Sam Sherrington – Osteopath – Page 2 – Move Well, Feel Well, Perform Well

Canine Cranial Cruciate Ligament Injuries – Surgery or what??

How Cranial Cruciate Ligament Injuries can be managed when surgery isn’t the first choice.

Ruptures and partial tears to one or both Cranial Cruciate Ligaments (CCL) is a remarkably common injury in our doggy friends. While certain breeds seem to have significantly more frequency of injury, I see it in a wide variety of breeds, ages and sizes of dogs.

(image: petmd.com)

Traditionally, it has been believed that typically only small dogs, under about 15kg, fare just as well with conservative management as they do with surgical repair options. This belief is based on a study which showed very positive outcomes for the small dogs and not so much resolution of lameness in the bigger dogs. Some practitioners, however, have been questioning the assumptions since.

Dr Narda Robinson DVM is one practitioner who has been quite vocal about the lack of options many pet owners are given when faced with a CCL injury. She has compiled some good evidence here to endeavour to debunk many commonly held beliefs around why surgery should always be the primary option for sorting out our dogs dodgy knees.

So, when an owner makes the decision to give the surgical option a miss, even on a trial basis, what actually are the conservative options?

Weight management – The first step is to ensure the dog is at a healthy weight or slightly underweight. Evidence is mixed but several well designed studies suggest that advancing age and increased body weight are two of the big factors influencing the likelihood of degenerative lesions in CCLs and also risk of of full ruptures. Obviously there isn’t much we can do to stop the clock, but body weight is absolutely one of the most manageable risk factors. This makes a lot of sense from a physiologic perspective as fat cells are inherently inflammatory, and become more so as fat accumulates. As such, it’s not only the mechanical effects of extra weight itself, but even more significantly the systemic inflammation that is created when a dog is carrying excess weight that aggravates the situation.
Rest and control exercise – This one is huge, and plays an enormous role in the outcome whether managing CCR conservatively or with surgery. Complete crate rest was once advised however studies have shown it to be not necessary in most cases. Restriction to a space that minimises excitement, but has room for gentle movement is ideal. Provide good surfaces which eliminate the risk of slipping. Eliminate opportunities for jumping up or down from vehicles, bedding or step/verandas. Incorporating frequent short controlled leash walks which are more aimed at providing mental stimulation – a good sniff is amazing at calming the stir-crazy pent up energy that can build when dogs are relatively confined, is the ideal for 6-8 weeks.
Reduce inflammation and pain – Finally, the use of anti-inflammatory or analgesic medication as required. In the early weeks veterinary prescribed medications might be required, however there is a fine line to walk as far as the potential for reducing pain to such a degree that the dog becomes far too active for the stage of healing. We certainly don’t want our animals sitting through strong pain, however a small amount of awareness that they aren’t quite 100% can sometimes help during the crucial rest period. This is a topic to discuss on an individual basis with your veterinary professionals, as each dog will be very different and many factors play into this balancing act!

From an osteopathic and allied perspective it is possible to boost the effects of this conservative management firstly by recognising that it is, in most cases, strongly likely that biomechanical restrictions and asymmetrical movement in the dog’s body have contributed to uneven weight bearing through the hind legs and the stifle joint. This asymmetry and dysfunction can be addressed using Osteopathic techniques which are gentle and generally largely pain free. By allowing the dog’s musculoskeletal system to function to the best of it’s ability, it is possible to greatly reduce the overloading of individual joints and enhance the circulatory, lymphatic and nervous system function around the joints and tissues and hence allow the body to achieve optimal healing.

One of the big risks with CCL rupture is that around 50% of dogs will present with rupture to the other CCL within 6 months of surgery to repair injury to the first. This suggests two possibilities. Firstly, the obvious one that during recovery, the ‘good’ knee will be taking more than its fair share of workload. Secondly, the likelihood that there are underlying biomechanical and physiological factors that haven’t been addressed in the first instance which are continuing to compromise the healthy functioning of the joint. Whether post-surgery, or opting for the conservative option, it is therefore crucial to ensure the dog’s body is actually able to work symmetrically, as well as to then formulate a thorough rehabilitation plan to help ensure the dog begins to use themselves evenly. This rehab can begin within the first few weeks post-surgery or during the rest period if managing conservatively.

