ACPAT 2013 FourFront Journal

FRONT COVER

INSIDE FRONT COVER DO NOT PRINT

CONTENTS Editorial

Maruska Aylward and Stephanie Brighton MSc BSc (Hons) MCSP HCPC ACPAT A

Chairing ACPAT

Sonya Nightingale MCSP SRP Grad Dip Phys ACPAT Cat A

An Interview with ACPAT’s New Chairman

Stephanie Brighton MSc BSc (Hons) MCSP HCPC ACPAT A

Equine Veterinary Physiotherapy: What is the Evidence for its Application?

Jill P Stone BHSAI, ITEC Dip., HNC, PG Diploma

The Use of Hydrotherapy in the context of the management and treatment

of soft tissue injuries in the canine patient

Natalie Fizio MCSP HCPC ACPAT Cat A

Working the Games

Sonya Nightingale MCSP SRP Grad Dip Phys ACPAT Cat A

Muscle Tension from a Vets Perspective...

Kate Granshaw BVetMed (Hons) CertAVP (EM, ESOrth) MRCVS

First Aid for Horses Dr. Debra Archer BVMS PhD CertES DipECVS MRCVS FHEA Underwater Treadmill (UWT) Therapy in Dogs: Finding the Evidence to Create a Protocol for its Use. A Small-Scale Literature Review Laurie Edge-Hughes, BScPT, MAnSt(Animal Physio), CAFCI, CCRT A Physiotherapy Approach to Stifle Pathologies South Central ACPAT Regional Group Feeding the Canine Athlete Esther Rawlinson BVMS MRCVS,Veterinary Affairs Manager, Purina Canine Research Digest Kate Davy MCSP ACPAT Cat A Diary of events Course review Book reviews Recent Research Publications Useful tip Recent news Writing for Four Front

Front cover supplied by Kate Davy MCSP ACPAT Cat A, South West Animal Rehabilitation (physio@ swanimalrehab.co.uk) and Anna Thompson, Anna Thompson Photography (info@annathompson.co.uk)

Designed by Three Hats Design . threehatsdesign@gmail.com

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EDITORIAL Maruska Aylward and Stephanie Brighton

Maruska Aylward and Stephanie Brighton are delighted to present you with this fourth edition of Four Front.

This has certainly been a year of change and turn around with the stepping down of Sonya Nightingale and the stepping up of Louise Carson as chairman of ACPAT. We have also seen changes within our PR and course organisation teams and hope that you will all directly benefit from the changes and improvements that have been planned. We have further added a research digest section to our magazine which we can develop further next year should this section be well received. Thank you to all members that have contributed so far to our conference, PR events and magazine.

As new committee members we were excited, if not a little daunted, to take on our new roles as Journal and Newsletter editors. We were keen to maintain the high standard set by Di Messum and Polly Hutson before us and we will endeavour to develop the profile and content of the magazine moving forward.

Firstly, thank you to all of our authors for the time they have spent writing their articles, without your efforts we would have no magazine. We hope our readers will find the content both diverse and relevant and a worthy spend of your CPD time.

We continue to require your input as ACPAT members. The magazine still requires articles, case studies and literature reviews for next year. Please be encouraged to show other members your skills and knowledge. In this ever changing time, with the continuous growing threat of alternative veterinary physiotherapy qualification routes at large, we as ACPAT members now more than ever need to communicate and share knowledge and skills.

Whatever information you have to share, we are sure it will be interesting and a useful read. Please contact the editors should you have any material that you would like to publish.

We have continued to have our articles peer reviewed to help raise the overall profile of our profession and magazine. This takes a tremendous amount of time from our peer reviewers and we are incredibly lucky to have their input. We thank them for their time, expertise and patience.

As this is our first year collating the journal we appreciate that there may be some areas that you may feel require addressing. Please be encouraged to provide us with your thoughts, both negative and positive, either via a ‘letter to the editor’ or by emailing us at journal@acpat.org.

Thank you again Maruska Aylward and Stephanie Brighton

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CHAIRING ACPAT Sonya Nightingale MCSP SRP Grad Dip Phys ACPAT Cat A The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) started life 28 years ago because a group of Chartered Physiotherapists, led by Mary Bromiley MBE (who knows how much ACPAT influenced this award but we certainly nominated her), held a belief that animals could benefit from the skills of a physiotherapist just as much as humans. By 2008, when I joined committee, it had evolved into an organisation with 200+ members and provided them with ongoing training, support and a framework for regulation. It also required its practising members to have completed an approved upgrading route to practise animal physiotherapy.

However ACPAT was also facing considerable challenges. For a relatively small organisation its administrative workload and support systems had become a real burden, government cuts in HEI (higher educational institution) funding meant the closure of one of its upgrade routes and getting its ‘message’ out to the public and the veterinary profession was not working. Advances in social media and the rise of other courses offering ‘veterinary physiotherapy’ training, because of lack of protection of title, had become a real threat.

After only a few months on committee I was elected Chair in early 2009 and had no idea what I had stepped into! All I can say is that it was probably a good thing that I didn’t. At this stage we had already looked into strategies for major savings in our admin costs and had elected to use a ‘pay as you go’ secretarial service rather than continue employing someone. This had the effect of halving our admin bill overnight (we still benefit greatly from the superb service that we receive from Sharon Morgan), and this, probably more than anything

else, persuaded me that seemingly small changes could reap big rewards and it also freed up cash that we could use to really make some changes for the members.

Now for the fun part, what could we do to raise our profile and tackle some of our problems?

The first action here was to set up a PR team, ACPAT had always had a PR officer but working alone is a demoralising task, so we set up a PR team with very objective goals. To re vamp all the literature/ pamphlets, to design and create a trade stand that we could be proud of and to design and create the more portable banners which would complement the trade stand and allow our members to borrow an eye catching and branded item for more local events. This achieved, the next goal was to choose two major equine and two major canine events to attend on an annual basis. The proviso being that one of each was more professionally orientated and the other more orientated towards the public. Hence ACPAT currently exhibits at Crufts, the London Vet Show, BEVA and Your Horse Live. Once set up the PR Team has then reset its own goals each year and monitors its own tasks, from manning stands to writing articles etc working within the budget set by the executive committee. Taking these logistical decisions away from the executive committee allows PR to be more proactive and react faster to events.

One of ACPATs stated aims is to provide training and CPD support to its members, so seminar and course organisers worked hard together to organise more of these.

Again working as small teams is more fun and engaging than either being on your own or asking the whole committee to work on it at once. As everyone knows nothing gets decided by a large group of women, especially physios, there are too many opinions! More about the

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internet later but on line journal access has been a part of this teams achievement. The same approach was taken by the formation of a small magazine team who have completely revamped the look of the magazine, Four Front, made it peer reviewed, and turned it into a professional looking publication, software hasn’t always been helpful here but we live and learn! Engaging professional help was crucial but has paid off. The latest development is an electronic newsletter to enable faster communication of news in a less formal format but has also involved, for all concerned, a considerable learning curve in IT skills!

The website has been rebuilt twice in four years as the world wide web hurtles forwards and integrates more and more into our daily lives.

The way ACPAT communicates with its members has changed dramatically over the years and changes faster than we often realise, facebook and twitter certainly weren’t a major consideration four years ago. Our members and our clients and members of the public are also much more internet savvy and demand a professional looking website with access features that work! This is our shop window and is often a challenging and temperamental beast, don’t ever tell me or the website officer that computers are logical or that they always work as expected! However when your professional body, in the form of the CSP, actually compliments you on it the work becomes worthwhile.

Just as you think everything is beginning to run smoothly a curved ball comes to attack you.

The UWE upgrade course was just getting underway, and the first reports were good after much work during the set up phases with the validation process, when cuts in HEI funding caused the RVC to axe its veterinary physiotherapy

course. This was a huge blow.

Not only had the RVC trained a lot of our members, it had spearheaded the MSc standard of education and supported ACPAT in promoting ‘properly qualified’ veterinary physiotherapists. It also had enormous expertise which we would potentially lose completely.

Thankfully some of this expertise decamped to Liverpool and, while still working closely with ACPAT, they have set up the new upgrade route while also fostering more international relations with overseas students. I am grateful for their proactive approach but also for working with us to provide suitable training for our members.

In the middle of all this was the small matter of the Olympics, London 2012. Without some help from members outside the committee this could have been a nightmare, but they enabled me to hold an overseeing role, keeping closely involved but not doing a lot of the more time consuming tasks. This was also a huge PR

opportunity for ACPAT and the whole profession. Much has already been said on this topic but suffice it to say that this was the opportunity of a lifetime and I was so grateful to be involved. Volunteering has its rewards! However this kind of involvement also forges valuable professional links and triggers invitations to lecture and write articles, be interviewed and meet people, which is the kind of PR money cannot buy.

Among other projects over the last four years ACPAT has trademarked its logo, been involved in the set up of the International Animal physiotherapy group and its gaining of recognition by WCPT, participated in the organisational changes at the CSP with the setting up of the Networks, set up a Protection of title subcommittee and an awards structure to reward those members who deserve special recognition. This all takes place alongside a general background of dealing with complaints, questions and queries from all the members

and the general public. When I look back I cannot believe the amount that has been achieved by this fantastic team of workers.

For any Chair of any organisation building a good team and getting them to work with you, through good and bad times, is a challenge but a hugely rewarding one and, when it works as well as I think it has here, just goes to show that a lot of small actions can together make a massive difference.

For myself I will now divert more of my time to the considerable challenge of exploring the logistics of regulating all the musculoskeletal therapists out there, whatever their training, to ensure that scopes of practice are defined and adhered to for the good of the professions and the welfare of the animals. Chairing ACPAT has taught me that, if you take enough determined small steps, mountains can be climbed; just let’s hope there is enough oxygen at the top!

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An Interview with Louise Carson, ACPAT CHAIRMAN Stephanie Brighton MSc BSc MCSP HCPC ACPAT A A new ACPAT chairman has started her term in office and I caught up with Louise Carson to find out a bit more about her.

Louise qualified from Leeds with a human physiotherapy degree in 1998. She completed her junior rotations in West Yorkshire and in 2000 moved down to London for a senior II position at Chelsea & Westminster Hospital. In 2003 during the second year of her Veterinary Physiotherapy MSc at the Royal Veterinary College (RVC) Louise moved to the dark side and left the NHS to start work parttime in private practise in central London.

This meant that not every annual leave day was used to complete the “CARB” (as it was then) and a possibility of regaining some sanity as we can all remember battling with I’m sure. Ten years on Louise still works two days a week in the same job and finds it helps to instil a little fear of compliance in the city trader and solicitor clients when they discover that Louise treats animals the rest of the week!

Qualifying from the RVC with an MSc in 2004 Louise worked for Charlotte Baldwyn and gained lots of experience and a wide range of skills including navigational skills.

Louise said “I had 4 counties of A-Z’s until I finally gave in and bought a TomTom!”; another skill included adopting a firm mask of professionalism as when faced with a particularly memorable monologue before she’d barely got out of her car and been marched across a farm, “so, you’re comfortable around cattle? Jolly good. I’m sure you’ll have dealt with a number of bulls before.

How about the Aberdeen Angus?

This way...!”; and of course a huge amount of practical hands-on skills.

After 3 years Louise was finally defeated by the M1/M25 combo and she set up her own animal practise covering Herts, Beds, Bucks & South Northants, which she is pleased to say, is thriving. Louise was also lucky enough to be one of those selected to work at the Paralympics last year,

a huge career high.

A typical weekday 24 hours for Louise is to be up by 6am (guessing you can never take the commuter alarm clock out of the girl), check emails, walk Bruno (her one eyed black lab), head out to work for the first client and try to include some time in the diary for Bruno’s walks.

Her day with clients aims to finish around 7pm; she then returns any phone calls and emails and then rides which may either be a hack with Bruno or include a 20min hack before or after schooling (so that Bruno gets a decent leg stretch).

Once home she’ll tend to veg on the sofa with her husband and have dinner for an hour before answering any more emails. Her aim is for bed 10/10.30pm, what a party animal!!

Louise says “I have one golden rule which is that I won’t work weekends. Weekdays are too busy with no quality time for me, Andy, or the horses (Bruno tends to do ok on the deal!), so to preserve harmony and sanity that is set in stone.”

“..STAYING AT THE FOREFRONT OF IDEAS AND RESEARCH WITHIN ANIMAL PHYSIOTHERAPY” When Louise has more time and after riding her two horses and exercising Bruno she enjoys kicking back on the sofa with her husband, cooking & photography. She does work Bruno for her brother in the shooting season and competes with the horses. Louise says “I have a bucket list of things I want to do when I have more time”!’

Louise was then asked to answer a few questions specifically about ACPAT …

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Was ‘wanting to be ACPAT’s Chair’ on that Bucket list?

“Hmmm, not entirely sure!”

“With many of the longstanding committee members leaving as they finished their terms of office or were due to within six months, I didn’t want to see any loss in the momentum that Sonya and the others had achieved and I am keen to continue to push our profession forwards. I felt that ACPAT as an organisation had grown and really pushed forward over the preceding 4 years. Becoming much more widely recognised and regarded as the gold standard qualification for animal physiotherapists both in the UK & internationally. The other hope is to provide the membership with an increase in post graduate courses & training and we now have a bigger team on the committee working to that end.”

Where do you see ACPAT in the next 5 years?

“Continuing on the upward path that we’re on, increasing our membership, raising our profile further and staying at the forefront of ideas and research within animal physiotherapy. Who knows, maybe even a direct entry CSP recognised BSc in animal physiotherapy!”

If you had one wish for ACPAT what would it be?

To maintain our position as leaders in animal physiotherapy. I would also love more people to understand why the quality and amount of training that we do is so important. The techniques and exercises we use aren’t rocket science but the true skill of an ACPAT Physiotherapist is in our ability to clinically reason what to do when and why-or why not.

ACPAT & BEVA Members All Three Days £495 One Day £225

11th-14th September, Manchester, UK

Non Members All Three Days £685 One Day £315

What to expect......

The largest equine veterinary conference in Europe.

All of the sessions are open to Allied Professionals.

Musculoskeletal Sessions include:

An outstanding CPD programme crammed full of worldclass science, combining tried and trusted favourites, Lameness in Sports Horses (Thurs 12th) with the latest breakthroughs in equine medicine and n Dressage, Showjumping, Eventing and Endurance surgery.

Advances in Lameness Diagnosis (Sat 14th) High profile international speakers, delivering n Objective evaluation of lameness in the field using innovative, captivating lectures and panel based bodymounted inertial sensors discussions. n Flexion tests An eclectic programme suitable for veterinarians and Dorsal Spinous Process Disease (Fri 13th) allied professionals throughout all stages of their career. n Panel: How to diagnose and manage impinging dorsal spinous processes A large lively commercial exhibition offering the perfect Myopathies (Thurs 12th) chance to check out the latest products and services, and bag yourself a bargain. n Atypical myopathy: epidemiology and Legendary socials that guarantee fun and entertainment.

Manchester is a vibrant city that offers a truly diverse mix of culture, architecture, nightlife, food, shopping and much more.

aetiopathogenesis

n n

Diagnosis of myopathies

Managing acute myopathies Lameness Panel (Sat 14th) and much more.....

Discounted registration before the 5th August

i Full programme details and online registration is available at www.beva.org.uk or contact Tel: 01638 723 555 Email: 8clare.ascroft@beva.org.uk

EQUINE VETERINARY PHYSIOTHERAPY: WHAT IS THE EVIDENCE FOR ITS APPLICATION? Jill P Stone BHSAI, ITEC Dip., HNC, PGCert equinemechanics@hotmail.com

Submitted as part of the equine orthopaedics module of the University of Edinburgh MSc in Equine Science The role of the physiotherapist involves the assessment and treatment of a wide variety of musculo-skeletal problems with the aim of “restoring and maintaining mobility, function, independence and performance” (anon.1, 2012).

In equine practice physiotherapy techniques are applied to leisure and competition horses to help maximise physical performance and avoid injury, or to aid rehabilitation following injury/surgery. There is evidence that animal physiotherapy is developing on an international basis with 10 nations having official governing bodies forming the International Association of Physical Therapists, and with other nations undergoing a regulatory process (Edge-Hughes, 2008). In addition, team physiotherapists are commonplace at the Olympics and high level equestrian events, (McGowan et al, 2007).

In review articles, both Buchner et al (2006) and McGowan et al (2007) state that the practice of physiotherapy should be based on scientific data to include functional biomechanics, neuromotor control, and exercise physiology.

To achieve these scientific standards, practitioners undergo training for qualifications and in the UK the majority become Chartered Physiotherapists (CP’s) holding a degree in human physiotherapy and post-graduate training in animal therapy. Practitioners are governed by the Association of Chartered Physiotherapists in Animal Therapy (ACPAT) and are required to undergo continual professional development to keep abreast of scientific research.

However,

whilst the term ‘physiotherapist’ is protected (anon.2, 2012) that of ‘equine physiotherapist’ or similar prefix is not, and accordingly this term may encompass a wide variety of so called complementary/ alternative therapies. Varying levels of qualifications/scientific knowledge are required by such practitioners (Veenan, 2006) and many are not controlled by appropriate governing bodies, despite the fact that animal therapies are subject to legislation (The Veterinary Act, 1966) stating that veterinary permission must be obtained prior to treatment (Rodwell, 2009; Veenan, 2006).

Accordingly, it is possible that the practice of some physical therapies may well add credence to the insinuations included by the title of this essay in providing questionable monetary value to owners.

Figure 1. PYRAMID OF EVIDENCE (Vandeweerd et al, 2012)

Even for well-qualified, experienced practitioners, the title of this essay provokes the concept that any argument championing the practice of physiotherapy must contain ‘gold standard evidence’ for its efficacy. The rise of ‘evidencebased medicine’ (EBM) in human practice is well documented (Sackett et al, 1996) and promotes a combination of clinical expertise and best available external evidence

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from research to achieve diagnosis and select. This procedure is enhanced by medical databases - the Cochrane Institute and PEDro to give doctors/medical professionals quick access to current research (Elkins et al, 2012).

Figure 1 shows a pyramidal approach to selecting evidence from research. Each category is also recognised by letter as Type A, B, C, etc., running top to bottom.

A similar approach has been encouraged and accepted by the veterinary profession (Rossdale et al, 2003; Holmes and Ramey, 2007) as evidence-based veterinary medicine (EBVM) and in order to sustain the premise that physiotherapy should have a scientific basis, equine therapy is expected to meet similar standards of evidence.

However, the application of EBM in human physiotherapy practice, (Greenfield et al, 2006; Jones et al, 2006) is by no means without its problems and critics and a review of EBVM

by Vandeweerd et al, (2012) highlighted several obstacles in its application including lack of high quality research. Meta-analysis and Random Clinical Trials (RCTs) are rare in both equine medicine and equine therapy (Cohen, 2003) mainly due to lack of funding and in addition many research findings are based on small sample sizes which lack statistical power (Muir, 2003).

Other problems include difficulties gaining access to relevant research data bases. Such findings are also in accordance with views by Kastelic (2006).

Furthermore, while of EBM in human is considered valid, an argument that

the relevance physiotherapy there is also over reliance

on quantitative data may under value that provided by qualitative research which encompasses the needs of individuals (Greenfield et al, 2006; Jones et al, 2006). This point is also made with regard to veterinary medicine by Rossdale, especially in view of the diversity of equine breeds, size and environment (Rossdale et al, 2003), and Kastelic (2006), who advises EBVM should be based on multiple sources of information as do Mair and Cohen (2003).

Accordingly, it would seem acceptable not to reject the efficacy of physiotherapy treatment in horses on lack of Type A and B evidence alone. The design of the venn diagram (Figure 2) shown below is proposed by Holmes and Ramey (2007) to balance decision making in EBVM and is also relevant to the application of EBM for animal physiotherapy.

Figure 2 VENN DIAGRAM - DECISION MAKING IN EBVM (Holmes & Ramey, 2007).

A more detailed look into the various methods by which physiotherapy is applied together with current research helps to illustrate whether this balanced view of an evidence-based approach provides a fair assessment of its validity and efficacy. Common techniques used to provide pain relief and improve function include manual therapy, (joint and soft tissue mobilisation and manipulation, massage, myofascial and trigger point release), physical exercises, and the application of thermal therapy, hydrotherapy, and electrotherapy (laser, interferential,

ultrasound, magnetic, H-wave, electrical muscle stimulation).

Bauchner and Schildbeock (2006) reviewed the physiological effects on horses from the application of these key techniques and found few reliable studies on which to base their findings. However, they also state that this lack of scientific evidence does not necessarily infer that the therapy technique has no medical value and that lack of such evidence may be due to other circumstances i.e. lack of effective research parameters as well as the possibility that inefficacy of treatment exists. Porter (2008) and Wright and Sluka (2001) comment on the use of similar applications for treating horses, citing findings from human research as evidence for their useful application.

Work by McGowan et al (2007) puts forward the view that just looking into evidence of efficacy in the various different techniques is inappropriate - the aim of physiotherapy being to reach a functional diagnosis and treatment.

This requires observation of neurophysiological and pathophysiological impairment and the application of an appropriate combination of techniques to manage/restore function e.g. joint pathology may also cause compensatory musculoskeletal problems (Porter, 2005).

Accordingly, research into single techniques alone may not show a clinical benefit as this may only be achieved by the combination of applications and monitoring of their effect to suit individual cases.

Modern human research has focused more on a combination of neurosciences, biomechanics and kinematics, for example increasing neuromotor control and stability to control back and pelvic pain.

These findings have subsequently been applied by equine researchers (Degueurce et al, 2004; Goff et al, 2006; Denoix, 1999; Stubbs et al, 2006). McGowan et al (2007) conclude that there is further scope for equine research being aligned with research from both human and other quadrupeds. Recent research

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(Goff, 2009) expands this premise by providing details on manual therapies related to these areas and cites evidence from human research but does little to add to the required clinical trials for equine physiotherapy. Haussler et al (1999, 2003, 2007) and Gomez Alvarez et al (2008) have investigated the efficacy of manipulative therapy for equine back pain but findings appear to lack conviction (Ramey, 2008).

There is some evidence that recent research (Haussler et al, 2010; Hill and Crook, 2010) shows progress towards achieving evidence through randomised clinical trials but sample sizes are small. Research shows some evidence of positive effects from massage therapy, (Salter et al, 2011; Scott and Swenson, 2009), and passive and active stretching, to maximise range of movement and consequent performance (Hill and Crook, 2010; Riley and Van Dyke, 2012; Watson et al, 2001).

