Holistic medicine is particularly applicable to the performance horse for several reasons. Holistic equine medicine considers the evaluation of the horse within its environment including the evaluation of the rider, saddle, conformation, shoeing, training and nutrition. The complementary approach to medicine not only accelerates healing times, it restores the horse to optimal performance and health. The holistic modalities have minimal to no side effects and no drug residues to test positive in competitions and racing jurisdictions where drug use is regulated. With this approach horses can reach their full potential because the whole animal may become healthier, not just a single part, as is commonly treated in conventional medicine. Horses last much longer in competition because they are healthy and moving correctly.
As the price of acquiring and maintaining horses increases, people wish to keep their horses and not treat them as disposable commodities. The holistic approach can keep horses going for a lifetime. Currently, most of the star equine athletes last one to three years in competition, then disappear or are downgraded significantly. Owners also wish to keep their horses longer for emotional reasons, since more people are becoming connected to their animals on a deeper level, or are at least acknowledging their emotional attachment as the “new age” movement gains momentum. This is evident as one reviews the lay magazines and books where there are numerous articles on holistic approaches to health care, management and training.
In the racing industry, wastage through lameness and respiratory disease has been well documented. In all of the horse industry, including racing, there is an enormous and largely undocumented wastage of horses due to performance problems. Many horses in all sports are bought as expensive prospects or are purchased while performing at an acceptable level of competition only to have performance deteriorate later. The traditional approach is to treat the horses with drugs and hope they improve; however, these horses rarely return to truly maximum performance. They are usually sold at a reduced price. Many very talented horses end up either as school horses or in sale barns due to what is perceived as behavioral or performance problems. The end results are losses of significant amounts of money, as well as frustrated owners.
Taking a truly holistic approach to health requires making many changes, however, the rewards are great. The weekend pleasure horse needs to be viewed as an athlete, as is the weekend rider. A complete holistic program for the horse should involve the rider as well. Riders who are in pain or are unhealthy may influence their horses in a negative way. Encouraging riders to become part of the process is often a challenging part of a holistic health program because traditionally riders do not see themselves as athletes. We must not forget to look at the whole horse and the environment.
Performance problems may be due to physical pain as well as mental attitude. Mental attitude of the horse, often a very difficult factor to observe, needs to be considered. Most horses that are pain-free will perform well to the best of their ability, and if specific behaviors remain after relieving the pain, such as a fear of jumping, boredom in dressage, or nervousness on the trail, then it may be time for that horse to find a new career. Sometimes there is no way to know if a horse can deal with the stress of high levels of competition until the higher levels are reached. A horse that mentally enjoys the sport it is involved in appears more relaxed, and consequently has less pain and tension than a horse who is not content. Enjoyment is difficult to evaluate and quantify. However, horses that are in pain do not enjoy, or perform well at anything they do.
Performance and/or behavioral problems are often a result of soft-tissue pain in the neck or back areas. There are many causes of this pain. One of the most frequent is saddle-induced pain, either from a poor fit or improper positioning. Other causes are poor rider balance from the rider's body pain, lack of rider skill, or training techniques that inhibit the natural movement of the back as well as unbalanced feet, mouth pain from sharp teeth, rough hands, or a harsh bit. Any of those factors may result in a horse hollowing its back, inverting its neck, and constantly attempting to evade the rider. Lower leg lameness may cause chronic back soreness or, more commonly, can be caused by back soreness. In many cases lower leg lameness will disappear when the back problem is cleared up, and will not recur unless the back pain returns. Muscle pain from injuries caused either in the pasture (extremely common), or while being ridden (also very common) is also often present.
