Prehabilitationis 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.
When our dogs get older we often seek extra ways to help them. Osteopathy can be invaluable in adding quality to their lives, read on to find out how.
Life can be tough on the body, even for the best loved and pampered pooch, and by the time they reach their ‘Golden Years’ they can be starting to show their age in many different ways. Their metabolism slows down, often increasing weight and lowering their ability to regulate their body heat. This extra weight in itself, adds strain to already worn joints, which in turn make it harder to get your dog out for some gentle exercise to help manage the weight gain. Older dogs often also experience changes in their temperament, becoming grumpy or aggressive towards family members, especially other pets and children. This is frequently due to undiagnosed or under-treated pain, and goes hand in hand with depression, a reduced social capacity and loss of function in their normal daily activities. Pain management often becomes a big problem when the elderly dog shows the commonly seen increasing signs of side-effects and reactions to medication, and an increased reliance on them to manage simple daily tasks. I frequently hear owners feeling powerless to break this cycle – a feeling having very few satisfactory answers to helping their dog manage as their age creeps up.
Osteopathic care is a gentle approach to helping any animal function the best they can taking into account the conditions they are experiencing. Osteopaths are university trained professionals who are able to recognise where the body can function more efficiently, helping the animal move closer to ‘homeostasis’ – the body’s sense of optimal balance, ease and functioning. Osteopaths use primarily manual therapy techniques, as well as adjunctive techniques such as laser, kinesiology taping and exercise prescription.
Human studies focusing on Osteopathic Treatment in the elderly have shown improvements in respiratory function, functional ability, balance and wellbeing. There has also been noted reduction in pain levels, medication reliance and assistance with some side effects of medications such as constipation commonly seen with some pain medications. These studies, while conducted on humans, have great relevance for guiding the kind of allied care we can offer for elderly dogs, in conjunction with care provided by your Veterinarian.
Osteopathy helps to restore an animals range of motion of all joints and soft tissues of the body, creating an ability to move more comfortably through activities of daily living. In conjunction with Hydrotherapy, we can then add numerous general and specifically tailored exercises and activities for the dog and owner to complete at home to help build added strength and function. In the elderly, it always amazes me how many of the co-morbidities (additional conditions such as failing organs, sight, hearing etc) can become less bothersome when the dog is up and moving more efficiently. Movement really is the most amazing medicine for all bodies.
For more information or to discuss how I can help your Golden Oldie live their very best life, please give me a shout on 0452 472 959 or shoot me a message @centaurusosteo on facebook.
How to use easy polework exercises to build a strong foundation of soundness for your horse.
When it comes to options to help your horse develop a better, more functional posture and increased strength as well as improving their awareness of where it is they are putting their feet and how they are controlling their body (proprioception), Polework is something every horse owner would benefit from understanding.
Proprioception (/ˌproʊprioʊˈsɛpʃən, -priə-/ PROH-pree-o-SEP-shən), from Latin proprius, meaning “one’s own”, “individual”, and capio, capere, to take or grasp, is the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement.
One of the biggest problems I see in horses of all ages and experiences is a lack of this proprioceptive awareness, both in the core and the peripheries, which sets them up to use their body incorrectly and to ultimately be far more likely to succumb to soreness, under-performance and injury.
As well as appropriate osteopathic techniques and treatment which will free up restrictions and help allow the horse to use his body in a more biomechanically correct fashion, the work the owner does in the period between treatments plays a huge role in determining the outcome. All the manual therapy in the world won’t change a horses soundness and fitness for its work if the work it is doing continues to be done in the way it has always been done – the way that built it up to develop soreness and unsoundness in the first place. This is where polework, both on the lunge (or free) and under saddle, can really help change things.
It often seems believed that unless you’re doing something really complicated you may as well not bother, but in reality the majority of horses would hugely benefit from the regular inclusion of the most basic polework exercises. Consider this: Would you expect to launch straight into a high level gymnastics programme without mastering the very basics of how to use your body correctly? This is exactly how we need to be thinking about most of our horses who have, at one stage or another, whether due to training deficiencies or conformational tendencies, formed a habit of using their body less than optimally.
The pictures below, from my friend Sal, which prompted me to jot down these thoughts, are an excellent example of the value of poles.