An interesting aspect of the above venn diagram is that of owner preference. Several writers (Edge-Hughes, 2008; Grant, 2003; Scott et al, 2009; Veenan, 2006) comment that there is a necessity for veterinary surgeons to utilise physical therapies due to interest from owners, so it is appropriate to consider what is driving this trend. Rising numbers of horse owners and interest in competitive equestrian sports and subsequent pathologies, may contribute, (EdgeHughes, 2008), and many equine insurance policies provide a level of cover for physiotherapy. Some early pathologies present as behavioural problems (Porter, 2008; Veenan, 2006) which cause distress to owners who may find benefit from the support of a physiotherapist helping to rehabilitate their horses back to training (Meredith et al, 2011). Many animals require specific exercises to complete their rehabilitation. Work by Stubbs et al (2011) found positive benefits with mobilisation programmes to improve dynamic stability and Clayton et al (2010) researched exercises to improve neck mobility with a positive outcome. Denoix and Pailloux (2001) designed a

sensory re-education pathway to improve proprioception following limb injuries.

Another possible benefit from physiotherapy is that of a protective role from therapists observing early signs of underlying pathology on routine check ups (Grant, 2003; Hesse and Verheven, 2010; Porter, 2009) and reporting this to trainers/veterinary surgeons. This is optimised when practitioners have good working relationships with veterinary surgeons as owners then benefit from a united approach but incidences of this are variable (Meredith et al, 2011).

The picture regarding the absolute justification for physiotherapy for horses is complex. Wright and Sluka (2001) conclude that it may take several decades before research can provide clear evidence for owners. Currently, it is yet to prove itself scientifically due to the absence of Type A and Type B research and this is also the case in human physiotherapy but there is recognition of this and a move towards better planning and reporting of research. In addition there are reasons for lack of research other than perceived lack of efficacy, although results from a survey of veterinary attitudes in Ireland related lack of evidence as the main reason for doubting its value and consequent lack of referral. There is strong interest from owners in having their horses treated which may be to do with perceived performance and welfare benefits and possibly by being supported through difficulties.

Well trained and effective physiotherapists may contribute by having a preventative role in recognising early signs of developing pathology and good working relationships with veterinary surgeons enhances this role.

Whether owners are getting ‘good value for money’ from physiotherapist treatment is difficult to quantify - it is likely some are at risk from less trained individuals practising ‘therapy’ but with insufficient training to carry out a full assessment and recognise

when veterinary intervention is required. However, it is up to veterinary practices to protect their clients by refusing ‘permission to treat’ if they are not confident in the qualifications and knowledge of therapists practising within their geographical area.

It maybe that the ‘marginal evidence’ of physiotherapist treatments provides only ‘marginal gains’ in terms of equine musculo-skeletal health but if these assist owners with the performance, training and safety of their horses this may be sufficient justification for its continued development.

References Anon. 1 (2012) Associated Chartered Physiotherapists in Animal Therapy -Home Page. (online) Available at: <http://www.acpat. org/> (Accessed: 1 December 2012).

Anon. 2 (2012) Associated Chartered Physiotherapists in Animal Therapy - Careers and Development, Protection of Title. (online) Available at: <http://www.acpat.org/ careers-and-development/protection-of-title> (Accessed: 4 December 2012).

Brennen, A., McKenzie, B.A., (2012). Is complementary and alternative medicine compatible with evidence-based medicine?

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Physiotherapy applied to the horse: a review.

Equine Veterinary Journal, 38 (6) pp 574-580.

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Cochrane, A.L., (1972). Effectiveness and Efficiency: Random Reflections on Health Services. London, Nuffield Provincial Hospitals Trust.

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Clayton, H.M., Kaiser, L.J., Lavagnino, M., Stubbs, N.C., (2010). Dynamic mobilisations in cervical flexion: Effects on intervertebral angulations. Equine Veterinary Journal 42 Suppl. 38, pp 688-694.

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

Denoix, J.M., (1999). Spinal biomechanics and functional anatomy. Veterinary Clinic North America: Equine Practice, 15, pp 27-60.

Denoix, J.M., Pailloux, J.P., (2001). Physical Therapy and Massage for the Horse. London, Manson Publishing Ltd. Edge-Hughes, L., (2008) International Trends in the Practice of Animal Physiotherapy & Rehabilitation. Congress of the Canadian Physiotherapy Association. (online) Available at: <http://www.PhysioSurvey of the Practice of Animal Physiotherapy Internationally.pdf>.(Accessed: 1 December 2012).

Elkins, M.R., Moseley, A.M., Sherrington, C., Herbert, R.D., Maher, C.G., (2012). Growth in the physiotherapy evidence database(PEDro) and use of the PEDro scale. British Journal of Sports Medicine. Federation Equestre International. Services at Olympics 2012. (online) Available at: <http://www.fei.org/ sites/default/files/file/EVENTS/GAMES/ PARALYMPIC_ GAMES/London/2012/ Veterinary/and/Farrier/Services/Guide.pdf>.

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Movement between the equine ilium and sacrum - in vivo and in vitro studies. Equine Veterinary Journal Suppl 36, pp 457-461.

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Gomez Alvarez, C.B., L’Ami, J.J., Moffatt, D., Back, W., Van Weeren, P.R., (2008). Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems. Equine Veterinary Journal, 40, (2) pp 153-159.

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Physical Therapy in Sport, Volume 8, Issue 1, pp 44-54.

Haussler, K.K., (1999). Back problems.

Chiropractic evaluation and management.

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Therapeutics: Chiropractic Evaluation and Management of Musculoskeltal Disorders, in Ross, M.W., Dyson, S., Editors: Diagnosis and Management of Lameness in the Horse, 2nd Edition, Missouri, Elsevier Saunders.

Marr, C.M., (2003), Defining the clinically relevant questions that lead to the best evidence: what is evidence-based

Haussler, K.K., Hill, A.E., Puttlitz, C.M., McIlwraith, C.W., (2007). Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region. American Journal of Veterinary Research. 68 (5) pp 508-16.

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Oxford, Blackwell Publishing Ltd.

Haussler, K.K., (2010).

The role of manual therapies in equine pain management. Veterinary Clinics of North America: Equine Practice. Vol 26, Issue 3, pp 579-601.

Haussler, K.K., Martin, C.E., Hill, A.E., (2010). Efficacy of spinal manipulation and mobilisation on trunk flexibility and stiffness in horses: a randomised clinical trial.

Equine Veterinary Journal, 42, Suppl. 38, pp 695-702.

Henson, F.M.D., (2009). Equine Back Pathology - Diagnosis and Treatment.

Oxford, Blackwell Publishing Ltd. Hesse, K.L., Verheven, K.L., (2010).

Associations between physiotherapy findings and subsequent diagnosis of pelvic or hindlimb fracture in racing Thoroughbreds.

Equine Veterinary Journal, 42 (3), pp 234-9.

Hill, C., Crook, T., (2010).

The relationship between massage to the equine caudal hindlimb muscles and hindlimb protraction. Equine Veterinary Journal Suppl (38) pp 683-7.

Holmes, M.A., Ramey, D.W., (2007). An introduction to evidence-based veterinary medicine.

Veterinay Clinic Equine Practice, 23, pp 191-200.

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Kastelic, J.P., (2006). Critical evaluation of scientific articles and other sources of information: An introduction to evidence-based veterinary medicine.

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Evidence-based medicine: can it be applied to equine clinical practice?

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Equine Veterinary Journal, 35, (4) pp 339-340.

medicine? Equine Veterinary Journal, 35, pp 333-336.

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Equine Veterinary Journal, 39 (1), pp 90-94.

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Equine Veterinary Journal, 35, pp 337-338.

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Watson, C.D., Jejurikar, S.S., Kallianen, L.K., Calderon, M.S., Urbanchek, M.G. Eguchi, T., Kuzon, W.M., (2001 ). Range of motion physiotherapy reduces the force deficit in antagonists to denervated rat muscles. Journal of Surgical Research, Vol. 99, Issue 1, pp 156-160.

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THE USE OF HYDROTHERAPY IN THE CONTEXT OF THE MANAGEMENT/TREATMENT OF SOFT TISSUE INJURIES IN THE CANINE PATIENT Natalie Fizio MSc BSc MCSP HCPC ACPAT Cat A

Submitted as part of the veterinary physiotherapy rehabilitation module of the UWE Hartpury MSc in Veterinary Physiotherapy.

In human practice, hydrotherapy, within a physiotherapy programme, has evolved from combining knowledge of hydrodynamic theory – the physical properties of water and physiology of immersion, with the physiotherapists’ ability to assess and re-educate movement patterns (Geytenbeek, 2002). The Chartered Society of Physiotherapy (CSP) defines hydrotherapy as a therapy programme, designed by a physiotherapist, utilising the properties of water to improve function (CSP, 2006). Within the animal field this differs slightly as veterinary physiotherapists or canine hydrotherapists can prescribe hydrotherapy rehabilitation programmes (National Association of Registered Canine Hydrotherapists, 2009; Canine Hydrotherapy Association, 2010).

Literature regarding the use of hydrotherapy in managing and treating canine soft tissue injuries predominantly surrounds rehabilitation after cranial cruciate ligament (CCL) surgery; this will therefore be the main focus of this assignment. Monk et al, (2006) included hydrotherapy within an early intensive physiotherapy programme post Tibial Plateau Levelling Osteotomy (TPLO). The physiotherapy programme began within two hours of surgery and an underwater treadmill (UWTM) regimen commenced at day 10, after suture removal. The aquatic medium allowed reduced weight bearing and

therefore reduced load through the healing osteotomy (Becker, 2009; Nganvongpanit et al, 2011). The control group were given a home exercise programme. Six weeks post TPLO, the physiotherapy group had significantly greater hip and stifle range of movement (ROM) and thigh circumference than the control group. Lameness scores and willingness to weight bear were not significantly different between the two conditions. It is difficult to directly measure strength in dogs but increased thigh circumference demonstrates increased strength (Au et al, 2010). Each exercise’s contribution to the improvements shown is unquantifiable, but it is believed that UWTM exercise contributes to increasing joint ROM (Monk et al, 2006) and possibly increasing strength (Monk, 2007). Dogs can have altered biomechanics post TPLO for several months (Monk et al, 2006) so ceasing measurements at six weeks may have been premature.

Randomisation was not performed in this study; group allocation was determined by the owners’ ability to commit to the physiotherapy programme or not, which happens in daily practice.

Berte et al (2012) studied the effect of immediate physiotherapy, including hydrotherapy, after extracapsular surgical stabilisation of experimentally induced CCL rupture. This study received ethical approval. Thigh circumference, ROM, radiographic changes and knee stability were not significantly different between the two groups (exercise restricted controls were used). Lameness scores significantly

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improved in the physiotherapy group, demonstrating greater functional gait recovery. Artificial inducement could detract from the results as the dogs may not have the characteristics of true CCL rupture patients, potentially explaining why, compared with Monk et al (2006), contrasting results were found.

Gait analysis was performed by one individual, reducing assessor variation, but it is unknown whether they were blinded to group allocation, so bias may not have been controlled. Conversely, radiographs were evaluated by two blinded examiners.

While the previous studies focused on early rehabilitation, Marsolais et al (2002) investigated the effects of rehabilitation beginning three weeks post CCL repair with exercise restriction. Swimming was used rather than the UWTM to eradicate joint loading. Limb function (i.e. peak vertical force and vertical impulse) increased significantly in both groups by six months postoperatively, but between the two groups the rehabilitation group had a significantly larger increase and showed no difference in limb function between their affected and healthy hind limbs. This study was not randomised or blinded, so has high bias potential.

Marsolais et al (2003) enrolled dogs with surgical management of CCL rupture in an aquatic rehabilitation programme, performing evaluations at 21 and 35 days postoperatively to compare hind limb kinematics between swimming, UWTM and walking. While each dog acted as its own control, there was also

a healthy control group with similar profiles (age and breed for example) to the surgical group, allowing further comparison.

Healthy dogs had greater hip ROM when swimming than walking but in postoperative dogs hip ROM did not differ between these two mediums, but was greater when swimming compared with the UWTM. Stifle and tarsal ROM were significantly greater (due to more flexion) in both groups when swimming, compared with walking, but remained significantly lower in the surgical group regardless of environment. These results suggest that if recovery of ROM is a major influence in return to function after surgical correction of CCL rupture, then swimming results in better functional outcomes than walking. Whilst all markers for kinematic measurements were placed by the same individual, refraction occurs when filming through water which may have distorted images (Marsolais et al, 2003) and therefore measurements obtained. Evaluating limb function in dogs with naturally occurring CCL rupture is difficult due to the number of uncontrollable variables associated with it (Marsolais et al, 2003); however, this study is made more reliable through the inclusion of control dogs with similar profiles.

Within a smaller research base, hydrotherapy has been suggested as a treatment modality for other canine soft tissue injuries, for example tendonitis, sprains and strains (Saunders, 2007). MarcellinLittle et al (2007) describe using hydrotherapy within rehabilitation post transposition of the bicipital tendon or fibrotic contracture of infraspinatus. Moores and Sutton (2009) demonstrated that hydrotherapy had a roll in managing a dog with a quadriceps contracture which presented with significant reduction in stifle flexion.

These findings are congruent with Marsolais et al (2003); swimming was more successful in putting the stifle through a greater flexion ROM than walking. Exploitation of the properties of water, through hydrotherapy, has been advocated

as means to improve some dysfunctions associated with soft tissue injuries (Owen, 2006; Monk, 2007; Becker, 2009; Nganvongpanit et al, 2011; King et al, 2012; Verhagen et al, 2012). For example, cases reluctant to use a limb or those who lack strength, proprioception, ROM or have a reduced weight bearing status (Levine et al, 2004; Canapp et al, 2009), may benefit from some rehabilitation in an aquatic environment.

In the correction of CCL rupture no single surgical technique is considered superior, and in a study where an identical rehabilitation programme, which included UWTM exercise, was prescribed after either TPLO or lateral fabellar suture stabilisation for CCL rupture, there were no significant differences in functional outcomes or radiographic appearance after six months (Au et al, 2010). It is arguable, therefore, that rehabilitation, within which hydrotherapy has a popular role, is the key influence on the outcome of CCL surgery patients.

As previously mentioned, if owners could not commit fully to the rehabilitation programmes their animals were put into the control group. This makes the studies more ethically acceptable as treatment was not withheld from participants and it accurately reflects clinical practice.

In some studies (Marsolais et al, 2002; Monk et al, 2006; Berte et al, 2012), hydrotherapy was used alongside a land based programme and results compared with a â&#x20AC;&#x2DC;no rehabilitationâ&#x20AC;&#x2122; control group.

Therefore, where rehabilitation did result in better outcomes, it is impossible to attribute these to hydrotherapy alone or to interpret the effect of the hydrotherapy component (Geytenbeek, 2002).

Whilst making determining the direct worth of hydrotherapy difficult, this format accurately represents current practice, as hydrotherapy is unlikely to be given as a standalone treatment and would most often be prescribed alongside land physiotherapy.

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However, some studies in the human field provide more direct comparisons between the mediums in which rehabilitation programmes can be performed.

Tovin et al (1994) is one such study: patients with intra-articular anterior cruciate ligament (ACL) reconstruction were randomly allocated to either a water or land based exercise group; exercises were matched between them so that only the environment was different. In the first week post-surgery, both groups were prescribed identical domiciliary exercise plans, provided with crutches and instructed to weight bear as much as tolerated. In week two, the groups began the land or water programmes. After week eight, there was no significant difference in knee ROM or thigh musculature circumference, as measured by a blinded tester.

Differences did occur in hamstring strength (higher in the land group), joint effusion (less in the water group) and self-reported functional recovery (greater in the water group). The primary goal of rehabilitation post ACL reconstruction is restoration of quadriceps strength (Tovin et al, 1994; Micheo et al, 2010). Results from Tovin et al (1994) suggest that either environment can be used to achieve this. However, rehabilitation must not over stress the graft, increase joint effusion or exceed patient tolerance (Tovin et al. 1994). Hydrotherapy may achieve this better than land based exercise, as buoyancy reduces load placed through the joint (Becker, 2009; Nganvongpanit et al, 2011), hydrostatic pressure can reduce oedema and aid return of extracellular fluid (Owen, 2006) and pain can be reduced (Levine et al, 2004; King et al, 2012).

Micheo et al (2010) support using hydrotherapy when rehabilitating ACL injuries as, although early mobilisation is encouraged to achieve better outcomes, the optimal amount of load on the graft is unquantified. Hydrotherapy allows early mobilisation whilst avoiding

high stresses on the graft, due to the aforementioned effects of buoyancy.

Surgical reconstruction reinstates static stability, but dynamic stability is not re-established (Micheo et al, 2010) and can be addressed through specific exercises within the aquatic environment, maximising the combined effects of buoyancy, the high density of water and viscosity to increase proprioceptive awareness (Owen, 2006).

Kim et al (2010) assessed functional outcomes in elite athletes with lower limb ligament injuries.

Similarly to Tovin et al (1994) exercises were matched between groups, so only the environment (water or land) in which they were performed differed. Five weeks post injury there were no significant differences in outcome measures between the two groups, however at two and four weeks the hydrotherapy group had a significantly greater magnitude of improvement, suggesting hydrotherapy facilitates quicker recovery. This has important implications in all clinical practice but particularly regarding canines, where the number of sessions may be limited by finance, time and ultimately owner compliance; hydrotherapy may allow goals to be reached earlier, requiring less sessions. This could be particularly important with working animals.

Canine studies discussed in this assignment have used hydrotherapy in two main formats: UWTM (Monk et al, 2006; Au et al, 2010; Berte et al, 2012) or swimming (Marsolais et al, 2002; Moores and Sutton, 2009), and in one study, both (Marsolais et al, 2003).The main difference between them is whether the patient is partially weight bearing or completely non weight bearing and therefore, performing closed or open chain exercises, respectively. Closed chain exercises are more closely affiliated with everyday activities on land so recruit muscles in a more functional manner (Levineet al, 2004). As discussed earlier, the properties of water reduce weight bearing forces through joints (importantly the

stifle post CCL surgery) (Becker, 2009) minimising inflammation, pain and damage to the soft tissue structures (Tovin et al, 1994; Levine et al, 2004), whilst still providing some compressive forces through the joint which promote muscular co-contraction (Micheo et al, 2010) developing dynamic stability. Monk (2007) recognises the benefits of swimming but states that the UWTM increases muscle mass more rapidly post CCL surgery and allows a more controlled situation, so should be the method chosen whenever possible. However, the study by Marsolais et al (2003) demonstrated that swimming had more significant impact on ROM than the UWTM, suggesting that patient specific problem lists should be considered when the therapist clinically reasons which aquatic modality (UWTM or swimming) would be most beneficial for each individual.

potentially explain why an optimal rehabilitation protocol post CCL surgery has not been produced (Au et al, 2010).

In the human studies (Tovin et al, 1994; Kim et al, 2010; Micheo et al, 2010) both open and closed chain exercises were included within the same aquatic rehabilitation programme, meaning hydrotherapy was used in a different manner to the majority of canine rehabilitation studies, limiting the direct comparability of results.

Eligibility for participation in studies is predominantly ascertained by diagnosis and matching inclusion criteria, rather than determination of suitability for an intervention due to an individualâ&#x20AC;&#x2122;s clinical signs and symptoms (Geytenbeek, 2002).

In animal and human practice, hydrotherapy is prescribed based on assessment by a suitably qualified individual, meaning patients may be better suited to this method of rehabilitation than some study participants (Geytenbeek, 2002).

This could limit how representative study results are. Also, within each study the hydrotherapy protocol is standardised, with little allowance for individual variance in practice, physiotherapeutic hydrotherapy is very interactive with constant re-assessment and adjustments (Geytenbeek, 2002), which may have skewed results and

References

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Therapeutic exercise, of which hydrotherapy can be a part, is an enjoyable innovative part of canine rehabilitation (Saunders, 2007). Whilst hydrotherapy can allow for earlier intervention and be an important aspect of canine rehabilitation, it should not be the sole form of therapy given (Monk, 2007). Additional controlled clinical studies are required to appraise the efficacy and knowledge base surrounding the various modalities (UWTM, swimming) within hydrotherapy (Owen, 2006), including the variable benefits they offer and their indication for the treatment and management of specific soft tissue injuries in canines.

Becker, B.E., (2009) Aquatic therapy: scientific foundations and clinical rehabilitation applications.

Physical Medicine and Rehabilitation 1(9), pp.859-872.

Berte, L., Mazzanti, A., Salbego, F.Z., Beckmann, D.V., Santos, R.P., Polidoro, D., Baumhardt, R., (2012) Immediate physical therapy in dogs with rupture of the cranial cruciate ligament submitted to extracapsular surgical stabilisation. Arquivo Brasileiro de Medicina Veterinaria e Zootecnia 64(1), pp.1-8.

Canapp, S., Acciani, D., Hulse, D., Schulz, K., and Canapp, D., (2009) Rehabilitation therapy for elbow disorders in dogs. Veterinary Surgery 38(2), pp.301-307.

Canine Hydrotherapy Association (2010) Canine Hydrotherapy. Available from: http:// www.canine-hydrotherapy.org/.

Chartered Society of Physiotherapy (2006) Guidance on good practice in hydrotherapy.

Available from: http://www.csp.org.uk/.

Geytenbeek, S., (2002) Evidence for effective hydrotherapy. Physiotherapy 88(9), pp.514529.

AU, K.K., Gordon-Evans, W.J., Dunning, D., Oâ&#x20AC;&#x2122;Dell-Anderson, K.J., Knap, K.E., Grifton, D. Johnson, A.L., (2010) Comparison of shortand long-term function and radiographic Osteoarthritis in dogs after postoperative physical rehabilitation and Tibial Plateau Levelling Osteotomy and Lateral Fabellar Suture Stabilisation. Veterinary Surgery 39(2), pp.173-180.

Kim, E., Kim, T., Kang, H., Lee, J., Childers, M.K., (2010) Aquatic vs. land based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. Physical Medicine and Rehabilitation 2(8), pp.703-712.

Micheo, W., Hernandez, L., Seda, C., (2010) Evaluation, management, rehabilitation and prevention of anterior cruciate ligament injury: current concepts. Physical Medicine and Rehabilitation 2(10), pp.935-944.

King, M.R., Haussler, K.K., Kawcak, C.E., Mcllwraith, C.W., Reiser, R.F., (2012) Mechanisms of aquatic therapy and its potential use in managing equine Osteoarthritis. Equine Veterinary Journal Supplement 25(4), pp.204209.

Monk, M., Preston, C., McGowan, C., (2006) Effects of early intensive postoperative physiotherapy on limb function after Tibial Plateau Levelling Osteotomy in dogs with deficiency of the cranial cruciate ligament.

American Journal of Veterinary Research 67(3), pp.529-536.

Levine, D., Rittenbury, P.T., Millis, D., (2004) Chapter 15 Aquatic therapy. In: Millis, D., Levine, D. and Taylor, R. eds. (2004) Canine Rehabilitation and Physical Therapy. Missouri: Saunders, pp.264-276.

Monk, M. (2007) Chapter 11 Hydrotherapy.

