Osteopathy And The Stressed or Anxious Horse.

How Osteopathy can help your horse’s mood.

A study published in 2017 has begun to give some credence and ask some interesting questions about chronic stress or depression in our horses. According to Jodi Pawluski   and team(1) a group of horses showing signs of compromised welfare (living conditions fostering social restrictions, limited space and interactions with inexperienced riders) showed abnormally low cortisol levels.

Cortisol, aka ‘the stress hormone’ is one useful indicator of the way the horses Autonomic Nervous System (ANS) is working. The ANS is a largely unconscious mechanism which regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It is also involved in controlling blood sugar levels, regulating metabolism, helping to reduce inflammation, and assisting with memory function.  It has two complimentary sides – the Sympathetic “flight/fight”and the Parasympathetic – “rest/digest”.  When there is a balance these work nicely together to maintain homeostasis – a happy balance.  Sympathetic stimulation acts to increase the blood pressure, heart rate, respiratory rate, blood sugar levels and muscular tension. All these are characteristic of the sympathetic nervous system driven “flight/fight” reaction so commonly seen both humans and animals.  Elevated cortisol is one marker of Sympathetic activity.  On the flip side, insufficient or suppressed levels of cortisol, as can occur when stress is chronic, reduces all these functions.  One may think ‘Great! The opposite of flight/fight is rest/digest. That’s good, right?’, but unfortunately this isn’t the case. When cortisol levels become abnormally low, the body is on an almost constant ‘go slow’, with symptoms including fatigue, muscle weakness, lack of motivation or drive, an inability to cope with stress and depression. Neither state is conducive to a happy, enthusiastic individual, whether horse or human.

Further studies are obviously needed to help drill down into the relative influence of common management practices when it comes to our horses, though without a doubt the more a horse can live like a grazing herd animal and be handled by knowledgeable and gentle handlers, the better. In reality there are many things which limit this ideal situation, and we as horse owners have a duty of care to try to mitigate the effects our environment and interactions have on our horses.  For many the idea that Osteopathy can help to do this might be a new one. Many studies and much clinical evidence exists to support the idea that Osteopaths can play a significant role in helping to restore balance to the ANS function of our horses.

Recently I’ve had the pleasure of working with a thoroughbred mare who has had what can only be described as more than her fair share of stressful experiences in her life. Being used as a surrogate for several years, and being a highly sensitive mare, she has developed a strong fight response to the sensation of being confined. This likely relates to being handled within a crush and coming to associate pressure against her sides or hindquarters as a stressful and threatening thing. This, of course, makes closing her into a horse float a highly charged event. Her owner has been working patiently with her, doing regular training to help desensitise her to touch on her sides and hindquarters as well as to teach her the float is a safe environment and has got her to the stage where she self loads, however as soon as she feels the divider or ramp come up she begins double barrelling and swinging her hind end from side to side to the point of inflicting wounds on herself. This naturally only serves to reinforce her inherent stress response and belief that confinement is dangerous. In general, she was noted to be an aloof and non-affectionate mare who displayed many stress responses both in handling and in the paddock. When ridden she works and is quite relaxed and happy, however would never mouth the bit and regardless how much suppling work was done would never display a single drop of saliva at the lips.

Our initial treatment involved working through the ribcage to encourage freedom of motion at the costovertebral joints all the way to the thoracolumbar junction to effect the adrenals sympathetic ganglion as well as to encourage full function of the diaphragm during respiration. She was found to be a very shallow breather and the ribcage as a whole was quite immobile. Human studies have shown significant effects of osteopathic techniques on stress hormones,  one in particular using a technique known as Rib Raising (2). This technique addresses the costovertebral joints through the length of the ribcage and is clinically well known to be a powerful way of helping balance the autonomic nervous system due to the anatomical link to the sympathetic ganglia.  Further work was done to put a calming stimulus into the sacrum, which is also associated with the sympathetics.  Again, the sympathetic side of the autonomic nervous system is the one which drives the fight/flight response.

