Anatomy, Equine, Injury and Rehab, Injury Management

Equine Acupressure: To the point of it!

You may be asking what is acupressure and how can it help my horse? If so then the following post will help answer this question.

Equine acupressure has the same roots and theory as acupuncture. It involves the application of pressure from fingers rather than the use of needles making it safe and noninvasive (acupuncture in the UK can only be performed by equine vets). It can be used as a stand alone treatment or integrated into a sport massage to help support your horses health.

Acupressure is based on traditional Chinese medicine, which offers a method of natural healing by trying to maintain the innate balance of the body. Acupressure uses invisible lines of energy flow called meridians, and along these lines are specific points which can influence the body when pressure is applied. There are 14 meridians connecting organs with other parts of the body. It is thought that energy (Chi) that flows along these meridians can get blocked causing symptoms to develop. By applying pressure the balance and energy flow can be restored. Chi (energy) is composed of Yin and Yang, which are two dynamic forces that are the opposite to each other. Yin is seen to be represented by water, wet, cold, nourishing, and dark (to name a few), whereas Yang is fire, dry, hot, active, red and consumes. When Yin and yang are in balance chi is flowing harmoniously and the body is healthy, however when they are not in balance there is disharmony and disease develops. Acupressure can help restore balance and act as a preventive.

Acupressure can have the following benefits

  • Releases natural occurring pain relieving chemicals in the body
  • Reduces inflammation and swelling
  • Increases blood flow allowing an increased rate of recovery from injury
  • Increase energy levels and wellbeing
  • Decrease anxiety
  • Encourage relaxation
  • Help joint lubrications and movement

When working on equine clients I often integrate acupressure points into my bodywork (massage) sessions to help create a bespoke and more holistic approach. I frequently find horses relax hugely with use of acupressure by their eyes softening, heads lowering, muscles relaxing and often dosing off. This allows me to be more effective in treating areas of discomfort as well as supporting the horses overall health.

If you would like to discuss the potential use of acupressure in your horses treatment then do contact Pollyanna using the form below


Anatomy, Biomechanics, Human, Injury and Rehab, Injury Management

Stress Fractures

You may have heard the term stress fracture being used before and wondered what makes it different from other types of fractures. In short stress fractures are not caused by a specific impact or trauma to the site of the injury but rather a repetitive overuse of that area forming micro trauma, inflammation and superficial cracks in the bone. Stress fractures form over time but can be prevented. Read on if you want to know how to prevent stress fractures forming.

How do stress fracture form?

As mentioned above stress fractures occur over time. Naturally our bodies go through a cycle of bone remodelling, where bone is reabsorbed by the body and new bone then laid down to replace it. When this process is disrupted then stress fractures can result.

Generally a sudden increase in activity is the main reason for the disruption in the remodelling process. This can be an increase in load, frequency, intensity or duration that doesn’t allow the body time to adapt. As a result the bone is reabosrned by the body quicker than bone is laid down causing bone weakness.

The majority of the time the bones affected are weight bearing such as the bones of the feet and lower leg but other bones can also be susceptible. In sport it can be common in high impact and endurance sports such as running, basketball, dance, gymnastics and tennis. In sports like rowing stress fractures can occur to the ribs due to tight muscles that repeatedly pull at the surface of the ribs.

Risk factors

  • Sport- certain sports as mentioned above can have a higher risk.
  • Sudden increase in activity- this includes increase in intensity, load, duration and not having enough recovery time.
  • Being female- abnormal menstrual cycles can affect bone density
  • Foot problems- flat feet, high or rigid arches can affect the ability of the foot to absorb impacts.
  • Worn footwear- footwear that doesn’t support the foot correctly can place undue strain on bony structures.
  • Weakened bones- osteoporosis is a condition that affects bone density. Certain medication can also have an affect.
  • Previous stress fractures- if you have had them before then unfortunately there is a higher chance of developing another one.
  • Lack of nutrition- not taking enough calories in can affect bone remodelling as well as deficiencies in Vitamin D and calcium.

How to reduce the risk

  • Eat a well balanced diet and get advice from a nutritionalist
  • Don’t restrict calories when increasing intensity and volume of exercise
  • Increase intensity of exercise gradually
  • Increase volume of exercise gradually
  • Make sure you have enough recovery time between training sessions
  • Replace equipment regularly and don’t let it get to worn
  • Look after you feet

If you suspect you have a stress fracture then seek medical advice from a doctor. Often stress fractures do not show up on x-ray when they initially occur so you may not initially get offered one. Once stress fractures start healing they become more apparent on x-ray.

