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What is Veterinary Physiotherapy? 

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Veterinary physiotherapy is the assessment and treatment of musculoskeletal and neurological disorders in animals through manual manipulation of soft tissue, the application of electrotherapies and implementation of remedial exercise, restoring normal function, reducing pain, and optimising the health of the animal. It is a science-based profession, which takes a holistic approach, aiming to optimise the rehabilitation of injured animals, the performance of working animals and provide long term management for chronic conditions to optimise the animals’ quality of life.

Scientific theory into practice

I utilise several physiotherapeutic techniques within my sessions, ensuring that everything I do is well supported by research. I have put together a brief summary of the clinical and cellular effects of the manual techniques, electrotherapies and remedial exercise I use as part of my physiotherapy treatment. I am hoping this will help to guide many of you to the most optimal and effective treatment for your animals and give you an insight into what veterinary physiotherapy can do and how it can assist and support your animals rehabilitation and or performance.

Massage

Massage is the manipulation of the soft tissues of the body which includes muscles, tendons, ligaments and fascia. Using palpation, muscle tightness, spasms, trigger points and uneven muscle tone can be felt across the horses body.

When a horse is suffering from pain and discomfort from a muscle injury, the body tries to protect the area to allow it to heal. This results in the muscle fibres contracting and replacing injured muscular tissue with thick fibrous scar tissue, which lacks flexibility and suppleness. If gone untreated, this can lead to the muscle going into spasm and resulting in tightness of the entire muscle. A tight muscle can lead to the horse compensating with other muscles and therefore resulting in straining of secondary muscles.

Pressure applied by the massage elicits varying degrees of tissue ischemia. this pushes blood flow out of the area and into the peripheral spaces, the body responds by sending more blood to the area as we have created an area of low concentration of vital substances, the increase in blood flow creates and area of high concentration of oxygen and nutrients in the extracellular environment. This creates a gradient for the oxygen and nutrients to enter the cell. The pressure change also stimulates mast cells to produce more histamine, stimulating the release of bradykinins from the hypothalamus and resulting in vasodilation of blood vessel cell walls, increasing the volume of blood in the area. 

 

This also increases cellular exchange within the lymphatic system, aiding the removal of of waste products and chemical irritants, reducing nerve irritation and therefore reducing pain THe mechanical pressure also pushes the lymph out of the interstial spaces towards the lympth nodes, unccreasing lymphatic circulation and increasing the production of white blood cells, helping to boost yuor animals immune system. This is important because oedema is a normal by-product of inflammation and is the plasma left over from the breakdown of capillary filtration (movement of fluid out of capillaries into interstitial spaces). Most is reabsorbed by the blood vessels and a small portion is removed by the lymphatic system. Damage to the lymphatic system or blood vessel walls prevents the removal of fluid from the area, the body is then unable to remove fluid from the cells and surrounding tissue. Adhesions and restrictions in the muscle tissue can also reduce the efficiency of lymph removal. This fluid sits and pools in the interstitial spaces causing a lack of oxygen supply and cellular metabolism as the pressure prevents normal cellular activity as well as placing pressure on the nerve endings and therefore leading to pain.

Massage provides mechanical stimulation to the underlying tissue and following activation of cellular signalling pathways, massage is thought to moderate inflammation, increase glucose uptake and protein synthesis, contributing to muscle recovery and reduces production of local cytokines following acute muscle damage, therefore reducing nociceptor stimulation and providing an analgesic effect (Crane et al., 2012).

Massage also stimulates sensory receptors in the skin, reducing neuromuscular excitability and the Hoffman reflex amplitude (Gasibat and Suwehli, 2017). Mechanical pressure also stimulates large, myelinated nerve fibres, which blocks transmission of smaller, slower nerve fibres responsible for transmitting pain (Field, 2014) and therefore reducing pain through the gate-control mechanism (Field, 2014; Gasibat and Suwehli, 2017).

 

The mechanical pressure also stimulates sensory receptors in the skin, influencing the endocrine system. Massage stimulates the release of oxytocin, which provides natural analgesic effects (Rapport et al., 2012; Xin et al., 2017) as well as stimulating the autonomic nervous system, increasing the release of seratonin, which is the rest and digest hormone, and directly inhibits the release of norepinephrine, reducing the tonicity of skeletal muscle, and reduces the level of cortisol, reducing stress and improving immunity. This also stimulates the release of dopamine, which increases feelings of pleasure and makes the animal feel good. 

