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Equine Physical Therapy

By Les Sellnaw

Physical therapy long has been a mainstay for human athletes. Competitors in sports ranging from football to gymnastics have utilized a variety of approaches to help maintain physical fitness and to assist in the recovery process when injury occurs to a joint, muscle, ligament, or tendon.

Today, physical therapy also is a part of the racing and sport horse world, and it seems it is here to stay. Equine physical therapists are using a number of modalities and techniques that range from simple stretching exercises to sophisticated laser equipment.

Controversy surrounds some of these methods and approaches and much is yet to be learned. In upcoming articles on alternative therapies, we will be delving into a variety of specific modalities. In this article, we want to take a look at just what physical therapy is all about, and what it can and cannot accomplish in preventing and treating equine injuries.

Before advancing into the field of ultrasound, lasers, the use of magnets, and the like, it seems wise to first take a look at some basic approaches—warming up and stretching the competitive horse prior to competition, and the application of cold and heat when injury occurs.

The majority of the material that follows comes from Mimi Porter of Lexington, Ky., a well-known equine physical therapist who authored the book Equine Sports Therapy. Porter launched her physical therapy career by serving as an athletic trainer at the University of Kentucky for 10 years. She moved into the equine field because of a lifelong love of horses and the firm belief that they have a physiology that is similar to humans and that they suffer some of the same types of injuries as do human athletes. Porter holds a masters degree from the University of Kentucky and is a certified athletic trainer.

In the opening chapter other book Porter describes the role of the equine sports therapist as follows:

"The role of the equine sports therapist can be compared to that of the athletic trainer or sports therapist in human sports medicine. The job of these specialists is considered adjunctive to that of the sports medicine physician or orthopedist. The athletic trainer works cooperatively with the physician as well as the coach in setting up and carrying out conditioning and rehabilitation programs for the athletes. He administers first aid to injured athletes and applies protective devices or injury preventive equipment. Another important function of the athletic trainer or sports therapist is the application of therapeutic modalities to ease the discomfort of injury and facilitate exercise. These modalities include ice, heat, water, electricity, light, sound, exercise, and stretching."

Porter is quick to say that equine physical therapists should work only on a referral basis from a veterinarian and that no invasive techniques should be employed by the therapist.

In fact, that position is a cornerstone of the by-laws of the National Equine Therapists Association, which was formed in 1987 to improve the standards of equine therapy. One of the goals of the organization is to establish a certification exam for equine therapists.

"Once this is established," notes Porter, "and more direct educational opportunities develop, there will be considerable professional advancement in this rapidly developing profession."

There are a number of goals that the physical therapist seeks to reach. They include pain reduction, restoring range of motion, restoring strength, and injury prevention.

Here is how Porter explains each of them:

Pain Reduction—
"In an injury prevention or rehabilitation program, therapeutic agents should be used with specific goals in mind. A primary goal is pain reduction. This can mean a reduction in the amount of medication necessary for pain relief, or it can mean pain control solely through the use of the therapeutic modality."

Restoring Range of Motion—
"The pain of injury or surgery often leaves a Joint immobile. Over a period of time, this immobility results in contractures in the soft tissues around the joint. Shortening and stiffening of those structures will cause immobility long after the pain is gone. If a program of flexibility exercises is begun immediately after surgery or injury, normal range of movement can be maintained. Stretching, as part of a pre-exercise warm-up, will play an important role in injury prevention."

Restoring Strength—
"It is nature's dictate that a body part should be rested after an injury. Unfortunately, this rest leads to disuse atrophy in the surrounding musculature. Weakened muscles are vulnerable to injury themselves, and they set the stage for re-injury when there is a return to activity."

Injury Prevention—
There is still so much to learn about how to optimally condition the horse for his work or sport. Perhaps, as we gain knowledge in this area, ways of preventing sports injuries will come to light. In the meantime, thermography, heart rate monitors, weight scales, and diagnostic tools traditionally used by veterinarians should be employed in a timely manner in hopes of discovering injury while it is in a more easily treatable stage.

"Although therapeutic modalities and techniques are useful in many ways in dealing with injury, they are non-invasive in nature. As such, they are most effective in the early stages of the injury process. Once the horse is visibly lame, an on-going process must be reversed. Rehabilitation is a much more challenging task at this stage."

Stretching

Perhaps the most basic of physical therapy techniques involves stretching. This procedure is relatively new for horse owners, although human athletes have long recognized its value. Basketball players, track contestants, gymnasts—the list could include every form of athletic endeavor—spend valuable minutes before a competition in warming up and in stretching and limbering exercises. If this is important for the human athlete, one can logically reason, it should be just as important for the equine athlete.

