Return to flip book view

1 Animal Therapy Magazine | ISSUE 20Governing Bodies and RegistersWho do you go to?Coronavirus How Levi Hunt has adapted his training regimeTop tips from Dr. Jane Williams on bringing your horse back to into work after a breakRehoming dogs - top tips from an Animal BehaviouristRehabilitation From Brachial Plexus injury Thermal Imaging in practiceThe tale of the tailWhat does tail posture tell you about your horseCanine Arthritis Management What is arthritis and what can you do to manage it in your dogISSUE 20M A G A Z I N EAnimalerapy

2Animal Therapy Magazine | ISSUE 20Our members are highly skilled in providing physiotherapy care for animals. We work as part of the multi-disciplinary team which is involved with the care and welfare of animals. Members are graduates of university validated BSc or PgD/MSc Veterinary Physiotherapy courses.NAVP members must fulfil certain requirements including CPD, they must carry Professional Liability Insurance and practice in line with the Associations regulations and standards of practice. FOR FURTHER DETAILS PLEASE CONTACT:info@navp.co.ukwww.navp.co.ukPromoting Excellence in Veterinary Physiotherapy

3 Animal Therapy Magazine | ISSUE 20GET IN TOUCH:Hannah Ashton – Editorhannah@animaltherapymedia.co.ukBeth Lorraine - Sales Manager info@animaltherapymedia.co.ukDonna Boddie - Account Manager donna@animaltherapymedia.co.ukTony Nevin - Podcasts and Research tony@animaltherapymedia.co.ukM A G A Z I N EAnimalerapyISSUE 20Issued Quarterlywww.animaltherapymedia.co.ukWhile every eort has been made to ensure that information is correct at the time of going to print, Animal Therapy Media Ltd cannot be held responsible for the outcome of any action or decision based on the information contained in this publication/website. The publishers or authors do not give any warranty for the completeness or accuracy for this publication’s content, explanation or opinion. No part of this publication and/or website may be reproduced, stored in a retrieval system or transmitted in any form without prior written permission of Animal Therapy Media Ltd and/or the authors of the articles within. Permission is only deemed valid if approval is in writing.Front cover image: Thermal image of a horse - see article on page 20.Welcome! In April 2020, Animal erapy Magazine made the tough decision to move to an online only version following the eects of COVID-19. is uncertain period has been tough for many both mentally, physically and nancially but the Animal erapy team are passionate about continuing to provide this platform for the many professionals and dedicated owners.We are delighted at how our online access has grown and continues to grow daily and with some new writers on board we are condent we can continue to release relevant articles and information regarding treating animals with therapeutic skills.If you'd like to know how to subscribe, please visit our website www.animaltherapymedia.co.uk for more details.As some restrictions start to ease, how we went about our daily lives has already changed and will likely continue to do so, however, our animals still deserve the best care and opportunities in life so we truly hope we can continue to provide you with relevant and thought provoking features.ank you for your continued supportTeam Animal erapyResponding to Coronavirus ____________________ 4Tail Carriage abnormalities ____________________ 8Canine Arthritis Management _________________ 12Retraining of Racehorses _____________________ 14Levis Blog _________________________________ 17Choosing a Governing Body __________________ 18Infrared Thermal Imaging ____________________ 20New Rescue Dog ___________________________ 24Moorcroft Equine Rehabilitation Centre _________ 26Rehabilitation of Brachial Plexus Avulsions _______ 28Photizo - Treating Laminitis ___________________ 32CONTENTS

4Animal Therapy Magazine | ISSUE 20EQUESTRIAN sports and non-competitive leisure riding are popular in the UK, with approximately 3 million people regularly riding (Williams and Tabor, 2017; BETA, 2019). e quarantine restrictions implemented in response to the current Coronavirus (COVID-19) pandemic in the UK (a nationwide lockdown on March 23rd 2020) required rapid changes in how we went about day-to-day activities in response to government guidelines and local establishment guidance to reduce the spread of the virus, including the training and management of our horses. e current COVID-19 pandemic is having a signicant impact on the British equestrian sector (British Equestrian, 2020). Horse owners and livery yard proprietors are responsible for the management of the horses under their care and should engage in practices which optimise equine health and welfare (Williams and Tabor, 2017; McLean and McGreevy, 2005). A recent survey (Marlin and Williams, unpublished data) investigating the impact of COVID-19 on horse owners found the pandemic had prompted changes in livery yard management and inuenced how the majority of horse owners interacted and looked aer their horses. Owners who kept their horses within private livery yards have been the most aected, with ~80% visiting their horse less due to social distancing restrictions, ~40% reducing or stopping Responding to CoronavirusFactors to consider when returning your horse to work after a breakby Dr Jane Williams, Hartpury University riding, and between 40-50% of owners ‘roughing o ’ their horses (turning their horses out on pasture rather than being stabled). e pandemic has therefore lead to many horses experiencing an unplanned break in training or a reduction in their normal training regimes. In response to the recent easing of lockdown and quarantine restrictions, British Equestrian has encouraged owners to resume riding their horses (May 2020) and it is likely that UK horse owners are now faced with a situation where they will returning their horse to work aer a period of rest or reduced exercise. ere is also the potential that while no vaccine and limited medical capacity are available to treat the disease, that diering forms of enforced restrictions could be in place for up to 18 months (Wang et al., 2020) exerting an ongoing eect of horse owners and equestrian competitions. is article will review the basic principles of training and highlights some common areas owners and riders should consider when returning their horse to work or if management regimes are subject to change. Principles of training e key objective of equestrian training is to prepare the horse and the rider for the physical, physiological and psychological demands of the workload we expect of them, be that participating competitively in a specic discipline or being able to undertake regular hacking (Williams, 2013). During training, there are three principles, which we are aiming to achieve for our horses (and ourselves):1. Developing sucient physiological conditioning to ensure adequate tness to complete the workload expected without demonstrating signs of fatigue,HARTPURY UNIVERSITYFigure 1: Horse commencing a ‘break’ in workload

5 Animal Therapy Magazine | ISSUE 20Responding to CoronavirusFactors to consider when returning your horse to work after a breakcontinued overleaf2. Generating improvements in performance by developing the key motor skills required e.g. jumping or lateral movements in dressage, promoting a balanced or symmetrical athlete and improving neural plasticity (or reaction times), and,3. Through ensuring the appropriate preparation of horse and rider, preventing injury and increasing career longevity.Short-term breaks are anecdotally reported to exert a benecial impact on horses’ psychological and physical wellbeing, and are oen integrated into competition horse schedules without any detrimental impact to equine health or welfare if accompanied by appropriate management changes. For example, owners should change their horse’s diet and reduce calorie intake to match revised exercise levels, thereby reducing the risk of obesity and inappropriate behaviour because of excess energy that could lead to subsequent handling and ridden issues. Horses on a ‘break’ will experience minimal decline in their current tness levels for a period of approximately 2 weeks, but periods of rest or reduced training longer than this will result in a more pronounced reduction in tness (Figure 1). Research has found thoroughbreds previously in race training retain their aerobic and cardiovascular capacity aer 12 weeks turned out at grass (Mukai et al. 2006). However decreases in muscle mass aer stopping or reducing training have been reported within 2-4 weeks with detraining of muscle bres occurring aer 5 weeks (Essen-Gustavsson et al., 1989), suggesting the impact of periods out of work for longer than two weeks should be considered carefully. Horse owners and riders who have roughed o their horses or reduced their exercise levels in response to the COVID-19 pandemic, should also contemplate that re-establishing tness and muscle condition will take a minimum of 6-8 weeks, and should consider this when planning how to bring their horse back into work. Successful training regimes incorporate a range of dierent exercise types that are matched to short and long-term performance goals (Williams, 2013). erefore, the rst stage when designing an appropriate training programme is to determine what you are training your horse to achieve. Given the current uncertainty regarding the 2020 competition season, deliberation of what your short and long term goals are is worthy of some thought. e second stage is then determine the type of exercise activities to be included and how oen (frequency), how long (duration) and how hard (intensity) the horse is worked within these activities, and across a training regime. A good starting point is to consider the demands of the competition or of the long-term work level you want to achieve if a recreational rider. Generally, horses require dierent levels of stamina, strength and use dierent gaits at dierent speeds depending on the exercise and discipline they are engaged in. Stamina is the ability to sustain prolonged physical (or mental) eort and is needed for disciplines, which require prolonged duration, low-medium intensity exercise e.g. hacking or schooling; these types of activities usually utilise aerobic energy pathways using oxygen as a fuel source. Strength combined with explosive power is needed for high intensity activities such as jumping and galloping, and horses will usually need to utilise anaerobic and aerobic pathways to maintain performance, and this level of exercise intensity cannot be sustained for long periods. Horses that are not t enough for the exercise intensity they are worked at or that exercise for extended periods of medium intensity work are also likely to work anaerobically and demonstrate signs of fatigue with continued work.ree main types of training are used within programmes to increase the tness and condition of the equine athlete: endurance, strength and conditioning and high intensity training (Williams, 2013; Table 1). Designing a training regime is not easy and understanding the specic needs and responses of individual horses is essential to be able to produce a personalised plan. Generally, traditional Table 1: Types of training (Williams, 2013)*Interval training can be dened as repeated bouts of high intensity exercise, separated by rest periods performed on the same dayCategoryEndurance or stamina development (EN)Strength and conditioning (SC)Speed or high intensity (HI) trainingDescription• high frequency of repetition• predominately aerobic• long duration - low intensity exercises• for example, long periods of walk and trot• discipline focused• mimics specic competition demands• aerobic and anaerobic• duration and frequency linked to skill development• for example, grid-work, jumping a course or practising collected dressage movements• short duration-high intensity activity including anaerobic contribution • low frequency of repetition• for example, canter and gallop at 75-80% maximal exercise, canter and gallop interval training* or galloping on a high speed treadmill using inclines of 5-10%Impact• improved oxidative capacity • increased capillarisation• increased mitochondria• higher ratio of aerobic muscle bres (I and IIA)• some improvement in oxidative capacity • improved motor skill acquisition • increased muscle bre synchronicity• muscle bre hypertrophy• enhanced neuromuscular excitability improving energy when training is linked to specic discipline demands • higher ratio of aerobic muscle bres (IIA and IIAX)• improved oxidative capacity (IIA)• muscle hypertrophy• increased capillarisation• increased mitochondria• higher ratio of anaerobic muscle bres (IIX)