 

Massage also has a piezoelectric effect on the tissue. This refers to the electrical charge that accumulates in the tissue in response to applied mechanical stress e.g., pressure and touch. This can then alter the cellular charge of the cell to produce therapeutic benefits. Bone, ligament, and muscle tissue can transduce this mechanical energy provided by your hands into electrical energy and polarising the cell. The therapeutic benefit of polarising the cell helps to increase collagen proliferation. At rest, Type I collagen is positively charged and Type III collagen can be both negatively and positively charged. In a collagen molecule, if the overall charge is positive, there is no active proliferation of collagen. Type III collagen is capable of altering its charge and becoming active and therefore is readily laid down much quicker than Type I collagen. However, Type I is more desirable as it is stronger and more organised. Therefore, massage, is capable of stimulating a negative charge to stimulate proliferation and activation of Type I collagen fibres.

 

Massage also reduces muscle tone by decreasing motor neuron excitability, decreasing myotatic reflexes (Forementon et al., 2017) or by stretching the underlying tissue (Crommert et al., 2015). As well as increase tissue extensibility and pliability. The connective tissue, which surrounds the muscle fibres, contains a base substance called mucopolysaccharide. This substance has thixotropic properties. Thixotropy is a time-dependent shear thinning property. Certain gels or fluids that are thick or viscous under static conditions will flow over time when shaken, agitated, shear-stressed, or otherwise stressed. They then take a fixed time to return to a more viscous state. The thixotropic substance within the connective tissue becomes less viscous in response to heating. This allows it to act as both a lubricant, to allow sliding of the muscle tissue during movement, as well as a glue to hold the tissue together. Therefore, through manual movement of the tissue, friction from the massage strokes and associated blood flow, heat is generated in the area during massage, which reduces the viscosity of the thixotrophic substances that surround the muscle fibres and connective tissue, this allows smoother movement of between myofibrils and longitidinal stress applied through the massage strokes relaxes and elongates the muscle fibres by straightening the crimped fibres.  

Cross fibre friction massage uses a different mechanism. CCF massage is the application of direct pressure on the tissue and then working across the fibre direction. It aims to realign fibres by causing microtrauma to the tissue (Goldsberg and Tomlinson, 2017), loosening adhesions (Johnston et al., 2008) and disrupting collagen cross links within the muscle (Scott and Swenson, 2009). Stretchung or effleurage along the fibre direction following cross fibre friction, encourages correct realignment of the muscle fibres. 

 

Tapotement massage is indicated to address the atrophy and hypotonicity of musculature as it stimulates cutaneous reflexes resulting in an increase in muscle tone and neural stimulation (Goats, 1994). This increase muscle activation and encourages muscle recruitment and strengthening. 


Summary of clinical benefits:

