ACPAT 2012 FourFront Journal

Four Front August 2012

The Magazine of the Professionals in Animal Therapy

Tips and Tricks for Tackling Spinal Disease Step by Step

Preparations for the Olympics

Book reviews

Š

Association of Chartered Physiotherapists in Animal Therapy

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www.acpat.org www.acpat.org

Your animal deserves the best.

Choose a professional.

Choose a Chartered Physiotherapist.

The Association of Chartered Physiotherapists in

Animal Therapy

The professionals in animal physiotherapy and rehabilitation ACPAT is a specialist interest group of the Chartered Society of Physiotherapy, the professional membership organisation for all physiotherapists in the UK. Â All ACPAT category A physiotherapists receive training to the highest standard and have the MCSP qualification (Member of the Chartered Society of Physiotherapy), meaning that they first qualify in human physiotherapy before starting a career in animal care. Â They have accompanied and treated British Team horses at European, World and Olympic games since 1992 and are the only allied Heath profession to be supporting the veterinary team at London 2012 Olympic games. To find your local Chartered Physiotherapist contact www.acpat.org.uk

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CONTENTS 4

Editorial

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Preparations for the Olympics Anna Johnson MCSP SRP Grad Dip Phys ACPAT Cat A

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Equine Abdominal Muscles in Locomotion Helen Robartes MCSP HPC MSc VetPhys ACPAT Cat A

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Critically discuss the diagnostic procedures used in the management of a horse with sacroiliac pain Natalie Fizzo MCSP HPC UWE/Hartpury Student ACPAT Cat B

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Veterinary Physiotherapy for the Dairy Cow – A Case Study Emma Strachan MCSP HPC BSc(Hons) MSc VetPhys ACPAT Cat A

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Tips and Tricks for Tackling Spinal Disease Step by Step Mark Lowrie MA VetMB MVM DipECVN MRCVS RCVS and European Specialists in Veterinary Neurology

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Latest Findings on the Effects and Mechanisms of Diet Restriction on Ageing, Longevity and Health Parameters in Dogs (Nestle Purina) Clementine Jean-Philippe DVM PhD European Veterinary Communications Manager

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Everyone can benefit by working in closer co-operation Pat Crawford Society of Master Saddlers (SMS)

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Diary of events

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Course reviews

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Book reviews

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Articles of Interest 2011 - 2012

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Recent news

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Writing for Four Front

Front cover: Show Jumping at the Olympic Test Event in June 2011

Designed by Three Hats Design . www.threehatsdesign.com

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EDITORIAL Di Messum and Polly Hutson

It is with great pleasure we welcome you to the third edition of Four Front. We hope you find that we have produced another exciting magazine. As always we would like to thank the author’s who have contributed to this edition as without you there would be no magazine.

We encourage our members to consider writing something for our next magazine or newsletter. Without your contributions we would have nothing to share with our membership and other veterinary professionals.

The magazine continues to be peer reviewed to maintain and help raise the profile of our profession. A huge thank you to our peer reviewers, who have given us their time over the past three years to ensure we produce an excellent magazine for our profession.

2012 will be a year to remember with our strong presence at the Equestrian discipline of the Olympic Games. We are very proud of our members who have been selected and who will be representing ACPAT within this public arena. ACPAT also continues to market throughout the year at events including BEVA, Your Horse Live, The London Vet Show and Crufts. To all those members who have contributed their time to these events, we thank you.

Sadly this is our last magazine as our term in office is about to come to an end in February 2013 when we will be handing the reins over to a new team. We would like to express our thanks to all our members for their continued support and feedback that you have given us since the rebranding and launch of this new magazine three years ago.

We still need your comments, negative or positive, in order for Four Front to evolve. Please contact us via email to journal@acpat.org.

Di Messum and Polly Hutson

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PRIOR PLANNING AND PREPARATION PREVENT “P**S” POOR PERFORMANCE (The 7 “P’s”) Anna Johnson MCSP SRP Grad Dip Phys ACPAT Cat A I have had the great pleasure of being ‘The Olympic Co-ordinator’, not a title I gave myself but used

by ACPAT at the National Equine Forum and really means sounding board/email contact and general info provider between the powers at the London Organising Committee of the Olympic and Para-Olympic Games (LOCOG) and ACPAT. I was alarmed when Sonja Nightingale (ACPAT Chairman) asked me to write an article on the organisation and preparation involved with having ACPAT vet physios at London 2012. The goal of the Olympics is the ultimate experience for a physio interested in equine performance and sport.

Having our profession represented is a great achievement.

The preparation is therefore exciting for me as I know the ultimate goal, but a tedious and laborious process to read about so I shall endeavour to make this interesting!

In my role as physio to the British Equestrian Federation (1998-2006), I was lucky enough to attend the Sydney (2000) and Athens (2004) Olympics. These were truly amazing experiences and therefore on a personal level I could not let an Olympics come to London and not be involved. On a professional level I felt it imperative that vet physios were providing the service that I know the human physio profession provide at any Olympics.

In July 2005 I cried tears of joy when London won the bid to host the 2012 Olympics only to be followed by tears of sadness and horror the next day when London suffered the worst terrorist attack since WWII. This emoted a “Life is for living“

feeling and a small candle inside me was lit.

In 2009 I had a ‘chat’ with my old colleague Jenny Hall at the European dressage/show jumping championships at Windsor. Jenny was the team vet for the majority of my employment with the British Team. She was attending the 2009 Europeans in her role as 2012 veterinary services organiser, observing practice in staging a championships in preparation for 2012. My ears pricked up and my ‘candle’ was re-ignited.

AJ - “Do you think vet physios should be provided as part of the vet services at 2012?”

JH - “Put something on paper and send it to me” The candle was not just lit, the fire was fully fuelled!

By the end of 2009 I had contacted some of the ACPAT physios that I frequently work alongside at events such as Badminton, Burghley, Bramham and Blenheim and managed to persuade them to update their CV’s and agree to be part of a Team of ACPAT physios to work at London 2012. A formal ‘Tender’ was sent to Jenny Hall and LOCOG. This lead to LOCOG and Jenny Hall approaching ACPAT to provide vet physios at London 2012. In May 2010 an email was sent out to all ACPAT members and the opportunity to apply for the voluntary role of vet physio at London 2012 was advertised.

At Badminton 2010, Sonja Nightingale and myself had discussions with Jenny Hall and

LOCOG regarding the type of equipment that would be necessary, this was when the first ‘list’ was drawn up. The ‘Noreply Gamesmaster’ emailed out to successful candidates, including myself, dates for generic interviews to be a volunteer. These took place at EXEL in London.

I had a rather testing interview as the interviewer, a keen follower of equine sport and qualified vet and doctor challenged there was NOT a role for vet physios at the Equestrian Olympics, as all teams would have their own physio.

I advised that ‘back up’ to a team physio is always necessary due to the number of horses (I had 17 in my care at Sydney), there will be 240 horses on site at Greenwich.

Also some of the less wealthy nations, who do not have their own physios, should have the opportunity to have the same chance as wealthier nations, in the level of care. Finally I suggested that the medical team provides physio and massage for the human athletes, so surely the equine athletes also deserve a similar service. Great Britain wants to provide the best Olympics ever…….?!

I left the intensity of my interview rather dazed and was asked directions to the X-FACTOR auditions running in another part of the EXEL centre. Having always fantasised that “I could have been Kylie”……I was sorely tempted.

In June 2011 Sonja, Rachel Greetham, Vicky Spalding and myself were finally asked by LOCOG to accept the role as vet physio for the TEST event at Greenwich. Clearly we all accepted and duly attended a meeting at the site at Greenwich Park. Here we were shown round

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the venue, met our veterinary surgeon and farrier colleagues and were administered with our TEST event uniform (2 white T-shirts and a waterproof coat……..London PREPARES!!!) There was a very amusing sight as the horsey/country folk disembarked from the train at Greenwich all looking lost and out of place and wearing clothing not often seen in London Town!

As I noticed Rossdales coats, gilets, paddock boots etc, I established at least I had got off at the correct train station!!

Despite our comprehensive list of physio kit, NONE had been ordered for the TEST event. Not wanting at any point for the vets to underestimate the value and undermine the role of the vet physios (I think because of the interview!) I suggested I provide the kit for the TEST event.

The other fact staring us in the face was the logistics to get to Greeenwich. We were to cover 6am to 10pm between 4 of us from Saturday 2nd July to Wednesday 6th July 2011. As my journey to Greenwich had taken 3 hours door to door, commuting was not an option. Rachel and I hastily booked a room at the Novotel Hotel (5 minutes from the park). We had to “swallow” slowly when told the price but really had no choice. Later I congratulated myself that although expensive, it was money well spent as I reveled in the TEST event atmosphere and socialised with colleagues.

I duly tested and packed the equipment to go to Greenwich (Laser, ultrasound, TENS, muscle stim, whirly boots, tubigrip and PEME rug). It was picked up by a “field vet” (i.e. a vet working at Greenwich) as only VERY limited cars had passes and I hoped and prayed it would be safe and undamaged by the end of the event.

I had a similar concern as I waved a trunk of equipment off to the Sydney Olympics, so at least it was only London!!

had 40 horses competing from 8 Nations. We worked shifts so one of us was always at the event, poised in the veterinary clinic, receiving from our walkie talkie radio at any time from 6am - 10pm.

Our colleagues - vets, farriers, vet technicians, admin staff all became friends. We did “friendly” treatments (on the floor of the stable) to any who asked, drank tea with the farriers, sunbathed and watched the action. We also did some veterinary physio on some equine athletes and most importantly educated our fellow professionals about vet physio and ACPAT, it was a perfect marketing and PR exercise!

Although still not officially offered the roles of vet physio by LOCOG for 2012, I was one of the “vet physios most likely to be using the equipment at 2012”, and asked to compile an equipment list again. In discussion with Rachel and Sonja we compiled our final wish list of necessary kit. This was forwarded to the organising vet and LOCOG. I had contacted all the suppliers of the kit we wished to use to check they would be happy to supply their product for our use.

Eventually (again many emails with unopenable attachments) I spoke to the procurement team (Dr. Joe Loe) at LOCOG and my wish list was granted, HURRAY!!

The venue and atmosphere were superb and electric. Cross country day felt that the “who’s who” in the horse world had descended on Greenwich. Being such a small venue you were bound to bump into someone you knew. The pubs and cafes in the area surrounding the park were overflowing with the fraternity more commonly seen at Badminton etc; Being a weekday and term time many of the local schools had come on an ‘outing’, this enhanced the atmosphere dramatically. Every time a horse was sighted the children clapped and cheered, ‘oohed and aahed’, as fences were cleared or not.

Due to an incident resulting in a positive dope test at the Bejing Olympics, we were advised that the ultrasound coupling gel needed to be FEI dope tested. Having contacted equine and human laboratories it became apparent that this was not an easy test as one would not know “what” we would be testing for. With MANY emails and discussions, at last the FEI vets decided a resolution to this dilemma. We shall use small bottles of Eko Gel (250ml). This would be labelled for each individual horse that needed it (similar to a urine/ blood sample) and will be sealed and locked away after use. In the unlikely event of a positive dope test, the Gel in a particular bottle could be tested for the specific substance. I now know in detail, the contents and manufacturing process of Eko Gel!! So many hours of time sorting this situation with the help of Jenny Hall, Peter Bowling, John Mekewan, HFC labs, LGC Forensics and Dr. David Cowan (senior dope tester for human tests during the games) and the legendary Simon Francis of Patterson, makes this the most expensive 20 litres of Eko Gel in the world!!

With the knowledge that every hotel within the 10 mile radius was already pre-booked for the 2012 Olympics, Sonja, Rachel and I did some intense investigation into the possibilities for accommodation.

None of us had officially been asked to do 2012, but felt it imperative that whoever attended (and we had been told a potential 16 vet physios would be used for the 2012 Olympics and Paralympics), that we secured some accommodation near the venue as soon as possible.

Having followed up many avenues and many emails later, Sonja’s wonderful friend offered us a relatively cheap and logistically friendly option, we could rent rooms in her house for “B & B” at £50 per night.

The TEST event (a 2*, 3 day event)

On Christmas Eve in 2011, the role of vet physios at 2012 Olympics and Paras was offered. ALLELULIAH! Congratulations to the lucky few, we had our ‘TEAM’. I was lucky enough to be one of the physios and continued in my newfound role

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as ‘OLYMPIC CO-ORDINATOR’.

A meeting with the physio team was organised to coincide with the ACPAT conference in February 2012. Here we were able to share our knowledge of the logistics and how the TEST event ran, while everyone was encouraged to voice any concerns or queries. It was a great feeling of enthusiasm and excitement from those who attended. From this we concluded that a training day with the actual equipment would be necessary to familiarise everyone and get hands on experience of each piece of equipment. Nothing would be more embarrassing than in the heat of the competition environment a vet physio is called for and the physio was unable to ‘work’ the machinery needed!! This training is to be

held at my home as I am the most central person geographically. All the suppliers will be attending.

catch up with vets and farriers and meet some of the others that we will be working alongside at 2012.

All the vet physios have attended the Official LOCOG Orientation at Wembley Arena, an hour of inspiration followed by 3 hours of frustrating ‘role’ play videos.

Thankfully there was plenty of free chocolate (Cadburys are sponsors), and it was a one off. However a time consuming and expensive experience for those who had come a long distance. Within the same few weeks in February 2012 we also had our role specific training in Hackney!!

This did include the official LOCOG 2 hours of frustrating role play, but was then followed by valuable information from Jenny Hall, Peter Bowling and Laura Green. It was a good time to

We still have our uniform fitting to look forward to, and a venue specific training day at the wonderful sight of Greenwich Park.

The ROSTERS have been drawn up; there will be physio cover from 6am - 10pm throughout the whole games and Para-Olympics on a shift pattern of early, day or late involving 3-4 physios per day.