Allied therapies including dietary changes (examples here and here) and nutritional supplementation and herbs, hydrotherapy, acupuncture, laser, orthoses, stem cell therapy and cryotherapy (cold) are some of the many that may be useful within the management plan for CCL rehabilitation.

(Image: Web-dvm.net)

Prevention is better than cure! From a preventative point of view, again it is crucial to ensure dogs are able to use themselves as symmetrically as possible and carry as low an inflammatory load in their body as possible. This can be achieved by taking a few routine steps to ensure your dog is as healthy and strong as possible whatever the stage of life.

Osteopathic preventative/maintenance visits from a young age, to thoroughly examine and uncover any dysfunctional regions of the body and remove these restrictions before they begin to significantly alter the way the dog is moving.
Regularly assessing dietary needs, both for weight management as well as for minimising systemic inflammation that can develop due to unbalanced or overly processed diets.
Ensure that dogs are given consistent, relatively controlled activity that builds progressive strength and condition for their daily activities and specific sporting activities minimises the risks of injury significantly – avoid the weekend warrior approach of relatively little or no exercise during the week followed by manic ball chasing or frisbee catching at the weekend. Make intentional exercise a big part of your daily routine so your dog has a good baseline level of fitness and strength to help cope with the inevitable extra fun at the weekends or on holidays.
Specific range of motion/position exercises are particularly worthwhile for building great proprioceptive and core control in all dogs and can be built from simple routines to very complex movements depending on training levels and the needs of the individual. Chat to your Osteopath or canine conditioning expert for ideas!
Make sure nails are kept trimmed regularly, both to avoid slipping risk and also to help avoid changes in limb posture which may occur if the dog is feeling discomfort during activity from overly long nails.

If you are noticing your dog has uneven movement patterns or is occasionally showing signs of stiffness or soreness there is plenty you can do at home to improve their comfort by introducing a routine of safe stretches and exercises. I have compiled a comprehensive range of these within my eBook – The Canine Athlete Warm-Up and Cool-down Manual, which is a safe way for you to start exploring better musculoskeletal health for almost any dog. Check it out HERE or get in touch if you’re uncertain how to get started for your specific dog’s problems.

Working with excellent vets in my own local area, I am by no means anti-surgery – a well stabilised knee followed by dedicated and thorough rehabilitation is often the ideal option, however if you would like to discuss options, please don’t hesitate to contact me to discuss whether conservative management might be appropriate for your dog in the task of preventing, managing or rehabilitating a CCL injury.

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.

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.

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.)

Osteopathy for the Agility Dog

How to avoid and treat agility injuries for a long and fruitful agility career.

It’s a well known fact that for all the amazing benefits Agility offers dogs and their handlers and the relationship between both, it can be a hard sport physically on the dog (and the handler, but that’s another story!). Injuries can be either acute or chronic in nature, and management of the inherent risks presented by obstacles such as A-frames, jumps and seesaws is an important part of making sure your dog gets to have a long and enjoyable agility career. Factors which add to the risk of agility are the speed at which the dog is travelling, the tight lines often needed to navigate today’s courses and the athleticism required to traverse these obstacles, all of which leave the dog open to repetitive stress on various parts of their body as well as potential falls from or hitting the obstacle.

From a training perspective it is very worthwhile to aim to minimise the repetitive nature of the work the dog does, especially with young dogs whose growth plates are still very susceptible to damage from excess and repetitive pressure. Keeping the work they do varied, while practicing the skills might look like breaking the exercise down into small chunks and practicing each part at a much slower and more controlled pace to perfect the skill, then building those parts to perform the full obstacle. Working on many small varied parts of the greater task, at a slower pace, allows the trainer and dog to refine their skills and communication while avoiding many high speed repetitions of the full obstacle.

As mentioned above, injury to growth plates in young dogs is one worry when involved in intense competitive training, and this is largely mitigated by changing the way the dog is worked at least until physical maturity. Other risks such as sprains, strains, contusions (bruising from hitting an obstacle) and postural changes due to repetitive movements of an asymmetrical nature can be more readily managed or mitigated with the help of Osteopathy and other rehabilitation or wellness options such as swimming.