Sympathetic chain

The parasympathetics, drive the “rest and digest” functions. This is the calm and relaxed state of affairs. Structurally this is in part composed of cranial nerves that supply the face, cardiovascular system, respiratory system and gastrointestinal system. Parasympathetic function can be readily supported by allowing the jaw and diaphragm to function optimally. By encouraging full diaphragmatic function with simple exercises, it is possible to also give the vagus nerve a nice bit of stimulation. In the image below we are looking at numbers 3, 15 and 16, so you can see how far reaching work around the jaw and poll can be and how the diaphragm (which divides the thorax from the abdomen) may stimulate parasympathetic function via the vagus nerve.

Screenshot (1)

Immediately after the first treatment the mare was noted to be far more calm than usual, quietly wandering around the small yard we were working on another horse in, picking at grass.  This was noted by the owner to be quite unusual behaviour for a mare who was usually on guard around other horses and tended to pace the fence line if not in her own paddock.  I left the owner with several easy exercises to do daily to help keep the autonomic nervous system more balanced.  Over the next week I was pleased to receive several updates saying how relaxed the mare had become, a total change in character. The next visit we decided to push our luck a little and give her her treatment standing next to the horse float, a space she would usually become anxious and on edge. Initially obviously nervous we quietly worked through similar areas, noting a big improvement in passive range of motion and tissue tension around the ribcage as well as a greater capacity for diaphragmatic breathing. The owner was again pleased to see the mare calm and relaxed and picking grass while standing next to her least favourite piece of metal.

Our next plan is to work towards adding more stimulus by opening the tail gate and potentially eventually treating her or doing daily exercises to flick her nervous system into ‘rest and digest’ while standing on the horse float. It may take a while to retrain her nervous system that this is not a threatening situation which requires a fight response, however initial changes have been very positive and have reaffirmed how powerful Osteopathic treatment can be for modulating this crucial part of our nervous system.

For those interested in more reading about how Osteopathic treatment can help us (and presumably our horses) towards a less stressed and more healthy state, I have attached are some extra references for studies (2, 3 & 4) which also have shown preliminary findings of positive effects of various Osteopathic technniques on the autonomic nervous system in both relaxed and stressed humans, measuring indicators for sympathovagal function at heart level, cortisol levels and immune function.

It is a fascinating aspect of Osteopathic practice which I always enjoy seeing results from. As with all natural approaches, results will vary and een after 15 years of practice i’m still often surprised by how much change can be achieved, and in ways I wasn’t necessarily anticipating. The main principle of Osteopathy is that if the tissues in the body are moving and functioning to the best of their ability then that body will head towards homeostasis (a happy healthy balance), and the path that takes is sometimes a little unpredictable but with time and patience it’s a rare case where we can’t help the horse achieve that balance in their system.

Update – After posting this, I received a call from the mare in questions owner. She was thrilled to report she had spent an afternoon during the week playing with the mare around the whole travelling in the float issue. She began with groundwork exercises to calm the mares nervous system as prescribed. Then as she was going so well progressed to loading her, letting her stand, bringing the divider across, again waiting, bringing up the tail gate and the final test a slow drive around the block. The mare maintained her composure the entire time besides one small kick out when actually moving. Upon return she stood calmly for another 5 minutes with the tail gate down and waited for the cue to back off. Naturally the owner is absolutely thrilled to be approaching the stage she can again contemplate taking her lovely horse out again! I’m also thrilled to see the changes 2 treatments have brought to this lovely mare’s general day to day anxiety levels.  Stay tuned and I’ll add more updates as they come to hand.

 

 

 

 

References/Further Reading:

1 – Pawluski, J.,  Jego, P., Henry, S., Bruchet, A., Palme, R., Coste, C., Hausberger. M. Low plasma cortisol and fecal cortisol metabolite measures as indicators of compromised welfare in domestic horses (Equus caballus). PLOS ONE, 2017; 12 (9): e0182257 DOI: 10.1371/journal.pone.0182257

2 –  Henderson, A.T., OMS III; Fisher, J.F., OMS III; Blair, J., OMS I; Shea, C., OMS III; Li, T.S., DO; Grove Bridges, K., PhD. Effects of Rib Raising on the Autonomic Nervous System: A Pilot Study Using Noninvasive Biomarkers. The Journal of the American Osteopathic Association, June 2010, Vol. 110, 324-330.

