, SI 2018/1149. Available at: Veterinary Surgeons Act 1966 (legislation.gov.uk) (Accessed: 19 November 2023). Referrals and second opinions. RCVS. Referring a case. Available at: https://www.rcvs.org.uk/setting-standards/ advice-and-guidance/code-of-professional-conduct-forveterinary-surgeons/supporting-guidance/referrals-andsecond-opinions/ Hydrotherapy and physiotherapy. Protexin Veterinary. Article 428. Available at: https://www.protexinvet.com/ article/428-hydrotherapy-and-physiotherapy-

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Burnout and Stress in the Animal Healthcare Professional: Collaborative Working and Management Strategies.

Rebecca Wyatt, BSc Hons Physio., PGdip Vet. Physio., MCSP, HCPC, ACPAT Cat A, RAMP Email: rwyatt.physio@gmail.com

Introduction Psychoanalyst Freudenberger first introduced the term ‘burnout’ in the early 1970’s1-2. It represents a large list of predominantly subjective symptoms, alongside some physical signs in the more chronic sufferer, which ultimately as it compounds over time can lead to an individual sense of job dissatisfaction, poor mental wellbeing, impacts on decision making and ultimately leads to poor clinical outcomes for both the professional and service user alike. Whilst formal diagnoses can be difficult, several signs and patterns can emerge which if an individual is aware, can lead to both effective selfand professional management to ensure ongoing career satisfaction. There are alarming rates of mental health and wellbeing concerns amongst the UK veterinary profession, particularly that of suicide, with reported mortality ratio figures being four times that of the general population and two times that of other healthcare professions3. Animal healthcare professionals (for the purposes of this article referred as AHCP’s) are unique with some working in both human- and veterinary-care fields, often operating over long hours as lone workers in all-encompassing clinical and business roles. The exposure to stress and pressure from both clinical and non-clinical duties alongside any home life factors has the potential to create

scenarios where feelings of loneliness, reduced resilience, compassion fatigue and risk of drop out occur. It is important to be mindful of ourselves and colleagues and be open to collaborative working in an ever-competitive market with the goal of ensuring AHCP’s care for themselves as well as their clients for longevity of careers.

“Burnout is a state of emotional, mental, and physical exhaustion caused by long-term involvement in situations that are emotionally demanding.” – Herbert Freudenberger Disclaimer: The following article is intended by the author for awareness and discussion purposes only and should be appropriately referenced as so. It is not the intention of the article to be used as a substitute for diagnosis, advice, guidance, or intervention from a suitably trained and qualified mental health professional. At the end of the article is a list of helpful UK-based charities and mental health pathways if you have concerns about you or someone you know.

Definition of Burnout A work-related stress syndrome which results from chronic exposure to job stress. It has been further defined as consisting of three qualitative factors: • Emotional exhaustion, cynicism, and depersonalisation. • Reduced professional efficacy. • Personal accomplishment.4

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Fig.1. 12 stage model of burnout as described by Freudenberger7

Whilst it can occur in any professional field healthcare workers seem to be at particular risk, with the addition of the UK veterinary industry holding disturbingly high rates of suicide amongst its profession. The list of symptoms is long with most being subjective and lacking in specificity, this vagueness alongside the absence of a generally accepted definition results in burnout forming more as a syndrome. As such, true burnout prevalence figures in populations are hard to collate and identify yet seem to mainly occur in professions. Some examples of previously described symptoms include but are not limited to: • Increased commitment to goals • Reduced commitment to clients and work • A reduction in resilience • Resentment • Inner withdrawal • Poor motivation • Lacking creativity • Psychosomatic reactions (e.g. headaches, IBS-type symptoms, cardiovascular, cutaneous, allergic and musculoskeletal diseases) • Flattening of emotional and social life • Hopelessness • Reduced performance. A good reference read on the topic is “Burnout: a Fashionable Diagnosis” by Kaschka et al5. It is important to note that symptoms and experiences felt will vary from one individual to another and can manifest in the short and long term emotionally, physically, and mentally. Several models of burnout have been developed across the years (see figures 1-2) and further reading around the included reference list will provide a more in-depth investigation of the topic. It is important to note at this point that “burnout syndrome” is currently not recognised as a classified condition under the International Classification of Diseases 11th edition7.

Fig.2. Symptoms in the different stages of burnout; taken from De Hert, 20224.

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The AHCP

Reference list:

As previously mentioned, the AHCP role, specifically in the neuro-musculoskeletal fields, anecdotally tends to be one of lone working and highly competitive environments. It often features variable hours that are often unsociable to fit around client needs, repetitive and physically demanding techniques and manual handling, with varied opportunities for co-working and networking. When these elements are factored in alongside a clinical caregiving role plus the need to have business prowess and an ongoing education, it becomes clear there are many factors and pressures which unless managed, could surmount to burnout patterns. Resilience is an important skill and regularly required in caregiving/ medicine roles and research has shown that having social support can improve mental well-being and resilience8. It would be reasonable to suggest a concept for AHCP’s where mutual networking with fellow lone workers for group meetings, social interaction and even mentoring could begin to address some of the factors mentioned above. Other options can be the use of business coaches, outsourcing tasks (such as social media, invoicing, debt chasing) and the integration of technology to streamline work and create time accountability as a way of further alleviating pressure on the AHCP.