6Animal Therapy Magazine | ISSUE 20 Aerobic (<180bpm) vs. Anaerobic (>180pm) (Vincent et al., 2006) Lactate threshold is usually attained at 75 -85 % of HRmaxHRmax for the horse = 220 – 240 bpm, therefore anaerobic threshold = 178 – 204 bpmMUSCLE FIBRES RECRUITED: Type I > Type IIA > Type IIAX > Type X Exercise level: LOW INTENSITY MEDIUM INTENSITY HIGH INTENSITY Walk working trot Extended / collected trot canter Galloping and jumpingFibre recruitment:Type I+++ > Type IIA+ Type I+ > Type IIA+++ > Type IIAX ++ Type I+ > Type IIA+ > Type IIAX +++ > Type X+++HARTPURY UNIVERSITYtraining plans progress though three stages; stage 1: long and slow distance work, progressing to include stage 2: strength work and nally integrating stage 3: fast work, to develop aerobic capacity. When designing training regimes, horse owners and riders should also consider the duration, frequency and intensity of individual exercise sessions and the cumulative impact of multiple exercise sessions over a period of days on the horse. Overtraining occurs when a horse demonstrates a reduction in performance despite maintaining or increasing exercise during training (McGowan et al., 2002). It is therefore also important to think about how you plan your horse’s training regime, to ensure sucient opportunities for recovery are embedded within exercise schedules. Glycogen stores within equine muscle can take up to 72 hours to fully replenish aer depletion, whilst the presence of muscular fatigue during exercise will increase the load on the tendons and ligaments and reduce their capacity to stabilise the limbs during movement, increasing injury potential. erefore, integrating rest days from the start of a training regime and avoiding repetitive medium and high intensity exercise sessions are essential strategies to aid recovery and to reduce injury in your horse (Williams, 2013). How hard the horse works within specic exercise sessions will depend on the type of activities being undertaken, the length of the exercise session, the gait being used, speed and the inuence of environmental conditions such as weather, surface and terrain. Figure 2 summarises the impact of the low, medium and high intensity exercise on the key physiological systems supporting performance in the horse. Being able to judge if your horse is t enough to be able to undertake the current level of work and understanding how hard a horse is working, are essential skills to be able to design programmes to progress tness and when designing (and adapting) eective equine training plans. Maximal oxygen uptake in the horse’s muscle tissue or VO2max is commonly used to measure the aerobic capacity of the horse and to assess tness. To assess VO2max accurately in the eld is challenging, however a linear relationship exists between VO2 max and heart rate (HR) up to ~200 beats per minutes, which enables HR monitoring to act as a proxy measure of aerobic capacity in real-world environments. e initial stages of training in walk and trot equate to ~40% VO2max (HR: 100-130bpm) and will induce tness in an untrained / unt horse through improvements in the horse’s aerobic capacity. However to continue to develop tness, the horses’ workload within exercise session will need to increase every 2 -3 weeks until they achieve the required tness level for the competition demands or work levels required of them, at which point the training regime can be adapted to maintain tness. It should also be remembered that not all exercise within a training regime needs to be ridden exercise!Monitoring training Regular monitoring of how your horse responds to exercise across a training regime should be undertaken to enable you to develop baseline parameters for your horse which can then be analysed to assess progress. Knowing how your responds to exercise can also enable you to pick up on uncharacteristic responses or poor performance that could indicate the beginning of a problem. HR monitors can be a really useful tool to help you evaluate how hard the horse is working and to provide objective data which can be used to analyse if a training regime is going to plan. Most HR monitors will record HR, speed and distance and this information can be used to establish if the horse is working aerobically or anaerobically, and to calculate the percentage of HR maximum the horse is working at using the simple formulae below (Williams, 2013). If you don’t have access to a heart rate monitor then you could take your horse’s pulse (Figure 2) during and aer exercise. Using this approach is less accurate as the horse is an exceptional athlete and the HR / pulse can return to walking values (50-70bpm) very quickly when you stop exercising. Gathering HR, speed and distance data can be complemented by recording your horse’s weight, diet and details of the specic exercise sessions undertaken to develop a detail training diary. Percentage of HRmax:%HRmax = average HR in the exercise session / (240 – your horse’s age) x 100% (Vincent et al., 2006)e.g. a 5 year old horse with an average HR of 195bpm in an exercise session would be working at 83% of their maximum HR, so would be working above the anaerobic thresholdRegular assessment of the %HRmax your horse is working at can help you monitor how eective your training regime is, and when to increase or decrease the intensity level of exercises contained within it.HR at anaerobic threshold:Horses will start to work anaerobically at between 75 to 85% of HRmax depending on their tness, age and breed. Generally, horses used for recreational riding would have a lower anaerobic threshold (75%) than sport horses (~80%) and racehorses (80-85%).HR at 80% anaerobic threshold = (240 bpm – horse’s age) x 0.80 HR at 75% anaerobic threshold = (240 bpm – horse’s age) x 0.75e.g. for the same ve year old horse, they would be working anaerobically at HRs > 188 bpm (using 80% HRmax as the anaerobic threshold) and HRs 176 bpm (using 75% HRmax as the anaerobic threshold).Figure 2: Impact of dierent intensities of exercise in the horse

7 Animal Therapy Magazine | ISSUE 20Knowing this information can help the rider to assess workload during an exercise session if they are using a HR monitor by reviewing the horse’s ‘live’ HR and seeing if this is above or below the HR which represents the horse’s anaerobic threshold. e rider can then increase or reduce the intensity of the exercise session depending on the aim of that session.Riders - don’t forget yourself! As well as implementing a structured and planned training regime to bring their horse back into work, riders should also consider how their own tness can impact on their horse. Limited research has evaluated the physiological demands of horse riding to date. Studies have found that heart rate and blood lactate responses of the rider increase with the horses gait and markedly increase in canter and when jumping (Douglas et al. 2017; 2012). However oxygen uptake does not increase at the same rate as heart rate during horse riding activities, suggesting isometric muscle activity is key when riding (Douglas et al., 2017). Postural stability is also important to facilitate a balanced seat, controlled application of the aids and to promote optimal performance in the horse. erefore engaging in a training programme that develops tness and strength and conditioning should improve both horse and rider performance.A nal thought on managementSwi changes in management regimes can also represent risk factors to equine disease. Horses kept predominately at pasture have increased access to forage with a higher water content and spend more time eating at pasture (55% compared to 15%) than when stabled. Horses are also reported to increase water intake, reduce faecal output but increase faecal volume and experience reduced colon motility when moving from pasture to stabling with light exercise for a transition period of ve days (Williams et al., 2015). ese factors alongside spring growth of new grass and the sunniest spring on record in the UK, increase the risk of colic and laminitis, and horse owners and keepers should be vigilant to the early clinical signs of these conditions during transitions in management practices.Whilst no vaccine is available for COVID-19 how we live and interact with each other and our horses will remain subject to changes in response to the impact of the virus. Developing a working knowledge of monitoring your horse’s response to exercise alongside taking an informed approach to planning a training regime and monitoring how your horse responds to this on a regular basis, should enable you to manage your horse’s tness, health and welfare and to be ready for a successful return to competition when it returns.REFERENCES British Equestrian. 2020. COVID-19 FAQs. Available at: https://www.britishequestrian.org.uk/coronavirus/covid-19-faqsBritish Equestrian. 2020. COVID-19 FAQs. Available at: https://www.britishequestrian.org.uk/coronavirus/covid-19-faqsBritish Equestrian Trade Association. 2019. National equestrian survey 2019. Available at: www.beta-uk.org/pages/industry-information/market-information.phpDouglas, J.L., Price, M. and Peters, D.M., 2012. A systematic review of physical tness, physiological demands and biomechanical performance in equestrian athletes. Comparative exercise physiology, 8(1), pp.53-62.Douglas, J.L., 2017. Physiological Demands of Eventing and Performance Related Fitness in Female Horse Riders (Doctoral dissertation, University of Worcester).Essen-Gustavsson, B.., McMiken, D., Karlström, K., Lindholm, A., Persson, S. and Thornton, J., 1989. Muscular adaptation of horses during intensive training and detraining. Equine Veterinary Journal, 21(1), pp.27-33.McGowan, C.M., Golland, L.C., Evans, D.L., Hodgson, D.R. and Rose, R.J., 2002. Eects of prolonged training, overtraining and detraining on skeletal muscle metabolites and enzymes. Equine veterinary journal, 34(S34), pp.257-263.McGreevy, P. and McLean, A., 2005. Behavioural problems with. The domestic horse: The origins, development and management of its behaviour, pp.196.McLean, A.N. and McGreevy, P.D., 2010. Ethical equitation: Capping the price horses pay for human glory. Journal of Veterinary Behavior: Clinical Applications and Research, 5(4), pp.203-209.Mukai, K., Ohmura, H., Hiraga, A., Eto, D., Takahashi, T., Asai, Y. and Jones, J.H., 2006. Eect of detraining on cardiorespiratory variables in young thoroughbred horses. Equine Veterinary Journal, 38(S36), pp.210-213.Vincent, T.L., Newton, J.R., Deaton, C.M., Franklin, S.H., Biddick, T., McKeever, K.H., McDonough, P., Young, L.E., Hodgson, D.R. and Marlin, D.J., 2006. Retrospective study of predictive variables for maximal heart rate (HRmax) in horses undergoing strenuous treadmill exercise. Equine veterinary journal, 38(S36), pp.146-152.Wang, L.S., Wang, Y.R., Ye, D.W. and Liu, Q.Q., 2020. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. International journal of antimicrobial agents, p.105948.Williams, J., 2015. The principles of training: the horse. In Training for Equestrian Performance (pp. 175-192). Wageningen Academic Publishers.Williams, J. and Tabor, G., 2017. Rider impacts on equitation. Applied Animal Behaviour Science, 190, pp.28-42.Williams, S., Horner, J., Orton, E., Green, M., McMullen, S., Mobasheri, A. and Freeman, S.L., 2015. Water intake, faecal output and intestinal motility in horses moved from pasture to a stabled management regime with controlled exercise. Equine veterinary journal, 47(1), pp.96-100.TOP TIPS FOR MONITORING YOUR HORSE’S PROGRESS WITHIN TRAINING1. Keep a training diary – include what exercise you do, monitor and record your horse’s workload and their response to exercise sessions and recovery capacity so you can track progress over time2. Invest in a HR monitor to enable you to accurately calculate how hard your horse is working: average HR and percentage of HRmax, speed and distance covered during exercise sessions3. Calculate the percentage of heart rate maximum (%HRmax) your horse is working at regularly to monitor the impact of dierent exercise activities on your horse and progress across training 4. Integrate a regular SET (standard exercise test) within your training to enable you to assess how well your training plan is working to improve your horse’s tness. Find an exercise that you can repeat at regular times during training for example this could be a regular piece of work up the gallops, a set hill you can canter up for the same distance and at same speed on dierent occasion, or jumping round a set course of showjumps. You can then assess your horse’s tness throughout your training regime by comparing their end HR and average HR up the hill every couple of weeks. These measures should decrease as your horse gets tter, if you have kept the distance and speed consistent (and the environmental conditions are comparable). You can also calculate the percentage of heart rate maximum your horse is working at to compare progress across SETs.