(Twenty-three participants were recruited, of whom 14 completed the study (7 in each group). Subjects who received rib raising had a statistically significant decrease in α-amylase activity both immediately after (P=.014) and 10 minutes after (P=.008) the procedure. A statistically significant change in α-amylase activity was not seen in the placebo group at either time point. Changes in salivary cortisol levels and flow rate were not statistically significant in either group.
Conclusions: The results of the present pilot study suggest that SNS activity may decrease immediately after rib raising, but the hypothalamic-pituitary-adrenal axis and parasympathetic activity are not altered by this technique. Salivary α-amylase may be a useful biomarker for investigating manipulative treatments targeting the SNS. Additional studies with a greater number of subjects are needed to expand on these results.)

3 –  Fornari, M. DO (Italy); Carnevali, L. PhD; Sgoifo, A. PhD. Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants. The Journal of the American Osteopathic Association, September 2017, Vol. 117, 559-567. doi:10.7556/jaoa.2017.110

(Conclusion: The application of a single OMTh session to healthy participants induced a faster recovery of heart rate and sympathovagal balance after an acute mental stressor by substantially dampening parasympathetic withdrawal and sympathetic prevalence. The OMTh session also prevented the typical increase in cortisol levels observed immediately after a brief mental challenge.)

4 – Saggio, G., DO; Docimo, S., DO; Pilc, J., DO; Norton, J., DO, RN; Gilliar, W., DO. Impact of Osteopathic Manipulative Treatment on Secretory Immunoglobulin A Levels in a Stressed Population.  The Journal of the American Osteopathic Association, March 2011, Vol. 111, 143-147.

(Conclusion: High levels of human secretory immunoglobulin A (sIgA) have been shown to decrease the incidence of acquiring upper respiratory tract infections. This study demonstrates the positive effect of OMT on sIgA levels in persons experiencing high stress. Results suggest that OMT may then have therapeutic preventive and protective effects on both healthy and hospitalized patients, especially those experiencing high levels of emotional or physiological stress and those at higher risk of acquiring upper respiratory tract infections.)

Pain and lameness in ridden horses

Lameness

Call Sam Sherrington on 0452 472 959 for more information on Human and Animal Osteopathy.

It is established that more than 47% of the sports horse population in normal work may be lame, without having been identified as such by their regular owner or trainer. A new study by the industrious and ever driven Sue Dyson and team has made huge headway by testing the validity of a list of easily observed behavioural features that may indicate lameness in the ridden horse. The ethogram allows owners and riders to be more attuned to the signs that their horse may be in pain and thus could help to reduce the incidence of undiagnosed lameness in performance horses. The study compared the frequency and reliability of a group of 114 behaviours and reduced the list down to 24 reliable signs that occur significantly more frequently in lame horses than non-lame horses under saddle in trot and canter, when working large, on 20m and on 10m circles.

Many of the behaviours discovered to be significantly more common or exclusively seen in the lame group of horses are commonly viewed as purely behavioural and thus often addressed by stronger tack/equipment or punitive training methods. This study therefore provides some very compulsive evidence for always giving the horse the benefit of the doubt when a new or unusual behaviour crops up during work.

In my practice I’ve long seen many of these features as signs of pain in one part of the body or another, so it is fantastic to have some solid evidence to affirm the link and to help owners become more adept at recognising that these behaviours are in fact a cause for action. As the study concluded –

If ≥ 8 of the 24 identified behaviours linked to pain are observed within a fixed period of 3-5 minutes, it may be advisable to seek out a specialist for assessment of pain (lameness) in the horse.

