Physiotherapy Assessment and Treatment of the Equine Forelimb

Original Editor - Jess Bell Top Contributors - Jess Bell, Tarina van der Stockt, Kim Jackson and Stacy Schiurring

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Introduction

Physiotherapists do not play a significant role in the management of horses with forelimb injuries. Usually these animals will require veterinarian intervention - any soft tissue involvement that physiotherapists can help to manage is often compensatory.

This page will discuss key considerations for the animal physiotherapist, including the importance of working closely with the multidisciplinary team (i.e. veterinarian, farrier, rider), the need to obtain a thorough history, as well as the basics of assessment and physiotherapy interventions.

Physiotherapy Assessment

Once the horse has been given a diagnosis by a veterinarian, the equine therapist needs to obtain a full history of the patient’s presenting condition. This will provide important information about the horse’s level of disability, time-line and progression of the condition, and any past history that is relevant to the current presentation.

Questions to ask include in the subjective interview are:

• When did the horse go lame?
• How lame is the horse?
• What interventions have been tried so far, including medications?
• What occurred in the lead up to the injury? (including training, shoes, boots, surfaces, supplements)
• What type of work does the horse do? What is the horse’s expected level, schooling, breeding, and training programme?
• Have there been any changes in saddles, bridles etc?
• Does pain / lameness improve when the horse has warmed up or does it get worse throughout the ride? Is it worse on small circles or with a change of direction?
• Are changes more subtle? (e.g. loss of height in piaffe / passage, dropping foot over bigger fences, changing lead at gallop)

It can be useful to also discuss the patient’s history with its grooms, and handlers - particularly when attempting to determine what other interventions the animal has received.

While obtaining the subjective history from the owner, the therapist is also able to observe the horse’s demeanour, behaviour, condition, conformation, gait and posture.

Observation

Static Observation

The therapist should observe and compare with other horses from the same breed, the patient’s:

• Conformation
• Mentation
• Muscular condition and coverage (compared to horses of its age, type, level of work)
• Muscle symmetry and bony landmarks
• Weight bearing ability (compared side to side)

Dynamic Observation

Observing the horse in motion enables the therapist to establish how willing the patient is to move. Movements must be provocative enough to highlight the impairment (walking / trotting in a straight line may not adequately challenge the horse).

Movements that could be included in a dynamic assessment are:

• Handler walks the horse away and back
  • Therapist looks at the way the horse goes, if there is any reluctance to move, can the handler settle the horse?
• Repeat
  • Therapist looks for symmetry of movement, flat foot placement, even strides, head nod
• Trot away and trot back
  • Therapist looks for any head nod (which indicates forelimb lameness) and at stride length
• Small circles
  • Therapist looks for cross over in both directions, neck bend
• Different surfaces
  • Therapist looks for any apprehension, snatch back
• Lunging
  • Therapist looks for symmetry, enthusiasm without the riders weight
• Under saddle
  • Looser rein, then collection. Tricky movement

Functional Assessment

The functional assessment might include whole tasks (e.g. gait / functional activities) or components of movements. For example:

• Small circles
• Gait on a hill
• Walking on soft surfaces, over poles

Any functional test / movement can be used as both an assessment and as an intervention.

Physical Assessment

The physical examination should include:

• Active physiological movements
• Soft tissue palpation and testing
• Passive physiological joint assessment
• Passive accessory joint assessment
• Neuromechanical tissue testing

Goniometers, tape measure, and photography / video are often used as outcome measures during the physical assessment in equine physiotherapy.

Palpation

When palpating a horse, it is important to consider the following points:

• Always approach the horse with care
• Palpate for muscle type, bulk
  • Remember to consider the horse’s breed (i.e thin thoroughbreds vs heavier cobs)
• Allow the horse to be comfortable with you
• Check the horse’s temperature, response to touch, and look for swelling, symmetry and effusion
• Compare left to right
• Look for compensatory patterns – assess the opposite musculature, and diagonal musculature

A top down approach can be useful when palpating the forelimb of a horse:

• Scapular ridge
• Spine of scapular
• Supraspinatus, infraspinatus
• Scapulohumeral joint
• Biceps bursa and biceps tendon
• Triceps and elbow, point of the olecranon
• Forearm – flexor groups. Muscles and associated tendon sheaths
• Extensors- Muscles and associated tendon sheaths
• Radius – medially palpate the radial bone
• Carpus – extensors over the front of the carpus. Carpal effusion
• Accessory carpal bone, effusion in carpal sheath
• Metacarpus and splint bones
• Flexor tendons
• Suspensory ligament
• MCP joint and palmar digital flexor tendon sheath
• Pastern
• Coronary band and hoof