Page 964 - Adams and Stashak's Lameness in Horses, 7th Edition

930 Chapter 8

the foot) and hind limb proximal metatarsal desmopathy Passive accessory and physiological joint mobiliza-
were most notably the highest identified sources of lame- tion techniques are specific to PT and osteopathy and
VetBooks.ir limb suspensory desmopathy carries a poor prognosis to treat the horse. Some technique examples used in
have been clinically reported to be successfully adapted
ness. Furthermore, conservative management of hind
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with only 14% of horses returning to work for at least 1
human manual therapy include Maitland, Mulligan,
44
year. However, recent retrospective studies are demon- Kaltenborn, McKenzie, and muscle energy techniques.
strating that professional rehabilitation alongside other Numerous myofascial and neuromuscular mobilization
employed therapeutics improved results, with 56% of techniques also can be used, some of which include mas-
horses suffering from hind limb proximal suspensory sage (friction, effleurage, petrissage, tapôtement, vibra-
disease returning to their previous level of work. 97 tions, and shaking), trigger point therapy, direct and
Back pain is considered one of the most common and indirect myofascial release, positional release, reflex
least understood clinical problems in horses. It is a com- inhibition techniques, craniosacral therapy, adverse neu-
mon cause of decreased performance, behavioral issues, ral tension techniques, and stretching.
and loss of work in equine athletes. Equine back pain To effectively establish a treatment protocol and apply
can be of primary origin or can be secondary to referred these techniques, an accurate functional assessment of
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pain from the appendicular skeleton. The prevalence the musculoskeletal and neuromuscular systems is vital,
of back problems has been reported in 27%–100% of identifying the primary and secondary condition(s) that
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the ridden horse population. It has been reported that may be responsible for and/or attributed to pain and loss
32% of horses with lameness also have concurrent back of function. The assessment procedure, where applicable,
pain. Biomechanical studies demonstrating three‐ includes a full static and dynamic examination, followed
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dimensional motion of the thoracolumbar and pelvic by palpatory evaluation including specific manual test-
regions have provided valuable information into the ing and provocation tests. Examination procedures
adaptive and maladaptive compensatory movement pat- determine the regions of altered range of motion, quality
terns associated with fore and hind limb lameness and of movement, muscle function, and tissue irritability that
back pain. With our increased understanding of the may be related to pain, pathology, altered motor control,
8
underlying mechanisms causing various types of back and/or dysfunction. 61,62,151
pain comes a dire need to develop multimodal therapeu-
tic and rehabilitative protocols. Joint Mobilization
Common treatments of back pain in horses include local
injection with corticosteroids, systemic anti‐inflammatories, Degenerative joint disease or osteoarthritis is an
extracorporeal shockwave therapy, and acupuncture. example of a common dysfunction and cause of lame-
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Unfortunately, these traditional therapeutic pursuits often ness and loss of performance in the horse in which man-
result in recurrent pain, associations with concurrent lame- ual therapy can be successfully applied, as is the case in
ness and behavioral issues. 21,37 In people with low back humans. Many manual therapy techniques such as pas-
pain, the early institution of therapeutic modalities target- sive mobilizations can be applied to the articular system,
ing pain, muscle spasms, and restricted range of motion including the vertebral column and peripheral joints,
leads to significant improvements in function and substan- with complementary soft tissue techniques applied to
tial reductions in pain. 25,103,203 In addition, institution the associated neuromuscular and fascial tissues in this
of core stability exercises results in reduced back pain condition. These repeated movement techniques have
and longer remission of low back pain. 2,102,218 In horses, reported effects on the intra‐articular, periarticular (joint
improving core fitness results in improved lameness. capsule and ligament), and extra‐articular structures
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However, before a core fitness program can be instituted (muscle, fascia, and neural tissue) and thus affect the
effectively, a reduction in the horse’s pain must occur. passive and active constraints of the joint complex and
Whether human or equine, the specific rehabilitation primarily assist in pain modulation. 60,62,70,151
goals to augment spinal and pelvic dysfunction include There is a vast amount of scientific evidence in the
decreasing pain, improving flexibility, and restoring human literature to support manual therapy techniques
neuromotor control and function. Treatment of back and the possible biomechanical and neurophysiological
pain can be extremely challenging and often requires a mechanisms behind the effects, with many studies using
multimodal approach including targeted rehabilitation animal models. 10,90,183,184 The neurophysiological mecha-
protocols designed to maximize back pain treatment nisms that explain the pain‐relieving effects are now
efficacy. supported by scientific evidence, both in the vertebral
column and in peripheral joints. Evidence has shown
MANUAL THERAPY that manual therapy produces an initial treatment‐spe-
cific hypoalgesia and sympathetic excitatory effect
Manual therapy techniques are suitable for many locally in the treatment area beyond placebo or control
conditions following a veterinary pathoanatomical diag- conditions and then a nonopioid‐mediated hypoalgesia
nosis, when possible. These techniques encompass the systemically. 148,183,201,202,204,213
application of very specific passive and/or active assisted Human clinical studies assessing passive range of
movements by the therapist to the horse to manage and/ motion exercises in patients following knee arthroplasty
or alter pain and dysfunction of the articular, neural, showed a significant improvement in range of motion
and muscle systems. Manual therapy techniques are that was still apparent after 1 year. 170,171 The improve-
based on a wide range of methods and theories related ment in range of motion can be supported from results
to the intervertebral and peripheral joint complexes, in the rabbit models that demonstrate as healing occurs
myofascial, and the neuromuscular system. within the joint capsule collagen fibers align randomly.