CONTENTS
2. Welcome
An introduction from ACPAT Chair, Megan King.
3. A Tribute to Mary Bromley
A touching eulogy by Kate Hess
4. A Review of the 10th IAVRPT Symposium
Overview and abstracts from the International Association of Veterinary Rehabilitation and Physical Therapy (IAVRPT) meet
6. The Effect of Low Level Laser Therapy on Canine Hip Arthropathy
Hannah Oliver-Byrne MSc BSc ACPAT Cat A from Combined Physio Ltd
14. Critical Review of Physiotherapeutic Management/Treatment of a Horse Following Surgery for Over-Riding Dorsal Spinous Processes
Wareham, N., Hutson, P. and Tabor, G. (Hartpury University, Gloucester, GL19 3BE)
20. Global Positioning System Derived Performance Measures are Responsive Indicators of Physical Activity, Disease and the Success of Clinical Treatments in Domestic Dogs A Review by Libby Hope MCSP ACPAT B 22. International Conference of Equine Exercise Physiology (ICEEP) Update
Lynne Harrison MCSP ACPAT A
26. Critical Review of the Evidence Supporting Physiotherapeutic Management of Equine Sacroiliac Regional Pain
Wareham, N., Hutson, P. and Tabor, G. (Hartpury University, Gloucester, GL19 3BE)
30. Research Digest
Manessa Faal MCSP ACPAT A
34. Sharon May-Davis Dissection Course
Course Review by Sally Cinnamond MCSP ACPAT A
36. Should Ice Just be for Our Gin and Tonic?
Dr David Marlin
38. Recent Research Publications 41. Book Reviews 43. Writing for Four Front
1
Welcome from ACPAT Chair – Megan King
M
embers of ACPAT, I would like to welcome you to this year’s edition of Forefront, made possible by the hard working Journal and Research committee members – Robyn Dunn, Emma McCagherty and Amy Shakeshaft. It is a privilege this year taking on the chairmanship of ACPAT with a very new but incredibly enthusiastic committee alongside me, who are working hard to get our many new events, training courses and new ventures running smoothly. I have been on the committee for four years in education, international liaison and vice chair roles, each providing me with a new insight into how our professional network fits into a much larger professional organisation. This has enabled me to attain a more comprehensive understanding of how
we can best work to benefit ACPAT now and into the future. As we grow, it is important to keep developing our standing as physiotherapists in the veterinary world and to continue to build our relationships with veterinarians and other allied professionals. It is also a very exciting year ahead as we look forward to the IAVRPT 2020 Symposium next August. A talented and experienced ACPAT team led by Di Messum are working very hard behind the scenes to make it an event not to be missed. Our courses team have done a wonderful job providing a wider selection of courses on the request of our members across small and large animal areas. We have had good attendance on these courses and apart
from learning and refreshing new skills, it is also an opportunity to catch up with our colleagues. The website and social media this year has been going from strength to strength. We have been working hard to sharpen the way information is reaching our members as well as the wider public and we have received some terrific feedback. We have now re-established an ACPAT newsletter after a two-year hiatus, which is being sent out seasonally this year to all of our members. We look forward to updating you on the latest news throughout the year. It is a privilege to be a part of such a wonderful organisation and it has been a great experience working with such an enthusiastic group of people who make things happen.
Looking forward to updating you with more news!
Megan .
2
A Tribute to Mary Bromiley MBE FCSP
M
ary Bromiley’s appearance at the Sydney 2000 Olympic Games triggered a surge of excitement in the horse hospital, followed by a mass exodus as everyone beelined to the New Zealand three day event stables hoping to catch a glimpse of the renowned equine physiotherapist. It was as though the Rolling Stones had arrived; such was the buzz around Mary who had a kind of rock star status of her own. I deliberately waited a couple of days to allow the hysteria to settle, but before I could arrange an introduction to the revered grandmother and queen of my profession, there was a tap on the shoulder, and I was summonsed to meet her. It felt like being at school and going to the headmaster’s office, but Mary immediately put me at ease with her warm smile, relaxed demeanour and ready wit.
she thought what you were saying was even slightly ridiculous, you knew it before you could finish your sentence. She would give you that look, or there would be an uncomfortable pause over the phone. It was no wonder that in some circles she was affectionately known as scary Mary, but this contributed to her tremendous success as a teacher and was part of her colourful character and widespread appeal. Emphatically spoken, some of her best advice to veterinary physiotherapists was (1) to do the job and not look like you’re standing there patting a horse; (2) to be honest and not afraid to say when you have been wrong; and (3) to converse with the owner, trainer and stable staff in their language.
· Mary Bromiley · 1931 - 2019
Always a stickler for anatomical detail and in-depth knowledge of the patient’s discipline, Mary developed a reputation for no nonsense.
Perhaps Mary’s greatest professional achievements were in horse racing where her work did the talking. In a tough, male-dominated industry, Mary earned the admiration of those at the very top. Sir Michael Stoute, tentimes champion trainer of British Flat racing, said “Mary was a fascinating lady with a prodigious knowledge of her subject. If you were interested, she was the most brilliant teacher”. Martin Pipe CBE, fifteen-times champion trainer of National Hunt racing whom Mary helped with over 4000 winners, described her in the Racing Post as “the best equine physio in the world”. He went on to say “Mary could just look at a horse and tell us what was wrong. She could see things nobody else could see”.
She was a formidable force in her relentless pursuit of high standards and was unapologetically straighttalking with those who fell short. If
Her incredible powers of observation and affinity with horses were quickly apparent. She possessed an innate horsemanship and was unflappable
Mary also became an accomplished author of several books and contributed to numerous veterinary and equestrian publications. She lectured internationally, set up an equine sports massage diploma course, and delivered practical sessions at the Royal Veterinary College on the MSc Veterinary Physiotherapy programme.
She found no greater satisfaction than in rehabilitating a cast-aside animal to good health. A grassroots kind of person, she would have baulked at being called a celebrity in equestrian sport, but that’s what she was. Always humble, she specialised in selfdeprecating humour, telling Horse & Hound that she was shocked to receive an MBE and considered sending it back the following year when Tony Blair’s hairdresser got one. Inside the cover of her third edition of Equine Injury, Therapy and Rehabilitation which she kindly sent me, she scribbled “Another 200 pages of garbage!!”. Mary was exceptionally kind and generous. She gave me advice when I asked for it, and even when I didn’t, but always when I needed it. It encompassed everything from complex cases, to tricky trainers, awkward vets, and navigating the pitfalls of business.
Beyond Sydney we developed a lasting friendship and Mary, who was older and infinitely wiser, became a trusted mentor. I regarded her like a cool aunty - the slightly nonconformist one for whom no topic is off limits. As the most prominent pioneer of veterinary physiotherapy, Mary was among the founding members of ACPAT, and was the first chairperson. Around the same time, with the help of her two daughters, she established a world-first specialist rehabilitation facility for horses, Downs House, in 1984. Her results helped win over the trust and respect of the veterinary profession.
around high-spirited horses, not giving them the slightest sniff of adrenaline. Money was never her motivation; it was always a love of the job and genuine compassion for injured animals.
3
My favourite chats however were the personal ones when she would share stories from her life and point me in the right direction in mine - regarding family, people, travel, education, marriage, divorce, survival and selfbelief. We didn’t always agree but when I look back, I realise that Mary, ever the wise owl, was pretty much always right. I feel so privileged to have known her and called her my friend. I speak for ACPAT when I say she will always be fondly remembered, and her legacy will live on. Mary passed away on 7 September 2019, aged 88. She is survived by sons Nick and Sam, daughters Pelly and Rabbit, and grandchildren Tom, Katie, Mat and Morgan. Kate Hesse On Track Physiotherapy Ltd Newmarket
The 10th Symposium for the International Association of Veterinary Rehabilitation and Physical Therapy (IAVRPT) Diane Messum HPCP MCSP BSc(Hons) MSc ACPAT Cat A
T
he 2018 symposium was held at the Knoxville Convention Centre in Tennessee, just a short distance from the University of Tennessee and home to the co-founders of the IAVRPT and the Certificate programme for Canine Rehabilitation Practitioners (CCRP), Darryl Millis and David Levine. The day before my arrival there had been wetlabs, allowing rehabilitation practitioners to get hands on experience learning new assessment and treatment techniques on live dogs and horses. Having attended one of these wetlabs at the previous symposium, this is always a great opportunity to discuss and share ideas in an informal group setting and learning from some of the best rehab practitioners in the world.
After a late night arrival at the hotel due to flight delays I arrived at the convention centre for the first day of the four. The American College of Rehabilitation Veterinarians (AARV) and American College of Veterinary Rehabilitation and Sports Medicine (ACVRSM) held a scientific programme for their members permitting nonmembers to also attend. Speakers included Hilary Clayton, Cindy Otto, Kevin Haussler and Deborah Torraca to name a few.
Key analysis One of the key things I learnt was that in a retrospective analysis, photobiomodulation therapy to the thoracolumbar spine combined with rehabilitation therapy can significantly increase the length of time of ambulation in dogs diagnosed with degenerative myelopathy. After this meeting I was already excited for day one of the symposium to arrive.
Poster Presentation This years theme was ‘The Athlete’ and the symposium attracted approximately 300 delegates from all over the world. Optional breakfast meetings are available throughout the symposium but these are not for the faint-hearted, starting at 7.15am and with friends dragging you out of bed for a morning run prior to this there were some very early starts. There was one occasion when we arrived in our running attire! The days come at you hard and fast with masses of information to take on board, but all of this is combined with welcome drinks, social events and finally a Gala event on the penultimate night.
analysis, assessing lameness and the effectiveness of surgical techniques and postoperative protocols. 3. Thermal imaging was used to assess the changes in surface temperature after cryotherapy application for the postoperative TPLO. Surface temperature was significantly lower after cryotherapy with rewarming beginning 15 minutes after application and normal by 45 minutes indicating more frequent application may be indicated post-operatively.
Results I attended over 30 small animal sessions (keynote and scientific) during the main symposium and here are the results of some of the abstracts that were presented: 1. Low cost consumer applications measuring 2D motion are available but how does they compare to 3D kinematic gait analysis system (KGAS) when assessing trot in the sagittal plane? Mean joint angles on the application were not significantly different to the KGAS with 97.5% of measurements accurate within 5% of the KGAS values.
This was another sensational week of exciting research in the field of veterinary physiotherapy and rehabilitation and I urge anyone considering attending this symposium to do so. You will not regret it and we are very fortunate to be hosting the next IAVRPT symposium in Cambridge in 2021.
2. A pressure sensitive matrix equipped stationary treadmill (Canidgait, Zebris) provides reliable temporospatial and kinetic data with excellent intra- and inter-session reproducibility. This system is valid for objective gait
It was wonderful to see two of our ACPAT colleagues Tracy Crook and Gillian Tabor speaking and presenting posters respectively and I hope that we will have a larger representation of ACPAT speakers in 2021.
4
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The Effect of Low Level Laser Therapy on Canine Hip Arthropathy Hannah Oliver-Byrne MSc BSc ACPAT Cat A (Combined Physio Ltd) “Dissertation submitted as part of the MSc Veterinary Physiotherapy Programme (Hartpury University) May 2014”
Introduction
L
ow level laser therapy (LLLT) is the application of monochromatic light to promote tissue repair, reduce inflammation or induce analgesia (Carroll, 2013). LLLT increases the absorption of cytochrome c oxidase releasing nitric oxide, increasing ATP synthesis and modulating reactive oxygen species and NF-Kb, which modulates cell inflammation (Carroll, 2013). LLLT has been shown to be effective in treating arthropathy and decreasing time to ambulation after spinal injury in small animals (Cho et al., 2004, Schleder da Rosa et al., 2012, Draper et al., 2012). There are currently no studies investigating the use of LLLT to treat hip arthropathy in either humans or dogs. Osteoarthropathy (OA) is estimated to affect up to 20% of dogs over one year of age (Paradis et al., 2003, Fox and Millis, 2010). One of the joints most commonly affected by OA in the dog is the hip, also considered to be secondary to hip dysplasia (Clements et al., 2009). Dogs with OA hip classically present with reduced range of movement (ROM) with signs of pain on hip extension (Farrell et al., 2007 and Renberg, 2005). Arthropathy in dogs has historically been managed with pharmaceuticals (Fox and Millis., 2010). LLLT has been found to compare favourably with pharmacological interventions, for which evidence is sparse and side effects are common (Chow et al., 2011). Canine hip joint replacements can be costly and there are complications (Guerrero and Montavon, 2009). Acupuncture has been successful in managing MSK conditions in small animals (Gülanber, 2008), and laser acupuncture has been shown to be successful at treating people with knee pain (Shen et al., 2008).
Physiotherapists are not able to treat animals using acupuncture (Veterinary Surgeons Act, 1966), so LLLT could be a useful replacement. There is a need for more effective and economical treatments for canine hip arthropathy and LLLT may be an option. The aim of this study is to investigate the efficacy of LLLT to manage pain and dysfunction associated with canine coxofemoral arthropathy. The objectives are to help validate a LLLT protocol for canine coxofemoral arthropathy; to investigate ROM of the affected canine coxofemoral joints using video analysis and dartfish before and after LLLT; and to investigate canine pain and function associated with coxofemoral joints using the LOAD questionnaire before and after LLLT.
Table 1 Exclusion criteria Previous surgery/ steroid injection < 3 months to the affected limb/ spine Heart disease Taking immune-suppressant drugs Neurological disease Infectious disease Open wounds on the hind limb Fractures Undiagnosed lameness
Null hypotheses
Pregnancy
1. Null hypothesis (HO1) - there will be no difference in hip joint flexion in dogs with hip arthropathy after LLLT
Cancer
2. Null Hypothesis (HO2) - there will be no difference in hip joint extension in dogs with hip arthropathy after LLLT 3. Null Hypothesis (HO3) - there will be no difference in LOAD score in dogs with hip arthropathy after LLLT.
Materials and Methods Study population and Randomization Eight dogs were used with radiographic evidence of hip arthropathy, had been seen by a vet in the previous 3 months where unilateral lameness had been noticed, and had been referred to the Combined Physio clinic by a veterinarian. The owners were telephoned to assess suitability for the study, and after inclusion / exclusion criteria were applied they were invited with their dog for data collection and intervention. 6
No LLLT in the last 3 months The sample was randomly allocated to Group 1 or 2. Group 1 was treated with LLLT, and Group 2 was treated with sham LLLT where the laser is placed in the same places but not switched on. Both groups also received a similar exercise therapy programme, and were kept on their usual medication throughout the study. The owners of the dogs were asked for informed consent for their dogs to participate in the study. Ethical approval was obtained by the Research Ethics Committee of The University of the West of England, Hartpury College.
Outcome measures, Equipment and Data Collection The outcome measures used were maximal flexion and extension angles of the affected hip joint during walk, and the LOAD questionnaire for owner perceived chronic pain. The same investigator collected all
the data and had been trained in using the recording equipment and the laser. Each owner filled out the LOAD questionnaire. Markers were then attached to the anatomical
Owners
were
questionnaire
sent
2
days
the
LOAD
after
the
intervention with instructions to fill it out and return within 24 hours.
points. The dogs were desensitised to
LLLT was performed using a laser
the markers and familiarised to the
array with five 200-mW 810-nm-
walking task before being recorded.
wavelength lasers, or using the LED
A Microsoft Lifecam HD 6000 was used to record the participants at 30 frames per second. The camera was mounted on a tripod at the height of the dog’s greater trochanter, perpendicular
cluster probe, delivering 2000mW [DDV Control Unit+Laser Cluster Probe, wavelength=810nm, power=1 W (5x200mW), and LED cluster probe 56
x
power=10mW
660nm and
48
wavelength, x
850nm
power=30mW
(total
and 2 meters from the dog walking on a
wavelength
marked out straight line.
2000mW) THOR Photomedicine Ltd,
Each dog was recorded walking along the line. The owners were instructed on straightness, and speed. The
greater
trochanteric
marker
was removed for LLLT intervention. Safety glasses were worn by the investigator
and
owner
for
Figure 2. Acupuncture points relating to the hip (Janne Potter 2001).
Chesham, UK]. Safety glasses were provided by Photomedicine Ltd. The LOAD questionnaire was used to measure owner perceived response to intervention before and 2 days after intervention.
the
intervention or sham. The lenses prevented the owner from seeing red light. Immediately after intervention, the
greater
trochanteric
marker
was reapplied, and each dog was rerecorded walking on the line. Dartfish (7: 7.0.10521.0) Motion Analysis Software was used to analyse the maximum flexion and extension angles of the affected hip joint. The angles were calculated
Figure 3. Thor LLLT protocol for canine
frame by frame, and only the angles
hip OA (THOR Photomedicine ltd 2014).
closest to the optical plane of the camera were used for each dog. Stride length was determined by maximal hip extension to the next maximal hip extension of the affected limb. Each dog was recorded with the camera until 3 strides of straight relaxed walking were captured before and after intervention. Speed was recorded using the Dartfish software in metres per second (m/s).