1. Freudenberger HJ. The staff burn-out syndrome in alternative institutions. Psychotherapy. 1975; 12:73–82

Strategies Suggestions from literature4 on self-management techniques and care could involve: • Exercise and sport • Reviewing the work-life balance • Making time for relaxation and recuperation

2. Freudenberger HJ. Burn-out: occupational hazard of the child care worker. Child Care Q. 1977; 6:90–99. doi:10.1007/BF01554695 3. Bartram, D.J. (2009) A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Social Psychiatry and Psychiatric Epidemiology, DOI: 10.1007/s00127-009-0030-8 4. De Hert, S. (2022) Burnout in Healthcare workers: Prevalence, Impact and Preventative Strategies. Local and Regional Anesthesia, 16, pages: 171-183, DOI: 10.2147/LRA.S240564 5. Kaschka, W.P., Korczak, D. and Broich, K. (2011) Burnout: A Fashionable Diagnosis. Deutsches Arzteblatt International. 108 (46): 781-787, DOI: 10.3238/ arztebl.2011.0781 6. ICD-11 for Mortality and Morbidity Statistics (Version : 01/2023) (2023) World Health Organization. Available at: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/ entity/129180281 (Accessed: 19 December 2023). 7. Freudenberger HJ. Counseling and dynamics: treating the end-stage person. In: Jones JW, editor. The Burnout Syndrome. Park Ridge III: London House Press; 1982. 8. Biro, E., Veres-Balajti, I. and Kosa, K. (2016) Social support contributes to resilience among physiotherapy students: a cross-sectional survey and focus study group. Physiotherapy, 102 (2): 189-195, DOI: https://doi. org/10.1016/j,physio.2015.05.002

Helpful Links:

• Affirming relationships • Humans are inherently social beings, with quality time with friends, family, significant others can form part of a type of social rest. • Developing connections with colleagues that are scheduled into the diary on a mutually agreed basis

Mind: https://www.mind.org.uk/ Mental Health UK: https://www.mentalhealth-uk.org/ NHS Mental Health Advice: https://www.nhs.uk/nhsservices/mental-health-services/ Steps 2 Wellbeing: https://www.steps2wellbeing.co.uk

• Personal well-being • This can include spiritual and mindfulness practice. Other areas which are important to consider and may require professional input include sleep, nutrition, medical care, and counselling/ talking therapies. Of course, a lot of the aforementioned require an active awareness and ability to objectively observe your own situation, and then not feel too overwhelmed to be able to effect change. An issue which could also be stressful. This is where having a professional support network and collaborative working channels can assist. Reaching out functions for both the observer and the participant to a situation, and whilst it may feel intrusive or burdening, has the potential to open the door to support, and ultimately a happier ACHP.

Call 116 123 to talk to Samaritans, or email: jo@samaritans. org for a reply within 24 hours Text “SHOUT” to 85258 to contact the Shout Crisis Text Line

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MSc student research: Hartpury University Research Poster Presentations

The effect of canine leg length and back length on stride length during walk and trot Lucinda Stott, MSc Veterinary Physiotherapy, Hartpury University Email: stott82@live.co.uk

Introduction

Objective

With over 400 recognised dog breeds world-wide (Parker, 2012; Rimbault and Ostrander, 2012) dogs have arguably become the most morphologically variable land mammal on earth today (Shearin and Ostrander, 2010, Darwin, 1859). Variable phenotypes within breeds such as, body shape, leg length and size, prevents the standardisation of the canine (Bannasch et al., 2021;

• To explore the effect of leg length on stride length during walk and trot in canines.

Shearin and Ostrander, 2010) leaning research to be conducted within breed types, thus supporting reliability and validity (Jaegger et al., 2007; Thomovsky et al., 2016; Formenton et al.,

• To determine how many stride lengths would be required by each leg length category to travel a a set distance (100 metres).

2019). Whilst breed specific research improves our understanding of the canine, it is judicious to remember research data is often not interchangeable. However, the canine leg can be measured and categorised by length, irrespective of breed, creating data that are transferable across the species. Research exploring the direct correlation within canines would appear fundamental to both canine professionals and owners alike. For example, it may help Veterinary Physiotherapists to further understand the implications of their prescribed exercise plans, such as time completing exercise therapy or time on a treadmill. To Veterinarians when prescribing post-operative exercise/walk times to owners. Furthermore, to owners trying to understand how far to walk their rehabilitating dogs, or establishing if their dog is suited to a specific canine sport.

• To explore the effect of back length on stride length during walk and trot in canines.

Additional aims

• To determine how far each leg length category would complete if they travelled a set number of strides (100 strides).

Methodology The research was conducted using a quantitative non experimental correlational design methodology. A sample of 50 canines of 34 breeds were recruited and analysed by a Veterinary Physiotherapist. Participants had their leg and back length measured, from a standing position, using a standard measuring tape. Leg length was recorded in centimetres from the acromion to the floor, and back from withers to the base of the tail. A non-slip, five-metre walk way was marked at one metre increments on the floor, and a camera positioned midpoint of the walkway. The height of the camera was adjusted to equal each participant’s leg length. Data was captured using a smartphone, analysed using OnForm smartphone technology (OnForm, 2023),

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and speed monitored using Freelap timing technology (Hayati et al., 2019). Owners walked their Dog five times along the walkway in walk, and then in trot. Stride Length data, collected via OnForm, was extracted and input onto to an Excel spreadsheet, along with the leg and back length data collected by the Veterinary Physiotherapist. This was then transferred to SPSS for analysis. Data was analysed using descriptive statistical analysis and tested for normality using a Shapiro-Wilk test. As a result, a Pearsons correlations test was used to establish its correlation coefficient relationship (Winter et al, 2016). Each leg length category mean walk will be applied to both distances covered in 100 strides and the number of strides needed to cover 100m.

Discussion It is apparent from the results that stride length increases, in both walk and trot, with increasing leg and back length. The percentage increase differs slightly depending on the various leg length categories. This was mostly evident in the smallest and longest length categories. Shorter legged dogs adopted trot as their natural gait as a method to maintain their owners natural stride length. This would suggest during regular walks shorter legged

dogs are frequently overworking to maintain pace with their owners natural walking stride. Alternatively, longer legged dog owners appeared unable to adequately stride out sufficiently to permit their dog’s natural trot stride length, suggesting dogs with a leg length over 50cm may never achieve full trot stride length within their normal on lead walks. Equally, when directly comparing the smallest to longest mean stride length, the smallest leg length dog would complete five strides to every one of the longest. This is a relevant consideration for both veterinary and canine professionals when deciding on post operative, rehabilitative, and conditioning programs.