In: McGowan C., Goff, L. and Stubbs, N. eds.

(2007) Animal Physiotherapy: Assessment, Treatment and Rehabilitation of Animals.

Oxford: Blackwell Publishing, pp.187-198.

Marcellin-Little, D.J., Levine, D., Canapp, S.O., (2007) The canine shoulder selected disorders and their management with physical therapy.

Clinical Techniques in Small Animal Practice 22(4), pp.171-182.

Moores, A., Sutton, A., (2009) Management of quadriceps contracture in a dog using a static flexion apparatus and physiotherapy. Journal of Small Practice 50(5), pp.251-254.

National Association of Registered Canine Hydrotherapists (2009) NARCH Available from: http://www.narch.org.uk/.

Marsolais, G., Dvorak, G., Conzemius, M., (2002) Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. Journal of American Veterinary Medical Association 220(9), pp.1325-1330.

Marsolais, G., McLean, S., Derrick, T., Conzemius, M., (2003) Kinematic analysis of the hind limb during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament rupture.

Journal of the American Veterinary Medical Association 222(6), pp.739-743.

Nganvongpanit, K., Kongsawasdi, S., Chuatrakoon, B., Yano, T., (2011) Heart rate change during aquatic exercise in small, medium and large healthy dogs.Thai Journal of Veterinary Medicine 41(4), pp.455-461.

Owen, M.R., (2006) Rehabilitation therapies for musculoskeletal and spinal disease in small animal practice. European Journal of Companion Animal Practice 16(2), pp.137-148.

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Saunders, D., (2007) Therapeutic exercise.

Clinical Techniques in Small Animal Practice 22(4), pp.155-159.

Tovin, B.J., Wolf, S.L., Greenfield, B.H., Crouse, J., Woodfin, B.A., (1994) Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions.

Physical Therapy 74(8), pp.710-719.

Verhagen, A.P., Cardoso, J.R., BiermaZeinstra S.M., (2012) Aquatic exercise and balneotherapy in musculoskeletal conditions.

Best Practice and Research Clinical Rheumatology 26(3), pp.335-343.

WORKING THE GAMES - OR LONDON 2012 FROM A PHYSIOTHERAPY POINT OF VIEW Sonya Nightingale MCSP SRP Grad Dip Phys ACPAT Cat A

Picture 1. The Trot up area

The application process complete, places offered, venue specific training, role specific training, uniform collection and a multitude of other tasks fulfilled, equipment ordered, gel sorted (now that’s a whole story on its own) and we are ready for......WHAT exactly!

All physiotherapists had been divided into three shifts, 6am until 2pm, 9am until 5pm and 2pm until 10pm. The first and last shift had one person on them and the middle shift had two so that during the day there was ample cover.

The exception was the evening of cross country day and the following morning before the second trot up when it was all hands on deck

(See Picture 1). In reality we usually stayed well beyond our shift times anyway, or arrived early to enable a soaking up of the atmosphere and viewing of the competition!

Shift cover started five days before the opening ceremony on the first day that horses were due to arrive on site. On arrival all horses were unloaded and vet checked off site, where their passports, feed equipment etc was examined

by FEI officials and vets, prior to them being allowed to come down and unload at the venue stables.

In Greenwich all the stables were supported on platforms to protect the archaeologically sensitive ground underneath. This protection

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extended to run off, ie all ‘water’ was collected from beneath these platforms and stored in pump out tanks for disposal elsewhere, and all other waste was stored in colour coded wheelie bins. The horses therefore often had to walk up a series of ramps to access their stable block as the platforms of many of the blocks interlinked.

Some of the larger teams inhabited their own block or just shared with one other, smaller teams were often mixed, up to seven or eight teams to a block. Blocks varied in size but there were mostly around twenty boxes plus spare boxes used for tack rooms and feed stores.

The stables area was well equipped with a fully functioning forge, weigh bridge stable, freezers, wash down bays, ready grass and a small amount of real grazing! In a separate area away from the main stabling was the vet centre. This consisted of a large open reception come rest area come communal space for note writing and drinking coffee plus the FEI offices, a fully equipped lab, dispensing room, four stables, padded stable/operating theatre, X-ray equipment, ultrasound scanning, horse ambulance, a multitude of other veterinary kit and a small store room (See Pictures 2, 3 and 4).

This store room was where ‘everything else’ had to go.

Physiotherapy was allocated one and a half shelving units and a couple of shelves in a lockable cupboard (for gel and notes), cosy but perfectly functional. This area did however have to house lasers, ultrasounds, TENS, NMES, Game

Picture 2. The Horse Ambulance

and the physical space provided by the width of the warm up arenas. In many ways the stables area and vet centre felt like a quiet oasis away from the ‘storm’ of competition, something that I am

Picture 3. The Padded Emergency Stable

Ready machines and Activomed rugs and boots (See picture 5). The vet centre really did seem to be fully equipped for any kind of equine emergency (See picture 6). This also included a fully equipped horse ambulance with turntable, winches, easy access ramps, slings and more!

Thankfully very little of it was required this time.

This back stage area was separated from ‘the field of play’ by fencing

seen by a physiotherapist of any kind before and had certainly never been seen by these physiotherapists.

This, added to the fact that there were language barriers and a certain reticence to divulge a full history in

Picture 4. The Treatment stables in the Veterinary Centre

sure the competitors appreciated, and certainly removed some of the intense media interest and pressure.

Being on site for five days prior to competition did at least allow us to become very familiar with our surroundings and also to meet and assess a few of our patients, this built bridges and confidence for some of the more stressful times ahead. Some of the horses treated during the Games had never been

19

case it was viewed as a ‘problem’ in some camps, added to the challenge.

Before any horse was assessed both veterinary and rider consent was obtained and documented.

Veterinary consent came from either the team vet, if present, or a headquarters vet. A full assessment was often not possible with limited space so a palpatory exam and minimal trot up had to suffice in most cases. However it was not

unusual to have a whole team present during the examination, vet, farrier, rider, groom etc so the mix of ideas and professional input was a real bonus and it could be truly said that many cases were a real team effort in every sense of the word.

Team work was key and one of the lasting legacies will be the improved mutual respect and cooperation that has grown from this experience.

Bearing in mind that many horses were unused to physiotherapy and that they were due to compete at the highest level within days or even hours, care was taken with all modalities used. Electrotherapy was mainly reserved for those animals that had experienced it before with no side effects, or for whom it was the only option and they were unlikely to be sound without it! However teams could borrow all the electrotherapy equipment at their own risk should they wish to

use it themselves without the help of a physiotherapist and some did. The items borrowed were mainly the Activomed rugs and the Game Ready machine. However any ultrasound used, either borrowed or by a Headquarters physiotherapist, had to go with a bottle of gel assigned for use on one horse only. After use it was labelled and locked away, only to be released again for use on its allocated horse. This was to ensure that if any doping issues were raised the gel could be retrospectively tested and cleared as the cause of contamination. Treatment from physiotherapists consisted of soft tissue work, massage, myofascial release, mobilisations etc but all on the gentle side, ice, electro therapy, and lots of advice. Some animals even went home with homework! Injuries seen covered the whole spectrum from acute to chronic, from superficial bruising

Picture 6. Veterinary centre and treament area

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Picture 5. The Storage shelves for all our kit

Picture 7. The Collecting rings and warm up areas

to deeper old muscle injuries with considerable scarring (those were the ones that were not treated at the time but went home with homework), from minor joint stiffness to overt lameness. We are proud to report however that all event horses treated by the headquarters physiotherapy team passed their second veterinary inspections and some went home sounder than they arrived! In total 18 horses received 61 treatments at the main Games and 17 horses received 72 treatments at the Paralympics.

As was well reported on the news, there was a public outcry within hours of the Games starting because of large numbers of spare seats in the grandstands. Up until this point the physiotherapy team had attended the trot ups but were under the impression that our viewing of the competition itself would be limited to the television

screen in the vet centre. A notice went up saying ‘if you are not busy please go and fill seats’. We needed no second invitation! It was becoming abundantly clear that the competitors favoured treatment times outside competition times so that they too could watch, so what else could we all do? All I can say is that the atmosphere was indescribable and being there was the experience of a lifetime. As a spectator hearing your National Anthem playing as a gold medal is awarded is emotional enough, I cannot even imagine what it was like for the competitors receiving them (See picture 7).

The lasting legacy for Veterinary Physiotherapy will be that we were seen to be a highly professional group of individuals who worked well as a Team and with the wider Team. We were commended for being a ‘can do’ group with a positive attitude. This kind of

21

exposure provides wonderful opportunities for education and bridge building and I hope that many of the wider membership of ACPAT have felt some of the ripples of this success. Roll on Rio and good luck and enjoy to anyone given the opportunity to go.

So thank you to all of that team, in no particular order, Emma Dainty, Louise Carson, Anna Risius, Sonya Nightingale, Victoria Henderson, David Jackson, Jackie Grant, Sarah Sandford, Lee Clark, Anna Johnson, Jo Spear, Karen Mather and Rachel Greetham.

MUSCLE TENSION FROM A VETS PERSPECTIVE… Kate Granshaw BVetMed (Hons) CertAVP (EM, ESOrth) MRCVS

Lingfield Equine Vets, Chester Lodge, Woodcock Hill, Felbridge, Surrey, RH19 2RD info@lingfieldequinevets.com 07912 087776 Just like our human Olympic athletes, the performance horse is subject to pain, tension and fatigue associated with muscles, joints, ligaments and tendons (Gibson et al, 2002; Dyson, 2000). This pain often starts from the moment that training for competition commences and in some instances as early as the breaking in process. Performance horses also experience problems in specific areas of their body due to the type of work they are performing.

Proximal suspensory desmitis or suspensory branch injuries are seen frequently in dressage horses (Dyson, 2000; Gibson et al, 2002), superficial flexor tendonitis or desmitis of the accessory ligament of the deep digital flexor tendon in the forelimbs of showjumpers (Dyson, 2000; Gibson et al., 2002) and tendon, ligament and traumatic injuries in the event horse. Horses performing in all disciplines appear vulnerable to degenerative joint disease of the centrodistal, tarsometatarsal and distal interphalangeal joints or tenosynovitis of the digital flexor tendon sheath whether primary or secondary (Dyson, 2000).

In such circumstances, the horse’s inability to verbalise their pain, tension or fatigue calls for the observation of a trained professional. As we strive to build fitness and develop specific muscles, soreness is almost inevitable.

Overexertion by pushing the horse beyond its fitness level will cause muscle soreness and the horse may become stiff and hesitant as a result. During the normal course of exercise, muscles tear and fatigue, glycogen is broken down for energy and lactic acid can accumulate in muscles. When an injury occurs, the body responds with the spasmpain-spasm cycle (Johnson, 2012) which will escalate unless adequate recovery time is allowed.

Muscle tension, spasm or soreness is frequently identified by both vets and physiotherapists as areas of hypersensitivity within a muscle during clinical examination. These are often localised to the motor point of the affected muscle or muscle group and are commonly termed as ‘trigger points’. So when is muscle tension justified due to the level of exertion a horse is subject to and when is it an important clinical sign of a more serious underlying issue? When is it primary and when is it secondary?

These are key questions we should be pondering in each and every case to ensure that we do not miss key information relevant to accurate diagnosis, treatment and prognosis.

Muscle tension can be a normal finding in horses performing any discipline: whether hacking up hills in the forest; competing at Badminton; or performing a canter pirouette, the equine athlete’s body can be put under tremendous biomechanical strain.

Even if time is taken to train the muscle groups needed to perform such strenuous movements and adapt the proportional type of muscle fibres to sustain isometric strength, it is likely that muscles will be overstretched and overused and thus muscle pain and tension will develop during training and competition.

Dressage horses will rarely succumb to acute stress-induced traumatic injuries, but more likely to repetitive, accumulative subclinical injuries which may surface at irregular intervals. In particular, in dressage they are prone to thoracolumbar and sacroiliac pain due to the asymmetrical and extreme use of muscle groups during collection and lateral movements (Dyson, 2000) and suspensory ligament damage during extension in trot (Walker et al., 2013) . In contrast, showjumpers and event horses are more likely to sustain traumatic injuries within

22

the hoof capsule and to the stifle region and experience episodes of exertional rhabdomyolysis (Dyson, 2000).

Vets are inherently suspicious of muscle tension as more often than not it is a clue to a pathological process. The most common anatomical areas in which muscle tension is identified are the atlantoaxial and atlanto-occipital regions, lower cervical spine between the fifth and seventh cervical vertebrae, cranial thoracic spine, thoracolumbar junction, sacroiliac region (Dyson and Murray, 2003), gluteals and hamstrings.

Muscle tension may be unilateral or bilateral and individual muscles or entire muscle groups can be affected. Accurately mapping this muscle tension, its response to treatment and rate of recurrence is crucial in all cases (Gomez Alvarez et al, 2008a and 2008b).

Cervical Pain Apart from palpable muscle tension, other clinical signs indicative of cervical pain range from the subtle to the obvious and can include: heat; swelling; deviation of the cervical contour; headshaking; reluctance to work ‘on the bit’; reluctance to bend/decreased range of motion; ‘hanging on the rein’; straddling of the forelimbs when grazing or eating from the floor; stiffness; restricted forelimb gait or lameness; an abnormally low head carriage; change in preference of feeding height; and difficulty placing the bit or bridle.

In cases where muscle tension affecting the cervical region is secondary to pain or discomfort elsewhere (Dyson, 2011) the following primary causes should be considered: dental disease; temporomandibular joint pain; illfitting tack or over-strong bits; overtraining or inappropriate

training (particularly common in young horses and those performing dressage); forelimb lameness (particularly seen with tension in the pectorals, brachiocephalicus and biceps brachii (Ricardi and Dyson, 1993)); trauma (acute or chronic); facet joint osteoarthritis; thoracolumbar or sacroiliac pain (Dyson and Murray, 2003); exertional rhabdomyolosis; myositis; myopathy; injection site reaction; and cervical fracture or subluxation.

Thoracic and lumbar muscle spasm Thoracolumbar muscle tension is the most common clinical presentation of muscle tension and the most likely to be identified by the owner. It may be seen in isolation or in combination with muscle pain in other areas (Wennerstrand et al, 2009; Cauvin, 1998; Jeffcott, 1999). The most common cause of primary back pain is ill fitting tack (Harman, 1999) and forelimb and hind limb lameness are the most common causes of secondary back pain (Landman et al, 2004). This pain often results from abnormal posture and use of the thoracolumbar soft tissues when the horse attempts to compensate for the lameness, resulting in detectable alterations in spinal biomechanics and kinematics (Gomez Alvarez et al, 2007; Gomez Alvarez et al, 2008a). Bilateral lameness due to caudal heel pain, poor foot balance or navicular syndrome, hock osteoarthritis or proximal suspensory desmitis, can be particularly difficult to identify without provocative tests or nerve blocks and may be easier for a competent rider to feel than for an observer to see.

Other causes include: sacroiliac joint pain; facet joint osteoarthritis; impingement of dorsal spinous processes (‘kissing spines’); supraspinous ligament desmitis (Henson et al, 2007); ill-fitting saddle; skin disease; reproductive issues (ovarian pain); rib fractures; chondritis; pleuritis; myositis; myopathy; azoturia; fracture; neurological

disease (‘Wobblers Syndrome’); longissimus dorsi muscle strain; and gastric ulcers. This list is by no means exhaustive but illustrates how complicated the ‘back pain’ case can be, especially as multiple pathology can often be found concurrently. Poor development of the epaxial musculature can be both a symptom and a cause of back pain. Overweight riders can be a particularly difficult subject to broach, as is the unbalanced or unskilled rider.

than muscle tension per se. Some of the most common reasons for veterinary assessment in these circumstances are (Jeffcott, 1999; Dyson, 2000):

Pelvic muscle pain

•

The gluteals and hamstrings are the most common hind limb muscle groups affected by tension: they are particularly vulnerable to overextension, tearing and haematoma which can lead to fibrotic myopathy. This leads to a characteristic gait abnormality which manifests as a shortened cranial phase and sudden ‘slap’ when landing commonly only noticed at walk. In my clinical experience the middle gluteal and biceps femoris muscles are the most likely to be sore on palpation. It is proposed that hind limb lameness can result in tension which causes a reduction in stride length and ground reaction forces in order to unload the affected limb (Gomez Alvarez et al, 2008a) however, this hypothesis remains as yet unproven.

Overtraining or overexertion can lead to exertional rhabdomyolosis and Delayed Onset Muscle Soreness (DOMS) in susceptible individuals.

•

Generalised muscle pain can be seen after a fall, post excessive exercise, as a manifestation of DOMS, exertional rhabdomyolosis, liver disease, viral infection, sacroiliac disease, myositis, or myopathy (Aleman, 2008).

Veterinary Involvement Initial Assessment As vets we are often called by owners who have noticed a change in their horses’ behaviour or a difference in the way their horse is working under saddle, rather

23

•

• •

• • • • • • • • • • •

bucking during upward transitions or difficulty striking off on the correct canter lead and maintaining canter; refusal to stand during mounting/discomfort when saddled or girthed; jumping mistakes or refusals/ change in jumping style; difficulty in negotiating hills (walking sideways/stumbling); lack of impulsion and suppleness/toe dragging/poor engagement; lameness; vigorous tail movements/tail swishing; teeth grinding; reluctance to bend/stiffness/ heavy through the rein; reluctance to work ‘on the bit’ or ‘work over his back’; evading contact during grooming; resents lateral work, often in one direction; is fidgety, tense and unable to concentrate; weight loss; headshaking/head tilt; and rearing

When you examine performance problems as possible expressions of discomfort, it is very important to consider the point in the manoeuvre that triggers the horse’s resistance. Is it when the horse has to bring his hindquarters under him, move laterally, bear weight on a particular limb or reach forward with his head and neck? Noticing a pattern in his objections can help pinpoint the true source of the problem. It is important to perform a thorough static and dynamic examination (Dyson, 2000; Cauvin, 1998; Martin and Klide, 1999) including trot up on a hard surface, lunging on both hard and soft surfaces, flexion tests and a ridden examination (it is important that the usual rider is present as a more experienced rider is often able to mask subtle issues). It may necessary

to see the horse jumped if this is where the problem is noted.

Further Investigation and Diagnostics • Once a problem has been identified it is important to ask whether or not the horse is the correct breed/type and has appropriate conformation to do the job asked of it, whether it is trained appropriately to do the job, whether the rider is able to do the job effectively, and whether the horse has enough aerobic fitness to perform the task. If rider, tack (Harman, 1999), training technique, fitness level and trauma can be ruled out conclusively then further investigation can include (Denoix, 1998): •

•

•

• • •

• •

•

Blood sampling: pre- and postexercise to test for muscle damage (myopathy, DOMS) (Aleman, 2008).

Nerve Blocks; to accurately pinpoint the source/s of lameness (Dyson, 2000; Dyson and Murray, 2003).

Radiography; particularly useful for bony lesions, assessment of ligamentous insertions and joint capsules (Weaver et al, 1999).

Ultrasonography; useful for soft tissue injury assessment (Henson et al, 2007).

Gamma scintigraphy (Tucker et al, 1998; Weaver et al, 1999).

Magnetic Resonance Imaging; very useful for diagnosis of soft tissue lesions within the hoof capsule (Dyson et al, 2005).

Computed Tomography; limited to head and neck lesions currently.

Referral for a physiotherapy assessment which may provide further information, with particular relevance to the quality of muscle spasm. In some cases response to various types of muscle stimulation e.g.

H-wave, can provide further information about the degree of muscle spasm present.

Assessment of the response to physiotherapy techniques such as various electrotherapy modalities, physiotherapy

•

manual techniques, rest or a modified exercise programme (Gomez Alvarez et al, 2008b; Faber et al, 2003; Haussler 2010, Wolf, 2002).

Response to remedial farriery; the importance of good foot balance and optimal shoeing cannot be underestimated. Foot balance radiographs can be very useful to ensure best possible results (Dyson, 2000).

Muscle biopsy; in cases of myopathy (Aleman, 2008).

Treatment Options Regardless of the cause, rest is often essential in the treatment of muscle tension, ranging from weeks to months. More specific treatment will depend on the diagnosis and can include the following in isolation or combination (Ridgway and Harman, 1999; Marks, 1999): •

•

•

Non steroidal antiinflammatory agents whether administered intravenously or orally are essential in the acute stage and can be useful in long term management of the more chronic case.

Application of ice, or cold therapy using a refrigerated unit like the Zamar, may be indicated if there is localised muscle damage or inflammation, especially in the early stages.

Later, as the muscle heals, hot packs or warming gels may improve circulation and muscle function. A veterinary equivalent of Ralgex, called Compagel, has recently been launched in the UK for use on inflammatory swellings and bruising.

Referral for physiotherapy; in order to treat with or without sedation to relieve muscle spasm, improve strength, proprioceptive awareness and suppleness. They can further provide education and training of owners to perform daily stretches and exercises targeted specifically by diagnosis alongside veterinary guidance during the rehabilitation phase post injury (Gomez Alvarez et al, 2008b; Faber et al, 2003;

24

•

•

• • • • • • •

•

•

Haussler, 2010; Wolf, 2002; Stubbs and Clayton, 2008).

Corticosteroids, such as triamcinolone (Adcortyl) and methyl prednisolone (DepoMedrone), are most commonly used for the direct medication of injuries or degenerative diseases. Multiple injections of local anaesthetic and corticosteroid under the saddle area –using a technique called mesotherapy – can also be of help in horses with general stiffness in this region.

Surgery is indicated in some cases of dorsal spinous process impingement (Jeffcott and Hickman, 1975) and some fractures, proximal suspensory desmitis, osteochondrosis dissecans.

Controlled exercise programme.

Cartrophen Injections; useful for global treatment of inflammation.

Tildren; may be of use in cases of active bony remodelling.

Acupuncture (Xie et al, 1996).

Dental treatment.

Equine Gastric Ulcer Syndrome treatment and management.

Other pain-relieving agents may also be administered, including Sarapin, which contains extracts of pitcher plants that are commonly used in the treatment of back pain in humans (Reisner, 2004) and the homeopathic anti-inflammatory Traumeel.

Extracorporeal shock wave therapy has also been shown to be effective in treating a variety of back disorders and chronic suspensory desmitis (Boening et al, 2000). It is unclear, however, whether its benefits are due to it simply providing pain relief as opposed to modifying any underlying disease.

Standard ‘tying-up’ preventives, such as feeding supplemental vitamin E and selenium and extra electrolytes, may also improve muscle metabolism and help prevent muscle paineven if the horse in question has never actually tied up.

•

Local muscle cramping can be part of a continuum, starting with spasm and progressing to full-blown tying up. These cases must be identified correctly as manipulation/Hwave etc could have deleterious consequences and further exacerbate continued myodegeneration. Clinicians should be alerted to horses with abnormal tissue tone in general as conditions such as Equine Metabolic Syndrome (which demonstrates regional adiposity), Polysaccharide Storage Myopathy and Equine Motor Neurone Syndrome may be identified in this way.