Figure 1. Marker Placement
Statistical Analysis A Kolmogorov-Smirnov test was
Intervention
used to assess the normality of the
The protocol used was one occasion of 1 minute 2.5hz using the LED cluster over affected side inguinal lymph nodes, popliteal lymph nodes and then the hip joint, followed by 30 seconds of the 1watt laser probe over acupuncture points GB29, 30, 31, 34
The difference in speed before and
and ST54 and the spinous processes
after intervention was calculated to
of T13-S1. The dogs were freely
make sure the speed was within 0.3
allowed to change position between
metres per second.
points throughout the intervention.
7
data. Mean and standard deviation were calculated from the raw data to provide a comparison of the two groups. Levene’s test was used to estimate homogeneity of the data. MANOVA was used to investigate whether the null hypotheses could be
rejected.
ANOVAs
Separate were
univariate
automatically
conducted to support the MANOVA. Statistical significance was set at p<0·05 (Field, 2013).
RESULTS Table 2. Demographic characteristics of the participants
LLLT group 1 (n=4) Mean (SD)/n (%)
Placebo group 2 (n=4) Mean (SD)/n (%)
7.03 (3.98)
8.5 (5.26)
Labrador Retriever
1 (12.5%)
1 (12.5%)
Staffordshire Bull Terrier
1 (12.5%)
0 (0%)
German Shepherd
2 (25%)
1 (12.5%)
English Springer Spaniel
0 (0%)
1 (12.5%)
Border Collie
0 (0%)
1 (12.5%)
Male
0 (0%)
1 (12.5%)
Female
4 (50%)
3 (37.5%)
3 (37.5%)
4 (50%)
Characteristics Age (years) Breed
Gender
On analgesia
Figure 4. A bar graph to illustrate the change in hip joint flexion in the LLLT group compared to the control group.
Figure 5. A bar graph to illustrate the change in hip joint extension in the LLLT group compared to the control group.
Figure 6. A bar graph to illustrate the change in LOAD score in the LLLT group compared to the control group.
Table 3. Gait speed (m/s)
4.2 Significant statistics The results from MANOVA showed that using Pillaiâ&#x20AC;&#x2122;s trace there was n Âo significant effect of LLLT on flexion ROM, extension ROM and LOAD score, V = 0.62, F(6,1) = 2.56, p = .89. Separate univariate ANOVAs on the outcome variables revealed significant treatment effects on increasing hip extension, F(6,1) = 6.03, p = .049, but not hip flexion F(6,1) = 0.297, p = .606, or LOAD score F(6,1) = 2.419, p = .297, (Appendix E). No side effects were reported by any of the owners. Table 2 illustrates that the difference in speed between the recordings before and after were less than 0.3m/s difference except for a dog in each group.
Group
Before
After
Difference
LLLT
3.62
2.57
1.05
LLLT
0.73
0.77
-0.03
LLLT
0.87
0.97
-0.10
LLLT
0.75
0.57
0.18
Control
0.90
0.93
-0.03
Control
0.70
0.60
0.10
Control
0.93
0.90
0.03
Control
8.80
9.83
-1.03
8
Discussion Results of this study suggested that LLLT improved mean flexion ROM, extension ROM and owner perceived chronic pain using the LOAD questionnaire. Using a multivariate approach, there was no statistical difference (p = 0.89). However, the subsequent univariate analysis did find a significant difference in extension ROM (p = 0.049), allowing rejection of the null hypothesis of there being no difference in hip joint extension in dogs with hip arthropathy after LLLT, but acceptance of the other null hypotheses. LLLT is being used more frequently in the clinical setting with evidence to support its use in human MSK conditions (Chow et al., 2009), and spinal injury in dogs (Draper et al., 2012). There is currently no evidence for the use of LLLT on canine peripheral conditions, yet it seems to be a regular treatment tool used in clinical practice for dogs with peripheral joint dysfunction. There is a need for further research in this subject for evidenced based clinical practice. The reason why the current study found that there was a statistically significant improvement in hip extension maybe because LLLT improved the clinical sign of pain on hip extension. However, the mean LOAD scores may suggest that this improvement was not sustained for 48 hours when the follow up LOAD score was completed. This may be because only 1 treatment session was conducted, and repetitive treatments over several weeks may have a more sustained effect as found by previous studies (Shen et al., 2008, Omar et al., 2011, Castano et al., 2007, and Kannan, 2012). Kannan (2012), also supported by Hashimoto et al., (1997), found a significant difference in pain relief and ROM after just one treatment, compared to ultrasound therapy and ischaemic compression. Interestingly, figure 6 illustrates how the baseline LOAD score seemed to be lower for the LLLT group, suggesting that the owners perceived their dogs to be already in less chronic pain than the placebo group owners, although this did not seem to be a statistically significant variance (Appendix E). The implementation of owner blinding seemed to be successful in reducing bias, as both groups improved their LOAD score. However, this suggests there is an element of placebo effect, and maybe another reason why the LOAD scores were not statistically significant. The current study treated the spinal levels innervating the hip and surrounding tissues to produce pain relief, which may have contributed to the results. Vinck, et al. (2005) supports this
as their investigation found that LLLT on nerve tissue in human participants, reduced the number of impulses per unit of time, which could induce pain relief. Hashimoto et al. (1997) also supported this by finding that LLLT near the stellate ganglion caused a similar affect to stellate ganglion block. They found this after just one session of treatment with 150mW or 60mW LLLT. Draper, et al. (2012) found that LLLT significantly decreased time to ambulation in dogs after hemilaminectomy. Although they suggested this was due to axonal regrowth, reduced scaring, and reducing the immune and inflammatory response that causes secondary damage. Similar to the current study, except for the treatment time, Draper et al. (2012) used a THOR laser of 810nm, with a treatment head of 5 beams of 200mW, continuously for 1 minute over the level operated on, the one above and below, effectively delivering 25,000 mW/cm2. This would mean between 2 and 8J were delivered to the spinal cord. The current study delivered 6 Joules of energy per spinal level and acupuncture point in line with the findings by Chow et al. (2009), who found RCTs with significant results that chronic neck pain in humans was reduced using LLLT over placebo, depending on the optimum dose of 6 Joules being delivered per point. Kannan (2012) found LLLT to be significantly superior to ultrasound and ischaemic pressure on treating pain, and restriction associated with myofascial trigger points, also associated with acupuncture points (Melzack 1977). Bjordal et al. (2003) conducted a literature review, finding that LLLT significantly reduced pain in people with OA in the knee. The present study’s results found LLLT had an insignificant effect on reducing owner perceived chronic pain in their dog, but this was likely to be due to insignificant statistical power, and further research is needed with a larger sample to obtain a significant effect. Inflammation is specifically associated with stiffness after rest, and reluctance to exercise (Farrell et al. 2007 and Renberg, 2005). Figure 5 illustrated the difference in extension ROM between the LLLT group and the placebo group. The placebo group’s extension seemed to reduce after the sham intervention, compared to the LLLT group where extension increased. This could be due to stiffness and inflammation after exercise then rest during sham treatment. The LLLT in the intervention group may have reduced inflammation, and helped to increase ROM. Cerati et al. (2003) and Omar et al. (2011) also found positive results with lymphatic drainage using LLLT. However, they both used a
9
different 904nm wavelength laser, with an output of 5mW, delivering 1.5 J/cm2 at several points to the effected axilla lymph nodes, although still applying between 5 and 6J per session. Omar et al. (2011) treated 3 times a week for 12 weeks, and used a pulsed frequency. Cho et al. (2004) also treated 3 times a week for 4 weeks, did not describe their wavelength, fluence or irradiance parameters, but they did use a frequency of 2.5Hz. This supports the current study’s use of 2.5Hz laser over the lymph nodes and hip joint, and may be more successful at reducing inflammation and improving healing than continuous LLLT. The current study’s results are comparable to other modalities for the management of canine arthritis (Sanderson et al. 2009, Black et al. 2007, Jaeger et al. 2007, Guerrero and Montavon 2009). The owners of the participants were blinded to reduce bias in answering the LOAD questionnaire, a quantitative closed-question questionnaire, investigating owner perceived chronic pain previously validated by Walton et al. (2013). The method used has been considered valid within the scope of the study due to all the dogs following the same protocol. The inclusion and exclusion criteria for the sample were derived from analysis of previous research and current contraindications (Black et al., 2012, Sanderson et al., 2009, Hielm-Björkman et al., 2012, Jaeger et al., 2007 and Carroll, 2014). The intervention protocol was derived from acupuncture points associated with hip pain (Sawaya, 2007), lymph nodes associated with the hip, and spinal levels innervating the hip and surrounding tissues, as suggested by THOR Photomedicine ltd (2014). Guo et al. (2009) found that in mice lymphatic drainage, specifically associated with popliteal nodes, is reciprocally related to the severity of hind limb joint lesions during the development of arthritis. This supports the current study’s use of LLLT on lymphatic drainage, along with the studies by Cerati, et al. (2003), and Omar et al. (2011). Kim et al. (2008) previously validated the method of data collection for hip joint angles. The method of analysing the joint angles using Dartfish was partially validated by Birch and Lesniak (2013), and Norris and Olson (2011). Repeatability was confirmed using a pilot study.
Limitations The ROM results may have been effected by statistical error, due to mediolateral movement affecting the results and different breeds adding variability.
However, owners were encouraged to walk the dogs as straight as possible, and if significant medio-lateral motion was noticed when recording, the dog was rerecorded. The current study attempted to control parallax error by keeping the dogs walking on a straight line at the same distance from the camera, and only the frames directly in front of the camera were used for analysis. Khumsap, et al. (2002) found that stance phase was increased more than swing phase, suggesting that extension would be more affected than flexion. Using a treadmill would be a more repeatable way of maintaining speeds but there are conflicting views in the equine field with regards to the similarity of treadmill versus over-ground locomotion (Buchner et al. 1994 and Clements et al. 2005). Biological error may have caused variability in results due to movement of the skin over the bony landmarks used for marker placement. Surgical fixation of the markers would reduce the geometric instability of the skin, but this would be problematic due to animal welfare and resources needed. It is also understood that bone-fixated markers cause altered gait patterns in horses (Haussler et al. 2007). The effect of hair on the markers may have introduced variability to the results (Kim et al., 2008). Owners were reluctant to allow their dogs to be clipped, but clipping the hair would be a solution in further research. In the present study, every effort was made to ensure correct marker placement of the centre of the 2cm tape on the greater trochanter. Artifacts may have also been introduced by software calculation of target position, and camera lens distortion (Poy et al., 2000). Higher quality recording equipment may reduce these errors further. The small sample size maybe why a statistical significance was not found in all dependent variables. Another potential variance to the results was body size of the dogs as found by Bockstahler et al. (2007a). However, Black et al. (2007) found there was no correlation between weight and improvement score. Another factor limiting homogeneity was pain medication. For ethical reasons and due to the professional scope of the veterinary physiotherapist involved, no advice was given to alter the medication previously prescribed by the referring vet. However, Bjordal et al. (2003) found that LLLT was not as affective when nonsteroidal anti-inflammatories were used.
Conclusion The aim of this study was to investigate the efficacy of LLLT to manage pain
and dysfunction associated with canine hip arthropathy. Previous research has identified the effects of LLLT on human and small animal arthropathy, and human MSK related pain, but there is no research focussing on functional outcomes, during in vivo studies on the efficacy of LLLT in peripheral joint dysfunction, let alone hip arthropathy. There were methodological limitations due to the scope of the study affecting the reliability of the results. The results of the present study suggest that in dogs with hip arthropathy there is no significant effect of LLLT on hip joint flexion or chronic pain behaviour but there is a significant effect of LLLT on hip joint extension. This suggests that LLLT may be an effective, safe treatment modality for dogs with hip arthropathy, but further research is needed.
Bockstahler, B., Henninger, W., Müller, M., Mayrhofer, E., Peham, C., and Podbregar, I. (2007) Influence of borderline hip dysplasia on joint kinematics of clinically sound Belgian Shepherd dogs. American Journal of Veterinary Research. 68, pp. 271–276
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Melzack, R., Stillwell, D.M., and Fox, E.G. (1977) Trigger points and acupuncture points for pain: correlations and implications. Pain. 3, pp. 3-23. Norris, B.S., and Olson, S.L. (2011) Concurrent validity and reliability of two-dimensional video analysis of hip and knee joint motion during mechanical lifting. Physiotherapy Theory and Practice. 27, (7) pp. 521–530. Omar, M.T.A., Ebid, A.A., and Morsy, A.M.E. (2011) Treatment of PostMastectomy Lymphedema with Laser Therapy: Double Blind Placebo Control Randomized Study. Journal of Surgical Research. 165, pp. 82–90. Owen, M.R., Richards, J., Clements, D.N., Drew, S.T., Bennett, D., and Carmichael, S. (2004) Kinematics of the elbow and stifle joints in greyhounds during treadmill trotting – An investigation of familiarisation. Veterinary and Comparative Orthopaedics and Traumatology. 3, pp: 141-145.
Paradis, M., Sauve, F., Charest, J., Refsal, K.R., Moreau, M., and Dupuis, J. (2003) Effects of moderate to severe osteoarthritis on canine thyroid function. Canadian Veterinary Journal. 44, pp. 407–412. Pet Food Manufacturers Association. (2013) Regional Pet Population 2013. Available from: http://www.pfma.org.uk/ regional-pet-population-2013 [Accessed 05 December 2013]. Potter, J. (2001) Veterinary Acupuncture: Canine Points. Available from: http://homepage. eircom.net/~progers/potter/canine1. htm [Accessed 28 April 2014]. Poy, N. S. J., DeCamp, C.E., Bennett, R.L., and Hauptman, J.G. (2000) Additional kinematic variables to describe differences in the trot between clinically normal dogs and dogs with hip dysplasia. American Journal of Veterinary Research. 61, pp. 974–978. Quinn, M.M., Keuler, N.S., Lu, Y., Faria, M.L.E., MUIR, P., and Markel. M. D. (2007) Evaluation of Agreement Between Numerical Rating Scales, Visual Analogue Scoring Scales, and Force Plate Gait Analysis in Dogs. Veterinary Surgery. 36, pp. 360–367. Riggs, C.M., DeCamp, C.E., SoutasLittle, R.W., Braden, T.D. and Richter, M.A. (1993) Effects of subject velocity on force plate measured ground reaction forces in healthy greyhounds at the trot. American Journal of Veterinary Research. 54, pp. 1523– 1526. Renberg, W.C. (2005) Pathophysiology and management of arthritis. Veterinary Clinics in Small Animal Practice. 35, pp. 1073-1091. Ross. T. (2012) A Survival Guide For Health Research Methods. Maidenhead: Open University Press. Sanderson, R.O., Beata, C., Flipo, R-M., Genevois, J-P., Macias, C., Tacke, S., Vezzoni, A., and Innes, J.F. (2009) Systematic review of the management of canine osteoarthritis. Veterinary Record. 164, pp. 418-424. Sawaya, S. (2007) Physical and alternative therapies in the management of arthritic patients. Veterinary Focus. 17(3), pp. 37-42. Sharifi, D., Abedi, G., Joderi, H., Haghdoost, I.S., and Mortazavi, P. (2008) Clinical and Histological Evaluation of Low Level Laser on Regeneration of Hip Joint Cartilage in Rabbit. Iranian Journal of Veterinary Surgery. pp. 48-56.
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Act
(1966)
Vinck, E., Coorevits, P., Martine De Muynck, B.C., and Cambier, G.V. (2005) Evidence of changes in sural nerve conduction mediated by light emitting diode irradiation. Lasers in Medical Science. 20, pp. 35–40. Walton, M.B., Cowderoy, E., Lascelles, D., and Innes, J.F. (2013). Evaluation of
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Physiotherapy for the Elderly Patient Pain management ‣ Heat ‣ Cryotherapy ‣ Transcutaneous electrical nerve stimulation ‣ Class 3B laser ‣ Soft tissue techniques to address compensatory muscular tensions ‣ Muscle strengthening and core stability training
• • • • • •
Hydrotherapy Proprioceptive and balance exercises Controlled exercise programme Maintain and enhance joint range of movement Gait re-education Owner education - Manual handling advice - Encourage regular gentle exercise - Use of supportive bedding, coats, ramps, splints/ slings/supports •
Research Crook et al (2007) found that a home stretching regime for joint restriction increased the range by 7% to 23%. Krstic et al (2010) found that TENS had the greatest effect on suppression of chronic pain in dogs with ankylosing spondylitis. Laser has been found to be better than NSAIDs at reducing pain in humans (Chow et al 2009). Kathmann et al (2006) found daily physiotherapy helped dogs with CDRM to remain ambulatory longer. THIS INFORMATIONAL PRESENTATION IS AVAILABLE AS A POSTER FOR USE BY MEMBERS FOR LOCAL PR EVENTS
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Critical Review of Physiotherapeutic Management/ Treatment of a Horse Following Surgery for Over-Riding Dorsal Spinous Processes. Yeates, S. and Tabor, G. Hartpury University, Gloucester GL19 3BE. Submitted as part of the MSc Veterinary Physiotherapy programme (May 2017). Introduction
O
verriding dorsal spinous processes (ODSPs) are one of the largest causes of equine back pain, with a prevalence of 33-68% (Jeffcott, 1980; Turner, 2011), creating poor performance and lameness. However, prevalence is also high in the asymptomatic population (3992%) (Townsend et al., 1986; Haussler et al., 1999; Turner, 2011). Therefore, diagnosis must combine imaging, history of poor performance and tenderness on palpation in order to exclude false positive results and an incorrect diagnosis. Treatment approaches include endoscopic or open desmotomy of the interspinous ligament, resection of dorsal spinous process’s (DSP’s), corticosteroid injections or conservative treatment (Appendix, Table 1). As thoracic spinal extension increases DSP proximity, ODSPs have been attributed to lordotic posture and incorrect training (Jeffcott, 1980), with the weight of a rider further creating extension of this region (Cocq et al., 2004). Physiotherapeutic management and treatment of ODSPs could have a large impact on posture and training, and therefore success of outcome.