Back and neck muscles can become sore for a variety of reasons. However, it must also be remembered that the horse can be his own worst enemy. Horses do inflict a lot of damage to themselves, both in the pasture and in the stall. The forces exerted on the body of a horse are extremely large if two horses are playing and slip or fall down. A horse falling and throwing a thousand pounds of weight on the ground is analogous to a person experiencing an automobile accident. Like an auto accident victim, the horse will suffer repercussions in the months that follow. Vertebrae are tightened in a fashion similar to that of humans after an accident. Muscles, tendons, and ligaments are pulled and gradually become tighter over time unless the spasms are relieved. Six months or a year afterwards, when the accident is forgotten, chronic back pain has set in and performance problems may become severe. Becoming cast, a frequent problem in horses that spend a lot of time in their stalls, can put a great deal of torque on the musculoskeletal system. The owner usually does not see the inciting accident; all that is known is that the horseÕs performance is deteriorating, and in many cases the decrease in performance starts almost overnight. (Table 1)
Evaluation of the back
The horse's back is central to the function of the musculoskeletal system and to its ability to carry a rider. Biomechanically, the head, neck, back, and hindquarters are connected and move together, so if a horse carries his neck in a raised “upside-down”, hollow position, his back is also going to be hollow. The hollow position of his back will alter the position of the pelvis, making it impossible to engage the hind quarters correctly underneath his body. To allow the horse to use his back properly the abdominal muscles, the ileopsoas, tensor fasci latae, and the quadriceps must contract. Contracture of the back muscles flex the back downwards (ventroflexion), and if the back is contracted from pain usually the muscles are in spasm and motion is restricted. The contraction of the lower half of the “ring of muscles”, described by Dr. Deb. Bennett in Principles of Conformation Analysis 1, (Bennett, 1988) raises the back, allowing the longissimus dorsi (back muscle) to relax and contract selectively, which then allows the back to move freely.
Most horses in all sports today are performing with hollow backs, at all levels of training and competition, from backyard pleasure to the Olympics. The horse that uses the lower half of the ring of muscles is the exception. This is the horse that makes its performance look effortless, no matter which sport is done. The dressage horse that looks like it is lifting the rider off its back and floating through the motions, the open jumper who makes a five foot course look like a pony hunter course; all these horses are using the lower half of the ring of muscles.
As the horse's back becomes hollow or stiff, his hind legs cannot engage properly, and the front feet tend to hit the ground heel first. Essentially the horse is in a “parked out” position similar to that of a gaited horse. This parked-out stance is an exaggerated example of how a horse with a hollow back looks and moves. Picture the same horse in a dressage test or on a jumping course with his hind legs out behind him. Not only will the dressage scores be poor, but fences will be easily knocked down. Unnatural strain is placed on the stifles and hocks creating lameness or soreness, leading to resistance. The front legs in the hollow-backed horse are often working slightly in front of the vertical rather than truly under the horse. Some horses have an attractive headset with a motionless back and relaxed abdominal muscles. The feet and tendons endure the stress of this position and can become sore or strained.
Good dressage training has traditionally been aimed at strengthening the abdominal muscles to give the lift and suspension so desirable in that sport. Dressage horses especially need strong abdominal muscles to allow true engagement of the hindquarters, lifting of the back, and lightness in their movements. The correct use of the abdominal muscles should occur in all sports, as the horse needs to lift his back and engage his hindquarters to carry a rider properly, whether the sport is cutting, western pleasure or endurance. Strong abdominal muscles and engagement of the hindquarters are crucial to the jumping horse as the source of power for the jump as well as for the lightness on its feet that helps prevent fatigue, especially in the cross-country phase of an event.
To illustrate the effect of the abdominal muscles, try this exercise with your horse. A finger (or fingernails or a plastic pen, if the horse is not very sensitive) run down the midline of the horseÕs abdomen from the girth area to just before the umbilicus will cause most horses to raise their back. The stomach muscles will contract, the back will rise, the back will relax, the neck will lower and stretch forward and the pelvis will move into the correct position. With abdominal muscles contracted, the back can move freely while still carrying the weight of a rider. Observe the change in shape of the horse's back–the topline will look noticeably flatter, more like a young horse's. The flatter topline is what the horse should look like if he were pain-free and had well-developed abdominal muscles with strength and freedom to move his back.
Here is an exercise to illustrate what happens when the back becomes rigid: stand on one foot, hollow the back, and lift the other leg as high as possible, leaving the knee bent. Then round the back and see how much farther the “hind leg” can come, almost to the chest. Note the freedom the “hind leg” has with the back round, and the stiffness in the “hind leg” when the back is hollow.
In looking at the whole horse, it is important to remember the effect the rider has on the horse, the comfort of the mouth and teeth, as well as the hoof balance and shoeing.
Back and Neck Pain Diagnosis
The steps to arriving at a diagnosis are the standard ones, however, with a different emphasis. A very complete history needs to be taken, followed by observation of the horse at rest and in motion, with and without tack. The muscles and joints are palpated thoroughly. Standard diagnostic procedures such as nerve blocks and diagnostic imaging can be used.