8Animal Therapy Magazine | ISSUE 20THE equine tail has historically been a sign post to the horse’s emotions for owners and experienced professionals alike. Observing the tail high in the air right before you are due to mount is never a welcomed behaviour in most circumstances. Should a worried owner try and seek advice from Dr.Google they will be inundated with a dearth of articles commenting on the possible causes of their horse’s crooked tail, very few of which have any evidence basis. is is not surprising due to the distinct lack of literature and direct research studies on the topic, however this article will discuss some relevant sources which may assist clinicians in linking the presentation with what we know about the anatomy, biomechanics and potentially the pathologies at play. It is widely accepted that tail carriage is as a way in which a horse can display emotion; typical behavioural responses include increased vigilance behaviour which is demonstrated with a high head and tail position, oen alongside snorting and locomotory responses (Hall et al., 2018). However, the equine tail has more to tell than just emotion and can be an important indicator when it comes to musculoskeletal health (Tutko et al., 2002). e tail is a continuation of the axial skeleton attached caudally to the sacrum of which is represented by the fusion of typically ve sacral vertebrae. e horse has 15 to 21 caudal vertebrae also known as coccygeal vertebrae (Levine et al., 2007). e coccygeal vertebrae have a number of anatomical dierences compared with the rest of the equine spine. e biggest dierence is the cranial and caudal surfaces of each vertebral bodies are convex and the articulations between each vertebral body are met with a thick intervertebral disc. e coccygeal vertebrae do have transverse processes (TP) evident however they decrease in size caudally. Dorsal spinous processes (DSP) of the rst two vertebral are bid and are usually not present in the rest of the tail. ere are articular processes present with small cranial apophyseals present up to caudal vertebrae seven but caudal apophyseals are usually absent. e vertebral canal reduces gradually within the vertebrae and beyond the point of caudal vertebrae 3 - 6 the neural processes do not meet and the vertebral canal stops at approximately caudal vertebrae eight. Aer this point the coccygeal vertebrae are cylindrical with no vertebral arches (Henson, 2013, p15).e caudal vertebrae are surrounded by several muscles which are rarely discussed or highlighted. e four key muscle include Sacrocaudalis Dorsalis Medialis (SCDM), Sacrocaudalis Dosalis Lateralis (SCDL), Sacrocaudalis Ventralis Lateralis (SCVL), Sacrocaudalis Ventralis Medialis (SCVM). Other muscles acting upon the caudal vertebrae include Coccygeal and the dorsal and ventral Intertransverse muscles (Grolnberg, 2011). Range of motion of the coccygeal vertebrae comprises of exion, extension, lateral exion and rotations (Henson, 2013, p15). Research into the kinematics of the equine coccygeal vertebrae is lacking in most veterinary and physiotherapy texts, this is likely due to the lack of impact of damage to the equine tail to the function and performance of the horse directly especially when compared to the cervical or thoracolumbar regions. e dorsal muscles extend or elevate the tail, whereas the ventral muscle group create exion. A combination of the ventral and dorsal muscles allow lateral movement (Tutko et al., 2002). Although no literature has directly investigated the causes of altered tail carriage, it is highly likely that pain or dysfunction associated with the coccygeal muscles or joints will alter the movement and potentially the carriage of the tail. Wennerstrand et al. (2009) injected lactic acid into the le Longissimus Dorsi in eight horses to HARTPURY UNIVERSITYAttention to detailTail carriage abnormalities in horsesby Holly Allen, BSc (Hons), MSc, MCSP, ACPAT A, RAMP, HCPC

9 Animal Therapy Magazine | ISSUE 20simulate the eect of back pain. Induced unilateral back pain caused an increased in thoracolumbar extension and lateral exion and pelvic rotation to the aected side, even aer one week following pain was induced. is demonstrates the possibility that if muscular pain was present in the coccygeal muscles this would likely cause the tail to move towards the painful side.e Hamstring muscle group is also worthy of discussion when considering coccygeal function due to its additional proximal origins. e vertebral head of Biceps Femoris, Semimembranosus and Semitendinosus all have origins connecting to the proximal coccygeal vertebrae, with Biceps Femoris attaching to the spinous and transverse processes of caudal vertebrae three to ve (Grolnberg, 2011). It has also been documented that this muscle group also has an attachment to the tail via the caudal fascia (Henson, 2013, p28). ese powerful and inuential muscles have the relevant attachments to inuence the tail and therefore should be considered in detail when evaluating tail dysfunctions.Injuries to the tail are rare and largely undocumented in the veterinary literature, however in one unique study 12 horses were diagnosed with coccygeal fractures (Tutko et al., 2002). All participants had known trauma such as falling over or backing into wall and the rst or second coccygeal vertebrae was aected in all the patients. Veterinary diagnosis in these cases was based upon Tutko et al., (2002) Anatomy of the Coccygeal vertebrae and surrounding tissues. Available at: https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/j.2042-3292.2002.tb00172.x?casa_token=wbXxMfqI0LsAAAAA:J5kOWyBGF5kpmByPUvKn5WBYxCPufS7rF3Iei9pyllpy48PCFgjvKnC1EyiGuaNbB-nXlKw_TuuKoKjcEg (Accessed: 31 May 2020).pain response on direct palpation and then subsequent lateral radiographs. ree horses presented with atrophy to SCDL and or SCDM muscles and all but one horse had decreased horizontal and or vertical motor function. e ability to dierentiate between neurological decit, pain or structural limitation of motion was not able to be identied, however in these cases desensitisation of the tail tissues and motor loss would indicate nerve damage. In these cases scintigraphy may be required to rule out an additional sacral fracture which would cause greater dysfunction to the horse (Tutko et al, 2002). Following a coccygeal fracture the tail may have a permanent disgurement.Although coccygeal fracture is a rare potential source of altered tail position, there are anecdotally many horses who present with an altered tail carriage which is not linked to direct trauma is a common cause of referral to the vet or physio from worried owners. Literature is severely limited in the more subtle and non-painful cases that therapists will likely come across during routine maintenance sessions as new and long standing presentations. erefore use of anatomy and biomechanical literature may be a basis for determining other causes of altered tail positions in the horse without a directly painful musculature or coccygeal vertebrae. Biomechanically the tail is thought to assist the horse as a balancing mechanism. It is considered by some trainers and professionals an indicator of the muscular activity of the back and that a horse working correctly should have the tail arched up and away from the body, with the middle and end of the tail swinging. Tail carriage can of course be breed specic, with some Appaloosas or Arabs carrying the tail curled upward or held straight out or to one side, whereas Fresians, sometimes have tail hanging straight down, even when the top line musculature is relatively relaxed (Moore, 2010). Dyson et al. (2018) completed a substantial study investigating the behaviours that lame horse’s exhibit when ridden to produce the ridden ethogram. Among a list of 24 behavioural markers the tail was a key element that was highlighted by observers. Within the ndings the occurrence of tail swishing in a exion and extension (sagittal plane) motion was not signicantly dierent between lame and non-lame horses but were seen with this behaviour in the region of twice the frequency in the lame group. e other tail behaviours within the ethogram were tail lashing and repeated circling movements which were seen to occur signicantly more in lame horses than non-lame horses. Heleski et al. (2009) also describes tail swishing as a conict behaviour which may be occurring in the lame ridden horses. In addition to tail swishing, holding the tail clamped or to one side was found in 24.8% of lame horses compared with 5% of non-lame horses. According to Dyson et al. (2018) abnormal tail position alone does not indicate lameness, this would need to be in conjunction with up to seven other key behaviours when ridden (eight or more in total).In contrast, Weller et al. (2014) conducted one of the few available studies specically into tail position. Out of 50 lame horses there was no signicant relationship between tail carriage and forelimb or hind limb lameness. However a very high percentage of the horses (87.2%) were found to have some degree of tail deviation and therefore the use of comparison of a control group of sound horses would have been a useful addition. Unfortunately the direct comparison between the two studies is not possible due to the ridden nature within Dyson et al. (2018) and horses unridden on a treadmill in Weller et al continued overleaf

