Treatment- what are we actually doing with our hands?
Hands on soft tissue techniques and manual therapies are often a big part of the treatment your horse will receive from a physiotherapist. You may have noticed there are many different techniques but not known the difference between them. You may also have wondered why sometimes the physiotherapist is standing there with just a thumb or hand on the horse and doesn’t look like they are doing much! Read on to find out what we are actually doing!
Firstly, it is important to point out that the treatment undertaken follows on from an assessment and it is not that ‘one size fits all’ and every horse gets the same treatment. Following an assessment, the physiotherapist will use clinical reasoning to decide how best to treat the findings for that individual horse. There are a variety of options and much consideration is given to choosing the most appropriate ones.
Most will use a mix of soft tissue and/or manual therapy techniques alongside other modalities such as electrotherapy (laser etc.) and exercise.
Below are some of the commonly used soft tissue techniques. There are many others and their use varies dependent on factors such as training and preferences. However, they all aim to achieve a change in the soft tissues.
These are followed by a brief description of manual therapy techniques such as mobilisations and manipulations.
These are taut bands within the muscle fibers or fascia and are due to a sustained muscle fibre contraction. They often occur in similar places and are painful on palpation. Often there will be twitching or fasiculation of the muscle when they are palpated. They are thought to be due to acute or chronic overload. For example, if a horse is working hard or if a particular muscle is working harder than it should due to compensating for a problem elsewhere, a trigger point can develop.
They cause pain, can restrict movement, cause muscle weakness and alter muscle activation patterns in the affected muscle and those further away.
Treatment options include trigger point release where a sustained pressure is applied (using thumb, elbow etc.) until trigger point releases/ muscle relaxes. (Often looking like we are not doing much during this but actually working hard!). This is then followed by stretching the treated muscle. Laser and other massage techniques can be used also.
Fascia is a connective tissue which surrounds muscles, tendons and ligaments throughout the body. It connects and enables communication between various tissues and organs. Therefore, it effects posture and movement. Recent studies in horses have found that there are fascial chains throughout the body similar to humans. The fascial and muscular systems should be viewed very much as an interlinked whole body system rather than individual muscles working on their own to create movement.
Healthy fascia is hydrated and elastic. When dehydrated it becomes shortened and adheres to surrounding tissue and negatively impacts on movement.
Myofascial release techniques can return the system to a healthy state. They take advantage of the thixotropic properties of fascia where the application of heat or pressure turns it from a gel to sol state (more fluid). When using these, the tissues are first warmed using heat from hands (again we look like we are not doing much during this- its described as waiting for the melt!). Pressure and stretch is then applied to address the restrictions. The scapular sweep (photo) and cross hands technique applied to the back muscles are common methods.
Various massage techniques that many would be familiar with from a human perspective are also used in horses. These include effleurage (long stroking movements), petrissage (kneading, wringing movements), friction (rubbing) and percussion (clapping, hacking movements). These each have different effects and are chosen depending on what you are trying to achieve. Different techniques can be relaxing, stimulating, have an effect on scar tissue, relieve spasm or reduce swelling. These techniques can in be used to complement the other soft tissue techniques.
If an assessment has identified restriction or pain on movement of a joint, mobilisation or manipulation may be performed to return the joint to its optimum movement and state.
You may have seen a physiotherapist pushing on a vertebrae in the neck or back as part of the assessment. If pain or restriction in movement is found, a similar movement is performed as a treatment (mobilisation) but is graded in amplitude, velocity and position according to the findings. As with during all treatments, the physiotherapist will be constantly reassessing for a change or response in the tissues and also monitoring the horse behaviour to see the effect. Mobilisations can be performed on all joints- spinal, upper and lower limb and tempromandibular. The aim of the mobilisation is to reduce pain and return full range of movement.
A manipulation is slightly different in that it is a quick thrust movement. Many think that this is a bone being ‘put back in place’! This is not what is happening! The joint may have restricted movement generally or in a particular direction but it is not out of place. It is thought that these restrictions are due to soft tissue tightness and spasm. The manipulation provides a ‘shock’ to the tissues and resets them to allow normal movement by resolving the tightness.
This was a quick tour of commonly used techniques. As mentioned they are used after a thorough assessment and applied where appropriate, safe, not contraindicated and likely to have the desired effect. While the choice of techniques used may appear easy, there is actually a lot of thought and clinical reasoning behind each decision.
Each of these techniques is usually used as part of an overall program which includes exercises in hand or ridden to address any weakness or poor movement patterns which may be causing or result from soft tissue restrictions.
Different therapists will use different treatments. They are all likely trying to achieve the same result, just going about in a different way. If you are unsure what treatment somebody is using, just ask! They will be delighted to explain it to you!