Anatomy, Biomechanics, Human, Injury and Rehab

Feet the foundation of movement: Part two Injuries

In the last blog we introduced the anatomy and function of the foot (Part one anatomy and function). With this knowledge it can be seen that the foot is quite a complex structure and with so many components you would think quite a lot can go wrong. If you think how often you walk, run or jump and the forces going through your feet it is quite immense, and yet our feet seem to tolerate this on a daily basis. However there are occasions where trauma occurs or our feet just can’t recover as they should. Below are some common injuries your feet might experience.

Plantar fasciitis

Plantar fasciitis is one of the most common forms of foot pain. It is common in runners and older adults. It is often associated with biomechanical issues due to excessive pronation or supination. It is an overuse injury and what we would term a tendinopathy. You may have experienced tennis elbow or Achilles tendinopathy. Which is a similar condition just affecting a different part of your body. Tendinopathy in short is when the tendon is not healing in the normal manner, it can fray, become thickened and be painful.

Flat feet or high arches can increase the risk of plantar fasciitis. Tightness in the calf muscle, hamstrings and gluteals can also increase the risk. Plantar fasciitis has a gradual onset of pain which is often located on the medial aspect of the heel and experienced after activity. However when it becomes more severe pain can be experienced when weight bearing and on activity. Periods of inactivity during the day can also increase the pain when commencing activity again. Stretching the foot and fascia also can cause pain.

Stress fractures

The common bones in the foot that can suffer stress fractures are the calcanous, navicular and metatarsals. Calcaneal stress fractures are common in runners, military personnel, ballet dancers and sports that involve jumping. Having poor heel cushioning, overstriding and a heavy load can all increase the risk. The onset of pain is insidious in nature and aggravated by weight bearing. There is localised tenderness to the medial or lateral border of the heel.

Navicular stress fractures are the most common stress fracture in the foot. It can occur in sprinters, jumping sports and hurdling. It is an overuse injury and is thought to be due to training errors and impingement of the bone between other tarsal bones. Decreased dorsiflexion in the ankle is thought to perhaps bring about an increase in compensatory dorsiflexion in the foot increasing the stress placed on the navicular. Individuals often experience a midfoot localised ache, radiating along the medial aspect of the medial longitudinal arch. It often gets better with rest.

Metatarsal stress fractures occur with excessive loading of the forefoot and muscle fatigue. Forefoot pain is experienced and aggravated by activity. Pain gradually worsens with activity and tenderness over the metatarsal is present. Stress fractures don’t always present themselves on x-ray straight away so can be harder to diagnose than a complete fracture. However if one is suspected then management strategies can be implemented until diagnosis is confirmed

Metatarsalgia

Metatarsalgia is an inflammatory condition of the metatarsal phalangeal joints. It is caused by excessive pressure over prolonged periods of time. It is associated with high arches, excessive pronation of the foot, clawing/hammer toe, tight extensor tendons of the toes, prominent metatarsal heads and Morton’s foot. Pain is aggravated by forefoot weight bearing and affects the mid stance and propulsive phase of walking. Pain is gradual in onset and local tenderness over joints is present. Passive flexion of the toe causes pain and a v shape between toes can also be an early sign.

Bunion (Hallucis valgus)

This is when the big toe deviates laterally, it is more common in women and older people. There are a number of factors that can lead to the development of a bunion constricting footwear like high heels, excessive pronation of the foot, long first metatarsal (big toe), trauma to the medial and plantar ligaments and trauma to the medial sesamoid bone. As the deformity develops so does the pain over the medial border of the big toe this can be relieved by removing footwear or wearing wider shoes.

Toe Clawing

Toe clawing is not necessarily a painful condition but suggests that the long flexor tendons are tight. During the propulsion phase of gait the long flexors contract to stabilise the toes, if the foot is unstable the long flexor tendons excessively contract causing the toes to claw at the ground to maintain stability. If this continues then it could affect other areas of the foot or body as they compensate.

The above are just a few examples of injuries that can develop with feet. There are many others. The majority of the above injuries can be avoided by performing exercises and taking other everyday precautions. Part three of this series will address these solutions to help you maintain happy feet.

If you have concerns about your feet then either consult your doctor or Pollyanna would be happy to answer any queries you might have where she can

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Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part Two: Road to Recovery

Willow Road to Recovery

In part two we discussed Willows history and issues that were causing her complex lameness, which you can find more detail in Case study Part One: Complex lameness. In this part we are going to discuss what treatments were used and Willows progress.

Treatment

Willow’s treatment was started very gently. In this case less is more. Willow is also a very receptive and expressive horse, which as a therapists is brilliant as she leads her own treatments. It is so important to listen and respond to a horses reaction. In this case Willow directs me on duration and areas she needs working on. Willow is also very responsive to acupressure points.

Her treatment began with Bladder 25 to help strengthen her lower back, address any stiffness or pain in this area. Willow responded by lowering her head almost to the ground and softening her eye to the point that she almost went to sleep. This allowed me to massage through her hind quarters to release further tension and relieve pain. Willows neck and poll muscles were also released through a number of soft tissue techniques. As well as her adductors on her inner thigh. This caused increase tone and activation through the TFL and quadriceps.