10Animal Therapy Magazine | ISSUE 20(2014). In a follow up study Dyson and Van Dijk (2018) investigated horses that exhibited more than eight behavioural signs on their ethogram and then identied and abolished the source of pain. Of these lame horses (n=21) one horse had thoracic impinging spinous processes (in addition to unilateral hindlimb lameness) and 16 horses had a component of sacroiliac joint region pain. Unfortunately the breakdown on the eect on tail symptoms was not available post abolishment of pain source. Interestingly there is no current literature that creates a link between sacroliliac pain or dysfunction and altered tail carriage despite the close proximity and the potential to aect the surrounding musculature and fascia.A further factor that may be relevant in altered tail carriage within the literature is that lameness has a high correlation to back pain and perhaps the altered back kinematics and or osseous or muscular adaptations has the potential to have a greater eect on the tail. Moore (2010) states that a tail which is clamped or held into lateral exion is oen an indicator of sustained contraction in the long back muscles’ however this was not investigated through a controlled study by the author. It is well evidenced that the clinical manifestation of back pain results in diminished exion and extension movement at or near the thoracic lumbar junction (Wennerstrand et al., 2004; Jecott et al., REFERENCESDyson, S., Berger, J., Ellis, A.D. and Mullard, J., 2018. Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. Journal of Veterinary Behavior, 23, pp.47-57.Dyson, S. and Van Dijk, J., 2018. Application of a ridden horse ethogram to video recordings of 21 horses before and after diagnostic analgesia: reduction in behaviour scores.Equine Veterinary Education. Grolnberg, P., 2011. ABC of the Horse: Atlas. Hall, C., Randle, H., Pearson, G., Preshaw, L. and Waran, N., 2018. Assessing equine emotional state. Applied animal behaviour science, 205, pp.183-193.Heleski, C.R., McGreevy, P.D., Kaiser, L.J., Lavagnino, M., Tans, E., Bello, N. and Clayton, H.M., 2009. Eects on behaviour and rein tension on horses ridden with or without martingales and rein inserts. The Veterinary Journal, 181(1), pp.56-62.Henson, F.M. ed., 2013. Equine back pathology: diagnosis and treatment. John Wiley & Sons.Jecott, L.B., Dalin, G., Drevemo, S., Fredricson, I., Björne, K. and Bergquist, A., 1982. Eect of induced back pain on gait and performance of trotting horses.Equine veterinary journal,14(2), pp.129-133.Levine, J.M., Levine, G.J., Homan, A.G., Mez, J. and Bratton, G.R., 2007. Comparative anatomy of the horse, ox, and dog: the vertebral column and peripheral nerves. Equine Comp Cont Educ Pract Vet, 2, pp.279-292.Moore, J., 2010. General biomechanics: the horse as a biological machine. Journal of equine veterinary science, 30(7), pp.379-383.Tutko, J.M., Sellon, D.C., Burns, G.A., Vivrette, S.L., Ragle, C.A., McConnico, R.S. and Gibbons, D., 2002. Cranial coccygeal vertebral fractures in horses: 12 cases. Equine Veterinary Education, 14(4), pp.197-200.Wol, A., Hausberger, M. and Le Scolan, N., 1997. Experimental tests to assess emotionality in horses. Behavioural processes, 40(3), pp.209-221.Weller, R., Love, A., Clark, B., Smith, R. and Pfau, T., 2014. Is There a Relationship between Tail Carriage and Lameness in Horses?. Equine Veterinary Journal, 46, pp.55-55.Wennerstrand, J., Álvarez, C.G., Meulenbelt, R., Johnston, C., Van Weeren, P.R., Roethlisberger-Holm, K. and Drevemo, S., 2009. Spinal kinematics in horses with induced back pain. Veterinary and Comparative Orthopaedics and Traumatology, 22(06), pp.448-454.Wennerstrand, J., Johnston, C., ROETHLISBERGER‐HOLM, K., Erichsen, C., Eksell, P. and Drevemo, S., 2004. Kinematic evaluation of the back in the sport horse with back pain. Equine veterinary journal, 36(8), pp.707-711.1982). Unfortunately the tail position was not described throughout these studies therefore cannot conclude fully if this would be the case.e tail remains to be a key indicator of equine emotion and potential musculoskeletal dysfunction, whether directly from the localised muscle, joints, ligaments, nerves or resulting from other sources such as lameness or back pain. Further research investigating tail position and pain further would help clinicians develop greater understanding of the causes of tail changes and therefore improvement management of this common presentation.EquineHartpury UniversityHartpury, Gloucester GL19 3BEwww.hartpury.ac.ukHartpury is a specialist educational provider located in Gloucestershire with more than 3,600 college and university level students studying postgraduate and undergraduate degrees, A-levels and diplomas in the areas of sport, equine, animal, agriculture and veterinary nursing.Table 1: Actions and attachments of the tail muscles (Grolnberg, 2011)SCDMSCDLSCVMSCVLCoccygealIntertransverseActionExtends and lateral exionExtends and lateral exionFlexion and lateral exionFlexion and lateral exionFlexionLateral exionOriginSpinous and mammillary process of Sacrum and 1st Caudal vertebraeSacrum, lateral sacral crest, TP of Caudal vertebrae 1, and mammillary processes of succeeding caudal vertebraeVentral surface of caudal vertebraePelvic surface of sacrum, transverse processes of Caudal vertebrae 1Ischial spine, broad sacrotuberous ligamentSacrum, lateralInsertionDorsolateral surface of succeeding caudal vertebraeDorsolateral surfaces of succeeding vertebraeVentrolateral surface of caudal vertebraeVentrolateral surface of caudal vertebraeTransverse processes of caudal vertebrae 1-4Transverse processes of caudal vertebraeHARTPURY UNIVERSITY

11 Animal Therapy Magazine | ISSUE 20My name is Jenny Coates, I am a qualied veterinary physiotherapist and canine massage therapist. I combine my veterinary physiotherapy skills, running my own clinic with teaching at the University of Nottingham 2 days a week. My client base consists mainly of dogs with orthopedic issues, strength and conditioning of working/sporting dogs and geriatric dogs whose owners want to maximize quality of life.Since the arrival of the Stance Analyzer in December 2019, I have & continue to use it each time I see a dog after my initial gait analysis and palpation. The Stance Analyzer Companion Animal HealthSTANCE ANALYSIS IN VETERINARY MEDICINE UK Ofce // Georginam@LiteCure.com // +44 (0) 1646 603878CompanionAnimalHealth.comJenny Coates – Vet Physiotherapist, Canine Massage Therapist & Teaching Associate in Veterinary Physiotherapy BSc PGCE DipCTM AdvCertVPhysallows me to track improvement post injury and also helps me to spot an issue in the early stages before the dog is noticeably lame.One of my favourite things about the Stance Analyzer is that it increases owner compliance. It’s great that the owners can see their dog improving and that their hard work on their home exercise program is paying off. One of the benets to using the Stance is that it allows me to track improvement post injury providing a reliable outcome measure.The Stance Analyzer has become an integral part of my treatment plan and I wouldn’t be without it.

12Animal Therapy Magazine | ISSUE 20 OSTEOARTHRITIS (OA) is a disease that aects 20% of all dogs, and 80% of dogs over the age of 8 with these statistics thought to be underestimated. It is a debilitating, progressive disease but noticed early enough, can be successfully managed with a multi-modal approach in order to slow the progression down. Owners are a vital part of the management plan, and play an important role in recognising the rst signs of its presence.Most dogs presented to a veterinary practice have secondary OA, meaning it develops following injury, microtrauma or because of abnormal anatomy. Breed and conrmation play a part here, with many breeds having dysplastic or abnormal joints due to genetics. In agility and sporting dogs, concussive forces and injury are commonplace and thus awareness that these dogs may be more pre-disposed to secondary OA is vital.Lameness of course is one sign of underlying issues, but OA is much more than a disease of the joint and looking at the bigger picture can give clues to potential early recognition, when lameness may not be evident. An understanding that OA is an on-going, chronic pain as opposed to a sudden, acute pain where a dog my cry or yelp, Canine Arthritis Management (CAM) say that dogs can be showing signs of chronic pain in the following ways:Behavioural changeExamples of behavioural changes is an exhaustive list, but is generally recognised as a behaviour that the dog previously used to exhibit but has stopped, or a new type of behaviour. Suggestions may be dierences in the way a dog socialises with other dogs or with humans such as aggression and intolerance, removing themselves from social situations or becoming more clingy or needy. Licking feet or joints, circling before laying down, suddenly not getting on the sofa, a reduced tail wag, less enthusiasm for their work or a hobby sport could all be potential red ags.Gait changeWhilst sometimes tricky to appreciate, dogs with chronic pain will usually display gait changes that allow them to compensate for the aected joint. Examples may be “whisking” of the back feet, icking of the forepaws, scung of feet, hopping, a hip sway, a pacing gait or a preference to trot instead of a steady walk. For sporting dogs, dierences in how the animal copes with its work could also be clues. Any abnormal or unusual change during movement can be signicant if noted on more than one occasion. Postural changeThe way a dog stands can provide clues to underlying pain. Again, compensation is common and a dog will shift its weight into other areas of the body, or stand dierently to avoid using a joint, loading more into one limb than another. Examples could be; straighter sties, paws, sties and elbows turned inwards or outwards, a tilted pelvis, low head or tail carriage or standing with a wider or more narrow base.Muscular changeMuscle mass changes again are good indications that a dog is not using an area of its body appropriately. Muscle wastage can be subtle to begin with, and comparisons with the opposite limb can be useful to detect any change. On the ip side, a dog that is over-using a muscle or group of muscles to compensate for pain elsewhere will begin to look built up and over-worked, which can often be mistaken for tness. The prime example of this is the dog that has hip pain, and throws its weight forwards into it’s forequarters; pulling itself forwards rather than propelling with the back end. The consequence is a “torpedo” shaped appearance, with large shoulders and a solid neck, sometimes the appearance of a mane like a lion, yet with diminishing hind limb and gluteal musculature. Others can be less obvious, with lumbar muscles on each side of the spine becoming tense when a dog adopts a bottom sway-type walk to avoid using its hips or sties in the usual way. If you notice some of these dierences in your dog, he could well be coping with chronic pain. If you can tick o one or more from every section, you are highly likely to be dealing with a dog in chronic pain. With all of this in mind, it is important to obtain a correct diagnosis from your vet. Whilst all of these things can signify pain, compensatory change and the presence of arthritis, your vet needs to be able to rule out other diseases and conditions that can also present in similar ways. OSTEOARTHRITIS

