Physiotherapy Connections

Physiotherapy Connections Physiotherapy Connections is a private physiotherapy clinic

Experienced chartered physiotherapists, qualified to use acupuncture along side their manual therapy skills to treat any aches, pains, and sports injuries. Debbie is also a Masters qualifed Veterinary Physiotherapist treating horses or dogs with lameness, performance issues or pain related behaviour.

A ‘quick fix’ isn’t always possible, but with an holistic approach progress is
24/04/2022

A ‘quick fix’ isn’t always possible, but with an holistic approach progress is

The Power Of The Mind
“A visually identical hind limb extension in late stance may be accomplished by only hip extensor muscles, only knee extensor muscles or any combination of these.” (Liduin S. Meershoek and Anton J. van den Bogert. Mechanical Analysis of Locomotion.)

The phenomenon is not limited to stifle extension. Many apparently identical movements can be executed with different muscular combinations. This is why a horse can be crippled or rehabilitated by the same movement. If the training is limited to the exploitation of natural reflexes, the predictable outcome is lameness. Instead, if the education guides the horse’s brain toward the muscular coordination optimally adapted to the athletic demand of the performance, the outcome is soundness. The outcome is also winning in the show ring as many superior athletes perform below their real potential due to a dysfunctional physique.

Supah is a 17.2 hand Thoroughbred gelding whose body bears the scars of a racing career. Bony proliferations and swellings are on all of his legs, especially around the front fetlocks, his front incisors are broken, his right jugular vein was occluded and there is an enormous bony protuberance on the top left side of the 9th to 10th thoracic dorsal spine at the level of the supraspinous ligament. We do not really know what caused it - trauma from a fall is a possibility, especially as he was so crippled from the track he was prone to stumble and did occasionally fall when trying to play at pasture. Whatever was the cause, it was associated with him carrying his trunk sunk between his forelegs, which severely handicapped the motion of his left foreleg. The front limb could barely move forward ahead of the vertical of the point of the shoulder. He could only turn by planting and turning around his forelegs, thus he could not run away or protect himself and was low in the herd social order. Mentally, he was not weak, but physically he could not stand his ground.

When I first met him, Supah was lame and riding him left you with the impression of sitting on the slope of a ski jump. I tactfully refrained from going over all his problems and simply commented that he is a kind horse – which he is. “You see why I need your help” said Betsy. “We have to restore a sound range of motion.” I was ready to underline the magnitude of the challenge but Betsy added, “Well, if two people can do it, it is us.” Betsy is a veterinary pathologist, a researcher and a good rider. We work together at different professional levels. We both knew that manipulating Supah’s limbs would not have much result. The problem originated from a traumatized thoracic dorsal spine, supraspinous ligament and surrounding muscles. The horse had adapted to the trauma by creating a strange and restricted motion of the left front leg and consequently, his entire body. “Since he has been able to successfully recreate some range of motion, we should be capable to guide him toward a more functional and even perhaps sound locomotion.” However, we would need active participation of his mind. We would need mental processing, initiative and even creativity. Because of his injuries, Supah would have to figure out how to coordinate his movement by using muscle combinations very different from those usually involved. It would be a challenge. The SOM approach is to prepare the horse for the movement and then let him do it. With Supah that last step of finding the solution himself was a huge one.

Betsy commented: “In spite of what he has been through, he is curious and optimistic. He is also a quiet thinker. Just to be able to move the way he does, he must have figured out some complex compensatory mechanisms, and even though his movement is mostly very bad, there are sometimes moments when it is a little better. Perhaps we can teach him better muscular coordination.” We did, and today, Supah is far ahead of our expectations. Months ago, the canter was a three legged gait. It was not walk and it was not trot, therefore by deduction it had to be canter. As he learned a better body coordination, the canter improved beyond expectations, becoming the horse’s best gait. Today, he performed flawlessly his first flying change.

It was a real flying change. It was not a lead change type of move where the hind legs are late behind. It was a real flying change, straight, clean, executed soundly during the fly period. Betsy rewarded the horse and walked saying, “The power of the mind.” Mechanical rehabilitation by methods involving moving the limbs or releasing muscles is limited. In cases of severe damage, the structure is irreversibly altered and the rehabilitation is about guiding the horse’s brain toward a subtle, sound and efficient way to compensate. Tendon injuries for instance are in many instances irreversible. Once the fibers composing the heart of the tendon have been torn and disrupted, completely restoring clean and sound architecture is currently not feasible, although it might be possible one day with gene therapies and a better understanding of tissue microenvironment and mechanics. Until then, approaches that reduce scarring and strengthen the peripheral tissues – basically those that find ways to functionally compensate for the tissue damage, are the best way to facilitate recovery from such injuries.