To finish of the session 5 gentle dock pulls were included on both sides to help strengthen and activate the TFL and quadriceps. A number of belly lifts were also performed to help activate the core muscles and stretch through the back.

Initial Outcome

Just from the above treatment and exercise Willow showed immediate improvement. Firstly her TFL (tensor latae fascia) and quadriceps started to activate. Had increased tone and secondly she was far less sensitive through her back and hindquarters. Her movement seemed eased but was still showing signs that were present on initial assessment. However the goal of making Willow more comfortable was achieved.

Continued Treatment

The original plan was to come and treat Willow little but often to allow her body to make small adjustments and to not overload her system with change. So visits were made twice a week for about two weeks. During this time I was fully aware that the country might go into lockdown and that I wouldn’t be able to come up to physically treat Willow. So Willow’s owner was taught how to do some of the key techniques that were helping Willow the most and given equipment to allow progress if I couldn’t be there. Willows owner was also doing some of acupressure points on a daily basis in between my treatments.

So in the second treatment acupressure point Bl 25 continued to be used along with the introduction of Bl 21 which helps with atrophy, gastrointestinal issues, edema , back pain and general weakness. Each session I added a new point Bl 11 (helps strengthen bones and joints, nourishes and facilitates blood flow, benefits joint problems and also helps neck and spinal pain), Bl 19 (helps with hip pain and gastrointestinal issues) and lastly Bl 23 (helps with general weakness, lower back pain and estrous cycle). The owner was also taught these points as treatment progressed. Willow responded well to all these points

Massage through Willows back, hindquarters, neck and poll were also carried out to help activate muscles and release tension that has developed due to compensatory mechanisms. Again Willow responded well over the two weeks

Exercises

Initially dock pulls and belly lifts were introduced. Gradually the number of repetitions were increased and this was something Willows owner performed between sessions. In the second treatment weight shift directed through the shoulder was introduced this along with dock pulls were to encourage Willow to use her stabilising muscles. To start the main aim was to develop Willows core to give her a stronger foundation to develop more global muscle strength.

Willow was introduced to some foot pads. Just one placed under a fore foot to start and then moved to a hind foot. The foot pad was placed under for as long as Willow would stay. This was often a couple of minutes. This was again to encourage Willow to use the finer muscles to stabilise herself.

Before I got to progress Willow further lockdown occurred. However with guidance Willows owner was able to progress her exercises gradually. Walking over a pole in straight lines was introduced then progressed over a week to a figure of out over a pole. These progressions occurred over a 3 week period from initial treatment.

Willows owner continued with all the above acupressure points, exercises and pole work by week 4 she was walking over 2 poles in a row with several repetitions. By week 5 Willow was introduced to slightly raised poles done in hand exercises. Willow is also on a track for the summer months so poles and obstacles to step over were introduced to encourage her to use her hind quarters more throughout her daily life. By week 6 straight line trotting in hand was introduced. By week 7 3 poles on a circle at walk was performed with no ill effect.

Progress

Walk up 3 months after initial assessment

Willow showed great improvements in her walk and confidence by week 2 of initial treatment. She was also getting increased turnout time. By week 3 she was back out on full turnout and her Bute had been gradually decreased as well. Within a month Willow was out 24/7. Willows feed was also changed to help increase weight and muscle mass by phasing in Copra and Speedi beet into her seaweed, brewers yeast, lucerne and chaff. Gradually the lucerne was phased out and replaced with Agrobs Leichengrass. There were two aims with these changes one was to reduce any feed stuffs that might cause increase in inflammation (hoof friendly) and to help increase condition.

The above photographs show a vast improvement in muscle mass and posture. The video further up also shows huge improvement in movement patterns. Willow will always have some sacroiliac issues but with careful management she should be able to lead a happy and comfortable life.

If you have any concerns about your own horse and lameness then do consult a vet or contact Pollyanna with any queries and she will try and help the best she can.

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Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part One: Complex Lameness

Willow the complex case of lameness

This case follows the assessment and treatment of a 19 year old horse, Willow. It shows the complexity of a case that has multiple factors interacting together and that by viewing the horse as a whole all these factors can be addressed in an efficient and effective way. This first part introduces Willow’s history and the problems that were being experienced by her. The second part will discuss treatment used and the outcome.

History

Willow is an Irish cross (possibly thoroughbred with some Arad), she is 19 yrs old, 15.1hh in height and of a slight build. Willow has had hock surgery and been owned by the current owner for 9 years.

