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Chiropractic care is being applied to many horses today, and a growing number of veterinarians are learning about the modality and becoming certified in its use. New ground was broken in 2001 when Colorado State University (CSU) offered a special short course that could lead to certification in the field of veterinary manual therapy, which includes both chiropractic and osteopathic approaches. This marked the first time that such a course had been offered at a veterinary college, says Kevin K. Haussler, DVM, DC, PhD, of Cornell University's College of Veterinary Medicine. Haussler, who gave a talk on "Equine Chiropractic: General Principles and Clinical Applications," at the 2000 American Association of Equine Practitioners' meeting, was one of the instructors for the CSU course.
Chiropractic Certification
Chiropractic is usually not included in the curriculum at veterinary colleges, so practitioners who want to be certified must attend specialized courses following veterinary school graduation. In the past, says Haussler, there was one course offered in the United States; in 2001, there were three in the U.S. as well as several in other countries. This, he says, reflects the increasing interest in the modality by both veterinarians and horse owners.
One doesn't have to be a veterinarian to become an animal chiropractor. There are many human chiropractors with professional degrees (Doctor of Chiropractic or DC) who have attended the specialized animal course from the American Veterinary Chiropractic Association (AVCA).
The AVCA-approved program involves 150 hours divided into five modules, each with 30 hours of classroom and laboratory instruction. The first four modules focus on particular anatomical adjustment regions, and the integrated (fifth) module is a review of all techniques. Advanced courses of 180-200 hours also are available. The AVCA recommends that students complete an AVCA-approved Basic Animal Chiropractic Program and work in the field for at least a year before taking the advanced program.
Haussler cautions owners that not everyone who claims to be an equine chiropractor is trained and licensed. His advice is that if you want equine chiropractic services, make certain that the chiropractor involved is trained and licensed as either a veterinary or human chiropractor with advanced studies in animal chiropractic techniques.
What is Chiropractic?
Chiropractors apply specific, controlled forces or thrusts with their hands to a joint or bone to cause a change in joints, muscles, and/or nerve reflexes. The practice of chiropractic, Haussler says, focuses on the relationship between structure (primarily the vertebral column) and function (as coordinated by the nervous system), and how that relationship affects the preservation and restoration of health.
He explains further: "Chiropractic is a form of manual therapy that uses controlled forces which are applied to specific articulations (joints) or anatomic regions to induce a therapeutic response via induced changes in joint structures, muscle function, and neurologic reflexes. The principle common to all chiropractic theories is that joint dysfunction affects the normal neurological balance found in healthy individuals. The theory of a 'bone out of place' is outdated and not supported by current spinal research." If a bone were truly out of place, he adds, the patient would need surgery, not a chiropractic treatment.
A long-standing myth says that the popping noise often associated with a chiropractic adjustment was the sound of a bone snapping back into place. Haussler explains that the sound is actually the formation of an air bubble within the joint fluid, that is slowly resorbed again.
When a horse is in normal health and alignment, the bones and joints create a flexible structure that moves without pain. Healthy muscles are also involved--they allow joints to move freely and they, too, are free of pain, weakness, spasm, or degeneration.
The communication system involves nerves that direct messages between the brain and the body structures. When joints or muscles don't function correctly or nerves are irritated, the message system falters, along with reduced performance levels, pain, muscle spasms, and/or stiffness.
The Equine Back
The anatomy of the horse's back must be understood before one can understand how chiropractic techniques can help solve problems. Haussler points out, for example, that the horse's spinal column has 51-57 individual vertebrae (vertebra is singular, vertebrae is plural). The typical vertebra consists of a vertebral body and several vertebral processes (protruding areas). The vertebral column can be divided into five regions--the cervical (consisting of seven vertebrae), thoracic (18), lumbar (six), sacral (five), and coccygeal (15-21). It is the job of the vertebrae to protect the spinal cord and nerves. As the nerves exit the spine, Haussler explains, they divide into various branches. Some branches go to the joints, muscles, and skin of the back.
The large, superficial back muscles span large regions of the spine and ensure coordinated back movements. Smaller, deep back muscles connect one or two vertebrae and act to move or stabilize each individual vertebra. Spinal ligaments connect the individual vertebrae and provide joint support.
"The amount and direction of spinal movement is determined mostly by joint size and shape," Haussler says. "The neck and tail are the most mobile regions of the horse's spine. Limited back movement occurs in up and down motion, side to side motion, and rotation. Dressage requires a lot of spinal movement and strength. Jumping high fences requires rotation of the back and hindlimbs for proper gait and clearance of fences. All riding horses require pain-free backs to perform the required tasks asked of them."