A very effective approach is to teach a horse to use a different muscular coordination. However, it can only be done through respect, engagement and refinement of the horse’s mental processing. It is based upon guiding a horse’s brain toward the most efficient compromise for its body. Supah, for example, might not be capable of stabilizing the scapulo-humeral articulation at the impact of the left foreleg using the infra and supraspinatus muscles as a horse would normally do. Thus he must mentally figure out how to use different muscles for this purpose even if stabilization of the sacpulo-humeral joint is not the primary function of these muscles. Horses do this kind of compensation all the time, but immediate relief directs their choices, which is sometimes in conflict with long-term efficiency and soundness.

“Movements are generated by dedicated networks of nerve cells that contain the information that is necessary to activate motor neurons in the appropriated sequence and intensity to generate motor patterns. Such networks are referred to as Central Patterns Generators, (CPGs). The most basic CPGs coordinate protective reflexes, swallowing or coughing. At the next level are those that generate rhythmic movements. Some, such as respiratory CPGs, are active through life, but are modulated with changing metabolic demands. Others such as locomotor CPGs, are inactive at rest but can be turned on by signals from command centers.” (Sten Grillner, The Motor Infrastructure From Ion Channels To Neuronal Network.)

Basically, the horse’s central nervous system creates movement. However, the brain will naturally execute movement protecting whatever muscle imbalance, morphological flaw, or other issue is influencing the “body state” at the instant of the effort. Excellence and soundness demands guiding the horse’s brain toward the proper activation of motor neurons in the sequence and intensity that produce correct movement. The problem is that the Central Pattern Generators learn from each other and when they have adapted to incorrect locomotor patterns, they “sense” these incorrect locomotor patterns as normal. The concept is simplistically explained as “muscle memory.”

However, many problems cannot be resolved at the level of the muscles; they have to be resolved in the brain at the level of neuronal activation and processing. From the outside we cannot activate motor neurons in the appropriate sequence and intensity to correct movement but the horse’s brain can do it from within. Education is therefore critical for guiding a horse’s brain toward the appropriate body coordination for its body. This is why the horse’s intelligence has to be developed very responsibly and very carefully. How a movement or exercise is done is more important than the exercise itself. Imitation does not facilitate the kind of mental processing that the horse needs to develop. Having the horse mimic a trainer’s limb or hand movements inhibits the horse’s ability to think in terms of sophisticated body coordination as the focus is on imitating the gestures not on developing overall balance and fine control of movement. Obedience to touches, the whip or other techniques, keeps the horse’s mental processing at a primitive level. These techniques promise “dressage” because the horse executes pathetic parodies of the movements but they alter both the horse’s physique and mental processing. They damage the physique because they don’t prepare the horse’s body for the athletic demand of the performance, and they demean the horse’s intelligence by keeping the mental processing at elementary level.

The horse which stimulated this discussion was lame. He had to win his soundness through sophisticated mental processing. He was physically handicapped and had to process new locomotor pathways to compensate. Considering the extensive damage he likely had in the extrinsic muscles of his forelegs, wither, and cranial thoracic muscles, we conceived a plan to help him develop a better body coordination. Our specific goals were to reduce the load on his forelegs, correct the torsion of his thoracolumbar spine, increase the decelerating activity of the hind legs and increase the conversion of the hind leg trust to vertical forces through better coordination of the back muscles. Our hope was that reducing the weight on the front legs and educating the extrinsic muscles of the forelegs would allow greater amplitude of movement. Critical to this was to understand Supah’s mental processing of the exercises and guide him, when necessary, toward a better compromise for controlling how his body moved. Sometimes, Betsy had to change course between our monthly sessions, responding to the horse’s new tentative efforts. He is a quiet thinker. He processes, understands and tries, and his mind is often ahead of his body. We understood that developing a new body coordination is very hard and respected his limits. Some days he quickly tired from the effort and we stopped rather than push him to do it ‘one more time’. This respect and being allowed to experiment and make mistakes quickly made him confident and his understanding and interest in the work grew. In fact, in some instances we realized that his approach was a better idea that our original thought and we followed his initiative.

Supah’s progress was very slow, especially at the beginning, but it was constant, and he has physically changed in unexpected ways. He literally grew a wither in that as his muscles developed and his trunk became more elevated, the protuberance was no longer the highest point and has moved easily 5 inches further back. Betsy uses a thick and soft pad under the saddle and, as she was tacking up the horse for the training session, I joked, “Soon you will not need the pad as the protuberance will be behind the saddle.”

Once soundness was established we realized that Supah’s mind was on its way to greater goals and we continued the process. The last three months, the progress at the canter was so amazing that we were talking about the flying change. We did not decide to teach flying change, the horse showed a body coordination that allowed us to think the time to set him up to do it would soon arrive, but even so he did sooner and better than we expected. The idea was interesting as the vertebral column gymnastic during flying change would be a great way to further his body control. In parallel with his readiness for the flying change there was a clear gain in suspension and amplitude of the trot. Having come so far, we are curious to see how much further he will go in his task for excellence. Soundness is no longer a concern; now it is about sophisticated body control. It is fascinating to see a horse overcoming serious physical handicap through the development of his intelligence.