Finally, there are a number of products on the market that can help in the prevention and management of back pain, ranging from magnetic rugs to massage pads and systems like the Equissage. These are designed to promote blood flow, relieve tension and improve mobility, and are best used on a daily basis.

Prognosis Prognosis will vary widely depending on the underlying pathology and the individual’s response to treatment, and it is important to counsel owners as to their expectations for future ridden endeavours. Chronic soft tissue injuries have a guarded prognosis in general, but rest, controlled exercise and appropriate physiotherapy may be successful. Seventy-five percent (75%) of horses treated with acupuncture were able to perform at an acceptable level after five to eight treatments (Xie et al, 1996). The role that physiotherapy, acupuncture and manipulative therapies play in the relief and longterm management of equine neck and back pain cannot be overstated (Faber et al, 2003; Haussler, 2010; Wolf, 2002). Chances of success are greatest, in my opinion, when the practitioner works closely with the vet to deliver an effective treatment programme and schedule of rehabilitation after an accurate diagnosis has been obtained.

References Aleman, M., (2008). A review of equine muscle disorders. Neuromuscular disorders 18(4):27787.

Boening, K.J., Loffeld, S., Weitkamp, K., Matuschek, S.,(2000). Radial Extracorporeal Shock Wave Therapy for Chronic Insertion Desmopathy of the Proximal Suspensory Ligament. AAEP Proceedings.

Cauvin, E., (1998). Assessment of back pain in horses. In Practice 19(10): 522-526, 529-530, 533.

Denoix, J.M., (1998). Diagnosis of the cause of back pain in horses. Conf. Equine Sports Med. Sci 97-110.

Dyson, S., Murray, R., (2003). Pain associated with the sacroiliac joint region: a clinical study of 74 horses. Equine Veterinary Journal 35(3):240-5.

Dyson,S.,(2000).Lameness and Poor Performance in the Sports Horse: Dressage, Show Jumping and Horse Trials (Eventing). Proceedings of the Annual Convention of the AAEP.Vol 46:308-315.

Dyson, S., (2011). Lesions of the equine neck resulting in lameness or poor performance. Vet Clin North Am Equine Pract 27(3):417-37.

Dyson, S.J., Murray R., Schramme M.C., (2005).

Lameness associated with foot pain: Results of magnetic resonance imaging in 199 horses (January 2001-December 2003) and response to treatment. Equine Veterinary Journal 37(2):113121.

Faber, M.J., van Weeren, P.R., Schepers, M., Barneveld, A., (2003). Long-term follow-up of manipulative treatment in a horse with back problems. JVet Med A Physiol Clin Med. 50(5):2415.

Gibson, K.T, Snyder, J.R., Spier, S.J., (2002).

Ultrasonographic diagnosis of soft tissue injuries in horses competing at the Sydney 2000 Olympic Games. Equine Veterinary Education 14(3):149156.

Gomez Alvarez, C.B., Bobbert, M.F., Lamers, L., Johnston, C., Back, W., van Weeren, P.R., (2008a).

The effect of induced hindlimb lameness on thoracolumbar kinematics during the treadmill locomotion. Equine Veterinary Journal. 4(2):14752.

Gomez Alvarez, C.B., L’ami, J.J., Moffat, D., Back,W., van Weeren, P.R., (2008b). Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems.

Equine Veterinary Journal 40(2):153-9.

Gomez Alvarez, C.B., Wennerstrand, J., Bobbert, M.F., Lamers, L., Johnston, C., Back,W., van Weeren, P.R., (2007). The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion. Equine Veterinary Journal.

39(3):197-201.

Harman, J., (1999). Tack and saddle fit. Vet Clin North Am Equine Pract 15(1):247-61.

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Haussler, K.K., (2010). The role of manual therapies in equine pain management. Vet Clin North Am Equine Pract 26(3):579-601.

Henson, F.M.D., Lamas L., Knezevic, S., Jeffcott, J.B., (2007). Ultrasonographic evaluation of the supraspinous ligament in a series of ridden and unridden horses and horses with unrelated back pathology. BMC Veterinary Research Vol 3 (3).

Jeffcott, L.B., Hickman, J., (1975). The Treatment of Horses with Chronic Back Pain by Resecting the Summits of the Impinging Dorsal Spinous Processes. EquineVeterinary Journal.Vol 7 (3):115119.

Jeffcott, L.B., (1999). Back problems. Historical perspectives and clinical indicators.Vet Clin North Am Equine Pract. 15(1):1-12.

Johnson, D.S., (2012).The spasm-pain-spasm cycle.

Pain Med. 13(4):615.

Landman, M.A., de Blaauw,, J.A., van Weeren P.R., Hofland, L.I., (2004). Field study of the prevalence of lameness in horses with back problems. Vet Record 155(6)( August):165-8.

Marks, D., (1999). Medical management of back pain. Vet Clin North Am Equine Pract 15(1):17994.

Martin, B.B.Jr., Klide, A.M., (1999). Physical examination of horses with back pain. Vet Clin North Am Equine Pract. 15(1):61-70.

Reisner, L., (2004). Biologic poisons for pain. Curr Pain Headache Rep 8(6):427-34.

Ricardi, G., Dyson S., (1993). Forelimb lameness associated with radiographic abnormalities of the cervical vertebrae. Equine Veterinary Journal 25(5):422-6.

Ridgway, K., Harman, J., (1999). Equine back rehabilitation. Vet Clin North Am Equine Pract 15(1):263-80.

Stubbs, N.C., Clayton, H.M., (2008). Activate your horse’s core. Sport Horse Publications. Mason, MI. Stubbs, N.C., Kaiser, L.J., Hauptman, J., Clayton, H.M., (2011). Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. Equine Veterinary Journal 43(5):522-9.

Tucker, R.L., Schneider, R.K., Sondhof, 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):390-5.

Walker,V.A.,Walters, J.M., Griffith, L., Murray, R.C., (2013). The effect of collection and extension on tarsal flexion and fetlock extension at trot. Equine Veterinary Journal 45(2):245-8.

Weaver, M.P., Jeffcott, L.B., Nowak M.. (1999). Back problems. Radiology and scintigraphy. Vet Clin North Am Equine Pract 15(1):113-29.

Wennerstrand J., Gomez Alvarez, C.B., Meulenbelt, R., Johnston C., van Weeren, P.R., Roethlisberger-Holm, K., Drevemo, S., (2009).

Spinal kinematics in horses with induced back pain. Veterinary Compendium of Orthopaedic Traumatology 22(6):448-54.

FIRST AID FOR HORSES Dr. Debra Archer BVMS PhD CertES DipECVS MRCVS FHEA RCVS and European Specialist in Equine Surgery Equine Hospital, University of Liverpool, Leahurst Campus, Neston, Wirral. CH64 7TE Tel: 0151 794 6041 Email: darcher@liv.ac.uk Introduction

Being prepared

Veterinary physiotherapists are frequently present at equine competitions and may be asked for advice about treatment of horses following injury. The aim of this article is to outline what is useful to carry in an equine first-aid kit, how to perform a basic assessment of a horse’s vital parameters and to outline situations in which veterinary advice should be sought.

The final part of this article deals with emergency situations that may be encountered, including those that may occur during equine competitions, and first-aid measures that horse owners’ can perform until veterinary assessment and treatment can be undertaken.

It is always useful to have a horse first-aid kit on the yard, one kept on the horsebox and to remember to keep a human first-aid kit handy too. Ready-made kits can be quite expensive and do not always contain everything that might be needed so it is cheaper to put a kit together in a sealable, plastic container that is easy to store and carry (Table 1).

These items can be bought from a variety of sources including saddlers, chemists, veterinary surgeries, DIY stores and internet sources.

Knowing what is normal It is useful to know how to be able to assess a horse’s vital signs and to

know what is normal for a horse as this will provide a guide as to how urgently veterinary attention is required. In addition, this is useful information to be able to pass on to a veterinary surgeon over the telephone.

Rectal temperature Raise and keep hold of the horse’s tail whilst the free hand is used to insert a thermometer (with lubricating jelly applied to the tip) into the rectum to a distance of around 5cm. Take care not to be kicked (stand slightly to the side of the horse) and not to lose the thermometer into the rectum!

Digital thermometers that emit a beep when a steady temperature

Essential

Ideal / extras

Pen and paper

2x tubes sterile Hydrogel (e.g. Intrasite gel)

List of useful numbers including veterinary surgeon

Bottle of chlorhexidine scrub solution

Torch

3x rolls of soft conforming bandage (e.g. Soffban)

Blunt ended scissors

2x rolls of self adhesive crepe bandage (e.g.Vetwrap)

Small, clean plastic bowl 1x small packet table salt

5x non-stick sterile dressings (e.g. Melolin / Allevyn 10x10cm and 10x20cm) Head torch

1x tube KY jelly

Small pair pliers / wirecutters

Cotton wool roll

Handwipes (baby wipes / antiseptic wipes)

Poultice (e.g Animalintex)

Sterile saline solution spray (e.g. Aquaspray)

Tubular crepe bandage (e.g. Tubigrip)

Nappy (very useful absorbant dressing especially for feet, size 4) Sterile 20ml syringe for flushing saline into a wound

1x roll duck/gaffer tape Clean teatowel / handtowel Penknife / multipurpose tool Stable / exercise bandages Table 1. Recommendations on what to have in an equine first aid kit.

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Parameter

Normal values

When to seek veterinary advice

Oral mucous membranes (gums)

Moist, pale pink colour When digital pressure is applied to an area, normal colour returns within 1-2 seconds (>3-4 seconds is abnormal)

Can be unreliable; white, very red or purple coloured mucous membranes are a sign of problems but will usually be accompanied by other abnormal signs e.g. high heart rate, signs of colic or dullness

Heart rate

28-44 beats per minute (at rest)

>50-60 beats per minute persistently at rest and accompanied by other abnormal signs e.g. dull / off colour/ colic signs

Respiratory rate

8-12 breaths per minute (at rest)

>20 breaths per minute persistently at rest, if the horse is struggling to breathe or is making more noise during respiration than normal

Rectal temperature

37.5 -38.40C

>39.0 0C, especially if accompanied by dullness or off feed / diarrhoea <36.1 0C (hypothermia) â&#x20AC;&#x201C; rare in adult horses in the UK but can affect sick foals or debilitated horses / donkeys during severe weather

Table 2. Normal vital parameters and guidance as to when veterinary advice should be sought

has been reached are the most practical to use or keep a mercury thermometer in place for at least 60 seconds (See Figure 1) Respiration Stand to the front and slightly to the side of the horse so that movements of the flank can be timed as it moves in and out with respiration. Alternatively place the palm of your hand 10cm from the nostril and feel for the warm air exhaled at the end of each breath.

The horse should not be making an effort to breathe at rest (or its respiratory rate should return to normal within around 10-15 minutes after intense exercise) nor should there be any loud sounds associated with each respiration.

Heart rate The apex beat of the horseâ&#x20AC;&#x2122;s heart can be palpated by placing the back of your hand against the horseâ&#x20AC;&#x2122;s left side of the chest and by moving your hand into the axilla (Figure 2).

Following intense exercise, the heart

Figure 1. How to take a rectal temperature

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Figure 3. Palpating the facial artery

rate should return to normal within around 20 minutes (depending on the horseâ&#x20AC;&#x2122;s level of fitness). A pulse can be taken by using the index and third finger to feel for pulsation in the facial artery (Figure 3). This can be found by running your fingers down the angle of the jaw and feeling for a pencil-like tubular structure. The pulse should be felt to pound gently and in time with the heart. This sometimes takes a bit of time to perfect - the most common mistake is to apply too much pressure on the artery preventing the pulse from being felt.

When to seek veterinary advice Every situation is different and common sense will usually dictate whether veterinary advice needs to be sought or not. If in doubt, veterinary surgeons will be happy to provide advice over the telephone.

Below (Table 3) is a general guide regarding situations when urgent or immediate veterinary attention may be required. Most other problems can usually wait until normal working hours unless the horseâ&#x20AC;&#x2122;s condition continues to deteriorate or if other signs of illness start to develop.

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Figure 2.

Palpating the apex beat of the heart

Seek veterinary advice urgently if a horse:

Seek veterinary advice within a few hours (same day) if a horse:

•

•

h as sudden onset, severe lameness or a very swollen leg (keep confined until assessment has been performed)

•

has a high temperature (>39.0 0C)

•

has sudden onset severe diarrhoea and appears dull and off feed

•

has sudden onset laminitis or recurrent laminitis

•

has a flare up of a respiratory allergy

•

has gone off their feed completely (especially donkeys and fat, native ponies)

•

i s a neonatal foal that has developed severe diarrhoea or lameness or has stopped suckling

•

if a group of horses have suddenly become unwell

•

• • •

•

• • • • • •

cannot put any weight on a leg and is distressed or the leg is visibly deformed is bleeding heavily (i.e more than a fast drip) from anywhere or bleeding persists for more than 5-10 minutes despite application of pressure (where applicable) is struggling to breathe is collapsed / recumbent and cannot get to its feet or is stuck and cannot be easily freed has mild signs of colic (flank watching, pawing, getting up and down) that persist for >30 minutes or is showing severe signs of colic (e.g. violent rolling and pawing, thrashing around) is a mare that is foaling and the foal does not appear within 20 minutes of the waters breaking or the foal is obviously stuck has deep wounds (>3cm) anywhere on the body has any wounds deeper than full skin thickness in the danger zones (see Fig. 4a&b) cannot open or has injured its eye is repeatedly straining to urinate and seems uncomfortable has eaten large quantities of grain / concentrate feed is showing sudden, marked changes in behaviour e.g. staggering around, appears blind

Table 3. Guidelines on when to seek urgent or same day veterinary advice

Specific emergency situations The following section outlines emergency situations that may be encountered, including those that may occur in horses during or immediately following competition and first aid measures that should be performed.

Haemorrhage (bleeding) Where haemorrhage is evident from a wound, a clean (ideally sterile) dressing should be placed over the wound, followed by a layer of cotton wool or other absorbent material (in an emergency a clean t shirt will do) and veterinary advice should be sought immediately. If blood soaks through these layers, add more absorbent material over the top (don’t remove the layers underneath) and continue to apply

firm pressure over the site or place a bandage firmly over the site if it is an area suitable for bandaging (e.g. lower limb) until veterinary assessment can be performed.

Nosebleeds (epistaxis) are most commonly a result of trauma, usually associated with a veterinary surgeon passing a nasogastric tube or endoscope up the nasal passages which can traumatise the delicate nasal tissues. Epistaxis can also occur as a result of the horse traumatising its head (e.g. rearing over backwards), due to a fungal infection within the guttural pouches (which can be life threatening if not treated appropriately) or following intense exercise (exercise-induced pulmonary haemorrhage). If there has only been a trickle of blood (less than a few tablespoons), haemorrhage stops quickly and

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where no other nosebleeds have occurred in the preceding days / weeks, then many cases do not need to be investigated. However veterinary advice should always be sought if there is a large amount of arterial (bright red) haemorrhage or if steady dripping of blood persists for longer than around 10 minutes, if this is the second (or more) times that a horse has had epistaxis over the preceding few days / weeks or if epistaxis has been associated with known trauma to the head.

Internal haemorrhage can be more difficult to detect but may occur in horses that have sustained severe blunt trauma to the chest or abdomen (e.g. heavy fall over or running into an obstacle) or where a pre-existing defect in a major blood vessel has led to rupture of the vessel (usually in older stallions following intense exercise

or occasionally in mares following foaling). These horses will appear distressed and, if haemorrhage is severe, they will start to develop signs of cardiovascular shock including evidence of pale mucous membranes, a weak pulse and high heart rate (tachycardia). Where haemorrhage is on-going, horses may appear to stagger around until collapse and death occurs. These horses can be dangerous to handle if they become distressed. They should be kept quiet and calm and placed in a well bedded stable until veterinary assessment can be performed (if veterinary assistance is not immediately available).

Severe lameness Occasionally fractures and tendon injuries (lacerations / ruptures) may be sustained during exercise, competition or turnout. The limb may be obviously deformed and the horse may be distressed. In these situations the horse should not be moved unless it is in imminent danger and the horse and owner should be kept calm until veterinary assessment can be performed.

If there is nothing obvious to see and the horse cannot put weight on the limb always check the foot to ensure that there are no foreign bodies embedded within it e.g. nails or other sharp objects.

In this case, the object should be removed immediately taking a note of where it penetrated the foot, to what depth and direction it headed in and keep it for the vet to look at. These injuries can be potentially life threatening if an object has penetrated more than a couple of centimetres into the foot so veterinary advice should always be sought immediately in these instances, or if the horse has not been vaccinated against tetanus within the last 12-24 months. If the object is firmly driven into the foot, do not move the horse and await arrival of the vet.

Other causes of severe lameness include infection within a joint or tendon sheath after sustaining a wound to the site, tendon

Figure 4a. Danger zones for wounds including sites where synovial structures (joints and tendon sheaths) are relatively superficially located on the limbs.

section. In the case of myopathies, the horse should not be moved, should be encouraged to drink and immediate veterinary assessment sought so that analgesia can be provided. In the most severe cases, intravenous fluid administration may be required. Where tendon injuries have been sustained, perform hydrotherapy of the distal limb using iced/cold water or place a plastic bag containing ice or frozen peas over the site for 20 minutes until veterinary assessment can be performed.

Figure 4b. Danger zones for wounds around the head and neck.

injuries and myopathies. After checking that there are no foreign bodies in the foot, palpate the gluteal and associated musculature, check for pelvic asymmetry, feel down the affected limb for evidence of any heat, pain or swelling, palpate the flexor tendons and suspensory ligaments and look for any wounds.

Small puncture wounds can be easy to miss particularly in horses with hairy legs so the hair should be clipped away from any suspicious areas to make sure these are not missed. First aid treatment for wounds is covered in the following

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Wounds Any haemorrhage should be controlled first as already described.

The location, depth and size of any wound should be determined and any other wounds looked for – sometimes small puncture wounds, especially if they are located in any of the ‘danger zones’ (Figures 4a & b) can be much more serious than an obvious, large but superficial wound. Veterinary advice should always be sought if a wound is: •

located in any of the ‘danger zones’ and is deeper than full skin thickness

• • •

associated with concurrent signs of severe lameness located anywhere on the body where the skin edges separate or the wound is >3cm deep associated with the horse showing signs of distress or other unusual signs

In addition, veterinary advice should be sought if the horse had not been vaccinated against tetanus in the last 12-24 months – tetanus can kill unvaccinated horses and is preventable.

First aid measures should start by placing sterile KY or hydrogel in the wound and the skin around the wound clipped to remove hair around the site (the gel placed within the wound stops the hair fragments from becoming stuck in the wound). The wound should then be cleaned with a home-made saline solution (add 1 teaspoon of table salt to a pint of cooled, boiled water or clean, warm water) or commercial saline solution (e.g.

Aquaspray or sterile bag of saline) or a very dilute chlorhexidine solution (approx. 2ml added per pint of water). In an emergency if these are not available, tap water or water from a hosepipe is better to use than nothing at all- a wound contaminated with soil and other foreign material provides an ideal breeding ground for a bacterial infection to develop quickly which will ultimately slow down wound healing. Wounds should not be washed with other solutions e.g. tea-tree oil as these can damage the delicate cells below the skin nor should blue spray or wound powder be applied to any wound requiring veterinary attention as this makes assessment of a wound more difficult . In addition, wound powder acts as a ‘foreign body’ resulting in slower wound healing.

For superficial cuts and grazes that do not need veterinary attention, most will heal well if cleaned and kept clean and dry. Where superficial cuts are located over the lower limbs, application of a non-adhesive sterile dressing and a properly applied bandage will

help to keep the site clean and dry which will help them to heal faster with less risk of dirt and other foreign material entering the site.

Where veterinary assessment is required, the decision whether a wound needs to be sutured or not will depend on a number of factors including how contaminated the wound is, how recently it was sustained, its location and the degree of damage to the surrounding tissues.

Colic Colic is a sign of abdominal pain, which in the horse is usually related to the gastrointestinal tract. This pain is commonly due to intestinal spasm (‘cramping’-type pain) or distension of the gut wall due to an accumulation of gas or ingesta within a particular part of the intestinal tract. Occasionally colic signs may be due to the blood supply becoming cut off to part of the gut. The latter usually results in more severe signs of pain and in most cases will be life threatening unless surgery is performed quickly.

If a horse is showing only mild signs of colic pain (e.g. pawing, flank watching, occasionally kicking at their belly or lying down), then walking them around for 10-20 minutes can be enough to help resolve mild signs of colic by stimulating gut motility. However, if there is no improvement in 30 minutes or if a horse is showing more severe signs of colic (rolling, persistently getting up and down or thrashing around or is suspected to have been showing these signs e.g. horse found in a stable with multiple grazes around the head and is not behaving normally) then veterinary advice should be sought immediately. A colicky horse should never be exercised at more than a walk unless under direct veterinary guidance in certain cases of colic. It is a common myth that allowing a colicky horse to roll will cause the intestine to become twisted. There is no evidence for this and the signs of severe pain are due to an intestine that has already become twisted or has

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become compromised. In these cases, the horse should be put in a well bedded stable, food removed together with objects that they could injure themselves on and await arrival of the vet. Do not risk horses going down on the yard or injuring people by walking them around if they are in severe pain.

Most cases of colic respond to administration of analgesia (pain relief) and may sometimes require other therapies e.g. stomach tubing of fluids. In those cases of colic that are more severe and require surgery to save their life (around 9% of colic episodes), the sooner that surgery is performed, the greater the horse’s chance of surviving.

Choke (oesophageal obstruction) This is a common emergency that occurs when feed becomes lodged in the oesophagus. The offending feed can be hay/ haylage, unsoaked sugar-beet pulp or other feed pellets or occasionally larger feed objects such as carrots or apple.

Affected horses will suddenly stop eating and will appear to retch, swallow and sometimes cough. This can be quite distressing to watch but fortunately in most cases, the obstruction will clear spontaneously without any veterinary treatment. If choke occurs, take feed and water away, leave the horse in a calm environment and wait 5 minutes.

Horses will appear brighter and interested in feed once it clears – in this case, offer some water and wait a further hour or so before offering any feed. If the obstruction doesn’t clear after 5-10 minutes, contact a veterinary surgeon for further advice.

Respiratory distress Veterinary advice should be sought immediately if a horse appears to be struggling to breathe or if it has a raised respiratory rate that is accompanied by a noise. The horse should be kept quiet and any stress minimised i.e. keep with companion horse and do not move until veterinary assessment can be performed.