Osteopathically we look at the way the dog is moving and using their body and then palpate (feel) to identify any restrictions in the joints and any tender points, tightness or weakness in the muscles, ligaments or tendons. When identified, gentle manual techniques ranging from soft tissue work (massage like techniques) through to joint manipulation can be applied to restore healthy and full range movement throughout the body. Ensuring that the musculoskeletal system has full movement not only allows these tissues to function well, it also allows the circulatory and nervous systems which have branches running all through these tissues to function optimally. This promotes healing and gives the dog the best chance of recovering fully from any injuries, as well as helping to avoid injuries in the first place.

Agility buffs, your dogs are athletes! Their bodies are working very hard while having an absolute ball, so make sure you give them the benefit of keeping that body working to it’s best ability and you’ll give them the best chance of a long, enjoyable and injury free time leaping and bounding their way through their favourite pastime.

Specifically for our sporting dogs, but also for almost every other dog – I have compiled a comprehensive range of safe and effective stretches and exercises within my eBook – The Canine Athlete Warm-Up and Cool-down Manual, which is a safe way for you to start exploring better musculoskeletal health for almost any dog. Check it out HERE or get in touch if you’re uncertain how to get started for your specific dog’s problems.

Why does my dog lick to the point of bleeding?

A common problem dog owners find themselves facing is when their beloved dog develops a habit of excessively licking a paw or leg, or sometimes even a body part to the point a sore develops. Often this is put down to anxiety, however it is frequently also triggered by a pain sensation which either becomes chronic. Because the action of licking tends to release endorphins which reduce pain or stress, the dog then continues the excessively frequent licking even when it is exacerbating damage to the area . This frequently feeds into a very difficult to resolve behavioural loop Similar to the way we humans rub a sore muscle or joint, our dogs are simply seeking to find the best way they can to manage the discomfort. So what can we do to try to break this pattern of licking?

Firstly, and particularly if open sores are present we will want the owner to be consulting a vet for investigation for assessment for underlying factors such as parasites, allergies and arthritic joints amongst other sources as well as for topical management strategies, whether that be antibiotics, antifungals, antihistamines etc to help settle the local tissue response. An Elizabethan collar may also be an appropriate strategy to help break the licking habit and protect the skin while the underlying problem is addressed. In unison with Veterinary assessment, Osteopathic assessment takes the approach of looking for restrictions within the neuromusculoskeletal structures of the body, particularly those related to the region which appear to be painful or irritated.

One of the most common sources of lick sores when no definitive underlying problem has been identified is referred pain or nerve pain from a more central restriction or dysfunction in the body. In such cases, we assess the tissues and joints from the spine, limb and associated areas which could be creating a change in the function of the nerves, blood vessels and pain sensitive structures all the way to the tip of the toes. If you’ve ever sat on your leg or slept on your arm and then moved to find your limb initially ‘dead’, closely followed by a strong pins and needles sensation or many other odd sensations associated with nerve and blood flow restriction, you’re sure to be able to picture the sensations your dog is trying to ease. The recent addition of Fascial Counterstrain techniques to my practice has added an extra layer of depth to the assessment and treatment of the very deep neurovascular structures which influence many of the recurrent and chronic pain sensations felt by both us and our animals. By finding these kinds of restrictions in the tissues it is often possible to relieve much irritation around these very senstive structures and eliminate or significantly reduce the symptoms.

Along with individual assessment, it’s much the same for our animals as it is for us, in that adopting a regular preventative movement practice can be extremely useful in unwinding and preventing daily aches and pains. Think of the positive effects of intentional gentle stretching or yoga, and you’ll have a sense of these benefits. If you have a dog who is showing significant discomfort in their limbs or body, especially if paired with uneven movement patterns a thorough consult is absolutely worthwhile, however there is plenty you can do at home to improve their comfort. I have compiled a comprehensive range of safe and effective stretches and exercises within my eBook – The Canine Athlete Warm-Up and Cool-down Manual. Within it you will find a generalised routine for you to start exploring better musculoskeletal health for almost any dog. Check it out HERE or get in touch if you’re uncertain whether this might be a useful way to get started unwinding your specific dog’s problems.

Hip Flexor for the rider – Part 2

So what exactly are these hip flexors we’ve been speaking of, and why are they so darn important to the horse rider??