Conclusion Leg length and back length have a direct effect on stride length, both in walk and trot. Dogs with a longer leg length have increased stride length than those with a shorter leg length. Findings were reiterated when comparing back length to stride length. These results may have therapeutic value when considering rehabilitation programs for both Veterinarians and Veterinary Physiotherapists alike. The data provides baseline information for post-orthopaedic and post-operative dogs, especially when advising daily exercise routines to owners.

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Equiband System Effect on Thoracolumbar Dynamic Spinal Stability Hindquarter vs. Abdominal Band Andrea Carnero Charles, MSc Veterinary Physiotherapy, Quantitative Research Article (HYC50078357), Hartpury University.

Introduction Elastic resistance band training aid systems are designed to improve equine performance and rehabilitation outcomes (Equicore Concepts, 2023 a). This is important to reduce injury risk, promote recovery and improve equine welfare (Dyson, 2002; Paulekas and Haussler, 2009; Horseman et al., 2016 Williams, 2020). The Equiband System consists of an elasticated band placed around the abdomen and hindquarters attached to a saddle pad. Through proprioceptive stimulation the abdominal band (AB) is designed to activate abdominal core musculature whilst the hindquarter band (HQ) activates hindlimb muscles, improving posture, dynamic stability and muscle strength (Pfau et al., 2017; Shaw et al., 2021; Equicore Concepts, 2023b). Dynamic stability reduces the risk of injury by minimising intervertebral motion, improving support for rider’s weight and is biomechanically advantageous for transmission of forces during locomotion (Robert et al., 2001; de Cocq et al., 2004; Clayton, 2012). The AB and HQ bands can be applied separately in order to achieve different outcomes (Equicore Concepts, 2023a). However, no research to date has investigated these effects on dynamic spinal stability.

T13-T18 and T18-L3.

Methodology Quantitative, randomised cross-over design, over two days three weeks apart completed at Hartpury University. Sample • Seven healthy horses (HQ n = 4, AB n = 6) of mixed breeds, disciplines, wither height (1.63 ± 0.09m) and age (12 ± 3 years) with previous training aid experience, based on Hartpury Campus. Data Collection • Eight IMUs (Xsens MTw Awinda, AN Enschede, Netherlands) placed at the poll, T6, T13, T18 and L3, tuber sacrale (TS) and bilateral tuber coxae (LTC, RTC) using double-sided tape by the same ACPAT Physiotherapist. • Speed (m/s) via timing gates (Brower Timing Systems, US).

Aims and Objectives To evaluate the effects of the AB and HQ bands, when applied separately, to differential rotational values (pitch, roll and heading) of the thoracolumbar spine in horses trotting in a straight-line in-hand. • To gather kinematic data on spinal ROM at the sixth, thirteenth and eighteenth thoracic vertebrae (T6, T 13, T18) and third lumbar vertebrae (L3) using inertial measurement units (IMUs) in horses trotting in a straight-line in-hand during four different conditions (Baseline for HQ, HQ, Baseline for AB, AB) • To describe and compare the effects of the different conditions on differential rotational values at T6-T13,

IMU marker placement

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Experimental set up

Data Analysis • Software used: EquiGait DOT software (UK), MATLAB scripts (The Mathworks, US), Excel and SPSS (US). • Differential rotational values for pitch, roll and heading at T6-T13, T13-T18 and T18-L3 reported as described by MacKechnie-Guire and Pfau (2021) (additional data collected was not within the scope of this study). • Data found to be normally distributed using ShapiroWilk test. • Related (paired) samples t-test used to determine if significant differences between Baseline and Equiband conditions (P ≤ 0.05).

Protocol

• Cohen’s d with Hedges correction reported for effect sizes.

• Acclimatisation to arena (5-minutes).

1 • Horses fitted with IMUs, Fairfax Roller, Bridle and Equiband Saddle pad (no bands).

• Warm-up lunging protocol (10-minutes = 2-min walk, 2-min trot, 1-min canter on each rein).

Ethics Approval number: ETHICS2022-262-LR, informed written consent gained from all participants. Dyson et al. (2018) ethogram used to monitor for discomfort or adverse behaviours.

• Baseline straight-line trot-up data collection. • Coin flip for randomised band allocation. • Band (HQ or AB) fitted at 30% tension as per fitting guidelines (Equicore Concepts, 2023c).

3 • Warm-up lunging protocol (10-minutes). • Equiband condition straight-line trot-up data collection.

• Above repeated on day 2, with horses fitted with alternate Equiband condition.

4 • All straight-line trot-ups for each horse speed

matched (±0.3m/s) based of first accepted trial at their preferred speed.

Results Speed (mean (± standard deviation)): 3.31 ± 0.55m/s Strides: 27 ± 10 strides Hindquarter Band: • T6-T13 all values increased, however, only statistically significant for pitch (P = 0.04), medium effect size (0.60). • T13-18 heading significantly reduced (P = 0.01), with large effect size (3.80). • T18-L3 roll and heading values reduced, however no changes reached significance. Abdominal Band: • T6-T13 all values increased, however, only significant for pitch (P = 0.05), with a small effect size (0.32). • T13-T18 significant reduction in roll (P = 0.01) and heading (P < 0.001), with large effect sizes for both (roll = 1.77, heading = 2.73). • T 18-L3 all values increased but no statistically significant changes were found.

Discussion

Equicore Equiband System. Band placement: Green - Hindquarter band Pink - Abdominal band

Findings of this study suggest that separate application of bands does not appear to induce the same stabilising effects produced when both bands are used in conjunction, as found by Pfau et al. (2017). They reported increased stability at the withers, thoracic and lumbar regions with both bands in-situ which was not the case in this study. However, Pfau et al. (2017) looked at a four-week exercise regime and data collection methods differed making comparison difficult.