Exhaustion / heat stroke This may occur in horses undergoing strenuous exercise in competition situations e.g cross country phase in eventing. Most of these events will have multiple veterinary surgeons present on site and facilities for cooling horses (including fans if required) will be available. Occasionally unfit horses competing in unusually hot and humid conditions at lower grade competitions may be at risk. Where a horse is showing distress in these situations, cooling should be instituted immediately. Cold water should be liberally applied over the entire horse, any tack should be removed, a headcollar placed and water allowed to run off or be removed using a skin scraper whilst walking the horse quietly around.

Where possible the horse should be kept in a shady, well ventilated area, the pulse and rectal temperature should be taken and veterinary advice sought immediately.

Figure 5. When dealing with recumbent or trapped horses, people should never position themselves in the kicking or head butt zones (circled in red) but should work in the ‘safer working zone’ (demonstrated in a model horse).

(see Figure 5). If the horse can be released easily, this should never be done unless the horse has somewhere safe to be released.

Recumbent horse – collapse / trapped

Recumbent horse – cast in the stable / field

Veterinary help should be sought immediately and if a horse is trapped or if it is recumbent and cannot get to its feet. If a trapped horse appears unlikely to be freed easily, assistance may also be required from the fire and rescue service (it is fine to call 999 for this).

Whilst waiting for help to arrive, the horse should be kept calm by keeping a companion horse nearby or offering some food. The owner / rider should also be kept calm and human safety should never be compromised by people attempting to rescue the horse without necessary assistance. A headcollar should be placed to ensure that the horses head can be controlled provided it is safe to do so; a headcollar is better than a bridle which can be pulled off or the leather snapped. Any helpers should put on hard hats and ensure they are wearing suitable clothing and footwear. It is important to ensure that people stay away from the kicking and head butt zones and remain in the ‘safer working’ area

In most of these situations, horses can be freed without veterinary or other assistance but the same principles apply in terms of preventing any injury to humans if a horse kicks out or thrashes around whilst trying to free it (see previous section). If a horse becomes cast, get some other people to come and provide some assistance (do not try to roll the horse over without having someone else around to help just in case things go wrong) and get extra equipment including lunge lines, a pole/ walking stick with a curved end to use as a hook and a head collar if a horse is not already wearing one. Put on a hard hat and approach the horse from the spine side wherever possible. If the horse is struggling, an experienced assistant can kneel on the horse’s neck from the mane side to keep the horse recumbent. Place a headcollar if safe to do so and attach a lunge line to the headcollar allowing the horse’s head to be controlled. Using the pole to keep away from the horses legs and

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leaning over the horses body from the spine side, thread the lunge line underneath the lower hind and forelimb (create a loop if required for the curved end of the pole to hook around) so that the lunge line lies between the ground and the lower limbs. Pull the lunge line so that it sits just above the knee and hock of the lower set of limbs, bring the ends of the lunge line over the top of the horses body (forming a rough triangle shape) and get a person to hold onto each end. Also get the person at the head and neck end to stand back, keeping hold of their lunge line. Then use the lunge line under the limbs to roll the horse over onto the correct side ensuring that you stay clear of the legs and move back to prevent being knocked by the horse as it gets to its feet, particularly if having to do this in an enclosed space such as a stable. The lunge lines should be allowed to drop to the ground to prevent the horse becoming tangled.

Finally, check the horse over for any injuries and observe it closely for a short time to ensure that it is well in itself – occasionally horses can become cast if they have been rolling due to suffering from colic.

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UNDERWATER TREADMILL (UWT) THERAPY IN DOGS: FINDING THE EVIDENCE TO CREATE A PROTOCOL FOR ITS USE A SMALL-SCALE SAMPLE LITERTURE REVIEW Laurie Edge-Hughes, BScPT, MAnSt(Animal Physio), CAFCI, CCRT The Canine Fitness Centre, Calgary, AB, Canada - laurie@fourleg.com Introduction Hydrotherapy, in the form of swimming or underwater treadmill walking, has become increasingly popular in animal rehabilitation. Very little literature exists on the subject of hydrotherapy protocols for dogs and anecdotal recommendations are widely propagated in the industry.

Where can a practitioner find the information that would be helpful in making an informed decision on what parameters would be appropriate for use with this modality as it pertains specifically to dogs? Is there enough evidence to make specific recommendations for its use?

Methods Three English-language textbooks on animal physiotherapy possess chapters on aquatic therapy/ hydrotherapy were reviewed.

Two were well referenced (Monk, 2007; Levine et al, 2004). One was not referenced at all and hence the information contained within should be considered as opinion.

(Bockstahler et al, 2004) The symposium proceedings from the 1st to 4th International Symposia on Rehabilitation and Physical Therapy in Veterinary Medicine and the Royal Veterinary College 2nd and 3rd Annual Veterinary Physiotherapy Conference were reviewed. This search yielded 12 studies. On further examination of these studies, only 5 provided data that would be useful in selecting appropriate parameters for use of this therapy. (Jackson et al, 2002; Dunning et al, 2004; Hudson and Hulse, 2004; Hamilton, 2002; Tragauer et al, 2002) A pubmed search was conducted utilizing the terms dog or canine and hydrotherapy or

underwater treadmill, or water or water walking or water exercise. (http://www.ncbi.nlm.nih.gov/sites/ entrez) This resulted in only 2 applicable abstracts. (Gandini, 2003; Millis and Levine, 1997) A Google Scholar search identified 3 additional studies, 2 of which were useable for this purpose (Monk, 2006; Marsolais, 2003). The International Veterinary Information Service website (www. ivis.org) allowed free access to abstracts from veterinary conference proceedings and selected books.

None of the conference proceedings were original research but one book chapter did provide a small amount of information on hydrotherapy and procedural recommendations (Steiss, 2003). Reviewing the reference list from the two referenced textbooks, produced only two additional canine specific papers (Tangner, 1984, Marsolais, 2002). (Note: all papers were obtained via this authors access to 2 university library websites.) A review of the human literature was limited to that presented in the two well referenced textbooks.

Results Scientific studies pertaining to water parameters in the UWT Jackson et al, (2002) •

•

Joint flexion was greatest when the water is filled at or higher than the joint of interest (pertaining to the hip, stifle, shoulder and elbow).

The flexion obtained was comparable to flexion ranges achieved during swimming.

With water height at the greater trochanter, end stage propulsion (extension in the hip, stifle and shoulder) was reduced.

34

•

Full active joint extension of the hip, stifle and hock was achieved during full limb cycles when compared to walking on land at the levels of the lateral malleolus and stifle.

Tragauer et al, (2002) •

•

Land weight bearing ratio of front legs: hind legs was 64:36.

This same ratio was maintained with water heights at the lateral malleolus and lateral femoral condyle at the stifle. However, the ratio changed to 71:29 with water at the height of the greater trochanter.

Table 1 describes the percentage of land weight resultant from partial water immersion at varying depths in the dog.

Dunning et al, (2004) •

There was no significant difference in heart rate, respiratory rate, rectal temperature and perceived exertion score in dogs exercising for 10 minutes in an underwater treadmill at temperatures of 30, 31.1, 32.2, 33.3, 34.4 °C.

Parameters used or suggested for canine water exercise A compilation of scientific papers was attempted and results are contained within table 2. Very few studies looked at underwater treadmill specifically, and so two studies that utilized swimming were also included. Many studies did not report all variables. Anecdotal recommendations for hydrotherapy exercising are recorded in table 3.

Water Height Lateral malleolus Lateral femoral condyle Greater trochanter

% of land body weight 91% 85% 38%

Table 1. Percentage of body weight on land during partial immersion at various water depths in dogs (Jackson et al, 2002).

Study

Condition for which water therapy was choosen

When started on water therapy

Type of exercise

Water height

Water temp.

Exercise time

Frequency

Marsolais et al, 2002

Post operative cruciate repair

3 weeks post-op

Swimming

N/A

32.3 – 33.3°C

10 – 20 mins

2x/day 5days/wk

Hamilton, 2002

Osteoarthritis

Immediately upon referral

UWT walking

Not reported

Not reported

Up to 40 mins

2x/day 2 - 3days / wk

Marsolais et al, 2003

Post-operative cruciate repair

3 weeks postop

Swimming

N/A

32.2 – 33.3°C

10 – 20 mins

2x/day 5days/wk

Gandini et al, 2003

Fibrocartilaginous embolus

As soon as possible

UWT

Not reported

Not reported

10 minutes

2x/day

Hudson et al, 2004

Osteoarthritis

Immediately upon referral

UWT walking

Greater trochanter

94°F (appx 34°C)

2 x 3mins with 10 mins of standing in water btwn sessions

2days/wk

Monk et al, 2006

Post operative cruciate repair

After suture removal day 10 post op

UWT walking

Greater trochanter

32 °C

Wk 2 -3x3min Wk 3 -2x5min Wk 4 - 2x7min Wk 5 - 1x15min Wk 6 - 1x20min

1x/day

Table 2. Parameters used for aquatic exercise studies in dogs

Source

Type of exercise

Water parameters

Exercise time / frequency

Tangner, 1984

Swimming

Warm water

10 – 20 mins, 2 x / day

Millis et al, 1997

Swimming

Not reported

Start 1 – 3 mins, 1x / day 3 – 7 days / week

Steiss, 2003

Swimming or UWT

Tissue relaxation at 95 °F (36 °C) Lower temp for swimming or exercise

5 – 10 mins Only a few minutes if animal is deconditioned or debilitated

Bockstahler, 2004

UWT

25 – 35 °C

Start 3 x 2 mins Increase by 10% weekly 2 – 3 days / week Adjust according to fitness levels Include warm up and cool down for 2 mins each either in or out of the water

Table 3. Anecdotal recommendation from literature sources for aquatic exercising in dogs

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Variables for water exercising from human literature Exercise prescriptions for waterwork may not be as clear as one would expect and cannot be transferred directly from land.

Energy expenditure in water may be increased when exercising in cold water due to shivering which occurs in humans at temperatures of 28 - 34°C (Curtain, 1997). Evans (1978) found that ½ to 1/3 of the speed was needed to walk or jog across a pool in waist deep water at 31°C to achieve the same energy expenditure as walking or jogging on a dry treadmill. Monitoring of heart rate may yield invalid conclusions, as it has been shown to be lower by approximately 10 beats per minute with strenuous exercise in water (Craig and Dvorak, 1970; Evans, 1978). This same phenomena was observed in dogs walking in water as compared to land treadmills at the same velocity and length of time (Levine, 2004).

Resting heart rate is also affected in water. Resting heart rates in humans are lower in water but were increased with temperature increases to 36°C as compared to 28°C (Johnson et al., 1977; Hall et al, 1998). Optimal water temperatures for exercising for humans is reported between 28 - 30°C (Edlich et al, 1987).

Discussion and Conclusion Literature is lacking in the area of water exercising and therapy in canine literature. Within the existing literature, huge variability exists as to hydrotherapy parameters and recommendations.

(Note: without library access to the full texts of the specific journal articles, even the above literature recommendations would not be obtainable.

Clinicians would have difficulty making informed recommendations without this access.) To further the knowledgebase within this area of practice, it would be interesting to survey a wide base of practitioners that utilize swimming or UWT therapy currently with their canine

rehabilitation practices to determine individually-acceptable parameters.

Additionally, controlled studies that evaluate the effectiveness of different hydrotherapy parameters are needed to make evidence-based decisions on its usage.

and Physical Therapy in Veterinary Medicine.

Knoxville, TN. Johnson, B.L., Stromme, S.B., Adamczyk, J.W., Tennoe, K.O., (1977) Comparison of oxygen uptake and heart rate during exercises on land and in water. Phys Ther. 57: 273 – 278.

Levine, D., Rittenberry, L., Millis, D.L., (2004) Aquatic Therapy. In: Millis DL, Levine D, Taylor RA (eds) Canine Rehabilitation and Physical Therapy. Saunders, St Louis, Missouri, pp 264 – 276.

References Bockstahler, B., Levine, D., Millis, D., (2004) Essential Facts of Physiotherapy in Dogs and Cats Rehabilitation and Pain Management. BE Vet Verlag. Babenhausen, Germany.

Craig, A.B, Dvorak, M., (1970) Thermal regulation during immersion. J Appl Physiol.

21: 1577 – 1585.

Curton, K.J., (1997) Physiologic responses to water exercise. In: Routi RG, Morris DM (eds) Aquatic Rehabilitation. Lippincott, Philadelphia, PA, pp 39 – 56.

Evans, B.W., (1978) Metabolic and circulator responses to walking and jogging in water.

Res Q. 49: 442 – 449.

Dunning D., McCauley L., Knap K et al., (2004) Effects of water temperature on heart and respiratory rate, rectal temperature and perceived exertional score in dogs exercising in an underwater treadmill. Proceedings 3rd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine.

Research Triangle Park, NC. Edlich, F.R., Towler, M.A., Goitz, R.J., Wilder, R.P., Buschbacher, L.P., Morgan, R.F., Thacker, J.G., (1987) Bioengineering principles of hydrotherapy. J Burn Care Rehab. 8(6): 580 – 584.

Gandini, G., Cizinauskas, S., Lang, J., Fatzer, R., Jaggy,A., (2003) Fibrocartilaginous embolism in 75 dogs: clinical findings and factors influencing the recovery rate. J Small Anim Pract. 44 (2); 76 – 80.

Hall, J., Macdonald, I.A., Maddison, P.J., O’Hare, J.P., (1998) Cariorespiratory responses to underwater treadmill walking in healthy females. Eur J Appl Physiol. 77: 278 – 284.

Hamilton, S.A., (2002) Rehaiblitation of osteoarthritis in a dog. Proceedings 2nd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine.

Knoxville, TN. Hudson, S., Hulse, D., (2004) Benefit of rehabilitation for treatment of osteoarthritis in senior dogs. Proceedings 3rd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine. Research Triangle Park, NC. Jackson, A.M., Millis, D.L., Stevens, M l., (2002) Joint kinematics during underwater treadmill activity.

Proceedings 2nd International Symposium on Rehabilitation

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Marsolais, G.S., Dvork, G., Conzemius, M.G., (2002) Effects of post-operative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc. 220: 1325 – 1330.

Marsolais, G.S., McLean, S., Derrick, T., Conzemius, M.G., (2003) Kinematic analysis of the hind limb during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament rupture. J Am Vet Med Assoc. 22 (6): 739 – 743.

Millis, D.L., Levine, D., (1997) The role of exercise and physical modalities in the treatment of osteoarthritis. Vet Clin North Am Small Anim Pract. 27; 913 -930.

Monk, M., (2007) Hydrotherapy. In: McGowan C, Goff L, Stubbs N (eds) Animal Physiotherapy Assessment, Treatment and Rehabilitation of Animals. Blackwell Publishing, Oxford, UK. Monk, M.L., Preston, C.A., McGowan, C.M., (2006) Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the crania. cruciate ligament.

Am J Vet Res. 67 (3): 529 – 536.

Steiss, J.E., (2003) Canine Rehabilitation In: Braund, KG (ed) Clinical Neurology in Small Animals – Localization, Diagnosis and Treatment. IVIS, New York.

Tangner, C.H., (1984) Physical therapy in small animal patients: basic principles and application. Comp Cont Ed. 6 (10): 933 – 936.

Tragauer, V.L., Levine, D., Millis, D.L., (2002) Percentage of normal weight bearing during partial immersion at various depths in dogs.

Proceedings 2nd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine. Knoxville, TN.

FEEDING THE CANINE ATHLETE Esther Rawlinson BVMS MRCVS, Veterinary Affairs Manager, Purina -

Nestlé Purina PetCare, 1 City Place, Gatwick, RH6 0PA Tel: 07785 452038 Email: Esther.Rawlinson@purina.nestle.com All dogs require a complete and balanced diet, but some canine athletes require particular nutritional management.

The majority of performance dog nutrition research has been conducted using either endurance dogs or sprinters (greyhounds) (Cline and Reynolds, 2005; Wakshlag, 2013; Hill, 1998). Most performance dogs are neither but considered to undertake an “intermediate” level of activity.

Canine athletes participate in a wide range of physical activities such as agility, field trials, flyball or working in the field, and their nutritional requirements will vary according to the type and intensity of exercise performed. The family dog who doubles as a working gundog may exercise hard at weekends but very little during the week while other canine athletes may exercise more regularly but at moderate to low intensity. There may be short bursts of intense activity such as running up a hill or completing an agility course but the majority of exercise more closely resembles endurance than sprinting.

Nutritional Requirements Energy Physical activity requires an increase in metabolism which in turn increases the need for energy.

Energy is obtained from the fat (provides energy in the form of free fatty acids), carbohydrates and protein (provide energy in the form of glucose) in the diet. Fat is the most energy-dense nutrient, providing over twice as many calories (gram for gram) as protein or carbohydrates, so high fat diets are useful for dogs that have a high energy requirement (Grandjean and Paragon, 1992; Ramsey et al, 2012).

High intensity exercise (e.g. sprinting) relies heavily on anaerobic metabolism with most energy coming from carbohydrates

(glycogen).

Moderate intensity exercise is primarily aerobic, with energy supplied mostly by free fatty acids plus some from protein and carbohydrates. Low intensity exercise is completely aerobic and uses mostly free fatty acids.

Fat in the diet The fat stores of a lean, well-fed working dog contain far more energy than their carbohydrate stores (glycogen). Strategies for improving endurance have focused on enhancing the oxidation of fat for energy and sparing use of the more limited carbohydrate resources (Hill, 1998; Grandjean and Paragon, 1992; Reynolds et al, 1995).

Fat oxidation is improved when the maximal aerobic capacity (the maximum capacity of an individual’s body to transport and use oxygen during exercise) increases. Feeding a higher fat diet to fit dogs can increase the maximal aerobic capacity and the dogs also use muscle glycogen at a slower rate than when on a high carbohydrate diet (Cline and Reynolds, 2005 ; Hill, 1998 ; Reynolds et al, 1995).

Dogs are more efficient at fat metabolism than most other species (Cline and Reynolds, 2005; Hill, 1998; Grandjean and Paragon, 1992). A combination of training and diet can increase the amount of circulating free fatty acids available for use as an energy source (Grandjean and Paragon, 1992; Toll, 2002). During exercise, dogs fed a higher fat diet release more free fatty acids into their bloodstream than dogs fed a high carbohydrate diet (Reynolds et al, 1994 ; Kronfield, 1977).

Having the right ratio of protein:fat:carbohydrates in the diet helps optimise oxygen metabolism so that the dog can use the energy from fat more efficiently and helps the dog to recover better between bouts of exercise.

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Carbohydrate in the diet During the first few minutes of exercise, or when short bursts of intense exercise are required, glycogen is the primary fuel.

Glycogen is the storage form of glucose found in the muscles and liver, however there are very limited stores in the body. Therefore this is a critical fuel source that, when depleted, may affect a dog’s ability to perform to the best of its capability.

Studies in humans have shown that long-distance runners have decreased speed and a perception of greater fatigue if their muscle glycogen is not replenished during multiple days of running (Conlee, 1987). Likewise dogs with low glycogen levels have been described as “losing focus” or “losing drive” (Cline and Reynolds, 2005).

Moderate amounts of high quality carbohydrates can provide the energy needed for the start of an exercise session. Whilst canine athletes have no specific need for digestible carbohydrates provided there is enough protein in the diet, carbohydrates can help the dog to maintain good glycogen stores and be able to carry out repeated bouts of exercise and work on a longerterm basis (Cline and Reynolds, 2005). Unfit dogs (eg at the start of the hunting season) rely more heavily on carbohydrates as an energy source than a fit dog (Cline and Reynolds, 2005).

Carbohydrates in the form of fibre are also important for gut health: soluble fibres act as prebiotics, helping to increase the quantity of bifidobacteria in the gut and nourish the intestinal cells, while insoluble fibres help promote healthy gut motility (Hill, 1998).

Protein in the diet Protein is needed to build and maintain muscles. There is constant

“turnover” of muscles, and exercise can increase the needs of the muscles, which in turn increases the dog’s protein requirements by up to 15%. At least 25% of the calories in the diet should be provided by protein to maintain optimal maximal aerobic capacity and help muscle recovery (Toll, 2002). This is likely to be listed as about 30-32% protein in the “analytical constituents” on the label of a bag of energy-rich dry dog food. This amount of protein has also been shown to improve performance and to reduce the risk of soft tissue injury (Reynolds et al, 1999) (see Table 1).

Adequate levels of good quality protein also help to support the production of red blood cells which are needed to carry oxygen to the

muscles and organs (Reynolds et al, 1999).

require 2-3 times more calories than a pet dog. It is key to feed to maintain an appropriate body condition (4 or 5 on a 9-point scale (Laflamme, 1997)) so it is recommended to regularly monitor the dog’s body condition score and adjust the amount of food up or down as needed, see Diagram 1 below.

Feeding Quantities Guidelines regarding quantities to feed are always estimates and the dog’s actual requirements will vary depending on its energy expenditure. A working dog may

Guidelines for canine athletes (intermediate exercise)

% of calories from protein

% of calories from fat

% of calories from carbohydrates

>25

35-65

10-40

Table 1: Table showing guidelines for canine athletes (Toll, 2002 ; Hill, 2004)

Diagram 1: Condition Scoring System on a 9-point scale (Laflamme, 1997)

38

Feeding Practices As important as the nutrients fed are the feeding practices. Three things must be considered: diet digestibility, hydration and feeding time.

Diet digestibility should be at least 80% to promote adequate uptake of nutrients without excess faecal bulk (Cline, 2005). Hydration is important firstly to help dissipate heat (exercise produces heat) and secondly to remove the by-products of energy metabolism. Exercising dogs may be distracted by their environment or task, and therefore should be encouraged to drink water during extended exercise.

Unlike humans, dogs regulate their temperature mainly through panting rather than sweating, so lose mainly water and not electrolytes and do not benefit from electrolyte replacement.

Finally, meal timing is important.

It takes approximately 23 hours for a large meal to be completely digested (Kenney et al, 1988). The extra weight of faecal matter in the colon could potentially compromise performance and it is thought it may also cause irritation of the lining of the colon (Cline, 2005). It is recommended that dogs are fed about 24 hours before an intense exercise bout to help alleviate problems associated with a full colon (Cline, 2005).

The heat released during digestion can also increase the heat load in exercising dogs that are already at risk of excessive heat production.

Dogs should ideally be fed within 30 minutes of exercise to help replenish glycogen stores. Exercise diverts blood flow away from the gut and alters gut transit, which can change nutrient digestion and absorption (Kenney et al. 1988), however, most dogs can be fed within 45 minutes of cessation of exercise, provided they are no longer panting or showing signs of heat stress or dehydration (Cline, 2005).

Summary Athletic

dogs

generally

more energy, protein and antioxidants than sedentary dogs.

The extra nutrients required are related directly to the exercise intensity, frequency and duration.

