Sarah Cruickshank: Veterinary Physiotherapy - working with the animal athlete

MSc (Vet Physio, Distinction, RVC London), BHSc (Physio, AUT) Board registered Physiotherapist NZ & UK (HCPC), MPNZ, MCSP ACPAT Category A (Overseas), Chair & founder NZAVPA Graduated AUT BHSc Physiotherapy 2004 Graduated RVC MSc Veterinary Physiotherapy 2007

I was so young when I announced that I was going to be a Vet, no one seems to remember how old I was - certainly under 5, all through my childhood I was determined that that would be my career

path. Apart from a brief moment when I wavered at age 4 - I came home from kindy in 1984 having made ‘gold metals’ after watching Mark Todd and Charisma win Olympic gold in LA, and I proudly announced I was going to be Charisma when I grew up. But the Veterinarian dream persisted. I set up Vet clinics in the basement under our house; practiced suturing my soft toys and was obsessed with animals, in particular dogs and horses. I was also obsessed with Land Rovers and announced that I was going to be a Vet in Africa and drive a Land Rover. Interesting convictions for a little girl growing up in central Auckland!

It took years for me to persuade my parents to relent and allow me to have a pony, (apparently I was the equivalent of water torture - drip, drip, drip…) and I have been heavily involved with equestrian sport ever since. When I was 13 I had a life changing moment, my new eventing horse had a sore back, bucked me off and the Vet’s prognosis was 6 weeks off and some pain relief. I was devastated. It was the beginning of the competition season and 6 weeks off is NOT what you want to hear. A friend suggested an ‘equine physio’ she had heard of, and to my Mother’s amusement

we tried it. My highly strung horse, who hated men, and was highly suspicious of any human in overalls smelling of disinfectant loved her, and I remember thinking my horse loves this - I want to do this! She gave me a set of exercises to do, recommended I have the saddle checked and I was back in the saddle in under 2 weeks and had a long term partnership with this special horse for 21 years.

This experience was pivotal, I promptly announced that I was going to be an Equine Physio, and drove my school careers advisor crazy for the next few years of high school as she was unable to help me find a suitable pathway. Unfortunately, when I interrogated the lady that had come to see my horse, it turned out she had worked for a physio in the UK (one of the ‘gurus’ who was one of the first physiotherapists to shift their skills to animals), but sadly she wasn’t actually a qualified physio. Frustrated, I embarked on a Bachelor of Science in Anatomy & Physiology at Otago University, still desperate to find a career pathway into equine physio. In my second year, my Father contacted Bristol University regarding an equine course, and they explained that the Royal Veterinary College was launching a world first - a Masters of Science in Veterinary Physiotherapy. So I promptly charged my phone card (yes this was the late 90’s), and called London. The degree sounded amazing, and I could apply from NZ. I could hardly contain my excitement. But then at the end of the conversation - the game changer. You had to be a ‘human’ physiotherapist first.

So back to the drawing board, I had to complete my BSc before applying to the Otago Physio program, so I took my chances with AUT and thankfully was accepted. I embarked on a further 4 years in addition to the two I had already completed, and although I had moments of frustration where I just wanted to get straight into the animal physio, I did enjoy the degree. The RVC insisted on 2 years clinical experience, so as soon as I had my

registration I applied for a job in MSK private practice with Glen Putze, who was a wonderful mentor and taught me so much, really helping me hone my palpation skills. I cheekily applied early for the RVC MSc, hoping to be accepted and then be able to defer. Amazingly they took into account the clinical hours completed in the AUT BHSc and the concentrated hours in private practice compared to the British degrees and new grad structure and accepted me with only 15 months experience, so I packed my bags and took off to London in May 2005 to finally study Veterinary Physiotherapy.

The Masters program at the RVC was incredible and I loved every minute. Once there I realised to my surprise that it wasn’t just horses who could benefit from physiotherapy but other species too - companion animals (dogs, cats, rabbits) and other species too. While I started out wanting to research the broad topic of ‘Equine Back Pain’ I was offered the opportunity to travel to Dubai with an RVC research team to study racing camels, so decided that was a once in a lifetime chance. Three of us dissected 5 camels and investigated the structural and functional anatomy of the thoracic and pelvic limbs by gathering quantitative muscle architecture and moment arm data, while the other half of our research team trialled early models of inertial motion sensors on the camels at the racetrack (a single railing that went further than you could see out into the desert). Back then, the inertial units fitted into small tins which had to be bandaged to the camel’s distal limb and had cables running to sensors which they tried to glue to the camel’s toe nails (they had only previously been used on horse hooves). I then analysed the thoracic limb data for my pilot project and thesis, of which I won the Project Prize for and joint First Place, and a Distinction for my MSc. This still amazes me, but when you are passionate about what you are studying, it is astounding what you can achieve! During my MSc, having already collected my camel data, I was asked at the last minute to fly out to Australia to assist on another RVC project which was using the same methodology as I had used on the camels, but investigating two very different equine athletes - the Quarter Horse and the Arab. The equivalent of comparing the sprinter and the marathon runner. Of course I said yes, and we flew out from London a few days later to dissect 12 horses at the University of Queensland. These two