I have been giving Willow bodywork session for the last year and she also receives McTimoney chiropractic treatment from a very good practitioner. Willow has exhibited an unlevel pelvis on a number of occasions. This is potentially linked to an underlying issue within her sacroiliac joint, which could be a result of previous activities or injury. Willow had been ridden western style and potentially barrel raced in the past. With her current owner she is hacked and schooled at a low level. Willow has been barefoot for the last year.

Willows issues

Over the winter Willow lost a bit of condition and then the mud came. Willow seemed to find the mud particularly difficult to deal with. Willow developed some heat in her right fore and lameness. After a vets visit an abscess was ruled out. However it was noted that her gait was abnormal. Not just in her right fore but the hind legs as well. The vet placed Willow on restricted turnout on a firm flat surface for 4 weeks with Bute and then review her progress.

Willow’s owner asked me to come and help make Willow more comfortable. On initial assessment Willow showed a complicated lameness, by this I mean there were a number of potential issues going on. Firstly you had the forelimb lameness which was likely to be secondary refered lameness. There was also axial lameness going on, which can be harder to identify. Willow also showed left non weight bearing lameness in her hind due to the flight pattern and placing it along her midline when stepping through, this also affected her cornering to the left. She was also hesitant to place her left hind hoof down. Willow also walks on 3 tracks and has a slight head bob down suggesting a hind limb lameness. Lastly Willow’s right hind has a slight wobble when transferring weight onto it.

Willow on initial assessment

Closer look

On palpating, Willow showed a decreased tone and atrophy in her hind quarters specifically the quadriceps and gluteals bilaterally. Willow also showed decreased activation through her tensor fasciae latea and quadriceps on her right hind, this would explain the shaking through this leg when starting to weight bear. Willow was particularly uncomfortable through the lumbar and sacral area when palpated. Her neck showed tightness bilaterally but more so on the left.

The above introduces the issues that Willow has experienced. In part two we will discuss treatments and how Willow progressed. If your horse presents as lame always consult your vet before getting hold of a bodyworker. If you have any questions or concerns then please do get in contact with Pollyanna.

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Human, Injury Management

Lower Back Pain

At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement
Human, Injury Management

What is K-Tape all about?

What is K-Tape all about?

Most people have heard of K-tape (kinesiology tape), or at least seen athletes wearing it. There is a strong belief with some that tape is used for injuries (which it can be), and as a result don’t want to visibly give their opponent a psychological advantage. However k-tape has more uses than when injured.

For instance it can be used for the following

  • To help posture and proprioception
  • Improve recovery
  • Help prevent re-occurence of injuries
  • Reduce bruising, swelling, and pain
  • Increase flexibility

How can k-tape help posture and proprioception?

We are all being told about poor posture and that we need to be mindful to improve it. K-Tape applied in the correct manner can help remind individuals of a better posture. For example it can be used to help draw the shoulders back for those working for long periods of time at a desk so that they don’t slump. It can also be used in sport to remind an athlete on limb position (proprioception). A good example is with horse riders, it allows long lasting corrections to be made to a riders position and balance, which in turn allows the horse and rider a deeper partnership.

K-tape can help recovery, reduce bruising, swelling and pain

The way that K-tape works is that when placed on the skin it helps lift and decompress the tissues beneath. This is thought to help decrease muscle tone, allow easier movement between muscle fibres and increase circulation. This in turn allows for more rapid removal of inflammation, excess fluid and by products of exercise or injury. This is turn can help reduce bruising, swelling and chemicals causing pain. K-tape can therefore help recovery after exercise and injury making it very useful to have in your sports bag.

Increase Flexibility

Rocktape®️, which is the brand of tape I use on a regular basis, developed Powertaping™️. Which is meant to help develop neuromuscular function and movement along myofascial chains of movement. Myofascial chains was developed by Thomas Myers and is termed Anatomy Chains (which is a very interesting read if you want to learn more!). Powertaping™️ can potentially help treat pain, improve flexibility, delay muscle fatigue, and reduce imbalances. The way Powertaping™️ is thought to work is by the tape stimulating the sensorimotor system through cuteness afferent nerves. This in turn sends signals to the brain causing small adjustments to movement patterns to be made affecting proprioception. It is also thought that tape can alter the nociceptive pain pathways through the pain gate mechanism and lastly decrease tone in muscles allowing an increase in flexibility.

As you can see the way the tape affects the body interlinks and has several outcomes that are beyond just injury management. K-tape is a great tool to help injuries but can be used for so much more as stated above. Apart from massage I find it is one of the most useful treatment options to have at hand and works well with other treatment modalities. It is easy to carry round, apply and it can be used for up to 5 days. Rocktape®️ also have many colour and pattern choices, which also goes down well with clients. Lastly K-tape can be used on horses to help in a similar way to humans but I feel this is an area for its own post in the future, so watch this space.

Further information on Rocktape®️and how it can help movement can be found here blog.