Many diets formulated for nonworking dogs are not high enough in calories or protein for active dogs, however there are a number of diets available which are specially formulated for active/working dogs.

Feeding management practices are also vitally important and can directly affect canine performance.

References Cline, J., and Reynolds, A., (2005) Feeding the canine athlete. Purina Research Report 9 (1) 2-5.

Cline, J., Reynolds, A., (2005) Canine athletes and carbohydrate management during exercise. Purina Research Report 9 (1) 6-7.

Conlee, R.K., (1987) Muscle glycogen and exercise endurance: a twenty-year perspective. Exerc Sport Sci Rev 15 : 1-28.

Grandjean, D., Paragon, B.M., (1992) Nutrition of racing and working dogs. Part 1.

Energy Metabolism of dogs. Compend Cont Education 14 : 1608-1615.

Hill, R.C., (1998) The Nutritional Requirements of Exercising Dogs. J Nutr 128 : 2686S-2690S. Hill, R.C., (2004) Nutritional Requirements of Dogs & Cats. National Research Council (in press).

Kenney, M.J., Flatt, A., Summers, R.W., (1988) Changes in jejunal myoelectric activity during exercise in fed untrained dogs Am J Physiol 254 : G741-747.

Kronfield, D.S., Hammel E.P., Ramberg C.F., (1977) Haematological and metabolic responses to training in racing sled dogs fed diets containing medium, low, or zero carbohydrate. Am J Clin Nutr 30: 419-430.

Laflamme, D., (1997) Development and validation of a body condition score system for dogs. Canine Practice 22(4) 10-15.

Reynolds, A., (1994) Lipid metabolite responses to diet and training in sled dogs. J Nutr 124 ; 2754S-2759S. Reynolds, A.J., Fuhrer, L., Dunlap, H.L., Finke, M., Kallfelz, F.A., (1995) Effect of diet and training on muscle glycogen storage and utilisations in sled dogs. J Appl Physiol 79, 1601-1607.

require

39

Reynolds, A.J., Reinhart, G.A, Carey, D.P., Simmerman, D.A., Frank, D.A., Kallfelz, F.A., (1999) Effect of protein intake during trainng on biochemical and performance variables in sled dogs. Am J Vet Res 60, 789-795.

Ramsey, J.J., (2012) in Fascetti AJ and Delaney SJ. Applied Veterinary Clinical Nutrition. pp 23-45.

Toll, P.W., Reynolds, A.J., (2002) In Hand MS, Thatcher CD, Remillard RL, Roudenbush P (eds). Small Animal Clinical Nutrition.

Marceline. Walsworth Publishing. pp 261-289.

Wakshlag, J.J., (2013) The new age of working dogs : different jobs, different diets. Nestle Purina CAN Summit 55-61.

PHYSIOTHERAPY APPROACH TO STIFLE PATHOLOGIES South Central Regional Group Edleston, N. MCSP ACPAT A; Hutson, P. MSc, BSc (hons) MSCP, HCPC, ACPAT A; Nightingale, S. MCSP ACPAT Cat A; Clarke, E. BSc (hons) Physio pgDip Veterinary Physiotherapist ACPAT A HCPC MCSP ; Turner, M. MCSP HCPC ACPAT A Grad Dip Phys Grad Dip Animal Manip; Kerr, H. MCSP ACPAT; Richmond-Watson, L. MCSP ACPAT A ; Gilbert, J. MCSP ACPAT A; Marlow, R. MCSP ACPAT A; Davison, A. MCSP ACPAT A; Benson, H. MSc VetPhys ACPAT A MCSP, Cann, H. MCSP ACPAT A; Crump, J. MCSP ACPAT A; Richardson, K. MCSP ACPAT A; Robson, M. PgDip MSc BSc(Hons) BHSI(SM) MCSP HCPC ACPAT A; Clampton, K. MSc Vet Phys BSc Hons MCSP ACPAT A Introduction The equine stifle joint is the largest and most complex joint in the horse (Crijns et al, 2010). Injuries to the equine stifle can be due to athletic injuries or developmental changes.

Structures affected include bone, cartilage, ligament and synovial structures which if not treated effectively can lead to chronic joint instability and secondary arthritis (Gillis, 2011).

and lateral femorotibial joints are formed between the medial and lateral tibial and femoral condyles.

These are separated by the crescent shaped menisci.

The superficial and deep parts of the medial collateral ligament (MCL)

course within the capsule, also having attachment to the medial meniscus. The lateral collateral ligament is similar, and attaches in part to the lateral meniscus but is separated from it by the tendon of origin of the popliteus muscle, which also separates the ligament from the

Advances in veterinary diagnostics have enabled the stifle joint to be more accurately investigated, diagnosed and treated. Following a diagnosis of a stifle injury it may be beneficial for a Chartered Veterinary Physiotherapist to be involved and work alongside the referring Veterinary Surgeon to help enable the horse to reach itâ&#x20AC;&#x2122;s desired goals and maximal potential.

The Stifle Anatomy The following anatomical description is given by Powell, 2010.

The stifle comprises three compartments - the medial and lateral femorotibial joints and the femoropatellar joint, formed by the trochlear groove of the femur and patella. The medial trochlear ridge is more prominent. Cranially, there are three patellar ligaments (medial, middle and lateral) (see Figures 1 and 2). The centre of the tibial plateau forms the intercondylar eminence comprising two prominences (medial and lateral intercondylar tubercles). The medial

Figure 1. A drawing of a cranial view of a left equine stifle joint given by Turner M MCSP HCPC ACPAT A Grad Dip Phys Grad Dip Animal Manip.

40

lateral femoral condyle. Unlike its medial counterpart distension of the lateral femorotibial joint is not easily palpable due to the overlying biceps femoris separating it from the skin laterally. The two cruciate ligaments are extrasynovial between the medial and lateral femorotibial compartments (Powell, 2010).

The femoropatellar and medial femorotibial joints commonly communicate through a slit-like orifice at the junction of the medial trochlea and the medial femoral condyle. The femoropatellar and lateral femorotibial joints rarely communicate. The medial patella ligament forms the stifle locking mechanism used for energy conservation during rest. Upon extension of the stifle in weight bearing the medial patella ligament hooks over the medial trochlear ridge of the femur (Schuurman et al, 2003).

Palpable structures within the stifle, according to Walmsley (2005) are the patellar ligaments, the outline of the patella, the medial collateral ligament (MCL), the long digital extensor tendon, the tibial crest, and the medial and lateral femoral trochlear ridges. Dissention of the stifle is most readily appreciated in the femoropatellar joint and the medial femorotibial joint cranial to the MCL. The muscles involved with the stifle are the extensor muscles which include the quadriceps, long and lateral digital extensors, tensor fascia lata and the flexor muscles including biceps femoris, semimembranosus, semitendinosus combined with the three patellar ligaments (medial, middle, and lateral) which confer considerable stability to the stifle (Desjardins and Hurtig, 1991).

Presentation of stifle injuries Stifle injuries can occur due to the athletic demands placed on the horse or from the development of orthopaedic diseases (Gillis, 2011).

Histories that may alert the vet to potential stifle injuries would

Figure 2. A drawing of a medial view of a left equine stifle joint given by RichmondWatson L MCSP ACPAT A

include: an old known injury to the stifle, a locking patella, an activity related injury such as hitting a cross country jump, a slip or a fall or a rapid deceleration injury.

Particular attention should be paid to rotational and extension injuries of the stifle for example slipping on take-off to a jump. This is because primary meniscal injuries can occur from sudden compressive forces while the stifle joint is in extension (Walmsley, 2005). Other trauma can occur with stabling issues such as post box rest, being cast, a foot getting caught in a haynet, narrow doorways, rushing through doorways, slipping in the stable or on the yard.

The type of horse and age should also be considered, Walmsley et al (2010) found in a series of 410 arthroscopic procedures of 80 horses, the median age for meniscal injures was 8 and they occurred in 54 geldings. Various breeds were represented: there were 31

41

Thoroughbred crosses, 19 Warmbloods, 10 Thoroughbreds, 9 cobs and 5 Arabians.

Osteochondritis dissecans (OCD) should also be considered in horses with stifle pathology.

Osteochondrosis is a developmental orthopaedic disease which is common amongst young horses.

OCD is having a great impact on the equine industry with the stifle being a commonly affected joint (Kane 2012). In some cases it can be self-limiting or for others, catastrophic (Coumbe, 2013).

Osteochondrosis is a failure of normal endochondral ossification.

During the developmental period, abnormal cartilage is laid down within the joint which may be thickened, soft, collapsed or entirely separated from the bone (Kane, 2012). Clinical signs can include mild to moderate lameness and an enlarged joint. Further diagnosis is confirmed by radiographs (Coumbe, 2013).

Horse owners may report any of the following which may further indicate a possible stifle issue: •

• • • •

• •

• • •

Difficulties in canter such as changing legs, going dis-united, reluctance, bunny hopping and difficulty collecting.

An asymmetrical gait pattern at walk and/or trot.

Poor back or pelvic movement.

Problems picking out feet or with the farrier.

Reluctance to go forward, reduced propulsion, not working over the back, reluctance to go downhill and uphill.

Problems with jumping.

Clicking (not always stifle although often assumed), swivelling/twisting on one leg, shuffling /sliding, uneven shoe wear.

Rider getting back pain.

Saddle moving.

Poor rein back.

Table 1.I The results from a study of over 1000 horses by Murray et al (2006) showing the proportions of injuries to the stifle depending on the use of the horse.

(Gillis, 2011). Although OCD can present in a mix of breeds and ages it is currently a complex disease involving a multitude of potential causes from inherited genetic and external environmental risk factors (Kane, 2012).

Prevalence of stifle injuries Veterinary diagnosis Athletic injuries will depend on the type of sport the horse is competing at as well as the level.

Some sports predispose to specific injuries (Murray et al, 2006). Table 1.1 highlights the results from a study of over 1000 horses by Murray et al (2006), which showed the prevalence of stifle injuries in sport horses. They found that stifle injuries are most prevalent in elite event horses (8%) while least prevalent in non-elite showjumpers.

A review of injuries sustained by event horses during competition and training found that in the hind limb the stifle was the most injured body part in both one day events (ODE) and Cours Complet Internationals (CCI) (Singer et al, 2008). The most common cause of injury was hitting a cross county fence where skin abrasions were the most prevalent however most injuries did not result in any obvious lameness (Singer et al, 2008).

Special attention should also be paid to young Warmblood horses coming into work, due to their risk of OCD

The stifle provides the vet with a diagnostic challenge (Walmsley, 2003). Radiology and ultrasonography are the most commonly used diagnostic imaging techniques for stifle pathology.

However, they have their limitations due to the superimposition of the bony structures and surrounding bony structures restricting the ligamentous structures (Crijns et al, 2010). Developments in arthroscopy and ultrasonography have led to an increase in the diagnosis of meniscal tears (Walmsley et al, 2010).

Unfortunately, unlike in humans, an arthroscopy of the equine stifle is unable to examine the main body of the meniscus which can often go undiagnosed and untreated (Walmsley et al, 2003). Gillis (2011) found that meniscal tears and collateral ligament issues are usually initially positive to flexion tests and the horse is at least grade 2 lame. Injuries to the medial meniscus or collateral ligament are more prevalent than the lateral ligament and meniscus. The triad of cruciate, meniscal and collateral

42

ligament injury, seen in people, are uncommon in the horse (Walmsley, 2005; Gillis, 2011). Cruciate injury may be linked to meniscal injury in 15% of meniscal cases (Walmsley, 2005). Most horses will have more than one abnormal stifle structure upon examination (Walmsley, 2005; Gillis 2011).

Potential diagnosis of stifle pathology includes: • • • • • •

Medial patellar ligament desmitis.

Osteochondritis Dissecans.

Subchondral cystic lesions of the femoral condyle.

Cruciate, collateral or patella ligament injury.

Meniscal tears, hyaline cartilage damage, fractures.

Non-specific joint effusion.

Veterinary Treatments The treatment options for a horse with a stifle injury depends on the site of the pathology and the diagnostic tools used to diagnose it. Treatment can be conservative or invasive. Some of the treatment options include rest (box or penned), non-steroidal anti-inflammatories (NSAIDS), cold therapy, oral glucosamine and hyaluronic acid, arthroscopic debridement and repair, intraarticular injection of steroid and hyaluronic acid, or interleukin-1

Figure 3: A Chartered Veterinary Physiotherapist assessing hindlimb protraction.

receptor antagonist protein (IRAP) and a gradual return to work (Walmsley, 2005; Wallis et al, 2008; Gillis, 2011; Ortved et al, 2012).

Walmsley (2010) recommends that non-specific stifle lameness which has been diagnosed using noninvasive diagnostic tools, should be treated with stable rest and intraarticular medication. The horse should be reviewed in six weeks, if the lameness has improved then controlled exercise should begin but if there is no improvement an arthroscopic investigation is indicated. The proposed protocol

by Walmsley (2010) following a meniscal repair involved 6 weeks stable rest with incremental hand walking, followed by 4 months in a small pen and no free paddock exercise until the horse has returned to full work . For sprained medial collateral ligaments the horse should be given antiinflammatory drugs and rested for 6 weeks before starting a controlled exercise regime (Walmsley, 2010).

Presentation to the Physiotherapist In recent years the role of the equine physiotherapist has grown and they are now considered a valued member of the professional team. A physiotherapist may therefore be presented with a horse following a competition which presents with a mild performance issue. Following an assessment a stifle injury may be identified and referred to the vet for further diagnostic procedures (Figure 3).

Within orthopaedic human medicine the physiotherapist has a routine role post knee arthroscopy.

It is well documented that the quadriceps muscle atrophies quickly in the presence of pain (Williams et al, 2005; Natri et al, 1996) and a physiotherapist may well prescribe quadriceps strengthening exercises as well as range of movement exercises to improve joint range of motion and restore normal muscle function. In veterinary medicine the role of the physiotherapist following stifle surgery is growing and the

43

physiotherapist is in an ideal position to assist the vet in the rehabilitation process.

Objective assessment by the physiotherapist The following observations will help to differentially diagnose the stifle: Gait: •

•

•

Shortened cranial phase of the stride, a low arc of flight of the limb, and a worsening of the lameness with the limb on the outside during lunging (Walmsley, 2005). These are also seen in non-stifle issues.

The foot placed close to the midline while maintaining the stifle abducted by means of external rotation (Desjardins and Hurtig, 1991).

Elevated hip allowing the horse’s foot to clear the ground without the usual degree of hock and stifle flexion (Desjardins and Hurtig, 1991).

Palpation and further observations:

• •

•

• •

•

•

•

Effusion of the stifle joint.

Palpation between the patellar ligaments may identify joint effusion (Desjardins and Hurtig, 1991).

Quadriceps muscle asymmetry or spasm.

Restricted passive range of motion of the stifle with the non-involved limb (Brooks, 2011).

Horses with capsular or ligamentous sprain injuries of the stifle will resist abduction of the limb (Desjardins and Hurtig, 1991).

Locking stifle (Schuurman et al, 2003) or visible ‘jumping’ of the patella when horse weight shifts (Brooks, 2011). Reduced stifle stability when forced to weight shift (Brooks, 2011).

Asymmetrical shoe wear, rotation of the ilium, spinal or gluteal muscle soreness.

Tests •

Reluctance to 3-leg stance.

•

•

Resistance to proximal flexion of the limb.

Possible response to flexion testing, although flexion tests are non-specific and a positive result could implicate hip, hock or stifle (Walmsley, 2005; Desjardins and Hurtig, 1991).

Alterations/reluctance to rein back under saddle or in hand (Brooks, 2011) Clicking / palpable crepitus although clicking can often be difficult to localise to a specific joint.

Manipulation tests for evaluation of cruciate ligaments and MCLs are difficult to perform and interpret due to guarding by the horse (Walmsley, 2005).

Clinical signs and history are often consistent with other hind limb, pelvic or spinal issues (Desjardins and Hurtig, 1991) Physiotherapy treatment Horse owners often rely on specific and detailed rehabilitation programmes. Chartered Veterinary Physiotherapists with their skills

Figure 4. A stability exercise using baited cervical stretches.

44

in clinical reasoning and goalorientated exercise prescription are ideally suited to delivering these task specific rehabilitation programmes.

Physiotherapy treatment options will depend on the diagnosis, veterinary treatment and the vet’s protocols and the stage of healing.

At all times the physiotherapist will work as part of the team.

Physiotherapy input can commence from early diagnosis to end stage/ sports specific rehabilitation.

Physiotherapy treatments are aimed to reduce pain, promote quality healing and maintain the musculoskeletal system while the horse is not working and to prepare the horse for a return to work (McGowan et al, 2007). A rehabilitation program needs to adequately challenge the healing tissues to allow for strengthening and remodelling to occur and timely assessments prevent tissues from being over-loaded (Davidson, 2005; Millis, 2005). These programs require continued assessment and progression until the horse returns to full work.

(Figure 4 and 5).

Figure 5. A tail pull exercise aiming to facilitate quadriceps engagement.

Physiotherapy during relative rest Once box rest has been prescribed by the vet either following surgery or post injury, physiotherapy can begin (See Table 2). The type of rest varies amongst vets; some prescribe penned rest, use of horse walkers or in-hand walking from early on in the rehabilitation process. Early controlled mobilisation, specifically designed for the joint and type of injury, benefits ligament and joint injuries (Davidson et al, 2005; Schils and Turner, 2010). Horses may be more controlled if in-hand walking is done soon after relative rest is prescribed and it forms part of their daily routine. In our human work a physiotherapist would encourage early mobilisation and exercise but with regard to the Veterinary Surgeons Act 1966 the physiotherapist would discuss early mobilisation options with the vet. Mobilisation requires close monitoring and adjustments by the physiotherapist (Davidson et al, 2005; Brooks, 2011). Range of motion exercises should begin within the first day after injury or surgery along with low force flexibility exercises (Schils and Turner, 2010). Stability exercises are also important to commence early on due to the early atrophy of slow twitch muscle fibres following joint injury from the inhibition of motor units (Schils and Turner, 2010)

With regards to an upwardly fixated patella, Schuurman (2003) suggested it could be caused by spastic activity of vastus medialis, in this instance restoring normal neuromotor control would be of benefit. Brooks (2011) advised the following programme: passive full hip and stifle flexion; limb protraction; retraction, adduction for 10-30 seconds.

Brooks (2011) also advocated isometric exercises of lateral tail pulls holding for 10 seconds repeating 10 times which can be progressed to a 3 legged stand for up to 30 seconds while ensuring the horse is not weight bearing significantly on the person but on their standing hind limb.

Commencing Exercise The aims of the early stages of rehabilitation will still apply when commencing exercise with the aim to progress the exercise programme to further challenge the tissues.

Exercise prescription will depend on the anatomical structures being targeted (Davidson et al, 2005; McGowan et al, 2007).

Considerations will be made with respect to the surface, pace, time and repetition and will occur with close monitoring and relevant progression after assessment (McGowan et al, 2007; Brooks, 2011).

Exercise in hand is often recommended following a period of box rest but care needs to take into account with regards to the horseâ&#x20AC;&#x2122;s temperament, the environment, the amount of control the horse and owner will need, owner confidence and safety of horse and handler.

Other exercise options include ridden exercise, long lining, lunging and the treadmill particularly if safety of the horse and handler is an issue. Purpose built rehabilitation centres may also be indicated, at this point.

Ideally a horse recovering from a stifle injury should commence work in hand and on a firm level

45

surface in straight lines. Later on, to improve proprioception, neuromuscular control and fibre healing, the progression should incorporate different surfaces, slopes, shallow curves, circles, figures of eight, changing directions and adjusting length of time and occurrence (McGowan, 2007).

Other physiotherapy treatments include proprioceptive taping, elastic exercise bands, thoracic sling, pelvic strap, stability in the lateral plane, psoas activation, taping for excitation or inhibition of specific muscles, weights, proprioceptive chains, pole work, transitions, mazes, rein back, hill work (McGowan et al, 2007; Brooks, 2011) (Figure 6).

If there is access to a hydrotherapy pool, treadmill or spa this could be considered an option (McGowan et al, 2007).

For an upwardly fixating patella, Brooks (2011) advocated an isotonic exercise programme which should start with in-hand walking ensuring the horse is walking out with significant impulsion. The physiotherapist would prescribe a specific distance or time in order to progress the exercise.

In-hand walking prior to passive stretches will increase tissue extensibility to the stretches. The next progression Brooks (2011) advocated wasbacking up starting with 3 metres repeated 3 times, the quality of backing should be noted and encouraged. This exercise may be suitable for other stifle problems.

Ridden work Many owners assume once the saddle is back on their horse it is just a matter of a general gradual increase in work. Work should continue to be purposeful and include proprioception, core stability, joint stability work, muscle control and strengthening and sport specific reconditioning. Loading of joints, ligaments and tendons needs to be controlled to condition the structure before any ballistic forces are applied to the structures (McGowan, 2007). Physiotherapy rehabilitation for ridden work will

Aim

Treatment options

Reduction of effusion

Ice massage, cold hosing for vasoconstriction. Widely debated on cold therapy dosages but of importance is not to induce the Huntings reaction. One option is melted iced water on a wet towel for 10 minutes (Mac Auley, 2001) but for ease of application cold hosing twice a day for 10 mins may suffice.

Joint mobilisation.

Electrotherapy such as pulsed electromagnetic energy (Watson, 2012) Kinesotaping specifically can be used to help facilitate lymphatic drainage through specific applications techniques such as creating convolutions in the tape

Maintain joint movement and promote joint nutrition

Passive range of movement exercises through range (Reinold et al, 2006).

Pain management

Massage and soft tissue mobilisation techniques.

TENS. LASER.

Promote healing

Electrotherapy â&#x20AC;&#x201C; ultrasound, pulsed magnetic or low intensity laser therapy. Doses and rates to be calculated depending on the type of tissue and depth requiring healing (Sparrow et al, 2005; Watson, 2012).

Stretching and passive movement (Schils and Turner, 2010).

Early mobilisation (Schils and Turner, 2010).

Heat therapy.

Therapeutic exercise (McGowan et al. 2007).

Preventing muscle de-conditioning or atrophy

Early mobilisation (Schils and Turner, 2010).

Isometric muscle contraction and/or neuromuscular electrical stimulation (McGowan et al, 2007).

Stretching with care to avoid delayed onset muscle soreness (DOMS); suggested dose every other day or two days on, one day off (Brooks, 2011).

Improve neuromotor control

Weight transfer therapy such as lateral tail pull or 3 legged stance (Brooks, 2011).

Taping (McGowan et al, 2007).

Core stability exercises

Baited stretches, rhythmic stabilisations (Stubbs et al, 2011).

Treatment of associated muscle soreness

Massage (McGowan et al, 2007).

Education of the owner

Home therapy exercise program and massage.