breeds are at opposite ends of the spectrum of equine performance - the Quarter Horse (QH) can do a quarter mile (402m) in 21s and accelerate from a standing start to approximately 70km/h, has been selectively bred for acceleration and can accelerate faster than a thoroughbred. It is a very popular breed in the USA and there are over 4 million registered QH’s who participate in

Western sports, showing and racing. Whereas the Arab, an exceptional athlete in it’s own right, has been bred to cover huge distances at slower speeds (17km/h) and can cover 160km in 9.5 hours. It is thought the Arab has been selectively bred for 4500 years. We already knew that the muscle architecture of the fore and hind limbs of the horse are optimised for different biomechanical functions (Payne et al 2004, 2005), and the proximal hindlimb muscles provide power for locomotion (Dutto et al, 2004), while the forelimbs act as stiff spring-like struts (McGuigan & Wilson, 2003). The proximal hindlimb muscles account for the majority of the horses’s locomotor mass (Payne et al, 2005), many of which attach directly to the skeleton without a tendon, and provide the mechanical power for activities such as acceleration, running uphill and jumping (Robert et al, 2000). In comparison, the equine distal hindlimb muscles are significantly smaller and attach to the skeleton via long thin spring-like tendons - an

Arab endurance horses - UAE

Quarter Horse racehorse

adaptation in cursorial animals which reduces the need for energetically expensive muscle.

Elite sprint runners have longer muscle fascicle lengths, arranged at lesser pennation angles in their leg muscles (Abe et al, 2000) which has been linked to running speed, so could this be the same in Equine athletes? We dissected 6 QH’s and 6 Arabs to find out, and we discovered that the QH hindlimb muscle had a greater muscle mass and physiological cross sectional area (PCSA) and therefore greater isometric force potential when compared to the Arab, and all horses were of a similar height and body mass. Gluteus medius had the largest PCSA and force potential in both breeds, and the mean PCSA of semitendinosus in the QH was approximately double that of the Arab. We found no significant difference between the two breeds in muscle architecture or pennation angle. We also investigated the moment arms at the hip, stifle and tarsus during limb extension using the tendon travel method and found a trend towards the QH muscles having a greater length of moment arm and potential to generate a greater mean muscle moment at the hip than the Arab due to their greater PCSA, and the QH gastrocnemius and biceps femoris can potentially generate almost double the muscle moments. QH limb muscles are better suited to generating greater joint torques associated with rapid acceleration due to greater muscle PSCA and therefore greater isometric force potential, rather than by having greater length of muscle moment arm. Arab muscles at the hip and stifle tend to have greater MFL:MA ratio (muscle fascicle length:moment arm), which indicates their muscles have the potential to operate at slower velocities of contraction and therefore generate greater force outputs, optimising their muscles for economical locomotion during endurance racing.

https://onlinelibrary.wiley.com/doi/10.1111/j.14697580.2007.00848.x

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913009/

Following my graduation in London in 2007 I was fortunate enough to secure the only full time Veterinary Physiotherapy job on offer in the UK (and thankfully a work visa!) for Amanda Sutton, ex-British Team Physiotherapist in the beautiful English county of Hampshire for a year. I then moved on to become physiotherapist for a

number of international event riders and their horses in Hampshire and the Cotswolds Vittoria Panizzon (ITA), Yoshi Oiwa (JPN), and Andrew Hoy (AUS) & Bettina Hoy (GER) who were then based at Princess Anne’s picturesque Cotswold estate - Gatcombe Park. I worked at all the major 3 Day Events in the UK Badminton, Burghley, Blenheim as a physiotherapist for horse and rider. For me, this was living the dream and I was lucky enough to achieve one of my career goals and travel to the Beijing Olympics in 2008 with Vittoria Panizzon and her horse Rock Model, and was able to also

support Yoshi Oiwa and his horse Gorgeous George while there. On my return from the Olympics, I was sadly unable to stay in the UK due to visa issues, so returned home to New Zealand late 2008, thinking that this was a temporary move. A few months later, I was still unable to return to my career and life I had created in the UK, but realised that I had a business already in NZ, developed purely through word of mouth so decided to stay and Vetphysio was founded. Vetphysio is a mobile and clinic-based equine service, rider physiotherapy service and clinic-based small animal service. We offer pre and post operative physiotherapy services, rehabilitation, biomechanics analysis, geriatric and arthritis management, sports injury and performance optimisation.