With the saga of the Eko-Gel resolved and only 100 days until the opening ceremony, I am looking forward to what we hope will be the best Olympics ever staged…….. after this someone better put out my fire!!!

The Olympic Veterinary Physiotherapy Team

From left to right standing: Emma Dainty, Louise Carson, Celia Cohen, Anna Risius, Sonya Nightingale, Victoria Henderson, David Jackson, Jackie Grant, Sarah Dalton, Lee Clark Sitting: Rachel Greetham, Karen Mather, Jo Spear, Anna Johnson

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EQUINE ABDOMINAL MUSCLES IN LOCOMOTION Helen Robartes MCSP HPC MSc VetPhys ACPAT Cat A The role of equine abdominal muscles in spinal stability and locomotion is not fully established.

Physiotherapists may recommend exercises to stimulate the horse’s ‘abdominal core muscles’, in order to improve athletic performance, such as the ability to work in a collected frame, or to treat back pain, but these are mainly based on anecdotal reports and extrapolations from human practice (Haussler & Paulekas, 2009; McGowan et al., 2007a).

To date, it is not known whether such exercises actually increase abdominal muscle activity in the short term, or result in increased abdominal muscle strength in the long term. The impact of such exercises on overall athletic performance is also unknown.

‘Core stability’ of the spine The ability of the body to attain postural stability and balance depends strongly on dynamic neuromotor control, through optimal proprioceptive feedback from the muscles, ligaments and joints of the spine (McGowan et al., 2007a, b; Panjabi, 1992a; Panjabi, 1992b), and a “multi-dimensional interplay between central, peripheral, sensory and motor systems” (Akuthota & Nadler, 2004). ‘Global’ spinal stabilisers are larger, torque-producing muscles, such as rectus abdominis (RA) and longissimus dorsi (LD), which help to control large spinal movements and increase stiffness throughout the entire spine. ‘Local’ or ‘core’ stabilisers, such as multifidus (MTF) and transversus abdominis (TrA), are smaller muscles spanning short spinal segments. They are postulated to have a more isometric, proprioceptive function, for dynamic postural control and modulation at a segmental level, rather than for production

of spinal movement (Akuthota & Nadler, 2004; Bergmark, 1989; Cholewicki & McGill, 1996; Panjabi et al., 2004; Richardson & Jull, 1995; Willardson, 2007).

Core stability and back pain in humans Many researchers and clinicians consider TrA and MTF to be key muscles in postural stability and dynamic control of the pelvis and lumbar spine (GardnerMorse & Stokes, 1998; Hides et al., 1996; Hodges, 2001; Hodges & Richardson, 1996; O’Sullivan et al., 1998). However, the larger, global stabilisers may be important for control of large movements and increasing stiffness in the entire spine, which cannot be achieved by the smaller, intersegmental muscles (Panjabi et al., 1989).

Essentially, no one muscle is solely responsible for spinal stability: all trunk muscles contribute towards spinal stabilisation, with different and differing roles, depending on the task performed (Allison & Morris, 2008; Cholewicki & VanVliet, 2002; Hodges, 2011; Koumantakis et al., 2004; Lederman, 2010; Willardson, 2007).

In healthy human subjects, TrA and MTF ‘pre-activate’ before movements of the body, ahead of any other muscles. In the presence of back pain, pathology or dysfunction, these muscles atrophy and have a delayed activation pattern. Furthermore, they do not spontaneously recover in terms of activity pattern or cross-sectional area, when the symptoms have resolved. The resulting ‘instability’ or ‘core weakness’ has been linked to the high recurrence rate of low back pain (Gardner-Morse & Stokes, 1998; Hides et al., 1996; Hodges, 2001; Hodges & Richardson, 1996; Hodges & Richardson, 1999;

Panjabi, 2003; O’Sullivan et al., 1998). Weak proximal core (i.e. trunk or lumbo-pelvic) stability has been linked to a predisposition towards injury, particularly of the lower limbs (Leetun et al., 2004). Treatment of back pain, and exercises for improvement in athletic performance and prevention of injury, usually include a strong focus on the trunk stabilisers, increasing their activity and strength (Koumantakis et al., 2004; Willardson, 2007). It is suggested that the greater the core stability is, the greater the degree of power or control that can be generated in the limbs; however, as yet there is no good evidence to completely support this claim (Willardson, 2007). As with all physiotherapy treatment options, there are controversies regarding this subject, such as: which muscles need to be targeted; which exercises are most effective; and whether there is really any validity to the claims that core strengthening is effective in treatment, rehabilitation, injury prevention and sports performance enhancement (Allison & Morris, 2008; Akuthota & Nadler, 2004; Koumantakis, Watson & Oldham, 2005; Leetun et al., 2004; McGowan, Stubbs & Jull, 2007; Willardson, 2007).

Back pain and lameness in horses Back pain in horses is a common cause of lameness and reduced performance (Dyson, 2000; Faber et al., 2001). There is currently a paucity of scientific research on effective rehabilitation of equine back pain, particularly in comparison to human medicine (McGowan et al., 2007b; Paulekas & Haussler, 1999). Horses with back pain have been observed to have altered thoracolumbar kinematics and gait patterns (Wennerstrand et al.,

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2004). Studies have established a strong connection between back pain and lameness, although the ‘causal relationship’ has yet to be determined (Landman et al., 2004). Lameness causes alterations in spinal kinematics and muscle function, providing evidence that even subclinical lameness may eventually lead to spinal dysfunction and altered tone in the back muscles, resulting in back pain and vertebral changes (Gomez Alvarez et al., 2005; Zaneb, 2009).

Further research on clinical examination and treatment of equine back pain is a necessity. A ‘neuromotor control’ approach, as adopted in the treatment of human back pain sufferers, may provide better insights into the pathoaetiology of equine back pain and secondary problems associated with it (McGowan et al., 2007b).

Current research in spinal stability of horses The equine LD is a long, multisegmented epaxial muscle spanning the entire length of the back, and the muscle that may be considered its antagonist, RA, is a long hypaxial muscle attaching to the sternum and pre-pubic tendon, on the ventral aspect of the trunk (Budras et al., 2009; Wakeling et al., 2007). LD and RA are suggested to be important components of spinal stiffness and stability in the horse. According to the bow-andstring theory, where the spine forms the bow and the hypaxial muscles the string, these muscles (along with other muscles and structures) act to maintain constant tension in the spine (Slijper, 1946).

The activity and function of LD and RA has mainly been investigated at the walk and trot. Studies suggest that LD functions as a spinal stabiliser, limiting spinal movement, particularly at trot (Licka et al., 2004; Licka et al., 2009; Ritruechai et al., 2008; Robert et al., 2001). RA is proposed to act antagonistically with LD and appears to resist the passive extension of the spine that occurs as a result of the inertial

movement of the abdominal contents (Robert et al., 2001; Zsoldos et al., 2010). Together, LD and RA are suggested to stabilise and stiffen the trunk at trot, allowing for more effective transferral of propulsive forces generated from the hind-limbs, resulting in more efficient movement (Robert et al., 2002). RA may assist in drawing the femur cranially, via its attachment to the accessory ligament, and may increase the possible cranial placement of the hind-limb through flexion of the spine (Zsoldos et al., 2010). This requires further investigation.

Studies investigating electromyographic (EMG) activity in RA have used small, fairly homogenous subject populations; thus the results are only an indication of activity and possible function, and cannot be generalised to different breeds of horse in different disciplines. In addition, study designs vary, with different treadmill speeds and and electrode placement.

Standardisation of electrode placement is important, as RA is suspected to have different functions in different regions along its length (due to differences in biomechanics of the thoracic and lumbar regions of the spine [Robert, et al., 2001]). Studies of RA EMG activity involving larger subject populations and standardisation of procedures are required in order to better appreciate the activity and action of RA during locomotion.

A detailed study of equine MTF morphology revealed many similarities between horses and humans. It was concluded that, as in humans, MTF functions on an intersegmental level for postural control and proprioception in the thoracolumbar spine.

Ultrasonography showed that this muscle atrophies and weakens on the side and region of spinal pathology or dysfunction, as it does in humans (McGowan et al., 2007; Stubbs et al., 2006). More recently, Stubbs et al (2011) published a study demonstrating that dynamic mobilisation exercises, in the form of baited stretches, are effective

at increasing the cross-sectional area (CSA), and thus the power, of the multifidus fibres in the thoracolumbar region of the horse’s spine. It is also important to note that in horses that had suffered onesided muscle atrophy due to pain or pathology, the symmetry improved as a result of these exercises. This is exciting evidence on the efficacy of a particular physiotherapy exercise that may be used during rehabilitation of equine patients, to normalise or improve multifidus muscle mass.

Obliquus externus abdominis (OEA) activation during walking and trotting was investigated by Zsoldos et al. 2010, along with RA, using surface EMG. OEA activity levels were not as clearly defined in relation to specific movements or points in the gait cycle compared to RA, possibly because it may play a role in respiration as well as locomotion. The contribution of OEA to locomotion and specific movements requires further investigation (Zsoldos et al., 2010).

The ‘dual locomotor-respiratory function’ of some muscles was studied with implanted EMG electrodes by Gutting et al 1991: in particular, TrA, and to some extent RA, OEA and obliquus internus abdominis (OIA). They appeared to have a respiratory role when the ponies were at rest, and an increasingly locomotive and stabilising role as the speed of the gait increased. RA, OEA and OIA were suggested to have definite ‘locomotor functions’, but what these precise functions are, and how the muscles acted in order achieve their roles, was not within the scope of this study to discuss. There is, however, evidence suggesting that abdominal muscles do contribute, in different ways, towards locomotion, particularly at more demanding levels of exercise (Gutting et al., 1991).

Comparing equine and human spines Important differences human and equine

between structure

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and movement make direct extrapolations from human literature, regarding abdominal muscle function, impossible. Horses have a relatively rigid spine with comparatively little movement during locomotion (Jeffcot & Dalin, 1980; Johnston et al., 2004).

They are quadrupedal: their spines have a different orientation and they employ a different mode of neuromotor control in locomotion and coordination of limbs (Dietz, 2002; Smit, 2002). The relative anatomy, for example in terms of length and function of forelimbs and hind-limbs, also differs (Payne et al., 2004; Payne et al., 2005), and will impact on the biomechanics of the body, particularly at the spine.

Trunk stabilisers may be required to support the horse’s body and spine during equestrian sports, but whether it is the abdominal muscles that fulfil this role is uncertain.

Further investigation required There is a lack of evidence regarding equine abdominal muscles and the determination of their roles in terms of support of the spine and locomotion, and also, how these may change at different gaits. In human practice, treatment and rehabilitation of the spinal stabilisers is used in treatment of back pain, prevention of injury, and performance improvement. As these three topics are of great interest to the equestrian industry, it can be argued that investigations of the function of the equine abdominal muscles are highly warranted.

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Kinematic evaluation of the back in fully functioning riding horses. Equine Veterinary Journal. 36(6): 495-498 27. Koumantakis, G., Watson, P. & Oldham, J. (2005) Trunk Muscle Stabilisation Training plus General Exercise versus General Exercise Only: Randomised Controlled Trial of Patients with Recurrent Lower Back Pain. Physical Therapy. 85(3):209-225 28. Landman, M., De Blaauw, J., Van Weeren,

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P. & Hofland, L. (2004) Field study of the prevalence of lameness in horses with back problems. Veterinary Record. 155: 165-168 29 Leetun, D., Ireland, M.L., Willson, J.D., Ballantyne, B.T. & Davis I.M. (2004) Core Stability Measures as Risk Factors for Lower Extremity Injuries in Athletes.

Medicine and Science in Sports and Exercise. 36(6): 926-934 30. Licka, T., Peham, C. & Frey, A. (2004) Electromyographic activity of the longissimus dorsi muscles in horses during trotting on a treadmill. American Journal of Veterinary Research. 65: 155158.

31. Licka, T., Frey, A. & Peham, C. (2009) Electromyographic activity of the longissimus dorsi muscles in horses when walking on a treadmill. Veterinary Journal. 180: 71-76.

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Lieber, R. and Friden, J. (2000) Functional and clinical significance of skeletal muscle architecture. Muscle Nerve. 23: 1647-1666

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34. McGowan, C., Stubbs, N., Hodges, P. & Jeffcott, L. (2007b) Back pain in horses: epaxial musculature. Rural Industries Research and Development Corporation. Publication No 07/118.

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47. Ritruechai, P., Weller, R. and Wakeling, J.M. (2008) Regionalisation of the muscle fascicle architecture in the equine longissimus dorsi muscle. Equine Veterinary Journal. 40: 246-251 48. Robert, C., Valette, J. & 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): 466-472

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CRITICALLY DISCUSS THE DIAGNOSTIC PROCEDURES USED IN THE MANAGEMENT OF A HORSE WITH SACROILIAC PAIN Natalie Fizzo MCSP HPC UWE/Hartpury Student ACPAT Cat B Definitive diagnosis of sacroiliac (SI) pain in horses is difficult to achieve due to vague, inconsistent clinical features and the deep anatomical location of the joint (Haussler, 2004a; Gorgas et al., 2009). Consequently, even after imaging procedures, diagnosis is often based on exclusion of other pathologies (Denoix, 2003; Engeli et al., 2004a; Dyson and Murray, 2003; Goff et al., 2008).

The sacroiliac joint (SIJ) is an atypical synovial articulation between the ventral iliac wing and the dorsal sacral wing, connecting the pelvis to the axial skeleton and transmitting propulsive forces cranially (Haussler, 2003).

The joint capsule closely follows the joint margins (Goff et al., 2008) and is reinforced by strong SI ligaments (Haussler, 2004a), which support and stabilise the SIJ (Degeurce et al., 2004). This suggests that the joint has low motion capabilities (Degeurce et al., 2004; Goff et al., 2008) meaning its function is based on stability and pain may result if this is not maintained (Degeurce et al., 2004).