Table 2: Physiotherapy aims whilst the horse is on relative rest

46

Figure 6. Use of a theraband around the hindquarters whilst lunging.

include pole work, transitions, leg yielding and shoulder in (at walk for core stability and joint proprioception), figures of eight in the school, field or on a hack, weighted boots, elastic exercise band, proprioceptive chains and controlled rotational forces work such as turns on the forehand, sharper turns and deeper corners.

Continued physiotherapy assessment is required until the horse returns to full work to maintain, monitor and promote symmetrical musculoskeletal use.

Prognosis Most horses improve after surgery and between 37% and 62% of horses treated arthroscopically, have been shown to return to full use or previous levels of use (Cohen et al, 2009; Walmsley et al, 2003,

Walmsley, 2010). Poor prognosis was associated with advanced age, severe lameness, increasing severity of the meniscal injury, the presence of concurrent articular cartilage lesions and radiographic abnormalities in the joint (Cohen et al, 2009; Walmsley et al, 2003). Some lesions will be inaccessible and this must be taken into account when considering prognosis (Walmsley, 2010).

Appropriate rehabilitation following soft tissue injury gives good prognosis for return to athletic performance (Gillis, 2011).

Degenerative changes in the affected joint are prevalent (Flynn and Witcomb, 2002) and prognosis is fair for return to work following surgical debridement via arthroscopy (Gillis, 2011).

61% of horseâ&#x20AC;&#x2122;s with mild or moderate lesions of the cranial

47

cruciate ligament returned to use (Walmsley, 2010). Patellar ligaments and collateral ligaments generally require 6-8 months of increasing controlled exercise to heal (Gillis, 2011).

Conclusion Stifle injuries are both a challenge to the horse owner, vet and physiotherapist in regards to their presentation, diagnosis and treatment. Chartered Veterinary Physiotherapists are well placed to identify a possible stifle injury and to work closely with vets during assessments and rehabilitation of equines with stifle issues. Physiotherapists have the knowledge and skills to provide rehabilitation throughout the recovery from relative rest to return to full work.

References Brooks, J., (2011) Physical therapy approaches for strengthening the stifle and pelvic limb.

AAEP 2011; www.search.IVIS.org.

Cohen, J., Richardson, D., McKnight A., Ross, M., Boston, R., (2009) Long-term outcome in 44 horses with stifle lameness after arthroscopic exploration and debridement.

Veterinary Surgery. 38(4) pp. 543-51.

Coumbe, K., (2013) The OCD conundrum.

Horse and Hound. 16 May 2013.

Crijns, P. C., Gielen, I. M., Van Bree, H. J. and Bergman, E. H., (2010) Case Report: The use of CT and CT arthrography in diagnosing equine stifle injury in a Rheinlander gelding.

The Equine Veterinary Journal.Vol 42 (4).

Davidson, J.R., Kerwin, S.C., Mills, D.L., (2005) Rehabilitation for the orthopaedic patient. Vet Clin North Am Small Anim Pract.

Nov;35(6):1357-88.

Desjardins, M., Hurtig, M.B., (1991) Diagnosis of equine stifle joint disorders: Three Cases.

The Canadian Veterinary Journal. 32(9): 543– 550.

Flynn, K., Whitcomb, K., (2002) Equine Meniscal Injuries – A retrospective study of 14 horses. Proceedings of the Annual Convention of the AAEP 2002.Vol 48 pp 249.

Gillis, C., (2011) Stifle joint injuries – Diagnosis, Treatment and Prognosis. 7th Annual Promoting Excellence Symposium in the South East (USA). http://www.fvmace. org/FAEP%20PES%20Conference/Gillis_ Stifle%20Joint%20Injuries-%20Diagnosis,%20 Treatment%20and%20Prognosis.html.

Kane, E., (2012) Risk factors for equine osteochondrosis. DVM360mangazine. http:// veterinarynews.dvm360.com/dvm/article/ articleDetail.jsp?id=781647.

Hesse, K.L., Verheyen, K.L.P., (2010) Associations between physiotherapy findings and subsequent diagnosis of pelvic or hindlimb fracture in racing Thoroughbreds.

Equine Veterinary Journal, 42(3), pp 234-239.

Mac Auley (2001) Ice-Therapy: How good is the evidence? International Journal of Sports Medicine. 22(5) 379-84.

McGowan, C., Goff, L.,Stubbs, N., (2007) Animal Physiotherapy – Assessment, Treatment and Rehabilitation of animals.

Blackwells Publishing, Oxford, UK. Millis, D.L., (2005) Physical Therapy Techniques I.The North American Veterinary Conference 2005. www.ivis.org.

Murray, R., Dyson, S., Tranquille, C., Adams, V., (2006) Association of type of sport and performance level with anatomical site of orthopaedic injury diagnosis. Equine Exercise Physiology 7 in Equine Vet Journal Supplement, 36, pp. 411-416.

Natri, A., Jarvinen, M., Latvala, K., (1996) Isokinetic muscle performance after anterior cruciate ligament surgery: Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction. Int J Sports Med 17:223Y8.

Walmsley, J.P., Phillips, T.J., Townsend, H., (2003) Meniscal tears in horses: an evaluation of clinical signs and arthroscopic treatment of 80 cases. Equine Vet Journal. 35(4) 402-406.

Ortved, K. F., Nixon, A.J., Mohammed, H.O., Fortier, L.A., (2012) Treatment of subchondral cystic lesions of the medial femoral condyle of mature horses with growth factor enhanced chondrocyte grafts: A retrospective study of 49 cases. Equine Veterinary Journal 44(5), pp.

606-613.

Williams, G.N., Snyder-Mackler, L., Barrance, P.J., (2005) Quadriceps femoris muscle morphology and function after ACL injury: A differential response in copers versus noncopers. J Biomech Apr; 38 (4): 685-93.

Powell, S. E., (2010) Radiography and Ultrasonography of the Stifle. BEVA conference Friday 10th September 2010.

Reinold, M., Wilk, K., Macrina, L., Dugas, J., Cain, E., (2006) - Current Concepts in the Rehabilitation Following Articular Cartilage Repair Procedures in the Knee. Journal of Orthopaedic & Sports Physical Therapy. 36(1), pp774-94.

Schils, S.J., Turner, T.A., (2010) Review of Early Mobilization of Muscle, Tendon and Ligament After Injury in Equine Rehabilitation.

Proceedings of the 56th Annual Convention of AAEP December 4-8, 2010, Baltimore, Maryland, USA. www.ivis.com.

Schuurman, S., Kersten, W., Weijs, W., (2003).

The equine hind limb is actively stabilized during standing Journal of Anatomy 202 pp.355–362.

Singer, E. R., Barnes, J., Saxby, F., Murray, J. K., (2008) Injuries in the event horse: Training versus competition. The Veterinary Journal.

Volume 175, Issue 1, Pages 76–81.

Sparrow, K., Finucane, S., Owen, J., Wayne, J., (2005) The effects of low intensity ultrasound on MCL healing in the Rabbit model. American Orthopaedic society for sports medicine. 33(7) pp1048-56.

Stubbs, N., Kaiser, L., Hauptman, J., Clayton, H., (2011) Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. Equine Veterinary Journal, 43(5):522-9.

Wallis, T.W., Goodrich, L.R., McIlwraith, C.W., Frisbiw, D.A., Hendrickson, D.A., Trotter, G.W., Baxter, G.M., Kawcak, C.E., (2008) Arthroscopic injection of corticosteroids into the fibrous tissue of subchondral cystic lesions of the medial femoral condyle in horses: A retrospective study of 52 cases (2001–2006) Equine vet Journal, 40 (5) pp 461-467.

Walmsley, J.P., (2005) Diagnosis and Treatment of Ligamentous and Meniscal Injuries in the Equine Stifle.Vet Clin Equine, 21, pp 651–672.

Walmsley, J.P., (2010) Meniscal and ligament injuries of the stifle. BEVA conference Friday 10th September 2010.

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Watson, T., (2012) www.electrotherapy.org.uk.

CANINE RESEARCH DIGEST Kate Davy MCSP ACPAT Cat A LOW-LEVEL LASER THERAPY REDUCES TIME TO AMBULATION IN DOGS AFTER HEMILAMINECTOMY: A PRELIMINARY STUDY Draper WE, Schubert TA, Clemons RM and Miles SA. Low level laser therapy (LLLT) uses photobiomodulation, the application of a particular wavelength of light at a certain energy density to cells in the body. The cells react to the light in a predetermined fashion depending on their absorption spectrum. LLLT has been shown to reduce glial scarring, the immune and inflammatory response and secondary damage and promote axonal sprouting and regeneration after spinal cord injury. This study investigated if low-level laser therapy reduced the time to ambulation in dogs post hemilaminectomy for thoraco lumbar intervertebral disc disease (IVDD).

What they did 36 dogs were evaluated using the Modified Frankel Score (MFS) to measure neurological dysfunction and assigned to the control group or laser treatment group, all underwent surgery for their herniated disc. Dogs in the laser treatment group received LLLT daily for 5 days or until they achieved a MFS of 4. A 5 x 200Mw 810nm cluster array was used to deliver 25W/cm2 to the skin.

What they found The study found the time to achieve a MFS of 4 (ambulatory with paraparesis and/or ataxia) was significantly lower (P=0.0016) in the LLLT group (median 3.5 days) than the control group (median 14 days). This finding was independent of age, weight, MFS on presentation or duration of clinical signs on presentation.

Take-home message The authors conclude that LLLT in conjunction with decompressive surgery decreases time to ambulation in dogs that are non-ambulatory because of thoracolumbar IVDD and that the data indicates that LLLT may play an important role in the treatment of acute spinal cord injury secondary to intervertebral disc herniation.

They note however there are several weaknesses in the study that could contribute to a type 1 statistical error amongst these being lack of blinding of evaluating clinician and failure to sham treat the control dogs.

Journal of Small Animal Practice 2012; (53): 465-469 DOI: 10.1111/J.17485827.2012.01242.x USE OF BATHROOM SCALES IN MEASURING ASYMMETRY OF HINDLIMB STATIC WEIGHT BEARING IN DOGS WITH OSTEOARTHRITIS Hyytiäinen HK, Mölsä SH, Junnila JT, Laitinen-Vapaavuori OM and HielmBjörkman AK. The need for objective outcome measures in veterinary physiotherapy and orthopaedics is flagrant. The use of bathroom scales as a measurement for static weight-bearing has been reported in humans and they could be an economical objective measurement method if proven reliable and valid in dogs. The aim of this study was to conduct reliability testing of a quantitative measurement of hind limb static weight-bearing using bathroom scales.

What they did Two groups of dogs were tested 21 in a healthy control group and 43 in in a group with confirmed OA in at

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least one stifle joint with or without hip OA. The following examinations were done, manual static weightbearing evaluation, quantitative static weight-bearing measurement with bathroom scales, orthopaedic examination, dynamic force platform evaluation and radiographic evaluation.

What they found Using the limit for normal difference in static weight-bearing (3.3% ± 2.7%) the sensitivity of static weight bearing measurements using bathroom scales was 39% and specificity 85%. The repeatability of the static weight bearing measurements was 76% for all dogs, 61% for the control group and 79% for the OA group.

Take-home message The authors conclude that bathroom scales can be used as a reliable objective measurement tool when measuring and evaluating the symmetry of static weight bearing in dogs with hind limb OA. They show specificity, that is, they could show when rehabilitation has been sufficient with a low risk of false negatives. These results however show measuring static weightbearing with bathroom scales to have low sensitivity, meaning that it accepts many individuals with OA findings as having sufficient symmetrical static weight bearing between the hind limbs thus considering them sound. The low sensitivity requires further research.

Veterinary and Comparative Orthopaedics and Traumatology 2012; (25): 390-396 DOI 10.3415/VCOT-11-09-0135

OUTCOMES ASSOCIATED WITH TREATMENTS FOR MEDIAL, LATERAL AND MULTIDIRECTIONAL SHOUDLER INSTABILITY IN DOGS Franklin SP, Devitt, CM, Ogawa J, Ridge P and Cook JL. Instability is reported to be the most common type of shoulder pathology causing lameness. Medial shoulder instability (MSI) has received most attention whereas lateral (LSI) and multi-directional (MDI) instabilities are described infrequently. Optimal treatment algorithms for differing types of instability remain ill defined. The aim of this multi-centre retrospective cohort study was to describe demographic factors, treatments and outcome associated with shoulder instability in dogs.

What they did Medical records (Oct 2007-2010) from 4 hospitals, of dogs with shoulder instability were reviewed to record age, breed, weight and gender, categorise them into diagnosis cohorts of medial (MSI), Lateral (LSI) or multidirectional (MDI) instability, determine treatments and document outcomes. Treatment cohorts were defined as nonsurgical management, a radiofrequency-induced thermal capsulorrhaphy (RITC) or shoulder reconstruction. Outcomes based upon clinician re-evaluation and owner input > 1 year after diagnosis were used to determine success, failure and complication rates.

What they found The study showed most dogs were diagnosed with MSI but 23% had LSI and MDI. Those with MSI treated by reconstruction were more likely to have a successful outcome than those without surgery (oddâ&#x20AC;&#x2122;s ratio =3.0; P =0.1). Also those with MDI treated by reconstruction were more likely to have a successful outcome than non-surgical management (oddâ&#x20AC;&#x2122;s ratio =5.0; P =0.007). In LSI all dogs were considered to have a successful outcome irrespective of surgical or non-surgical management but

care should be taken in concluding non-surgical management is adequate for dogs with LSI due to the small sample size and lack of randomisation.

Take-home message The results confirm shoulder instability is typically unilateral, can effect either thoracic limb and that MSI is the most common type of instability as previously reported. However dogs with LSI and MDI compromised a substantial proportion of the dogs presented with lameness. The data indicates that age and weight ranges for affected dogs were large and overlapped among all diagnostic cohorts. The results highlight the importance of evaluating for LSI and MDI and the ineffectiveness of relying upon basic data such as signalment to assist identification and diagnosis of dogs with shoulder instability. The results indicate the likelihood of a dog with MSI regaining full or acceptable function is significantly greater when treated with surgical reconstruction than when treated non-surgically.

Veterinary Surgery 2013; (42): 361-364 DOI:10.1111/j1532950X.2012.01110.x GASTROCNEMIUS TENDON STRAIN IN A DOG TREATED WITH AUTOLOGOUS MESENCHYMAL STEM CELLS AND A CUSTOM ORTHOSIS Case JB, Palmer R, Valdes-Martinez A, Egger EL and Haussler KK. Historically, conservative treatment of common calcaneal tendon injury has been unrewarding due to high recurrence rates and surgical repair has been the preferred treatment.

There are no clinical reports of mesenchymal stem cell (MSC) treatment of common calcaneal tendon injuries in dogs but there are clinical publications on the use of MSC in the treatment of superficial digital flexor tendon strains in horses and hinged splints are frequently used in people after

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Achilles tendon repair to encourage early controlled use of the limb.

What they did This was a clinical report of a 4 year old spayed female border collie.

Radiographs showed increased soft tissue opacity of the common calcaneal tendon adjacent to the insertion on the calcaneus and thickening, mineralisation and severe loss of gastrocnemius tendon-fiber pattern with a large central core lesion proximal to the insertion on the tuber calcis was seen on ultrasound. Bone-marrow derived autologous mesenchymal stem cells were transplanted into the tendon core lesion and a custom, progressive, dynamic orthosis was fitted to the tarsus. Serial orthopaedic examinations and ultrasonography as well as long term force plate analysis were utilised for follow-up.

What they found Lameness subjectively resolved and the dog regained 92% of the peak vertical force and 61% of the propulsive forces shown in the left hind limb. Serial ultrasonographic examinations showed improved but incomplete restoration of normal linear fibre pattern of the gastrocnemius tendon.

Take-home message The findings suggest that autologous mesenchymal stem cell transplantation with custom progressive dynamic orthosis may be a viable, minimally invasive technique for treatment of calcaneal tendon injuries in dogs.

Although incomplete healing was seen with serial orthopaedic and ultrasound examinations functional outcome was equivalent to what is reported with successful surgical treatments. Further studies are indicated to evaluate the efficacy of this treatment before it can be recommended in clinical dogs.

Veterinary Surgery 2013; (42): 355-360 DOI:10.1111/J.1532950X.2013.12007.x

COMPARISON OF LONGTERM OUTCOMES ASSOCIATED WITH THREE SURGICAL TECHNIQUES FOR TREATMENT OF CRANIAL CRUCIATE LIGAMENT DISEASE IN DOGS Christopher SA, Beetem J and Cook JL. Three of the most commonly used surgical treatments for CCL disease are tibial plateau levelling osteotomy (TPLO), tibial tuberosity advancement (TTA) and Tightrope CCL (TR) but the superiority of one surgical procedure over another has not yet been demonstrated. The authors hypothesised that the TR technique would have significantly fewer complications and significantly more functional long-term outcomes than the osteotomy techniques (TPLO and TTA) What they did A retrospective clinical cohort study was undertaken with medical records from 2006 to 2009. Cases were included when all data was

available and clients returned a completed questionnaire based on their assessment of their dog at least 1 year after surgery. Outcomes associated with TPLO, TTA and TR were determined and compared based on medical records and the questionnaires data regarding return to function, presence and degree of pain and complications.

What they found 162 cases were included 65 TPLO, 18 TTA and 79 TR. TTA was associated with significantly (P < .03) higher rates of major complications and subsequent meniscal tears than TPLO and TR and TPLO had significantly higher rates of major complications and meniscal tears than TR. Percentage of function > 1 year after surgery was 93.1% +10.0% for TPLO, 92.7% + 19.3% for TR and 89.2%+ 11.6% for TTA. Significantly (P=0.016) more TPLO and TR cases were classified as reaching full function than TTA. The highest levels, frequency and severity of pain were noted in TTA cases; however no significant differences were noted among groups.

Take-home message Long-term outcomes for TPLO and TR were superior to TTA based on subjective clients and veterinarian assessments. All three techniques were associated with high longterm success rates with TR showing the highest safety to efficacy ratio.

Limitations of the study include its retrospective nature and relatively limited number of TTA cases though the number was deemed appropriate for rigorous statistical analysis. The study provides an initial database for further work in this important area.

Veterinary Surgery 2013; (42) 329-334 DOI:10.1111/J.1532950X.2013.12001.x

DIARY OF EVENTS Date

Event

Location

12-14th September 2013

BEVA

Manchester

4th October 2013

First Aid Course with Debbie Archer BVMS PhD CertES DipECVS FHEA MRCVS

Plum Park Farm, Towcester, Northamptonshire, NN12 6LQ

6-9th March 2014

Crufts

Birmingham

9-10th November 2013

Your Horse Live

Stoneleigh

21-22nd November 2013

London Vet show

London

22nd-23rd November 2013

Musculoskeletal and Spinal Assessment in canine patients with Laurie Edge-Hughes, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT

South Location

Musculoskeletal and Spinal Assessment in canines with Laurie Edge-Hughes, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT (north location)

North Location

24th-25th November 2013

22nd-23rd February 2014

ACPAT Seminar,

Please see www.acpat.org for further details

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Village Hall, Micheldever Station nr Winchester, SO21 3AR

Northern Racing College, Doncaster, DN11 0HN Dunchurch Park Hotel, Rugby Road, Dunchurch, Rugby, CV22 6QW

COURSE REVIEWS Kinesio Taping Course KT1 Lee Clark MSc BSc MCSP HCPC ACPAT A An Introduction to the Kinesio Taping ® Method for horses, basic Kinesio Taping® concepts and Kinesio Taping ® muscle applications: January 25-26th 2013 I attended this course, the first of its kind in the UK that was run by The Kinesio Taping® Association at Hartpury College.

This course began by teaching about the principles behind the application of Kinesio Tape® and how the properties of the tape aid its therapeutic effects. It really is nothing like Elastoplast, neither in its application technique nor in its theory of effects. The tape can be used as a treatment option when aiming to facilitate or inhibit muscle activity; accelerate tissue healing; facilitate lymphatic drainage; aid release of fascia tension; aid proprioceptive feedback and influence neuromotor control (picture 1).

When applying the tape, specific attention has to be paid to the anchor points and the tension being applied to the tape. Generally a lower tension was regarded as having a better effect on swelling and muscle activation i.e. around 15% -20%. This is quite a skill to master and it really is just a question of practising it. The areas that we practised taping included the gluteals and hamstrings (see picture 2), the cervical spine, the knee and hock and the paraspinals. The importance of reassessing movement after tape application was also stressed and clear differences could be seen.

In some cases horses did present more lame which highlights how this can aid our assessments as

Picture 1. Taping of the back to facilitate myofascial release

Picture 2. Taping to the hamstrings to facilitate hamstring contraction.

physiotherapists as well as our rehabilitation.

canine caseloads to enhance my rehabilitation and treatments.

This was a great course to attend and hopefully it will develop further as more groups are taken. I intend to apply this to my equine and

Maruska Aylward

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BOOK REVIEWS Canine Sports Medicine and Rehabilitation Zink .C,Van Dyke J.B Paperback: 484 pages Publisher: Wiley-Blackwell; 1 edition (9 April 2013) Language: English ISBN-10: 081381216X ISBN-13: 978-0813812168 RRP £60.99 This is a practical and informative book. It offers a useful reference for information for veterinary physiotherapists looking for an indepth guide to treating a range of canine athletic injuries. Each chapter includes a case study which helps to consolidate ideas and concepts discussed. It covers a variety of topics including exercise physiology, nutrition, biomechanics and common orthopaedic conditions. It is certainly a useful book to have on your shelves.

This is a really useful reference to use for equine neurological assessments.

It outlines the basic neuroanatomy and physiology before going into more detail with disease related clinical findings. It has practical features, such as charts and tables, designed to assist your clinical assessment of the nervous system and has further information regarding specific diseases including etiology, epidemiology, diagnostic methods, treatment, prognosis and prevention.

It is a little pricey but will last on your book shelf too.

it easy to read. It’s a must have for anyone engaged in improving the diagnosing and management of horses with back problems.

Stephanie Brighton The Elephant Whisperer Anthony L, Spence G.

Maruska Aylward Equine Back Pathology – Diagnosis and Treatment Ed Henson F.M.D.

Maruska Aylward Equine Neurology Furr, M., Reed, S.

Paperback:368 Publisher: Pan Books (2010) Language: English ISBN: 978-0-330-50688-7 RRP £7.99

Hardcover: 266 pages Publisher: Wiley-Blackwell 1 edition (2009) Language: English ISBN: 978-1405-1-5492-5 RRP £82.50

Hardcover: 412 pages Publisher: Wiley-Blackwell; 1 edition (2 Nov 2007) Language: English ISBN-10: 0813825199 RRP £72.08

This is a reference book that brings together the latest research in the equine back. It covers conditions and problems of the equine back and pelvis and its function and athletic ability. Alongside the diagnosis and treatment of specific conditions and back pathology in specific sporting disciplines.

