17 minute read
Horses Inside Out Conference - 2nd and 23rd February 2020
from ACPAT Journal 2022
by ACPAT
Horses Inside Out Conference : 22nd and 23rd February 2020 Holywell Conference Centre, Loughborough University, England
Sue Palmer MCSP, IHRA, ACPAT and RAMP Chartered Physiotherapist, BHSAI
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CPD hours: 16
Speakers:
Gillian Higgins
Vibeke Elbrond David Kempsell
Dr Seth O’Neill Dr Andrew Hemmings
Dr Sue Dyson Mark Johnson
Richard Hepburn Celeste Wilkins
Did you know that if you rest for 5 days after a tendon injury rather than keep moving appropriately, you could delay your healing for 3 weeks? Did you know that the liver is connected to the jaw?
Gillian Higgins and the Horses Inside Out team presented their annual Horses Inside Out conference on Saturday 22nd and Sunday 23rd February at the Holywell Conference Centre, Loughborough University, and I was lucky enough to be one of the attendees. The presenters, as always, were world class. The theme of this year’s conference was ‘Anatomy in Action’, with a particular focus on the role of fascia, tendons, ligaments, muscles and internal anatomy, as well as hoof anatomy, the thoracic sling, an examination of lameness diagnosis, and how to hel horses struggling with poor performance (yep, you’re absolutely right if you’re thinking that’s a lot of information to cover!).
Throughout each of the breaks and through lunch the presenters were available for individual questions (or perhaps they were cornered by audience members!), and Mark Johnson in particular invited us to go and see the hoof specimens and the specialised shoe that he’d brought with him. I’ve been to several Horses Inside Out conferences, and one of the things that Gillian and her team have done in response to feedback is to make the breaks much longer than they used to be, which allows more time for catching up with friends, browsing the stalls, reading the scientific posters and questioning their authors, blowing your mind at the stunning anatomical displays, and of course questioning the presenters.
Saturday 22nd February
Gillian Higgins
Gillian opened the conference at 8.50am with a discussion of anatomy in action. I learned, to my surprise, that Eadweard Muybridge created what is believed to be the world’s first moving picture, and it was of a galloping horse! He was working to answer the question of whether all four feet of the horse were off the ground during a trot stride. Cameras at the time did not have a fast enough shutter speed to capture movement, and Muybridge worked to change this. He invented the ‘zoopraxiscope’ to present 12 images of a galloping horse, hence the ‘moving picture’.
Gillian is releasing her own catalogue of ‘Anatomy in Action’ this summer, a unique fold out photographic anatomical catalogue of equine movements illustrating the versatility, strength, beauty and athletic prowess of the horse in motion, available this summer. Judging by the quality of her current books and DVDs, this will be one to look out for.
Associate Professor in Anatomy and Biochemistry at the Department of Veterinary and Animal Science with a PhD in Anatomy and Physiology and a research field in biomechanics / functional anatomy with a focus on the functionality and integrity of fascia.
Vibeke’s talk was titled ‘Understanding Locomotor Myofscial Connections’. ‘Myo’ is muscle, and ‘fascia’ is a connective tissue that is spread throughout the body. As a Chartered Physiotherapist, I have long been fascinated by fascia, and I manipulate it on a daily basis to improve the comfort and performance of the horses I treat. Fascia has many roles, including the force transmission of muscle contractions onto tendons, bones and other muscles, shock absorption, and the exchange of kinetic and elastic energy. The ‘myofascial lines’ are connections of muscle and fascia that, on dissection, have been shown to travel from one part of the body to another. Think of it a bit like a train, with the muscles as carriages and the connections as the fascia. There have been found to be many different myofascial lines, which provide a 3D full body network of balancing structures. This helps to explain the connections between one part of the body and another, both during standing and in motion, and may also explain how compensatory mechanisms develop and show up in the body. To help describe the importance of fascia in the body, Vibeke referenced Tom Myers, author of Anatomy Trains, as saying ‘We are one big muscle in 600 different bags’.
Take home messages:
“We are one big muscle in 600 different bags” Tom Myers
Warm up and cool down is important in terms of fascia.
The myofascial kinetic lines balance the body in a 3D network in standing and in motion.
David Kempsell: The thoracic sling connection
Saddler and Managing Director of Firth Thought Equine Ltd, which bases it’s products on scientific research and has revolutionised the saddle industry.