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The AB band appears to be a greater stabiliser of the caudal thoracic region (T13-T18). Potentially due to greater abdominal muscle activation due to the band’s placement compared to the HQ band. This could be of importance in the ridden horse to counter-act effects of the rider’s weight (de Cocq et al., 2004).

Further research to investigate muscle activation, use of bands in the ridden horse and on the lunge are needed.

The HQ band may provide greater stability in the thoraco lumbar region compared to the AB band. Which would support findings by Stenfeldt, Ericson and Jacobson (2016), which found increased lumbar stability from HQ band alone. Therefore, HQ band may also have the potential of inducing lumbosacral flexion as shown in Pessoa use (Walker, Dyson and Murray, 2013). The bands do not replicate ridden work, likely due to the vast number of variables in the ridden horse (MacKechnieGuire and Pfau, 2021) but effects may still complement it. Horses showed a variation of individual effects; therefore, it is important to consider the effect of the training aid on each individual horse when applying in practise. Strengths: Randomised, validated IMU method. Limitations: Small sample, unknown effects of habituation, spinal posture unknown, variations in conformation/postures.

Conclusion Both bands applied separately significantly increased pitch in the cranial-thoracic region (T6-T13) and reduced heading in the caudal-thoracic region (T13-T18). The AB band significantly reduced roll in the caudalthoracic region, indicating it may be a stronger stabiliser at T13-T18 which may be of importance in the ridden horse. The HQ band may have a greater effect in the lumbar region, but future studies with larger sample sizes and lumbo sacral data are required.

(* - statistically significant results)

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References Clayton, H.M. (2012) ‘Equine back pain reviewed from a motor control perspective’, Comparative Exercise Physiology, 8 (3-4), pp. 145-152. Available at: doi. org/10.3920/CEP12023. de Cocq, P., et al. (2004) ‘Effects of girth, saddle and weight on movements of the horse’, Equine Veterinary Journal, 36 (8), pp, 758-763. Available at: doi. org/10.2746/0425164044848000. Dyson, S. (2002) ‘Lameness and poor performance in the sport horse Dressage, show jumping and horse trials’, Journal of Equine Veterinary Science, 22 (4), pp. 145-150 Available at: doi.org/ 10.1016/S0737-0806(02)70139-1. Dyson, S. et al. (2018) ‘Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain’, Journal of Veterinary Behaviour, 23, pp. 47-57. Available at: doi. org/10.1016/j.jveb.2017.10.008. Equicore Concepts (2023a) About. Available at: https:// equicoreconcepts.com/about/ (Accessed: 20th February 2023). Equicore Concepts (2023b) Research. https:// equicoreconcepts.com/research/ (Accessed: 5th January 2023). Equicore Concepts (2023c) Fitting Guide. Available at https://equicoreconcepts.com/fitting-guide/ (Accessed 6th June 2023). Horseman, S.V. et al. (2016) ‘Current welfare problems facing horses in Great Britain as identified by equine stakeholders’, PLoS ONE, 11 (8), pp. 1-19. Available at doi. org/ 10.1371/journal.pone.0160269. MacKechnie-Guire, R. and Pfau, T. (2021) ‘Differential rotational movement of the thoracolumbosacral spine in high level dressage horses ridden in a straight line,

in sitting trot and seated canter compared to in hand trot’, Animals, 11 (3) pp. 1-15. Available at doi.org/10.3390/ ani11030888. Paulekas, R. and Haussler, K.K. (2009) ‘Principles and practice of therapeutic exercise for horses’, Journal of Equine Veterindysonary Science, 29 (12), pp. 879-893. Available at doi.org/10.1016/j.jevs.2009.10.019. Pfau, et al. (2017) ‘Effect of a 4 week elastic resistance band training regimen on back kinematics in horses trotting in hand and on the lunge’, Equine Veterinary Journal, 49 (6), pp. 829-835. Available at doi.org/10.1111/ evj.12690. Robert, C et al. (2001) ‘Effects of treadmill speed on the mechanics of the back in the trotting saddlehorse’, Equine Veterinary Journal, 33 (Suppl 33), pp. 154-159 Available at doi.org/10.1111/j.2042-3306.2001tb05380.x. Shaw, K et al. (2021) ‘The effect of ground poles and elastic resistance bands on longissimus dorsi and rectus abdominus muscle activity during equine walk and trot’, Journal of Equine Veterinary Science, 107-103772. Available at doi.org/10.1016/j.jevs.2021.103772. Stenfeldt, P., Eriscon, C. and Jacobson, I (2016) ‘The effect of an elastic resistance band around the hindquarters on equine dorsoventral back kinematics’, Acta Veterinaria Scandinavica, 58 (Suppl. 2), article number A38. Available at https://equicoreconcepts.com/wp-content/ uploads/2020/03/Study2.pdf (Accessed 4th April 2023). Walker, V.A., Dyson, S.J. and Murray, R.C. (2013) ‘Effect of a pessoa training aid on temporal, linear and angular variables of the working trot’, Veterinary Journal, 198 (2), pp. 404-411. Available at doi.org/10.1016/j.tvjl.2013.07.005. Williams, J. (2020) ‘Equine training aids can they really improve performance?’, UK-Vet Equine, 4 (6). Available at doi.org/10.12968/ukve.2020.4.6.196.

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Effect of four water depths on canine forelimb kinematics utilising an underwater treadmill Katherine Seychell MSc Veterinary Physiotherapy, Hartpury University Email: Kate.seychell@gmail.com

Introduction Given the multiple orthopaedic and neurological conditions affecting forelimb kinematics, it is vital to understand the impact of altering specific parameters on the underwater treadmill (UWTM), to improve clinical outcomes based on individual needs [1]. The properties of water provide multiple advantages on canine limb kinematic and stride parameters [2,3]. However, research which can quantitatively inform evidence-based practice regarding forelimb kinematics utilising an UWTM, is limited.