Both veterinarians and veterinary physiotherapists begin their assessment for SI pain in the same manner. A thorough history is obtained, findings of reduced performance (Denoix, 2003; Goff et al., 2008), intermittent low grade hindlimb lameness, reduced impulsion (Gorgas et al., 2009), behavioural changes and jump refusal (Dyson and Murray, 2003; Engeli et al., 2004a) would be suggestive of SI pain. To support this diagnosis, gait assessment may show reduced cranial phase of hindlimb stride, varying amounts of hindlimb flexion (Tucker et al., 1998; Haussler, 2003) and difficulty cantering (Dyson and Murray,

2003). Difficulty in completing small figures of eight may also indicate SI pain (Sutton, 2003). Palpation may reveal spasm, coupled with visible atrophy, within the hindquarter musculature, particularly gluteus medius and the hamstrings (Denoix, 2003; Haussler, 2003). Significance of bony landmark tenderness on palpation or asymmetry is controversial, especially relating to tuber sacrale (Denoix, 2003; Haussler, 2003). Manual tests, such as applying ventrally directed forces over bony landmarks and hindlimb manipulations (Haussler, 2003; Tomlinson et al., 2003), are used to assess the functional level of the SIJ, as well as tenderness, passive range of movement, compression of articular surfaces and to stress extra-articular structures (Goff and Crook, 2007; McGowan et al., 2007; Goff et al., 2008).

After these initial assessments, veterinarians have access to an array of technological investigations to inform their diagnosis.

Diagnostic analgesia, combined with other diagnostic procedures (for example nuclear scintigraphy), can be used to demonstrate the clinical significance of abnormal findings (Dyson et al., 2003a). Injections carry risk because of the vital neurovascular structures passing close to the SIJ (Haussler, 2003; Engeli et al., 2004; Cousty et al., 2008) and are difficult to perform due to the deep anatomical SIJ location, the depth of overlying hindquarter musculature (Engeli et al., 2004a), narrow joint space and variables associated with using bony landmarks for orientation (Cousty et al., 2008). These factors, coupled with interpretation difficulties due to the subtle gait abnormalities typical of SI pain, result in arguments that local analgesia of

the SIJ is impractical for diagnosis (Tucker et al., 1998). Dyson and Murray (2003) did, however, document gait improvements in horses with suspected SI pain post administration of local analgesia. Several studies have been undertaken to investigate a standardised, safer injection technique, for example Engeli et al. (2004a). There are strong cases for ultrasound guided injections (Cousty et al., 2008; Denoix and Jacquet, 2008) which reduce the aforementioned risks and enable intra-articular rather than periarticular injections to be performed, increasing accuracy and reliability of results (Engeli and Haussler, 2011). A safe, reliable technique enables injections to be used as a diagnostic and management tool of SI pain (Dyson et al., 2003a; Denoix and Jacquet, 2008).

Ultrasound can also be used diagnostically to identify soft tissue, articular cartilage and bone surface alterations (Malikides et al., 2007; Tomilinson et al., 2003). As well as being the only ante mortem diagnostic tool sensitive enough to detect soft tissue changes in the SI area (Engeli et al., 2004b; Goff et al., 2006), ultrasound is available to most practitioners (Kerston and Edinger, 2004; Tomilinson et al., 2003) and can be used outside the surgery environment (Engeli et al., 2004b). It is limited, however, in that it cannot image the interosseous ligament due to its location beneath the iliac wing (Haussler, 2003; Engeli et al., 2004b), and because there is minimal information regarding the normal ultrasonographic appearance of the SI region (Tomlinson et al., 2003) so findings must be interpreted in conjunction with other diagnostic

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tools

(Engeli

et

al.,

2004b).

Radiography is important in the evaluation of horses with reduced performance and lameness (Gorgas et al., 2007) but has limitations when applied to the SI area. The presence of the tuber coxae prevent standing radiographs being obtained caudal to the fourth lumbar vertebra, so images of the SI region must be obtained in dorsal recumbency under general anaesthesia (GA), which not only carries inherent safety risks and financial implications, but also the potential to exacerbate existing pelvic injuries and increase soft tissue damage during positioning and recovery (Tucker et al., 1998; Denoix, 2003; Tomlinson et al., 2003). Image quality is impaired by the angle at which the joint is orientated and the superimposition of gastric viscera (Dyson et al., 2003b; Kerston and Edinger, 2004).

However, Gorgas et al. (2007) demonstrated, in 77 out of 79 cases, that actively ventilating the horse caused movement and radiographical blurring of viscera resulting in diagnostic quality radiographs. Radiographs image osseous structures (Tomlinson et al., 2003) which have many irregularities (Dyson et al., 2003b) as demonstrated by the variations in appearance found by Gorgas et al.

(2007). Clinical relevance of these variations is difficult to determine as, like ultrasound images, there is a lack of information regarding normal appearance (Gorgas et al., 2007). However, radiographs can contribute to reaching a conclusion of SI pain when combined with other diagnostic methods and with consideration of clinical examination findings (Gorgas et al., 2007). For example, when superimposed over a scintigraphic image, radiographs can aid in its interpretation by providing landmarks for orientation (Dyson et al., 2003b).

The use of nuclear scintigraphy in diagnosis of SI pain is controversial, although commonly used (Gorgas et al., 2009). Various factors affect the radiopharmaceutical uptake of the SI region including sacral

conformation, musculature depth, soft tissue attenuation (Gorgas et al., 2009) and age (Kerston and Edinger, 2004) – questioning the adequacy of nuclear scintigraphy as a diagnostic tool (Gorgas et al., 2009). Indeed, this method is particularly limited in horses under two years old because ossification of the tuber sacrale is incomplete, meaning certain ligaments and tendons cannot be imaged (Kerston and Edinger, 2004). Image resolution is reduced by the large distance between the camera and bone, background activity, patient movement and the orientation of the camera relative to the pelvis which alters the perceived position of the SIJ (Erichsen et al., 2002).

Horse and camera positioning must be standardised as much as possible to reduce imaging technique errors (Tucker et al., 1998; Dyson et al., 2003b). Motion blur can be overcome by obtaining images under GA in lateral recumbency (Erichsen et al., 2002, Gorgas et al., 2009) however this increases muscle mass asymmetry due to pressure differences which can influence the images; financial and risk implications must also be considered (Gorgas et al., 2009).

Tucker et al. (1998) argues that a dorsal view over the vertebral column caudal to the last lumbar vertebra, in standing, is the most diagnostic. Motion blur hindering images obtained in this position can be reduced by motion correction (Erichsen et al., 2002; Dyson et al., 2003b). In Dyson et al.’s (2003b) study, examiners assessed 15 pairs of randomised images to decide which had been motion corrected and which had not – all corrected images were identified. All 30 images were then re-randomised prior to the assessors stating whether they were ‘normal’ or abnormal’, blinded to their subjective history.

14 of the 15 motion corrected images were correctly categorised whereas of the uncorrected images, 6 were deemed not to be of diagnostic quality and only 4 of the remaining 9 were correctly ascribed. This study demonstrates that motion corrected scintigraphic images offer greater opportunity

for accurate interpretation, a conclusion strengthened by the circumstances under which it was reached – randomisation and blinding. Interpretation of scintigraphic images is still arguably quite subjective but Tucker et al.

(1998) also found that examiners blinded to subjective history correctly determined images as normal or abnormal. Asymmetrical uptake of radiopharmaceutical is abnormal (Dyson et al., 2003b; Dyson and Murray, 2003) and has been correlated with a positive response to local analgesia (Dyson and Murray, 2003) so can be confidently attributed to on-going pathology in that area (Dyson et al., 2003a). It is important to remember that whilst uptake patterns change with age, they should remain symmetrical (Dyson et al., 2003a). General consensus is that nuclear scintigraphy is a non-invasive (Dyson et al., 2003b) and reliable (Tucker et al., 1998) method of imaging the SI region but results must interpreted alongside the use of other techniques and subjective findings (Dyson and Murray, 2003; Dyson et al., 2003a).

Thermography photographically maps body surface temperature (Kold and Chappel, 1998). Different colours correspond to different temperatures, reflecting changes of circulation in areas of active inflammation - ‘hot spots’, or areas of other disease processes, that reduce blood supply - ‘cold spots’ (Kold and Chappel, 1998; Tomlinson et al., 2003; Malikides et al., 2007).

Accordingly, it cannot determine the cause of temperature changes i.e. structures involved or specific disease processes (Tomlinson et al., 2003), but can highlight abnormal areas and therefore potential causes of clinical signs. It can also expose potential areas for future concern before clinical changes occur (Malikides et al., 2007). Kold and Chappel (1998) were able to diagnose SI inflammation when the findings of two unusual circular areas of increased heat emission over the SIJ’s were combined with subjective history and other clinical findings. This is a non-invasive,

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portable and safe imaging technique but equipment is initially expensive to purchase (Kold and Chappel, 1998). Within both the human and equine fields some practitioners believe thermography is more beneficial as an objective means of monitoring progress and response to treatment, than as a diagnostic tool (Kold and Chappel, 1998).

Although equine orthopaedic injuries are commonplace, accurately ascertaining the degree of associated musculoskeletal pain is difficult (Varcoe-Cocks et al., 2006). Conventionally, it has been assessed purely using palpation (Varcoe-Cocks et al., 2006) which is extremely subjective, sometimes difficult to interpret and difficult to accurately repeat (Goff and Crook, 2007). Pressure algometry provides a repeatable, objective tool to both measure and monitor muscle pain (Varcoe-Cocks et al., 2006) although research surrounding this topic appears to be lacking. Varcoe-Cocks et al.

(2006) completed a randomised, blinded trial from which they demonstrated that pressure algometry is well correlated with clinical signs (such as muscle atrophy, low grade, intermittent lameness) and muscle palpation scores associated with SI region pain. When Dyson and Murray (2003) performed periarticular analgesic injections within the SI region they found improvements in horses’ gait and stated that the analgesic had the potential to affect the longissimus dorsi tendon (as an example), thereby supporting the occurrence of local muscle response in SI pain (Varcoe-Cocks et al., 2006) and the use of both pressure algometry and thermography in the diagnosis of this condition.

Due to its anatomical positioning, the SI region is inaccessible to some other imaging techniques such as magnetic resonance imaging and computed tomography (Malikides et al., 2007).

Whilst being a suspected predominant cause of poor performance in equines (Goff

et al., 2008), the varying clinical signs, deep anatomical location of the SIJ and ignorance of what constitutes normal appearance of the joint, make diagnosis of SI pain particularly challenging for the practitioner (Gorgas et al., 2007; Engeli and Haussler, 2011). No diagnostic tool is suitable to be used independently in the diagnosis of SI pain, findings from various modalities must be considered in light of each other to offer the best chance of an accurate diagnosis (Dyson and Murray, 2003; Engeli et al., 2004b; Gorgas et al., 2007). Following their assessments, veterinarians strive to reach a patho-anatomical diagnosis whilst veterinary physiotherapists aim for a functional conclusion (McGowan et al., 2007); both of these approaches are beneficial in the difficult diagnosis of SI pain in equines.

Presently, management is often based on the horse’s clinical presentation rather than a conclusive diagnosis (Goff et al., 2008) and incorporates the adaptation and application of treatments created for similar manifestations in other areas (Haussler, 2004b). When technology facilitates a confident diagnosis of SI pain, it may also offer reliable, objective measures of progress thereby informing more condition specific rehabilitation plans and ultimately improving patient prognosis (Haussler, 2004b).

References 1.

Cousty, M., Rossier, Y. & David, F. (2008) Ultrasound-guided periarticular injections of the sacroiliac region in horses: A cadaveric study. Equine Veterinary Journal. 40(2), 160-166.

2.

Degeurce, C., Chateau, H. & Denoix, J.M. (2004) In vitro assessment of movements of the sacroiliac joint in the horse. Equine Veterinary Journal. 36(8), 694-698.

3.

4.

Denoix, J.M. (2003) Diagnosis of sacroiliac lesions in horses. Available from: http://www.tierklinik-hochmoor. de/index.php?id=107&L=1.

Denoix, J.M. and Jacquet, S. (2008) Ultrasound-guided injections of the

sacroiliac area in horses. Equine Veterinary Education. 20(4), 203-207.

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Dyson, S. and Murray, R. (2003) Pain associated with the sacroiliac joint region: a clinical study of 74 horses.

Equine Veterinary Journal. 35(3), 240245.

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Dyson, S., Murray, R., Branch, M. & Harding, E. (2003a) The sacroiliac joints: evaluation using nuclear scintigraphy.

Part 2: Lame horses. Equine Veterinary Journal. 35(3), 233-239.

7.

Dyson, S., Murray, R., Branch, M.,Whitton, C., Donovan,T. & Harding, E. (2003b) The sacroiliac joints: evaluation using nuclear scintigraphy. Part 1: The normal horse.

Equine Veterinary Journal. 35(3), 226232.

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Engeli, E., Haussler, K.K. & Erb, H.N. (2004a) Development and vailidation of a periarticular injection technique of the sacroiliac joint in horses. Equine Veterinary Journal. 36(4), 324-330.

9.

Engeli,E.,Yeager,A.& Haussler,K.K.(2004b) Use and limitations of ultrasonography in sacroiliac disease. Available from: ftp://ftp.aave .inv.org.ar/IVIS/aaep/ Use%20and%20Limitations%20of%20 Ultrasonography%20in%20Sacroiliac%20 Disease.pdf.

10. Engeli, E. and Haussler, K. K. (2011), Review of injection techniques targeting the sacroiliac region in horses.

Equine Veterinary Education. doi: 10.1111/j.2042-3292.2011.00313.x 11. E richsen, C., Berger, M. & Eksell, P. (2002) The scintigraphic anatomy of the equine sacroiliac joint. Veterinary Radiology & Ultrasound. 43(63), 287-292.

12. Goff, L.M., Jasiewicz, J., Jeffcott, L.B., Condie, P., McGowan, T.W. & McGowan, C.M. (2006) Movement between the equine ilium and sacrum: in vivo and in vitro studies. Equine Veterinary Journal supplement. 36, 457-461.