The iliopsoas is one of the very important factors in achieving a symmetrical seat. I find if the hip flexors as a group are not working well through a full normal range of motion there will be huge struggles with trying to maintain even and effective seat and leg aids. There will also be knock on effects on the upper body and aids from there also.

As you can see below, they attach to the front of the spine and the inside of the pelvis before running down through the pelvis to attach onto the inner thigh. They act to draw the knee up towards the body, and as such are a muscle group which is in a shortened position whenever we spend time sitting, either at a desk or in a car during out work days. They also play a huge role in stabilising the hip in a slightly flexed position, during many activities throughout the day. The very act of sitting on a horse puts the hip flexors into a slightly shortened position and, especially when the true core muscles aren’t doing their fair share, as soon as the horse begins to move we begin to use the hip flexors to help keep us upright and stable over the horses centre of gravity. To add to this complex system of controlling the hip and the core, we must consider the role the gluteal muscles (your butt!) play.

When tight, the hip flexors hold the hip joint in a position of slight flexion, and this is where the problems begin. In a neutral standing position this causes the pelvis to tip forwards and the lumbar spine to be pulled into extension (an increased arch in the lower back). This looks like the first mounted position we saw in the picture in Part 1.

Tightness in the hip flexors is usually also associated with other predictable muscular imbalances around the hips, pelvis and lower back, the most crucial of which is a weak abdominal core and gluteal muscles and a tight lower back and hamstrings . This pattern is often referred to as Lower Crossed Syndrome and creates for the rider a position of ‘duck butt’, lack of suppleness through the lower back, knees which grip and ride up in front of the centre of gravity and a lower leg and heel which just won’t stay where it belongs.

A strong core is crucial for a riders stability in the saddle, and may be the difference between sticking that awkward jump or unexpected stop or not. It also is crucial for allowing the rider to apply effective seat aids. The sum of these imbalances cause the body to move less freely and with less control than the ideal. Often one side is more restricted than the other and this is where many cases of short-stirrup-itis and dropping your hip or tilting one way originate from.

How does this affect your horse? From the seat alone, if one hip flexor is pulling tighter than the other, a tilt to one side is likely to occur. Looking at the shape of the pelvis in the picture above, you can see that tilting the pelvis to the side (dropping a hip/creasing at the waist) will cause one of your sit bones (ischial tuberosity) to contact the horses back more than the other. Thinking about how sensitive we hope for our horses to be to seat aids, one can instantly see the problems this might cause. The horse who always bends one way or is travelling on three tracks and just can’t seem to straighten no matter how much leg the rider applies, which incidentally feels much stronger one way than the other. The changing or disuniting canter leads. The inability to easily find or maintain the correct diagonal in trot and the horse who looks that little bit lame on one rein in trot but not the other and no clear diagnosis of true lameness can be found. These are just a handful of the problems created by unevenly tight hip flexors and the postural ramifications of such. When both are tight we typically see the proverbial “”duck butt” rider posture. The horse typically reacts by hollowing to escape the increased weight through the tree points and falls onto the forehand as the riders centre of gravity is thrown forward of the ideal. The horses back end then merrily trails out behind him, pretty much precluding any chance of hip engaging from behind and lifting the shoulder. His own core blows in the wind, while yours does the same up top.

(Above picture from this very humorous look at one riders battle with “duck butt”- https://barnbrat7732.wordpress.com/2015/07/15/a-swiftly-tilting-pelvis/).

In part 3 we will start to look at how you can test these muscle groups in yourself and where to start to unwind this pattern so you can begin to address the associated problems in yourself and your horses performance.

A new home for Canine Osteopathy

Some may have noticed changes to my logo and business name. These came about after being offered a great opportunity to increase the canine component of my practice. Whilst previously I saw a good amount of dogs in my travels around predominantly equine and human visits, as of the start of January I have been working within the K9 SWiM – Canine Wellness Centre NSW, North Richmond providing osteopathic treatment to the canine members of the family. I am delighted to be able to offer this dedicated time in my schedule for your doggy family members.

The article below appeared in K9 SWiM’s January newsletter and is well worth a read to help understand the work I do with dogs.

