Page 963 - Adams and Stashak's Lameness in Horses, 7th Edition

Principles of Therapy for Lameness 929

REHABILITATION/PHYSICAL THERAPY

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INTRODUCTION soon as possible after the injury occurs, alongside
therapeutic pharmacological measures such as anti‐
Rehabilitation and physical therapy (PT) play an inflammatory and other pain‐modulating agents.
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important role in performance enhancement, injury pre- This might also begin before or immediately after surgery;
vention, and restoration of full function during recovery therefore, the rehabilitative process is managed by a
from injury. The principles of rehabilitation and PT are multidisciplinary team.
based on a combination of evidence‐based medicine, There is still a great need for further research on the
clinical reports, and comparative human sports sciences. effects of PT in horses to complement the considerable
Veterinary medicine continues to follow the principles research in pathology and the high prevalence of injuries
of human sports medicine and rehabilitation to in athletic horses. 50,179,206 Although peer‐reviewed research
encompass many professional fields, including PT. is limited in equine rehabilitation, 29,31,72,106,107,161,193,204,211
Rehabilitation encompasses broad‐based concepts with many animal models have been used for human rehabili-
a focus on tissue healing, biomechanics, and neuromo- tation research, with many findings able to be related
tor control. These concepts relate to morphology, con- to current concepts in equine rehabilitation. The
formation, training, environmental conditions, type of Animal Physiotherapy: Assessment, Treatment and
competition, age, performance limitations, exercise effects Rehabilitation of Animals textbook laid the foundations
on the neuromuscular and skeletal systems, and interac- of animal physiotherapy; it is a good reference with
tion between horse and rider. The sciences underlying respect to evidence‐based rehabilitation. The profile
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rehabilitation/PT include biomechanics, motor control, of rehabilitation and performance enhancement has
and exercise physiology. 11,28,76,127 been heightened by the official use of PT and other allied
The word rehabilitation comes from the Latin “reha- health professionals during international level eques-
bilitare,” meaning to make fit again. Rehabilitation/PT trian competitions, highlighting how equestrian sports
techniques are individually tailored to each patient are rapidly catching up to other international competi-
rather than prescriptive for a given lesion or pathoana- tive sports.
tomical diagnosis and consider the whole horse, short‐ Readers are directed toward the many evidence‐based
and long‐term goals, discipline, and overall prognoses. human therapeutic texts to extend the scope of evi-
Each individual patient protocol is designed to comple- dence‐based techniques that may be enlisted to rehabili-
ment medical management and facilitate the process of tate joint and soft tissue disorders and lesions. These
recovery by promoting tissue healing, assisting the nor- include manual therapies, soft tissue mobilization/
mal physiological processes, and restoring the patient massage, myofascial pain and dysfunction, electro-
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to its former capacity following an illness or injury. This therapy and physical agents, 131,209 and integrative therapeu-
includes manual therapies, electrotherapy, functional tic approaches relating to mechanical passive constraints of
retraining, proprioceptive exercises, application of various locomotion and neuromotor control, including facilitation
modalities, and therapeutic exercise‐based treatments, and strengthening techniques. 116,126,135
along with education and ongoing owner‐managed It is beyond the scope of this section to cover all
procedures. These are the founding principles of the aspects of equine rehabilitation. The aim is to present
physiotherapy or PT profession as described by the some fundamental evidence‐based concepts of PT/
World Confederation for Physical Therapy (WCPT). rehabilitation focusing on manual therapies, electrother-
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PT in all species is concerned with identifying and max- apy, therapeutic and proprioceptive exercise‐based treat-
imizing quality of movement potential within the ments, and commonly applied modalities.
spheres of promotion, prevention, treatment/interven-
tion, rehabilitation, and more recently sports medicine
and performance enhancement. CLINICAL AND CLIENT DEMAND
Rehabilitation in veterinary medicine involves the FOR REHABILITATION/PT
veterinarian as the primary pathoanatomical diagnosti-
cian, a thorough objective functional assessment of the The clinical need for rehabilitation interventions is
patient, and consultation with other health profession- verified by the amount of waste and loss of performance
als. Using knowledge and skills unique to these pro- in equine sports due to musculoskeletal injuries. 14,50,146,200
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fessions, the movement potential of the patient is Statistics indicate that diseases of the musculoskeletal
assessed, with all information and confounding factors system are the predominant cause of loss of use and
incorporated to establish an accurate functional diagno- death in sport horses. 26,45,74,147,206 For example, it is well
sis, problem list, management plan, and goals. Clinically, established that flexor tendon and suspensory ligament
it is imperative that during the rehabilitation process, injuries are the most frequently reported soft tissue inju-
valid and reliable objective measures are taken to deter- ries in sport horses, resulting from chronic repetitive
mine accurate outcome measures. It is the author’s opin- overuse injuries. 32,92,125,133,162,165,167 Similarly, in a popula-
ion and one that is advocated in all modern sports tion of western performance horses, soft tissue injuries of
medicine literature that rehabilitation should begin as the forelimbs (deep digital flexor tendinopathy within