So, keep this list of prime signs in mind if, while working with your horses, they begin to show undesirable behavioural changes. Young or green horses may be expected to show some of these signs as they are physically and mentally establishing their work, however if the behaviour continues then it is also well worth considering as a possible sign of pain.

  • Ears back
  • Mouth repeatedly opening and closing
  • Tongue exposed or tongue repeatedly moving in and out of the mouth
  • Working on 3 tracks in a straight line.
  • Increased frequency or changes in frequency of steps within a gait, especially if when going from large to small diameter circles.
  • Incorrect canter (Changing behind/in front)
  • Unwillingness to move forwards and resistances.
  • Spontanously breaking from one gait to another
  • Stumbling and toe dragging

The full list of 24 signs is below for those really keen to keep on top of this aspect of horse management.

First port of call for all overt lameness cases is your vet, and once veterinary sources of pain are eliminated Sam Sherrington – Equine Osteopath if in the Hills and  Hawkesbury regions of NSW, Australia or another Osteopath or Chiropractor (or Veterinarian trained in biomechanical treatment of horses) who has university level training to assess and treat musculoskeletal causes of lameness and pain.

Dyson, S., Berger, J., Ellis, A.D., Mullard, J., 2018. Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J. Vet. Behav. 23, 47-57. http://www.journalvetbehavior.com/article/S1558-7878(17)30172-7/fulltext

 

Dangling front legs!

How to fix dangling front legs showjumping.

Call Sam Sherrington on 0452 472 959 for further information on Human and Animal Osteopathy.

Nothing is more frustrating than a horse who suddenly begins to knock poles when jumping. A dangly front leg (or legs) can be the source of huge frustration particularly when all the schooling in the world just doesn’t seem to be working to get your horse to pick up in front. Lots of tight grids, well placed poles on an upright, leaving off the boots, using heavier poles etc. can all give a horse a little reminder that front legs are worth lifting, but what about when none of these have any long term effect and your beloved gee gee just keeps reverting to dangly, pole knocking form?

This is a problem I’d often see in both young and older horses, and often it will trace back to an actual fatigue issue.  Due to restriction in the neck/shoulder, thoracics and ribcage the horse is having to work at least twice as hard to lift the shoulder and forelimb when jumping. Those muscles can become hugely fatigued and sore and try as he might, your horse begins to leave a leg or two dangling. Other signs this could be the source of your pole knocking woes include a sudden crankiness about being groomed around the shoulder or under the girth or when being girthed up. Poor drainage from the limb might also be evident with an increase in windgalls particularly after standing in for the night, or increased heat in the lower limb after work. You may find the horse begins to dip away from the saddle even though the saddler just confirmed that it does in fact fit the horse just fine. Your farrier may complain that your horse has become suddenly a little more recalcitrant about standing on one leg for shoeing. If you attempt to stretch your horses leg out in front after girthing (which incidentally isn’t the best way to ensure no pinching and can be risky for the horse – more on that later) you may find your horse leaning back and trying to pull the leg away from you.

Horse-Muscle-Chart

So, a few boxes ticked there? What can we do about this?

Firstly it would be good to consider if your horse is showing any signs of lameness which warrant a visit from the vet.  Then ask if he is due his biannual Osteopathic (or similar) MOT. Working horses do best with a regular once over, even if all feels to be moving ok in work, often niggles from slips in the field, jolts landing from a fence or simply working hard for us can be found and trouble averted before it becomes real trouble.

Secondly, have a good, but gentle, poke and prod around the muscles around the shoulder girdle and upper forelimb (7, 11-19 in the image above) . Can you find any soreness or ropey patches through these muscles? Pick up your horses leg and bring the heel towards the elbow, then try to gently move the whole shoulder girdle and foreleg in all directions in a big circle. That is, in front, out to the side, behind, and under the body, then up towards the wither and down towards the ground. If your horse reacts to these movements or you find there are restrictions in any direction again it would be worth giving your friendly Osteo a call.