Osteopathy has, over the years, become such a huge part of my life. I graduated from UWS in 2003 with a Master of Osteopathy and promptly set about establishing my human practice. Having been a little obsessed with animals since the time I could express my feelings, and having spent my childhood and teen years collecting stray cats, dogs and horses much to my parents hidden delight, it really was no great surprise to anyone that animals would creep into the practice one way or another.

In 2009 I was able to complete, with distinction, the Graduate Diploma of Animal Chiropractic through RMIT in Victoria. This course was the result of an amazing amalgam of Osteopathic, Chiropractic and Veterinary practitioners, with lecturers and tutors from all three fields. Our discussions over meal breaks were educational to say the least! To say this refueled my passion for Osteopathy and it’s potential to make a difference to all creatures, great and small, is a mammoth understatement.

My new qualifications prompted me to take a leap of faith and head overseas to Ireland to focus on the animal side of practice, and I have just after nearly 8 years, returned from a wonderful time living the Irish life while building up strong skills and experience in my practice with horses, dogs and people.

People often ask why on earth a dog might need an Osteopath, and like with horses and humans, the answer isn’t necessarily a quick one.

What is Canine Osteopathy?

Canine Osteopathy is a gentle hands on therapy for dogs which ultimately aims to restore movement wherever in the body it may be lost, and to reduce pain and discomfort resulting from these restrictions. When the joints, muscles, ligaments or tendons, connective tissue or even the vessels and organs of the body aren’t free to move pain and discomfort will often result. Many activities we, and our dogs consider a part of normal daily life, can result in these sorts of restrictions. Degenerative processes due to age, injury, breed predisposition or just bad luck can also create compensation and restriction of free and full range of motion. Helping to reduce the these restrictions can have huge effects on the comfort levels of the dog plus helping dogs gain the most from tailored rehab programmes after surgery and is where Osteopathy holds great value for our beloved animals.

The major goal to Osteopathic treatment is finding and addressing restrictions in movement, the premise being that restricted movement, in any tissue of the body, will reduce the capacity for full health of those tissues. This obviously can result in altered gait, altered ability to carry out normal activities of daily life and predispose the body to injury and/or pain. So with that in mind, the Osteopath primarily uses their hands to find and reduce restrictions in normal movement of the body to allow the natural healing ability to work to its best capacity. That’s the abbreviated version.

The full version is something I’m only too happy to converse at length whenever anyone asks! Even 15 years into my professional life I am still blown away, on an almost daily basis, by how powerful it can be to simply allow a body to move. The changes are often much bigger than even I expect, particularly with animals compared to humans, as they have no preconceived ideas as to what they should or shouldn’t be feeling, and what their pain does or doesn’t mean to their life.

Problems in dogs that Ostepathic treatment can help

So what might an owner see that might give them cause to think an Osteopath could help?

Obvious lameness especially if of uncertain origin

Is your dog suddenly throwing in an occasional hop or obviously favouring one limb?

Crooked posture at rest or in movement

Do they appear to be running like a crab?

Do they always sit and slump to one side or repetitively circle one direction only, when trying to get comfortable to sleep?

Does one limb seem to lose grip or slide out the side when on slippery surfaces?

Difficulty with normal daily activities

Is your dog showing reluctance or struggling to jump up or down from furniture, or negotiating steps?

Are they slowing down and/or avoiding obstacles during agility or jumping?

Changes in temperament

Has your dog started being less tolerant of touch, seeking less social contact or refusing to play with people or other animals like usual?

Growling or teeth baring are late signs a dog is uncomfortable either physically or psychologically.

Recent trauma or surgery

Has he your dog had any falls or slips, or been barreled by another dog in play?

Is your dog progressing as expected with rehabilitation after surgery or showing signs she that they need some help recovering from surgery?

Aging or degenerative processes

Has he your dog been diagnosed with osteoarthritis in any joints of the limbs or spine, either primary or subsequent to an injury?

Are they simply slowing down as she they get older and finding it tougher to get going after rest?

Less obvious signs of pain or altered nervous system function

Has your dog been excessively licking or chewing at a limb or body part?

Are they showing signs of weakness in the back or front end?

Have they been diagnosed by the vet and being managed for neurological conditions such as Wobblers syndrome or Disc Disease?