13 Animal Therapy Magazine | ISSUE 20 helps owners to realise that the dog may be aected by pain in many dierent ways. Pain from OA is not restricted to the joint alone, compensatory pain from a change in use of the rest of the body and neuropathic (nerve) pain associated with long-term pain are just two other aspects that need to be taken into account, making OA a much more complicated disease than we perhaps sometimes think. Coping with pain every day has a negative eect on both the physical and mental health of the dog, who will be exhibiting signs reecting this on a daily basis. ere is no cookie cutter solution for treating arthritis. Your vet may prescribe Canine Arthritis Management (CAM) is a veterinary driven initiative trying to combat the epidemic of undiagnosed pain we see in our canine population. Started by vet Hannah Capon, who realised she was having to euthanise large numbers of dogs prematurely, because of unrecognised pain that could have been addressed years before. Traditionally owners have believed “slowing down” is simple ageing when in fact it is highly likely pain from osteoarthritis. This is a welfare issue that has been identied as one of the top three welfare concerns aecting companion animals, and one CAM is determined to change. If we catch this disease earlier and employ a multimodal approach including simple, accessible, low cost interventions, we can see substantial results. CAM believes that by changing owner, vet and public perception of how to diagnose and treat chronic pain, we will improve the lives of the animals and their owners, for longer. pain relieving medications for your dog. ese will not be discussed in this article, but are oen the cornerstone for the treatment of arthritis. Your vet may also discuss surgery like hip replacements, or some of the more recent advances in regenerative medicine. CAM believes that a multi-modal management plan is imperative for coping with arthritis, and a combination of medications, weight management, home environment and lifestyle adaptations plus additional therapies such as physiotherapy, massage, hydrotherapy, acupuncture or laser give you and your dog the best chance at slowing down the inevitable progression of the disease.For further information on the multi-modal management of OA, please see our website: www.caninearthritis.co.uk, and our Facebook page Canine Arthritis Management for help, support and advice in how to manage your dog.

14Animal Therapy Magazine | ISSUE 20RETRAINING ex racehorses comes with so much; joy, pride and moments of feeling very proud. However, the journey is also littered with; self doubt, frustration, feeling of inadequacy and moments when you just question your utter sanity. We are taking an animal who has been bred for speed and agility and we are asking them to be; calm, obedient, supple, harmonious and not to use their adrenaline for haste and lightening quick reactions. For some it can take years, some it takes months, some never actually complete their ‘retraining journey’ for a multitude of reasons. Everyone approaches things dierently, each horse and rider learn dierently and at dierent rates. I believe that if we can have the greatest amount of knowledge and understanding of what it is that we are trying to get our ex racers to do then we will not only be better advocates for them, but also better riders, trainers and coaches. With this in mind, what I am about to ask and explain over the next article, I am asking for you as the reader, to approach with an open mind, and be willing to; get down and try …Retraining of RacehorsesTHOROUGHBRED DRESSAGEby Louise Robson, oroughbred DressagePut yourself in their shoesIn my previous articles I have used photographs of myself riding some of my wonderful ex racehorses at various stages of their training and development to help explain some of what, I feel, to be some of the most ‘common’ problems, or targeted training areas that the ex racehorse may struggle with in comparison to those breeds that have a conformation more suited towards dressage. I have explained what we are trying to achieve, the ‘look’ and ‘feel’ that we are searching for, but I realised when teaching the other day that you can only explain so much before you just have to get the rider to do it themselves! It isn’t every day that I ask a rider to get o and get down in the sand (I am usually trying to prevent that from happening, not to encourage it). As the saying goes:“You can’t understand someone until you've walked a mile in their shoes”Well, how about 40 metres up the arena?All horses, regardless of breed are wider at the hips than compared to the shoulders. What separates the racehorse from other breeds is that you have the above ‘problem’ combined with; being croup high and having limbs that don't naturally ‘bend’ but stay in more of a ‘straighter’ action.e bending of their joints, especially their hind limbs, isn’t really the thoroughbreds ‘thing.’ Due to the length of the hind limb in comparison to the forelimb you usually have what appears to be a straight action, almost like a tin man. is is not to say that through time and exercises you cannot encourage the hind limb to bend, it’s more a case of ‘how’ rather than ‘can’t.’ What I am about to demonstrate is obviously an ‘extreme’ of what your typical ex racer may look like and how they move, like I mentioned previously, keep an open mind. From Fig 1 you can see that you start o in a naturally ‘croup high’ position.AFig 2.1 Fig 2.2Fig 1

15 Animal Therapy Magazine | ISSUE 20continued overleafStart o in position 1, shown in g 1. From position one, bring each foot in line with your hands (Fig 2.1 and 2.2.) From there walk forwards with the hands, one by one, and then bring in the feet, one by one (the same foot pattern as a horse walking) Firstly, keep going like that for the duration of the length of the arena and see how much of a toll it can take on your body and breathing. Secondly, now think about the pressures and forces that have been used/what hurts? When you're in the position shown in Fig 2, you will feel a slight ‘toppling’ eect. All of the forces feel like you are tipping from the back end, on to your shoulders and the feeling of almost falling downwards into the sand/oor. You will balance yourself by putting your weight into your arms and hands-you are on the forehand! (See Fig 3 for direction of forces and loads placed)is is what happens to most, if not all croup high ex racehorses, especially those with the bigger walks. As riders, the feeling we get when on the horse is a slight pull forward and down on the rein and that we are being pulled slightly forward and out of the saddle. e most ‘go to’ answer is to either, try and pull the rein or to ask the horse to go more forward from the leg. In both cases this will not help improve the feel, but only exaggerate it. Sometimes the reason that your ex racehorse walks around with their head in the air is to actually help balance themselves. eir neck is like their h leg. If you repeat Fig 1-2 with your chin tucked towards your chest, it is even harder (Fig.4). If you extend your neck more forwards and out, it helps your balance as you move forward. continued overleafBIf you then think of this movement in the faster paces of the trot and the canter, you can see why your ex racer, in the early days, will have a very varied rhythm as they will have moments of not being able to nd their balance/work out where their feet have got to go without standing on themselves. What is also worth bearing in mind whilst performing Fig 1-2 is that you're doing this alone, without any tack on, and without rider, who will have their own balance issues. Furthermore, you will be doing this exercise, hopefully, without any pain, or too many asymmetrical issues. Add these to the list, of what already seems to be a dicult thing, and then we are part of the way to appreciating how much our ex racers try and give us, and how vitally important it is that we give them time, patience and understanding to avoid any orthopaedic, so tissue and mental problems. So, how do we begin to ‘resolve’ and begin to develop our new dancing partner? It is commonly said that; e horse ‘owns you’ on the so and you ‘own’ them on the hard. e same can be applied to your training approach. You can have greater inuence and a greater eect with your ex racehorse on a curved line, they can have a greater inuence on you on the straight. Your ex racer will not naturally ‘connect’ from front to back end i.e. the hind leg supporting and using forward into an uphill frame. ey will predominantly be ‘front end’ driven. As previously mentioned, they will use their neck to balance themselves and due to their slightly croup high conformation they will be loading the forehand. In the early stages they do not know or understand how to li the forehand by engaging the hind leg, we have to explain this to them. Fig 4Fig 3Fig 5.1Fig 5.2Fig 6.1Fig 6.2

16Animal Therapy Magazine | ISSUE 20When your ex racer is straight they go back to Fig 2. Going back to Fig 1 from that position if you place both hands to either the direct le or the direct right of your feet (Fig 5.1 and 5.2.) and then try to walk forward from your feet, you will have your inside foot placed underneath and to the middle of your body. is will help you ‘push’ forward. (Fig 6.1 and 6.2). I called this ‘threading the inside hind between both front feet’. Walking forward becomes easier than before, you end up bending the knee to push forward and when you do so you no longer feel the pressures and forces that you felt in Fig 3. Your shoulders and arms feel less pressure aka you start to li the forehand. You THOROUGHBRED DRESSAGEDates for your DiaryAnimal Therapy Magazine is one of a kind. The publication’s sole aim is to inform professionals and owners of current and pioneering treatments and techniques. Featuring interviews with top professionals in the eld, real life case studies and up-to-date news and reviews, Animal Therapy Magazine is a must have for anyone involved with animals; whether that is in a professional capacity, pet owner or both. • Quarterly publication• Circulated worldwide• Online version• Targeted audience and distribution• Course and CPD information• Editorials written by highly regarded industry professionals• Case studies• Professional proles• Product reviews• Interviews Don't forget to keep a close eye on our website for press releases, articles and hot off the press industry informationAnimalerapySUBSCRIBE NOW You can subscribe to read our online copy for just £10 per year.Further information can be found on our website animaltherapymedia.co.ukFig 7Fig 8.1 Fig 8.2are placing the forelegs and hind legs on a dierent line to each other and creating a space to allow the hind leg to step through and under. You're creating a connection and through this, a better balance. (Fig 7.) You will also notice that when you move in this way, you have more ability to move and adapt your neck. In the early days of retraining, circles, serpentines, shallow loops and baby leg yields, are all exercises that will help develop the connection and create the ‘new language’ between you and your ex racer. Each of the exercises place the shoulders on a dierent line to the hind leg whilst being able to move forward. You have to be careful that you're not pushing/asking for too much sideways step otherwise you can create a ‘collapse’ of the hind leg rather than trying to encourage and develop it in a supporting, and ultimately pushing role. In Fig.8.1 and 8.2 you can see how the collapse can cause the pelvis to ‘roll’ rather than staying straight. is in turn will not help with your connectionUltimately, when you're having; contact, connection, rhythm and balance issues, which may lead to behavioural and mental issues (from both horse and rider) put yourself back into your horses shoes. ink, understand and then develop.