Porter provides this differentiation between stretching and warming up:
"Stretching exercises are those exercises designed specifically to draw out or to extend the muscle and its connective tissue to their full lengths. Warm-up is an activity or series of exercises that raise the total body temperature, preparing the body for vigorous activity. Warm-up exercises include walking, slow jogging, and gentle stretching.

"It is thought that a good warm-up will improve subsequent physical performance by shortening the adjustment period of the cardiovascular and muscular systems to the increased activity. Warm-up exercises raise blood temperature, which enhances the dissociation of oxygen from hemoglobin and myoglobin, making it more accessible to the cells for metabolism."

Porter recommends that warm-up precede stretching because, she points out, and attempting to stretch a cold muscle could result in small tears in the muscle fibers.
Human athletes warm up and stretch so that tendons, muscles, and ligaments are more elastic, allowing them to be agile. Equine sports also demand great agility from competitors, so it stands to reason that they, too, need elasticity of muscles, tendons, and ligaments.

"An additional benefit of manual stretching," Porter points out, "is that it provides the opportunity to assess the physical health of one's horse in a unique way. An opportunity is provided to detect and assess imbalances in flexibility which could indicate the development of injury. Noting resistance to gentle stretching maneuvers, the handler has a clue that the muscle involved is not being used to full capacity. Such an imbalance is a part of the chronic injury syndrome or could lead to an acute injury.

"Stretching exercises can be of great benefit in providing relief from certain types of pain. Pain derived from a condition called fascial contracture responds to consistent repetition of stretching exercises. Fascial contracture occurs when muscles and their connective tissues tighten abnormally. Age, chilling, inactivity, and muscle strain can result in pain. They also limit the power the muscle is capable of producing during work."

No longer is it unusual on the backside of a racetrack or in the barn area at a competitive event to see handlers stretching forelegs and hind limbs of horses about to run or be involved in a contest.

Porter emphasizes that there are a couple of important things to keep in mind when carrying out stretching exercises with the horse. First of all, she states, the stretching should be done in a quiet, relaxed manner. The limb should be guided through a range of motion, held in that position briefly, and then gently returned to its normal position.

"Do not pull on your horse's limb," she admonishes, while adding the following advice.

• Disregard what you hear in the gym about stretching to the point of pain. Over stretching can produce microscopic tears in the tissues which may lead to scarring and the eventual loss of elasticity, the opposite of your goal.
• Human athletes work up to holding the stretch for 30 seconds. No research has been done to indicate how long a stretch should be held with a horse, so it is up to the owner to be aware of what he/she is feeling in the horse...Never use a bouncing or jerky stretch.
• Muscles should always be warmed up before stretching.
• Never stretch an acutely torn muscle.
• Avoid excessive traction or pressure on the joints. Avoid movements which twist the joints.
• Be aware of the normal range of motion of your horse's joints.
• Always consult your veterinarian before performing any stretching exercises with your horse.

Heat And Cold Therapy

The use of cold and heat as part of physical therapy long has been practiced by a number of knowledgeable horse owners and remains a valuable modality today, despite the advent of a variety of sophisticated equipment designed to alleviate problems that crop up following injury.

Simply put, cold is used early in an injury to reduce inflammation, and heat is utilized later to facilitate the healing process.

The key to success in utilizing cold as a therapy in the wake of an injury is timing. The more quickly cold therapy is administered, the more optimistic the prognosis for quick relief from pain and swelling. Applying cold therapy in the first hour after an injury is optimum.

"Cold therapy is indicated following all acute injuries," Porter declares, "and can be useful post-surgically. The use of cold therapy slows chemical reactions in cells and inhibits enzyme activity, thus reducing the inflammatory reaction. Although the inflammatory reaction is necessary to draw cells to the area that initiate healing, such as white blood cells, it should not be allowed to persist. The inflammatory condition creates hypoxia (reduction of oxygen supply) in the tissues. It is thought that cold therapy reduces the oxygen requirement of the cells, allowing them to survive the hypoxic condition.

"Chilling an injured area is effective in controlling the amount of initial swelling after an acute injury. Swelling should be treated in the first hour after injury by cold-induced vasoconstriction. The longer one waits after the injury before treatment is begun, the more damage that occurs."

A recent study involving human athletes has yielded information that can maximize the application of cold following an injury, reports Porter.

In the study involving human runners as subjects, it was found that during the first five minutes of cooling, no reduction in blood flow was seen. After 10 minutes of cooling, blood flow was significantly reduced. A maximum reduction of blood flow (69%) was seen 10 minutes after the cooling period.

