The Science Behind Rehab Therapy

Physical therapy, chiropractic, myofascial work and rehab can be incredibly effective on certain conditions, especially when done by someone who understands when and what to do. Some of these conditions include:

• Osteoarthritis;
• Bucked shins, splints, curbs, and some fractures, such as otherwise “untreatable” pelvic fractures;
• Injuries or paralysis of the suprascapular nerve, which innervates some of the shoulder muscles;
• Muscle atrophy;
• Muscle injury/damage following trauma or surgery;
• Tendon injuries (acute and chronic);
• Stifle weakness and dysfunction
• Spinal dysfunction and back pain
• Recovery from neurologic disease such as equine protozoal myeloencephalitis (EPM) or equine motor neuron disease;
• Acute and chronic wounds
• Disuse contractures or atrophy during stall rest or immobilization
• Neck, truck, and limb inflexibility;
• Loss of performance.

Although many owners, trainers, and veterinarians support using PT, chiropractic and rehab practitioners in horses, some members of the equine industry remain wary. The “science” behind physical rehabilitative disciplines in equine medicine is as inconsistent and unclear as it is with other complementary and alternative therapies, such as nutritional supplements and acupuncture. There are a number of reasons for this, the primary being that you cannot create a pill or procedure for these physical disciples, therefore there is no financial backing for good research by the pharmaceutical companies. Yes I did just say that and it’s because it’s true.

Extracorporeal shock wave, under water treadmill and cold laser companies are offering some small funding but its fairly dismal compared the to billions the pharmaceutical companies have t throw at research. For that (lack of research) reason these disciplines have not been fully integrated into the care and husbandry of horses, despite the large number of medical and surgical conditions that equine physical therapists and rehabilitation professionals suggest are amenable to PT.

What is physical therapy/ rehab etc?

Physical therapy helps a horse recover from injury and re-educates an injured body part to move or function normally. Rehab/PT includes the use of various modalities such as heat and cold, hydrotherapy, therapeutic ultrasound, extracorporeal shockwave therapy, cold laser, manual soft tissue and electrotherapy.

Lets look at these modalities:

Hydrotherapy Swimming and specialized under water treadmills have also become very popular. They allow rehabilitation in a buoyant environment which allows for endurance training without impact on affected joints.

Cold therapy, involves applying water to an injured area to encourage healing. Cold hosing an injury to reduce inflammation is one of the simplest forms of cold therapy. It helps reduce swelling in a recent injury and can also be accomplished by pressing or wrapping ice packs around an affected area.

Heat therapy, on the other hand, causes blood vessels to dilate, increasing blood flow to the injured site to maximize healing. This therapy is used after pain and swelling subsides. Hot compresses, or a soaking boot (for lower limb injuries), among other approaches are effective for applying heat.

Therapeutic ultrasound involves using high-frequency sound waves to raise the temperature of selected deep tissues without heating the horse’s skin. Ultrasound is used to treat musculoskeletal injuries and promote wound healing.

Laser therapy employs infrared wavelengths to stimulate normal cell activity that has been injured. This method is most commonly used to treat soft tissue injuries, joint pain and to repair wounds.

Electrotherapy is the application of an electric current via surface electrodes to produce controlled movement of the skin, muscle, tendon, and associated ligaments. There are two main types of electrotherapy devices: sensory nerve or motor nerve stimulators that work on different pathways and have different therapeutic uses. NMES and TENS have different therapeutic properties and work on different physiological pathways.

Extracorporeal shockwave therapy is a shock wave is an acoustic (pressure) wave with very high amplitude and rapid rise time. There are multiple ways to generate a shock wave. While the exact mechanism is not yet known, ESWT commonly leads to improved circulation due to blood vessel dilation in and around the injured area. Growth of new blood vessels has also been recorded.

Significant pain relief is almost immediately evident, although slight swelling and sensitivity may be noticed for a few days. ESWT also has a positive effect on the concentration of transforming growth factor beta 1, which stimulates cell activity. In addition, ESWT influences bone remodeling by thickening the outer layers and strengthening the cell network underlying joint cartilage.

The best results have been seen in horses with hock problems and proximal suspensory ligament injuries. Stress fractures, ringbone, navicular syndrome, back pain, and tendon injuries have been treated with variable results.

Despite the widespread availability and use of rehabilitation modalities, machines cannot replace a rehabilitation specialist’s own hands, skill sets, and problem-solving abilities. Biomechanics and gait evaluations and exercises as well as a full physical exam will determine what course the treatment will take. These treatments will improve the horse’s biomechanics and re-educate muscle memory, which will help heal the current injury as well as assist in preventing reinjury.

Controlled physical activities, such as using a treadmill, underwater treadmill, and/or mechanical walker, schooling and swimming, for example, are also widely employed. These, along with manual techniques such as massage, stretching, chiropractic adjustments, myofascial dry needling and core stability training, are often employed in the successful rehabilitation of an injured or post-surgical horse, to assist performance horses during competition, and even aid mares during the postpartum period.

Physical therapy should not be assumed to bring the horse back to pre-injury status, but should be viewed as a means to help heal the injury or surgery to the best possible outcome. Further, once a condition has become chronic, it will be more time-consuming and challenging to return to the horse to his previous level of performance.

Dr Hilary Clayton and colleagues are studying the effects of core training exercises on the horse’s neck and back. Clayton’s research has shown that performing baited stretches (“carrot stretches”) regularly over a three-month period can activate and strengthen the muscles that support and stabilize the horse’s back. These study results were published in the Equine Veterinary Journal in 2010 and 2011.

Kevin Haussler, DVM, DC, PhD, from the Orthopaedic Research Center at Colorado State University, is also making impressive headway in this field. Recently, Haussler and colleagues described their assessment chiropractic on the spine and concluded that it can improve spinal flexibility in actively ridden horses.

For rehabilitation to be successful in horses, it should not just rest on the shoulders of the specialist; it should involve the veterinarian, farrier, trainer, owner, barn manager, feed specialist, and saddle fitter, just to name a few. The key is putting all of our heads together to come up with an excellent rehabilitation plan.