The thoracic sling in the horse is the set of muscles, tendons, fascia and connective tissue connecting the horse’s front legs to the rest of it’s body. This is important since the hrose doesn’t have a collar bone. David introduced us to the idea of asymmetry in the horse being as a result of shorter muscles on one side of the thoracic sling than on the other. This, he postulates, leads to shorter leg length on one side (usually the right fore), which in turn affects the balance of the rib cage. He took us through one of his many case studies where he has measured the pressures under the saddle in the ridden horse whilst making adjustments to leg length (by placing pads under the shorter foot), or to the saddle fit (by increasing or decreasing the air in the pads front / back / left / right as appropriate).
Which comes first – the horse or the rider???
In David’s tests, he found that 95% of riders had more weight through their left seatbone, which in turn means their bodyweight is tipped to the right.
We need more research into the musculoskeletal imbalance of riders, and how this affects their weight distribution in the saddle.
Dr Seth O’Neill: Tendons and tendinopathy management
With his PhD ‘A biomechanical approach to Achilles tendinopathy management’, Seth, a Chartered Physiotherapist, has clinical and research interests focusing around tendon disorders, in particular lower limb tendinopathy and rupture, and is particularly interested in improving treatments and preventative strategies.
I don’t suppose I’ll ever forget the video clip that Seth showed of a person snapping their achilles tendon! It makes a noise like a gun going off, and is really not nice to watch!
Tendinopathy (damage to the tendon) generally happens over time. The research shows clearly that damage occurs when ‘loading is excessive for the maintenance of tissue homeostasis’. Basically, this means that damage occurs when the rate the body is ‘wearing’ is faster than that at which it is ‘repairing’. Over time, the overworked tendon effectively degenerates. Ultimately the tendon’s structure and material properties change and the tendon becomes less resilient. Because of this reduced resilience, injury is then more likely to occur even under normal work load. This provides important information on how we can approach exercise and training to give our bodies the best chance of maintaining healthy tendons, and trainers can provide programs that are informed by science. Since the structure of the horse’s tendon is similar to that of a human tendon, the research can also be applied to training our horses.
Take home messages:
Prevention is better than cure.
Overload is the predominant factor in developing tendinopathy in humans.
If you rest completely for five days after a tendon injury, rather than keeping moving at an appropriate level for your injury, you could delay your healing by up to three weeks!
Principal Lecturer in Equine Science and head of department (Equine Management and Science) at the Royal Agricultural University, Cirencester, Andrew’s main expertise and interest are in brain function in relation to behaviour.
Understanding the mechanisms in the brain that underpin behaviour helps us to understand the behaviour itself. Equally importantly, it helps us to understand how we can affect that behaviour, and how what we do may reinforce or reduce that behaviour. Andrew’s talk featured heavily on the neurotransmitter dopamine (a substance your body uses to send messages between nerve cells). Dopamine is pivotal in learning, and in directing and motivating the animal towards positive resources and away from potentially harmful aversive (unpleasant) stimuli. Understanding the brain better enables us to develop better training techniques, and also to improve the husbandry of the horse.
Take home messages:
When a horse learns, there are physical changes in the brain. This takes time and energy, and cannot happen as effectively if the horse is tired or stressed.
The physical changes in the brain need time to consolidate.
Understanding the brain better will allow us to train and care for our horses better.
Dr Sue Dyson: Why is the horse struggling in it’s performance – could it be helped?
A world-renowned expert in equine orthopaedics, with a particular interest in poor performance and subtle and complex lameness in sports horses, Sue has trained horses and competed at national level in both eventing and show jumping. She is an expert in diagnostic imaging, radiography, ultrasonography, scintigraphy and magnetic resonance imaging, and has published more than 250 papers in scientific journals.
Sue discussed the development of the ‘ridden horse ethogram’, a set of behaviours that indicate that a horse is in pain or discomfort. This ethogram has been developed through several scientific studies carried out at the Animal Health Trust, beginning with assessing photographs of horses and progressing to video assessment, and then using the ethogram live. The ridden horse ethogram consists of 24 behaviours, such as ears back, mouth opening, tongue out, going above the bit, head tossing, tilting the head, unwillingness to go, crookedness, hurrying, changing gait spontaneously, poor quality canter, resisting, stumbling and toe dragging. Sue and her team have shown that the presence of eight or more of the 24 behaviours warrants further investigation for pain or discomfort. She pointed out the importance of recognising pain in horses, to enable earlier recognition of lameness, and to avoid punishment-based training.
Take home messages:
Horses who are ‘misbehaving’ may be in pain.
The presence of several different ‘bad behaviours’ in the ridden horse could be an indicator that pain may be present.
Lack of recognition of pain behaviour in the ridden horse can lead to punishment based training.