If you find tightness but no strong reaction from your horse (beware, so many of our beloved beastie are hugely stoic and pretend all is well even when they’re struggling), you can try for a week or so to use that circular range of motion as a warm up exercise to help mobilise the shoulder and see if there is an improvement in the lift over fences. If no change, again it would be worth getting an osteopathic MOT to determine if there are deeper restrictions preventing the muscles from releasing.

Finally, don’t forget to consider your own position. Are you leaning significantly to one side over fences and creating extra work for your horse? That’s something for both your instructor and also possibly your Osteopath to help with.

panam-showjump-1-7

As always, it’s worth considering if there are any signs of needing a vet. Problems in the lower limb or feet may also be worth ruling out. And, as for the best way to make sure there’s no girth pinch – a simple hand run down between the elbow and the girth will do the trick, without any risk of overstretching cold muscles.

Happy jumping, and please don’t hesitate to contact me if you’d like that MOT for your horse (or yourself)

 

Your Horses Body Type – Training to Avoid Injuries

When bringing a horse into training for any discipline, it is important to consider an individual plan aiming to get the best improvement in muscle strength, tone and flexibility while minimising the risk of injury. Anyone who has dealt with a range of horses within various disciplines, or even within one discipline alone will know that some horses seem so much more prone to injuries during training than others. Many times this can be due to the horses past work, for example ex-racers often come into their second career with variable degrees of ligament or joint damage due to the nature of their previous training. Starting with a fresh horse with a known history can be a major headstart, however every horse has his own physique and as such care in formulating a program accordingly can minimise the chance of injury.

Human professional athletes and their coaches have long considered their physique in optimising their training programs to get the best outcome from their training regimes and similar principles may be of great value in ensuring our horses perform their best. Three types of body type are widely recognised, the Ectomorph, the Mesomorph and the Endomorph. These three represent three distinct physiques, however in reality most individuals show elements of 2 or more.

The Ectomorph – The typical lanky thoroughbred type, light of bone, lightly or poorly muscled with weak connective tissue, they are long necked and small shouldered. They have small joints and relatively long legs in relation to their body size. They often carry low body fat, and are difficult to get good condition on, even with higher than average feed consumption. They are often also quite sensitive to temperature extremes and changes. Having poor natural muscle tone and weak connective tissue, this type is most prone to overtraining, and require the most care to build their strength gradually to allow them to perform without joint or ligament damage.



The Mesomorph – The athletic, well proportioned type with mature muscle, strong connective tissue and large bones. They tend to carry themselves well naturally, gain fitness and body condition readily. They are typically quite stoic and due to their inherent strength are more physically forgiving of errors in training than the ectomorphic type.


The Endomorph – Low natural muscle tone however, unlike the ectomorph, with work will gain muscle bulk readily. They have soft bodies and gain weight readily. They typically have smaller bone structure than the mesomorph, and due to their propensity to be ‘pudgy’ often resemble the typical “Thelwell” pony, with a big round body and little legs. This type are more resilient in training than the ectomorph, however require an awareness during training of the imbalance between body weight and the relatively small bone structure carrying this large body along.

Regardless of body type, basic principles of training are common to all. Following these guidelines you can help keep your horse fit and healthy while aiming for your ultimate performance goals.

  • Avoid excessive fatigue. Soft tissue injuries are far more common when muscles are fatigued.
  • Increased training should be matched with increased rest. It is during rest that significant increases in muscle strength and power are developed.
  • Resistance training increases the ability of muscle to endure hard training. Combinations of poles or cavalettis and working in varied and deeper surfaces build a horses core muscles required for support during faster and more jarring activities.
  • Introduce new work gradually. The more time the horse is given to build strength, the less likely he is to injure himself when being pushed during training or competition.
  • Train on as many different surfaces as possible. Varied ground stimulates the proprioceptors in the joints and improves the horses ability to maintain good stability when moving quickly over uneven ground.
  • Always incorporate a good warm up and cool down period to ensure maximum elasticity and power in the ligaments and muscles respectively during work, and preventing stiffness after work.
  • Professional athletes make use of manual therapists to ensure their bodies are working at their best and small injuries are dealt with before they become large problems. Your horse benefits in the same way from an Osteopathic consultation allowing his joints, muscles and tendons to work most efficiently and thus minimising the strain and risk of injury during your training and competition.
  • Do yourself the favour of considering your own balance and its effect on your horse. The daily impact of your imbalances can greatly affect your horses balance and work.