Exercise Protocols Investigation into efficacy of exercise protocols for post-operative rehabilitation is lacking, with comments found only in the investigations of medical treatments (Appendix, Table 1). Turner (2011) found that exercise as part of conservative treatment, was more effective in creating positive outcomes than corticosteroid injection or mesotherapy. Although it is difficult to detect the effect size of exercise in isolation, these results are encouraging.
Graduated loading Week 1 One to three days box-rest with short in-hand walks is initially advised (Appendix, Table 1). Initial relative rest should be encouraged, as it allows for bleeding to cease and inflammation
to settle, with earlier loading creating damage and prolonging these stages (Watson, 2003; Bleakley et al., 2011). Speed of progress will be influenced by amount of tissue damage (open and endoscopic surgery) and type of anaesthetic (Coomer, 2012; Walmsley et al., 2002).
Weeks 1-8 Proliferation and remodelling of tissue peaks at days to weeks and exercise regimes gradually increase loading by hand-walking during this time (Appendix, table 1). Early graduated loading, rather than box rest, is preferable for all healing tissues in this scenario, as no weight bearing tissues which have to manage high strain are affected, and tissue union is only required of superficial tissues (epaxial muscles and supraspinous ligament). Bone fracture healing would normally involve 6 weeks of immobilisation however resection healing requires periosteum formation only and the area is only stressed by connecting soft tissue (e.g. interspinous ligament and spinalis and multifidus muscles) (Grönberg, 2002) which will not place the area under as much stress as weight-bearing, therefore chance of failure with early loading is reduced. Older research suggests loading of healing ligament, skeletal muscle and bone increases cell activity, organisation of tissue to reflect load, increases strength and may speed healing (Buckwalter, 1995; Järvinen et al., 1993; O’Sullivan, 1994). Immobilisation appears to have opposite effects causing slower, poorer healing (Uhthoff, 1978; Woo et al., 1975; Tipton et al., 1970; Buckwalter, 1995). One cochrane review investigating human lateral ankle sprains, found quicker return to activity with exercise, compared to immobilisation, although once lowquality evidence was removed this was not significant (Kerkhoffs et al.,2002). Immobilisation has also been suggested to slow recovery in horses as, in a small study, reduced active range of the metacarpophalangeal joint following seven weeks of immobilisation was not remedied with eight weeks of exercise
14
(Harreveld et al., 2002). Although complete immobilisation does not occur in this case, this study highlights its potential effects. DSP resection does not require immobilisation as no bony union is required, however too much movement has been shown to delay bony healing and increase callus formation (Kuiper et al., 2000), possibly causing the bony proliferation reported by Debrosse et al. (2007) and Jeffcott (1978) and possible further impingement. Assessment of the horse’s temperament and sedation need is therefore necessary before turning out as suggested by Coomer (2012) and Warmsley (2002), to prevent overload and re-injury of damaged tissue. Overall, a graduated controlled early loading program to create tissue able to withstand the strains required of it without detriment to healing, is appropriate (Glasgow, 2015). Lunging, hand-walking or long reining are all suggested in the first one to two months (Appendix, Table 1). Lunging will depend upon fitness and level of training. Lunging is thought to be hard work for the horse and creates multi-directional forces (Pfau et al., 2012), and which initially may fatigue or damage weak tissue, therefore sessions must be short and gradually introduced. Long reining or handwalking may be preferable to repetitive circling, however as not all horses are trained to long-rein, this may not be appropriate. Also, trot work cannot be introduced in-hand unless the horse is well behaved and the handler very fit. Progressing from hand-walking to short bouts of lunging, may therefore be the best option for most, however this has not been investigated. A common theme based on the bow and string theory (Slijper, 1946) is core strengthening (contracting the string) to encourage ventral flexion of the spine (stretching the bow), to separate DSPs (Coomer, 2012; Turner, 2011). Although this management is logical, there is no research into flexion focussed
versus normal protocols. It could be argued as not necessary following DSP resection, as the impinging structure has been removed, however prevention of reoccurrence at other levels of the spine, could be argued. Sometimes pessoa training-aid usage is prescribed to encourage flexion (Coomer, 2012). However, flexion may not always be achieved as, although the pessoa increases lumbosacral flexion, no postural change was detected in lordotic horses (Walker et al.,2013) and increased use of already over working muscles was suggested (Paulekas and Haussler, 2009), which could reinforce lordotic posture. It also does not increase epaxial activity as previously thought (Cottriall et al., 2008), although strengthening of the hypaxial muscles cannot be ruled out. Also, Álvarez et al., (2006) discovered that raised or lowered combined with rounded head and neck positions, created extension of the thoracic region, increasing DSP proximity where impingement is most common (Turner, 2011; Jeffcott, 1980). A sample of dressage horses was used here and results may differ in other conformations and levels of training. Lowering of the head and lengthening of the neck should be encourage in exercise, and at rest, by feeding from the floor (Álvarez et al., 2006) to encourage thoracolumbar flexion, however training aids should be used selectively provided that they achieve these aims. Trot appears to be introduced after three to four weeks of walk (Appendix, Table 1). Trot will strengthen the epaxial and hypaxial muscles as they act as spinal stabilizers (Robert et al.,1998), controlling the amplitude of the two flexion/extension cycles of the spine for each trot stride (Audigié et al.,1999). Pathological osseous changes (such as ODSP’s) create local epaxial muscle atrophy, as found by Stubbs (et al., 2010), therefore the introduction of trot could hypertrophy these areas. However, sufficient strength and stability must be present before trot is introduced, to prevent lack of control into thoracic extension and poor movement patterns (Licka and Peham, 1998; Glasgow, 2015). Three to four weeks of walk should be sufficient to increase muscle bulk, as significant hypertrophy is seen at 4 weeks in humans, although strengthening was only seen at
high loads in humans (Jenkins et al., 2016; Kristensen and Burgess, 2013; DeFreitas et al., 2011). Spinal stability could be encouraged with the addition of daily dynamic mobilisation exercises, which hypertrophy the multifidus muscle in the spine after 6 weeks (Tabor, 2014), although it is not known if this alters function or posture.
Week 6-24 At six to twenty-four weeks, tissues continue to remodel, but their structure is more organised and less likely to fail (Watson, 2003). Varied loading is required to create varied strains (Pearce et al., 2016), in order to build stronger tissue (Doblaré et al., 2004). Protocol progression to ridden and sports specific activities, will provide this (Appendix, Table 1) but specifics are vague, as this will depend upon the individual horse’s fitness, training, and current progress. Protocols for endoscopic as opposed to open surgery, appear to progress more quickly at this point (Appendix, Table 1) possibly as less healing is required. Progression to in/declines, different surfaces and poles, should occur first to challenge established strength and stability. Increase in speed and inclines increases epaxial and hypaxial muscle activity (Robert et al., 2002; Robert et al., 2001) and pole work creates similar limb kinematics to inclines (Brown et al., 2015) but no change to spinal kinematics, suggesting a similar increase in muscle activity. Activities should then be progressed on to faster speeds/ paces, jumping and lateral work. Canter creates a greater flexion/extension range of movement at T14-16 than walk and trot (Haussler et al., 2001) and lateral work has an association with thoracic extension (Licka and Peham, 1998), (although this will depend on head position), therefore both should only be introduced once the horse has the strength and motor control to maintain a relatively flexed posture. Like the introduction of trot, frequency, difficulty and time spent should be increased gradually over three to four weeks for each activity level, preventing overload and allowing for neuromotor control development (Glasgow, 2015). Continual assessment of the individual horse’s posture and muscle development is therefore important.
15
Manual Therapy Soft tissue manual therapy is also mentioned (Coomer, 2012) as part of post-surgical management. Although there is no direct evidence for this, its use could be reasoned. Sullivan et al., (2008) found significantly increased pain thresholds of the thoracolumbar spine after massage (12%) and manual therapy (27%), when treating spasm in horses with no history of back pain. Treatments were individualised decreasing internal validity, but somewhat increasing external validity provided those techniques are reproducible in the population. Effects may also be different in horses with back pain. Haussler et al., (2007) agreed, reporting spinal manipulations increased range of movement and tolerance to pressure. Their experimental design appeared rigorous, however a carryover effect was detected as the crossover period was too short, which may have reduced the significance of effect. Massage of caudal pelvic limb muscles significantly increased (p=0.01) passive, but not active hind-limb protraction (Hill and Crook, 2010), meaning application may ease movement, however validity of a slump test in the horse used here has not been investigated, so results should be taken with caution. An old paper (Indahl et al., 1999) mobilised the sacroiliac joint in pigs producing responses in the multifidus muscles (measured via electromyography), which could increase epaxial activation. Massaging a stressed horse on box rest or in pain may create relaxation, as an association was found in a small study by McBride et al., (2004), however there was no observer blinding, introducing bias. A literature review produced mixed evidence about scar massage in people, reducing hypertrophy, pain and improving range of movement, however it included low quality research (Shin and Bordeaux, 2012). As exercise increases, massage may reduce inflammation and muscle damage and improve performance post-exercise in humans and rabbits (Haas et al., 2013; Poppendieck et al., 2016). Evidence is limited and of poor quality but manual therapy and massage may be able to reduce pain and stress, ease movement and stimulate muscles, improve scar healing and when used as an adjunct to exercise, may improve movement patterns (Haussler, 2009).
Choice of techniques will depend upon the clinical reasoning for the individual, for example spinal flexion reflexes could be used to encourage DSP separation (Haussler, 2009), mobilisations and massage could be used on areas compensating for pain to maximise soft tissue use (for example by reducing epaxial muscle spasm and shortening, and therefore reducing relative spinal extension), and on spasm around the operated site once inflammation stage has passed.
Electrotherapy Coomer et al., (2012) (Appendix, Table 1) used neuromuscular stimulation (NMS) to improve recruitment of areas of atrophied muscle, however supporting evidence is limited. Twenty-two treatments of NMS over eight weeks increased myofibril mitochondrial density in horses in a small underpowered study (N=6) (Schils et al., 2015). Muscle spasm in this study and in a large (N=241) anecdotal retrospective study (Schils and Turner, 2014), reported a one grade improvement of the Modified Ashworth scale following 2-4 treatments. The Modified Ashworth scale has an 86.7% inter-relator reliability in humans (Bohannon and Smith, 1987), however in horses this has not been assessed, reducing the
reliability of results. In a human review, the effect of NMS on quadriceps strength produced mixed results, with 50% of papers reporting a significant increase. However, research was of moderate to low quality (Kyung-Min et al., 2010). NMS may therefore be of value in rehabilitation of ODSPâ&#x20AC;&#x2122;s by improving muscle recruitment, which may improve movement patterns, following a long term antalgic gait. Warmsley (2002) (Appendix, Table 1) reported the use of H-wave following resection. There is no research to support the use of H-wave or TENS in horses and limited research in humans, which reported a significant analgesic effect (McDowell et al., 1999; Blum et al., 2008). The latter was part funded by the manufacturer of H-wave, so should be taken with caution. Finally, use of low level laser on wound healing should be considered, as when delivered at 4 J/cm2 faster healing and inflammation resolution was reported in cows and rats (Medrado et al., 2003; Ghamsari et al., 1997). Anecdotal evidence suggests positive results in horses (Moraes et al., 2014), however no significant difference was found in the single experiment on horses, although a lower dose was used than above (Petersen et al., 1999).
16
Conclusion No of
research
into
the
physiotherapeutic
efficacy protocols
following ODSP surgery has been carried out. Protocols discussed were identified from papers investigating medical
management
of
ODSPs.
Graduated early loading is justified once inflammation has settled to create tissue that can cope with the required strains and avoid the negative impacts of immobilisation. This should later be progressed in individualised steps until the horse returns to work. Strengthening whilst in thoracic flexion in theory should be encouraged to separate DSPs, although this requires investigation. Training aids do not always have this effect and therefore must not be prescribed to all. The use of manual therapy, massage and electrotherapy could be reasoned, particularly for analgesic effect, however evidence is limited and often of poor quality, therefore use should be as adjuncts to exercise, not in isolation.
References Álvarez, C.G., Rhodin, M., Bobbert, M.F., Meyer, H., Weishaupt, M.A., Johnston, C. and Weeren, P. (2006). The effect of head and neck position on the thoracolumbar kinematics in the unridden horse. Equine Veterinary Journal, 38(S36), pp.445-451. Audigié, F., Pourcelot, P., Degueurce, C., Denoix, J.M. and Geiger, D., 1999. Kinematics of the equine back: flexion‐ extension movements in sound trotting horses. Equine Veterinary Journal, 31(S30), pp.210-213. Bleakley, C.M., Glasgow, P. and MacAuley, D.C. (2011). PRICE needs updating, should we call the POLICE? Bohannon, R.W. and Smith, M.B. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy 67: 206-207. Blum, K., Chen, A.L., Chen, T.J., Prihoda, T.J., Schoolfield, J., DiNubile, N., Waite, R.L., Arcuri, V., Kerner, M., Braverman, E.R. and Rhoades, P. (2008). The H-Wave® device is an effective and safe non-pharmacological analgesic for chronic pain: a meta-analysis. Advances in therapy, 25(7), pp.644-657. Brown, S., Stubbs, N.C., Kaiser, L.J., Lavagnino, M. and Clayton, H.M. (2015). Swing phase kinematics of horses trotting over poles. Equine veterinary journal, 47(1), pp.107-112. Buckwalter, J.A. (1995) Activity vs. rest in the treatment of bone, soft tissue and joint injuries. The Iowa orthopaedic journal, 15, p.29. Cocq, P.D., Weeren, P.V. and Back, W. (2004) Effects of girth, saddle and weight on movements of the horse. Equine veterinary journal, 36(8), pp.758763. Coomer, R.P., McKane, S.A., Smith, N. and Vandeweerd, J.M.E. (2012) A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. Veterinary Surgery, 41(7), pp.890-897. Cottriall, S., Ritruechai, P. and Wakeling, J.M., (2008) The effects of training aids on the longissimus dorsi in the equine back. Comparative Exercise Physiology, 5(3-4), pp.111-114. DeFreitas, J.M., Beck, T.W., Stock, M.S., Dillon, M.A. and Kasishke, P.R. (2011). An examination of the time course of training-induced skeletal muscle hypertrophy. European journal of applied physiology, 111(11), pp.2785-2790.