Back or neck injuries can involve a variety of occurrences. Often the injury involves trauma, such as a fall or tipping over backward. Additional culprits can be poor conformation, overexertion, poor saddle fit, and lack of fitness.
"Back problems," says Haussler, "can be classified into three basic types of injuries, involving either the muscles, bones and joints, or the nervous system. The most commonly reported injuries include muscle strain and ligament sprains. Muscle injuries usually occur in the withers and the low back region behind the saddle. Bone injuries are usually localized to the midsection of the back that lies under the saddle. Spinal cord damage in the horse occurs primarily in the mid-neck and lower back."
Chiropractic in Practice
When dealing with chiropractic, one term will be heard frequently--subluxation. Technically, subluxation means a partial dislocation of a joint. However, in chiropractic terminology, it describes the loss of normal motion due to pain, muscle spasms, or joint stiffness.
Many times, Haussler says, pain, muscle spasms, or joint stiffness can be identified within the horse's back. The prevalence of back problems, he says, varies greatly--from 0.9% to 94%, depending on what type of veterinary practice is being surveyed.
"Veterinarians often have difficulties when dealing with horses that have no obvious localized pain or have vague, unspecified lameness," says Haussler. "Neck or back problems and lameness are often interrelated. Lower limb injuries can cause an alteration in carriage of the affected limb and altered gait, which can subsequently overwork or injure proximal (upper) limb musculature. Similarly, vertebral column injuries can produce gait abnormalities, increased concussive forces, and lower limb lameness.
"The diagnostic dilemma facing veterinarians is to decide whether the limb or the vertebral column is the primary or initial cause of the horse's clinical problem," he continues. "Unless the primary cause of the neck or back pain is identified and treated, most horses will have recurrent back pain when returned to work after a period of rest or a trial of anti-inflammatory medications.
"Non-specific back pain is most likely related to a functional impairment (such as muscle spasms, or joint stiffness) and not a structural disorder (one which can be seen on an X ray), such as poor conformation or broken bones," he adds. "Therefore, many back problems may be related to muscle or joint dysfunction with resultant soft tissue irritation and pain."
Diagnosing/Preventing Problems
"Chiropractors," Haussler explains, "are also trained in the use of physiotherapy modalities, strength training exercises, massage, stretching techniques, and other forms of musculoskeletal and nerve rehabilitation. Equine chiropractic is a complementary modality that can be used in veterinary medicine for the diagnosis, treatment, and potential prevention of select musculoskeletal disorders in horses."
Before an equine chiropractor will treat a horse, he or she will conduct a thorough examination, says Haussler. The evaluation begins with a complete history, discussion of the chief complaint, and observation of the horse from a distance for conformation, posture, and signs of lameness. Also important to the chiropractic examination is the horse's conformation.
Horses with conditions that might respond to chiropractic treatment might display some of the following signs:
* Poor performance;
* Back or neck pain;
* Reduced neck or back flexibility;
* Inability to raise/lower the head and neck;
* Localized muscle tightness;
* Vague lameness;
* Uneven or asymmetric gait;
* Recent change in spinal conformation (such as an arched, or roached, back, scoliosis (curve), or sway back);
* Improper saddle fit;
* Discomfort with saddle placement or tightening of the cinch or girth;
* Stiffness and more warm-up needed;
* Bucking or pinning the ears when ridden;
* Lameness only when ridden;
* Constantly being on one rein or line;
* Difficulty with a lead or gait transition;
* Refusing jumps;
* Resisting collection;
* Difficulty turning in one direction;
* Consistently stumbling and/or toe dragging;
* Muscle mass asymmetry;
* Pelvic asymmetry;
* Not standing squarely on all four limbs;
* Difficulty standing for the farrier;
* Holding the tail to one side;
* Resenting grooming; and
* Behavior avoidance problems.
"Conformation," Haussler says, "relates the form of the horse to the function of the horse--stride length, balance, smoothness, collection, athletic ability, and use of the horse. Poor conformation is also a factor in the development or increased risk of musculoskeletal injury or lameness--resulting in increased concussive forces, swayback, interference or forging, and arthritis."