Following these guidelines will help both you and your horse work your best and pretty soon, you’ll start seeing the results in training and competition.

The Essential Jaw

Following on from our contemplations on the principles of Osteopathy, it seems natural to begin to consider some of the specific problems and syndromes that are commonly encountered in the performance horse. While focusing largely on the performance horse, the mechanical stresses in sporting dogs are often similar and principles of evaluation and treatment remain the same and may therefore be extrapolated in many cases.

I frequently have the privilege of helping horses who are showing signs of dysfunction in the TMJ – the Temporomandibular Joint. This is a fancy name for one of the most important joints in the performance horses body; the Jaw.

Symptoms that might suggest your horse is suffering from TMJ dysfunction might include localised pain or tenderness, leaning on the bit, resistance to one direction, poll flexion or one-sidedness, dropping a lot of feed or passing whole grains in his manure, ear or poll shyness, head-shaking, unexplained mild to moderate lameness especially “bridle lameness”, or generally being out of character.
Common management factors such as reduced grazing time and increased grain consumption, feeding from a raised feed trough, routine dental work, the use of various kinds of bits and nosebands can initiate or exacerbate dysfunction in this region. Injuries to the poll, pulling back or hitting the head in the stable or horse box are also common events leading to TMJ dysfunction. Conversely, dysfunction in associated regions can result in compensatory TMJ dysfunction as the horse attempts to work around discomfort in these areas.
The TMJ is an amazing joint, functionally it is involved in the simple act of chewing, the horses sense of balance, as well as being structurally linked to the rest of the body, from the upper neck to potentially as far as the pelvis. Because the function of the lower jaw requires so much movement for day to day survival, structurally it has come to be a complex joint allowing side to side movement, lengthways towards and away from the front teeth (retraction and protraction) as well as opening and closing. The structure of the joint itself is enhanced by strong connective tissue, musculature and nerve supply which supports the joint and enables the movement required. This tissue directly links the jaw to the base of the skull, the upper and lower neck and the structures through the upper respiratory and digestive system. Through the base of the skull run important cranial nerves which are responsible for many higher level functions in the head and the respiratory and digestive systems. The musculature from the upper neck functionally links the TMJ to the shoulder through both gross motor muscles and small deep postural muscles. The connective tissue of the TMJ also has slips to the connective tissue surrounding the spinal cord which ultimately ends at the level of the sacrum in the pelvis, functionally linking the jaw and the pelvis. Due to all these anatomical and functional links, the balance between the two sides of the jaw is integral to the correct functioning of all these systems. As such, when there is a loss of free range of movement and balance in the TMJ, the horse can suffer significant amounts of discomfort and ultimately loss of performance.
Osteopathically, the jaw is a satisfying structure to work with. Bringing balance to the TMJ typically triggers a cascade of improvements in many systems. Certainly, as with any other structure in the body, it is not a cure-all, however its effect locally as well as in functionally associated regions is powerful. Following release of the jaw horses will often yawn or shake their head, their expression often changes to a more relaxed and ‘happy’ demeanor. It is not infrequent to see a total relaxation of the whole horse due to the intimate links between the connective tissue of the jaw and the base of the skull and its cranial nerves. Upon walking the horse out, an increased freedom and length of gait is generally noted, due to the relationship of the jaw to the shoulder as well as the pelvic region through the spinal cord connective tissues.
If your horse is showing any of these signs it is well worth having him assessed for possible TMJ and surrounding dysfunction. As discussed, treatment can result in some huge improvements in performance and attitude. If you have experienced the days you wake up sore or with a headache and yet still have to go out and do your days work, you know how grumpy this can make you. Give your horse the benefit of being free of this kind of discomfort and you might find yourself and your horse coming ahead in leaps and bounds.