Vittoria, Rock Model & Sarah a few minutes before entering the Olympic arena to perform their dressage test - Beijing 2008

Olympic physio’s a bit damp after cooling down the horses in the 10min box post cross country - Sarah (ITA), Narelle Stubbs (AUS) & Ellie Tisch (CHN) - Beijing 2008

www.vetphysio.co.nz

It is a real passion for me to work with my elite patients high level sport horses (Eventers, showjumpers, dressage horses) and riders, racehorses, working and sporting dogs to really help them achieve that additional performance and at the other end of the spectrum I love working with our older animals, maximising their mobility and quality of life for as long as possible.

It was a privilege to travel back to the UK for the London 2012 Olympics to be physio again for Vittoria Panizzon and her horse Borough Pennyz, and I have travelled to the Adelaide 5* 3 Day Event (the only 5* 3DE in the Southern Hemisphere, and one of only 5 in the world) a number of times with my clients, and in 2019 as Physio for the NZ Eventing Team (another career goal ticked off) and I have travelled internationally treating racehorses. I’m lucky to work with many of New Zealand’s top equestrian athletes and I work at many of the major National Events in NZ throughout the Equestrian season and at the Horse of the Year show annually where I can support my clients in many of the Equestrian disciplines at the one event.

Vittoria Panizzon (ITA) & Borough Pennyz in the show jumping phase of the Eventing at the London 2012 Olympics

Borough Pennyz back in the stables enjoying her physio session between phases London 2012 Vittoria & Borough Pennyz - about to head out on the cross country course London 2012

I feel as a Veterinary Physiotherapist we are advocates for our animal patients who cannot verbalise their pain and discomfort, or their inability to perform a task or movement. We work closely with our wider professional team - Vets, Vet Specialists, Vet Nurses, Trainers, Coaches, Farriers, Saddle fitters, Massage Therapists & Bodyworkers. Just as in ‘human’ physiotherapy our multidisciplinary team working together is crucial to our success. In non-verbal patients, the more information we can gather the better! Our owners/riders/trainers love to feel that their medical team surrounds them and are communicating to work out the best plan for their animal.

As Physiotherapists we are able to treat the horse AND the rider which is a real advantage

After working closely with Veterinary Specialists for years, accepting referrals for non-surgical and post operative physiotherapy for small animals, it was significant when our main Veterinary Specialist group made it clear that they felt a Physiotherapy service for their new state of the art VSA (Veterinary Specialists Aoteoroa) animal hospital

in Sylvia Park was a necessity. It was a privilege to come on board and develop VSA Physio when we opened the new hospital back in 2016. VSA Physio is an inpatient and outpatient physiotherapy service which includes hydrotherapy in our HydroPhysio underwater treadmill. Our post operative case load includes orthopaedic and neurological conditions such as cranial cruciate surgery (TPLO), arthroscopies, surgical options for hip and elbow dysplasia, total joint replacements, fracture repairs, traumas, lumbosacral stabilisations and spinal decompressions. Our team has grown to three Veterinary Physiotherapists and two Canine Hydrotherapists and we offer physiotherapy at both Sylvia Park and Mount Albert hospitals. VSA is branching out to the South Island in the coming months and a VSA hospital is being developed in Christchurch.

On a side note, I did fulfil my other childhood dream and have two Land Rovers (one is a 19 year old 110 Defender), and have travelled to South Africa twice for work! Living the dream…

It is certainly a long (6 years study minimum) and arduous process to become a Veterinary Physiotherapist, requiring passion and commitment but I can honestly say it is absolutely worth it. We have a growing profession here in New Zealand, and as the founder and Chairperson of the New Zealand Animal & Veterinary Physiotherapy Association since 2007 it has been exciting to see the development and growth of the profession here in NZ. The pathway that I took of having to move to London for postgraduate study (and pay overseas student fees!) is not a necessity, as technology now enables qualified physio’s to study a postgraduate degree online through

the University of Liverpool from this side of the world. I am a clinical educator for this course, and it has been a pleasure to work with many of the Australasian graduates in recent years. I look forward to continuing to support and develop our future Veterinary Physiotherapists.

https://www.liverpool.ac.uk/vets/cpd/vet-physio/

REFERENCES

Abe T, Kumagai K, Brechue WF (2000) Fascicle length of leg muscles is greater in sprinters than distance runners. Med Sci Sports Exerc 32. 1125-9.