17 Animal Therapy Magazine | ISSUE 20“Be careful what you wish for” a saying that has come so true for us equestrian professionals who are forever wishing we had a bit more time in the day with a little less to do! Its’s a pity we have what we wanted because of these unprecedented circumstances. It’s well known that trainers, riders and other professionals in the equestrian industry don’t know what a weekend or bank holiday feels like, let alone a 9-5 working day, but all of a sudden COVID-19 has put the handbrake on all sports, specically Dressage for me.Stoic rural attitudes about our robust immune systems and anti-social distance lifestyles count for nothing during the collective eort to protect our health services and the vulnerable.A large proportion of my job involves travelling up and down the country either competing or holding clinics and demonstrations at equestrian centres. With neither of these outlets available I’ve been able to spend much more time at my yard with the horses I train daily. A blessing for me and I feel so fortunate to be able to have that to keep me sane, although I’m not sure everyone on the yard relishes the thought of more Levi time!As a rider I have been able to concentrate on the subjects and issues with my horses without the upcoming pressure of impending competitions.Dressage is a demonstration of your training but with each test requiring certain movements in a particular place and order, you tend to tailor your training at home to your next test.Without tests to prepare for I have been able to invest even more time into other benecial training exercises such as pole work, in-hand work and who would have ever thought I’d be saying this … hacking.Also, I feel for once, it’s socially acceptable to let my stubble reach day 5 which is a rare treat as beards and riding hats just don’t match!But with so many coaching and travelling hours now free, my attention had gone online. The thing us technologically challenged country folk fear the most …THE INTERNET.With many clients in need of training but unable to access it in person I put an invitation out for anyone (client or not) to submit videos or questions and I would give feedback and set goals for the following week.This has opened my eyes to the amount of riders out there who can’t access trainers even without the presence of a global pandemic. With more trainers helping online via facetime calls it feels like a step into the 21st century for sure.My nal bit of help that I thrust on everyone through social media was a series of training videos and picture examples. From ground work for those who could not / did not want to ride during the initial 5 weeks of lockdown and riding tips for those who were still in the saddle. The biggest thing I appreciated about doing these was just how painful editing videos are. If you’re reading this and edit for a living … I salute youLevi’s BlogGetting creative during lockdown!LEVI HUNTLevi Hunt - Grand Prix International Rider for Great Britain, British Dressage Young Professional of the year 2016, Regional British Dressage Team Trainer, UKCC3 CoachLevi regularly runs clinics up and down the country. You can contact him via his facebook page - Levi Hunt Equestrian or through his PA - Nicky on 07771 61002717 Animal Therapy Magazine | ISSUE 20

18Animal Therapy Magazine | ISSUE 20You’ve qualied in your chosen eld, and now it’s time to register with a governing body. But how do you choose? Stephanie Bateman investigates.WHETHER you qualify as a veterinary physiotherapist, a chiropractor, an osteopath or an animal masseur, all therapists become registered with a governing body after graduation. There’s a number of benets to this. Firstly, the association is there to support its members whether they need advice or help with CPD training. Secondly, they also have their own disciplinary procedures and codes of conduct which aim to maintain the reputation and professionalism of therapists and protects animals and their owners.In this issue, we will focus on physiotherapist and osteopaths, followed by chiropractic and massage therapy next time. The associations available for physios and osteos are shown in the panel.What happens after Graduation?WHO’S THE DADDY?Despite the wide variety of associations to choose from, what there isn’t is one, all-empowering ocial governing body for animal therapists. “Chartered physiotherapists are registered but this is in their capacity as a human physiotherapist and not as an animal physiotherapist,” says Sherry Scott, pioneer of animal physiotherapy and founder of the IAAT.“If you see an animal physiotherapist use the term “registered” or “regulated” this would be with their own association and not with or by the Royal College of Veterinary Surgeons (RCVS). There is also no ocial recognition given by the RCVS to any animal physiotherapy course or association.”Most practitioners believe that an ocial register is required and will benet the industry.“It’s just a matter of time,” says chair of the NAVP Halina Tombs. “We need an RCVS led register because we need somewhere that vets and owners can go to that says all these people on the register have a similar degree and are all trained to a standard. That will take us to protection of title which means if you aren’t registered, you can’t practice, like with human therapists.”Sherry agrees there is a place for a governing body. “The idea of having one governing body comes with umbrellas,” she explains. “It should be something that is cosy and comforting and gives you a means against the weather of all sorts of things. If people hit dicult times, they need somewhere to go. People nowadays are lucky, because when I started, there was no structure and nowhere to go for advice or support.”PHYSIOTHERAPYnThe International Association of Animal Therapist (IAAT) IAAT is an inclusive organisation that values cooperation and collaboration. Membership of IAAT is open to all animal therapists, veterinary surgeons and nurses who hold an accredited qualication in the relevant animal therapies. www.iaat.org.uknNational Association of Veterinary Physiotherapists (NAVP) NAVP welcomes applications for membership from all veterinary physiotherapists holding a university externally moderated and accredited qualication at BSc, PgD, or MSc degree level.www.navp.co.uknThe Institute of Registered Veterinary and Animal Physiotherapists (IRVAP) IRVAP membership community includes veterinary surgeons, veterinary physiotherapists, animal musculoskeletal practitioners, veterinary nurses, canine hydrotherapists, animal massage therapists and TTouch practitioners who are holders of animal therapy qualications. www.irvap.org.uknAssociation of Chartered Physiotherapists in Animal Therapy (ACPAT) ACPAT members are qualied Chartered Human Physiotherapists (MCSPs) who have further trained in physiotherapy and rehabilitation for animals. www.acpat.orgOSTEOPATHYThere is only one route to becoming a qualied animal osteopath and that is to do the human course rst. You are then governed by The General Osteopathic Council (GOsC). www.osteopathy.org.uk GOVERNING BODIES

19 Animal Therapy Magazine | ISSUE 20Once a governing body is in operation and is ocially legal, the associations become the professional interest groups and it’ll be the associations who lobby for and on behalf of their members. “It’s important to make a point that an ocial register is there to protect the animal, the owner and the profession – if something goes wrong, clients can go back to the RCVS with their complaint and something will be done,” says Halina. “They would also accredit courses to ensure an overall standard. It is not there to protect, support, embrace and develop the practitioner – that is the role of the associations. The two come together but they have dierent jobs to do.” WHICH ASSOCIATION?With a variety of dierent associations to pick from, how do practitioners choose? “It’s dicult because everybody is dierent and what is oered is dierent,” says Sherry. “I don’t necessarily approve of there being lots of dierent registers because it’s confusing for people not only looking to register to one, but for people and for vets looking for someone to treat their animal. The important point to make is that they need to belong to something – they need the advice and people making sure they are doing the right thing. I have emails from people all over the world asking what they can and can’t do. I’m there to listen and oer advice and help people connect.” Halina believes that most people join the association that is linked to the course they studied through. “Usually, when a course is set up, there is an association to run alongside it which is there to support the people who have been on their course,” she says. “You graduate and tend to join the association that historically produced your course.” AND THEN CAME THE REGISTERSTo mix things up even further, there are now also two voluntary registers available for practitioners to choose from. These two registers came about as a result of a failed attempt to set up one register. They include: nRegister of Animal Musculoskeletal Practitioners (RAMP) RAMP is a voluntary register of chiropractic, osteopathic and physiotherapy professionals who the register regards as animal musculoskeletal practitioners. Members of this register’s council have trained in human techniques before furthering their expertise in the animal sphere. www.rampregister.orgnAnimal Health Professions Register (AHPR) Membership of the AHPR is open to those who provide services for the treatment of animals under veterinary referral and for the maintenance of health. This includes chiropractic and manipulation, hydrotherapy, veterinary physiotherapy, sports therapy and massage. www.ahpr.org.ukInitial talks between the two registers aimed at uniting them as one governing register, couldn’t be agreed due to the ongoing diering opinions, and so there became two. Sadly not the step forward therapists had hoped for.The IAAT embraces every form of animal therapy. All these governing bodies have their place and they can complement each other, so it’s important that we can work together. It’s about nding the common ground.” The NAVP also welcomes cohesion amongst all the associations and will continue to support the call for one ocial register. ‘’Ultimately, we all need to work together – because our main aim has to be the welfare of the animals in our care’’.19 Animal Therapy Magazine | ISSUE 20