  • Increase in blood flow

  • Increase cell function

  • Assist with lymphatic drainage

  • Increased pliability of tissue and extensibility

  • Breakdown fibrous cross links and reduce adhesions

  • Decrease or increase muscle tone

  • Pain relief

  • Stress relief

  • Increase the body’s natural immunity

  • Increased stride length and joint range of motion

Stretching

Stretching is the application of an external force to a bodily structure to elongate soft tissue structures (Marcellin-Little and Levine, 2015). Upon lengthening of a muscle, two main neural mechanisms are involved; the myotatic stretch reflex and the inverse myotatic reflex. The myotatic stretch reflex involves muscle spindles, embedded within the muscle belly. These are intrafusal muscle fibres (Oliver et al., 2021), which are sensitive to muscle length and rate of change of length (Chalmers et al., 2004). These respond to a stretch by increasing their action potential and neural firing rate, generating a muscle contraction (Chalmers et al., 2004). Continued muscle lengthening at this point will increase the amplitude of the stretch reflex response. However, providing a slow stretch minimises the increase in muscle spindle firing rate (Chalmers et al., 2004) as well as providing only minimal muscular activity, which is unlikely to resist muscle lengthening (Magnusson et al., 1996a), leading to more effective and maximised tissue elongation in comparison to rapid, quick stretches (Light et al., 1984). The inverse myotatic reflex involves the Golgi tendon organ (GTO). The GTO are proprioceptive mechanoreceptors (MacKinnon, 2018), embedded within the myo-tendinous junction of skeletal muscle and are sensitive to muscle contraction (Oliver et al., 2021). They respond to muscle spindle activated contraction during lengthening, which straightens collagen fibres surrounding the organ, compressing the sensory ending (MacKinnon, 2018). This results in inhibition of the alpha motor neurons, initiating relaxation and therefore less active muscle resistance (Chalmers et al., 2004), elongation and protection of the muscle and connective tissue from damage (Jelvéus, 2011). Viscous material, surrounding muscle fibres, held at a stretched length will decrease force and resistance over time, known as viscoelastic stress relaxation, allowing elongation of the muscle tissue (Magnusson et al., 1996b). This highlights the need to hold a stretch in order to gain the therapeutic benefits as you need to soften the viscous material surrounding the muscle fibres and allow the GTO to override the muscle spindle to allow for active lengthening of the muscle and avoid resistance. Stretching increases the range of movement through increasing the compliance of the muscle, aka the willingness of a tissue to lengthen with minimal effort, and a reduction in viscoelasticity, which results in a gradual lengthening of the muscle on release.

There are two types of stretching that can be utilised during a physiotherapy session, these include passive stretches and active stretches. Passive stretching is the form of stretching where an external force is applied to the limb. For example the limb would be brought forward, encouraging the animal to assume an extended position and maintain that position until full range of movement is reached. Both dogs and horse benefit from passive stretches. Active stretches involve voluntary movements with the aim to activate and strengthen the muscles responsible for movement and stabilisation of those joints. This is generally only used in the horse and are referred as dynamic mobilisation exercises. 

Dynamic mobilisation exercises for the horse requires the horse to follow a treat either laterally towards the shoulder and further to achieve lateral flexion of the spine, stimulate increased unilateral contraction of the abdominal and iliopsoas muscle group in order to balance themselves as well as recruiting the epaxials, hindlimb and pectoral musculature (Clayton, 2016; Paulekas and Haussler, 2009). Asking the horse to follow a treat ventrally between the legs and down to the ground will stimulate bilateral contraction of the abdominal and iliopsoas muscle group, facilitating flexion and rounding of the thoracic spine and recruitment of the epaxial musculature (Clayton, 2016; Paulekas and Haussler, 2009; Shakeshaft and Tabor, 2020). It has also been found to significantly increase the cross sectional area and result in hypertrophy of the multifidus muscle (De Oliveira et al., 2015; Tabor, 2015; Stubbs et al., 2011), one of the deep stabilising spinal musculatures (Burns et al., 2016; Van Weeran, 2004). Therefore, this will help to improve core development, spinal stability and posture.

Summary of clinical benefits: 

  • Increase joint range of motion

  • Increased flexibility and extensibility of tissue

  • Increased proprioception

  • Increased stride length

  • Decrease periarticular fibrosis

  • Elongate muscle fibres

  • Prevent muscle adhesion

Pulsed Electromagnetic Field Therapy  

PEMFT is the use of an electromagnetic field, produced by an electrical current passing through a coil and targeting the cell membrane (Adey, 1993). It is capable of deep penetration into the tissue as it has a wide irradition field, this is extremely beneficial for deep structures. PEMF exposure increases the expression of 10 voltage gated calcium channels leading to an influx of calcium ions into the cell and increased intracellular calcium and calmodulin binding leading to downstream signalling pathways and the release of short burst nitric oxide due to the stimulation of nitric oxide synthase (Gaynor et al., 2018; Peng et al., 2021; Yuan et al., 2018). Changes to the delivery of the electromagnetic field, through varying frequencies and pulses, can emulate different biochemical tissue responses.

The production of nitric oxide is particularly important as it is an endogenous vasodilator and protects the functional ability of endothelial progenitor cells, which are important for vascular repair and angiogenesis (Levine et al., 2012). As a result, PEMF is able to facilitate an increase in blood flow which results in an increase in fluid exchange between the vascular and lymphatic system, an influx in oxygen and nutrients leading to increased diffusion across the cell membrane and therefore increased metabolic rate as well as increasing fluid exchange between synovial capillaries and the joint cavity, maintaining joint homeostasis (Te Moller and Van Weeran, 2017).