F H

A B C D E

Figure 1. B

Objectives Quantify the effect of differing water depths on range of movement at the carpus, elbow and shoulder of a healthy canine’s forelimb during locomotion on the UWTM.

Demonstrate the effects of differing water levels on stride length and stride frequency of a healthy canine forelimb. To provide guidance to support clinical practice, aid clinical reasoning and inform future research.

3 Kinematic analysis (2D) was utilised to assess range of movement of the canine shoulder, elbow and carpus joints, alongside stride length and frequency. Figure 2: Canine pelvic joint range of movement. (A) Shoulder flexion/ extension, (B) elbow flexion/ extension and (C) carpus flexion flexion/ extension

Methodology 1 Eight medium to large breed dogs participated, all free from musculoskeletal abnormalities, neurological or degenerative diseases. Gender comprised of five males and three females, mean (M) age of 3.5 ± 1.06 and weight of 31.3kg ± 8.33kg. 2 Reflective markers were placed on anatomical landmarks Figure 1: (A) Dorsal border of spine of scapular, (B) greater tubercle of the humerus, (C) lateral epicondyle of the humerus, (D) ulnar styloid process, (E) distal end of metacarpal, (F) ruff wear safety harness, (G) Polar H10 heart rate sensor, (H) participant number.

Figure 2.

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4 Dogs walked at 2.4m/s for 150-seconds at 4 water depths (dry and mid-way between joints) and all dogs repeated the data collection session twice.

Carpus peak flexion 150

140

ROM (degrees ֯)

130

5 Two digital video cameras captured the data (Figure 3), and a video kinematic analysis tool was utilised to examine forelimb kinematics.

120

110

100

6 A one-way repeated-measures ANOVA was utilised to determine the effect of water depth on the range of movement of a canine’s forelimb, stride length and stride frequency.

70 Water depth

Dry

Mid-carpus

Mid-ulnar

Mid-humerus

Shoulder peak flexion 140

130

ROM (degrees֯)

120

110

100

80 Water depth

Dry

Mid-carpus

Mid-ulnar

Mid-humerus

Conclusion This investigation demonstrates the effect of differing water depths on range of movement of the forelimb joints (carpus, elbow and shoulder) and forelimb stride parameters. The findings illustrate the beneficial effects of adapting UWTM depth on range of movement, providing a greater insight into subsequent canine forelimb kinematics. The findings also provide therapists with valuable information for delivering hydrotherapy treatment to dogs with neuromusculoskeletal pathologies and provide further information on canine forelimb kinematics, which may benefit future research.

Figure 3.

Resources Results Carpus and shoulder peak flexion significantly increased when walking at various depths on the UWTM. Carpus peak flexion was significantly lower when walking on the dry, with flexion increasing at all other water depths and most peak flexion produced at the mid-ulnar depth. Shoulder peak flexion increased with higher water depths, with most shoulder peak flexion produced at mid-humerus water level. Water depth did not have a significant effect on peak flexion at the elbow, nevertheless the means from the data did highlight that elbow peak flexion was higher at mid-ulnar and mid-humerus water depth, compared to dry and mid-carpus. These results demonstrate two key points, first, they suggest that elbow range of movement remains consistent across varying water depths; second, that higher water levels produce slightly more peak flexion than at lower depths. Furthermore, there was no significant difference of extension of all three forelimb joints, stride length or frequency.

1.Bertocci, G., Smalley, C., Brown, N., Bialczak, K., & Carroll, D. (2018). Aquatic treadmill water level influence on pelvic limb kinematics in cranial cruciate ligament-deficient dogs with surgically stabilised stifles. Journal of Small Animal Practice, 59(2), 121–127. https://doi.org/10.1111/jsap.127702. 3. Levine D,. 2. Marsolais G. S. Dvorak G. Conzemius M. G. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. Journal of the American Veterinary Medical Association. 2002; 220:1325-2002. 3. Barnicoat F, Wills A. P. Effect of water depth on limb kinematics of the domestic dog (Canis lupus familiaris) during underwater treadmill exercise. Comparative Exercise Physiology. 2016; 12:119. 4. Miró, F., Santos, R., Garrido-Castro, J. L., Galisteo, A. M., & Medina-Carnicer, R. (2009). 2D versus 3D in the kinematic analysis of the horse at the trot. Veterinary Research Communications, 33(6), 507–513. https://doi. org/10.1007/S11259-008-9196-X

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Research Digest

Kinematic characteristics of canine hindlimb movement during sit-to-stand and stand-to-sit motions Yoshikawa, K., Kitazawa, T., Sano, T., Ino, T. and Miyasaka, T. (2023). Research in Veterinary Science, 162, 104944, ISSN 0034-5288, https://doi.org/10.1016/j.rvsc.2023.104944. Author: Ellen Goldsmith

Introduction Canine rehabilitation is an important field within veterinary medicine. Rehabilitation programmes commonly include the sit to stand exercise as it is both a functional movement and it is easily employed. It is therefore fundamental to understand the kinematics of the movement in order to have the knowledge to implement it within a rehabilitation programme. Only 2 reports have, to date, studied such a phenomenon. However, these used different breeds and the range of movement of both the hip and tarsal were slightly different. In humans, the sit to stand motion can be divided into 3 to 5 phases. However, no study has attempted to identify any phasic classification in dogs.

Aims: In this study, canine hindlimb kinematic characteristics of the sit-to-stand motion were investigated and the characteristics were compared with those of walking. They also tried to establish phase classification of sit-to-stand and stand-to-sit motions considering the transition of range of motion of hindlimb joints.

