Assessment- what's it all about?
So, your horse doesn't feel right, he is struggling to do what you are asking. You decide to get somebody to look at him.
The following is what you can usually expect as an assessment by a veterinary physiotherapist. The information gathered during the assessment is then used to decide where the problem is and to inform treatment.
This is just an overview of what is involved, to describe it fully would require a book! Also, each person will have their own subtle variations to the process so it mightn't be exactly as described here.
It is important to note that there is no recipe for an assessment. It is carried out in a systematic manner but physiotherapists use clinical reasoning to decide what to do and which tests are appropriate. For example, if your horse is on box rest, then it is not appropriate or safe to take him out and trot him up! The assessment is tailored to suit the individual horse, owner, facilities and circumstances.
The assessment consists of:
- History: Information is collected from the owner/rider about age, breed, type of work, routine, previous injuries etc. There will be specific questions about the current issues or reason for assessment and what the goal or future plan is for the horse. Often some of this information will be already known from talking on the phone or previous visits.
From this information, the physiotherapist will begin to formulate a hypothesis of the problem. They will also use this information to decide what to include in the assessment.
- Standing observation: The horses confirmation and posture is observed and any swelling, atrophy or asymmetry of muscle or bony landmarks is noted. Any deviations from normal may indicate the location of a primary or secondary problem or be irrelevant. The horses general muscle condition is considered in relation to what is expected for his age, type and work. For example, a horse who is mature, working correctly and pain free would be expected to have a good topline. Any deviations from this would raise questions about the cause of this change. Any unusual positioning or resting of a limb is also noted.
- Movement observation: By observing the horse move, signs such as lameness, asymmetry, stumbling or toe drag can indicate issues. The horse should also track up well and movement should be visible through his back. Also, the quality, willingness and general way of going is noted. While a horse may not look obviously lame, a reluctance to move or negative facial and body expressions such as ears back or tail swishing, can indicate underlying discomfort. Watching the horse turn in tight circles and rein back also gives an indication of willingness and ability to move through the body. Difficulty doing these movements may also suggest neurological problems.
As a minimum the horse will usually be seen walk and trot in hand on a firm surface. Dependent on the horse, facilities, handler and need, the horse is sometimes seen on the lunge or ridden and possibly on different surfaces. For example, if the rider describes issues that are only apparent when ridden and there is nothing of note when moving in hand, the horse may be seen under saddle.
At this stage, findings such as lameness or indication of serious pathology may require further assessment by a vet.
- Palpation: This is done either before and/or after seeing the horse move depending on the circumstances. The physiotherapist will feel their way through the horses body. They will assess the feel of the soft tissues such as muscle and fascia. They are looking for areas of temperature change, muscle spasm, a pain response or where the tone feels tight or weak. By comparing both sides and against what would be expected as normal, areas where there is a problem can be highlighted.
By assessing neck range of movement generally in all directions and then at each level, any changes to movement can be noted. Similarly, movement through the back is tested by asking the horse to round, extend or laterally flex his back and by palpation at individual spinal levels/vertebrae. Limbs may also be taken through a range of movement to assess for any restricted or painful movement. Areas such as the sacroiliac joint can also be assessed using certain tests.
The quality, feel, range and willingness of movement is being tested during all of these tests.
- Other observations: During the assessment, the physiotherapist will also be aware of signs that may indicate a poorly fitting saddle or possible problems with teeth that need to be assessed by the appropriate professional.
The length of the assessment depends on the complexity of the situation and if the horse needs to be ridden. Following all these tests, the findings are used to create a problem list and then clinical reasoning is used to hypothesise what the problem is and how the symptoms fit together. For example- Why does an area feel tight, weak or painful? Are these connected? What is the primary problem and what are the compensations? How does this relate to the history? What are the causes or contributing factors?
It is rare that one specific test or movement alone will tell you what the primary problem is and sometimes there is not a definitive answer. It is usually more of a puzzle where all the information is looked at and then clinical reasoning is used to identify the likely area or structure at fault. From this a treatment plan can be formulated and carried out.