13. Goff, L. and Crook, T. (2007) Chapter 8 Physiotherapy assessment for animals.

In: McGowan, C., Goff, L. and Stubbs, N. eds. (2007) Animal Physiotherapy assessment, treatment and rehabilitation of animals. Oxford: Blackwell Publishing, 136-163.

14. Goff, L.M., Jeffcott, L.B., Jasiewicz, J & McGowan C.M. (2008) Structural and biomechanical aspects of equine sacroiliac joint function and their relationship to clinical disease. The Veterinary Journal. 176 (3), 281-293.

15. Gorgas, D., Kircher, P., Doherr, M.G., Ueltschi, G. & Lang, J. (2007) Radiographic technique and anatomy of the equine sacroiliac region. Veterinary Radiology & Ultrasound. 48(6), 501-506.

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16.

Gorgas, D., Luder, P., Lang, J., Doherr, M.G., Ueltschi, G. & Kircher, P. (2009) Scintigraphic and radiographic appearance of the sacroiliac region in horses with gait abnormalities or poor performance. Veterinary Radiology & Ultrasound. 50(2), 208-214.

algometry to quantify muscle pain in racehorses with sacroiliac dysfunction.

Equine Veterinary Journal. 38(6), 558562.

17. Haussler, K.K. (2003) Diagnosis and management of sacroiliac joint injuries.

In: Ross, M.W. and Dyson, S.J. eds. (2003) Diagnosis and management of lameness in the horse. Missouri: Saunders, 501508.

18. Haussler, K.K. (2004a) Functional anatomy and pathophysiology of sacroiliac joint disease. Available from: ftp://ftp.aave .inv.org.ar/IVIS/aaep/ Functional%20Anatomy%20and%20 Pathophysiology%20of%20Sacroiliac%20 Joint%20Disease.pdf.

19. Haussler, K.K. (2004b) Treatment options for sacroiliac joint disease.

Available from: ftp://ftp.aave.inv.org.ar/ IVIS/aaep/Treatment%20Options%20 for%20Sacroiliac%20Joint%20Disease. pdf.

20. Kersten, A.A.M. and Edinger, J. (2004) Ultrasonographic examination of the equine sacrolilac region. Equine Veterinary Journal. 36(7), 602-608.

21. Kold, S.E. and Chappell, K.A. (1998) Use of computerised thermographic image analysis (CTIA) in equine orthopaedic review and presentation of clinical cases.

Equine Veterinary Education. 10(4), 198204.

22. Malikides, N., McGowan, T. & Pead, M. (2007) Chapter 6 Equine and canine lameness. In: McGowan, C., Goff, L. and Stubbs, N. eds. (2007) Animal Physiotherapy assessment, treatment and rehabilitation of animals. Oxford: Blackwell Publishing, 73-101.

23. McGowan, C.M., Stubbs, N.C. & Jull, G.A. (2007) Equine physiotherapy: a comparative view of the science underlying the profession. Equine Veterinary Journal. 39(1), 90-94.

24. Sutton, A. (2003) The injured horse.

Hands-on methods for managing and treating injuries. Newton Abbot: David & Charles.

25. Tomlinson, J.E., Sage, A.M. & Turner, T.A. (2003) Ultrasonographic abnormalities detected in the sacroiliac area in twenty cases of upper hindlimb lameness. Equine Veterinary Journal. 35(1), 48-54.

26. Tucker, R.L., Schneider, R.K., Sondhoft, A.H., Ragle, C.A. & Tyler, J.W. (1998) Bone scintigraphy in the diagnosis of sacroiliac injury in twelve horses. Equine Veterinary Journal. 30(5), 390-395.

27. Varcoe-Cocks, K., Sagar, K.N., Jeffcott, L.B. & McGowan, C.M. (2006) Pressure

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VETERINARY PHYSIOTHERAPY FOR THE DAIRY COW – A CASE STUDY Emma Strachan MCSP HPC BSc (Hons) MSc Vet Phys ACPAT Cat A Veterinary Physiotherapists primarily work with horses, dogs and cats however with a farming background I was keen to explore the benefits of Veterinary Physiotherapy for the dairy cow.

Although I work predominantly with horses, I have had some interesting cases with dairy cows, which I will explain in this article.

Firstly, the function of the dairy cow is to produce milk and offspring with a key focus on longevity.

The average cow produces approximately 9000 litres of milk (15000 pints) per year. When a cow calves it is important to return her milk production to a profitable level with her best interests at heart. With this in mind, my aim as a Veterinary Physiotherapist is to facilitate this process. As with humans, giving birth is not always straightforward and this is where I had my first encounter with Bovine Physiotherapy.

Following a difficult calving, Paige a 6-year-old Holstein cow had been lying down for 3 days and was reluctant to get back on her feet.

Veterinary Physiotherapy (VP) assessment findings: •

Sacroiliac joint pain/ dysfunction

•

Oedematous throughout her fore and hind limbs

•

The development of pressure areas on her left side

applied to the sacroiliac joint using a triple concentric pad on 200Hz base and constant pulse setting for 15 minutes •

Passive range of movement exercises applied to all limbs in a side lying position

•

Working with the farmer to implement a regular turning routine

•

Home exercise programme including passive range of movement exercises and turning as mentioned above

•

On day 5 Paige stood up independently.

VP re-assessment findings: •

Unable to stand square

•

Partially weight bearing on right hind limb

•

Increased left forequarter muscle tone

Working with the vet and farmer to provide pain relief and anti-inflammatory medication

•

Pulsed electromagnetic therapy

I continued to reassess and progress Paige’s VP treatment on a regular basis, the vet, the farmer and myself are pleased with her progress. Paige is sound, she has returned to full milk production and turn out on the grass (see Figure 2).

VP treatment progression included: •

Pulsed electromagnetic therapy applied to the sacroiliac joint using a triple concentric pad on 50Hz base and 17.5 pulse setting for 15 minutes

•

Rhythmical stabilisation exercises applied cranially to caudally (see Figure 1), left to right and diagonally

•

Soft tissue massage and myofascial release applied to left forequarter muscles

•

Restricted walking

VP acute treatment: •

Box rest

Fig. 1

Fig. 2

Other bovine cases have included the application of photo therapy (laser) to speed up the healing process of wounds, an intense Veterinary Physiotherapy programme for a calf with a malformation of her hip joint (see Figure 3 and 4) and also Veterinary Physiotherapy for the showing dairy cow.

Showing dairy cows is certainly more involved than you may expect.

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Fig. 3

Among the many traits that a judge is searching for, good conformation is one of the most important. The biggest annual calf show is the All Britain All Breeds Calf Show.

Rumour, an 18-month old Jersey heifer, a hopeful for performing well at this event appeared to have a roached back posture and she was also showing some resistance to halter training.

VP assessment findings: •

Hind limbs camped under in stance

•

Muscle spasm and tension throughout her thoracic epaxial muscles

•

Stiffness throughout her thoracic spine

•

Reduced active range of movement of cervical spine

•

Reluctance to move forwards on the halter

Fig. 4

Following 5 treatment sessions, Rumour responded well, her muscle tension reduced, her stance and topline improved (marked reduction in her roached back appearance) and she was behaving on the halter.

Following a final physiotherapy treatment, clip and blow dry at the show, Rumour did remarkably well, winning her class and went on to win the title of Jersey All Britain Champion 2011 (see Figure 5). In Rumours case, Veterinary Physiotherapy certainly contributed to her show ring preparation and performance.

These cases suggest that Veterinary Physiotherapy is beneficial to the dairy cow and I look forward to exploring this further. I welcome

any of your comments or questions relating to these cases. www.provetphysio.co.uk Recommended Reading List 1.

Andrews, A.H., Blowey, R.W., Boyd, H. and Eddy, G.R. (2003) Bovine Medicine: Diseases and Husbandry of Cattle.

Second Edition. Wiley-Blackwell

2.

Ashdown, R.R. and Done, S.H. (1996) Colour Atlas of Veterinary Anatomy: The Ruminants. Mosby-Wolfe

3.

Greenough, P.R. (2007) Bovine Laminitis and Lameness: A Hands-on Approach.

Elsevier Health Sciences

4.

Scott, P.H., Penny, C.D. and McCrae, A. (2011) Cattle Medicine. Manson Publishing

5.

Weaver, D.A., StJean, G. and Steiner, A. (2005) Bovine Surgery and Lameness.

Second Edition. Wiley-Blackwell

VP treatment included: •

Soft tissue mobilisation/ massage and myofascial release applied bilaterally to the epaxial muscles

•

Reflex inhibition applied to the epaxial muscles

•

Rib angle mobilisations

•

Spinal reflex stretches

•

Cervical spine baited stretches

•

Walking on the halter with a low head carriage

•

Husbandry; moving Rumour into a larger barn allowing her plenty of space to move around in

Fig. 5

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TIPS AND TRICKS FOR TACKLING SPINAL DISEASE STEP BY STEP Mark Lowrie MA VetMB MVM DipECVN MRCVS RCVS and European Specialist in Veterinary Neurology Spinal diseases are important causes of disability in dogs and cats and represent a high proportion of the caseload in neurology referral centres. Although advanced imaging is helpful in confirming a diagnosis, a lot can be ascertained from the clinical and neurological examination.

This includes information about the likely diseases that are causing the clinical signs and also the prognosis, i.e. is it worth pursuing further investigation or not? This article gives a step-by-step plan for examining any patient with suspected spinal disease. It also gives information on how disease severity can be assessed simply by testing some basic responses.

Background Investigations into spinal cord disease require a very accurate neurolocalization, i.e. what part of the nervous system is affected. The spinal cord is divided into functional segments (eight cervical, thirteen thoracic, seven lumbar, three sacral and variable numbers of caudal segments). These segments contain the cell bodies of the lower motor neuron (LMN). The segments C6 to T2 and L4 to S1 contain the cell bodies of the LMN innervating the thoracic and pelvic limbs respectively. Lesions at these levels result in LMN signs corresponding to the limb(s) at that level (table 1). Accordingly the segments are divided as shown in figure 1.

Figure 1 – Schematic representation of the components of the nervous system and how they are divided. Lesions at C6 to T2 and L4 to S1 cause lower motor neuron signs.

Lesions in the region of C1 to C5 and T3 to L3 cause upper motor neuron signs.

It is important to remember that the spinal segments do not match up exactly with the vertebrae of the same name. The canine spinal cord actually terminates at around the level of the fifth lumbar vertebra (although there is considerable variation between individuals and breeds). The spinal nerves do, however, exit from their respective intervertebral spaces. In the cervical region this is at the cranial aspect of the vertebral body whereas all other spinal nerves exit at the caudal end.

Clinical Signs Two types of gait abnormality are possible with spinal cord disease that may occur alone or in combination:

a) Upper Motor Neuron Paresis – due to a lesion in the descending motor pathways of the brain or spinal cord causing a spastic paresis (see upper motor neuron signs – table 1) b) Lower Motor Neuron Paresis – due to a lesion involving the lower motor neuron causing a flaccid paresis (see lower motor neuron signs – table 1) 2. Ataxia – is defined as an uncoordinated gait. Three forms of ataxia are recognised

1. Paresis – is defined as weakness or an inability to

Upper Motor Neuron Signs

generate a gait. The term paresis implies some voluntary movement is present as compared to paralysis (or -plegia) in which complete loss of voluntary movement is observed.

Two types of paresis can be seen:

Lower Motor Neuron Signs

Reflexes

Normal or increased

Decreased or absent

Atrophy

Late and mild (disuse)

Rapid and severe (neurogenic)

Tone

Normal or increased

Decreased or absent

Occur with Brain, C1 to C5, and T3 to L3 lesions

Occur with C6 to T2, L4 to S3 and neuromuscular lesions

Location

Table 1 – The clinical signs that may be expected with upper motor neuron and lower motor neuron signs

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although only the first (i.e. proprioceptive ataxia) is associated with spinal cord disease: a) Sensory or Proprioceptive ataxia: resulting from a disorder of the sensory (afferent or ascending) nerve or spinal cord pathways involved in general proprioception. b) Vestibular ataxia: resulting from a vestibular disorder. c) Cerebellar ataxia: resulting from a cerebellar disorder.

Ataxia can be further subdivided into hypometria (a shorter protraction phase of the gait), hypermetria (a longer protraction phase of the gait) and dysmetria (a combination of hyper- and hypometria).

Depending on the severity and the limbs affected, the following terms are used: •

Tetraparesis/plegia – paresis/paralysis of all four limbs resulting from a lesion located cranial to the T2 spinal cord segment or from a generalised lower motor neuron disorder

•

Paraparesis/plegia – paresis/paralysis of the pelvic limbs caused by a lesion caudal to T2

•

Monoparesis/plegia – paresis/lysis of one limb caused by a lesion of the lower motor neuron innervating the affected limb

•

Hemiparesis/plegia – paresis/lysis of the limbs on one side of the body due to a lesion located cranial to T2. This hemiparesis/plegia is ipsilateral to a lesion located between T2 and the midbrain but contralateral to a lesion located in the rostral midbrain or cerebrum.

Aims of the Neurological Examination The aims of the neurological evaluation of a patient are to answer the following questions: 1. Do the clinical signs observed refer to a nervous system lesion?

2. What is the location of this lesion within the nervous system?

3. What are the main types of disease process that can explain the clinical signs?

4. How severe is the disease?

The first two questions are answered by the neurological examination and aim to determine the anatomical diagnosis (location and distribution of the lesion within the nervous system). The third question is answered by compiling information on the patient’s signalment and the history of the problem with the anatomical diagnosis to determine a list of likely differential diagnoses. Disease severity can help the clinician to determine the eventual prognosis of the conditions considered in the differential diagnosis. Diagnostic tests are then carried out. The choice and interpretation of these tests must rely on a clear knowledge of the lesion localisation within the nervous system and the expected disease processes.