Some of these presentations are ones which Osteopathy can bring a full resolution to the problem, such as when there is simple restriction after a slip, fall or jarring. Some require ongoing maintenance treatment to help the dog as the process of healing occurs at the rate the body can heal, for example after a successful cruciate repair, or helping a dog who has had an amputation adjust to life without a leg at each corner. Finally some can simply be assisted in maintaining the best function of the surrounding areas of the body, so that the problematic area causes the least impact upon the dogs daily life.

How Canine Ostepathic treatment helped Roly the Jack Russell

Occasionally these cases surprise you and make an almost miraculous turn around, like one wonderful little Jack Russell Terrier “Roly” who presented with full hind limb paralysis. Roly had 3 treatments over the space of a month, and along with veterinary management involving medication to manage pain and bandaging to protect his limbs, and some simple home exercises I prescribed for his owners to carry out, he was up and walking, albeit with reduced coordination. I next saw him almost a year later when visiting his owner to work on one of her horses and could hardly believe when I saw him leaping around the place as though there had never been a problem. He is a perfect example of how sometimes, simply giving their systems the space to heal by removing any restrictive roadblocks can reap huge rewards.

I am very excited to have the opportunity to work with the K9 SWiM team, and have access to the vast skills and knowledge base of the rest of the team, not to mention the ability for my clients to access the hugely beneficial hydrotherapy options.
I greatly look forward to helping your dogs achieve their best physical health in 2018, Initial consultation with you and your dog is generally up to one hour and then subsequent consultations are up to forty five minutes. If you have any queries please don’t hesitate to contact me on 0452 472 959

Hip Flexors for the rider – Part 1

How tight hip flexors (ilio psoas) affect the horse and rider.

Call Sam Sherrington on 0452 472 959 if you’d like any more information on horse and rider Osteopathy.

It’s been nearly 18 months since we covered this topic (on my facebook page. Since these posts never made it to this website I’m going to review the hip flexors again, since they’re such an integral part to getting your riding position working for you and your horse, rather than against you.

Do you find you often feel crooked on your horse? Is your instructor always shouting at you to stop tipping forwards or poking your backside out? Does your horse often land on the incorrect lead or not land straight over a fence? Is one stirrup being stretched or always feel shorter? Do you often feel like you’re always tipping forwards and can’t get your leg down and around the horse to give effective aids?

(Diagram source uncertain – if anyone knows where it came from do please let me know so credit can be given where it’s due!)

One big question I’m sure you’re all wondering – Why is it that so many people have tight hip flexors and an anterior pelvic tilt?

Surely if it’s not a biomechanically sound way to operate, it wouldn’t be the ‘go to’ posture so many people find themselves in, would it?
Lets think about what things we all might do on a day to day basis that promote short, tight hip flexors.

Get up from your bed and sit down to eat breakfast.
Get straight in the car and sit for whatever period of time it takes to get to work.
Spend a decent part of your day, you guessed it, sitting. Often with your legs crossed. If you’re lucky you have a job where you get to move around a lot, but even then, because our eyes are on the front of our head and our arms reach forwards there is a strong chance you do most things in your day reaching or slightly leaning forwards.
At the end of the day, you get back in your car, head to the yard.
Jump on board your favourite four legged beast having spent not a moment thinking about warming up or stretching out your own body.
Fight with your body and if you’re lucky, have someone on the ground shout at you to Sit up! Sit up! Stop tipping forwards! Drop your right knee! Stop leaning to the right, for goodness sake!
Head home and perhaps spend a bit of time on the sofa in something approaching the foetal position, mulling over why on earth you just can’t get it together on the horse, before heading off to bed to properly assume the foetal position.
All in all, it’s a solid day of flexed hips.

Now, when you stand yourself up in between these periods of sitting and bending, your hip flexors start to complain as they’ve become quite accustomed to being shortened. So rather than happily lengthen out, they stay relatively short and instead pull your pelvis forward into a nice anterior tilt with an exaggerated lumbar lordosis. This in turn promotes short, tight lower back muscles and weak abdominal core muscles which makes your body even more likely to switch on those hip flexors to help stabilise the pelvis and lower back during unstable activities – like riding your horse 😉

So, what did you do today that would have shortened up the ol’ hip flexors?? I clipped the dog, then could barely stand upright again!