The horse, Finn, is a 4 year old. He is in the process of being backed so has not had the years of vertical forces through his back that is the hallmark of the older ridden horse. He naturally carries himself ‘proudly’, that is to say he has a tendency to lift the head, disengage the core and hollow the back. Without specific work to help him learn to carry himself with his core engaged, lengthening and lifting his lower neck/thoracic sling muscles, and intentionally placing his feet, he shows a fairly typical young horse tendency to develop his musculature incorrectly. Fortunately he has a very diligent owner who has spent time regularly working him over trot poles at varied distances.
In the first picture it is easy to see how he is engaging the core and lifting the shoulder while using his body to slow the movement as he figures out where his feet are supposed to be landing. This is all part of the proprioceptive system at work – know where your legs and body are at all times or risk falling on your face.
This series of pictures illustrates beautifully the increased core activation, the lift through the thoracic sling, the lifting and lengthening of the epaxial muscles and ribcage, the engagement and intentional placing of the feet. All in all the horse is experiencing a huge increase in the amount of physical and neurological work he is doing, simply by being challenged to reach and place his feet between poles on the ground. By the 4th picture he had really figured things out, was lifting beautifully in front, measuring his stride, engaging the core and hindquarters and traveling really lightly over the poles.
Some pole work options:
Easy option 1: Stick 3-4 poles down in a straight line at a fairly normal 4-4.5 feet apart. For me this is simply 4 or so of my riding boots toe to heel or one decent step measuring from the heel of the hind foot to the toe of the forward foot. Give or take according to your horses size/length of stride so your horse can come through at its normal stride length without falling on his or her face.
Bring the poles together by a foot, and repeat. This will help your horse slow down, pick his way through more carefully and engage the core and the hocks some more.
Bring the poles apart by a foot or so. Try to keep your horse coming through with a nice steady rhythm rather than rushing full tilt and cat leaping over a pole or two in the process. This will help your horse reach, lift through the thoracic sling while also switching on the core and engaging the hocks.
Once your horse really knows to watch where he’s putting his feet, you can arrange the poles with slight variations in the distances or even in a pick-up-sticks kind of arrangement. For this I always recommend letting him walk through while he picks his way through. We’re aiming to reduce the chance of injury, not increase it 😉
Even easier option 2 (very good if you’re on board, less up and down for you):
Take your poles to a corner and set them up in an arc. Bring him through in the centre (normal stride length), then vary between closer to the centre for a shorter stride, or to the outside for a longer stride. You can even come through in a fairly straight line so you start with short strides and finish with longer stride. My most excellent illustrative capabilities show this below:
With the arc of poles, you can then progress to raising the outside of the poles to create a little more lift and activity in the outside limbs. This is especially useful if your horse has a tendency to lean or hang into one shoulder, or if you’re aiming to increase hock and glute activity.
Don’t forget to do both directions!
From these basics, you can progress to many and varied exercises which encourage both horse and rider to develop ever increasing levels of bodily strength and control, but always remember – if you can’t get these basics 100% then the chances of getting the harder ones done in such a way that both you and the horse are benefiting are slim.
And finally, when you’re doing these under saddle, do your horse a huge favour and try to stay in a light seat over the poles. But also, don’t throw your weight over his neck, forcing him onto the forehand either. Get a friend to video you, so you can really watch the way both you and your horse are doing these exercises. Ultimately you want him working with balance and engagement both front, back and core. If you’re achieving this both on the ground and under saddle then you’re good to start upping the ante and increasing the trickiness of the work, and even leaving the ground!
Finally, have a really honest and stern talk with yourself if you do find you’re struggling with your own balance, core and proprioception – Get yourself an Osteopathic treatment to unwind your own dodgy tissues, then get in touch with someone talented in helping riders develop these skills such as Rebecca Ashton at Equest Elite. You owe it to your horse!
Yep, I’ve had requests to do so, and i’m taking a deep breath and opening up this can of worms…
Photo Credit: Courtesy Kristen Janicki
This perspective is my own, based on clinical practice observations which tend to be backed up by the findings of a very rudimentary review of recent available literature. For a really thorough literature review, have a look here. This one conducted by Ruth Taylor; BSc (Hons) Equestrian Sports Science of Hartpury College, in 2016 looks into the research available around the topic. It is very well worth a look if you’re interested in the evidence behind the current suggested limits.
I see many horses with back soreness, and unfortunately, rider weight is one factor which does come into it. More so than rider weight though, I have noticed there appears to be a strong correlation between the riders overall fitness (if I’m asking if you do other sports, or any specific fitness work besides riding, that’s why).