Next, the chiropractor will analyze the horse's gaits. Gait problems that might suggest back issues, he says, can include:
* Uneven head motion;
* Difficulty flexing at the poll;
* Abnormal hoof flight;
* Reduced shoulder or pelvic motion;
* Shortened stride;
* Hoof striking or interference;
* Consistently dragging one toe;
* Unstable hock movement or wobble;
* Shifting leg lameness;
* Pelvic motion unevenness;
* Not tracking straight;
* Poor impulsion and poor transitions;
* Incoordination or stumbling;
* Rigid back motion;
* Muscle guarding; and
* Reluctance to back up.
The chiropractor will also inspect tack used on the horse to determine if improper saddle fit might be the problem.
Finally, a chiropractor will use muscle palpation to identify pain and abnormal or uneven muscle tension, bone palpation to evaluate bony pain or unevenness, and joint motion to evaluate joint injury or pain.
If the horse is determined to be in need of an adjustment, the chiropractor uses his or her hands in the treatment regimen.
How Treatments are Done
Chiropractic can be beneficial in not only identifying the problem, but in treating it, Haussler says. It is also an excellent tool to employ in a purchase exam, he says, because chiropractic examination techniques can help identify horses which have chronic underlying neck or back problems. Haussler says that the horse usually is held by a trained handler on a loose lead.
"Equine chiropractic," he says, "is physically demanding and requires significant mental concentration. The horse must be relaxed and focused on what the practitioner is doing. The practitioner must also be relaxed and focused on the horse to adjust a specific vertebral segment without causing injury to the surrounding tissues or to the practitioner. Muscle relaxation allows the specified joints to be brought to tension before adjusting and to evaluate the elastic barrier of the joint. Motion palpation is used to evaluate joint motion restrictions so that the adjustive thrust can be applied correctly. Stabilization of adjacent joints or vertebral segments is required for the application of a proper adjustive thrust. Chiropractic adjustments involve rapid, small-amplitude forces applied to specific musculoskeletal structures with the intent of evoking a therapeutic response."
Normally, Haussler says, there are few side effects after chiropractic treatment, but a horse might occasionally become stiff and even sore after being treated, especially if there is a lot of inflammation (heat, pain, swelling) or bony pathology (acute or active arthritis) that is also present. For that reason, he says, it is recommended that the horse not be ridden for at least one day. Stall rest and turn out are recommended.
While chiropractic can be valuable in diagnosing back and lameness problems as well as being the treatment of choice in many instances, Haussler is quick to point out that it is not a "cure-all." There are some conditions, such as fractures and degenerative joint disease, among others, he said, where chiropractic is not indicated.
Chiropractic can aid diagnosis and treatment of many problems when practiced by an educated, certified professional.
Chiropractic Certification
Chiropractic is usually not included in the curriculum at veterinary colleges, so practitioners who want to be certified must attend specialized courses following veterinary school graduation. In the past, says Haussler, there was one course offered in the United States; in 2001, there were three in the U.S. as well as several in other countries. This, he says, reflects the increasing interest in the modality by both veterinarians and horse owners.
One doesn't have to be a veterinarian to become an animal chiropractor. There are many human chiropractors with professional degrees (Doctor of Chiropractic or DC) who have attended the specialized animal course from the American Veterinary Chiropractic Association (AVCA).
The AVCA-approved program involves 150 hours divided into five modules, each with 30 hours of classroom and laboratory instruction. The first four modules focus on particular anatomical adjustment regions, and the integrated (fifth) module is a review of all techniques. Advanced courses of 180-200 hours also are available. The AVCA recommends that students complete an AVCA-approved Basic Animal Chiropractic Program and work in the field for at least a year before taking the advanced program.
Haussler cautions owners that not everyone who claims to be an equine chiropractor is trained and licensed. His advice is that if you want equine chiropractic services, make certain that the chiropractor involved is trained and licensed as either a veterinary or human chiropractor with advanced studies in animal chiropractic techniques.
What is Chiropractic?
Chiropractors apply specific, controlled forces or thrusts with their hands to a joint or bone to cause a change in joints, muscles, and/or nerve reflexes. The practice of chiropractic, Haussler says, focuses on the relationship between structure (primarily the vertebral column) and function (as coordinated by the nervous system), and how that relationship affects the preservation and restoration of health.
He explains further: "Chiropractic is a form of manual therapy that uses controlled forces which are applied to specific articulations (joints) or anatomic regions to induce a therapeutic response via induced changes in joint structures, muscle function, and neurologic reflexes. The principle common to all chiropractic theories is that joint dysfunction affects the normal neurological balance found in healthy individuals. The theory of a 'bone out of place' is outdated and not supported by current spinal research." If a bone were truly out of place, he adds, the patient would need surgery, not a chiropractic treatment.