Sunday 23rd February
Mark Johnson: Hoof anatomy in action
A qualified farrier with an interest in horsemanship, Mark focuses on finding the best and innovative ways to manage horses’ feet, ensuring they are comfortable and thus perform well for their owners. Mark is also a leading campaigner in the ‘Hope for Horses’ campaign, and is passionate about the welfare and well being of all horses.
Promoting shoeless where possible, Mark talked about health hoof anatomy, with some fascinating videos of the dissected hoof. He began by talking about the newborn foal, and the importance of a variety of surfaces for optimal development of the hoof structures. Could we be risking the future health of our horses by keeping them on the ‘same’ surfaces, such as in a stable or a grass field? I think it’s possible. He went on to discuss internal hoof structure, and how the creation of space to allow blood and lymphatic fluid to circulate efficiently is essential for optimal hoof performance. Again, his discussion was supported by video footage. Mark promoted the use of hoof boots where necessary, and also gave examples of his use of the Duplo composite shoe which he has found beneficial where 24/7 protection for the hoof is needed.
The health of the hoof of the newborn foal could affect the future health of the horse.
If your horse is unable to work shoeless, consider hoof boots.
Associate Professor in Anatomy and Biochemistry at the Department of Veterinary and Animal Science with a PhD in Anatomy and Physiology and a research field in biomechanics / functional anatomy with a focus on the functionality and integrity of fascia.
On the Sunday Vibeke showed us how the fascia that connects the muscles also connects to the internal organs. This, to be honest, is just mind blowing (as well as mind boggling). Her team have dissected out the deep ventral line, with connections to muscles as well as vital organs and structures of the body cavities. This might give rise to a new approach and explanation for viscero-somatic pains and interactions, for example kidney and / or ovarian problems related to lumbar pain. The ‘deep dorsal line’ includes muscles within the spine and also has an indirect contact to the meninges (dura mater), forming a connection known as the ‘myodural bridge’, which is believed to be involved in circulating cerebrospinal fluid. Who knew that touching the outside of a horse could potentially have an effect at such a deep level?!
Take home messages:
Everything in the body is connected to everything else.
What’s on the outside affects what’s on the inside.
The body is a miracle of engineering!
Dr Sue Dyson: What is new in lameness diagnosis?
A world-renowned expert in equine orthopaedics, with a particular interest in poor performance and subtle and complex lameness in sports horses, Sue has trained horses and competed at national level in both eventing and show jumping. She is an expert in diagnostic imaging, radiography, ultrasonography, scintigraphy and magnetic resonance imaging, and has published more than 250 papers in scientific journals.
Sue discussed several recent studies with us, in relation to lameness and poor performance. It’s so important to look for scientific evidence to support the tools used in diagnostics and treatment, and to continue to evaluate their effectiveness. For example, a recent study suggested that a bone scan is unlikely to lead to a full and correct diagnosis of the cause(s) of lameness or poor performance in sports horses. Pattern recognition has been used to suggest that certain unexplained forelimb lamenesses might be related to cervical nerve root compression. Pattern recognition has also been used in a study into horses with proximal suspensory desmopathy (PSD) who also had suspensory ligament injuries, which suggests that horses up to 5yrs old (including those who have not done any work) and overweight horses were more likely to have suspensory ligament injury alongside PSD. One study which shocked me showed that only 11% of people could correctly identify whether a horse was obese.
Take home messages:
If your horse is struggling with poor performance, find a good vet!
No all techniques that are used to diagnose obvious lameness are as helpful in finding the root cause of poor performance.
Look for / ask for scientific evidence to support the techniques used in diagnositics and treatment of your horse.
Richard Hepburn: Tuning the equine engine to prevent poor performance
Richard joined Willesley Equine Clinic in 2004, after completing a three year residency and Masters degree in equine internal medicine at the Marion DuPont Scott Equine Medical Center in Viginia, USA. He is a Diplomate of the American College of Veterinary Internal Medicine and a RCVS Recognised Specialist in Internal Medicine.
Richard talked about respiratory disease and gastric ulcers in particular. An incredibly knowledgeable man and a good speaker, his presentation was heaped full of information. He pointed out that differences in athletic ability are mainly due to breed and individual variation, rather than to a better training regime, but there are some things you can do to help your horse perform better. These come into the categories of 1. Changing the things you can change, i.e. those that respond to training, and 2. Limiting limiting factors, i.e. reduce the effect of things that cause a problem.
One of the limiting factors is respiratory function, since it doesn’t improve with training. Dynamic upper airway obstruction and inflammatory airway disease (equine asthma) are common in horses with poor performance, and Richard recommended preventative airway scoping for sports horses.