Desbrosse, F.G., Perrin, R., Launois, T., Vandeweerd, J.M.E. and Clegg, P.D. (2007) Endoscopic resection of dorsal spinous processes and interspinous ligament in ten horses. Veterinary Surgery, 36(2), pp.149-155. Doblaré, M., Garcıa, J.M. and Gómez, M.J., 2004. Modelling bone tissue fracture and healing: a review. Engineering Fracture Mechanics, 71(13), pp.1809-1840. Glasgow, P., Phillips, N. and Bleakley, C. (2015) Optimal loading: key variables and mechanisms. Br J Sports Med, 49(5), pp.278-9. Ghamsari S, Taguchi K, Abe N, et al. (1997) Evaluation of low level laser therapy on primary healing of experimentally induced full thickness teat wounds in dairy cattle. Vet Surg; 26:114-120. Grönberg, P. (2002) ABC of the Horse. Fifth edn. Finland: Otava Book Printing Ltd Haas, C., Butterfield, T.A., Abshire, S., Zhao, Y., Zhang, X., Jarjoura, D. and Best, T.M. (2013) Massage timing affects postexercise muscle recovery and inflammation in a rabbit model. Medicine and science in sports and exercise, 45(6), p.1105. Harreveld, P.D.V., Lillich, J.D., Kawcak, C.E., Gaughan, E.M., McLaughlin, R.M. and DeBowes, R.M., (2002) Clinical evaluation of the effects of immobilization followed by remobilization and exercise on the metacarpophalangeal joint in horses. Journal of the American Veterinary Medical Association, 63(2), pp.282-288. Haussler, K.K., Stover, S.M. and Willits, N.H. (1999) Pathologic changes in the lumbosacral vertebrae and pelvis in Thoroughbred racehorses. Am. J. Vet. Res. 60, 143-153. Haussler, K.K., Bertram, J.E.A., Gellman, K. and Hermanson, J.W., (2001) Segmental in vivo vertebral kinematics at the walk, trot and canter: a preliminary study. Equine Veterinary Journal, 33(S33), pp.160-164. Haussler, K.K., Hill, A.E., Puttlitz, C.M. and McIlwraith, C.W. (2007) Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region. American journal of veterinary research, 68(5), pp.508-516. Haussler, K.K. (2009) Review of manual therapy techniques in equine practice. Journal of Equine Veterinary Science, 29(12), pp.849-869. 17
Hill, C. and Crook, T. (2010) The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Veterinary Journal, 42(s38), pp.683-687. Indahl, A., Kaigle, A., Reikerås, O. and Holm, S. (1999) Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature. Clinical Spine Surgery, 12(4), pp.325-330. Jacklin, B.D., Minshall, G.J. and Wright, I.M. (2014) A new technique for subtotal (cranial wedge) ostectomy in the treatment of impinging/overriding spinous processes: Description of technique and outcome of 25 cases. Equine veterinary journal, 46(3), pp.339344. Järvinen, M.J. and Lehto, M.U. (1993) The effects of early mobilisation and immobilisation on the healing process following muscle injuries. Sports Medicine, 15(2), pp.78-89. Jeffcott, L.B., (1980) Disorders of the thoracolumbar spine of the horse—a survey of 443 cases. Equine veterinary journal, 12(4), pp.197-210. Jeffcott, L.B. and Hickman, J. (1975) The treatment of horses with chronic back pain by resecting the summits of the impinging dorsal spinous processes. Equine veterinary journal, 7(3), pp.115119. Jenkins, N.D., Housh, T.J., Buckner, S.L., Bergstrom, H.C., Cochrane, K.C., Hill, E.C., Smith, C.M., Schmidt, R.J., Johnson, G.O. and Cramer, J.T. (2016) Neuromuscular adaptations after 2 and 4 weeks of 80% versus 30% 1 repetition maximum resistance training to failure. The Journal of Strength & Conditioning Research, 30(8), pp.2174-2185. Kerkhoffs, G.M., Rowe, B.H., Assendelft, W.J., Kelly, K.D., Struijs, P.A. and Van Dijk, C.N. (2002) Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. The cochrane library. Kristensen, J. and Burgess, S. (2013) A comparison of two 3-week resistance training programmes commonly used in short-term military rehabilitation. Journal of the Royal Army Medical Corps, 159(1), pp.35-39. Küçükşen, S., Yilmaz, H., Sallı, A. and Uğurlu, H. (2013) Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Archives of physical medicine and rehabilitation, 94(11), pp.2068-2074.
Kuiper, J.H., Richardson, J.B. and Ashton, B.A. (2000) Computer simulation to study the effect of fracture site movement on tissue formation and fracture stiffness restoration. bone, 17000, pp.0-3. Kyung-Min, K.M., Croy, T., Hertel, J. and Saliba, S., 2010. Effects of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction on quadriceps strength, function, and patient-oriented outcomes: a systematic review. journal of orthopaedic & sports physical therapy, 40(7), pp.383-391. Licka, T. and Pehain, C (1998) An objective method for evaluating the flexibility 11 the back of standing horses. Equine wf. J. 30, 4 12-4 IS McBride, S.D., Hemmings, A. and Robinson, K. (2004) A preliminary study on the effect of massage to reduce stress in the horse. Journal of Equine Veterinary Science, 24(2), pp.76-81. Paulekas, R. and Haussler, K.K., 2009. Principles and practice of therapeutic exercise for horses. Journal of equine veterinary science, 29(12), pp.870-893. McDowell, B.C., McCormack, K., Walsh, D.M., Baxter, D.G. and Allen, J.M. (1999) Comparative analgesic effects of H-wave therapy and transcutaneous electrical nerve stimulation on pain threshold in humans. Archives of physical medicine and rehabilitation, 80(9), pp.1001-1004. Medrado A, Pugliese L, Reis S, et al. (2003) Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Laser Surg Med;32:239-244. O’sullivan, M.E., Bronk, J.T., Chao, E.Y. and Kelly, P.J., (1994) Experimental study of the effect of weight bearing on fracture healing in the canine tibia. Clinical orthopaedics and related research, 302, pp.273-283. Pearce, C.J., Tourné, Y., Zellers, J., Terrier, R., Toschi, P. and Silbernagel, K.G., 2016. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), pp.1130-1139. Petersen, S.L., Botes, C., Olivier, A. and Guthrie, A.J., (1999) The effect of low level laser therapy (LLLT) on wound healing in horses. Equine veterinary journal, 31(3), pp.228-231. Pfau, Thilo, Narelle C. Stubbs, LeeAnn J. Kaiser, Lucy EA Brown, and Hilary M. Clayton. (2012) “Effect of trotting speed and circle radius on movement symmetry in horses during lunging on
a soft surface.” American journal of veterinary research 73, 12: 1890-1899. Poppendieck, W., Wegmann, M., Ferrauti, A., Kellmann, M., Pfeiffer, M. and Meyer, T. (2016) Massage and performance recovery: a meta-analytical review. Sports Medicine, 46(2), pp.183204. Robert, C., Valette, J.P. and Denoix, J.M. (1998) Surface electromyographic analysis of the normal horse locomotion: a preliminary report. In: Proceedings of the Conference on Equine Sports Medicine and Science, Cordoba, Spain. pp 80-85. Robert, C., Valette, J.P. and Denoix, J.M. (2001) The effects of treadmill inclination and speed on the activity of three trunk muscles in the trotting horse. Equine veterinary journal, 33(5), pp.466-472. Robert, C., Valette, J.P., Pourcelot, P., Audigie, F. and Denoix, J.M. (2002) Effects of trotting speed on muscle activity and kinematics in saddlehorses. Equine Veterinary Journal, 34(S34), pp.295-301. Schils, S.J. and Turner, T.A. (2014) Functional Electrical Stimulation for equine epaxial muscle spasms: retrospective study of 241 clinical cases. Comparative Exercise Physiology, 10(2), pp.89-97. Schils, S., Carraro, U., Turner, T., Ravara, B., Gobbo, V., Kern, H., Gelbmann, L. and Pribyl, J., 2015. Functional electrical stimulation for equine muscle hypertonicity: histological changes in mitochondrial density and distribution. Journal of Equine Veterinary Science, 35(11), pp.907-916. Shin, T.M. and Bordeaux, J.S. (2012) The role of massage in scar management: a literature review. Dermatologic Surgery, 38(3), pp.414-423. Slijper, E. J. (1946) Comparative biological-anatomical investigations of the vertebral column and spinal musculature of mammals. Proc. K. Ned. Akad. Wet. Verh (Tweed Sectie) 47, 1-28 Stubbs, N.C., Riggs, C.M., Hodges, P.W., Jeffcott, L.B., Hodgson, D.R., Clayton, H.M. and Mc Gowan, C.M. (2010) Osseous spinal pathology and epaxial muscle ultrasonography in Thoroughbred racehorses. Equine Veterinary Journal, 42(s38), pp.654-661 Sullivan, K.A., Hill, A.E. and Haussler, K.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.
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Tabor, G. (2015) The effect of dynamic mobilisation exercises on the equine multifidus muscle and thoracic profile. Tipton CM, James SL, Mergner W, Tcheng TK. (1970) Influence of exercise on strength of medial collateral knee ligaments of dogs. Am J Physiol; 216(3): 894-902. Townsend, H.G., Leach, D.H., Doige, C.E. and Kirkaldy-Willis, W.H. (1986) Relationship between spinal biomechanics and pathological changes in the equine thoracolumbar spine. Equine Vet. J. 18, 107-112. Turner, T.A. (2011) Overriding spinous processes (“ kissing spines”) in horses: diagnosis, treatment, and outcome in 212 cases. In Proceedings of the 57th Annual Convention of the American Association of Equine Practitioners, San Antonio, Texas, USA, 18-22 November 2011 (pp. 424-430). American Association of Equine Practitioners (AAEP). Uhthoff, H.K.; And Jaworski, Z.F.G.(1978) Bone Loss in response to long-term immobilization. J Bone Joint Surg 60-B:420-429,1978. 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. The Veterinary Journal, 198(2), pp.404-411. Walmsley, J.P., Pettersson, H., Winberg, F. and McEvoy, F. (2002) Impingement of the dorsal spinous processes in two hundred and fifteen horses: case selection, surgical technique and results. Equine veterinary journal, 34(1), pp.2328. Watson, T. (2003) Soft tissue repair and healing-review [online] Available from: http://www.electrotherapy.org/ modality/soft-tissue-repair-and-healingreview (Accessed 20th March 2017) Woo SL, Matthews JV, Akeson WH, Amiel D, Convery FR. (1975) Connective tissue response to immobility. Correlative study of biomechanical and biochemical measurements of normal and immobilized rabbit knees. Arthritis Rheum; 18: 257-64.
Appendix Table 1 Author
Surgery
Protocol/management
Coomer et al., (2012)
Steroid injection v Interspinous ligament desmotomy
30mins hand walking x2 day for 3 weeks, then small paddock turn out with 10mins pessoa lunge increasing 10mins each week. No riding for 6/52. Soft tissue spasm released- TP release and reflex inhibition. Neuromuscular stimulation.
Debrosse et al 2007
Endoscopic resection DSP and interspinous ligament
3 days hospital, then hand walking 30mins x2 day, sutures removed at 14days, walking continued for 3 weeks, riding at 6-8weeks, full work at 8 weeks
Jacklin et al., 2014
Open DSP resection
Gradual increase of handwalking/walking for 4 weeks, 2 months of turn out, conditioning program of two months
Jeffcott, 1975
Open resection
2-3 days post-surgery 15- 20mins hand walking/ day, increases gradually over 1 month to 45-60 mins, gradual return to work after stitches removed
Turner (2011)
Conservative treatment
Walk and trot ridden in long and low head and neck posture, progressing to pole work/cavellettis
Walmsley (2002)
Open DSP resection
10mins hand walking 1-3 days, then lunging 10mins in long reins daily- progress to 30mins by week 7. 1st 30 cases turned out for 6 months at 2 weeks postsurgery. Then cases lunged with long reins from 2 weeks postoperatively and given physiotherapy, (H wave therapy, massage and suppling exercises), ridden at 2-6 months depending on progress
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A Review by Libby Hope
Global Positioning System Derived Performance Measures are Responsive Indicators of Physical Activity, Disease and the Success of Clinical Treatments in Domestic Dogs Elizabeth A. Bruno, James W. Guthrie, Stephen A. Ellwood, Richard J. Mellanby, Dylan N. Clements Introduction
T
here is a known need to further develop objective outcome measures in animals, including to measure physical activity. Currently measures do exist, including owner completed questionnaires and various electronic means, though each with their own limitations. Global Positioning System (GPS) is one tool that can be used to record multiple features of canine physical activity, specifically: Velocity; acceleration; deceleration; and distance.
What they did
A
small study involving ten control dogs, from staff at a veterinary school, and seven dogs with diagnosed elbow Osteoarthritis (OA), from a small animal hospital were recruited. Dogs took part in up to three activities wearing a GPS which was fitted onto a standard collar. The full protocol of three activities involved an onlead one kilometre (approximate) walk, an off-lead walk for one kilometre (approximate) and a play session chasing a ball ten times. This full protocol was undertaken by the healthy control group for five consecutive days. Strenuous play
activity and a long duration of walking were not felt appropriate for the dogs with OA and consequently, only offlead walking was completed with this group. This was also only undertaken once before treatment with Carprofen, and once after 14 days of taking this drug. GPS data was cleaned using statistical software and performance measure scores, within and between groups, analysed.
What they found
I
n the healthy control group, dogs walked significantly further off-lead compared to when they were on-lead and this difference was also apparent visually on GPS data traces. Distances travelled off-lead by dogs with OA, were non- comparable, as not all these dogs could complete the full walking route. The GPS could also significantly distinguish between activities. Greater velocity, acceleration and deceleration scoring was seen during play sessions, intermediate scoring during off-lead time and lesser scoring with on-lead walking. Most physical activity markers in dogs with OA pre-treatment were significantly lower than those of controls. Overall, the treatment group improved on indicators after a 14 day course. As such, post treatment
indicators, were not recognisably different between measures in the control group, with the exception to the mean scoring of velocity and deceleration (but not maximal scores of these).
Take home message
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here are some obvious observations that can be made about this study. These include small study sample size and open disclosure that one author was funded, albeit for a separate research study, by the pharmaceutical chain providing pain medication in this research. However, implications additional to Carprofen being effective in the treatment of dogs with OA, can be made for the scope of Animal Physiotherapists. GPS can be considered as a practical and objective outcome measure for physical activity marker and treatment effect, at least in research settings. Interestingly, findings relating to lesser acceleration/ deceleration capacity in dogs with OA versus their apparent ability to still reach maximal velocity on par with healthy dogs, draws attention to specifics in the functional presentation of OA.
Libby Hope BSc ACPAT Cat B
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International Conference of Equine Exercise Physiology (ICEEP) Update Lynne Harrison MCSP ACPAT A
T
he International Conference of Equine Exercise Physiology happened in Lorne, Australia in November 2018. This conference happens once every four years and attracts researchers, Veterinary Surgeons, Physiotherapists, biomechanics specialists, and even aeronautical engineers from around the world. I, along with Gillian Tabor, were fortunate to attend this conference.
SLO is the ongoing approval or broad social acceptance of ‘an’ industry by the general public and other stakeholders. It is: • Ingrained in the beliefs, perceptions and opinions held by the general public and other stakeholders. • Dynamic - as beliefs, opinions and perceptions are subject to change. • Has to be earned and then maintained.
There were several Physiotherapists presenting their research including Dr Lesley Goff, Gillian Tabor, Dr Anna Bergh (Physiotherapist and Vet from Sweden), and myself. This was very exciting and instrumental in getting physiotherapy recognised as an essential part of the multidisciplinary team in equine rehabilitation. Much of the work presented was on the Thoroughbred racehorse. This was in part due to Racing Victoria being a significant sponsor of the conference, but all the work presented plays a significant role in progressing our understanding of anatomy, physiology and rehabilitation of the horse. One of the lectures that stood out was given by a veterinary surgeon from Victoria who discussed “Animal Welfare and the Social Licence to Operate”. This term was unfamiliar to many of us listening, but it soon became apparent where she was coming from. The term “Social Licence to Operate” (SLO) was first coined by the Mining Industry. Historically, mining companies were following rules and regulations set out in law but were surprised by the reactions of communities with regards to the social values people held against such mines operating. Public opinion suggested that mining was bad for local communities and the environment and so needed to be stopped or changed.
In recent times the Racing Industry has undergone similar public backlash. In 2016, market research confirmed that 48% of adults totally reject thoroughbred racing and had concerns in relation to equine welfare and gambling. Market research tells us that equine welfare is consistently a barrier towards engagement with Victorian thoroughbred racing. This research also tells us that 18% of people who had never engaged with thoroughbred racing held these views and therefore did not participate in attending a race meeting, punting or viewing a race. Here in Australia, social media blew up at the death of The Cliffs of Moher following this year’s Melbourne Cup (Australia’s biggest and richest horse race). So much anger and misunderstanding was posted all over Facebook and Twitter, but much of what was said was incorrect or totally out of context.
That said, there has definitely been a public shift away from horse racing as being an acceptable sport, and the quote below sums it up well… “Watching yesterday’s acceptable practices turn into today’s social issues…”
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The racing industry has a huge task on its hands to try and change community opinion. It is essential for policies and practices to be evidence based and reflect social and ethical values. It is essential that issues are addressed pro-actively. There is also a need for continuous evolution as science progresses and social attitudes change. From what I experienced at ICEEP, the scientific community are striving to understand and improve welfare and training issues for all horses in all disciplines. The message just needs to get out there to the wider community. However, it may not be enough for the racing industry…
There was a significant amount of information presented at ICEEP, so I thought I’d share some of information relevant to Physiotherapy with you here; Russell Guire at al. (2018) investigated “The effect of tree width on the kinematics of the thoracolumbar spine”. The researchers hypothesised that a wide saddle would decrease vertical range of motion (ROM) at T13 and L3, and a narrow saddle would increase mediolateral ROM at T13 and L3. There is a notion within the industry that fitting saddles wide allows the thoracolumbar spine to increase ROM. Previous studies have shown an association between changes in gait and saddle pressures at T13. Due to a paucity of evidence on the effect that tree widths have on locomotion, this study was undertaken. Method: 13 non-lame horses were used in the study following assessment by a vet. Two riders weighing 70kg and 157cm tall were used throughout the experiment. A new GP Kent & Masters saddle was used throughout the study and was fitted to each horse
and assessed by five Society of Master Saddlers qualified saddle fitters. Saddles were fitted under three conditions – correct width, one width fitting wider, and one width fitting narrower.
dimensions. Further work is needed to establish if these changes are the result of saddle and rider instability, and to understand the biomechanics behind these changes. Gillian Tabor presented three abstracts and was heavily involved in the research of the following abstract along with David Marlin and Jane Williams:
Can human training load quantification be adapted for equine training?
