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.

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.