osteopath – Sam Sherrington

Prehabilitation and Rehabilitation

Prehabilitation is a Proactive/preventive approach to manual therapy, exercise, diet and lifestyle, designed to maximise health and wellness, and minimise individual risks for injury and disease. Well-studied in human medicine, prehabilitation is found to be valuable in ‘high risk’, aged, frail or obese patients, as well as younger patients who wish to maximise their athletic performance or if injured and facing surgery, to return to their chosen sports as soon as possible. It is especially valuable when an animal is requiring surgery, and as a pre-operative approach integrates biomechanical assessment and appropriate manual therapy treatment, individualised home exercises plus diet and lifestyle advice in advance of surgery. Prehabilitation has been shown to promote lower complication rates and earlier restoration of functional activities and status during the recovery from surgery. Good quality systematic reviews show a positive impact of pre-operative exercise therapy on physical function, quality of life, postoperative complications and length of hospital stay.

border collie with toy in mouth waiting for a command

Most animals have been developing compensations for minor slips, trips and falls for many months or years prior to pain or lameness becoming evident. Individualised prehabilitation helps to make sure the animal is moving well and has the best possible strength prior to undergoing surgery. This is believed to help improve the outcomes of surgery by promoting healthy circulation, minimising inflammation, reducing pain related behaviour and movement limitations, reducing strain on the healing tissues and as a bonus will often reduce the animals reliance upon medication to control inflammation and pain both before and after the surgery.

Rehabilitation takes a similar approach around the inclusion of biomechanical assessment and appropriate manual therapy treatment, individualised home exercise, diet and lifestyle advice in respect to promoting the most efficient and successful recovery after orthopaedic surgery or acute injury. Rehabilitation typically follows a pattern guided by the natural healing mechanisms within the associated tissues.

Inflammation is the main factor to manage for the first 2 – 4 weeks depending on the individual situation. This typically includes medication and rest, however these can also be complimented by gentle therapeutic options such as lymphatic drainage, laser and kinesiology taping to help the tissues clear the active inflammation and bring fresh blood supply into the healing tissues. Treatment is always considered on a case by case basis in conjunction with veterinary advice, as individual factors play a large role in the suitability of therapies during the acute stage. Gentle modalities such as laser, kinesiotaping and lymphatic drainage often appropriate immediately post surgery, and specific home exercises may be able to help maintain the nervous and muscular system function in relation to the injury.

Weeks 5-8, are crucial in ensuring the affected tissues are building their passive and active function in a symmetrical and biomechanically correct manner in order to ensure that the repairing tissue is as healthy and functional as possible. Again, passive and active techniques, more advanced exercises and modalities may be applied as appropriate to promote healthy tissue repair.

Remodelling, during weeks 9-12 is when the fun really begins. This is where, if previous stages have been completed with success, we can really start to challenge the body while still being aware there is much change still happening within the healing tissues. Monitoring the dog during this period is particularly important as they often begin to feel ‘like new’ and can easily overdo it. Rehab exercises can increase in complexity as we challenge both the musculoskeletal tissues as well as the nervous system which controls healthy movement.

Months 3 – 6 are the cherry on top as far as rehabilitation goes. While it may seem as though the dog is back to normal, it is very important to continue monitoring them for any signs that their tissues aren’t strengthening symmetrically or fully. Owners are coached on how to monitor their animals for small asymmetries or movement patterns in their own animals specific case, to help pick up early signs of trouble. This helps to reduce the likelihood of long term development of osteoarthritic changes that are common when surgical procedures have occurred. Typically at this stage home exercises should be part of normal daily life, with lifestyle changes well integrated to help the animal continue well into their older years. I always aim to make these lifestyle factors and exercises as easy to integrate into daily life as possible, which makes it significantly more likely that they will be maintained through the animals lifetime.

Birth Trauma in foals – what we can do about it.

Thoracic trauma (rib fractures or costochondral dislocation) in foals is a relatively common side effect of being born quickly, with a relatively deep chest, through a relatively small, hard pelvic ring. A study done in in 1999 in Coolmore Stud in Ireland by D Jean et al discovered a rate of around 1 in 5 foals having rib fractures, and further studies have suggested this might be a conservative estimate due to the lack of sensitivity of radiographic technique in detecting these fractures/costochondral damage. Interestingly, by around 3 days of age, the majority of foals are showing no overt signs of these fractures. Dr Ian Bidstrup has spent many years digging into this problem and correlating some of the typical ongoing issues that appear to be associated with a history of birth trauma, whether actually noted at birth or not. These include:

Increased sensitivity around the girth and ribcage
Spinal pain especially around the wither and associated dysfunction in this and other regions
Pelvic/sacral dysfunction – as the foal exits the birth canal large forces are exerted in an asymmetrical manner on the sacrum and pelvis
One sidedness in work
Forefoot asymmetry – one big flat foot with low heel and one narrow foot with high heel, or possibly even clubbed foot

In practice this pattern is seen quite commonly, presenting as a typical dipped thoracic and roached lumbar posture which predisposes horses to working in a hollow frame, dropping their sternum in the thoracic sling (by contrast think of a horse in self carriage lifting through the sternum and withers between the shoulder girdle). The following picture from Dr Bidstrup’s Spinalvet website is a perfect example of this posture.