Jean Luc Cornille

2014
Article web link https://www.scienceofmotion.com/the_power_of_the_mind.html

PS: Betsy just told me that ‘supah’ is New York city slang for ‘super’. The name fits him as exceptional ability and accomplishment are not only limited to those with physical talent.

24/03/2021
11/02/2021

SHOULD WE FIT SADDLES WIDER THAN INDUSTRY GUIDELINES*?

This is a question which has been raised multiple times. Some of the thoughts which underpin the idea that fitting a saddle “wider” than industry guidelines are; “allows the horse to work over the back better”, “allows the horse to lift up”, “allows muscle activation” and “won’t restrict scapula mechanics” just to list a few. Although at first glance this may seem logical, fitting a saddle wider, allowing the region of the back beneath to have more room, there is no experimental evidence to support this approach.

In the static horse, a wide saddle will have the appearance that the front of the saddle is down when compared to the back of the saddle (image B.). When applying pressure with your hand to the front of the saddle, the back will lift up. In the dynamic horse, the position and orientation of the saddle remains the same (down at the front), plus we add the mass of the rider. Previously we have demonstrated the effect that a “wide” saddle has on back movement, muscle dimensions, locomotion and rider position when compared to a “correctly” fitted saddle (1, 3, 4). During trot and canter when ridden in a wide saddle, the back showed altered range of motion, which is likely as a result of the saddle instability (down at the front, up at the back). As a function of the front of the saddle being down during locomotion, this resulted in areas of high pressures in the front region of the saddle (left and right, image B. ), the magnitude of pressure and locations were consistent across all horses with peak pressures being directly influenced by limb movement. To emphasise the effect that tree width has on the locomotor apparatus of the horse, after twenty minutes of exercise in a wide saddle, compressions (concavities) in the epaxial musculature in the region of T13 were recorded (1, 3, 4). These compressions are as a result of the high pressures which occurred as a function of saddle width (down at the front). Horses develop compensatory strategies to alleviate any discomfort caused, in this case by the saddle width. In a wide saddle, every motion cycle, the horse will experience high pressures in the front region of the saddle, and of course will alter its locomotion to compensate.

The idea that fitting a saddle wider than industry guidelines is a fallacy. In contrast to the anecdotal beliefs, it could have deleterious effect on the horse’s locomotor apparatus. It is assumed that if the horse has more room, it will be able to utilise that space by altering its biomechanics. However, the dynamic forces from the rider must be considered, in the case of the wide saddle which is down at the front when the horse is stood square (no rider), then adding the mass of the rider, combined with the locomotor forces, the saddle will remain and increase its pitch in a forward / downward direction – comprising the horses locomotor function. The wide saddle will also affect the rider biomechanics which will be addressed in part 2.

The results outlined here are in accordance with researchers in Europe (2) where a group of horses were ridden on a treadmill with saddles of varying widths. It is appreciated that the saddle width can be corrected with a half pad/front riser. This strategy may be of benefit however, we must consider the half pad/front riser being used, in respect that the pad must be able to manage the dynamic forces and not deform under load, as the saddle which is “in balance” with a half pad/front riser , which then deforms during locomotion will become “out of balance” wide. From preliminary data, saddles which were wide but rebalanced to correct width with the use of a front riser, after twenty minutes of exercise, the concavities at T13 were still apparent (sadly, COVID has prevented pressure data collection). Therefore, although the saddle is “in balance” we must be cautious that it doesn’t become out of balance during locomotion. There are situations where a half pad/front riser can used to help rebalance saddles, in these cases it is essential that horse owners work closely with their qualified saddle fitter with regular checks in order to monitor any changes and rebalance saddles accordingly.


*NB: correct width defined as: The shape of the head of the tree and the angle of the tree points corresponding to the shape and angle of the horse 5cm behind the scapulae.


Please like / follow our page for more blogs and please share to raise awareness 😃

Dr. Russell MacKechnie-Guire
Centaur Biomechanics
www.centaurbiomechanics.co.uk



1. MacKechnie-Guire R, MacKechnie-Guire E, Fairfax V, Fisher D, Fisher M, Pfau T. The Effect of Tree Width on Thoracolumbar and Limb Kinematics, Saddle Pressure Distribution, and Thoracolumbar Dimensions in Sports Horses in Trot and Canter. Animals (Basel). 2019;9(10).

2. Meschan EM, Peham C, Schobesberger H, Licka TF. The influence of the width of the saddle tree on the forces and the pressure distribution under the saddle. Vet J. 2007;173(3):578-84.