History: Some pertinent history questions to focus on are: what is the primary complaint, when does the problem show up, what makes the problem better, what makes it worse? A typical response is that the problem gets worse towards the end of a ride, or the horse takes a long time to warm up. Since many subtle performance problems show up as behavioral problems (Table 1), questions about the horseÕs behavior are important. Many riders are not aware that pain causes training problems.
Observation: The horse should be observed standing at rest with no equipment on. The natural stance of the horse is examined, as many horses develop a compensatory positioning of the legs at rest when there is pain present. Some horses stand stretched out or “parked out” to rest their back, while others stand with their limbs underneath their bodies. Look at the shoeing, as unbalanced feet lead to alterations in stance and to upper body pain. Does the horse always rest one foot, or place one foot in a certain position? Will the horse stand square if asked? Many horses are not able to stand square due to discomfort.
Look at the horse from all angles for symmetry and asymmetry. Many horsesÕ shoulders are uneven. Stand the horse squarely on level ground and look at the points of the shoulders, the knees and slope of the pasterns, as well as the shape of the feet. Stand directly behind the horse, noting asymmetries in the pelvic structure, muscle mass over the hindquarters and in the gaskins, and the shapes of the feet. Make note of the differences.
Place a stool behind the horse and stand above the horseÕs back, looking down. Be sure the horse is standing square, though it may be impossible to have it square in front and behind at the same time due to discomfort. If the horse cannot stand square on all four legs, observe the front first, then the rear end separately. The shoulders are often positioned asymmetrically. The differences in the positioning of the shoulders can lead to saddle-fitting problems, stiffness and imbalances in movement. The horse may stand crooked and be unable to straighten its neck, or there may be a crookedness of the spine that will not correct itself, even when the horse is repositioned.
The horse is observed walking and jogging in hand, while being lunged, with a rider mounted, and by using traditional flexion tests. Many horses move freely on the lunge line, but with a rider the horse loses its free movement, or changes its movement in some way, usually adversely. Significant changes in movement when the riderÕs weight is added indicate back pain, the origin of which may be a poorly fitting saddle, musculoskeletal trauma, poor riding technique, or training aids that put horses into artificial “frames” or head position.
The rider may feel that the horse is “off” or just not quite right on a particular limb. To the observer, the main sign is often stiffness or resistance in one direction or another, but the horse is not lame enough to block out in the suspect limb. There may be multiple limbs involved, either two legs on on the same side or the diagonal pairs of legs, with the cumulative picture being one of stiffness. The stiffness is a very important clue, as it usually means the spine is not moving correctly, the muscles are painful or in spasm, or the horse is protecting a painful part, often the back. As the horse moves stiffly and incorrectly, over time the distal limbs may become affected secondarily, slowly resulting in overt lameness. Correct treatment during the poor performance stage may alleviate the distal limb lameness, and actually allow the horse to perform at a higher level, with greater ease.
Palpation: The first palpation is a gentle passing of the practitionerÕs hands over the entire neck, back, and thorax looking for muscle tension, sensitivity, flinching or discomfort. A light touch often reveals more than a heavy touch and much practice is needed to develop the light touch.
The next stage is the acupuncture diagnosis. This involves palpation of the acupuncture meridians looking for pain or tension. The most common meridian to palpate for back pain is the Bladder meridian. The section of the Bladder meridian used is about 10 cm lateral to the spine in an average-sized horse, beginning in the pocket just behind the shoulder blade and ending near the tail. This meridian is one of the most important meridians in the body and is easily affected by ill-fitting saddles. The meridians along the neck are also palpated.
As the practitionerÕs fingers gain experience palpating for acupuncture points subtle changes can be found. Sensitivity at specific acupuncture points can be used diagnostically for not only back and neck pain but also for distal limb lameness. Due to the nature of the acupuncture meridians and their network of pathways over the body, it is possible to determine which points along the neck and the Bladder meridian are sensitive, then relate the findings to locations on the distal limbs. Each point along the back on the Bladder meridian relates to one of the other meridians. By knowing the path of the meridian and the internal organ to which that meridian relates, it is possible to locate the spot on the distal limbs where there is a problem. Diagnosing distal limb lameness through using acupuncture points is and adjunct to other diagnostic techniques. However, any sensitivity found along the back will also cause the horse to alter its gait when the rider and the saddle are in place, thus accentuating the distal limb soreness. Pain in the back and neck acupuncture points may in fact be the origin of the distal limb problems.