Equine Gastruc Ulcer Syndrome (EGUS) is not necessarily related to poor performance or behaviour, and it’s important to figure out which ones need treating. There’s a vicious circle involved where EGUS can cause stress and stress can cause EGUS (depending on the individual horse, stress might include transport, exercises, stabling, having another disease or illness, having more than two handlers). Some suggestions for reducing the likelihood of EGUS included:
• Feed corn oil or rapeseed oil
• Regular haynets (less than every six hours)
• If hay is limited, feed 80% during the day, 20% overnight
• Give hard feed before hay (this increases the saliva rate, which in turn helps to soften and break down the hay)
• Feed a mix rather than pellets, to provide layering in the stomach
• Feed chaff before exercises
Take home messages:
Preventative airway scoping is advised for sports horses.
In man, colonic (hind gut) ulcers are largely asymptomatic (do not cause problems).
Gastric ulcer supplements are preventative, but not curative (they can help prevent the problem, but they cannot fix it).
Celeste Wilkins: How to ride a horse – unravelling the postural strategies of dressage riders
Studying for a PhD in rider biomechanics and performance at Hartpury University, Celeste is using a Racewood Eventing Simulator and 3D motion capture to study rider biomechanics. Her studies aim to use movement analysies to improve our understanding of riders technique, with implications for both training and rehabilitation of riders in the future.
Every rider has a strategy to absorb the movement of the horse that is influenced
by their anatomy and physiology, as well as skill, horse, goals, confidence, etc. Celeste is researching these strategies, focusing on identifying the components of rider strategies. She uses the Racewood Event Stimulator at Hartpury. Cameras track markers placed on the rider and allow her to compare riders using numbers, such as angles, displacement and velocity. The results of her ongoing research will make for better coaching, more efficient rehabilitation, and off horse training that focuses on the individual riders needs.
Take home messages:
Riders are looking for a combination of stiffness and softness that results in harmony.
Your unique way of accomplishing that is called your ‘rider strategy’.
Studies show that advanced riders seem to have more stable movement patters that rely less on visual cues and sit centrally in the saddle.
At the end of each day there was a ‘panel discussion’. Audience members were invited throughout the day to write their questions down and put them in a box, which Gillian sorted through and presented to the presenters as a group on the stage. Some of the questions were aimed at just one presenter, but many benefited from collaborative answers, and so several of the presenters gave their thoughts. Bringing things to a close, Gillian asked each of them for their ‘top tip’. Sue talked about the importants of looking, feeling and seeing, and really thinking about what we look, see and feel in our horses. Seth recommended looking at the riders for asymmetry and considering how this might affect both horse and rider. Vibeke advised us to learn to look and see, and to think about what we see. Celeste pointed out that we are all individuals, and to embrace our individual patterns. She also talked about staying curious, and grabbing whatever opportunities come our way. Andrew reminded us that there are microanatomical (physical) changes that occur in learning which require both time and a relatively stress free environment, and so if we want our horses to learn then we must provide them with these things.
Conclusion
At the end of day one I was on a high, regaling my sister with the many highlights of the day. By the end of day two, I was cooked, my brain completely fried. It’s a feeling I always get from a good learning opportunity, and I relish it. Next year the conference is at Belton Woods Hotel (NG32 2LN) on Saturday 21st February for a theoretical day then Arena UK (NG32 2EF) on Sunday 22nd February for a practical day. For more information visit www.horsesinsideout. com. See you there!
Physiotherapy for Spinal Cord Dysfunction
Out-patient care
• Gait re-education to reduce compensatory patterns of movement • Proprioceptive, balance and co-ordination exercise • Muscle strengthening and core stability training • Owner education and home exercises • Physiotherapy for Spinal • Cord Dysfunction
In-patient care
• Pain management laser, pulsed electromagnetic energy, transcutaneous electrical nerve stimulation • Functional positioning sternal lying, sitting, assisted standing • Maintain normal range of movement • Normalise tone • Encourage voluntary movement • Hydrotherapy
Research
Draper et al. (2012) found 3B laser reduced time to ambulation in dogs post laminectomy by 50%. Gandini et al. (2003) found that 36/54 dogs with FCE that underwent physiotherapy, starting within 24-48hrs of onset, achieved spontaneous paw positioning in 2 weeks. This was supported by Kathmann et al. (2006). Nakamoto et al.(2009) found that 21/26 dogs with fibrocartilaginous embolism improved with physiotherapy in 2 weeks but continued to improve up to 2 months after onset. They indicated that physiotherapy should be continued with follow up visits during this time.