Because of this delayed reaction in reduction of intramuscular blood flow, it was theorized that applying external compression along with the cold would be more effective in reducing inflammation. In other words, it would be more effective if one were to wrap the injured member with an elastic bandage, then apply ice over the bandage. Researchers believe that a good compression wrap will limit the space into which blood can flow within the tissues and augments the effects of ice. Be warned, however, that too much pressure can lead to a compartment syndrome with increased tissue damage. Wrapping with an elastic bandage should be done very carefully.

While it is highly important to apply cold therapy immediately after an injury, it is not necessary to apply it for long periods of time.

"Ice applications longer than 30 minutes," advises Porter, "should be strictly avoided. Hours of continuous ice application will not increase the effectiveness of tissue cooling or extend the period of analgesia. At the racetrack, horses are sometimes made to stand in a tub of ice water for hours. This is unnecessary and can be harmful. Excessive use of cold can cause such a decrease in metabolic activity that local destruction of tissues can occur. Also, overexposure to cold can result in increased edema due to tissue damage and reflex vasodilation from prolonged exposure to cold."

Generally speaking, heat produces effects that are the opposite of cold. While cold serves to decrease metabolic activity in cells, heat increases the activity. Thus, in the wake of injury, heat therapy would not be used until the application of cold, with its beneficial reduction of inflammation, had been completed.

Heat can facilitate the healing process because the increased metabolic activity in the cells causes an increase in oxygen demand locally. As a result, says Porter, vasodilation occurs to increase the amount of blood bringing oxygen and nutrients to the area. Membrane diffusion and enzymatic activity also increase, enabling oxygen consumption and waste removal.

Applying heat correctly and utilizing the correct degree are extremely important. One of the keys to success is knowing how much heat to apply.

Porter offers these guidelines:

"In order to achieve a significant change in metabolic rate and collagen distensibility, temperature of the target tissue must rise at least five degrees. Temperature increases greater than 12 degrees create the sensation of pain rather than the sensation of heat.


"Unfortunately, by the time pain is registered and the horse attempts to move away, some damage may have already been done. The skin temperature of a horse is generally 90-92° Fahrenheit. The heat source must be warmer than this, obviously, to increase tissue temperature. However, it is well documented that heat applications over 133° Fahrenheit for prolonged periods will cause skin damage. There is a nine degree 'window' or therapeutic range between effective healing and surface tissue damage.

"Methods of heat application include heating pads, hot water bottles, hydrocollator packs, heating lamps, hot water whirlpools, hot towels, counter-irritating liniments, and ultrasound."

"Of all the heating devices listed, only therapeutic ultrasound has the ability to penetrate through the skin to the deeper structures, such as joint structures, tendons, and muscles. All the other sources heat only the skin and perhaps the underlying connective tissue. These two structures are not involved in most sport injuries. The temperature of the injured tissue must increase to have significant effect. That is not to say that the other forms of heat are useless. A comfortable level of heat is soothing and relaxing and stimulation of sensory nerves in the skin can have a damping effect on pain."

Whirlpools are frequently utilized by human athletes, but only in recent years have they been employed for the benefit of equines. Available today are a wide variety of whirlpools for horses that are capable of combining gentle massage of an injured limb with the application of superficial heat.

The agitation of the water, Porter points out, can also loosen scabs and crusts on the skin surface and help remove debris from a wound. Iodine should be added to the water to reduce the possibility of transmitting infections and aid in cleansing abraded skin only on the advice of a veterinarian. Using inappropriate iodine concentrations could hinder wound healing.

Porter recommends that water temperature in whirlpools should be between 103-110° Fahrenheit.

Also highly beneficial in applying heat therapy are hydrocollator packs. They are cotton packs that contain a gel that absorbs heated water and becomes soft, thus allowing it to conform to the contours of the body. Porter describes the packs as being "perhaps the most efficient of the superficial heating devices."

Future articles, as we mentioned, will explore other forms of alternative therapies, ranging from ultrasound to magnets, but the wise horse owner will always do well to remember that warming up and stretching are important in preventing injury in horses which compete, and that the application of cold and heat therapy at proper times remains highly important in treating injuries when they do occur.

About The Author

Les Sellnow is a free-lance writer specializing in articles on equine research. Based near Riverton, Wyo., Sellnow also is the author of fiction and non-fiction books. As "well as being a regular contributor to The Horse, Sellnow operates a ranch, -where he raises horses and various livestock.

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