20Animal Therapy Magazine | ISSUE 20TONY NEVINEarlier this year it hit the headlines when a well-known company was found guilty of grossly exaggerating what thermal imaging could do, and what the company was claiming they could oer, including references to qualications and colleges that simply didn’t exist.By committing these oences thermal imaging has taken a heavy knock.As an ardent user and proponent of this incredible assessment tool I would like to ght the corner for thermal imaging, and in particular its correct uses.First of all, I’d like to explain exactly how these cameras work in the case of scanning an animal patient. Infrared thermal imaging cameras measure the radiated heat given o by a subject. ey do have to be calibrated correctly to measure the exact emissivity of the subject being scanned. Human skin has an emissivity of between 0.95 and 0.98. is is the closest to a perfect emitter, or blackbody as is possible. Blackbodies are an idealization, as no structure can emit this maximum thermal temperature at a given temperature.1 In order to read this accurately it is essential to set out strict protocols, as well as using the appropriate equipment. e rst thing is to ensure that if you intend to use thermography as part of your clinical toolbox that you use the right sort of camera. A device that clips onto your smart phone is great for nding lost cats and for spotting an inammatory condition such as pus in a horse’s foot, but it is simply not up to the task of accurately measuring smaller temperature changes throughout the rest of the body of a patient.e main diculty when scanning is to get the camera and the subject positioned correctly so that what you capture is radiated heat. If the angle is incorrect then you will record reected heat, which might come from a source other than the subject.When I began working with Dr Chris Colles, he had been using infrared thermal imaging (IRTI) for around 15 years and had developed the protocols I will be talking about here. He had invested in a top of the range system in order to see if it was possible to measure temperature changes due to altered blood ow under the skin, as a result of altered activity within the sympathetic nervous system (SNS). He was keen to nd a way of assessing the work of equine Infrared Thermal ImagingIts role in the clinic by Tony Nevin, BSc (Hons) Ost, DO, Zoo Ost LtdINFRARED thermal imaging has been around for decades. It was developed by the British during World War Two, as a possible means of seeing enemy aircra at night and in bad weather, and thus aid anti-aircra defences. Since then it has been used for assessing thermal insulation, right the way through to police and other military applications.In more recent years it has also found a use in medicine and veterinary medicine. However, for some reason its use has not always been fully understood, and neither have the ways it has been applied, or the interpretation of the results used correctly.Below: Young bull African elephant with mild right forelimb lameness. Note the cold area over the spine of the scapula. Also of note is the ear, which elephants use as part of their thermoregulation.

21 Animal Therapy Magazine | ISSUE 20osteopath Anthony Pusey, for as any of us will know, measuring treatment outcomes can be vague at best, especially when looking at patients with long term musculoskeletal (MSK) problems.Over time Chris worked out the best time spans between scans in order to read accurately how the patient had been able to accept changes initiated by the osteopathic treatments. He also ascertained how long you need a horse to be kept in a climate-controlled room before you can expect to take an accurate scan.Since he and Anthony set up these protocols, and through the data they, and later I have been able to contribute, the clinic was able to assess more than 4000 dierent horses. All had been extensively screened by veterinary surgeons, and when they came to our clinic it was via rst or secondary referral. erefore, we were in the incredibly fortunate position of knowing an awful lot about each case we were seeing.In 2014 we nally managed to get a paper published in Equine Veterinary Education2. It took quite a while to satisfy the scrutineers, partly because we had only included cases that had been seen by at least one other recognised equine orthopaedic referral clinic prior to seeing them, and also due to the the fact that out of all of the cases in our paper, only one showed consistent ndings on using diagnostic (radiographs and scintigraphy) and assessment tools (IRTI), and that was a tooth abscess and not what it had been referred to us for treatment.continued overleafLeft: A standard set of six thermal images of a horse. Note cooler bands around the cranial part of the neck bilaterally, and over the left gluteal musculature; and raised temperatures over the thoracic sling area, quadriceps groups, and hamstrings. This horse had sustained a rotational fall several months prior to the images being taken.Below: White Rhino with sinus infection. IRTI was able to help the vets assess treatment progress from a course of antibiotics.Getting a horse to stand exactly where you want isn’t always easy, but over the years we seemed to develop ways to encourage this without stressing the patient. Stress will obviously aect the SNS and therefore any scan results.The protocols that we set out to use were as follows.1. All IRTI scanning was to be done inside a suitable climate-controlled room. This would rule out any atmospheric conditions aecting the radiated heat given o by each patient. Both ambient heat and humidity can aect the accuracy of infrared scans.2. Horses should arrive up to two hours before their allotted appointments to take account of any stress and sweating.3. All horses should be clean and dry prior to travelling. Any dried on mud, or wet coats would negate any scans taken.4. Upon arriving at the clinic each horse would be checked in and kept under cover from sun, wind, or rain.5. Horses were not to be groomed or heavily petted upon arrival, as this can stimulate SNS action and therefore alter subcutaneous blood ow.6. Once in the scanning room the horse would be allowed to acclimatise. This could be monitored through the IRTI camera prior to any scans being taken.7. Clip length of coat was noted, and settings would be adjusted for dierent clip lengths. 8. The IRTI camera was set to record temperature dierences in 0.5°C colour changes over a total range of 10°C. Each horse was calibrated against the heat given o by the eyeball, as this is constant. Emissivity was set at 0.95.9. All scans were taken at a set distance from the camera and with the subject at 90° to the camera lens.10. Each horse had a scan of the neck on both sides, the rest of the body from both sides, and then the back end, followed by an overview from behind, looking along the spine from tail to head. Each scan also contained all of the data printed onto the image.

22Animal Therapy Magazine | ISSUE 20What can the scans tell us? Well if we are looking at a horse with a fresh MSK injury then we would expect to see an increase in radiated heat from around the site of the injury.If the problem has been there for more than a few weeks then what we would be looking at would be the onset of a compensatory pattern, with altered muscle tension states at rest. All the areas with increased tension would radiate less heat due to the reduced blood ow through these tense structures, whilst other regions might have raised temperatures (above the norm for the rest of the individual).If we were to be presented with a horse with a very long-standing condition that has been coping up to a point, then what we found was that we would get a mottled pattern over the areas where these structures were adapting to their situation.is would be borne out by the continual updating of the case history and by clinical observation of the patient on each, and every subsequent, visit.erefore, it became second nature to have Dr Colles assess osteopathic treatments using this method. Owners and trainers found it useful too, once we had explained what we were looking at.Since spending so much time assessing IRTI on horses and the measurable changes it has been possible to take these skills to scan many other species with MSK, and sometimes other conditions. e main thing to remember though, is that IRTI can tell you what state the blood ow is directly under the skin. It does not tell you why it might be altered. No matter how much you want it to. However, when used as part of the amazing toolbox of protocols we use in clinically assessing a patient, it does have a massive part to play in monitoring progress.It can also be used dynamically with rehab work. Many riders will tell you that their horse feels like it’s back to normal. It’s oen interesting to scan it, then get the owner to work it up for around 15-20 minutes, and then re-scan. You can very quickly see which muscle groups it is using, and if in fact it is “back to normal.”e one thing it cannot do is work through really thick fur, hair, or feathers.It also needs a reasonable body mass to surface area too.REFERENCES1. Vollmer M., Mollmann K.-P. (2010), Infrared Thermal Imaging, Fundamentals, Research and Applications. Wiley-VCH pp21-40.2. Colles CM, Nevin A, Brooks J (2014) Equine Veterinary Education 26 (3) pp148-155. The Osteopathic treatment of somatic dysfunction causing gait abnormality in 51 horses.ADDITIONAL READING.Colles CM (2005) The use of thermography as a diagnostic tool in assessing musculoskeletal problems in the Asian Elephant, and as a gauge to the eectiveness of osteopathic treatment of such structures, Twycross Zoo. Proceedings of the Seventh Annual Symposium on Zoo Research, BIAZA, Twycross Zoo, Warwickshire, UK.Colles CM, Hola G., Pusey A (1994) Thermal Imaging as an aid to the diagnosis of back pain in the horse. Proceedings of the Sixth European Congress of Thermography, Bath, UK. Pp164-167.Colles CM, Nevin A (2015) Unpublished clinical data from 4000 horses scanned using IRTI.Nevin A. (2004) The use of thermal imaging to assess osteopathic treatment of a captive Asian elephant BIAZA: Proceedings of the Sixth Annual Symposium on Zoo research, 8th-9th July 2004, Edinburgh Zoo, Edinburgh, UK.Nevin A. (2012) Using IRTI to assess two Asian elephants. The First International Congress of Osteopathy in Animal Practice, Rome, Italy.TONY NEVINBelow: European hedgehog with left side facial nerve paralysis, caused by a dog bite, and the same hedgehog following a course of osteopathic treatment.Pregnant Rothschild Girae – part of a blind study of a captive breeding group by ZOL to see if there are any common thermal signature patterns that might indicate pregnancy.For my work it has been great with all of the major megafauna, and sometimes some of the more unusual patients we see.To summarise then, IRTI is a great assessment tool when used correctly. It is not a magic wand, but then neither are any of the other major diagnostic or assessment tools in use. It does have its place in veterinary medicine and animal therapy within a clinic environment. If you see someone waving one around at a horse show, walk the other way, or ask them why they want to degrade what is a fantastic scientic instrument.Tony Nevin, BSc (Hons) Ost, DO is Clinical Director on the MSc Animal Osteopathy programme, run through the McTimoney College of Chiropractic, Oxon. For more information contact Tony at +44 7831 759339. www.zooost.com www.horseost.co.uk www.coriniumradio.co.uk www.mixcloud.com/tonynevinBelow: This image shows the radiated heat given o by the hedgehog, and that reected o the examination table.