QUESTION 1 – Do the clinical signs observed refer to a nervous system lesion?

Is the problem neurological? This can be a very straight forward or challenging question depending on the individual case. Alterations in ability to ambulate, weakness, altered mental status, apparent pain and paroxysmal events are common presenting signs in animals with neurological disease. However, these signs are not exclusive to neurological conditions. Recognition of neurological versus nonneurological disease is essential for appropriate diagnostic planning.

Inappropriate diagnostics, such as cerebrospinal fluid collection, which require general anaesthesia and entail potential risk, should be avoided when a neurological localisation has not been achieved.

Similarly, a neurological localisation is important if expensive procedures such as magnetic resonance imaging are to be correctly performed. For example, a dog with referred neck and back pain due to a brain tumour may have normal spinal imaging but an abnormal brain on magnetic resonance imaging.

Correct localisation is essential.

Not all dogs and cats that are “off their legs” have neurological disease. The thing we look for when doing a neurological test (e.g. postural reaction testing) is usually movement of some sort. It is important to remember that an animal that is unwilling to move may look very similar to an animal that is unable to move. Therefore some form of encouragement should be given to encourage patients to walk when presented with an inability to move. Apparent pain is often a difficult clinical sign to localise.

Abdominal, pelvic, soft tissue and orthopaedic (particularly joint) pain may often manifest with signs such as cervical rigidity, an arched back (kyphosis) and abnormal gait; signs which are frequently and mistakenly assumed to be associated with neurological disease (examples of this include bilateral cruciate disease and polyarthritis). Many animals with disease affecting the brain will present with altered mentation and obtundation. However, these are clinical signs commonly seen with many systemic diseases. Seizures are paroxysmal events, i.e. they appear suddenly, manifest themselves dramatically and have an abrupt end.

However, “collapsing” secondary to fainting (syncope), hypoxia, or responses to acutely painful stimuli can also be paroxysmal in nature.

Gait evaluation is one of the best ways to determine if a problem is neurological and the presence of ataxia or paresis would usually imply a neurological condition is present.

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QUESTION 2 – What is the location of this lesion within the nervous system?

•

This can be answered by the Handsoff and Hands-on examination.

b) Motor function – lesions affecting motor function will result in weakness, paresis or paralysis (depending on the severity) and can be assessed by:

Hands-Off Examination: The neurological examination starts with watching the animal walk and observing how it interacts with its surroundings. Some abnormalities (for example, circling or hypermetria) are only apparent when the animal walks. This allows evaluation of: •

Posture – head tilt, wide-based stance, deviation of the body

•

Gait – ataxia, circling, paresis

•

Mental status – alert, obtunded, stuporous, comatose

•

Observation of behaviour and involuntary movements is also possible

Hands-On Examination: The idea of the first part of the hands-on examination is to precisely localise the lesion to a progressively smaller area of the nervous system. This can be divided into a series of questions that should be answered whenever performing any neurological examination of any patient.

•

•

•

•

Paw position response – testing conscious proprioception

information we can begin to localise the problem: •

Hopping – this is my preferred method of assessing motor function as it can be done in any animal regardless of size (see figure 2). It allows you to assess each individual limb for weakness and allows for an easy comparison between limbs Wheel barrowing (head should be elevated) – assesses the thoracic limbs

a) Sensory function – lesions affecting sensory function will result in ataxia and can be assessed by: will result in ataxia and can be assessed by: •

Observation of gait – this will allow detection of ataxia

If all four limbs are affected – the lesion is likely to be cranial to the T3 spinal cord segment or the lesion may relate to a generalised neuromuscular disease (i.e. a polyneuropathy, polymyopathy or junctionopathy).

Fig. 3

•

Extensor postural thrust (the reverse of wheel barrowing) – assesses the pelvic limbs

If the pelvic limbs are affected and the thoracic limbs are normal – this indicates a spinal cord lesion caudal to the T3 spinal cord segment, or a lesion of the pelvic limb peripheral nerves or muscles (i.e. neuromuscular disease).

Hemi standing and hemi walking – assesses the limbs on one side of the body

Fig. 4

•

If just one side of the body is affected – this is the same as for lesions affecting all four limbs, but the lesion is just on the affected side.

A neuromuscular disease is unlikely in this circumstance as these are usually bilaterally symmetrical.

•

If just one hindlimb is affected – this is the same as for a lesion affecting both pelvic limbs, but the lesion is just on the affected side.

A neuromuscular disease is unlikely in this circumstance as these are usually bilaterally symmetrical.

1. Step 1. Determine which limbs are affected Spinal cord tracts can be divided into afferent (ascending or sensory) and efferent (descending or motor) pathways.

Figure 2 – The hopping reaction is tested by holding the patient so that the majority of its weight is placed on one limb while the animal is moved laterally. Normal animals hop on the tested limb to accommodate a new body position as their centre of gravity is displaced laterally. An equal response should be seen on both sides. Subtle ataxia or weakness of one limb may be detected using this test.

Performing the above tests should make it clear as to how many limbs are affected. Based on this

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Fig. 5

•

If just one forelimb is affected: the lesion is likely to be on that side in the central grey matter of C6T2, the nerve roots, brachial plexus, peripheral nerves, neuromuscular junction or muscle.

Fig. 6

2. Step 2. Does the lesion affect the reflex arcs to the limbs (i.e. is it an upper motor neuron or lower motor neuron lesion)?

is likely to be. To narrow this localisation further we must check the patient’s reflexes and look specifically for upper or lower motor neuron signs (see table 1).

If lower motor neuron disease is present then only some of the signs listed in table 1 may be observed, particularly early on in the course of the disease.

Cutaneous Trunci (also known as the “Panniculus”) Reflex – allows accurate localisation in the T3 to L3 spinal cord segments only (figure 8). It is also useful in assessing the integrity of the C8 to T1 region of the brachial plexus (outflow of the cutaneous trunci reflex).

The skin is pinched by using a pair of haemostats starting at the iliac crest (around the level of the L4 dermatome) and about one inch lateral to the midline. This should result in a bilateral contraction (or twitch) of the cutaneous trunci muscles. A focal cut-off indicates the cranial extent of the lesion.

Total absence of the panniculus reflex or absence on just one side may indicate a lesion at the level of C8 to T1 spinal cord segments (most commonly seen in brachial plexus avulsions or brachial plexus tumours invading the nerve roots)

•

Sympathetic Innervation to the Eyes – the sympathetic outflow to the head travels from the brain down the spinal cord to exit at the T1-T3 spinal cord segments, before travelling up the neck as the vagosympathetic trunk.

A lesion of the cervical spinal cord, the T1-T3 nerve roots or the brachial plexus may interfere with the sympathetic innervation to the head resulting in Horner’s syndrome (most commonly manifest as a small pupil on the affected side)

Spinal reflexes that are commonly used to assess for lower motor neuron signs include: •

Patellar reflex – evaluates the femoral nerve (L4-L6; see figure 7)

•

Withdrawal reflex (pedal or flexor reflex) – evaluates multiple thoracic (C6-T1) and pelvic (L6-S1) limb nerves

3. Step 3. Accurate localisation to specific spinal cord segments (e.g. by focal pain or the cutaneous trunci reflex) Having decided which segments the lesion lies within it may be possible to further pinpoint the problem using some of the following tests: •

Focal Pain – palpate the spine in the region of the suspected localisation feeling for focal pain, muscle spasm and heat. Flex the neck from side to- side, dorsally and ventrally. Extend and flex the lumbosacral junction or palpate it via a rectal examination

Figure 7 – Patella reflex. This reflex evaluates the integrity of spinal cord segments L4 to L6 (and associated nerve roots) as well as the femoral nerve. It is performed when the animal is in lateral recumbency, with the stifle slightly flexed and the tested limb supported by placing one hand under the thigh. Striking the patellar tendon with a reflex hammer induces extension of the limb due to a reflex contraction of the quadriceps femoris muscle.

Now that we have ascertained which limbs are affected we have a broad idea of where the lesion

•

Figure 8 – The cutaneous trunci reflex in the dog.

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QUESTION 3 – What are the main types of disease process that can explain the clinical signs?

Different spinal cord segments are affected by different diseases.

Similarly, the age, breed and speed of onset will also determine the more likely diseases. Therefore each disease process has a typical signalment, onset and progression as well as distribution within the nervous system (see tables 2 to 4). For example, a middle-aged Dachshund presenting “off their legs”, is most likely to have an intervertebral disc extrusion (figure 9).

followed by sensation. Therefore any patient with spinal disease that has movement (no matter how reduced) in the legs will have sensation.

Deep pain perception is therefore the major thing that must be performed to determine prognosis.

Any patient that has movement (no matter how little) in the affected limb will have retained deep pain perception and therefore this test should be reserved only for those cases that have complete paralysis of a limb or limbs. A conscious response is the animal turning around when the limb is stimulated

Key Point: Deep Pain Perception is not the same as the Withdrawal Reflex!

It is important not to confuse the withdrawal reflex with the conscious perception of pain – if the lesion does not affect the reflex arc then the withdrawal reflex may be intact even if deep pain sensation is lost due to a spinal cord lesion situated more cranially. Pain sensation is tested by pinching the digits. If there is no conscious response then the nail beds and digits are pinched with haemostats. If there is still no response then forceps are used on the tibia.

Summary If a spinal cord disease is suspected then this article has shown the importance of gait evaluation in determining whether the cause is neurological, and if it is, where in the nervous system the problem is likely to be. The more precise the lesion localisation then the more refined the list of possible causes will be.

The differential diagnoses are also related to the patient’s signalment, the disease history, the symmetry of the clinical signs and the presence or absence of spinal pain.

Further Reading

Figure 9 – Certain breeds are well known for being predisposed to particular conditions. A good example of this is in chondrodystrophic breeds such as the Dachshund that have a predisposition for intervertebral disc extrusions.

QUESTION 4 – How severe is the disease?

The spinal cord has numerous functions and each function is lost in turn as a spinal cord injury progresses. The first thing that is lost in spinal disease is proprioception. Then movement diminishes slowly over time

with a pair of haemostats, whimpering or trying to bite and not just the withdrawal of the limb.

The pathways that carry this deep pain perception are contained deep within the spinal cord white matter.

An absence of deep pain sensation carries a poor prognosis.

1. Garosi, L. (2012) Examining the neurological emergency.

In Small Animal Neurolgoical Emergencies 1st edn. Ed S.R. Platt and L.S. Garosi. Manson publishing. 15-34 2. Coates, J.R. (2004) Paraparesis.

In: BSAVA Manual of Canine and Feline Neurology 3rd edn. Ed S.R. Platt and. N.Olby.

Gloucester, BSAVA. 237-3264

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Differential diagnoses for common diseases affecting the C1 to C5 and C6 to T2 spinal cord segments Typical Breeds

Disease

Age

Onset

Neurological Signs

Spinal Pain

Mainly toy or small; Yorkshire terriers, Poodles

Typically young, <2y

Acute or chronic

Common, obvious ataxia and tetraparesis

Present in most cases

Cervical Disc Disease (extrusion)

Any, mainly small breeds

>2y

Acute

Mild or absent

Severe

Cervical Disc Disease (protrusion)

Any, mainly large breeds

>2y

Chronic

Mild to moderate

Mild to moderate

Cervical Spondylomyelopathy (bone-associated)

Great Danes, other giant breeds

<4y

Usually chronic

Common, obvious ataxia and paresis

Mild

Cervical Spondylomyelopathy (disc-associated)

Dobermans, other large breeds

>2y

Usually chronic but can be acute

Common, obvious ataxia and paresis

Mild

Fibrocartilaginous Embolism

Any

Any

Acute

Common, can be asymmetrical

None

Spinal Trauma

Any

Any

Acute

Common

Common

Steroid Responsive MeningitisArteritis

Boxers, Beagles, Young, Any <2y

Acute or chronic

Uncommon

Severe

Atlantoaxial Instability (Subluxation)

Table 2 – The common diseases affecting the canine cervical spine.

Differential diagnoses for common diseases affecting the T3 to L3 and L4 to S3 spinal cord Typical Breeds

Disease

Age

Onset

Neurological Signs

Spinal Pain

Degenerative Myelopathy

GSD, Corgi, mainly large breeds

>5y

Chronic (months)

Common, progressive

None

Fibrocartilaginous Embolism

Any

Any

Acute

Common, can be asymmetrical

None

Hemivertebral Instability

Pugs, Screwtailed breeds

Young, <1y

Chronic

Common, can be progressive

Rare

Extruding Disc Lesions

Any, mainly small breeds

>2y

Acute

Moderate to severe

Moderate to severe

Protruding Disc Lesion

Any, mainly large breeds

>2y

Chronic

Mild to moderate

Mild to moderate

Meningomyelitis

Any

Any

Subacute

Variable, can be asymmetrical

Variable, can wax and wane

Spinal Trauma

Any

Any

Acute

Common

Common

Spinal Neoplasia

Any

Any

Acute or Subacute

Common

Common

Table 3 – The common diseases affecting the canine thoracolumbar spine.

Differential diagnoses for common diseases affecting the L7 to S3 spinal cord Disease

Typical Breeds

Age

Onset

Neurological Signs

Spinal Pain

Lumbosacral Stenosis (Cauda Equina Syndrome)

Mainly large breeds, GSD most common

>5y

Chronic

Typically mild to moderate, may be lame or weak but no ataxia

Often present but hard to elicit

Spinal Trauma

Any

Any

Acute

Common

Common

Spinal Neoplasia

Any, usually large breeds

Any

Acute or Subacute

Common

Variable

Discospondylitis

Any, usually large breeds

Any

Acute or Chronic

Usually not present

Severe pain

Table 4 – The common diseases affecting the canine lumbosacral spine 23

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LATEST FINDINGS ON THE EFFECTS AND MECHANISMS OF DIET RESTRICTION ON AGEING, LONGEVITY AND HEALTH PARAMETERS IN DOGS (NESTLE PURINA) Clementine Jean-Philippe, DVM, PhD European Veterinary Communications Manager Summary: Diet restriction and maintaining lean body condition in the canine species from early puppyhood throughout life has been shown to have significant impact on numerous physiological parameters with: •

15% longer life span, on average

•

better maintenance of lean body mass

•

higher insulin sensitivity during ageing favourable modulation of immune capacity

• •

•

•

delayed prevalence and reduced severity of osteoarthritis

Metabonomics technology, using H-NMR-based urine metabolite dynamics, reflected diet restrictionrelated differences: •

•

reduced energy expenditure, with a shift in protein, carbohydrate and fatty acid pathways shift in gut microflora metabolism

These findings are reflecting the numerous metabolic processes stimulated by the cellular adaptation to the nutritional challenge of diet restriction.