It’s generally accepted that riders should be somewhere between 10 and 20% of the horses bodyweight. This to me completely fails to take into account that there are heavier riders who are very forgiving of their horse – using their core correctly, keeping in balance with the horses movement and generally not hindering their horse in the goal of staying balanced throughout their work. It also fails to specify that a quite light rider who is very unbalanced, and who is on a horse with a poorly fitted saddle may be far more deleterious to the horses biomechanical wellbeing than the aforementioned heavier rider. It also fails to take into consideration the horses morphology – a stocky well boned, broad loined horse would obviously be more likely to withstand heavier weights and/or less balanced riders before soreness occurs than a fine boned, narrower horse would. Fitness also likely plays a part and a horse who has been properly and gradually conditioned with biomechanically correct work, is likely to hold up to heavier rider weights better than a poorly conditioned horse, working with the topline hollowed, who was pulled out of the paddock and asked to go out for a weekends activity.
My ultimate take therefore is that while it’s important to be mindful of your weight vs your horses weight, it is also important to consider the type of horse you ride in regards to morphology and the work you want to do. Further, if you’re suspicious that you might be slightly underhorsed or your horse is showing signs that this might be a factor I would advise that you consider improving both of your ability to control your bodies through biomechanically sound movement training.
For you that might include an Osteopathic treatment plan, to ensure you can move symmetrically without injuring your self. Then, general fitness work (I personally love a mix of HIIT and light strength work to avoid cutting into my very small windows of available time), but also investing in some really good Pilates classes to learn how to control your core and use your limbs independently without losing that core control the moment you try to move. Remember, core control is about movement and function. If you can’t control it while moving then it’s pretty pointless. Keeping yourself balanced and light over your horses centre of gravity will hugely reduce the impact of any weight ratio imbalance that exists between you and your horse.
For your horse, I would highly recommend ensuring he is able to move symmetrically and remove any existing soreness by having him assessed by a good Animal Biomechanical Medicine practitioner (membership list here of fully qualified and insured Osteopaths, Chiropractors and Vets who’ve studied this stuff at University level). Also be sure that your tack fits. Your saddle needs to fit both of you or it will be an uphill battle to perform in a balanced manner which will reduce this ability to cope if there is an imbalance in regards your weight ratio. Very importantly – treat him like an athlete. Regardless of your chosen discipline, he not only has to go out and perform a bunch of extra movements than he would in the paddock, he has to carry you whilst doing so. Find someone who can teach you what a correct frame looks like, not just one where he is holding his neck all pretty, but one where he is using his core consistently, where he is swinging evenly through the back, where he is stepping evenly from behind and keeping his centre of gravity balanced throughout the work he is doing. Ensuring he is able to do this might involve spending time each day warming him up with correct lunge work (that is, not galloping around full pelt to get the bucks out) preferably including ground work and pole exercises. Again, your ABM professional can help to formulate a plan which incorporates specific exercises which are relevant for your horse specifically. I personally love when people incorporate groundwork into their normal routine as it also means they are getting to routinely look at their horse moving and so pick up on changes in movement which might indicate soreness well before the horse actually throws a lame step.
So there you have it… it’s not a straight forward answer at all, but it is one which we should all be contemplating when choosing our horses and/or managing the ones we already have.
I hope this has helped and if you’re keen to increase the balance and performance you and your horse have when out enjoying your chosen discipline please don’t hesitate to get in touch.
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.
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.
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.)
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 slower 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.
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 often also triggered by a pain sensation which either becomes chronic, thus the dog continues giving it attention, or becomes a comforting habit. In the case of a chronic irritation, this can be as a result of localised pain, referred pain or pain in another area which causes the dog to seek comfort and the feel-good endorphin release provided by the licking behaviour. Similar to the way we humans rub a sore muscle or joint, our dogs find the best way they can to manage the discomfort.
Obviously if open sores are present we will want the owner to be consulting a vet for investigation 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. From an Osteopathic perspective there is much we can do to help alleviate this discomfort.
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 these cases, we search for tissues and joints around the spine, limb and associated areas which can alter 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. By finding these kinds of restrictions in the tissues it is often possible to create take enough pressure off these sensitive structures which may allow the dog to return his attention to the more fun things in life.
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.
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.
(Above picture from this very humorous look at one riders battle with “duck butt”-