A long-standing myth says that the popping noise often associated with a chiropractic adjustment was the sound of a bone snapping back into place. Haussler explains that the sound is actually the formation of an air bubble within the joint fluid, that is slowly resorbed again.
When a horse is in normal health and alignment, the bones and joints create a flexible structure that moves without pain. Healthy muscles are also involved--they allow joints to move freely and they, too, are free of pain, weakness, spasm, or degeneration.
The communication system involves nerves that direct messages between the brain and the body structures. When joints or muscles don't function correctly or nerves are irritated, the message system falters, along with reduced performance levels, pain, muscle spasms, and/or stiffness.
The Equine Back
The anatomy of the horse's back must be understood before one can understand how chiropractic techniques can help solve problems. Haussler points out, for example, that the horse's spinal column has 51-57 individual vertebrae (vertebra is singular, vertebrae is plural). The typical vertebra consists of a vertebral body and several vertebral processes (protruding areas). The vertebral column can be divided into five regions--the cervical (consisting of seven vertebrae), thoracic (18), lumbar (six), sacral (five), and coccygeal (15-21). It is the job of the vertebrae to protect the spinal cord and nerves. As the nerves exit the spine, Haussler explains, they divide into various branches. Some branches go to the joints, muscles, and skin of the back.
The large, superficial back muscles span large regions of the spine and ensure coordinated back movements. Smaller, deep back muscles connect one or two vertebrae and act to move or stabilize each individual vertebra. Spinal ligaments connect the individual vertebrae and provide joint support.
"The amount and direction of spinal movement is determined mostly by joint size and shape," Haussler says. "The neck and tail are the most mobile regions of the horse's spine. Limited back movement occurs in up and down motion, side to side motion, and rotation. Dressage requires a lot of spinal movement and strength. Jumping high fences requires rotation of the back and hindlimbs for proper gait and clearance of fences. All riding horses require pain-free backs to perform the required tasks asked of them."
Back or neck injuries can involve a variety of occurrences. Often the injury involves trauma, such as a fall or tipping over backward. Additional culprits can be poor conformation, overexertion, poor saddle fit, and lack of fitness.
"Back problems," says Haussler, "can be classified into three basic types of injuries, involving either the muscles, bones and joints, or the nervous system. The most commonly reported injuries include muscle strain and ligament sprains. Muscle injuries usually occur in the withers and the low back region behind the saddle. Bone injuries are usually localized to the midsection of the back that lies under the saddle. Spinal cord damage in the horse occurs primarily in the mid-neck and lower back."
Chiropractic in Practice
When dealing with chiropractic, one term will be heard frequently--subluxation. Technically, subluxation means a partial dislocation of a joint. However, in chiropractic terminology, it describes the loss of normal motion due to pain, muscle spasms, or joint stiffness.
Many times, Haussler says, pain, muscle spasms, or joint stiffness can be identified within the horse's back. The prevalence of back problems, he says, varies greatly--from 0.9% to 94%, depending on what type of veterinary practice is being surveyed.
"Veterinarians often have difficulties when dealing with horses that have no obvious localized pain or have vague, unspecified lameness," says Haussler. "Neck or back problems and lameness are often interrelated. Lower limb injuries can cause an alteration in carriage of the affected limb and altered gait, which can subsequently overwork or injure proximal (upper) limb musculature. Similarly, vertebral column injuries can produce gait abnormalities, increased concussive forces, and lower limb lameness.
"The diagnostic dilemma facing veterinarians is to decide whether the limb or the vertebral column is the primary or initial cause of the horse's clinical problem," he continues. "Unless the primary cause of the neck or back pain is identified and treated, most horses will have recurrent back pain when returned to work after a period of rest or a trial of anti-inflammatory medications.
"Non-specific back pain is most likely related to a functional impairment (such as muscle spasms, or joint stiffness) and not a structural disorder (one which can be seen on an X ray), such as poor conformation or broken bones," he adds. "Therefore, many back problems may be related to muscle or joint dysfunction with resultant soft tissue irritation and pain."
Diagnosing/Preventing Problems
"Chiropractors," Haussler explains, "are also trained in the use of physiotherapy modalities, strength training exercises, massage, stretching techniques, and other forms of musculoskeletal and nerve rehabilitation. Equine chiropractic is a complementary modality that can be used in veterinary medicine for the diagnosis, treatment, and potential prevention of select musculoskeletal disorders in horses."