Stay tuned for Part 2, where we will look at the anatomy involved in a bit more detail and begin to consider what it is doing to you and your horse in daily work.

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)

SPD/PGP in Pregnancy

Symphysis Pubis Dysfunction or Pelvic Girdle Pain is a common reason women visit an Osteopath during pregnancy and sometimes after pregnancy. Beginning from as early as the first trimester, however more commonly from around 20 weeks onwards, SPD creates a distinctive pain in the pubis at the front of the pelvis often with pain also felt through the back of the pelvis and radiation into the hips, thighs, lower back and abdomen. Women typically find this pain to be at its worst when they are standing, especially on one leg such as when getting dressed, or when separating the knees such as when turning in bed, getting into and out of the car, walking with long strides, swimming breaststroke or having sex.

The hormone relaxin is often blamed almost exclusively for SPD, however research is quite inconclusive with 3 out of 4 high quality studies included in a 2012 systematic review finding no association between relaxin levels and pregnancy related pelvic pain. This leaves us with the question of – if relaxin is potentially less of a factor that typically thought, what really is going on?

Pregnancy places a huge strain on the body in many ways, with great changes in the physiology and functioning of the whole body. The musculoskeletal system is not immune to these changes. Small functional restrictions that the body as a whole was able to cope with quite readily prior to pregnancy become potential sites of pain.

Osteopathically, the most significant function of the body is movement. I like to explain it as the human body has a certain amount of movement it considers ideal at each joint within the body. some move a lot, some move very little, but every joint has the capacity for some movement. Within the axial skeleton, the lower back (lumbar) and neck (cervical) regions move relatively a lot, the upper back (thoracic) significantly less, and the joints between the spine and the pelvis and within the pelvic ring, very little at all. Ideally, the day we are born we have perfect movement at each of these joints, though sadly that’s not often the case, and that’s a topic for another day. Over the course of our lives we bump, slouch, crash, twist and jolt our bodies many thousands of times, many without ever really considering it an ‘incident’. We go through childhood bouncing around like kids do, we spend our school years carrying increasingly heavy loads on our backs and spending increasing amounts of time sitting in front of a desk. We then join the workforce where we typically do one activity repetitively, whether that’s more sitting at a desk, manual labour or driving or … well you get the picture. All of these factors ever so steadily use up our body’s ability to compensate for the little restrictions that build up in our body. That slip when you fell on your backside in the big freeze might have created a restriction through your sacroiliac joint between your spine and your pelvis, or perhaps a restriction in the lumbar spine. The fatigue you feel in your thoracic spine and neck when sitting in your desk chair each day at work coupled with a minor prang in the car several years back might be representative of restrictions through the thoracic spine and the musculature associated with the entire shoulder girdle, which of course, given the human body’s love of sharing it’s woes around, begins to affect the muscles headed up into the neck. These are just two examples of the simple things we do to ourselves day in and day out. Usually we get ourselves out for a good walk, maybe do some stretches or have a hot shower and a good sleep and we feel pretty close to functional again to battle on the next day. Ultimately the body compensates for joints with restricted movement by increasing the movement in other joints and regions. Everything seems pretty hunky dory.

Then pregnancy happens and we can’t quite fathom why our body suddenly begins screaming at us.

One of the most common factors in pelvic girdle pain in general, but in pregnancy in particular, in my experience is that the sacroiliac joints and the pubic symphysis are joints which aren’t designed to move very much at all. They are also joints which don’t have any muscles directly supporting them, so once ligaments begin to be hit with the effects of relaxin, they are prime candidates for strain when related areas of the body aren’t moving the way they ideally should be. This makes treatment of pelvic girdle pain often quite simple. Get the restrictions elsewhere moving and the body is no longer forced to seek extra movement through these little joints which aren’t designed to be moving a whole lot. Often, simply balancing the pelvis and getting the thoracic spine moving is sufficient to get a woman out of pain. Naturally the body, being the wondrous complex marvel that it is, doesn’t always make things so simple, however this simple case serves to demonstrate how Osteopathy seeks to help return the body to a state where the pains related to the strains and stresses of pregnancy can be significantly reduced or removed.

If you have any questions with regards how I can help you to enjoy your pregnancy as much as possible don’t hesitate to contact me.