Horses were fitted with three different measuring systems; 1) Inertial Measuring Units (IMUs) positioned along the thoracolumbar spine at the poll, wither, T13, T18, L3, tuber sacrale, and left and right tuber coxae. 2) A pressure mat was fitted underneath the saddle, containing 256 pressure sensors divided into two halves; 3) 2D motion capture with 24 reflective joint markers to capture shoulder flexion, elbow flexion, carpal/tarsal flexion and fetlock hyperextension. Horses were exercised on the same artificial surface. The surface was groomed between horses. Data was collected three times on a calibrated track in rising trot and canter on the left and right rein after a 15-minute warm up. Data Processing: Each condition was compared using a general linear model with repeated measures and Bonferroni post hoc correction (p<0.05). Discussion: The researchers found that using saddles that were too narrow/ too wide affected:
Optimal training requires understanding of exercise variables to achieve enhanced performance and progression. Rating of perceived exertion scales (RPE) are validated as proxy measures for physiological workload in human sport alongside Edwards’ training load. Edwards’ methodology is an algorithm using duration of time within defined heart rate (HR) zones. Both methods are validated to monitor Training load (TL) in human athletes. This study investigated if these methods could potentially offer a simple and repeatable measure of workload in equine training regimens. HR data (Polar V800) were obtained during exercise from 32 horses across a range of equestrian disciplines with experienced riders and trainers. Based on Edwards’ TL, duration (minutes) spent within five pre-defined training zones (1:<80, 2:80-120, 3:120160, 4:160-200, 5:>200 beats per minute) were factored to obtain total TL (HRTL). Ratings (1:very,very easy -10:maximal) were collected from riders and trainers, reflecting horses‘ RPE for entire sessions then multiplied by exercise duration to determine internal TL (INHR).
Spearman’s correlations (p<0.05) identified if relationships existed between HRTL and INHR. Statistically significant correlations between HR and INHR were found for both riders and trainers ratings of TL, riders: cohort: r=0.80, p=0.0001, sportshorses: r=0.81, p=0.0001, racehorses: r=0.72, p=0.002 and for trainers: cohort: r=0.82, p=0.0001, sportshorses: r=0.89, p=0.0001, racehorses: r=0.94, p=0.0001. The results suggest HRTL and INHR can be used as an inexpensive and easy tools to quantify TL and objectively assess progress in training. Exploration of optimal HR zone allocation for specific disciplines and breeds, alongside application of TL monitoring within equestrianism is warranted. The other titles presented by Gillian were “Equine endurance race pacing strategy and performance in 160km single day races” and “Analysis of faults in international show jumping competition”. I was also fortunate enough to present my MSc research with Lesley Goff. Below is the abstract from my paper.
• Limb kinematics • T13 ROM
The effect of kinesiology tape on the walking gait of sound horses
• L3 ROM • Saddle pressures at T13
Kinesiology taping (KT) has become popular in both human and veterinary rehabilitation, yet there is a paucity of studies specifically focusing on the use of KT in horses. Preliminary studies within human research indicate that KT may improve joint proprioception and muscular strength. The aim of this gait analysis study was to compare horizontal, shear and vertical forces, and corresponding moment components in a group of sound horses
• Thoracolumbar dimensions Murray et al (2017) also found gait alterations occurred with increased pressures at T13. This study confirmed the hypothesis that and concluded correct saddle width (and fit) is essential to promote unhindered back function. Tree width has an effect on locomotion, saddle pressure and thoracolumbar
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at walk. Force measurements were recorded under three taping scenarios in order to test if the forces/moments recorded varied between different tape applications. Five Standardbred mares were walked over a force platform in each scenario until a total of ten valid trials were recorded. A trial was considered valid when the right hind and right forelimbs made contact with the force platform respectively (a lateral sequence). From the ten valid trials recorded, graphical data was generated, and the best five graphs were analysed for each scenario. The amplitudes for all force and moment components were recorded, along with time of foot lift-off and foot strike. Data was collated and prepared for statistical analysis. A 2-way analysis of variance was performed and no statistical difference (P<0.05) was identified between each scenario. A number of reasons may explain these results including inadequate stretch applied to the tape, non-lame horses were evaluated, and potentially inappropriate outcome measures were assessed. It is recommended therefore, that further research with KT be undertaken in abnormal horses. A link to the proceedings of the conference is: https://www.wageningenacademic. com/toc/cep/14/Supplement+1
Final Horse Gems! • When the wheels of a plane touches down, there is 8G of force at impact. • At 12G, a plane’s wings will fall off. • At gallop, there is 200G of force as the horse’s hoof hits the ground! • Trot is 7x more energy expensive than walk or canter due to collisional energy losses. • Collisional energy on the spot (Grand Prix piaffe) is 4 x greater than at trot. Therefore, high intensity training is likely to need only very short bursts of training as the level of energy expenditure is so high.
The next ICEEP meeting will be in Uppsala, Sweden in 2020. I cannot encourage you enough to go and learn from some of the world’s leading researchers in the Equine kingdom.
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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
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 Þbrocartilaginous 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.
THIS INFORMATIONAL PRESENTATION IS AVAILABLE AS A POSTER FOR USE BY MEMBERS FOR LOCAL PR EVENTS
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Critical Review of the Evidence Supporting Physiotherapeutic Management of Equine Sacroiliac Regional Pain Wareham, N., Hutson, P. and Tabor, G. (Hartpury University, Gloucester, GL19 3BE) Introduction
Background
E
ERSP is associated with causing poor performance, most commonly presenting with reduced hindlimb engagement, reduced willingness to move forwards into a contact and a poor quality canter (Dyson and Murray, 2003). ERSP can also be a result of referred pain from pathology affecting the thoracolumbar spine and hindlimb, which share complex neurophysiological pathways with the sacroiliac joint (SIJ) region (Van de Wurff et al., 2006) further supporting collaboration with the veterinarian to establish correct diagnosis.
quine regional sacroiliac pain (ERSP) encompasses a wide variety of symptoms and is a recognised cause of hindlimb lameness and poor performance (Dyson and Murray, 2003). ERSP is more commonly recognised in performance horses; in particular those competing in dressage and show jumping sports (Dyson and Murray, 2003). The veterinary approach to managing ERSP aims to identify the underlying pathological process, followed typically by medical intervention; an imperative step in the veterinary physiotherapist referral pathway (Goff et al., 2008). Physiotherapy intervention utilises a range of assessment and treatment techniques, which act to identify and treat sensory and motor disturbances; restoring function, relieving pain and thus improving performance and quality of life (McGowen et al,. 2007). Current literature supports therapeutic exercise as an effective means of treating and managing ERSP (Clayton, 2012; Denoix and Jacquet, 2008; Goff et al., 2008; HeuftDorenbosch et al., 2006; McGowen et al., 2007; Stubbs et al,. 2011).
The kinematic importance of the SIJ is to provide a stable means of transferring force from the hindlimb to the thoracolumbar spine via the surrounding musculoligamentous system (Bronlinson et al., 2003). Notably, Degruence et al., (2004) assessed equine SIJ movement in vitro reporting less than 1 degree of translation. Goff et al., (2008) use the term ‘functional instability’ to describe reduced postural control around the SIJ rather than a true joint instability; reported in human literature as subluxation often secondary to catastrophic trauma or pathology (Bronlinson et al., 2003). Functional
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instability has been noted to cause a mild increase in articular translation which may result in SIJ remodelling and ERSP if not addressed (Bronlinson, 2003; Goff et al., 2008). Such functional instability affords the potential for physiotherapy intervention to assess and treat muscular imbalance and postural disturbances (McGowen et al., 2007) therefore supporting long term reduction in ERSP and promoting improved performance. ERSP secondary to SIJ dysfunction has been classified into two groups (Dyson and Murray, 2003; Goff et al., 2008); the first presenting with insidious onset of poor performance, responsive to local analgesia and the second, a more chronic picture encompassing poor performance and osseous, pathological SIJ change. Goff’s concept of functional instability is further supported by human research that suggests that it is the shearing and abnormal force closure of the joint that causes pain secondary to reduced postural control by the surrounding muscles (Hossain and Nokes, 2005; Snijders et al., 1998). It is proposed by Snijders et al., (1998) that the shearing forces are caused by the longitudinal muscles and that protection from this is sought from transversely aligned musculature such
as the internal oblique and abdominal musculature. This is reinforced in equine literature by Goff et al., (2008), Stubbs et al., (2011) and Clayton (2012) who emphasise the role of Multifidus, a deep spinal stabiliser, in supporting lumbopelvic stability.
Treatment of ERSP The primary objective for both veterinary and physiotherapeutic treatment is to reduce pain and restore normal movement (Dyson and Murray, 2003; Engeli and Haussler, 2004; Goff et al., 2008; McGowen et al., 2007). Therapeutic exercise has been demonstrated to be effective in restoring long term improvements in SIJ function, pain reduction and consequently, overall performance status (Clayton, 2012; Dyson and Murray, 2003; Goff et al., 2008; Haussler, 2003; Laslett, 2008; McGowen and Goff, 2016). Physiotherapy treatment is deemed to be more effective if pain is addressed and this sits well with the first line of veterinary treatment which is often analgesic periarticular joint injection (Dyson and Murray, 2003; Engeli and Haussler, 2004; Goff et al., 2008; McGowen et al., 2007). Dyson and Murray (2003) describe one technique of periarticular injection into the SIJ that improved performance in all horses (n=34) however they did not comment upon the longevity of the analgesic effect. Reduction in pain associated with ERSP supports physiotherapy treatment and the physiotherapy treatment can offer the potential longevity in symptom reduction that analgesia alone may not (McGowen et al., 2007). The physiotherapist should consider the type of procedure undertaken by the veterinarian, for example, if injections are done ‘blindly’ there is a risk of anaesthetising the very structures that will be the focus of physiotherapeutic rehabilitation i.e. neuromuscular control of the SIJ (Engeli and Haussler, 2004). In the
human field, joint injections are often carried out under guided imaging (ultrasound / CT) due to the significant improvements in accuracy and treatment effect (Balint et al., 2002; Cunnington et al., 2010; Sibbitt et al., 2009) and this may improve outcomes in the equine population. Once analgesia is optimised, therapeutic exercise can commence and may be utilised to reduce ERSP secondary to SIJ dysfunction in the following ways; i) Early rehabilitation - restoration of pelvic stability, ii) Functional rehabilitation - improving dynamic stability of the SIJ and iii) Performance management improving global muscle strength and conditioning, thereby reducing the risk of future ERSP.
Early Rehabilitation: Pelvic Stability Dynamic mobilisation exercise (DME) is a veterinary physiotherapy term used to describe exercises to improve spinal and postural stability in horses (Clayton, 2012; McGowen et al., 2007; Stubbs et al., 2011). Stubbs et al., (2011) have demonstrated DMEs to be key in increasing cross sectional area (CSA) of multifidus; a deep stabiliser of the spine, at levels T10-L4. The multi-layered and multidirectional fibres of multifidus stabilise the intervertebral joints and therefore activation and strengthening can result in reduced functional instability, which may be associated with injury and degenerative change (Clayton, 2012; Stubbs et al., 2011). Core stability exercises have been demonstrated as
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beneficial in the treatment of human SIJ pain (Akuthota et al., 2008; Richardson et al., 2002) however similar research in the equine field is limited. Core stability exercises in humans and in equines focus on increasing neuromuscular control and increased cross sectional area of the deep stabilising musculature of the spine and pelvis and it is suggested that this could also influence the stability and postural control of the SIJ (Dyson and Murray, 2003; Denoix and Jacquet, 2008; McGowen and Goff, 2016). The human biomechanical model utilised by Richardson et al., (2002) emphasises activation of transversely orientated muscles such as lumbar multifidus, transversus abdominis, piriformis and the pelvic floor muscles as being key to pelvic stability. This is because the transversely oriented fibres act to compress the sacrum against the ilia and maintain stability of the SIJ thereby reducing ligamentous ‘creep’ and/or damage to the joint capsule (Goff et al., 2008; Van Wingerden et al., 2004). Richardson et al., (2002) found independent activation of transversus abdominis and lumbar multifidus decreased SIJ laxity to a significantly greater degree than global abdominal exercise patterns. Laslett (2008) reinforces the importance of stabilisation exercises in the treatment of human SIJ pain but also highlights the limitations in outcome measures due to poor reliability and validity of tests for SIJ dysfunction. Richardson et al., (2002) in the human population, utilised real time ultrasound and EMG to provide objective means of resultant muscle patterns, however this would not be readily available to the veterinary physiotherapist and therefore more functional performance measures can be utilised as treatment outcomes e.g. assessment of gait (McGowen et al., 2007). Future research could help support the use of DMEs in the treatment of ERSP caused by functional instability of the SIJ. Examples of DMEs include
baited exercises whereby the horse is encouraged to flex through the spine in order to engage the aforementioned deep spinal stabilisers and abdominal musculature (Stubbs et al., 2011).
Functional Rehabilitation: Dynamic Control DMEs should be established prior to advancing the exercise/ treatment program, with the progression aiming to incorporate lumbopelvic and SIJ stabilisation into a more functional situation (Akuthota et al., 2008; Clayton, 2012). For example, similarly to DMEs, longlining is a useful training aid in order to encourage the horse to flex through the thoracolumbar spine (McGowen et al., 2007). Incorporation of ground poles should encourage the horse to further recruit hypaxial and abdominal musculature in order to stabilise the spine and pelvis for increased limb flexion (over the poles) during the cranial phase of gait (Clayton, 2012; McGowen et al., 2007). During the stance phase of each hindlimb, stabilisation via means of abdominal, hypaxial and gluteal co-contraction is vital in order to provide spinal, pelvic and SIJ stability (Clayton, 2012). Further to this, Hodges and Richardson (1997) have shown that transverse abdominus activation precedes limb movement in humans regardless of the direction of the movement and it is transverse abdominis that is suggested by Dyson and Murray (2003) and Goff et al., (2008) as being vital in equine SIJ stabilisation. Therefore by incorporating dynamic therapeutic exercise, it can be hypothesised that there is an increased activation of the equine transversus abdominis. In order for propulsion to occur effectively, the horse is required to engage and protract the hind limb under the body through the cranial phase in order to push and propel during stance/ ground reaction phase (Clayton, 2012). Hindlimb protraction requires activation of the hip and lumbosacral flexors, iliopsoas and psoas minor, which also provide an element of SIJ stability due to their skeletal attachments ventral to the SIJ (Goff et al., 2008). Therefore exercising the horse over poles for example, would aim to improve the local stability but also global activation of lumbopelvic musculature. A progression may incorporate circles and change of direction where ipsilateral contraction of longissimus dorsi in combination with the abdominal obliques supports
lateral flexion through the vertebral column (Clayton, 2012). In performance horses, it is important that sufficient spinal and pelvic stability precedes this in a linear direction (hence the aforementioned DME’s) so that the horse is then able to stabilise effectively enough to generate sufficient lateral bend whilst maintaining a more vertical orientation and suspension through the lower limb (Clayton, 2012; McGowen et al., 2007, McGowen and Goff, 2016) as required in higher level dressage requirements. If the horse is able to generate sufficient stability through the spine and SIJ, the force produced through the hind limbs will be more effectively transmitted through the SIJ as per the intended biomechanical and physiological purpose (Dyson and Murray, 2003). With less functional instability, it can be hypothesised that the SIJ is at less risk of injury due to ligament creep, increased force placed upon the joint capsule or indeed degenerative osseous change (Clayton, 2012; Dyson and Murray, 2003; Goff et al., 2008). Less risk of pain and / or injury supports improvements in horse welfare and increases potential to maximise performance and competitive longevity (Clayton, 2012; Dyson, 2000).