Before an equine chiropractor will treat a horse, he or she will conduct a thorough examination, says Haussler. The evaluation begins with a complete history, discussion of the chief complaint, and observation of the horse from a distance for conformation, posture, and signs of lameness. Also important to the chiropractic examination is the horse's conformation.
Horses with conditions that might respond to chiropractic treatment might display some of the following signs:
* Poor performance;
* Back or neck pain;
* Reduced neck or back flexibility;
* Inability to raise/lower the head and neck;
* Localized muscle tightness;
* Vague lameness;
* Uneven or asymmetric gait;
* Recent change in spinal conformation (such as an arched, or roached, back, scoliosis (curve), or sway back);
* Improper saddle fit;
* Discomfort with saddle placement or tightening of the cinch or girth;
* Stiffness and more warm-up needed;
* Bucking or pinning the ears when ridden;
* Lameness only when ridden;
* Constantly being on one rein or line;
* Difficulty with a lead or gait transition;
* Refusing jumps;
* Resisting collection;
* Difficulty turning in one direction;
* Consistently stumbling and/or toe dragging;
* Muscle mass asymmetry;
* Pelvic asymmetry;
* Not standing squarely on all four limbs;
* Difficulty standing for the farrier;
* Holding the tail to one side;
* Resenting grooming; and
* Behavior avoidance problems.
"Conformation," Haussler says, "relates the form of the horse to the function of the horse--stride length, balance, smoothness, collection, athletic ability, and use of the horse. Poor conformation is also a factor in the development or increased risk of musculoskeletal injury or lameness--resulting in increased concussive forces, swayback, interference or forging, and arthritis."
Next, the chiropractor will analyze the horse's gaits. Gait problems that might suggest back issues, he says, can include:
* Uneven head motion;
* Difficulty flexing at the poll;
* Abnormal hoof flight;
* Reduced shoulder or pelvic motion;
* Shortened stride;
* Hoof striking or interference;
* Consistently dragging one toe;
* Unstable hock movement or wobble;
* Shifting leg lameness;
* Pelvic motion unevenness;
* Not tracking straight;
* Poor impulsion and poor transitions;
* Incoordination or stumbling;
* Rigid back motion;
* Muscle guarding; and
* Reluctance to back up.
The chiropractor will also inspect tack used on the horse to determine if improper saddle fit might be the problem.
Finally, a chiropractor will use muscle palpation to identify pain and abnormal or uneven muscle tension, bone palpation to evaluate bony pain or unevenness, and joint motion to evaluate joint injury or pain.
If the horse is determined to be in need of an adjustment, the chiropractor uses his or her hands in the treatment regimen.
How Treatments are Done
Chiropractic can be beneficial in not only identifying the problem, but in treating it, Haussler says. It is also an excellent tool to employ in a purchase exam, he says, because chiropractic examination techniques can help identify horses which have chronic underlying neck or back problems. Haussler says that the horse usually is held by a trained handler on a loose lead.
"Equine chiropractic," he says, "is physically demanding and requires significant mental concentration. The horse must be relaxed and focused on what the practitioner is doing. The practitioner must also be relaxed and focused on the horse to adjust a specific vertebral segment without causing injury to the surrounding tissues or to the practitioner. Muscle relaxation allows the specified joints to be brought to tension before adjusting and to evaluate the elastic barrier of the joint. Motion palpation is used to evaluate joint motion restrictions so that the adjustive thrust can be applied correctly. Stabilization of adjacent joints or vertebral segments is required for the application of a proper adjustive thrust. Chiropractic adjustments involve rapid, small-amplitude forces applied to specific musculoskeletal structures with the intent of evoking a therapeutic response."
Normally, Haussler says, there are few side effects after chiropractic treatment, but a horse might occasionally become stiff and even sore after being treated, especially if there is a lot of inflammation (heat, pain, swelling) or bony pathology (acute or active arthritis) that is also present. For that reason, he says, it is recommended that the horse not be ridden for at least one day. Stall rest and turn out are recommended.
While chiropractic can be valuable in diagnosing back and lameness problems as well as being the treatment of choice in many instances, Haussler is quick to point out that it is not a "cure-all." There are some conditions, such as fractures and degenerative joint disease, among others, he said, where chiropractic is not indicated.
Chiropractic can aid diagnosis and treatment of many problems when practiced by an educated, certified professional.