It is very detailed and is broken into manageable chapters which make

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This is a beautiful non fiction story of animal behaviour and how to learn about life, loyalty and freedom from a herd of elephants. It is written by a conservationist who was asked to look after a herd of troubled wild elephants and it’s about the hierarchy of the elephant family and how they value good relationships with humans. This book is not about our domesticated clients that we work with on a daily basis but we can learn and relate to the animal behaviour it demonstrates and the importance of our understanding of animal behaviour when working with non human patients.

Stephanie Brighton

RECENT RESEARCH PUBLICATIONS Here are some journal titles that may be of interest to you from the Equine Veterinary Journal and the Journal of Small Animal Practice.

of voluntary versus negatively reinforced approach to frightening stimuli (pages 298–301) J. W. Christensen

All these articles are available online via www.onlinelibrary.wiley. com to all ACPAT members using the ACPAT Wiley username and password. If you require these details or have any questions regarding accessing these journals then please feel free to email me at

March 2013 Volume 45, Issue 2

physio@swanimalrehab.co.uk Many Thanks Kate Davy MCSP ACPAT Cat A Research Officer EQUINE VETERINARY JOURNAL May 2013 Volume 45, Issue 3 Science in brief: Clinical highlights from the American Association of Equine Practitioners’ 58th Annual Convention and Equine Veterinary Journal Supplement 43 (pages 261–264) C. Collatos and L. K. Pearson Finite element analysis of stress in the equine proximal phalanx (pages 273–277) L. M. S. O’Hare, P. G. Cox, N. Jeffery and E. R. Singer Case–control study of high-speed exercise history of Thoroughbred and Quarter Horse racehorses that died related to a complete scapular fracture (pages 284–292) S. A.Vallance, R. C. Entwistle, P. L. Hitchens, I. A. Gardner and S. M. Stover A randomised, blinded, crossover study to assess the efficacy of a feed supplement in alleviating the clinical signs of headshaking in 32 horses (pages 293–297) W. A. Talbot, G. L. Pinchbeck, D. C. Knottenbelt, H. Graham and S. A. Mckane Object habituation in horses:The effect

Subclinical ultrasonographic abnormalities of the suspensory ligament branch of the athletic horse: A survey of 60 Thoroughbred racehorses (pages 159–163) P. H. L. Ramzan, L. Palmer, R. S. Dallas and M. C. Shepherd The proximal aspect of the suspensory ligament in the horse: How precise are ultrasonographic measurements? (pages 164–169) J. M. Zaucher, R. Estrada, J. Edinger and C. J. Lischer A preliminary study into the correlation of stiffness of the laminar junction of the equine hoof with the length density of its secondary lamellae (pages 170–175) P. Kochova, K. Witter, R. Cimrman, J. Mezerova and Z. Tonar Humeral stress remodelling locations differ in Thoroughbred racehorses training and racing on dirt compared to synthetic racetrack surfaces (pages 176–181) A. N. Dimock, K. D. Hoffman, S. M. Puchalski and S. M. Stover The effect of collection and extension on tarsal flexion and fetlock extension at trot(pages 245–248) V. A. Walker, J. M. Walters, L. Griffith and R. C. Murray January 2013 Volume 45, Issue 1 Science in brief: Interactions between the rider, the saddle and the horse (pages 3–4) H. M. Clayton Reducing injuries in racehorses: Mission impossible? (pages 6–7) K. L. P.Verheyen Misbehaviour in Pony Club horses: Incidence and risk factors (pages 9–14)

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P. Buckley, J. M. Morton, D. J. Buckley and G. T. Coleman The use of equipment and training practices and the prevalence of ownerreported ridden behaviour problems in UK leisure horses (pages 15–19) J. Hockenhull and E. Creighton The association of 2-year-old training milestones with career length and racing success in a sample of Thoroughbred horses in New Zealand (pages 20–24) J. C. Tanner, C. W. Rogers and E. C. Firth Dynamic properties of a dirt and a synthetic equine racetrack surface measured by a track-testing device (pages 25–30) J. J. Setterbo, P. B. Fhyrie, M. Hubbard, S. K. Upadhyaya and S. M. Stover The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology (pages 36–40) A. R. Fiske-Jackson, W. H. J. Barker, E. Eliashar, K. Foy and R. K. W. Smith Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses (pages 74–79) T. W. McGowan, G. P. Pinchbeck and C. M. McGowan Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses (pages 107–110) V. L. H. Roberts, J. D. Perkins, E. Skarlina, D. A. Gorvy, W. H. Tremaine, A. Williams, S. A. McKane, I. White and D. C. Knottenbelt Journal of Small Animal Practice June 2013 Volume 54, Issue 6

CT assessment of the influence of dynamic loading on physiological incongruency of the canine elbow (pages 291–298) N. J. Burton, C. M. R. Warren-Smith, D. P. Roper and K. J. Parsons

W. E. Draper, T. A. Schubert, R. M. Clemmons and S. A. Miles Journal of Small Animal Practice

May 2013 Volume 54, Issue 5

CT assessment of the influence of dynamic loading on physiological incongruency of the canine elbow (pages 291–298) N. J. Burton, C. M. R. Warren-Smith, D. P. Roper and K. J. Parsons

Development, validation and reliability of a web-based questionnaire to measure health-related quality of life in dogs (pages 227–233) J. Reid, M. L. Wiseman-Orr, E. M. Scott and A. M. Nolan

June 2013 Volume 54, Issue 6

May 2013 Volume 54, Issue 5

An ex vivo investigation of the effect of the TATE canine elbow arthroplasty system on kinematics of the elbow (pages 240–247) N. J. Burton, J. R. Ellis, K. J. Burton, A. R. Wallace and G. R. Colborne

Development, validation and reliability of a web-based questionnaire to measure health-related quality of life in dogs (pages 227–233) J. Reid, M. L. Wiseman-Orr, E. M. Scott and A. M. Nolan

A comparison between fixation methods of femoral diaphyseal fractures in cats – a retrospective study (pages 248–252) T. Könning, R. J. Maarschalkerweerd, N. Endenburg and L. F. H. Theyse

An ex vivo investigation of the effect of the TATE canine elbow arthroplasty system on kinematics of the elbow (pages 240–247) N. J. Burton, J. R. Ellis, K. J. Burton, A. R. Wallace and G. R. Colborne

The vacuum phenomenon in intervertebral disc disease of dogs based on computed tomography images (pages 253–257) M. K. Müller, E. Ludewig, G. Oechtering, M. Scholz and T. Flegel

A comparison between fixation methods of femoral diaphyseal fractures in cats – a retrospective study (pages 248–252) T. Könning, R. J. Maarschalkerweerd, N. Endenburg and L. F. H. Theyse

Patellar ligament-bone autograft for reconstruction of a distal patellar ligament defect in a dog (pages 269–274) M. Farrell and N. Fitzpatrick

The vacuum phenomenon in intervertebral disc disease of dogs based on computed tomography images (pages 253–257) M. K. Müller, E. Ludewig, G. Oechtering, M. Scholz and T. Flegel

April 2013 Volume 54, Issue 4 Evaluation of accuracy of the Finnish elbow dysplasia screening protocol in Labrador retrievers (pages 195–200) A. K. Lappalainen, S. Mölsä, A. Liman, M. Snellman and O. LaitinenVapaavuori January 2013 Volume 54, Issue 1 Low-level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study (page 57)

Patellar ligament-bone autograft for reconstruction of a distal patellar ligament defect in a dog (pages 269–274) M. Farrell and N. Fitzpatrick April 2013 Volume 54, Issue 4 Evaluation of accuracy of the Finnish elbow dysplasia screening protocol in Labrador retrievers (pages 195–200) A. K. Lappalainen, S. Mölsä, A. Liman, M. Snellman and O. Laitinen-Vapaavuori

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January 2013 Volume 54, Issue 1 Low-level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study (page 57) W. E. Draper, T. A. Schubert, R. M. Clemmons and S. A. Miles

USEFUL TIP This is a useful tip if you are an iphone owner. ‘Coaches eye’ is a smart phone app that is approximately £2.99. You can upload any of your videos from your phone and then watch them in slow motion, even frame by frame if you want. You can also put two videos alongside each other and play them simultaneously to compare them and add features such as grid lines and reference points. It further allows you to zoom in and out to home your eye in to certain areas and you can email the videos and record a spoken analysis of your observations. This is a great movement analysis tool and outcome measure.

Louise Carson MSc BSc MCSP ACPAT Cat A Chairman

RECENT NEWS New ACPAT Category A members Well done to all newly upgraded ACPAT A members. We hope you enjoy your new roles as Chartered Veterinary Physiotherapists and veterinary physiotherapy caseloads.

Helen Cartwright Natalie Fizio Amelia Gourlay Nicola Grant Laura Greenwood Sara Hewett Katherine King Magdalena King

Charlotte Mustarde Katherine Parsons Rachel Quinn Kate Scothorne Colette Smith Robyn Stewart Freiderike Von Rabenau Amie Weld

MEET THE ACPAT COMMITTEE Chair Louise Carson louise.carson@yahoo.co.uk

Deputy Chair Helen Millward millward2001@yahoo.co.uk

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Secretary Sharon Morgan secacpat@btinternet.com

PR Officer Rachel Greetham rachel@equineand caninesolutions.co.uk

Treasurer Andrea Walters andreajwalters@hotmail.com

CIG Liaison Officer Helen Millward millward2001@yahoo.co.uk

PR Officer Emma Dainty emmajcdainty @hotmail.com

PR Officer Hannah Price hannahprice.vetphysio @yahoo.co.uk

Education Officer Amy Barton ajbarton79@yahoo.co.uk

Research Officer Kate Davy physio@swanimalrehab.co.uk

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PR Officer Kath Welland info@oaklandsphysiotherapy.co.uk

CPD Officer Kate Davy physio@swanimalrehab.co.uk

Regions Co-ordinator Kim Sheader kimsheader@gmail.com

Seminar Organiser Megan Rees barcphysio@gmail.com

Seminar Organiser Annelise Scorer anniescorer@icloud.com

Course Organiser Nycky Edleston Edleston@hotmail.com

Course Organiser Kate Anscombe katherineanscombe @yahoo.com

Course Organiser Anna Johnston annajohnsonphysio @hotmail.co.uk

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Course Organiser Catherine Watts catherine @rivendalephysio.co.uk

Newsletter Stephanie Brighton stephanie_brighton@hotmail.com

Journal Officer Maruska Aylward ma@bridgefieldphysio.co.uk

Website/IT Officer Anna Armstrong anna@vetphysio.org

Protection of Title Liaison Louise Towl louise@louisetowlvetphysio.co.uk

Additional Support to Committee AHPC Rep Sonya Nightingale sonya@highworthphysio.co.uk

AHPC Rep Kim Sheader kimsheader@gmail.com

Interactive CSP Moderator Melanie Haines melvetphysio@yahoo.co.uk

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Cat B member Maxine Cooch maxine.cooch@hotmail.co.uk

A UNIQUE OLYMPIC LEGACY PROJECT Pat Crawford reports.

Hadlow College, Hadlow, Tonbridge, Kent. TN11 0AL Tel: 01732 850 551 Fax: 01732 853 207 Web: www.hadlow.ac.uk The ideals guiding Olympic Legacies relate to regeneration, promotion of sports and similar benefits.

The Olympic Legacy partnership between the Royal Borough of Greenwich and Hadlow College fulfils this philosophy but it is unique in its other aspirations.

With additional funding from the British Equine Federation (BEF) and Sport England, the Royal Borough of Greenwich Equestrian Centre is an innovative and highly enterprising initiative that embraces opportunity-creating objectives for local people. Managed by Hadlow, graded Outstanding and one of the UK’s elite land-based colleges, the centre is already offering some BHS courses and in September these will be joined by a number of other options.

This education mix is very important in terms of providing people with the skills needed to find jobs in the equestrian industry. The centre - so close to central London and just down the road from Greenwich Park where the British Olympic and Paralympic equestrian teams excelled last year - is in an area that is green and leafy, peaceful and very attractive. But Greenwich is a borough of many parts and unemployment is a social and economic problem in some of them.

Hence the opportunities to develop new sets of skills are fundamental to the scheme.

The other part of the project is, in some ways, quite different - and is virtually unique. In September Hadlow’s BSc (Hons) programme in Equine Sports Therapy and Rehabilitation commences. Validated by the University of Greenwich - as are all the Hadlow range of

degrees - this year’s entry is already fully subscribed and the college is receiving applications for entry in 2014. The first intake of students will come from geographically diverse regions and this has the advantage of promoting exchange of ideas and broadening experiences and outlook. In addition, some students from the local area who are currently enrolled on BHS and further education courses intend progressing to the degree programme.

This very much fulfils the opportunities for career progression that are central to this particular Legacy partnership.

of the most advanced in the UK – a dedicated laboratory (see picture 3, to the right), a hydrotherapy unit, treadmills (see picture 4) and a horse walker - plus farriery and treatment areas. Staff and students will work closely with specialist equine vets and physiotherapists and excellent relations have already been built with The King’s Troop Royal Horse Guard Artillery and other equestrian establishments in the area. The centre enjoys remarkably ‘green’ views in all directions, is located next door to the Woodlands Trust and, across the road, there is access to a bridlepath.

From another perspective, it is fitting that an Olympic Legacy project directly relates to equine sports therapy. The success of our Olympic equestrian teams was dependent on talent and hard work – but implicit in the preparation was ‘fitness’ – of horses and riders.

Equestrian sports are increasingly competitive and achievement of optimum performance is directly related to the attention that is paid to every detail. The fact that the UK horses stood up to the various stresses and pressures undoubtedly part relates to the excellent advice and help from the team’s vets and therapists. .

Another plus for all the students – no matter which course they are following – is the fact that they will be given plenty of opportunities to visit Hadlow’s main campus.

Located in the Kent countryside near Tonbridge, the equine unit has 65-plus horses, two indoor arenas, a jumping paddock and a cross country course plus a variety of other facilities. Students will be encouraged to compete internally and externally and also attend the lectures and demonstrations given by leading trainers and other visiting specialists.

The Royal Greenwich Equestrian Centre yard incorporates Monarch stabling for twenty-seven horses, an Olympic size indoor arena, dedicated isolation stabling and an outdoor arena plus the usual ancillary facilities.

Residential accommodation for staff, lecture rooms and offices, changing rooms and showers are located in an attractive large house that was already on site which has been carefully renovated with due consideration for the character of the property.

The additional – impressive – equine rehabilitation facilities include a 25-meter equine swimming pool (see picture 1), solaria (see picture 2), an equine spa – said to be one

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More and more veterinary practices and training yards including, of course, racing stables – are employing their own equine therapists or using the services of freelances. Thus graduates from the new programme can expect plenty of interesting job offers including, no doubt, some from abroad. The fact that Hadlow enjoys an excellent reputation will not be lost on prospective employers and is an additional CV benefit.

A Preview and Tour event held at the centre earlier in the year was attended by over a hundred guests including Clive Efford – Shadow Minister or Sport - representatives from the BEF, Sport England, various equestrian establishments, local schools and community groups. Visitors were

unanimously impressed with the centre itself and supportive of the ideals and objectives relating to the project. This is significant for the Royal Borough/Hadlow partnership and indicates that this particular Olympic Legacy is being well received and that the underpinning ideals stand up to analysis and are set to accomplish meaningful and lasting results.

Building and equipping the Royal Borough of Greenwich Equestrian Centre ate up a fair amount of money - and a great deal of time too. Hadlow’s Financial Director, Mark Lumsdon-Taylor, and his team worked closely with Chris Roberts, Leader of Royal Greenwich Council and his team. They wanted an initiative that would produce the right mix of benefits and thought long and hard before making a commitment to the scheme seeing

no point in creating a ‘legacy’ that didn’t match up to the ‘Legacy’.

Derek Payne, who manages Hadlow’s highly respected equine department, worked closely with architects and contractors throughout the project and his attention to detail has resulted in an impressive yard designed to be functional, pleasant to work in, practical from the perspective of visiting clients - and very attractive. Early on there is no doubt that some local people were concerned that an equestrian centre - albeit one that is highly specialised - would detract from the area. Now that the centre is up and running to high professional standards, there is no doubt that local residents are extremely proud and fully supportive of a project that promises to be one of the most enduring Olympic Legacies.

Picture 1: 25 meter Hydrotherapy Pool

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Government funding is shrinking rather than expanding and these days education institutions in every sector - including equine - must consider the bottom line. The Royal Greenwich Equestrian Centre mix of education, research and business is well planned and coordinated, something that will undoubtedly benefit current and future students.

Summing up, Mark Lumsdon-Taylor said ‘The project could never have been brought to fruition without the partnership of the Royal Borough and Hadlow working towards the same objectives. The interest and support of the British Equestrian Federation and Sport England have also been big factors. We have fulfilled our vision and created something new, something very different, something that produces opportunities - and something that will support equestrian sports’.

Congratulations to Berna Lindfield The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) would like to congratulate Berna Lindfield on being awarded the CSPâ&#x20AC;&#x2122;s Distinguished Service Award and to acknowledge her immense contribution to the education of Chartered Physiotherapists specialising in Animal Therapy. Her determination and very high standards of professionalism and integrity have shaped ACPAT physiotherapists in to what they are today.

Picture 2: The Equine Solaria

As ACPAT Education Officer in 1996, Berna established courses in Animal Physiotherapy and contributed to the formation of the Royal Veterinary College course in Veterinary Physiotherapy. In 1998, Berna helped develop ACPATâ&#x20AC;&#x2122;s own experiential training and recognition course by developing the Continual Assessment Record Book (CARB).

This involved three very large volumes of work containing syllabus, requirements and assessment criteria. The attention to detail was incredible and helped to standardise practice and ensure that ACPAT members were trained and therefore practicing at the highest levels. The MSc course commenced at the RVC in 2000 and became the gold standard for Chartered Physiotherapists wishing to train in this field. As an MSc, this course provided the extensive and valuable research in the field of Animal Physiotherapy that had previously been lacking. This helped establish Chartered Physiotherapists as the Professionals in Animal Physiotherapy and started the process by which members of the CSP have become recognised by the Veterinary Profession and members of the public as key team members in the assessment and treatment of animals.

Picture 3: Rehabilitation Centre with spa pictured on the right.

Thank you and congratulations Berna.

Picture 4: Hydrotherapy Treadmill.

Louise Carson ACPAT Chair

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ACKNOWLEDGMENTS Thank you to our Canine and Equine Consultant Editors: Canine articles James Grierson BVetMed CertVR CertSAS DipECVS FHEA MRCVS RCVS Specialist in Small Animal Surgery, European Specialist in Small Animal Surgery Anderson Moores Veterinary Specialists The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire, SO21 2LL Reception: 01962 767920 Fax: 01962 775909

Thank you to Kate Davy MCSP ACPAT Cat A and Anna Thompson for supplying our front cover photograph.

Thank you also to all of our authors that have contributed this 4th Four Front edition.

Thank you also to Joanne Boddy and Associates (www. animalphysiotherapist.co.uk) and to Angela Griffiths at Veterinary Rehabilitation & Hydrotherapy Referrals (www.greyfriarsrehab. co.uk) for their additional input.

Editors

The editors of Four Front are extremely grateful to you for the time and effort you gave up for this.

Maruska Aylward MSc BSc MCSP HCPC ACPAT A Bridgefield Physiotherapy Ltd Stephanie Brighton MSc BSc MCSP HCPC ACPAT A

Equine articles Wishes to remain anonymous

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.

Post: M. Sharon Morgan Pembroke House Middle Lane Shotteswell OX17 1JQ Editorial Product Reviews Email: secretary@acpat.org Literature Reviews Business Related topics Submitting an article Clinical Articles/Case reports Letters to the Editor Research Articles Please send all text in electronic Useful addresses form (ideally in Microsoft Word) Conference / Course Reviews by attaching the file to an e-mail or Small Adverts on a disk, along with any original Product News photographs to the editor.

Book Reviews

DATES FOR SUBMISSION How to contact us Research Articles â&#x20AC;&#x201C; By end of February If you have an article that you would like to submit for publication or you Literature Reviewswould like to discuss the outline By end of April of an article that you would like to write, please do not hesitate Clinical Articles/Case to contact ACPAT secretary who Reportswill pass on the information to the By end of March Journal Officer. under the following sections:

We invite you to present material

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Product/Book/course/ conference reviews – By end of June Small adverts/Useful addresses/useful tips – By end of June 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.

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 comprise the following sections: •

• • •

•

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.

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

Case Reports

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.

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: • •

Title Page • A title page is needed for all manuscript types, it must contain

•

Summary (maximum 150 words); Keywords - for use as metadata for online searching Introduction - brief overview of the subject Case Histories - containing

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•

clinical detail Discussion - describing the importance of the report and its novel findings

To be considered for publication in a single case report must: - 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.

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 doublespaced for the purpose of peer reviewing.

All manuscripts must be numbered throughout for purpose of peer reviewing.

line the

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 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.

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

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

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 authorâ&#x20AC;&#x2122;s e-mail address in every article.

Presentation of Book, Product and Course Reviews

Copyright and exclusive licence

Book, Product and course reviews should be between 500 â&#x20AC;&#x201C; 700 words long. Book reviews should quote the title, publisher, ISBN number and price of the book.

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

Some points to consider before and during writing an article

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.

Tables and Figures

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.

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.

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 summer 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.

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.

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THANK YOU A special well done must go to Tracy Crook who graduated with her PhD this year in the “The Functional Anatomy of Equine Hind Limb Muscles and their Activation Patterns during Different Locomotor Tasks”. What a huge achievement, well done Tracy from ACPAT.

Those who stepped down but remain to report to the committee include: Polly Hutson Tracy Crook A special thank you and farewell must also go to Sonya Nightingale who stepped down as Chairman this year. Sonya’s term in office created legendary changes to the structure of the ACPAT committee and the vision for ACPAT. More recently, Sonya has been heavily involved in the talks taking place with LANTRA and the other musculoskeletal therapy groups to try and find a way forward for the proper regulation of these professions. She will continue with this work as it is something which she believes passionately is vital for the future of the professions and good animal welfare.

Finally, thank you to all committee members who stepped down from the ACPAT committee this year and to those who will soon be stepping down. Your enormous efforts and dedications have continued to raise the profile of ACPAT, so thank you. The newly formed committee will endeavour to continue your hard work.

Those who stepped down this year include: Tor Henderson Mel Haines Di Messum Sarah Sandford Sonya Nightingale Fiona Dove Steph Wilson Sam Rodwell

Sonya’s role as chairman has been truly extraordinary and she would say that she has worked with a great team behind her. However, it is her motivation and enthusiasm which has created great teamwork and the high standards it has. For this ACPAT would like to thank her.

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INSIDE BACK COVER - DO NOT PRINT

BACK COVER