The increased production of nitric oxide also hyperpolarises the cell and reducing the cellular voltage from -70mV to -90mV. This makes the cell voltage too low for the synapse to trigger the release of the chemical transmitters, this then blocks pain signals and provides a form of pain relief. 

Healthy cells in tissue have a voltage difference between the inner and outer membrane referred to as the membrane resting potential that ranges from -70 to -80 mV. This causes a steady flow of ions through its voltage-dependant ion channels. In a damaged cell, the potential is raised and an increased sodium inflow occurs. As a result, interstitial fluid is attracted to the inner cellular space, resulting in swelling and oedema. Exposure to PEMF is thought to restore the electrochemical gradient and thus encourage a reduction in swelling (Reale and Amerio, 2013). 

At a lower frequency of 50Hz, PEMF exposure increases osteoblast differentiation, significantly reduces osteoclast numbers and results in increased efficiency of the extracellular matrix as well as increasing callus formation when applied to fracture sites. As a result, PEMF is able to facilitate an increase in bone cellular activity and increase the efficiency of bone healing, aiming to restore and improve the biomechanical strength of the bone. In dogs 4 weeks following a tibial plateau levelling osteotomy (TPLO) presenting with a delayed union, those exposed to PEMF were found to have a significant increase in load bearing of the operated limb 4-8 weeks post-surgery as well as a significant increase in periosteal callus area 6 weeks post-surgery (Inoue et al., 2002). Therefore, PEMF was able to result in faster recovery through early dynamic weight bearing, significant increases in new bone formation and therefore increase mechanical strength of the bone.

The electromagnetic field produce by the PEMF device also stimulates the normal response of bone cells, physiologically, as to applied mechanical stress. Mechanical stress and loading is able to stimulate increased osteogenic activity and increasing cortical bone formation and therefore accelerating bone turnover and restoration of healthy bone. Therefore, pulse mag works on the same principles as ‘Wolff’s law’. This is because electrical charge of the cell plays an important role in bone regeneration and is capable of producing the same benefits as mechanical loading. This is extremely important with non-weight bearing patients and those on crate or box rest as it initiates bone cellular activity earlier in the rehabilitation process and results in accelerated healing and faster recovery. 

The benefit of PEMF exposure on degenerated connective tissue within arthritis is placed under three major categories – chondroprotection, anti-inflammatory and bone remodelling.

Exposure to PEMF increases chondrocyte proliferation, leading to increased synthesis of aggrecan, type II collagen and extracellular matrix and therefore resulting in increased chondroprotection for the joint. PEMF exposure also is thought to increase cell membrane adenosine receptor expression. Activation of these receptors by endogenous adenosine reduces in the production of prostaglandins and inflammatory cytokines. Therefore, protecting the joint from damage and reducing pain (removal of chemical irritants). As stated above, PEMF exposure enhances osteoblast differentiation, increase bone formation and reduces osteoclast synthesis.Therefore, increases structural integrity of bone.

Summary of clinical benefits:

  • Soft tissue: reduces inflammation, pain and oedema, restores cell resting membrane potential and increases cellular activity, increases blood flow and enhances healing.

  • Bone: increases cell proliferation, bone formation, increases bone strength, formation of a callus, increases blood flow and enhances healing.

  • Neural: increases blood flow, re-establishes cellular currents, reduces pain, increases the growth of neurons.

Phototherapy (Laser / photobiomodulation)  

Phototherapy refers to the use of red, near-infrared or blue light. Photons emitted by red light therapy are thought to reduce conduction velocity and action potential of peripheral nerves, reducing nociceptive response to stimuli by inhibiting A and C fibres and well as suppressing bradykinin stimulation of nociceptors resulting in pain relief (Chow et al., 2011). This results in a 30% neural blockade within 10 to 20 minutes following application, and which is reversed within about 24 hours (Cotler et al., 2015). Not only does this block peripheral nerve sensation, it also decreases the release of pro-inflammatory mediators (Cotler et al., 2015; Piggato et al., 2019). This is useful for reducing pain and hypersensitivity of myofascial trigger points.  