A lifelong study was conducted

by Nestlé Purina scientists. This study, exceptional by its length, still delivers scientific outcomes on both canine ageing and diet restriction mechanisms, together with impacts on health. Indeed, peer-reviewed reports have been published recently in British Journal

throughout the study. Repeated biofluid sampling and storage has most recently enabled a more detailed biochemical analysis to be performed using a newer technology called metabonomics

of Nutrition (2008) and Journal of Proteome Research (2007).

The Lawler et al. article summarises the numerous findings from two decades of the study on a wide range of parameters measured, including life span, insulin-glucose metabolism, body composition, energy metabolism, immune system, and general health consequences The second paper from Wang et al. using some of the latest research technologies, investigates the metabonomics pathways in canine ageing, together with the specific, yet subtle, metabolic changes induced by diet restriction. It gives precise information on the adaptation of the canine’s metabolism to this nutritional intervention

Major observations of diet restriction in dogs over two decades Diet restriction results in up to two years longer lifespan1,2 •

Median life span was increased by 1.8 years, or 15 percent, in the DR group compared to the CF dogs (figure 1)

•

Median life span was 13.0 years in the DR group compared to 11.2 years in the CF group

•

Maximum life span was significantly different between the DR and the CF groups between 11.5 – 14.0 years

•

9 DR dogs (37.5%) remained alive at the time that all control dogs had died

General methodology1 •

•

•

•

48 Labrador Retriever dogs born at the Nestlé Purina Pet Care Centre were paired within their litters according to gender and body weight They were randomly assigned into either a control-fed (CF: control-fed) or a diet-restricted (DR) group Dogs in the DR group received 75% of the amount of the same food eaten by each paired littermate; resulting in a 25% diet restriction Numerous non-invasive data collection were performed

Diet restriction induces better maintenance of leanbody mass and insulin sensitivity during ageing1,3 •

Lean body mass always represented a greater percentage of total body composition in the DR group

•

Declining lean body mass was observed after 9 years of age in the CF dogs, whereas this was not observed among DR dogs until after the 11th year

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Fg. 1. Survival curves for diet-restricted and control feeding groups.

•

•

•

•

Insulin sensitivity was 58% greater among DR dogs on a whole body weight basis, and 147% greater on a lean body mass basis Proportional hazard analysis of body composition data from DEXA values showed that high static fat mass and declining lean mass both strongly predicted death at one year prior In advanced age, basal glucose decreased more in DR dogs than in CF dogs, whereas basal glucose generally increases with age in calorie-restricted animals Increasing insulin resistance was associated with a greater risk for onset of treatment for a chronic disease in this study

•

•

Slower age-related rate of decline in lymphoproliferative responses to mitogens Slower age-related decline in numbers of total lymphocytes, T-cells, and CD4 and CD8

median life span

subsets (age x diet) •

No decline over time for total lymphocytes, T-cells and CD8 cells

•

Smaller magnitude in rate of decline for age-related CD4 cells

•

Prevalence and severity of OA in the shoulder and elbow joints were similar but less dramatic by the end of life

•

The median age at which dogs required regular medical treatment for this chronic disease was significantly different between the two groups of dogs – among CF dogs, this occurred at a median age of 10.3 years and was significantly delayed by almost 3 years (median age of 13.3 years) in the DR group

•

The need for treatment of any chronic late-life health condition was also delayed in the DR dogs: median age when 50 percent of the dogs required treatment for a chronic condition was 12.0 years among the DR dogs, compared to 9.9 years for the CF dogs.

Diet restriction consequences on prevalence and severity of osteoarthritis and other chronic diseases 3,6-9 Radiographic hip OA in the group of forty-eight dogs increased in a linear fashion over the 14·5-year period of feeding and data collection, with significant differences between the 2 groups over time: •

At 2 years of age, 42% of CF dogs had radiographic evidence of hip osteoarthritis (OA), compared to only 4% of DR dogs

•

At 5 years of age, 52% of CF dogs had radiographic evidence of OA versus only 13% of DR dogs

Favourable modulation of immune capacityin response to diet restriction4,5 Immunological tests were conducted over the ages of 4 to 11 years to study the impact of diet restriction on numerous immune parameters. Compared to CF dogs, the DR group showed some significant differences:

Fig. 2 Number of dogs with radiographic lesions of osteo-arthritis in various joints at 8 years of age.

•

•

At 8 years of age, 77% of CF dogs had osteoarthritis in two or more joints compared to only 10% of DR dogs (figure 2) By the end of the study, 83% of CF dogs had developed radiographic evidence of hip OA compared to 50% of the DR dogs that had a longer

Diet restriction pathways identified by metabonomics Metabonomics: subtle metabolic pathways identification methodology Nestlé Purina, in collaboration with the Department of Biomolecular Medicine of the Imperial College of London, has thoroughly analysed information from biofluids collected non-invasively on dogs during the longevity study. The technique used, called metabonomics, belongs to the

25

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signals arising from hundreds of endogenous molecules representing many biochemical pathways from different organs •

•

The complexity of the spectra is simplified by using data reduction to access the latent biochemical information present in the spectra Metabonomics involves the use of multivariate statistical analysis on repeated measures (principal component analysis [PCA] and orthogonal signal correction projection to latent structure discriminant analysis [O-PLS-DA]) (figure 3)

Using metabonomics technology allows detection of subtle metabolic changes, beyond the clinical observations that are noted using conventional metabolic techniques.

This technique can be regarded as a dynamic and full body systems approach, reflecting the attempt of the cells to maintain homeostasis in the face of a nutritional change.

Metabolic effects of ageing: gut microflora stabilisation at adulthood and metabolic protein shifts at 9 years10 H NMR-based metabonomics strategy was used to monitor urinary metabolic profiles throughout the lifetimes of CF and DR dogs. Urinary metabolic trajectories were constructed for each dog. Metabolic variation was found to be both influenced by age and diet restriction.

from the degradation of dietary choline by the gut microbiota, were also observed at that age10 These results could be linked to the establishment of a stable microflora at adulthood11 Metabolic shift at 9 years of age10 As also observed by the DEXA analysis, protein metabolism change progressively with age in parallel to muscle performance and lean body mass quantity: •

Creatinine was the metabolite that exerted the most marked variation on the overall metabolic change with age

•

Urinary excretion of creatinine increased with age, reaching a maximum between ages 5 and 9 years and declining thereafter (figure 4)

•

The decline in creatinine excretion with advancing age was most likely associated with progressive changes in muscle performance and lean mass.

Metabolic effects of diet restriction10 •

1

Fig. 3 : Metabonomics analysis of biofluids by 1H-NMR and statistical classification

area of functional genomics.

•

Metabonomics technique can be carried out using multiple biofluids or tissue samples.

The biological samples are analysed using either MS (mass spectrometry) or 1 H-NMR (1H-Nuclear Magnetic Resonance) spectroscopy

• 1H-NMR is used for most metabonomics studies and is particularly adapted to samples that require little to no preparation, such as urine. 1H-NMR spectra of biofluids contain thousands of

Reduced energy expenditure, with a shift in protein, carbohydrate and fatty acid pathways10 (figure 5)

A systematic and dynamic change of energy-associated metabolites for the diet restricted dogs was observed:

Gut microflora stabilisation at 1.5 years of age10

•

Decrease in urine concentration of creatine

Gut microflora can modulate urine concentrations of hippurate and other aromatic metabolic entities11.

Their variation likely indicates timerelated changes in the activities or population of the gut microflora.

•

Decrease in urine concentration of 1methylnicotinamidemetabolised from nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP)

•

•

Decrease in urine concentration of lactate (end-product of glycolysis)

•

Decrease in urine concentration of acetate (from fatty acid beta-oxidation)

•

A considerable increase in urinary hippurate and 3-HPPA(3-(hydroxyphenyl) propionic acid) was detected in dogs at 1.5 years Changes in urinary levels of aliphatic amines, which result

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A

A

0

2

-2

1

-4

3-HPPA

-6

hippurate

-5

8.5

8

7.5

7

0.8

mixed N-acetyl glycoproteins DMA

0.6 0.4

0 1 2

creatinine 4.5

4

un

3.5

DMG 3

a-keto-butyrate 2.5

2

1.5

1

0.2 0

Chemical shift (opm)

diet-restricted

Control

References:

100 80

1. Lawler DF, Larson BT, Ballam JM, Smith GK, Biery DN, Evans RH, Greeley EH, SegreM, Stowe HD, Kealy RD (2008) Diet restriction and ageing in the dog: major observations over two decades. Br J Nutr. 99(4):793-805.

32 weeks

1-2 years

60

component 2

3

Correlation (r 2 )

O-PLS-DA coefficients (a.u)

13 weeks of age 2

40

13 weeks

20 0

18 weeks

5-9 years

-20

- 40 - 60

4

B

-80 3

hippurate 3-HPPA

creatinine

0.5 alanine

1

2

0

0 2 6.5

creatinine taunne

2

8.5

8

acetate lactate DMA succinate N-acetyl glycoproteins 3 2.5 2 1.5 1

1 lactate

un 7.5

7

2

4.5

4

3.5

0.4 0.3 0.2 0.1 0

B

citrate DMG succinate lactate TMA alanine

0.5 0.4 0.3

0 a-keto-butyrate

1 -2 8.5

8

7.5

7

mixed N-acetyl glycoproteins 4.5

4

3.5

3

2.5

2

1.5

1

0.2 0.1 0

component 2

un

Correlation (r 2 )

O-PLS-DA coefficients (a.u)

creatinine

120

32 weeks

1-2 years

40 20 0

-20

- 40

5-9 years

- 60

over 10 years

- 80 -80

50

-40

-30

Fig. 4 Coefficient plot obtained from O-PLS-DA of 1H NMR Spectra of urineobtained from dogs at ages 13 weeks (A), 1.5 years (B), and 9 years (C)

In the diet restricted group, a lengthy and dynamic increase in urine concentrations of aromatic metabolites was strongly associated with the gut microbiota, such as: •

Hippurate

•

PAG ((phenylacetyl)glycine)

•

4-HPPA (4-(hydroxyphenyl) propionic acid)

This could suggest a role of the gut flora on the adaptation on the host to diet restriction.

Diet restriction and maintaining lean body condition from early puppyhood throughout life in the canine species has been shown to have a significant impact on lifespan (up to 2 years of additional life for the dogs in this study). The clinical observations of Nestlé Purina researchers also include significant changes in body weight, body

-20

-10

0

10

20

component 1

Chemical shift (opm)

Shift in gut microflora metabolism

170

Control

80

9 years of age 1

70

diet-restricted

60

2

20

100

Chemical shift (opm)

C

30

component 1

Correlation (r 2 )

O-PLS-DA coefficients (a.u)

0

over 10 years

- 80

1.5 years of age

Fig. 5 Cross-validated scores mean trajectory derived from O-PLS-DA of 1H NMR spectra of dog’s urine normalised on the sum of the spectrum indicating metabolic changes associated with ageing and dietary restriction. (B) is an expansion of (A).

composition, insulin-glucose metabolism, energy metabolism, immunological modulation and chronic disease (such as osteoarthritis) prevalence and severity.

These findings are reflecting the numerous metabolic processes influenced by the cellular adaptation to the nutritional challenge, but underlying molecular mechanisms that are not yet fully understood.

Metabolic shifts may be important components of the diet restriction longevity effect. Metabonomics technology, using 1H-NMR-based urine metabolite dynamics, reflected diet restriction-related differences.

The role of the microbiota in diet restriction longevity and health improvement represents a completely new field of exploration for the future.

2. Kealy RD, Lawler DF, Ballam JM, Mantz SL, Biery DN, Greeley EH, Lust G, Segre M, Smith GK, Stowe HD.(2002) Effects of diet restriction on life span and agerelated changes in dogs. J Am Vet Med Assoc 220(9):1315-1320.

3. Lawler DF, Evans RH, Larson BT, Spitznagel EL, Ellersieck MR, Kealy RD. (2005) Influence of lifetime food restriction on causes, time, and predictors of death in dogs. J Am Vet Med Assoc 226(2):225-231.

4. Greeley EH, Spitznagel E, Lawler DF, Kealy RD, Segre M (2006) Modulation of canine immunosenescence by life-long caloric restriction. Vet ImmunolImmunopathol.

111(3-4):287-99.

5. Greeley EH, Kealy RD, Ballam JM, Lawler DF, Segre M. (1996) The influence of age on the canine immune system. Vet Immunol Immunopathol 55:1-10.

6. Szabo SD, Biery DN, Lawler DF, Shofer FS, Powers MY, Kealy RD, Smith GK. (2007) Evaluation of a circumferential femoral head osteophyte as an early indicator of osteoarthritis characteristic of canine hip dysplasia in dogs. J Am Vet Med Assoc 231(6):889-92.

7. Smith GK, Paster ER, Powers MY, Lawler DF, Biery DN, Shofer FS, McKelvie PJ, Kealy RD (2006) Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc 229(5):690-3.

8. Kealy RD, Lawler DF, Ballam JM, Lust G, Biery DN, Smith GK, Mantz SL. (2000) Evaluation of the effect of limited food consumption on radiographic evidence of osteoarthritis in dogs. J Am Vet Med Assoc 217(11):1678-1680, 2000.