Performance Management : Strength and Conditioning Functional exercise and ridden schooling are considered vital in the longer term prevention and management of ERSP, particularly in performance horses (Clayton, 2012; Dyson, 2000; Dyson and Murray, 2003; McGowen et al., 2007). Often the end goal of treatment is for the horse to return to the same, if not a greater level of competition (Clayton, 2012; Dyson, 2000; McGowen et al., 2007) and this can be used as an outcome measure by the physiotherapist in the treatment of performance horses. Competition horses should benefit from schooling exercises focused on specific strength and conditioning for performance (Clayton, 2012). For example, dressage horses could carry out exercises that encourage spinal flexion and activation of hypaxial musculature to support engagement of the hind limb, such as collected, lateral and pole work, renvers and travers. For show jumping horses, gymnastic exercises such as grid work, bounce fences, jumping on an angle as well as
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some of the aforementioned flatwork (Dyson, 2000). Although equine research is limited, human research indicates cross-training in this way as beneficial in improving overall fitness and the fitter the athlete the less likely for injury to re-occur (Harman et al., 2008; Smith et al., 2013). It could be argued that similarly the fitter the horse, the less risk there is of dysfunction at the SIJ and associated ERSP, hence the importance of the veterinary physiotherapist’s role in performance management of the horse.
Conclusion ERSP can present with a multitude of symptoms and some of these may replicate differential diagnoses. A veterinary-led, holistic approach to assessment and treatment is therefore paramount. Physiotherapeutic exercises aimed at increasing postural control and reducing functional instability at the SIJ are deemed beneficial. Physiotherapy intervention can also drive improvements in strength and conditioning, reducing the risk of future dysfunction of the SIJ and associated ERSP. Future research is required into the effect of DMEs and progression of therapeutic exercises on SIJ stability and associated ERSP.
References Akuthota, V., Ferreiro, A., Moore, T. and Fredericson, M., (2008) Core stability exercise principles. Current sports medicine reports, [online] 7(1), pp.39-44. [Accessed 20/02/2016] Bromlinson, P. Kozar, A., Cibor, G., (2003) Sacroiliac joint dysfunction in athletes. Current sports medicine reports (2), pp.47-56. [Accessed 10/03/2016] Clayton, H.M., (2012) Equine back pain reviewed from a motor control perspective. Comparative Exercise Physiology, [online] 8(3-4), pp.145152. [Accessed 20/02/2016] Cunnington, J., Marshall, N., Hide, G., Bracewell, C., Isaacs, J., Platt, P. and Kane, D., (2010) A randomized, double‐blind, controlled study of ultrasound‐guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis & Rheumatism [online], 62(7), pp.18621869. [Accessed 18/02/2016] Dalin and Jeffcott, (1986a) Sacroiliac joint of the horse 1. Gross Morphology. Anatomy, Histology, Embryology [online] 15, pp.80-94. [Accessed 17/02/2016]
Degruence, C., Chateau, H., Denoix, J-M. (2004) In vitro assessment of movements of the sacroiliac joint in the horse. Equine Veterinary Journal. [online] (36), pp.694-698. [Accessed 20/02/2016] de Oliveira, L.C., de Oliveira, R.G. and de Almeida Pires-Oliveira, D.A., (2015) Effects of Pilates on muscle strength, postural balance and quality of life of older adults: a randomized, controlled, clinical trial. Journal of physical therapy science, [online] 27(3), p.871. [Accessed 20/02/2016] Dyson, S., (2000) Lameness and poor performance in the sports horse: dressage, show jumping and horse trials (eventing). In Proceedings of the Annual Convention of the AAEP. [online] (46), pp.308-315. [Accessed 20/03/2016] Dyson, S and Murray, R. (2003) Pain associated with the sacroiliac joint region: a clinical study of 74 horses Equine Veterinary Journal, [online] 35 (3), pp.240-245. [Accessed 20/03/2016] Goff, L.M., (2009) Manual Therapy for the Horse - A Contemporary Perspective. Journal of Equine Veterinary Science [online] 29 (11), pp.799-808. [Accessed 12/02/2016] Goff, L.M., Jeffcott, L.B., Jasiewicz, J. and McGowan, C.M., (2008) Structural and biomechanical aspects of equine sacroiliac joint function and their relationship to clinical disease. The Veterinary Journal, [online] 176 (3), pp.281-293. [Accessed 11/02/2016] Harman, E.A., Gutekunst, D.J., Frykman, P.N., Nindl, B.C., Alemany, J.A., Mello, R.P. and Sharp, M.A., (2008) Effects of two different eight-week training programs on military physical performance. The Journal of Strength & Conditioning Research, [online] 22 (2), pp.524-534. [Accessed 20/02/2016] Haussler, K.K. (2003) Diagnosis and management of lameness in the horse, Saunders and co Philadelphia, pp.501508. Haussler , K., Stover, S., Willits N., (1999) Pathological changes in the lumbosacral vertebrae and pelvis in racehorses. American Journal of Veterinary Research [online] 60, 143153. [Accessed 20/02/2016] Heuft-Dorenbosch L, Weijers R, Landewe R, S van der Linden, D van der Heijde (2006) Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: Inter-
reader reliability and prevalence of abnormalities. Arthritis Res Ther. [online] (8), p.11. [Accessed 15/02/2016] Hodges, P.W. and Richardson, C.A., (1997) Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Experimental Brain Research, [online] 114 (2), pp.362-370. [Accessed 23/02/2016] Hossain, M. and Nokes, L.D.M., (2005) A model of dynamic sacro–iliac joint instability from malrecruitment of gluteus maximus and biceps femoris muscles resulting in low back pain. Medical Hypotheses, [online] 65 (2), pp.278-281. [Accessed 14/02/2016] Kaneps, A.J., (2016) Practical Rehabilitation and Physical Therapy for the General Equine Practitioner. Veterinary Clinics of North America. Equine Practice, [online] 32 (1), pp.167-180. [Accessed 20/03/2016] Kibler, W.B., Press, J. and Sciascia, A., (2006) The role of core stability in athletic function. Sports medicine, 36 (3), pp.189-198. [Accessed 19/02/2016] Laslett, M. (2008)Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Man Manip Ther. [online] 16 (3), pp.142–152. [Accessed 16/02/2016] McGowan, C., Goff, L. (2016) Animal physiotherapy: assessment, treatment and rehabilitation of animals. John Wiley & Sons. p313-315. McGowen, C., Goff, L., Stubbs, N. (2007) Equine treatment and rehabilitation. Animal Physiotherapy, Blackwell publishing. Pp. 242-243. Richardson, C A.; Snijders, CJ.; Hides, J A.; Damen, L; Pas, MS.; Storm, J(2002) The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain. Spine, [online] 27 (4), pp 399-405. [Accessed 20/03/2016] Rosenberg JM, Quint TJ, de Rosayro AM (2000) Computerized tomographic localization of clinicallyguided sacroiliac joint injections. Clin J Pain, [online] 16 (1), pp.18-21. [Accessed 20/02/2016] Smith, M.M., Sommer, A.J., Starkoff, B.E. and Devor, S.T., (2013) Crossfitbased high-intensity power training improves maximal aerobic fitness and body composition. The Journal of Strength & Conditioning Research, 27(11), pp.3159-3172. [Accessed 20/02/2016]
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Stubbs, N.C., Hodges, P.W., Jeffcott, L.B., Cowin, G., Hodgson, D.R. and McGowan, C.M., (2006) Functional anatomy of the caudal thoracolumbar and lumbosacral spine in the horse. Equine Veterinary Journal, [online] 38 (36), pp.393-399. [Accessed 01/03/2016] Stubbs, N.C., Kaiser, L.J., Hauptman, J. and Clayton, H.M., (2011) Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. Equine veterinary Journal, [online] 43 (5), pp.522-529. [Accessed 01/03/2016] Sturesson B, Uden A, Vleeming A. (2000) A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine, [online] (25) pp.214–217. [Accessed 20/03/2016] van der Wurff, P., Buijs, E.J. and Groen, G.J., (2006) A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Archives of physical medicine and rehabilitation, [online] 87 (1), pp.10-14. [Accessed 21/02/2016] van Dijke, G.A.H., Snijders, C.J., Stoeckart, R. and Stam, H.J., (1999) A biomechanical model on muscle forces in the transfer of spinal load to the pelvis and legs. Journal of biomechanics, [online] 32 (9), pp.927933. [Accessed 26/02/2016] van Weeren, P.R., Brama, P.A. and Barneveld, A., (2000) Exercise at young age may influence the final quality of the equine musculoskeletal system. AAEP Proceedings [online] (46), pp. 29-35. [Accessed 20/03/2016] van Wingerden JP, Vleeming A, Buyruk HM, Raissadat K. (2004) Stabilization of the sacroiliac joint in vivo: Verification of muscular contribution to force closure of the pelvis. Eur Spine J. [online] (13), pp.199–205. [Accessed 20/03/2016]
Research Digest Manessa Faal MCSP ACPAT A Local Back Pressure Caused by a Training Roller During Lunging With and Without a Pessoa Training Aid (2018) R. Mackechnie- Guire, E. MackechnieGuire, R. Bush, D. Fisher, M. Fisher, R. Weller. Pages 112-117. Vol 67. DOI: 10.1016/j.jevs.2018.03.018
Introduction:
G
round schooling (especially lunging) is routinely performed in the rehabilitation and training of horse. Training rollers are commonly used to provide attachment for training aids. In an attempt to condition the horse’s musculature, a variety of exercises can be provided. Most commonly used is lunging with a training aid. It has been reported that the overall force acting on the horses back while trotting is equivalent to two times the body mass of a rider. A previous study has shown that the Pessoa training aid has an effect on the whole horse locomotion, there a reduction in speed, stride length, head angle and lumbosacral angle were reported.
Aims: To investigate the pressure distribution beneath a roller when fitted with and without a Pessoa training aid, to identify if there is a pressure beneath the roller when using a Pessoa training aid and to investigate its effect on pelvic range of motion.
Method: 10 adult sport horses were recruited. Inclusion criteria included that horses were in regular competitive work preceding the study and were deemed fit and sound by their riders. Veterinarians assessed horses on the day. As part of the normal work routine, all horses engaged with lunge exercise at least once a week using a Pessoa training aid; therefore, all horses were suitably acclimatized to lunging and the attachment of training aids. All horses were warmbloods and of a similar conformation, all competing at affiliated dressage (elementaryadvanced medium) and displaying
good muscle definition well-defined musculature thoracolumbar region.
with a of the
Each horse underwent a 10-minute warm-up period on the lunge without the roller or Pessoa training aid being attached. Spherical cones positioned at a 17-m diameter marked the circumference of the circle in which trot and canter locomotion with and without the Pessoa training aid were measured. All measurements were performed on the same outdoor sand and rubber surface, which was groomed before and in between each trial (logic, single blade leveller). All horses were handled and lunged by the same handler: female, 58 years, 5’2 height. A crossover design was carried out, with each horse lunging on the left and right rein in trot and canter for both conditions, the order of which was randomized. If the horse lost regularity, tripped, or made an obvious alteration in gait pattern or circle size, the trial was repeated. For two horses, circle size altered, so the trial was aborted and repeated. From IMU and pressure distribution, data were matched in relation to movement condition, and data were collected from 40consecutive strides totalling mean 40±3 being used for analysis, in trot and canter on both left and right circles for each horse. This was repeated for both conditions with and without a Pessoa training aid.
Results: Speed – No significant differences were found in stride time between the two conditions for any of the four combinations of gait (trot/canter) and movement direction (left/right rein). Kinetic Data – Pressure Distribution – Significantly higher peak pressures were found beneath the width of the roller, directly on top of the spinous process in the region of the 11th and 12th thoracic vertebra when using a training aid compared to no training aid. The peak pressures occurred in both forelimb stance phases. In canter, repeatable pressures were recorded in the region of T11 and T12. No significant differences were found on either side of the spine when using a training aid compared to no training aid.
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Kinematics – IMU – No significant differences for any of the IMU derived movement parameters were found when using a training aid compared to no training aid in left/ right or trot/canter.
Conclusion: When using a roller with a high withered dressage square and a wool pad, there were localised pressures similar to ridden exercise, located directly beneath the roller directly on the spinous processes. Localized pressures increased and moved caudally beneath the roller when a Pessoa training aid was fitted, likely due to the back strap of the Pessoa training aid attaching to the ring positioned on the back of the roller. Improved manufacturing design is needed to create clearance of the vertebrae, similar to a treed saddle, during lunge exercise. Horse owners, veterinarians, physiotherapists, and instructors should be aware of the effect that a training roller can have on back pressures, especially in horses undergoing rehabilitation of back problems. Attempts to alleviate pressures should be made with either a pad creating clearance of the vertebrae or by placing a roller over the top of a correctly fitted saddle.
A Modified Tibial Compression Test for the Detection of Meniscal Injuries in Dogs (2017) S. Valen, C. McCabe, E. Maddock, S. Bright, B. Keeley. Vol 58. Issue 2. DOI: 10.1111/jsap.12619
Introduction:
C
ranial cruciate ligament failure is the most significant underlying factor for the development of meniscal injury in the canine stifle joint. The instability in the stifle with a cranial cruciate failure results in abnormal forces on the menisci and predisposes them to injury. Meniscal injury can contribute to degenerate joint disease in dogs with CCL failure.
In the novice group, the CDTe exhibited the greatest PPV (75%), while the ROM test displayed the highest NPV (62%). In the experienced group, the mTCT had the highest PPV (67%) and NPV (67%). Sensitivity, specificity, PPV and NPV for all five tests can be viewed in Table 2. Thirty stifles had entire menisci at the time of arthrotomy, though 8 and 11 of these for the novice and experienced group respectively were falsely positive during the physical tests. Of the 27 stifles with concurrent meniscal damage, 9 and 10 for the novice and experienced group, respectively, were undiagnosed upon manipulation (false negatives).
Conclusion:
The displacement of a torn meniscus during manual manipulation may create an audible click upon palpation in humans. Meniscal click may also be detected during physical testing in canine stifles, as the meniscus moves back and forth under the femoral condyle through tibial subluxation. It creates friction between the femur and the meniscus and manifests as an audible and palpable click.
Aims: To assess diagnostic efficacy of a modified tibial compression test in predicting medial meniscal injury in dogs with cranial cruciate failure. Routine preoperative stifle surgery assessment by orthopaedic clinicians at a UK referral hospital included the TCT, cranial drawer test in flexion (CDTf) and extension (CDTe) and range of motion (ROM). Additionally, a modified tibial compression test (mTCT) was carried out by performing the TCT under axial loading through a full range of stifle motion. In this prospective study, we aimed to compare the diagnostic efficacy of the TCT, CDTf, CDTe, ROM and mTCT in predicting medial meniscal injury in dogs affected by CrCL failure.
Method: Dogs selected for inclusion in the study were required to have orthopaedic and radiographic examination findings consistent with cruciate failure. The orthopaedic examination had to include a positive cranial drawer and, or tibial compression testing. The five tests (mTCT, TCT, CDTf, CDTe and ROM) were performed under general anaesthesia by one examiner from an intern group (novice group) and one examiner from an experienced orthopaedic surgeons group (experienced group). The novice group consisted of three novice examiners while the experienced
group consisted of four examiners with a CertSAO, CertSAS or DipECVS qualification. Examiners were blinded to case history, radiographs and to one another’s examination and findings. The examiners applied, from extension to flexion, constant axial loading through the hand grasping the dog’s metatarsus. A meniscal click represented a positive test while its absence represented a negative test. The results of the five clinical tests, being either positive or negative, were recorded separately for the examiners (surgeon database and intern database) using client numbers for patient identification.
Results: 170 dogs were included in the study, but reduced to 57. The most sensitive test for the detection of meniscal click in both the novice and experienced group was the mTCT, having a value of 63 and 59% respectively. ROM had a sensitivity of 44% (novice group) and 33% (experienced group) while the remain- ing tests ranged between 4 and 11%. The CDTe was the most specific test, with a value of 97% in both groups. The mTCT displayed the lowest specificity of the five tests, with values of 77% (novice group) and 73% (experienced group). Menisci with displaced vertical longitudinal tears had more positive tests during physical testing than nondisplaced vertical longitudinal tears. A displaced vertical longitudinal tear was associated with a meniscal click in 72 and 61% of dogs in the novice group and experienced group, respectively. A non-displaced vertical longitudinal tear was associated with a meniscal click in 57% of dogs in both groups. The novice group identified only one of the complex tears while the experienced group identified both.
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None of the five physical clinical tests performed in this study were accurate in reflecting meniscal integrity for dogs with cruciate failure. Out of the five tests, the mTCT was the most sensitive test for the detection of medial meniscal lesions, regardless of examiner experience. It’s sensitivity is slightly lower when compared with other non-invasive diagnostic modalities (high- field MRI, US) but has important advantages of high availability, affordability and can be easily performed. Owing to its low sensitivity, the mTCT should not be used as a sole diagnostic test for the detection of medial meniscal injury but may prove useful during the initial noninvasive assessment of a stifle with CrCL failure. The presence of a meniscal click during physical testing may also indicate stifle lesions other than medial meniscal injuries.