 

Photons emitted by phototherapt devices also penetrate the tissue and are absorbed by the mitochondrial chromophore ‘Cytochrome C Oxidase (CCO)’ (Kuffler, 2015). Within damaged tissue, nitric oxide can become cytotoxic and cause oxidative stress by binding to CCO, reducing cellular respiration (Levine et al., 2012; Monkoena et al., 2018). Absorption of laser light dissociates nitric oxide from CCO (Karu, 2014) and results in a twofold increase in mitochondrial activity, increased cellular activity, ATP production and downstream metabolic effects (Kuffler, 2015). In terms of tissue healing, exposure to laser light results in an upregulation of transforming growth factor beta (TGFB) expression, reduced inflammatory cells infiltration, increased neovascularisation, fibrogenesis, collagen accumulation, faster re-epithelisation (Keshri et al., 2016), increased collagen type I expression and deposition, and decreased apoptosis and pro-inflammatory cytokines in compromised models (Houreld et al., 2010; Paraguassu et al., 2014). This results in progression from the inflammatory to the proliferation phase, modulated by TGFB (Monkoena et al., 2018), and increased granulation tissue formation. Therefore, phototherapy is able to inhibit excessive inflammation, facilitate proliferation and enhance the healing process of wounds and soft tissue injuries. 

Blue phototherapy light provides a broad-spectrum anti-microbial effect on both Gram-postive and Gram negative bacteria. The mechanism of action of blue light involves photo-excitation of intracellular porphyrins within the bacteria, that leads to the generation of reactive oxygen species, which are toxic to bacterial cells resulting in oxidative stress and cell death (Dai et al., 2012). This is useful for post-operative wounds to prevent rapid bacterial replication and development of infection, but is also capable of treating already established wound infections. 

Transcutaneous Electrical Nerve Stimulation (TENS)

 Transcutaneous electrical nerve stimulation (TENS) is the use of a low voltage electric current produced by a device to stimulate the nerves for therapeutic purposes. It is used to relieve symptomatic pain and is generally used for chronic conditions. It is used in horses and rarely used in dogs as they dislike the sensation. Low frequency TENS is capable of doing this via activation of Aẟ fibres, stimulating the release of endogenous opioids through activation of the periaqueductal grey – rostral ventromedial medulla (RVM) pathway, which directly inhibits dorsal horn activation (Sluka and Walsh, 2003). The RVM is a major source of nociceptive transmission, projecting to the medullary and spinal dorsal horns (Khasabov et al., 2015). In response to electrical stimulation, opioid release inhibits the transmission of noxious stimulation from the RVM. The dorsal horn is also a structure responsible for processing sensory information from primary afferent nerves, responding to noxious and non-noxious stimulation and is therefore responsible for the transmission of pain perception to the brain (Todd, 2010). Therefore, the use of low frequency TENS is capable in reducing pain perception through the endogenous opioid mechanism. Endorphin release lasts for 4 hours after application. 
 

Summary of clinical benefits:

  • Symptomatic pain relief for acute and chronic pain 

  • Improves comfort

Heat therapy 

 Heat therapy is the transmission of heat to the underlying tissue. Following application of superficial heat, cutaneous thermoreceptors stimulate the release of bradykinin resulting in local vasodilation (Dorn, 2015). This enhances the supply of oxygen and nutrients to the tissue and as tissue temperature rises, oxygen also becomes more readily available (Barcroft and King, 1909). This can double/triple the metabolic rate and increase diffusion of oxygen and nutrients through the cell membrane. As well as increasing the dispersal of noxious chemical irritants such as inflammatory mediators and therefore also providing an analgesic effect by reducing the stimulation of nociceptors (Dorn, 2015).

 

Heating the tissue also reduces viscosity and increases tissue extensibility by softening the viscous material surrounding the muscle fibres as well as warming the synovial fluid when applied over joints, improving lubrication and facilitating more fluid and smoother movement. Increases in tissue temperature can also stimulate a reduction in muscle tone and spasm by decreasing the firing rate of alpha motor neurons (Dorn, 2015).

 

Superficial heat also stimulates sensory receptors in the skin, inhibiting nociceptive transmission from nerve fibres and therefore reducing pain (Corti, 2014; Dorn, 2015).