Methods 8 healthy beagles with no abnormalities on orthopaedic nor neurological examination, of different ages, gender and weights were habituated to treadmill walking at 0.7m/s, sit to stand and stand to sit. Colour markers were attached to anatomical landmarks of the hindlimbs of each dog. The anatomical landmarks were: • the iliac crest • greater trochanter of the femur • femorotibial joint between the lateral epicondyle of the femur and the fibular head • lateral malleolus of the distal portion of the tibia • the distal lateral aspect of the fifth metatarsal bone. Hindlimb movement was assessed using a threedimensional motion analysis system. Data was gathered from each dog performing 10 gait cycles and 5 sit to stands

and stand to sit motions each. The hindlimb angles of maximum flexion and maximum extension and the range of motion (ROM: maximum angle minus minimum angle) during walking and during a sit-to-stand motion were compared by the Wilcoxon rank-sum test (p<0.05) using R version 3.6.1 software.

Results The maximum extensions of the hip, stifle, and tarsal joints during sit-to-stand motion were significantly smaller than those during walking. The maximum flexion of the stifle and tarsal joints in sit-to-stand were larger than those during walking. On the other hand, the maximum flexion of the hip joint in sit-to stand motion was smaller than that the walking data. Therefore, ROM in the hip joint in sit-to-stand motion was half of that in walking, but ROM of the stifle and that of the tarsal joint in sit-to stand motion were two-times larger than those in walking. There was increased hindlimb external rotation during sit-to-stand motion compared to walking. The total ROM for hindlimb external/internal rotation during sit-to-stand motion was also significantly greater than that observed during walking. Movements of hindlimb joints in sit-to-stand and stand-to-sit motions were monophasic. Thus, the kinematic data indicated that sit-tostand and stand-to-sit movements cannot be divided into multiple phases.

Conclusions The results indicate that sit-to-stand and stand-to-sit motions are quite different from walking. The differences in total ROM during walking and that during sit-to-stand exercises might be important for determining appropriate rehabilitation for individual patients with a limited ROM in their hindlimbs, ranging from those in the acute postoperative phase to those in a chronic condition. In addition, sit-to-stand and stand-to-sit motions were monophasic which differs from those of human. It might be difficult to divide these motions into phases by only kinematic data alone.

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Saddle Thigh Block Design Can Influence Rider and Horse Biomechanics Murray, R., Fisher, M., Fairfax, V., MacKechnie-Guire, R. (2023). Animals, 13, 2127. https://doi.org/10.3390/ani13132127. Author: Rebecca Wyatt

Introduction Over recent years, saddle design continues to change with one aspect of this being the knee block. Knee blocks have altered in all forms transforming into more of a thigh block with varying designs, positioning, and sizes available, yet little is known about their effect on the saddle-rider-horse interaction and subsequently rider kinematics and equine locomotion. The rider’s pelvis functions as a platform for weight distribution and enabling effective limb coordination to provide cues to the horse to effect desired ridden outcomes. It is therefore important to consider and review whether any restrictions to this platform would compromise the effectiveness of the rider’s seat and therefore the synchronicity with the horse.

Aims: This study aimed to investigate the effects of two different thigh block designs on the kinematics of elite horse-rider combinations during straight line locomotion at sitting trot. It was hypothesised when using a standardised saddle under two different thigh block scenarios, it would result in differing values for: contact area and the magnitude of pressures between the rider’s seat and saddle, rider trunk and leg kinematics, and horse thoracolumbar and limb kinematics.

Methods: Eighteen elite sport horses (12 dressage and 6 event) who were deemed fit and absent of lameness and/ or orthopaedic issues following a veterinary and physiotherapy examination were included. Four FEI Grand Prix dressage riders (2 male, 2 female) and two FEI fivestar ranked event riders (1 male, 1 female) who were all healthy and uninjured were recruited. Horses and riders all underwent static and dynamic saddle fit assessments by five Society of Master Saddlers practitioners on the day of the study. A standardised saddle, girth and numnah combination was used with the only difference being the thigh block design as described below: • Thigh block S- a moulded block, 260mm long, featuring a vertical face covered in leather with no additional padding.

lumbar vertebrae (L3), the occiput, and the dorsal midline at the level of the tuber sacrale (TS). Kinematic data collected at these points were orientation-time signals for differential axial rotation, flexion-extension, and lateral bending at T5, T13, L3, as well as differential rotational movement at the TS. Two-dimensional motion capture was performed with a high-speed video camera system using 24 anatomical skin markers placed on the horses, and spherical markers placed on laterally located anatomical landmarks on the riders. The same Chartered Physiotherapist was used to initially fit and review markers between trials.

Protocol Following 15 minute warm up and stratified randomization for thigh block order, horses were ridden in sitting trot through a marked straight- line zone in an arena both in clockwise and anticlockwise directions to allow for eleven repeated straightline strides to be captured. Data analysis used Shapiro-Wilks normality test, Paired Student’s t-test and Wilcoxon sign rank test using statistical analysis software (Analyse-It for Microsoft Excel version 3), with a significance level of p < 0.05.

Results: Thigh block F had a significantly greater total contact area between the rider’s seat and saddle compared to thigh block S, and this was consistent when the cranial and caudal halves of the saddle seat were compared separately. Regarding rider seat pressures, the maximum mean and peak pressures occurred during 75-80% of the diagonal stance phase. At mid-stance phase, rider trunk kinematics had less posterior tilt and more vertical trunk alignment with thigh block F compared to S. Equine thoracolumbosacral data at T5-T13 was significantly less for flexion-extension and axial rotation with thigh block F. At T13-L3, there were no differences found in flexionextension between the thigh blocks yet, thigh block F was associated with less axial rotation and greater lateral bend compared to thigh block S. There were no differences found at L3-TS in any of the conditions/ parameters.

• Thigh block F- a deformable face, 260mm long, featuring a concave rider-facing aspect made from three closed-cell foam layering of varying density.

During swing phase, equine limb kinematics revealed thigh block F resulted in significantly greater carpal flexion than thigh block S.