Crook, T. C., Cruickshank, S. E., Mcgowan, C. M., Stubbs, N., Wakeling, J. M., Wilson, A. M., & Payne, R. C. (2008). Comparative anatomy and muscle architecture of selected hind limb muscles in the Quarter Horse and Arab. Journal of Anatomy, 212(2), 144–152. https://doi.org/10.1111/ j.1469-7580.2007.00848.x

Crook, T. C., Cruickshank, S. E., McGowan, C. M., Stubbs, N., Wilson, A. M., Hodson-Tole, E., & Payne, R. C. (2010). A comparison of the moment arms of pelvic limb muscles in horses bred for acceleration (Quarter Horse) and endurance (Arab). Journal of Anatomy, 217(1), 26–37. https://doi.org/10.1111/j.1469-7580.2010.01241.x

Dutto DJ, Hoyt DF, Clayton HM, et al. (2004) Moments and power generated by the horse (Equus caballus) hind limb during jumping. J Exp Biol 207, 667-674.

Mcguigan MP, Wilson AM (2003) The effect of gait and digital flexor muscle activation on limb compliance in the forelimb of the horse Equus caballus. J Exp Biol 206, 1325 -1336. Payne RC, Crompton RH, Isler K, et al (2006) Morphological analysis of the hindlimb in apes and humans. II. Moment arms. J Anat 208, 725-742’ Payne RC, Hutchinson JR, Robilliard JJ, Smith NC, Wilson AM (2005) Functional specialisation of pelvic limb anatomy in horses (Equus caballus). J Anat 206, 557-74.

Scholz MN, Bobbert MF, Soest Van AJ, et al. (2008) Running biomechanics: shorter heels, better economy. J Exp Biol 211. 3266-3271.

by Emma Lattey

For this bulletin I am reviewing the AirBands app which gives us the ability to bring the latest technology into our clinics, and further advances our scope/roles as sports physiotherapists. Gone are the days we wrap high resistance theraband around thighs, these AirBands from VALD make BFR rehabilitation so much more skilful and scientific. I couldn’t recommend them more highly - AirBands add a new dimension to rehabilitation which makes it easily accessible for the athletes we treat of all levels.

Seller: Size: Vald Performance Pty Ltd 36 MB

Category:

Health & Fitness Version: 0.12.0 Compatibility: Requires iOS 11.0 or later. Apple and Android Languages: English Age rating: 12+ Copyright: Ó AirBands 2020 Cost: App is free. Family Sharing: Yes

AirBands BFR cuffs are the world’s first fully automated and wireless BFR training solution. They provide an easy and cost-effective solution to BFR training in any rehabilitation environment.

Personalized BFR training is a training strategy (or an exercise modality) that involves exercising at low intensities (i.e. 20-35% 1-RM) while occluding venous blood flow out of a limb and restricting arterial blood flow into a limb by using a system that is calibrated based off of personalized limb occlusion pressure.

Extensive scientific literature has validated BFR and its benefits:

• Improved rehabilitation

Blood Flow Restriction Therapy Preserves Whole Limb Bone and Muscle Following ACL Reconstruction

• Increased strength Restoring knee extensor strength after anterior cruciate ligament reconstruction: a clinical commentary

• Increased endurance

Short-Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction

Any patients who have none of the contraindications set out in the link below. I have mostly used with patients post ACLR, patella dislocation, quads tendon repair with good success.

• AirBands inflate and deflate to exact pressure automatically • App automatically calculates your personalised pressure zone • App has a BFR medical screening tool before patient uses the AirBands • Comes in two sizes – arm cuff 25-45cm and leg cuff 45-65cm

• Can take time to find cuff via Bluetooth connection • You have to stay very still for calibration, and this can take 2-3 attempts

https://theprehabguys.com/personalized-blood-flow-restriction-training/ - helpful to read about further research, training options, and contraindications

https://valdhealth.com/airbands/ - outlines pricing of arm and leg bands