There are a variety of people choices available to you.... veterinarians or therapists and also numerous treatment regimes and machine modalities . Making a choice between these is often most confusing. It is natural of course that different professional people and therapists will expound upon the virtues of their own methods / machines over other forms of therapy. I will now endeavour to present some simple guidelines which ‘may’ assist you in making your choices.
Question:- 1) Does the injured site / complaint respond well to anti-inflammatory medication? Bute! 2) How long since the accident / injury occurred?... 3-4 weeks, months, years. 3) Is the horse lame? (head bobbing) or does he / she exhibit an awkward (altered gait). 4) Have symptoms of laminitis or heel pain developed?
.....1) The first thing to do is to try and differentiate between (i) muscle / tendon / ligament, joint injuries, i.e....musculoskeletal injuries, VERSUS (ii) conditions where Neuropathic Pain is evident. One assumes that in both cases ‘pain’ is involved. The difference is that cases of (i) most often have some degree of inflammation associated with them and thus will respond to anti-inflammatory medication. In the case of (ii) there is usually little to no inflammation and thus the opposite occurs. i.e..... no response to ‘Bute’!
With (i) these horses should really undergo a veterinary examination as medication may be indicated and there is also the possibility that other musculoskeletal conditions are primary and muscle ‘sensitivity- spasm’ is secondary. If the condition involves ‘soft tissues’ (tendon/ muscle....etc) then massage, magnetic field, poultice...etc can be utilised to aid healing but ‘Manipulation’ is not indicated.. in fact may be contra-indicated.
....2) How long since the injury occurred? If it is a case of (ii) (spinal joint complex trauma with evidence of ‘neuropathic pain” ) that occurred 2 months (or less) ago then there are a variety of treatments, carried out by qualified therapists, which should lead to a useful outcome. Acupuncture, massage, standing mobilisation, trigger point therapy.... are a few that come to mind.
If however the ‘initial trauma’ ( there may have been several incidents since) was 2-6 years ago then one could expect some degree of serious reduction in spinal joint ROM range of movement. Translated that means ‘stiffness’ (like a wrist that no longer bends) that may well require some ‘extended pressure’ (pressure applied over 5-10 minutes) to restore full or useful range of joint movement. Having treated many thousands of horses like this (particularly cervical / neck injuries) I can assure you that in general the only way to achieve this is with the horse anaesthetised. I still find it quite an effort in the anaesthetised animal and thus fail to agree with those who declare that “I can do all that without a general anaesthetic!”
The simple rule is then that early treatment opens up the range of useful treatment modalities. Later treatment when physical (joint) stiffness has become significant, ‘reduces’ the effectiveness of many forms of standing treatment. i.e. there may be a change for the better with treatment, but this change is most often not complete and / or short lived.
WARNING. If your horse shows any signs of ‘incoordination’ ...legs everywhere, falls over, hindquarters move independently then a veterinary examination is paramount as joint instability or a fracture may be present. Any evidence of ‘swelling’ about the spine is also often indicative of a fracture. These horses should always be examined by a veterinarian first. Some treatment modalities could lead to further trauma and even death.
3) If the horse is lame .... the lameness will either respond dramatically to antiinflammatory medication...... or it wont! If it does then a lameness work up should be carried out. If there is little to no response then a neurological (spinal) examination may well be indicated. Altered gaits again either respond to medication Anti-inflam or they don’t. If they don’t ....? neurological....?
4) In humans with ‘neuropathic pain’ it is not unusual to get changes in blood flow to the extremities hands / feet. In horses similar changes particularly in the fore feet may accompany neuropathic pain states. These changes may well exacerbate a laminitic condition which has been precipitated by other known factors (overfeeding, stress..etc). Veterinary attention is always indicated in cases of laminitis. However in some cases reduced range of movement of the lower cervical (neck) spine (with associated peripheral alterations to blood flow) appears to complicate this process. The best way to treat the lower neck (reduced ROM) in a horse ...except for recent trauma.... is under general anaesthetic. The reason for this is that the lower neck is so well protected by the huge mass of muscle and associated soft tissues. We are simply not physically able to deal with such a mass where the animal can in any way ‘resist’!
The outcome of treatment (Physical Therapies) will depend mostly on 2 factors.
(A) The extent to which joint range of movement can be restored by the therapy / therapist. (B) The extent to which secondary degenerative processes (joint and soft tissue) have progressed prior to therapy. e.g........ Arthritic change may have already occurred.
The length of time since the injury occurred seems to be less important as regards the outcome. It may well however dictate the type of therapy utilised!