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• Is Global leading special veterinary kinesiology tape developed for animals and offers a wide portfolio for the equine and canine health professional. • Differentiates compared to current (human) kinesiology tapes available on the market; glue used, flexibility of the tape, thickness and size of the tape. • Is developed with former Animal Health professionals (MSD/Merck) and THYSOL; the unique combination that brings all knowledge, experience and expertise together. • Offers veterinary Equine and Canine courses specially developed veterinary professionals. • Is manufactured in our own factory and has all international quality certificates. • Is the official Global Partner of ISELP (Equine education) We have secured a discount of over 25% which means you will receive each roll at £10 per roll of 6cm x 5m with FREE POSTAGE if you buy the display package with 10 rolls. (P&P £7 normally if you are purchasing less then 10 rolls) VetkinTape® have advised we can mix and match tape width, so please specify which size you require when you order. Also available is an INTRODUCTION PACK, only for 1st orders, which contains; 4 rolls VetkinTape® (all colors) + VetkinTape® scissors + VetkinTape® horse (squeeze) for £45 (incl shipment). To order simply email your full name, ACPAT number and address, alongside preference and quantity to info@vetkintape.com - please quote “ ACPATCOUPON”
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400+ MEMBERS MINIMUM 5 YEARS ACADEMIC STUDY PHYSIOTHERAPY TO GB EQUESTRIAN TEAMS SINCE 1992 OLYMPICS
LEADERS IN ANIMAL PHYSIOTHERAPY Only highly qualified, Chartered Physiotherapists may undertake the specialist animal physiotherapy training in order to become an ACPAT member ACPAT physiotherapists hold specialist knowledge in anatomy, physiology, biomechanics and pathology. All treatments are based on a peer-reviewed evidence base meaning each animal receives the very best in treatment and care
GOLD STANDARD THERAPY VETS | SURGEONS | FARRIERS | PHYSIOTHERAPIST | OWNER | DENTISTS ACPAT physiotherapists work as part of a highlyqualified and regulated multi-disciplinary team of professionals.
ACPAT physiotherapists work only under veterinary referral ensuring a trusted and approved professional partnership.. partnership
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Working alongside the owner, vet and multi-disciplinary team provides the highest quality treatment and care.
Course Review
Sharon May-Davis Dissection Course Sally Cinnamond MCSP ACPAT A
L
ast year I attended a 3 day horse dissection course with equine anatomist Sharon May-Davis. This involved the dissection of the complete body of a horse. Sharon is highly personable and entertaining and obviously has an in-depth knowledge of equine anatomy. It was an excellent learning experience with plenty of opportunity to discuss topics of specific interest to any of the course participants. The participants were a mix of mainly vet physios as well as a vet student, a dental technician, a saddler and some riders/owners. Although I have been involved with several previous dissections it was very beneficial to see a full dissection of a complete cadaver. Dissection of the skeleton involved examination of the joints and this is where I found I could not fully agree with the assumptions made from examination of the joint surfaces. It was assumed that any cartilage wear/degeneration would be associated with pain in the horse. The horse we dissected was 16 years old and cause of death was unknown although there was evidence of a traumatic event. In my opinion it would be expected to observe joint surface damage/changes in a horse of this age. However as we know from our human experience the presence of pathology on X-ray/scan is not always an indication of clinical symptoms. In this case we had no medical history of the horse or knowledge of any clinical issues. Consequently, I felt it was inappropriate to assume the horse had been in pain due to joint surface changes. To me this
further emphasised the benefit of being a human physio with a more medical based training and knowledge. It’s so easy to make assumptions without a full clinical history. It was, however, an extremely interesting 3 days which I would recommend as a positive learning experience. Sharon has done a lot of work comparing the anatomy of nondomesticated horses to our modern day domesticated horses and has made numerous interesting observations. Some of the observed differences she attributes to the changed feeding behaviours of domesticated horses, in particular with respect to the fact that they are predominately grazers rather than browsers. These observations have led Sharon to believe that most domesticated horses would benefit from the introduction of browsing to their feeding regime and she highly recommends variable height feeding. Despite the fact that non-domesticated horses are natural browsers as well as grazers we are often led to believe that horses are just grazers and, as such, that feeding from the ground is most beneficial for them. However, horses are actually both grazers and browsers with non-domesticated horses spending about 20% of their feeding time browsing. Modern pasture management limits the availability of browsing for many of our domesticated horses. If stabled horses feed only from the ground or in one fixed position this can exacerbate the problem.
Variable height feeding has several benefits: 1. Increased movement around the stable 2. Decreased boredom 3. Increased use of neck muscles in a variety of positions rather than repeatedly using a specific muscle group when feeding from a single fixed hay net or rack 4. Increased loading through the hind limbs when browsing compared with constant increased fore limb loading when grazing However, it should be noted that in horses with recurrent airway obstruction/ disease raised feeding heights may not be appropriate as they could exacerbate susceptibility to irritation from airborne fungal spores. Consequently, for horses with RAO/RAD feeding from the ground may be preferable.
LEADERS IN ANIMAL PHYSIOTHERAPY
400+ MEMBERS PHYSIOTHERAPY TO GB EQUESTRIAN TEAMS
MINIMUM 5 YEARS
Ideally horses should have access to hedgerows, bushes and shrubs and in the stable it is beneficial to have several hay stations and/or foliage fixed around the stable at varying positions and heights including poll level. This will encourage the horse to move around the stable to feed from the different positions. A movable structure such as a hay net or foliage is potentially more beneficial than a fixed hay rack as it facilitates more neck mobility and weight transference throughout the body.
SINCE 1992 OLYMPICS
Only highly qualified, chartered physiotherapists may undertake the specialist animal physiotherapy training in order to become an ACPAT member
CADEMIC STUDY
A
CPAT physiotherapists hold specialist knowledge in anatomy,
A
physiology, biomechanics and pathology. All treatments are based on a peer-reviewed evidence base meaning each animal recieves the very best in treatment and care
GOLD STANDARD THERAPY
VETS SURGEONS FARRIERS PHYSIOTHERAPIST OWNER DENTISTS SPECIALIST INTEREST GROUP OF CHARTERED SOCIETY OF PHYSIOTHERAPY
CPAT physiotherapists work as part of
CPAT physiotherapists work only
Working with the owner, vet and multi-
a highly-qualified and regulated multi-
under veterinary referral meaning
disciplinary team means animals get
disciplinary team of professionals
trusted and approved partners
an improved, joined up service
A
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A
Physiotherapy for Cranial Cruciate Disease Pain management post op ‣ Heat ‣ Cryotherapy ‣ Transcutaneous electrical nerve stimulation ‣ Class 3B laser Gentle weight bearing exercises to encourage healing and reduce swelling
• Neuromuscular electrical stimulation to recruit
hypotrophied muscles
• Maintain range of movement • Gait re-education • Manual therapy to reduce compensatory muscle
soreness
• Proprioceptive stimulation e.g. kinesiotape to facilitate
muscle contraction
• Hydrotherapy
Research • Berte et al (2012) found no instability was caused and lameness was improved 90 days
post CCLR stabilised with lateral suture stabilisation (UWTM walking started at week 2).
• Full extension whilst weight bearing improves static quadriceps efÞciency & helps reduce
the risk of patella luxation (Lafaver et al 2007).
• Risk of complication CCLR post op increased without physio (Lafaver et al 2007). • Monk et al (2006) found that 6/52 after TPLO, the physical rehabilitation group had
signiÞcantly larger thigh circumference and range of movement than the home exercise group.
THIS INFORMATIONAL PRESENTATION IS AVAILABLE AS A POSTER FOR USE BY MEMBERS FOR LOCAL PR EVENTS
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Should Ice Just be for Our Gin and Tonic? By Dr David Marlin
M
any professionals will likely be aware over the anti-RICE (rest, ice, compression, elevation) movement that has been gaining publicity for the past perhaps 15-20 years. But even so, the most widely used method in human medicine/sports medicine for the treatment of acute soft tissue injury is still RICE. In the equestrian world, cold or cryotherapy is still widely used and there does not appear to be much in the way of campaigning against its use as there is in human medicine. So is the difference because we know something that those dealing exclusively with human patients don’t know or is it just that we don’t yet have the studies to show its at best ineffective or at worst harmful and actually slowing recovery from injury? Perhaps the first thing to examine is the way in which cryotherapy could be used with horses. The first and most obvious is in acute injury. Here the use of cold has the effect of reducing the inflammatory response and reducing pain. There have been suggestions that reducing inflammation in acute injury is detrimental as the inflammatory response is part of the repair process. The jury still seems to be out on this but this is certainly a core argument against the RICE protocol; that is inflammation is good and should not be controlled. In this context, these two quotes are pertinent. “Acute inflammation is an important part of the healing process after musculoskeletal injury, but unless it is controlled early, it can significantly hamper rehabilitation.” (Baumert, 1995). “The objective of RICE is to stop the injury-induced bleeding into the muscle tissue and thereby minimise the extent of the injury.” Jarvinen et al. (2007). So the key aspects of using ice or RICE are about limiting but not abolishing inflammation and reducing the extent of the effect of an injury into surrounding (uninjured) tissue. The second and equally important aspect of cryotherapy in acute injury is the analgesic benefit. In cases of moderate to severe injury it may be some time before a vet can see a horse and administer anti-inflammatory medication and these still take some time to produce a significant effect, so in that period cryotherapy can provide a degree of analgesia.
I believe the ideal is actually likely somewhere in between and I think this may be where the arguments have become polarised and extreme. From my perspective It’s not an argument about whether to cryotherapy or NOT, it should be a discussion about how much cryotherapy is useful and in what situations.
The other use of cryotherapy is prophylactically in relation to regular training and competition when there is no obvious injury. In the horse this is particularly relevant to the feet, the fetlock and knee joints and the flexor tendons. Training or competing on hard ground can lead to soreness in the feet and joints which can be treated with cryotherapy following exercise. Similarly, older horses with arthritic changes in their joints can be made more comfortable after exercise with acute cryotherapy. With respect to tendons and ligaments, particularly those of the lower limbs, we are aware that these are a very common site of injury and that the injuries are in the main the result of accumulation of lowgrade damage over months and years of use. The temperatures within these tendons are also some of the highest in the body and this enhances any inflammatory effect. Is this natural? I would argue the domesticated horses tendons are not ideally designed to cope with the temperatures that they reach during training and competition. The temperature at the end of exercise is a combination of intensity and duration. In the wild horses do not canter and gallop for the same durations as we ask in training and competing and
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so likely their tendons do not reach extremely high temperatures which lead to inflammation and degradation of the tendon matrix. For this reason, I believe that cooling after exercise is an important tool for tendon longevity. To return to the controversy over the use of RICE in human medicine/ sport. There is evidence from published peer-reviewed studies that reducing inflammation is beneficial in many circumstances. It’s not that all evidence supports not adopting the use of cold. In addition, this is not about blocking inflammation entirely, which is unachievable, but about a moderated inflammatory response as a degree of inflammation is clearly part of the repair process. Use of cryotherapy in the horse has to also be considered in the light of a number of factors: (1) We cannot actually adopt RICE – we can only partially rest (non-weight bearing is not an option), we can ice, we can compress, but we cannot elevate (2) Ice is used on the lower limbs of horses not only for tendon and ligament but also for joint and for the feet (e.g. concussive laminitis, reducing the severity of laminitis from other cause, etc) (3) Tendon and ligament injuries are the most common lower limb injury in mature horses (e.g. Murray et al. 2006), particularly SDFT tendinitis. Consensus is now that the majority of these injuries are as a result of accumulated (chronic) low-level damage/repeated insults as opposed to isolated catastrophic events. The wild horses spend the majority of time walking, whilst domesticated horses experience significantly greater periods of trot, canter and gallop i.e. an exercise regimen they did not evolve for (4). Horse tendons reach very high temperatures during exercise – 45°C (Wilson and Goodship, 1994). There is clear evidence from two unrelated studies that hyperthermia (at the temperatures recorded in vivo) reduces equine tendon cell viability in vitro (Birch et al. 1997; Hosaka et al. 2006). (6) “In conclusion, while temperatures experienced in the central core of the SDFT in vivo are unlikely to result in tendon cell death, repeated hyperthermic insults may compromise cell metabolism of matrix components, resulting in tendon central core degeneration” Birch et al. (1997). So if you are going to use cryotherapy either for acute injury or on the limbs after training or competition, which methods are most effective and how long should they be used for? I recently
compared a variety of commonly used limb cooling methods including hosing, ice and water, ice boots, clay and evaporative/water cooling boots (Marlin, 2019). Standing in ice and water was the most effective, whilst cold hosing with water at 15°C and the commercial ice
boots that were tested produced similar and acceptable results. Methods to be avoided as they are ineffective include evaporative water-cooling boots, clay (covered or uncovered) and alcoholbased gels. Human research indicates that after exercise (not injury) between 10-15 minutes with a temperature under 15°C is recommended, however for horses legs its common to see 30 minutes recommended. The horses’ lower legs have no subcutaneous fat, no muscle and the tendons themselves have a poor blood supply. So the impact of ice and compression should be accentuated. A possible comparison in people is the Achilles tendon which is similar in structure to the horses’ flexor tendons and has also little subcutaneous fat, is near the surface and also has a poor blood supply. Studies with Cryocuff, an ice and compression wrap, on the achilles tendon have shown that repeated periods of 10 minutes of ice and compression application are most effective. This is suggested to be because the most marked effects on the microcirculation are evident within the first 10 minutes after application. There is also evidence from in vitro studies which demonstrate no damage to the tendon cells maintained at 10°C for 1 hour. Therefore, why not ice for longer than 10-15 minutes? Keeping tissues too cold for too long has the potential to cause superficial tissue damage and nerve palsy after only 20 minutes. Internal temps of under 15°C can cause inflammation and oedema and increase lymphatic permeability, so
reversing the initial beneficial effects of cold that cause vasoconstriction (limiting bleeding into uninjured tissue) and anti-inflammatory effects. Ice and compression reduces blood flow more than just ice alone, by reducing blood flow the inflow of heat from the rest of the body is reduced. Ice and compression does produce significantly colder internal tissue temperatures than ice alone. Colder temperatures decrease tissue metabolism which in turn slows the inflammatory response; a 10°C drop in temperature produces a 50% decrease in metabolic rate. Reducing blood flow also reduces tissue oxygenation. This has been proved in studies with the Aircast Cryo/Cuff, that uses both ice and compression. Oxygen is a double-edged sword as oxygen leads to free radicals which play an important role in inflammation but it is also central to the healing process. Studies with the Cryo/Cuff in the Achilles tendon injury demonstrated better tissue oxygenation after removal with an application time of 10mins compared with baseline, suggesting an increase in blood flow after removal.
high temperatures as a result of exercise and that we know these are damaging. On balance I believe that cryotherapy is a beneficial and an important tool in the physio, owner, rider and vets armoury but there is still an opportunity for further research to determine whether the current cooling protocols we use in horses after exercise and injury are optimal.
References Baumert,
P.W.
(1995)
Acute
inflammation after injury, Postgraduate Medicine, 97:2, 35-49. Birch HL, Wilson AM, Goodship AE. (1997) The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol. 1997 Jun;200(Pt 11):1703-8. Hosaka Y et al. (2006) Effect of heat on synthesis of gelatinases and proinflammatory
cytokines
in
tendinocytes.
Biomed
Res.
equine 2006
Oct;27(5):233-41. Jarvinen,
T.A.H.
et
al.
(2007)
Muscle injuries: optimising recovery. Best
Practice
&
Research
Clinical
Rheumatology, Volume 21, Issue 2, April, 317-331. Kaneps, A.J. (2000) Tissue Temperature Response to Hot and Cold Therapy in Two studies in live horses (Kaneps, 2000; Petrov et al. 2003) investigated the temperatures of skin and the SDFT after 30 & 60 minutes of ice water immersion. The SDFT temperatures dropped very quickly to between 10 and 15 °C within the first 10 minutes and then started to plateau. The implication is that blood flow to the limb may increase after 10 minutes to prevent a further decrease in SDFT temperature below ~10-15°C.
the Metacarpal Region of a Horse. AAEP
To summarise, the debate over cryotherapy is likely to continue and there are still gaps in our knowledge. Some of the human research is not directly comparable to horses. For example, we know that horses can greatly reduce blood flow to the extremities without tissue damage as would occur in people (cf frostbite). We also have to recognise that equine tendons reach
temperature and cell viability in equine
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Proceedings, Vol 46, 208-213. Marlin, D.J. (2019) Evaluation of the cooling efficacy of different equine leg cooling methods. Comparative Exercise Physiology: 15 (2), 113 – 122. Petrov R, et al. (2003) Influence of topically applied cold treatment on core superficial digital flexor tendons. Am J Vet Res. 2003 Jul;64(7):835-44. Wilson AM and Goodship AE. (1994) Exercise-induced a
possible
degeneration.
hyperthermia
mechanism J
Jul;27(7):899-905.
for
Biomech.
as
tendon 1994
Recent Research Publications Here are some journal titles that may be of interest to you from the Journal of Equine Veterinary Science and the Journal of Small Animal Practice. If any ACPAT members need any assistance accessing these articles please contact our Research Officer on research@acpat.org.
