The effect of dynamic mobilisation exercises on the equine multifidus muscle and thoracic profile

Introduction: A relationship between spinal musculature and back pathology has been established in human and equine studies. Exercises to increase Multifidus cross sectional area (CSA) have been shown to reduce the amount and reoccurrence of back pain in humans. Similarly dynamic mobilisation exercises (DME) have led to an increase Multifidus CSA in horses on box rest. The effect of DME on the Multifidus muscle of thoroughbred racehorses in training was investigated and two measurement methods, that can be used to evaluate the outcome of a treatment or exercise programme on Multifidus, were compared. Methods: Ultrasound imaging was used to measure the CSA of the left and right Multifidus muscle at T16 spinal level on 12 Thoroughbred and the transverse external profile at T16 was recorded with a flexible curve ruler (FCR). Both measurements were repeated 3 times and the horses were randomly allocated to a control group or an experimental group which underwent DME. All horses followed the same training regime as determined by their trainer. In a different six horses the thoracolumbar posture was measured using two techniques (area and angle) and repeatability of these methods tested. Results: DME led to a significant increase in Multifidus CSA, whilst no significant change was observed in the control group. There is no relationship between the Multifidus CSA measured by ultrasound imaging and the external profile measured with FCR, at T16. There was no significant difference in the repeated measures of either the area or angle method of measuring the thoracolumbar posture Conclusions: DME resulted in an increase in Multifidus CSA in racehorses that were undergoing a normal training programme. Although the FCR is not a reliable measurement tool when assessing change in Multifidus, measuring posture of the thoracolumbar spine could be used to evaluate treatment effects. Further research is required to determine whether exercises to increase the CSA of Multifidus benefit horses with back pain. Effective treatment of equine back pain will improve welfare and performance

The use of objective markers and outcome measures in equine physiotherapy and rehabilitation

Objective measures are used to determine the baseline function of a patient at the beginning of physiotherapy treatment, and at regular intervals, to monitor progress and treatment efficacy. The use of standardised and validated objective measures is an explicit requirement of human physiotherapy practice. Tools such as goniometers, to assess range of motion and pressure algometers, to measure mechanical nociceptive thresholds are single factor objective markers (ObjM) that have been tested for reliability and validity. However, these tools are limited in equine physiotherapy practice as they are unidimensional tests that may not measure the complex multi-faceted construct that relates to musculoskeletal performance and function in horses. Therefore, a composite outcome measure (OM), that includes a bank of ObjM, may provide a truer representative profile of a horse's status before, during or after rehabilitation.The research aims of this thesis were to evaluate the current application of ObjM and OM in equine physiotherapy, as well as investigate and test the repeatability and validity of objective measures considered to be practical, simple and relatively inexpensive. The secondary aim was to progress the field of equine physiotherapy to fully meet the requirements of the physiotherapy professional standards; to undertake development of a composite OM that can be used to measure the quality of equine physiotherapy practice and therefore ensure effectiveness of physiotherapy interventions, improving the welfare of horses receiving treatment.To evaluate the use of ObjM and OM used in equine physiotherapy practice a questionnaire was used to survey physiotherapists, with 76% reporting they used objective measures although these were mainly subjective assessment methods such as observation. Subsequently a literature review was undertaken to understand what OMs are available. Whilst single factor objective markers are reported in the evidence base, there is a lack of musculoskeletal function and performance measures. Understanding what should be included in a composite OM, specifically for equine musculoskeletal rehabilitation, is essential as the first stage in the development of a new OM. To achieve this, a Delphi study was undertaken with a panel of experts working in equine rehabilitation and consensus on ten domains to be included was achieved: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. Where a domain did not contain pre-tested, or clinically practical objective measures, studies were undertaken to test tools and techniques for inclusion.The next stage in the development of a composite OM, for objective measurement of physiotherapy treatment and rehabilitation, is to confirm which reliable and valid ObjMs or OMs to include for each domain. Once formulated, the composite OM, named The Equine Musculoskeletal Rehabilitation Outcome Score (TEMROS), can then be taken forward for testing within specific equine musculoskeletal conditions.The research undertaken has contributed to the existing literature by adding new knowledge of OM use in horses and increasing understanding of the OM required by equine physiotherapists, as well as supporting clinical practice with reliability studies on ObjM not previously tested. This thesis and the papers included will aid equine physiotherapists with their clinical reasoning by providing clinically relevant critique of existing research, as well as clinically useful tools to use, when evaluating physiotherapy and rehabilitation interventions, in their own practice and in the wider equine musculoskeletal research community