9.Kealy RD, Lawler DF, Ballam JM, Lust G, Smith GK, Biery DN, Olsson S-E. (1997) Five-year longitudinal study on limited food consumption and development of osteoarthritis in coxofemoral joints of dogs. J Am Vet Med Assoc 210:222-225.

10. Wang Y, Lawler D, Larson B, Ramadan Z, Kochhar S, Holmes E, Nicholson JKJ (2007) Metabonomic investigations of aging and caloric restriction in a life-long dog study.

Proteome Res. 6(5):1846-54.

11. Nicholls, A. W., Mortishire-Smith, R. J., and Nicholson, J. K. (2003). NMR spectroscopicbased metabonomic studies of urinary metabolite variation in acclimatizing germfree rats. Chem. Res. Toxicol. 16, 1395–1404.

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EVERYONE CAN BENEFIT BY WORKING IN CLOSER CO-OPERATION Pat Crawford for the Society of Master Saddlers (SMS)

It is estimated that hundreds of thousands of horses had to be destroyed in the First World War – not as a result of enemy action but because their backs were so sore the animals were beyond treatment.

Ill fitting and badly looked after saddlery played a part but the major contributor was probably poor riding exacerbated by long hours in the saddle. So disastrous was the situation that, at one time, the loss of a horse was said to be more significant to the war effort than the loss of a trooper.

Problems continue today - albeit numbers and degree of injury are less. The main improvement relates to the fact that the majority of horse owners are aware of the importance of having their saddle professionally fitted and the need

for follow-up fitting checks.

Researching and analysing the causes of sore backs and the knock-on effects in relation to behaviour, performance, longevity, et cetera is probably a worthy PhD subject. More often than not it is simplistically assumed that the saddle is the offending article whereas diagnosing the actual problem can be immensely complicated and time consuming – and might well involve the services of a trainer, an equine physiotherapist, a saddle fitter - and other specialists.

The seat of the problem can often trigger off a series of other problems - thus ‘chicken and egg’ and ‘looking for a needle in a haystack’ are the phrases that spring

to mind. Identifying and rectifying the root cause - and dealing with the consequences - can be costly in both time and money – and may well result in the horse being off work for a considerable period.

The sort of complex situations that can arise might involve a saddle that provided an excellent fit eighteen months’ ago but doesn’t fit now – and has been pinching and creating a number of pressure points for several months. The rider didn’t recognise the degree to which the horse had changed shape and is only alerted to a ‘problem’ when – over a period of several months - the animal’s behaviour changes.

Previously willing and cooperative, he is becoming increasingly irritable and nappy, is difficult to saddle up and attempts to lie down when the

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required to provide a comprehensive service that protects the welfare of the horse…. the comfort of the rider….is conducive to the production of optimum performance…. and embraces all safety considerations.

Attendance of a Qualified Fitters’ Course - and assessment for qualified status - are exclusive to SMS members but the Introductory Course in Saddle Fitting is open to equine vets and physiotherapists, trainers and instructors and other professionals within the equestrian industry. (Information can be obtained on the website: www. mastersaddlers.co.uk or telephone 01449 711642.) rider is in the process of mounting.

The horse may need veterinary attention and will certainly be off work whilst his back recovers. After the saddle is modified – or a new one fitted – it may take months of patient handling and schooling to restore the animal’s confidence.

Another situation SMS fitters come across regularly relates to rider position problems. A ‘crooked’ rider – one who sits lop-sided – will cause the saddle to relocate in the direction of the greater weight and this in turn will influence the horse’s way of going. Over a period of time the horse will develop noticeably asymmetric musculature. This will produce further knock-on effects and it may be difficult to determine the root cause of the problem.

The Society of Master Saddlers has carried out sterling work in relation to saddle production and saddle fitting. When the saddle fitting qualification was instituted some fifteen years ago, there was no noncommercially linked assessment available anywhere in the world and that remains the case today.

Candidates who wish to take the Saddle Fitting Course and Assessment must have a minimum of three years’ saddle fitting experience and attendance of an Introductory Course is also mandatory. The assessment covers horse-handling and includes the

ability to deal with young, nervous or ill-mannered animals.

Candidates must be able to provide full descriptions of horses including breeding or type, colour, markings and age. They are also required to carry out back examinations including identifying asymmetrical musculature, bruising, soreness, et cetera. A saddle fitter is not a vet but it is important for him – or her – to recognise the existence of symptoms that indicate a problem that might adversely influence the efficacy of the saddle-fit. By the same token, candidates must also recognise unlevel steps, lameness and other gait malfunctions that might have an impact on the fit of the saddle. (There will be times when the fitter wishes to delay the fitting pending veterinary advice.)

The actual fitting processes are, of course, central to the structure of the assessment and the most crucially important part. As well as selecting and fitting new saddles, the candidate must also be able to offer advice about second-hand saddles - their condition, viability in regard to any repairs and refurbishment needed and their suitability for the horse concerned. The assessment also includes other important aspects such as record-keeping, advising the client about follow-up fitting calls, et cetera.

Go back twenty years or so and the types of saddles then on the market were much more limited. Today there are specialist saddles available for ever type of discipline, many of which incorporate innovative design features. Thus the total range of saddles is now massive and the saddle fitter’s knowledge must necessarily embrace this factor – and keep up with all the latest innovations too!

In recent times saddle fitters have collaborated more and more with equine vets and physiotherapists and other professionals within the industry. Holism is essential to progress - and the SMS welcomes greater involvement with professional bodies such as ACPAT. It is by working together - being more aware – sharing ideals – that we can develop comprehensive understanding and so make the strides forward that will benefit all horses and their riders.

In other words, the saddle fitter is

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DIARY OF EVENTS 27th July – 12th August 2012

The Olympics, London

15th – 18th August 2012

The International Symposium on Veterinary Rehabilitation and Physical Therapy, Austria

29th August – 9th September 2012

The Para Olympics, London

12th – 15th September 2012

BEVA, Birmingham

10th – 11th November 2012

Your Horse Live, Stoneleigh Park, Warwickshire

15th – 16th November 2012

London Vet Show, Olympia, London

23rd – 24th February 2013

ACPAT Seminar, Dunchurch Park Conference Centre, Rugby

For Further details please see www.acpat.org

COURSE REVIEWS Splinting Course (November 2011) Ilaria Borghese International speaker Ilaria Borghese came over from the United States to spend four days (two, two day courses) lecturing to ACPAT members who had a special interest in preformed and custom made splints for the small animal.

This excellent course included an introduction to products that are currently available on the US and UK market, which may assist in the surgical and conservative management of both neurological and orthopaedic conditions. We were educated on the benefits of preformed and custom made

splints for the appropriate cases and the safe use of them. Delegates were then introduced to different splinting materials, thermoplastics and their properties and splinting tools required in order for us to produce a custom made splint for different cases.

With this knowledge now at our fingertips, this practical course allowed us to fabricate a thermoplastic wrist splint to each other, enabling us to experience the feel of wearing such a rigid structure, similar to what our

patient would be subjected to, for a couple of hours. The course also taught us how to construct neoprene and thermoplastic splints for the canine carpus and tarsus. I can highly recommend this course as an introduction to canine and feline splinting, taking away some early skills for the fabrication of neoprene and static thermoplastic carpal and tarsal splints.

Diane Messum HPC MCSP BSc(Hons) MSc ACPAT Cat A

BOOK REVIEWS Dogs in Motion M. S. Fischer and K. E. Lilje This beautifully presented book explores canine locomotion in a scientific yet readable manner. It has excellent pictures of canine anatomy including the skeleton and muscles during locomotion. The information was gathered following one of the largest studies of canine locomotion involving over 300 dogs and 32 different breeds know as the Jena study.

The first part of the book focuses on the evolution of dogs from wolves and how man’s interference with breeding lead to the huge variety of dogs we see today. It then goes on to explain the experimental design of their study including X ray videography and high speed movement analysis. The gaits are then explored from a kinetic

and kinematic perspective. There is further analysis of the biomechanics of dogs including figures on the load distribution of joints. It then presents the anatomical proportions of all breeds within the study. The motion sequence of dogs is shown in a variety of ways highlighting the range of movement each joint goes through. The muscles are well presented but do not expect a list

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of origins and insertions. There is a good explanation of the muscle physiology and it explains why they will go on all day: don’t try to tire out that Cocker Spaniel, it will win!

The book explores in detail the role of the main muscle groups and how they interact together to produce locomotion.

At the end of the book there is a break down of each breed

used with in the Jena study, this includes the proportions and gait parameters. They used a good selection of dogs such as the Dachshund, French Bulldog, Bedlington Terrier, Golden Retriever, Mastiff, Whippet and Welsh Corgi to name but a few.

shortage of canine anatomy books this is one worth having.

Polly Hutson MCSP HPC MSc BSc(Hons) ACPAT A

Accompanying the book is a DVD which features 400 movies, X-ray movies and 3D animations. With a

ARTICLES of Interest 2011-12 Dear All, Here are some journal titles that may be of interest to you from the Equine Veterinary Journal and the Journal of Small Animal Practice.

All these articles are available online via www.onlinelibrary.wiley. com to all ACPAT members using the ACPAT Wiley username and password. If you need these details or have any questions regarding accessing these journals then please feel free to email me at courses@acpat.org.uk Best wishes Sarah Sandford (nee Dalton) ACPAT Course Organiser

Vallance, SA., et al. (2012) Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot.

Part 2: Lesion identification. Equine Vet J. 44, 149-156 Milner PI., et al. (2012) Short-term temporal alterations in magnetic resonance signal occur in primary lesions identified in the deep digital flexor tendon of the equine digit. Equine Vet J. 44, 157-162 Nagy, A. and Dyson, S. (2012) Magnetic resonance imaging findings in the carpus and proximal metacarpal region of 50 lame horses. Equine Vet J. 44, 163-168 Powell, SE. (2012) Low-field standing magnetic resonance imaging findings of the metacarpo/metatarsophalangeal joint of racing Thoroughbreds with lameness localised to the region:A retrospective study of 131 horses.

Equine Vet J. 44, 169-177 Also check

The Equine Veterinary Journal

Equine Veterinary Journal (2010) Proceedings of the 8th International Conference on Equine Exercise Physiology. 42(8) 1-702

May 2012 Volume 44 Issue 3 Biggi, M. and Dyson, S. (2012) Distal border fragments and shape of the navicular bone: Radiological evaluation in lame horses and horses free from lameness. Equine Vet J. 44, 325–331 Lykkjen, S., Roed, KH. & Dolvik, NI. (2012) Osteochondrosis and osteochondral fragments in Standardbred trotters: Prevalence and relationships. Equine Vet J. 44, 332–338 Smith, MR. and Wright IM. (2012) Endoscopic evaluation of the navicular bursa: Observations, treatment and outcome in 92 cases with identified pathology. Equine Vet J. 44, 339–345 Dyson, S. and Murray, R. (2012) Management of hindlimb proximal suspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003–2008). Equine Vet J. 44, 361-367 Clegg, PD. (2012) Musculoskeletal disease and injury, now and in the future. Part 2: Tendon and ligament injuries. Equine Vet J. 44, 371-375 March 2012 Volume 44 Issue 2 Wright, IM. and Minshall, GJ. (2012) Injuries of the calcaneal insertions of the superficial digital flexor tendon in 19 horses. Equine Vet J. 44, 136-142 Owen, KR., et al. (2012) Identification of risk factors for traumatic injury in the general horse population of north-west England, Midlands and north Wales. Equine Vet J. 44, 143-148

Journal Small Animal Practice Adams, P., et al (2011) ‘Influence of signalment on developing cranial cruciate rupture in dogs in the UK’ JSAP 52(7) 347-352 Andersen, A., (2011) ‘Treatment of hip dysplasia’ JSAP 52(4) 182-187 Ridge, P.A., (2011) ‘A retrospective study of the rate of postoperative septic arthritis following 353 elective arthroscopies’ JSAP 52(4) 200-202 Hayes, G.M., (2010) ‘Risk factors for medial meniscal injury in association with cranial cruciate ligament rupture’ JSAP 51(12) 630-634 Guilliard, M.J., (2010) ‘Third tarsal bone fractures in the greyhound’ JSAP 51(12) 635-641 Fischer, A., (2010) ‘Static and dynamic ultrasonography for the early diagnosis of canine hip dysplasia’ JSAP 51(11) 582-588 Millard, R.P., et al (2010) ‘Kinematic analysis of the pelvic limbs of healthy dogs during stair and decline slope walking’ 51(8) 419-422 May 2012 Volume 53 Issue 5 Pratesi, I., et al. (2012) Toggle rod stabilisation of coxofemoral luxation in 14 cats. J Small Animal Practice. 53, 260-266 Guthrie, JW., et al. (2012) Effect of signalment on the presentation of canine patients suffering from cranial cruciate ligament disease. J Small

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Animal Practice. 53, 273-277

histopathological investigation into the disease(s) involved. J Small Animal Practice. 52, 665

April 2012 Volume 53 Issue 4 November 2011 Volume 52 Issue 11 Motta, L. and Skerritt, GC. (2012) Syringosubarachnoid shunt as a management for syringohydromyelia in dogs. J Small Animal Practice. 53, 205-212

Scott, M., et al. (2012) Statistics: making sense of what we see. J Small Animal Practice. 52, 560–565 October 2011 Volume 52 Issue 10

February 2012 Volume 53 Issue 2 Beltran, E., et al. (2012) Clinical and magnetic resonance imaging features of canine compressive cervical myelopathy with suspected hydrated nucleus pulposus extrusion. J Small Animal Practice. 53, 101-107

Comhaire, FH. and Schoonjans, FA. (2012) Canine hip dyslasia: the significance of the Norberg angle for healthy breeding. J Small Animal Practice. 52, 536–542

January 2012 Volume 53 Issue 1

Vanhaesebrouck, AE., et al. (2012) Neuromyotonia in a dachshund with clinical and electrophysiological signs of spinocerebellar ataxia. J Small Animal Practice. 52, 547-550

Venzin, C., et al. (2012) Loss of implant-bone interface following distal radial locking-plate endoprosthesis limb-sparing surgery in a dog. J Small Animal Practice. 53, 57-62

September 2011 Volume 52 Issue 9

December 2011 Volume 52 Issue 12

Yeates, JW., et al. (2012) Promoting discussions and decisions about dogs’ quality-of-life. J Small Animal Practice. 52, 459-463

German, AJ. (2012) Canine obesity – weighing on the mind of the owner?