Photo: http://www.spinalvet.com.au/saddles.html

Horses will typically also begin resisting requests for a supple bend in one direction more than another by using their head and neck like a rudder for balance and by cocking or bracing the jaw. This resistance through the front end will also obviously have ramifications for the way the horse uses its back end, and if pelvic/sacral function isn’t as it should be that will compound the problems. I have also noted an anecdotal link to a propensity to gastric ulcers though of course this is often a case of chicken and egg where digestive dysfunction has a deleterious effect on thoracic and lumbar function.

So what can we do about this? Ideally all foals should be assessed and if needed treated within the first week or so of birth. By doing so, much of the asymmetry could be addressed to allow them to grow as evenly as possible with the aim of having a youngster who is as balanced as possible by the time they reach the stage of being backed and starting work. Observing foals to see how inclined they are to always graze with one particular leg forward can give a good idea of how much asymmetry they are carrying.

Photos: The Horse.com; Shutterstock.com

When we get to the stage of an established horse we’ll be dealing with more posturally and neurologically ingrained patterns as well as muscle memory and hoof asymmetry. These can take a little longer to unwind and often a few steps back in work schedule are necessary to help give the horse a chance to relearn how to use his body while the dysfunction is being worked on. It is phenomenal to see how quickly a horses patterns can change when given the chance with good Osteopathic treatment combined with some rehabilitative changes to their environment, for example introducing variable feeding positions, good farriery/hoofcare and some exercises on the ground to help translate those postural changes to work under saddle.

NB – Not a recommended Exercise. Photo: Unknown – if anyone knows please let me know as I love it!

By addressing these asymmetries early on, it is possible to hugely minimise the strains on the horses body and legs and give your horse the best chance of long term soundness and performing to the peak of their ability. If you have youngsters you’d like to ensure have the best chance of a sound and successful performance career please do get in touch to see how much difference Osteopathic management can make to their future.

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 pop up 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. At significantly less cost also. 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 be the primary go-to option for sorting out our dogs dodgy knees.

So, when an owner makes the decision to give the surgical option a miss, at least on a trial basis, what is the conservative option?

The first step is to ensure the dog is a healthy weight or slightly underweight to help reduce the loading on the stifle joint. Being overweight is one of the biggest and most manageable risk factors noted to contribute to CCL damage.
Next, keeping your dog’s activity controlled. Complete crate rest was once advised however studies have shown it to be not necessary. Rest and avoiding jumping up and down from vehicles, beds etc; minimising risk of slipping on smooth floors, and going for frequent short controlled leash walks is the ideal for 6-8 weeks.
Finally, the use of anti-inflammatory or analgesic medication as required.

From an osteopathic perspective it is possible to boost the effects of this conservative management firstly by recognising that it is, in most cases where the lameness has developed gradually and insideously, strongly likely that biomechanical restrictions in the dogs body have contributed to asymmetrical weight bearing through the hind legs and the stifle joint. This asymmetry and dysfunction can be addressed using Osteopathic techniques which are gentle and often pain free. By allowing the dog’s body, especially the lumbar and pelvic regions to function to the best of their ability, it is possible to minimise overloading of individual joints and enhance circulatory and nervous flow to the joints and tissues and hence allow the body to do it’s best healing work.

One of the big risks of CCL damage is that around 50% of dogs will present with damage 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, and secondly, that there is some underlying biomechanical factors that haven’t been addressed in the first instance which are continuing to throw excess loading into the joints. 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 are some of the many that may be useful within the management plan for CCL rehabilitation.

(Image: Web-dvm.net)

From a preventative point of view, again it is crucial to ensure dogs are able to use themselves as symmetrically as possible. This can be achieved by 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. Ensuring that dogs are given consistent, relatively controlled activity allows them to develop strong and healthy musculoskeletal systems – so 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 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. Also, 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.

For further advice or consultation, please don’t hesitate to contact me to discuss how Osteopathy can be of use in helping prevent, manage or rehabilitate a CCL injury.

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.

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.

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 Horse’s 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.