3. R. MacKechnie-Guire, E. MacKechnie-Guire, V. Fairfax, D. Fisher, M. Fisher and T. Pfau. (2019), Kinematics of the thoracolumbar spine whilst cantering in horses fitted with a saddle of three different widths, BEVA Congress, EVJ Supplement, https://onlinelibrary.wiley.com/doi/full/10.1111/evj.13_13152?af=R

4. R. MacKechnie-Guire, E. MacKechnie-Guire, V. Fairfax, D. Fisher, M. Fisher and T. Pfau. (2019), Can saddle tree width affect saddle pressure distribution whilst cantering?, BEVA Congress, EVJ Supplement, https://onlinelibrary.wiley.com/doi/full/10.1111/evj.16_13152?af=R

18/01/2021
12/11/2020

Hacking - long or short rein?

“I'd love to hear more regarding your thoughts on hacking on a long rein Vs in an outline. In particular, if you have a horse that is just coming back into work (and has atrophy and is out of shape) will hacking on a long rein mean they are not engaging correctly and may develop incorrect muscles? Obviously a horse just coming back into work, or a youngster might not be able to maintain an outline for the duration of an hour hack. I have ridden horses that seem to naturally carry themselves well, but for horses that do not, is walking on a loose rein detrimental? Should hacking time be relaxing time? Or a bit of both?“ Jen Major

Hi Jen, thanks for this excellent question 😊
I think, as you said at the end, a bit of both is key. Variety is the spice of life. If you’re talking about a horse coming back into work after time off, it’s like an out of shape person starting to get into shape. There’s lots on the internet now around the ‘couch to 5k’ movement. And it’s easy nowadays, especially since everything has moved online with Covid, to find a personal trainer online, or a personal training app.

Whatever you read about getting fit, it will tell you to build up gradually, and to give yourself days off to allow your body to heal. If you exercise your arms one day, give them 72hrs of gentler exercise before you target them again, and the same applies to any exercise.

With the horses, there are various things coming into play here. It might be the length of the hack that needs to be varied. You might long rein or lead your horse as his ‘rest’ days, for example. You might hack out ridden for the first half of the hack then get off and lead him home (or vice versa).

I think a similar principle applies to working in an outline. It is a set of muscles that need to be built up. They should be worked initially for very short periods of time, perhaps just a minute in an outline, 3 minutes long rein, a minute in an outline... and so on. Days where you’ve worked harder on the outline could be interspersed with days where you focus on it less. Topline could be developed through a combination of groundwork and ridden work, school work and hacking, straight lines and circles, forwards and sideways, flatwork and pole work.

I also feel it’s important to vary the speed and the terrain. Hill work, if it’s an option, is hugely beneficial in developing core strength. A mixture of hard / soft / rough ground (assuming the horse can cope physically) is great for developing body awareness. To me I imagine the horse getting quite uncomfortable in his back if we sit in walk all the way, simply because there is minimal change in the pattern of pressure, so I like to do a few strides of trot, or shift my position in some other way.

Definitely I think that hacking can be about relaxation, enjoying the surroundings, switching off (for us) and mental stimulation (for the horse). The research clearly shows that our horses are more likely to stay sound if we include a variety of surfaces (such as are found out hacking), compared to riding in the same school every day.

And for me it’s about that feeling of oneness. It is much easier to exercise if you enjoy the form of exercise that you are taking, and exercise builds muscle. So for a horse who enjoys hacking and is able to relax into it, it makes sense to me that he would strengthen with hacking, whether on a short or a long rein.

I hope this answers your questions, and gives you more to think about. Happy hacking 😀

05/07/2020

Article in H & H featuring one of our rider based research projects. In this study we wanted to quantify the effect that rider aysmmertery has on equine locomotion.

Research titled “The Effect That Induced Rider Asymmetry Has on Equine Locomotion and the Range of Motion of the Thoracolumbar Spine When Ridden in Rising Trot” published in the Journal of Equine Veterinary Science. 😃

As always - a massive thank you to all of the riders+horses, the research team and co-authors. We have 5 new rider based papers on the go and then when things settle down - we will be back in the lab doing more rider based research.

Evaluating rider biomechanics + the rider’s interaction with the horse + saddle and then working on exercises to improve rider biomechanics is something we do exstensively in our rider biomechanics clinic 😃

Rider Biomechanics dates and info ⬇️

http://www.centaurbiomechanics.co.uk/rider-analysis/

Research: List of published papers ⬇️

list http://www.centaurbiomechanics.co.uk/research/






😃

13/01/2020

We put together this useful patient focused info-graphic explaining what you really need to know about acupuncture

21/11/2019

Developing a horse’s core strength is vital in ensuring they are able to fulfill their athletic potential and avoid injury. Veterinary Physiotherapist Hayley Marsh PgDip Vet Phys BSc MNAVP gives you some exercises to try at home.

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