J Small Animal Practice. 52, 619-620

Yeates, JW and Main, DCJ. (2012) Veterinary surgeons’ opinions on dog welfare issues. J Small Animal Practice. 52, 464-468

Jordan, C., et al. (2012) Femoral head and/or neck disease in cats: a

RECENT NEWS Protection of Title 2012 The Protection of Title subcommittee has been set up to investigate potential routes to gaining protection of title for Chartered Physiotherapists working with animals. All work done by the subcommittee is closely monitored by the ACPAT committee.

Current situation: The title ‘Physiotherapist’ is protected by the Health Professions Council (HPC). However, the HPC states on their website that ‘Prefixes such as ‘animal’, ‘equine’, ‘veterinary’ or ‘industrial’ show there is no intention to deceive because the prefix clearly indicates that the person concerned does not treat human beings.

The Veterinary Surgery (Exemptions) Order states: 1.

The Veterinary Surgery (Exemptions) Order 1962 allows for the treatment of animals by ‘physiotherapy’, provided that the animal has first been seen by a veterinary surgeon who has diagnosed the condition and

decided that it should be treated by physiotherapy under his/her direction.

2. ‘Physiotherapy’ is interpreted as including all kinds of manipulative therapy. It therefore includes osteopathy and chiropractic but would not, for example, include acupuncture or aromatherapy.

This lack of protection of title has led to the emergence of courses qualifying students with no prior physiotherapy knowledge as ‘Animal Physiotherapists’ and ‘Veterinary Physiotherapists’ (including an MSc in Veterinary Physiotherapy).

In fact, no qualification whatsoever is required for a person to market themselves with one of these titles!

What are we doing about it?

The Protection of Title subcommittee is investigating various avenues, including through the HPC, RCVS, and Government, with the support of the CSP and the ACPAT committee.

They are developing contacts within organisations including the British Equine Veterinary Association (BEVA), the British Small Animal Veterinary Association (BSAVA),

British Horse Society, Kennel Club, Cats Protection League, RSPCA, World Horse Welfare, the Scottish and Welsh Assembly, the Veterinary Nurse Council (who suffer from the same lack of protection of title) the General Osteopathic Council and the General Chiropractic Council (both of which have protected titles, whether or not an animal related word is placed in front of them). In December 2011 Frontline printed a news story relating to the problem of lack of protection of title for physiotherapists working with animals.

What can you do to help?

Raise public awareness of the issue amongst your friends, colleagues and clients. At the moment, the only protection of title that ACPAT members have is of the title ‘Chartered’, so if you are a member of ACPAT then be careful to make use of this in any promotional material. If you know someone looking for a physiotherapist to assess and treat their animal, raise awareness of this issue to help them make an informed decision.

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SEMINAR 2012 PHOTOS

New ACPAT Category A Members

Wedding and Baby News Congratulations to Sarah Sandford (nee Dalton) who gave birth to a gorgeous baby boy Joseph Harry Sandford on the 5th June 2012.

Congratulations to the following RVC MSc/PGDip Veterinary Physiotherapy students who have upgraded to Category A membership in 2012:

Congratulations to Helen Mathie who gave birth to a beautiful baby girl Natalia Felicity on the 29th May 2012

Kate Ashdown, James Beacroft, Sarah Beale Paula Drury, Charlotte Harris, Gillian Hayes Tamsyn Lafferty, Alice Love, Juliet Oâ&#x20AC;&#x2122;Brien Helen Robartes, Kim Sheader, Michaela Smith Laura Spalding, Catherine V Watts

In addition, I, Di Messum also gave birth to a baby girl, Eleanor Rose, on the 28th May 2012. We are all producing the next generation of ACPAT members!

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10% discount and free UK delivery for ACPAT members Physical Therapy and Massage for the Dog In this book the authors are concerned with the prevention, management and treatment of movement and allied disorders. It encompasses detailed assessments, treatment programmes that involve hands-on therapy along with dynamic remedial and strengthening techniques using exercise plans. Topics covered include canine anatomy and physiology, movement and muscles; exercise; preparation for sports performance; rehabilitation techniques; massage and physical therapy; and common relevant pathologies affecting dogs.

ISBN: 978-1-84076-144-3 Price: £24.95 £22.45

Physical Therapy and Massage for the Horse second edition This classic bestseller is now reissued in softcover, at a greatly reduced price. The authors provide a unique blend of basic biomechanics and practical physical therapeutic techniques, to relieve pain and improve performance, particularly in the sporting horse.

ISBN: 978-1-84076-161-0 Price: £19.95 £17.95

Anatomy of the Dog, fifth edition ISBN: 978-3-89993-018-4 Price: £86.00 £77.40 Anatomy of the Horse, fifth edition ISBN: 978-3-89993-044-3 Price: £82.00 £73.80 Veterinary Anatomy of Domestic Mammals, fourth edition ISBN: 978-3-79452-677-2 Price: £249.00 £224.10 Small Animal Orthopaedics - Self-Assessment Colour Review ISBN: 978-1-87454-582-8 Price: £24.95 £22.45 The Equine Distal Limb ISBN: 978-1-84076-001-9 Price: £135.00 £121.50

order online at www.mansonpublishing.com using discount code: ACPATMANSON Orders can also be placed by telephone: +44 (0)1752 202 301

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WRITING FOR FOUR FRONT THE OFFICIAL MAGAZINE OF THE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS IN ANIMAL THERAPY Guidelines and Information for Authors The Editor would like to encourage ACPAT members to get involved in the magazine. If you are doing interesting clinical work, have a philosophical viewpoint that you would like to express, would like to share some research findings, have read a relevant book, article or attended an interesting course; please write something for the ACPAT magazine.

The aims of the magazine are to inform members about clinical, research and business developments that affect physiotherapists working with animals. It also provides a channel of communication between ACPAT members by informing and debating all aspects of animal physiotherapy.

We invite you to present material under the following sections: Editorial Product Reviews Literature Reviews Business Related topics Clinical Articles/Case reports Letters to the Editor Research Articles Useful addresses Conference / Course Reviews Small Adverts Product News Book Reviews How to contact us If you have an article that you would like to submit for publication or you would like to discuss the outline of an article that you would like to write, please do not hesitate to contact ACPAT secretary who will pass on the information to the Journal Officer.

Post: M. Sharon Morgan Pembroke House Middle Lane Shotteswell OX17 1JQ Email: secretary@acpat.org

(ideally in Microsoft Word) by attaching the file to an e-mail or on a disk, along with any original photographs to the editor.

We can accept articles up to 3,000 words and encourage the use of tables, illustrations and photographs. If an article is longer please discuss with the editor.

There is no need to spend time adjusting fonts, columns etc, as we will adjust these to match the current publishing style.

Where appropriate, articles must be supported by a reference list using the Harvard system. In the text quote the authors surname and year of publication.

In your reference list please include the full reference, to include authors name, initials, year of publication, full title of the paper, name of the journal, volume number and the first and last page numbers.

Any identifiable photographs must be accompanied by written permission from the owner of the animal, otherwise the image will be obscured, so that recognition is not possible.

Please supply your full name, address, telephone number and e-mail address that you would like to be published with your article.

Format and structure of manuscripts Manuscripts should be headed with the full title of up to 15 words, which should describe accurately the subject matter.

Authors should avoid including within the text: the name of the institution at which the work was performed, initials of the authors; and must remove institution names from illustrations in order to maintain anonymity for the review process.

Title Page

Submitting an article Please send all text in electronic form

A title page is needed for all manuscript types, it must contain the title of the

paper, names and qualifications of all authors, affiliations and full mailing address including e-mail addresses, and contact telephone number of corresponding author. No author details are to be submitted in the manuscript. In addition details of any acknowledgements should be given on the title page.

Original Papers/Research Articles Each paper should following sections:

comprise

the

Structured Summary - maximum of 200 words, divided, under separate headings, into Objectives, Methods, Results, Clinical Significance.

Keywords - maximum of five, for use as metadata for online searching.

Introduction - brief overview of the subject, statement of objectives and rationale.

Materials and Methods - clear description of experimental and statistical methods and procedures (in sufficient detail to allow others to reproduce the work).

Results - stated concisely, and in logical sequence, with tables or figures as appropriate.

Discussion - with emphasis on new and important implications of the results and how these relate to other studies.

Case Reports Full Case Report Reports of single or small numbers of cases will be considered for publication if the case(s) are particularly unusual or the report contributes materially to the literature. A case report should not exceed 1500 words and must comprise of: Summary (maximum 150 words); Keywords - for use as metadata for

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online searching Introduction - brief overview of the subject Case Histories - containing clinical detail Discussion - describing the importance of the report and its novel findings To be considered for publication in a single case report must:

reports is 1500 words. Review articles should not exceed 4000 words. All word limits include the summary but exclude the reference list. Authors should indicate the word count at the beginning of the manuscript.

Tables and Figures The minimum number of tables and figures necessary to clarify the text should be included and should contain only essential data.

- Exemplify best practice All papers and case reports are subject to peer review and publishing preference will be given to reports of original or retrospective studies.

Letters to The Editor Letters describing case reports or original material may be published and will be peer-reviewed prior to publication. Letters commenting on recently published papers will also be considered and the authors of the original paper will be invited to respond.

Presentation of Book, Product and Course Reviews Book, Product and course reviews should be between 500 – 700 words long. Book reviews should quote the title, publisher, ISBN number and price of the book.

Some points to consider before and during writing an article Try to produce a structured abstract and a list of key messages before you begin, this will help the article to be more focused and succinct and therefore more interesting for the reader.

Style of manuscripts Writing should conform to UK English, and acceptable English usage must be presented within the manuscript. Where abbreviations are used, the word or phrase must be given in full on the first occasion.

All Manuscripts must be double-spaced for the purpose of peer reviewing.

All manuscripts must be line numbered throughout for the purpose of peer reviewing. All units of measurement should be given in the metric system or in SI units. Temperatures should be in °C. Drugs should be referred to by Recommended International NonProprietary Name, followed by proprietary name and manufacturer in brackets when first mentioned, eg, fenbendazole (Panacur; Intervet).

Anatomical terminology should conform to the nomenclature published in the Nomina Anatomica Veterinaria (1983) 3rd edn. Eds R. E. Habel, J. Frewein and W. O. Sack. World Association of Veterinary Anatomists, Ithaca, New York.

Length The maximum length for research papers is 3000 words and for case

Try to make the article as concise as possible, think hard what needs to be in the article to get the message across.

Very few articles are longer than 2,000 words.

Try to ensure that references cited for tables and legends are done in sequence at the point where the table or figure is first mentioned in the text.

Finally check the final copy carefully.

Previous publication We do not have a strict policy on publishing material that has appeared elsewhere, but welcome authors to do so, especially where the subject is important to animal physiotherapists.

We may use material on the APCAT website, if you do not want us to publish information on the website, please explain this when you submit your work.

Terms and Conditions Material accepted for publication will be edited. All articles will be treated as though all authors have read and approved the manuscript. Each author should give his or her name as well as the address and current e-mail for correspondence. We now aim to publish the corresponding author’s e-mail address in every article.

Copyright and exclusive licence Many publishers traditionally asked authors to assign their copyright as this allows them to tackle copyright infringement, to republish and reproduce on a website.

We however require all authors for an irrevocable licence so that we can reproduce articles on our website without the need to seek further permission.

All articles submitted to the editor are therefore accepted on the basis that all authors of the material agree to ACPAT acquiring this irrevocable license upon the publication of the article in any medium owned or controlled by ACPAT. Corrections We try hard not to make mistakes, but errors, both by authors and editors can creep into the journal. We publish corrections when necessary. If you want to notify us about the need for a specific correction, please contact the editor.

Final note from the Editor The Editorial Board reserves the right to edit all material submitted.

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 of the Editor.

Four Front is an annual publication and aims to be published in the spring of each year.

We are looking forward to receiving articles from any member of ACPAT on any relevant topics that you wish to share with fellow members. The success of the magazine and its benefit to members is ultimately dependent on the collective contributions that we receive, thank you, the Editor.

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EXECUTIVE COMMITTEE MEMBERS 2012

Amy Barton Alison Bates Louise Carson Tracy Crook Fiona Dove Rachel Greetham Melanie Haines Victoria Henderson Polly Hutson Sonya Nightingale Diane Messum Hannah Price (Warne) Sarah Sandford (nee Dalton) Samantha Rodwell Stephanie Wilson

Education Officer CIG Sub Committee PR Officer Research Officer Protection of Title Sub Committee Co-Opted PR Seminar Organiser Vice Chairperson/ CIG Liaison Officer CPD Officer/ Diversity Officer/ Journal Sub Committee Chair Journal Editor/Regional Groups Co-Opted PR Course Organiser PR Website/IT Officer

ajbarton79@yahoo.co.uk bates842@btinternet.com louise.carson@yahoo.co.uk research@acpat.org

melvetphysio@yahoo.co.uk cig@acpat.org cpd@acpat.org chair@acpat.org journal@acpat.org regions@acpat.org courses@acpat.org sam@countryphysio.co.uk webmaster@acpat.org it@acpat.org

SECRETARY/TREASURER Sharon Morgan

Secretary

Andrea Walters

Treasurer

secretary@acpat.org secacpat@btinternet.com

M. Sharon Morgan Pembroke House Middle Lane Shotteswell OX17 1JQ secretary@acpat.org 40

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