Summary of clinical benefits:

  • Increased circulation

  • Pain relief

  • Increase in soft tissue extensibility and joint range of motion

  • Relieve osteoarthritis discomfort

  • Relaxation of muscle spasm

  • Increased oxygen uptake

  • Decreased sympathetic output – reduces smooth muscle contractibility

  • 10°C increase in temperature (up to 45°C) can double/triple metabolic rate

Cryotherapy 

The application of superficial cold results in several biological changes which primary result from a reduction in tissue temperature including activation of sympathetic nerves to release norepinephrine, leading to local cutaneous vasoconstriction (Johnson et al., 2005), a decrease in vascular permeability, reduced influx of inflammatory mediators and a 33% reduction in nerve conduction velocity (Algafly et al., 2007; Cheing et al., 2005; Daglish et al., 2016). This results in local anti-inflammatory and analgesic effects. This is beneficial in the first 72 hours following an injury, surgery or acute flare-ups of chronic conditions as the decrease in blood flow slows the formation of oedema, reduces the level of histamines released which reduces the degree of tissue damage, reduces inflammation, and reduces pain. It is speculated that lowering the temperature of nerve fibres increases the friction between calcium and cellular voltage gates upon entry, resulting in a delay in action potential generation (Reid et al. 2002). This reduces nociceptive (pain) transmission and temperatures below 10 degrees completely block neural transmission. 

Initial cooling of the muscle stimulates muscle spindles to contract the muscle, however during application golgi tendon and muscle spindle application is reduced, decreasing the firing of alpha motor neurons and therefore decreasing the stimulation of the muscle and decreasing muscle spasm. 

To gain the benefits of cryotherapy, it should be applied for 10 minutes, to allow for significant cooling of the tissue as the therpeautic effects occur between 10-15 degrees. .

Summary of clinical benefits of cryotherapy:

  • Reduces the formation of oedema and inflammation 

  • Pain relief

  • Relieves muscle spasm

Remedial exercise

Controlled walking and mobilisation:

Controlled walking in the form of in hand walking for the horse and lead walking for the dog is implemented into every rehabilitation plan to gradually restore normal function and strength in a controlled manner. Controlled and low impact exercise is necessary to protect the animal from re-injury, as sudden or repetitive impact are significant risk factors for joint abnormality (Davidson, 2016; Te Moller and Van Weeran, 2017), improve muscular support to prevent excessive stress and improve shock absorption and minimise fatigue related injury (McGowan and Goff, 2016).

Slow and controlled walking will encourage and promote utilisation of the affected limb through individual placement and weight bearing of each limb, greater active ROM, improve muscular strength through increased muscle activation and recruitment, improve cardiovascular fitness, promote dynamic weight bearing of the affected limb and provide proprioceptive input (Baltzer, 2020; Millis, 2004; Saunders, 2007). In horses, progression onto trot work is also important as the rectus abdominis, external abdominal oblique and longissimus dorsi activity is greater in trot and therefore improving core muscle development and spinal stability (Tabor and Williams, 2018; Zsoldos et al., 2010). Transitions within the gaits helps to encourage the hindlimbs to step under, greater flexion of the hindlimb and engagement of the core and therefore improving self-carriage, balance and way of going (Paulekas and Haussler, 2009). 

Passive range of motion:

Passive ROM promotes articular cartilage nutrition, decreases periarticular adhesions, prevents joint capsule fibrosis and soft tissue contracture and improves vascular and lymphatic circulation through proprioceptive mechanoreceptor stimulation, which in turn improves sensory awareness (Baltzer, 2020; Marcellin-Little and Levine, 2015; McGowan and Goff, 2016). Performing passive ROM exercises to mimic the normal gait pattern in the dog is also beneficial to restore functional ROM of the limb (Millis, 2004)

Weight shifting and stability exercises: 


Weight shifting exercises provide a source of rhythmic stabilisation, which encourages weight bearing (Saunders, 2007), stimulates stability and increases co-ordination (Baltzer, 2020), particularly important for when dynamic exercises are gradually increased, promotes the return of normal limb use and function (McGowan and Goff, 2016) and causes isometric muscle contraction, contributing to muscle development. It works by placing the body off balance, which is detected by mechanoreceptors and the balance system tells the cerebellum that the body is being pushed off balance. The brain then sends motor signals to muscles to contract and pull the animal back to the correct position. 

 

In the horse, asking the horse to weight shift caudally displaces the centre of mass and stimulates contraction of the thoracic sling musculature, sub-lumbar, gluteal and the biceps femoris, aiming to improve postural balance and musculature development. This can be progressed onto backing up, which helps to strengthen the hind limb muscles as the horse resists the shift of the centre of gravity towards the fore hand, improves the flexor muscles strength, which counteract lordosis, improves hindlimb engagement, weight bearing, core stability, proprioception and strengthens the quadriceps.