Journal of Equine Veterinary Science Investigation of Myofascial Trigger Points in Equine Pectoral Muscles and GirthAversion Behaviour (2017) A. Bowen, L. Goff, C. McGowen. Pages 154-160. Vol 48. DOI: 10.1016/j.jevs.2016.04.095.
Effects of Large Saddle Panels on the Biomechanics of the Equine Back During Rising Trot: Preliminary Results (2017) P. Martin, L. Cheze, P. Pourcelot, L. Desquilbet, L. Duray, H. Chateau. Pages 15-22. Vol 48. DOI: 10.1016/j.jevs.2016.08.006.
The Biomechanics of Movement of Horses Engaged in Jumping Over Different Obstacles in Competition and Training (2017)
Pages 121-128. Vol 50. DOI: 10.1016/j.jevs.2016.11.009.
Modifying the Height of Horseshoes: Effects of Wedge Shoes, Studs, and Rocker Shoes on the Phalangeal Alignment, Pressure Distribution, and Hoof-Ground Contact During Motion (2017) J. Hagen, M. Huppler, S. Geiger, D. Mader, F. Hafner. Pages 8-18. Vol 53. DOI: 10.1016/j.jevs.2017.01.014.
The Use of Treadmills Within the Rehabilitation of Horses (2017) K. Nankervis, E. Launder, R. Murray. Pages 108-115. Vol 53. DOI: 10.1016/j.jevs.2017.01.010.
Objectives, Principles, and Methods of Strength Training for Horses (2017) C. Castejon-Riber, C. Riber, M. Rubio, E. Aguera, A. Munoz.
C. Fercher.
Pages 93-103. Vol 56.
Pages 69-80. Vol 49.
DOI: 10.1016/j.jevs.2017.04.011.
DOI: 10.1016/j.jevs.2016.10.002.
Conservative Management of a Cervical Vertebral Fracture in a Gelding (2017) H. Murphy, N. Nelson, H. Schott.
Equine Performance and Autonomic Nervous System Improvement After Joint Manipulation: A Case Study (2017)
Equine Rehabilitation: A Review of Trunk and Hind Limb Muscle Activity and Exercise Selection (2017) G. Tabor and J. Williams. Pages 97-103.e3. Vol 60. DOI: 10.1016/j.jevs.2017.03.003
Feeding and Management Practices for Racehorses in Turkey (2017) G. Kaya-Karasu, P. Huntington, C. Iben and J. Murray. Pages 108-113. Vol 61. DOI: 10.1016/j.jevs.2017.04.009
Acute and Prolonged Effects of Vibrating Platform Treatment on Horses: A Pilot Study (2018) C. Nowlin, B. Nielsen, J. Mills, C. Robison, H. Schott, D. Peters. Pages 116-122. Vol 62. DOI: 10.1016/j.jevs.2017.12.009
A Pilot Study Into the Utility of Dynamic Infrared Thermography for Measuring Body Surface Temperature Changes During Treadmill Exercise in Horses (2018) M. Soroko, K. Howell, K. Dudek, I. Wilk. M. Zastrzezynska, I. Janczarek.
Pages 110-115. Vol 50.
E. McQueen, S. Urban, M. McQueen.
DOI: 10.1016/j.jevs.2016.10.014.
Pages 44-46. Vol 62.
Pages 80-87. Vol 56.
DOI: 10.1016/j.jevs.2017.12.010
A Randomised Blinded Crossover Clinical Trial to Determine the Effect of an Oral Supplement on Equine Limb Kinematics, Orthopedic, Physiotherapy and Handler Evaluation Scores (2017) R. Murray, V. Walker, C. Tranquille, J. Spear, V. Adams.
DOI: 10.1016/j.jevs.2017.04.012.
The Impact of Training Regimen in the Inflammatory Response to Exercise in 2-Year-Old Thoroughbreds (2017) A. Page, J. Stewart, R. Holland, D. Horohov. Pages 78-83. Vol 58. DOI: 10.1016/j.jevs.2017.08.011.
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Changes of Ground Reaction Force and Timing Variables in the Course of Habituation of Horses to the Treadmill (2018) B. Bachi, T. Wiestner, A. Stoll, N. Waldern, I. Imboden, M. Weishaupt. Pages 13-23. Vol 63. DOI: 10.1016/j.jevs.2017.12.013
Assessment of Saddle Fit in Racehorses Using Infrared Thermography (2018) M. Soroko, P. Cwynar, K. Howell, K. Yarnell, K. Dudek, D. Zaborski. Pages 30-34. Vol 63. DOI: 10.1016/j.jevs.2018.01.006
Quantification of Equine Sacral and Iliac Motion During Application of Manual Forces and Comparison Between Motion Capture with SkinMounted and Bone-Fixated Sensors (2018) L. Goff, C McGowan, P. Condie, J. Jasiewicz, R. Weeren. Pages 5-11. Vol 64. DOI: 10.1016/j.jevs.2018.01.007
Global Epidemiological Analysis of Prevalence and Risk Factors Associated with The Deep Digital Flexor Tendinopathy in the Equine Distal Limb: 100 Cases (2018)
What Is Known About The Safety of Intraarticular Corticosteroid Injections and How This Might Impact Safety in Thoroughbred Racehorses (2018) Pages 21-28 Vol 69. DOI: 10.1016/j.jevs.2018.05.215.
Relationship Between Saddle and Rider Kinematics, Horse Locomotion, and Thoracolumbar Pressures in Sound Horses (2018) R. Mackechnie- Guire, E. MackechnieGuire, M. Fisher, H. Mathie, R. Bush, T. Pfau, R. Weller. Pages 43-52. Vol 69. DOI: 10.1016/j.jevs.2018.06.003.
Horse and Rider Interaction During Simulated Horse Jumping (2018) P. Nemecek, L. Cabell, M. Janura.
Pages 55-60. Vol 67.
DOI: 10.1016/j.jevs.2018.07.001.
Local Back Pressure Caused by a Training Roller During Lunging With and Without a Pessoa Training Aid (2018) R. Mackechnie- Guire, E. MackechnieGuire, R. Bush, D. Fisher, M. Fisher, R. Weller. Pages 112-117. Vol 67. DOI: 10.1016/j.jevs.2018.03.018
Diagnosis, Treatment, Surgical Management and Outcome of Septic Arthritis of the Tarsocrural Joint in 16 Foals (2018) R. Rinnovati, B. Butina, A. Lanci, J. Mariella. Pages 128-132. Vol 67. DOI: 10.1016/j.jevs.2018.04.003.
Effects of Rider Experience Level on Horse Kinematics and Behavior (2018) R. Strunk, K. Vernon, R. Blob, W. Bridges, P. Skewes. Pages 68-72. Vol 68. DOI: 10.1016/j.jevs.2018.05.209.
M. Pechanec, A. Lee-Barthel, K. Barr, M. Mienaltowski. Pages 90-97. Vol 71. DOI: 10.1016/j.jevs.2018.10.011.
L. Smith.
M. Crisan, A. Damian, L. Stefanut, C. Dezdrobitu, D. Neagu, J. Deniox. DOI: 10.1016/j.jevs.2018.03.005
Model for Equine Superficial Digital Flexor Tendon (2018)
Pages 26-31. Vol 70.
The Influence of Different Hind Shoes and Bare Feet on Horse Kinematics at a Walk and Trot on a Soft Surface (2018) S. Caure, P. Mortange, D. Leveillard, F. Blanville, M. Carro, M. Cousty, D. Salazar, R. Weller. Pages 76-83. Vol 70. DOI: 10.1016/j.jevs.2018.08.002.
Objective Detection and Quantification of Irregular Gait With a Portable Inertial Senor-Based System in Horses During an Endurance Race â&#x20AC;&#x201C; a Preliminary Assessment (2018) M. Lopes, A. Eleuterio, M. Mira. Pages 123-129. Vol 70. DOI: 10.1016/j.jevs.2018.08.008.
Evaluation and Optimization of a ThreeDimensional Construct 39
Equine Posture Analysis: Development of a Simple Tool to Record Equine Thoracolumbar Posture (2019) G. Tabor, A. Elliot, N. Mann, J. Williams. Pages 81-83. Vol 73. DOI: 10.1016/j.jevs.2018.11.011.
Journal of Small Animal Practice TTA- Rapid in the treatment of the canine cruciate deficient stifle: short-and medum-term outcome (2017) S. Butterworth and D. Kydd. Vol 58. Issue 1. DOI: 10.1111/jsap.12610.
A modified tibial compression test for the detection of meniscal injuries in dogs (2017) S. Valen, C. McCabe, E. Maddock, S. Bright, B. Keeley. Vol 58. Issue 2. DOI: 10.1111/jsap.12619.
Re-opening the window on fenestration as a treatment for acute thoracolumbar intervertebral disc herniation in dogs (2017) P. Freeman and N. Jeffery. Vol 58. Issue 4. DOI: 10.1111/jsap.12653.
Combined tibial plateau levelling osteotomy and lateral fabellotibial suture for cranial cruciate ligament rupture with severe rotational instability in dogs (2017) M. Schaible, J. Shani, A. Caceres, M. Payton, Y. Segev, R. Ben-Amotz. Vol 58. Issue 4. DOI: 10.1111.jsap.12648.
Treatment of tibial diaphyseal fractures following plateless tibial tuberosity advancement to manage cranial cruciate disease (2017) R. Sousa, P. Egan, K. Parsons, S. Butterworth, I. Calvo, S. Roch, A. Moores. Vol 58. Issue 7. DOI: 10.111/jsap.12673.
Tibial plateau levelling osteotomy lockingcompression plates for stabilisation of canine and feline ilial body fractures (2017) J. Guthrie and S. Kalff. Vol 59. Issue 4. DOI: 10.1111/jsap.12803.
Late-onset Becker-type muscular dystrophy in a Border terrier dog (2018) A.Jeandel, L. Garosi, L. Davies, L. Guo, R. Salguero, G. Shelton. DOI: 10.111/jsap.12824.
Cervical myelopathy due to complex Atlanto-axial malformation including partial atlantal dorsal arch aplasia in a domestic rabbit (2018)
bilateral surgery for medial patella luxation is small/ medium breed dogs (2018) L. Sanders and J. Bevan. Vol 60. Issue 1. DOI: 10.1111.jsap.12939.
Multiple idiopathic fibrotic myopathies, including the tensor facia lata muscle, in a cat (2018) D. Miraldo, M. Solano, S. Kalff. DOI: 10.1111/jsap.12953.
J. Nessler, F. Attig, M. Thole, B. Raddatz, A. Beineke, M. Fehr, A. Tipold, V. Stein. DOI: 10.111/jsap.12823.
Treatment of feline patellar luxation with polyethylene sulcal ridge prostheses Canine total hip replacement (2018) using a cementless threaded J. Mills and T. Hargittai. cup and stem: a review of 55 DOI: 10.1111/jsap.12956. cases (2018) Neurofibroma of ulnar H. Denny, M. Linnell, T. Maddox, E. nerve in carpal canal in a dog Comerford (2018) Vol 59. Issue 6. DOI: 10.111/jsap.12827.
Coxofemoral luxation in pet rabbits (2018) M.Gallego and J. Villaluenga DOI: 10.111.jsap.12866.
An unexpected diagnosis in a cat with sudden lameness (2018) N. Erikson, B. Munzer, M. Dunkel, L. Mundhenk. Vol 59. Issue 10. DOI: 10.111/jsap.12899.
Long-term imaging followup of a conservatively managed presumptive osseous cervical stenotic myelopathy in a puppy (2018) C. Doran, S. Platt, L. Garosi. Vol 60. Issue 3. DOI: 10.1111.jsap.12923.
Comparison of short-term complications between unilateral and single-session 40
R. Basa, A. Crowley, K. Johnson. DOI: 10.1111/jsap.12945.
Feline Shoulder Luxation: A cadaveric study of injury and repair using ligament prostheses (2019) D. Carwardine and S. Langley-Hobbs. Pages 1-8. DOI: 10.1111/jsap.12999
Tibial tuberosity advancement technique in small breed dogs: study of 30 consecutive dogs (35 stifles) (2019) A.Ferreria, R. Bom, S. Tavares. Vol 60. Issue 5. DOI: 10.1111/jsap.12991.
Low-field magnetic resonance changes in the paravertebral musculature of dogs with acute intervertebral disc extrusion (2019) A.Furtado, G. Cherubini, O. Taeymans. DOI: 10.1111/jsap.12979.
Book Reviews Riegel, R.J. and Godbold, J.C. (2017)
Laser Therapy in Veterinary Medicine. Photobiomodulation. Wiley Blackwell
T
his book is a useful resource for those regularly using laser within their practice. The authors of the various chapters are experts in their fields and information is supported throughout by relevant references. It is easy to read and very much focused on practical application and includes case studies. Some of the suggested settings, for example, for acupuncture points are different to what users may currently be using. It is written from a veterinarian perspective but is relevant to physiotherapists also. As it covers
such a diverse range of animals and conditions, it may be lacking in detail on specific areas but provides a good overview. The book begins with a couple of chapters exploring the physics and principals of laser therapy as well as the contraindications and precautions. It then goes on to describe its use in a wide variety of animals- everything from dogs and horses to birds, zoo animals and reptiles! However, the focus is on the more commonly seen dogs, cats and horses. For these
species, it covers use post operatively, wounds, pain control, musculoskeletal conditions, neurological conditions, geriatric rehabilitation, sports medicine/ performance applications and use within a multimodal approach. There is a strong laser acupuncture bias within the equine chapters. The final chapters discuss its use within a veterinary practice i.e. marketing, cost, role of nurses. Emma Sayers ACPAT A
Nevin, T., Colles, C. and Tozzi, P. (2020)
Animal Osteopathy A comprehensive guide to the osteopathic treatment of animals and birds Handspring Publishing
A
lthough this book is primarily aimed at Osteopaths working with animals I think it could prove to be a useful resource for Physiotherapists too. It includes chapters on a huge variety of animals including birds, livestock, wildlife and megafauna as well as more commonly treated animals such horses, dogs and cats. The information provided on some of the more unusual animals is actually quite comprehensive making it a valuable resource for those likely to be working with them.
Each chapter has a similar structure, first discussing anatomy and physiology of the species followed by common orthopaedic conditions and assessment/ treatment techniques. The pictures and diagrams are excellent and the information is clear and concise making it quite easy to read and navigate through. Real life case studies were also discussed for each species. Although some of the terminology is different to what we, as Physiotherapists, might use I think the information included in the book is very relevant to our practice. There is a lot of discussion
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around working with other professionals including information on things such as foot balance and saddle fit in relation to musculoskeletal issues found in the horse. It also provides relevant information on health and safety and working within the law (UK). In summary I think this book would work well as a reference textbook for those in clinical practice, particularly those working with a wide variety of animals. I also think it would be a good book for students. Robyn Dunn ACPAT A
Writing for Four Front The official magazine of the Association of Chartered Physiotherapists in Animal Therapy. We would like to encourage all ACPAT members to get involved in the next edition of Four Front. If you are working on an interesting research project or case study we would love for you to get in touch.
We invite you to present material under the following sections:
Product/Book Reviews Conference/Course Reviews Literature Reviews Research Articles/Case Studies Business Related Topics Any other news/useful piece How to contact us: If you have anything you would like to submit for publication or you would like to discuss with the Journal Team please do not hesitate to contact us on :
journal@acpat.org Final note from the editor: The views expressed in Four Front are not necessarily those of ACPAT, the editor or the editorial committee. The inclusion of advertising does not imply any form of endorsement by ACPAT. No article, drawing or photograph may be reproduced without prior permission from the editor.
M. Sharon Morgan, Pembroke House Middle Lane, Shotteswell OX17 1JQ secretary@acpat.org 42
Physiotherapy for Hip Dysplasia • Pain management
‣ heat, ‣ cryotherapy, ‣ transcutaneous electrical nerve stimulation ‣ Laser
• Hydrotherapy
• Neuromuscular electrical stimulation
‣ to recruit weak muscles
• Proprioceptive stimulation
‣ e.g. Kinesio tape to facilitate muscle contraction
• Gait re-education
‣ to reduce compensatory patterns of movement
• Owner education & Exercise prescription
Research Laser has been found to increase cartilage regeneration and angiogenesis in rats and rabbits with arthritis (Cho et al. 2004, ShariÞ et al. 2008 & Lin et al. 2010); and better than NSAIDs at reducing pain in humans (Chow et al. 2009). Hydrotherapy has been found to improve strength and physical function in patients with osteoarthritis (Foley et al. 2003). Rahmann et al. (2009) found early physical therapy & hydrotherapy increased functional strength after hip replacement.
THIS INFORMATIONAL PRESENTATION IS AVAILABLE AS A POSTER FOR USE BY MEMBERS FOR LOCAL PR EVENTS
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