The chiropractic examination is the next stage. All joints in the body including the spine should move smoothly through their entire range of motion. Many horses have lost normal motion throughout their spine, resulting in stiffness and pain. To examine the range of motion, the practitioner gently moves the spine through its normal range, looking and feeling for stiffness. A carrot can be held by the horseÕs hip, stifle and down between the front limbs to check neck mobility (the “carrot stretch”), then the back can be raised by pressing on the midline to contract the rectus abdominus (“sit-ups” for horses). A normal horse can reach its hip and stifle as well as reach down well between its forelimbs. The back should be able to rise up easily, resulting in the horse extending and lowering its neck. Horses can become very upset if raising their backs is painful, and if they certainly cannot raise their back while standing still, they cannot raise their back with a rider in place. Loss of normal motion at the junction of the ribs and the sternum or loss of motion through the withers and mid-thorax usually produces pain when raising the back.
The practitioner then does a specific motion palpation of the individual joints of the spine and extremities looking for restrictions. Healthy joints move freely and have spring to them, while problem joints often feel stiff. Muscle palpation is also important, starting with a light touch and moving deeper to assess muscle quality. A healthy muscle will feel soft and springy; the horse will not object in any way to the palpation. Muscle under tension will feel tight and hard, and will have little spring. Muscle spasms and fasciculation can be seen locally and at a distance from the palpation site. Muscle in spasm will be more likely to become injured and will take a long time to warm up, as there is less blood flow through the spasm. Sometimes a horse will “splint” its back, or hold it rigidly in place while being examined, to avoid moving it. This reflects pain.
As the palpation is being done, if signs of saddle-induced injuries (Table 2) are found, they indicate that there has been a problem with a saddle, either past or present. If a poorly-fitted saddle has been used on a horse for any length of time, there will be residual back pain and probably loss of normal motion of the thoracic and lumbar vertebrae.
Pain reactions vary from mild contracture of the surrounding muscle at a few places to severe sinking from the pressure, accompanied by a hardening of the longissimus dorsi. The common reaction of “splinting” (bracing the back muscles so that they do not move) is a frequent response in many horses, because they hurt less when the painful muscle is held rigid. The splinting of the back is sometimes misinterpreted as not painful because the horse does not appear to sink away from pressure. Some horses splint their backs so hard they almost buck. These horses often buck when ridden, especially during the warm-up. Neck pain can be observed by palpating with one or two fingers along the vertebral column looking for tight or sore places. The horse may only flinch slightly, however any muscle tightness and hardness is significant. Neck soreness may be caused by vertebral subluxations, muscle pain, pain along the acupuncture meridians that traverse the neck or referred from other areas.
TREATING BACK PROBLEMS
Acupuncture. Acupuncture has proven extremely successful for this author in treating the poor performance syndrome in all sports. When combined with correcting saddle fit, shoeing and riding techniques the improvement in performance is outstanding, with approximately 85 to 90% of the horses treated returning to the previous level of performance, or higher, in one to four treatments given about one month apart. When people have been unwilling or unable to correct saddle fit problems, have poor quality farriers or continue with management and training techniques (Table 3) that cause problems, the horse must be maintained with regular treatments. Horses in hard work need more regular treatments than horses in light work. A horse working near its maximum ability, whether training level or Olympic level, will require more frequent therapy. As the human athletes have discovered, it is necessary to maintain some regular form of musculoskeletal therapy to keep maximum performance with minimum injuries since continued athletic activity puts a certain degree of strain on the musculoskeletal system.
Acupuncture treatment works well in treating many diseases and conditions. Though it is best known for its treatment of back pain and chronic diseases, acute conditions such as colic and laminitis respond well also. It is not advisable to treat a horse with acupuncture within 48 hours before a race as they may be relaxed from the endorphin release that occurs, and will run poorly. Acupuncture is best performed by a veterinarian with advanced training in the technique. Practitioners who just pick a few standard points or follow a single formula will find that their results are inconsistent.