Lateral tail pulls may also stimulate improved postural balance and contraction of the pelvic limb musculature (Paulekas and Haussler, 2009). Wither rocks target the forelimbs and stimulate thoracic sling muscle contraction, increasing the loading through the forelimbs and soft tissue structures down the limb, aiming to improve postural balance and gentle increase the strain through the tendons and ligaments of the limb. 

In the dog, weight shifting can be performed in a similar way by gently pushing the dog off balance, by either pushing them side to side to target the forelimbs or the hindlimbs, or pushing them backwards to increase the loading onto the hindlimbs and improve core activation and strength. Weight shifting can be progressed with the use of a wobble cushion to stimulate and increase spinal and abdominal strength (Baltzer, 2020) and to challenge the dogs' stability and balance further. Foam pad can be used to increase the loading and weight bearing of the limbs, specifically targeting the forelimbs or the hindlimbs, depending on the individual dog. 

 

Cavaletti poles: 

Lunging and long-reining: 

In the horse, lunging induces greater flexion, extension and lateral bending of the thoracolumbar back in comparison to straight lines (Greves et al., 2017). Travelling on a circle also alters the symmetry of loading and push off of the hindlimbs as the outside and inside limb are travelling on a different radius around the circle, suggesting the outside limb would need to work harder and may achieve greater protraction (Pfau, 2012). On a circle, concentric contraction of the longissimus dorsi and the oblique abdominals is required on the inside in order to bend the horse in the direction of turning as well as controlled eccentric contraction of the contralateral musculature to allow lateral bending (Clayton, 2016; Tabor and Williams, 2018). Equiband resistance training involves rhythmic sensory stimulation (Paulekas and Haussler, 2009) and, the abdominal band, is thought to increase recruitment and development of the abdominal musculature and increases dynamic stability of the vertebral column and the pelvis through significant reductions in wither roll, thoracolumbar mediolateral movements, but increases dorsoventral range of motion (ROM) of the thoracic spine, which is 10% greater on the lunge, maintaining optimal spinal mobility (Pfau, 2017). Therefore, the inclusion of regular lunging with the use of an Equiband and the inclusion of loops and serpentines into the sessions, is beneficial to improve spinal flexibility, increase dynamic balance control (Paulekas and Haussler, 2009), provide dynamic stability of the vertebral column, increase core engagement, hindlimb protraction and longissimus dorsi muscle mass.

Long reining, in particular, is beneficial in establishing balance and co-ordination and providing a source of mental stimulation when out on tracks (McGowan and Goff 2016), varying surfaces will also stimulate firing of sensory and proprioceptive fibres and therefore will provide a form of neuromotor and proprioceptive training (Pauleskas and Haussler, 2009).

 

Hack work: 

 

Uphill gradient activates the propulsive muscles in the hindlimbs, helping to increase strength and muscle building. Downhill gradient requires stabilisation and weight shifting to the hindquarters to resist gravity, activates muscles to raise the withers. This improves self-carriage and balance. Different terrain, as stated above provides proprioceptive input by stimulating the firing of sensory and proprioceptive fibres, improving balance, co-ordination and stability. Varying surfaces will also expose soft tissue structures to varying degrees of strain, and gradually increasing strain tolerance and stretch if gradually introduced.  Deeper surfaces strengthen muscles, encourages joint flexion and increases cardiovascular loading. Road surfaces increase bone strength due to the increased mechanical loading, stimulating bone cellular activity. 

Canine active range of motion exercises:

Sit to stand exercises for dogs are implemented into the rehabilitation of various hindlimb conditions as the they help to strengthen hip and stifle extensor muscles and improve active ROM of the pelvic limb joints as it requires almost twice as much flexion of the stifle and hip joints compared to walking (Drum et al., 2014; Gaynor and Muir, 2015) and controlled lowering of the hindlimbs results in eccentric muscle contraction and raising from the sit results in concentric muscle contraction, improving neuromotor control and muscle activity. 

Asking the dog to stand and lower their head to the ground increases muscular control and stability of the forelimbs, particualry increasing active ROM of the elbow joints. 

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