Pliance seat mats were used on top of the saddle to quantify the riders’ seat pressures with habituation time for riders performed prior to testing. Simultaneous video footage was captured to help identify at which point in the stride cycle the peak pressures with each thigh block design occurred. Contact area (cm2), mean and peak (kPa) pressure data were obtained for the tubera ischii region of riders. Seven inertial measurement units (IMU) were placed on the horses at the fifth thoracic vertebrae (T5/ withers), T13, and third

This study satisfied its experimental hypothesis and concluded that it is possible to affect elite rider kinematics, rider-saddle interaction, and equine kinematics in sitting trot on straight lines in the immediate short term when comparing two thigh block designs. Longitudinal data collection would be required to evaluate the long-term effects of the differences seen in this study as well as quantifying the effect of different gaits (i.e., walk and canter), different riding positions and the impact of less skilled riders.

Conclusions:

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Equine References Clark, L., Bradley, E.J., Mackechnie-Guire, R., Taylor, A. and Ling, J., 2022. Trunk kinematics of experienced riders and novice riders during rising trot on a riding simulator. Journal of Equine Veterinary Science, 119, p.104163. Byström, A., Rhodin, M., Von Peinen, K., Weishaupt, M.A. and Roepstorff, L., 2009. Basic kinematics of the saddle and rider in high-level dressage horses trotting on a treadmill. Equine veterinary journal, 41(3), pp.280-284. Byström, A., Clayton, H.M., Hernlund, E., Roepstorff, L., Rhodin, M., Bragança, F.S., Engell, M.T., van Weeren, R., Weishaupt, M.A. and Egenvall, A., 2021. Asymmetries of horses walking and trotting on treadmill with and without rider. Equine veterinary journal, 53(1), pp.157-166. Baxter, J., Hobbs, S.J., Alexander, J., St George, L., Sinclair, J., Chohan, A. and Clayton, H.M., 2022. Rider skill affects time and frequency domain postural variables when performing shoulder-in. Journal of Equine Veterinary Science, 109, p.103805. Bye, T.L. and Lewis, V., 2020. Saddle and stirrup forces of equestrian riders in sitting trot, rising trot, and trot without stirrups on a riding simulator. Comparative Exercise Physiology, 16(1), pp.75-85. Hardeman, A.M., Egenvall, A., Serra Bragança, F.M., Koene, M.H., Swagemakers, J.H., Roepstorff, L., van Weeren, R. and Byström, A., 2022. Movement asymmetries in horses presented for prepurchase or lameness examination. Equine Veterinary Journal, 54(2), pp.334-346. O’Sullivan, S., McGowan, C.M., Junnila, J. and Hyytiäinen, H.K., 2022. The effect of manually facilitated flexion of the thoracic spine on the interspinous space among horses with impinging dorsal spinous processes of the thoracic vertebrae. The Veterinary Journal, 289, p.105909. Pressanto, M.C., Pepe, M., Coomer, R.P., Pilati, N. and Beccati, F., 2023. Radiographic abnormalities of the thoracolumbar spinous processes do not differ between yearling and trained Thoroughbred horses without perceived back pain. Journal of the American Veterinary Medical Association, 261(6), pp.844-851. Takeyama, T. and Sasaki, N., 2022. Multivariable Logistic Regression Models of X-Ray Thoracic Spinous Process Osseous Changes Findings and Body Measurement Factors Associated With Defined Over-riding of the Dorsal Spinous in Riding Horses. Journal of Equine Veterinary Science, 109, p.103839. de Souza, T.C., Crowe, O.M., Bowles, D., Poore, L.A. and Suthers, J.M., 2022. Minimally invasive cranial ostectomy for the treatment of impinging dorsal spinous processes in 102 standing horses. Veterinary Surgery, 51, pp.O60-O68. MacKechnie-Guire, R. and Pfau, T., 2021. Differential rotational movement of the thoracolumbosacral spine in high-level dressage horses ridden in a straight line, in sitting trot and seated canter compared to in-hand trot. Animals, 11(3), p.888. Derham, A.M., Schumacher, J., O’Leary, J.M., Kelly, G. and Hahn, C.N., 2021. Implications of the neuroanatomy of

the equine thoracolumbar vertebral column with regional anaesthesia and complications following desmotomy of the interspinous ligament. Equine Veterinary Journal, 53(4), pp.649-655. Rubio-Martinez, L.M., 2021. Complications of Surgery for Impingement of Dorsal Spinous Processes. Complications in Equine Surgery, pp.833-842. Story, M.R., Nout-Lomas, Y.S., Aboellail, T.A., Selberg, K.T., Barrett, M.F., Mcllwraith, C.W. and Haussler, K.K., 2021. Dangerous behavior and intractable axial skeletal pain in performance horses: a possible role for ganglioneuritis (14 cases; 2014–2019). Frontiers in Veterinary Science, 8, p.1419. Quiney, L., Stewart, J., Routh, J. and Dyson, S., 2022. Gross post-mortem and histological features in 27 horses with confirmed lumbosacral region pain and five control horses: A descriptive cadaveric study. Equine Veterinary Journal, 54(4), pp.726-739. Dyson, S.J., 2020. Unexplained forelimb lameness possibly associated with radiculopathy. Equine Veterinary Education, 32, pp.92-103. Pluim, M., Heier, A., Plomp, S., Boshuizen, B., Gröne, A., van Weeren, R., Vanderperren, K., Martens, A., Dewulf, J., Chantziaras, I. and Koene, M., 2022. Histological tissue healing following high-power laser treatment in a model of suspensory ligament branch injury. Equine Veterinary Journal, 54(6), pp.1114-1122. Dewey, C.W., Brunke, M.W. and Sakovitch, K., 2022. Transcranial photobiomodulation (laser) therapy for cognitive impairment: A review of molecular mechanisms and potential application to canine cognitive dysfunction (CCD). Open veterinary journal, 12(2), pp.256-263.

