Page 966 - Adams and Stashak's Lameness in Horses, 7th Edition

932 Chapter 8

Following soft tissue trauma or pathology, dynamic of musculoskeletal conditions, especially related to spi-
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stretching regimes can be implemented to regain and nal disorders and dysfunction. 75,102 McGowan et al.
VetBooks.ir As a preventative measure, this also applies to any horse function and pathology via ultrasonography and nec-
reported that there is a relationship between muscle
maintain full range of motion during the healing process.
ropsy analysis, whereby significant atrophy of the mul-
that is on a restricted exercise regime or confined to the
stable for other reasons to help avoid the detrimental tifidus muscles was evident at the level and side of the
effects of immobilization. Passive stretching techniques thoracolumbar lesion in 22 racehorses. This has been
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are much more difficult in the horse because the horse is widely reported in the human literature. This is also
never entirely passive with respect to muscle tonicity, an area of veterinary medicine in which rehabilitation/
because it is usually standing during treatment. Therefore, PT techniques may be of great use.
the stretching procedure is dynamic and never com- Many of these mobilization techniques/exercises use
pletely passive, even when stretching limbs. However, an neuromuscular reflexive responses along with muscular
osteopathic technique that is reported in the clinical lit- facilitation and inhibition. They use similar theoretical
erature suggests that a form of gentle stretching (“posi- principles to those used in human manual therapy,
tional release”) in the treatment of chronic myofascial including muscle energy techniques to gain motion that
restrictions can be performed under sedation or anesthe- is limited by restrictions of neuromuscular structures, as
sia. This technique has been reported to have some suc- well as restore or normalize motor control. In people,
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cess. The technique is often used after all other avenues the patient is asked to contract and relax specific mus-
have been exhausted due to the anesthetic risk. Therefore, cles in a given range of motion, and often resistance is
tissue mobilization with movement may be a more apt applied to the body part. These techniques promote
title for many forms of stretching techniques in the horse. muscle relaxation by activating the Golgi tendon reflex.
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These techniques are performed rhythmically or in a sus- The techniques implement the principles of reciprocal
tained manner depending on the desired response and inhibition and post‐isometric relaxation. Reciprocal
effect on the tissues. Examples of these techniques are inhibition uses the body’s antagonist‐inhibition reflex to
described below in the section on mobilization with induce relaxation of a muscle.
movement exercises. A simplified example in people: If there is a loss of
If there is a primary lesion of a soft tissue structure elbow flexion range of motion due to tricep muscle
such as muscle, ligament, or tendon, stretches or active hypertonicity, the elbow is placed into end range of flex-
mobilizations with movement exercises in conjunction ion, and biceps (agonist) are then contracted, which
with other therapies may be appropriate to avoid exces- induces the triceps (antagonist) into relaxation. The
sive scar formation and disorientation of the fiber align- joint is then moved farther into maximal flexion, and
ment in the subacute and chronic phases of healing. With the technique is repeated, with incremental restoration
respect to rehabilitation of distal tendon and ligament of range of motion. Conversely, other techniques use the
lesions, it has been widely reported in the human litera- antagonist‐inhibition reflex to incrementally restore
ture that dynamic motor control‐based exercises, includ- range of motion, whereby a muscle is stretched immedi-
ing eccentric loading exercises, accelerate healing and ately following its isometric contraction due to the neu-
tensile strength, especially in relation to Achilles tendon romuscular apparatus becoming briefly refractory, or its
lesions. This type of rehabilitation strategy is begin- inability to respond to further excitation.
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ning to be more commonly implemented where appro- It is the author’s opinion that many of these applied
priate in horses. In these cases, the horse undergoes techniques/exercises are very useful in the majority of
“active rest” and begins a walking program along with rehabilitation cases to maintain and improve mobility,
other forms of therapy, once the lesion is determined to strength, and dynamic stability. This is especially true
be stabilized. It is the author’s suggestion to also include in those cases involving regions where the affected
unmounted exercises to increase the dynamic core mus- joint complexes are inaccessible due to the horse’s
cle strength as described below. Fibrotic myopathy is morphology.
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an example of a chronic condition in which repeated sus- The horse alters its posture reflexively in response to
tained positioning of a limb may be warranted in combi- digital pressure on various regions of the axial skeleton,
nation with other forms of therapy. In this case, the both into dorsoventral flexion–extension and into cou-
affected limb is manually moved to the available range of pled lateral bending/rotation and dorsoventral motion.
motion to stress the desired soft tissue structures. For example, this can be seen when there is a reduction
of dorsoventral motion into flexion and/or lateral bend-
Mobilization with Movement Techniques/Exercises ing of the cervicothoracic and thoracolumbar–lum-
bopelvic regions due to pain, muscle spasm, and/or joint
Indirect mobilization with movement techniques/ pathology or dysfunction. The intention is not only to
exercises in conjunction with direct manual therapy increase the joint mobility but also to activate and
techniques is also very effective clinically, especially in strengthen the muscles required to move the horse’s
relation to functional motor control. Altered motor body to the desired position.
control (neuromuscular function) may be a result of the A simple example of these exercises is seen in
underlying lesion in the spine and/or peripheral joint Figure 8.17, where the therapist applies a slow, constant
disease, with pain and inflammation causing reflex pressure to the ventral midline and dorsal sacral region
inhibition of motor neurons, which in turn causes simultaneously, facilitating end of range of motion via a
weakness and atrophy of associated muscles. This is dorsoventral flexion response of the cervicothoracic and
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widely reported in the human literature, indicating that thoracolumbar spine and the pelvis. In this example, acti-
motor control is a vital component of the management vation of the horse’s core muscles, serratus ventralis and