Chiropractic: When chiropractic and acupuncture are combined the horses can reach their full potential. When either form of therapy is done alone, increased performance will occur, however, the increase in performance is not usually as long lasting or as good as when both therapies are combined. More repeat treatments are required of each one individually, because there will still be soreness or stiffness in the system that was not addressed. If horses are just undergoing chiropractic treatment, this author will adjust them once a week for a month or two, then quarterly unless they have significant problems, are in heavy competition or are racing. Horses receiving acupuncture and chiropractic treatments will be treated once a month for two to four months, then quarterly or less often as is needed. The idea is to prevent problems from recurring, rather than to treat them when they recur. Chiropractic work will treat most of the behavioral problems and stiffness associated with poor performance (Table 5).
A chiropractic adjustment is a short-lever, high velocity, controlled thrust, by hand or instrument which is directed at a specific articulation in a single motor unit (two vertebrae and the associated nerves, tendons, ligaments, and soft tissue). Chiropractic adjustments do not require great strength, just skill in making the short, sharp thrust, and knowledge of how to direct that thrust. The horses are very receptive and their relaxation makes the job easier, since it is very difficult to adjust even a person when the muscles are tense. A manipulation, as is frequently done in the name of chiropractic, is a forceful passive movement of a joint beyond its active range of motion, generally done with a long lever by jerking a leg or twisting the entire neck. Manipulations can result in damage to the joint capsules and to the joints themselves — joint damage is a common occurrence with horses. Initially improvement in flexibility and performance can be seen, but the long-term joint damage has begun and may not show up for several years.
Exercises: Sit-ups (to tone up the rectus abdominus) will help raise horsesÕ backs to their natural position. Sit-ups are done by running a finger, or in some cases a plastic device like a needle cap, along the midline, to contract the rectus abdominus, similar to a sit-up for a person. These are done regularly throughout a grooming or handling session, but not constantly as the horse can become irritated. Many horse cannot raise their backs and will need chiropractic adjustments to the withers, sternum or ribs before they will tolerate this exercise. Do not force a horse to do these lifts, though small, gentle movements can be tried on a regular basis to loosen the thoracic girdle. Carrot stretches, as described above, are very beneficial to entire spine. Audible popping sounds heard are the joints moving abnormally, and may or may not indicate that an adjustment is occurring. Leg circles are done by holding the limb in a relaxed position, similar to cleaning out the hoof. Four or five circles are made with the limb, starting small, and getting larger as the limb loosens up. Hip joints are particularly responsive to this exercise, and horses become easier to shoe, sounder in their hind limbs and more flexible as athletes, when their hip joints are loosened with the leg circles.
The rewards of looking at the whole horse are great. The challenge is establish which pieces of the puzzle are needing attention, then to see if the pieces can be made to work together. Sometimes harmony cannot be accomplished; many times better harmony is accomplished.
1) showing any objection to being saddled
2) being “cold-backed” during mounting
3) slow to warm up or relax
4) resistance to work<
5) resistance to or requires training aids
6) hock, stifle, or obscure hind limb lameness
7) front leg lameness, stumbling or tripping
8) excessive shying at all sorts of things
9) lack of concentration on rider and aids
10) rushing to/from fences; refusing jumps
11) rushing downhill or pulling uphill with front legs–unable to use hind end
12) inability to travel straight
13) inability to round back and/or neck
14) swishing tail, pinning ears, grinding teeth, tossing head
15) hypersensitivity to being brushed or touched
16) exhibiting a “bad attitude”
17) difficult to collect or maintain impulsion
18) twisting over fences
19) bucks or rears regularly
20) decreasing speed on the racetrack
21) slow out of the starting gate
22) ducking out of turns
23) starts ride doing well, gets more resistant later
24) not moving, or bucking, rolling excessively in field
25) difficult to shoe
1) obvious sores
2) white hairs under the saddle
3) swellings–temporary (after removing saddle), or permanent
4) scars deep in the muscle
5) atrophy of muscles on sides of withers
MANAGEMENT AND TRAINING PRACTICES THAT CAUSE DISCOMFORT
Mechanical hotwalkers, horse walkers
Lounging excessively, especially in sidereins
Paying no attention to the muscles after exercise
Ignoring the importance of warm-up and warm-down
Excessive use of swimming to condition
Blankets that are too tight
Sharp teeth or painful bits
Poor riding, training techniques
Conformation incorrect for the sport
1) Bennett, D. 1988. Principles of conformation analysis I. Fleet Street Publishing Corporation Gaithersburg, MD. pp 48-57.