Canine References Clarke, K., Terry, J., Blake, S., Ferro de Godoy, Roberta. Kinematics and Kinetics of Dogs Walking Over Increasing Heights of Cavaletti Exercise. Available at SSRN: https:// ssrn.com/abstract=4312715 or http://dx.doi.org/10.2139/ ssrn.4312715 Carr, B.J.(2023) Regenerative Medicine and Rehabilitation Therapy in the Canine. Veterinary Clinics of North America: Small Animal Practice, Volume 53, Issue 4, 2023, Pages 801-827. https://doi.org/10.1016/j.cvsm.2023.02.011. Miyata, T., Kawai, S., Yasuki, A., Ishioka, K. (2023) Changes in physiological parameters in healthy dogs on an underwater treadmill when the water level is set at the hip joint. Research in Veterinary Science, Volume 161, Pages 20-22. https://doi.org/10.1016/j.rvsc.2023.05.013. Henea, M.E., Șindilar, E.V., Burtan, L.C, Mihai, I., Grecu, M., Anton, A., Solcan. G. (2023.) Recovery of Spinal Walking in Paraplegic Dogs Using Physiotherapy and Supportive Devices to Maintain the Standing Position, Animals, 13, no. 8: 1398. https://doi.org/10.3390/ani13081398 Edge-Hughes, L., Kramer, A.L., Acciani, R. (2023) Select Manual Assessment Techniques and Clinical Reasoning Skills Used in Canine Physical Rehabilitation Before Engaging in Manual Therapy Treatment. Veterinary Clinics of North America: Small Animal Practice, Volume

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53, Issue 4, Pages 743-756. https://doi.org/10.1016/j. cvsm.2023.02.007. Clark, N. and Comerford, E. (2023), An update on mobility assessment of dogs with musculoskeletal disease. J Small Anim Pract. https://doi.org/10.1111/jsap.13650 Monteiro, B.P., Lascelles, B.D.X., Murrell, J., Robertson, S., Steagall, P.V.M. and Wright, B. (2023), 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract, 64: 177-254. https://doi. org/10.1111/jsap.13566 David L. Dycus, D.L., Levine, D., Ratsch, B.E., MarcellinLittle, D-J. (2022) Physical Rehabilitation for the Management of Canine Hip Dysplasia: 2021 Update. Veterinary Clinics of North America: Small Animal Practice, Volume 52, Issue 3, Pages 719-747, https://doi.org/10.1016/j. cvsm.2022.01.012. Sebzda, M.K., Kauffman, L.K. (2023) Update on Brucella canis: Understanding the Past and Preparing for the Future. Veterinary Clinics of North America: Small Animal Practice, Volume 53, Issue 5, 2023, Pages 1047-1062. https://doi. org/10.1016/j.cvsm.2023.05.002.

Pye, C., Clark, N., Bruniges, N., Peffers, M. and Comerford, E., 2023. Current evidence for non-pharmaceutical, nonsurgical treatments of canine osteoarthritis. Journal of Small Animal Practice. DOI: 10.1111/jsap.13670 Olby, N.J., Moore, S.A., Brisson, B., Fenn, J., Flegel, T., Kortz, G., Lewis, M. and Tipold, A., 2022. ACVIM consensus statement on diagnosis and management of acute canine thoracolumbar intervertebral disc extrusion. Journal of Veterinary Internal Medicine, 36(5), pp.1570-1596. https:// doi.org/10.1111/jvim.16480 Gallucci, A., Dragone, L., Al Kafaji, T., Menchetti, M., Del Magno, S. and Gandini, G., 2020. Functional outcome in cats with acute severe injuries of the thoracolumbar spinal cord following intensive rehabilitative physiotherapy. https://doi.org/10.21203/rs.3.rs-47933/v2 Piotti, P., Albertini, M., Lavesi, E., Ferri, A., Pirrone, F. (2022) Physiotherapy Improves Dogs’ Quality of Life Measured with the Milan Pet Quality of Life Scale: Is Pain Involved? Veterinary Sciences 9, no. 7: 335. https://doi.org/10.3390/ vetsci9070335

Barbeau-Grégoire, M.; Otis, C.; Cournoyer, A.; Moreau, M.; Lussier, B.; Troncy, E. A 2022 Systematic Review and MetaAnalysis of Enriched Therapeutic Diets and Nutraceuticals in Canine and Feline Osteoarthritis. Int. J. Mol. Sci. 2022, 23, 10384. https://doi.org/10.3390/ ijms231810384

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Legislative reform in the animal therapy industry: The time for collaboration education and growth Fiona Dove, Vice Chair of ACPAT, MSc Vet Phys, BSc Hons Physio, MCSP, HCPC, ACPAT, RAMP Email: chair@acpat.org

Over the last few years huge excitement has been brought to the veterinary sector due to the ongoing development and discussion around legislative reform. As physiotherapists we understand the development and growth that comes with autonomy and independence in the industry. Indeed, we recognise that this also promotes collaboration within the multidisciplinary team and the wider community which also stimulates cross-professional learning, educational links, and job satisfaction. The opportunity to give back to the industry is here and we have the most wonderful platform in which to move forward. Collaboration has occurred across the industry with DEFRA engaging with stakeholders to gain information, RAMP bringing together many professional groups, ACPAT lobbying in parliament for a rise in animal welfare standards and of course our membership collaborating locally in regional groups. Having been part of an exceptional regional group in the early part of my career, I always find this of significant use to facilitate both learning and to enable a collaborative approach to education.

Progress has also been made in the educational sector with ACPAT recently showcasing an excellent seminar with many of our own evidence-based, client focussed practitioners presenting. In addition, there has been some wonderful contributions to research from our student population and from established ACPAT clinicians obtaining PHD’s. I feel extremely passionate about making sure the future of animal physiotherapy remains current and evidence based, therefore it is delightful to see so much research being performed across the industry. It is in our power to ensure we are advocating for the very best treatment using our research, and clinicians across the industry. Finally, we are at the precipice for growth and development of our industry, and this is incredibly exciting. We have an opportunity to really showcase the very best of animal therapy, safeguarding our industry and the clinicians of the future.

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