23 Animal Therapy Magazine | ISSUE 20Equine ThermographyGiving your horse a voice by Elaine Hall, DipICAT (Dist), Cert Vet Ed (Merit), MAAT, FHEA, Certied ThermographerElaine is a fully trained Equine Thermographer oering a professional, condential service in thermal imaging for horse owners, trainers, vets and other equine professionals. ELAINE HALL DipICAT, Cert Vet Ed, MAAT, FHEA, Certified Equine Thermographer www.equine-thermography.co.uk PROFESSIONAL EQUINE THERMOGRAPHY 07876716417 I have ridden all my life and evented for twenty years up to Advanced Level. Currently I concentrate on dressage, competing with my warmblood mare. I have extensive experience and depth of knowledge including; Veterinary Nursing experience, am a SMS Trained saddle tter, a qualied Equine Sports Massage Therapist (DipICAT) and a Certied Thermographer. Therefore I have an excellent understanding of equine anatomy & physiology, horse & rider balance and the stresses & strains placed on the horse through training & competing. My husband Alf, of Equine Foot Clinic, is a Remedial Farrier so I have a keen interest in the Thermal Patterns of Equine Feet, and as a suerer myself of chronic neuropathic pain I have a keen interest in equine chronic pain and nerve damage.I have attended training courses given by Dr Tracy Turner DVM, Prof Ram Purohit, Dr Jim Waldsmith DVM and Dr Ken Marcella, all pioneers in Veterinary Thermal Imaging. I have been trained in the thermal patterns associated with nerve damage and Equine Dermatome Patterns by Prof Ram Purohit, a specialist in this subject. I am a Member of The Veterinary Thermal Imaging Society (USA), the American Academy of Thermology, the International Equine Thermography Association. The UK Thermography Association and am a principle at The Equine Thermography Training Centre and the Equine Trainer at iRed Academy. I have a PG Cert in Veterinary Education from the Royal Veterinary College and am a Fellow of the Higher Education Academy in relation to my aim of raising the quality of Equine Thermography through iRed Academy and The Equine Thermography Training Centre.How I use thermal imagingI travel to your premises where I take two sets of images (about 120 images in total), adhering to strict industry standard protocols and standards, one set before exercise and one after exercise. This gives me further information for example about how your horse is weight bearing, giving me valuable information in the interpretation of the all the images. You are provided with a 9 page report that meets the standards expected in the veterinary and thermal industries, giving you more information than you may other wise have and may highlight any area/s needing more critical evaluation. CASE REPORT 18 yr old cob. Owned since 3 yr old. Canters OK on lunge but bucks when ridden. Thermal imaging highlighted abnormal thermal pattern cranial aspect proximal right hind (white circle), veterinary investigation found injury to stie ligament, this was repaired and 3 months post surgery cob is back cantering.CASE REPORT 25 yr old warmblood. Became hard to catch at rst, then would get excited and zzy, now rearing and bucking.Thermal imaging highlighted abnormal thermal pattern mid thoracic back (white circle). Veterinary investigation showed narrow gaps between some thoracic vertebrae, with chiropractic treatment behaviour is improving.

24Animal Therapy Magazine | ISSUE 20RESEARCH estimates that 130,000 dogs come into UK rehoming charities each year. As a nation of dog lovers, in the UK we are seeing more and more people rescuing troubled dogs from across the globe than ever before. Rehoming charities across the country deal with dogs who have been abandoned, abused and unloved from all around the world and rehome them to those who are ready and willing to oer them loving, long term homes. As a behavioural company, most of the dogs we see and work with are rescue dogs with a whole host of behavioural problems and are in need of some training to readjust to life in your everyday family home. So we created this list of our top 5 tips for new or potential rescue dog owners that can set you up to succeed straight away!New Rescue Dog Top Tips for Owners1. Create and stick to a routineA lot of people when they get a rescue dog want to shower them in love and aection and spoil them with lots of new toys, treats, beds and accessories. While this is a lovely thing for a dog who has probably lived a life with near to nothing, it can be really overwhelming for such a drastic change so suddenly. Most rescue dogs come with an unknown history and some may have never lived in a home environment before. The worst thing you can do for a new dog who is nervous and unsure of their new surroundings is allow them too much freedom. Too much freedom too soon can make dogs nervous and confused and this is generally where a lot of unwanted behaviours start to show up. Generally, new dogs will be in their ‘honeymoon period’ for a minimum of a month from their arrival. This means that for the rst month of owning your dog, they generally will act very well behaved because they are nervous. The best way to help your new dog in this time is to create a good routine and stick to it to help your dog know what is happening each day and to allow them to adjust to their new home in their own time.2. Utilise a house leadWhen you initially get a new dog, you’ll both be learning how to live together and what life looks like as a family together. Your dog will be exploring and testing the waters to see what is allowed and what isn’t. If you have a rescue that may be nervous or jumpy, it’s a good idea to have a lead on so you aren’t grabbing collars when your dog’s doing something you don’t like. We generally use a 2 metre lead that stays on the dog whilst it’s free roaming for at least the rst two weeks of having it. by Charlotte Groom, Balanced Energy - Canine Training

25 Animal Therapy Magazine | ISSUE 20This makes it easy for you to give your dog direction through the lead if it does something unwanted or needs some help. This makes teaching your dog new things in those rst few weeks easier and safer for everyone.3. Get and stick to a good dietOne of the rst things we do when we work with a new dog is look at their diet and overall health before we start anything else. We generally recommend getting a full set of bloodwork done, a health check and make sure they are on a really good diet. We’ll then stick to that diet for at least a month before making any major changes. Getting your dog on a good diet is essential as what you feed your dog has a huge eect on their overall health and behviour. Do your research, pick a good food and stick to it for a minimum of a month. Give your dog regular feeding times and if they don’t eat it take it away after 30 minutes and try again at their next feeding time. Don’t be alarmed if they don’t eat straight away – nervous or stressed dogs will often take a couple of days to settle and eat properly. Just give them a safe and quiet place to eat and if they don’t want it then don’t force them. 4. Don’t expect too much too soonRescue dogs may have been through a lot in their life and its important not to rush things and expect them to do and be a lot too soon. When you rst bring your new dog home, don’t expect them to simply adapt immediately and be your perfect family pet day one. Their life will have completely changed and there may be a lot of new things they haven’t experienced before. Allow your dog to adjust and be prepared to do some training if your dog shows that they are scared or unsure about something. On the ip side, just because your dog is a rescue or is new doesn’t mean you can’t or shouldn’t be training them. At the beginning start training what you do and don’t want from your dog. If they’re scared of the TV, do some training to help them not to be. Use your rst walk to start training them to walk nicely on the lead straight away. Don’t expect them to be perfect straight away but start with the basics and work your way up. Rescue dogs are just as trainable as puppies!5. Get help early on if you need itWhen you get a rescue dog, the best thing to do is treat them as if they’re a puppy and start training straight away. If you start training straight away, it will be much easier for your dog to understand the rules of the house and means they will feel more comfortable at home. Don’t be afraid to get help from a trainer early on and deal with small issues straight away rather than waiting for it to become a bigger one. Things like pulling, o lead recall, manners in the house and reactivity can be easily solved early on with the help of an experienced trainer or behaviourist. Fixing these issues early on means your dog won’t be stressed and you can both live a happier and more harmonious life together.Getting a rescue dog is one of the most rewarding things you can do and can also be one of the most challenging. It is important to remember that every dog is dierent and although getting a new dog is exciting, it can also be very scary for the dog. Having a dog, whether it’s a rescue or a puppy, is a lifelong commitment. Part of owning a dog is teaching them how to live in our human world and if you start o early, you’ll be ready to take on whatever the world throws at you together.

26Animal Therapy Magazine | ISSUE 20Moorcroft Equine Rehabilitation CentreREHABILITATION In discussion with Mary Frances, CEO of Moorcroft Equine Rehabilitation Centre, about future plans following the appointment of Chief Veterinary Advisor, Dr Sue DysonC126 Animal Therapy Magazine | ISSUE 20Tell us about Moorcroft and how it was established Moorcro Equine Rehabilitation Centre is a charity in Slinfold, West Sussex. Established in 1999, the charity originally focused on helping ex-racehorses to transition into a second career. Now Moorcro provides equine rehabilitation and re-training to all horses, helping injured or damaged horses as well as dressage, showjumping, racing and/or leisure horses. Moorcro runs a training and education centre oering bespoke courses with industry experts on all aspects of equine soundness, rehab and care, and is a centre of excellence with a high standard of facilities including a newly built indoor school with viewing platforms.Our main focus is to give every horse the best possible chance of a pain free existence; all that we do centres around that. We have extensive experience – our sta here have been with us a long time and continually build on their knowledge. We use a strong team of excellent vets and physiotherapists who help us hugely in our quest. Another one of our goals is to be a centre of education and for that reason we run as many educational courses as we can in all areas of equine rehabilitation so we can pass on our knowledge to others and therefore help more horses. Some of the regular courses that take place at the centre include Long-reining, Rehabilitative What are your main goals? In short our goals are:• To truly help every horse that comes our way in a long-term sustainable way.• To help and give condence to any rider/trainer that seeks our help with their horse or comes to a course or lecture here.• To continuously build our own knowledge and practical skills on the management of Equine Lameness issues and Back Pain in horses and to truly learn to prevent it.

27 Animal Therapy Magazine | ISSUE 204What areas of equine research do you feel are vital to explore?e lockdown has focused all our minds on the here and now, and our main focus is to help provide support and help on the education of both Horse and Rider. We are also committed to improvingall veterinary care for the horseshere, and Equine Physiotherapists are a large element of that work. Last year Dr Dyson gave an excellent talk at Moorcro to Equine Physiotherapists about identifying pain in horses. e event was fully booked, and we had excellent feedback from the attendees who greatly benetted from the discussions and practical demonstrations. We are planning for Dr Dyson to oer a follow up session Above centre: Dr. Sue Dyson. Below: Mary Frances, Lianne Bird and Kate AkersRiding and Equine Massage along with talks on Gut Health, Nutrition and many more. We have been rehabilitating ex-racehorses for many years and they all come with their problems. Some are very young, others much older, but we also help other breeds who suer from lameness issues or problems and are in need of rehabilitation. More importantly these horses need a management system for the future so they can live a much more comfortable life. Horses can come to us for a few weeks before returning home having improved; whilst some stay longer. We like to work WITH the owner/rider so nothing is hidden and so the rider goes away with better skills and more understanding. Most horses have problems but it is learning to manage the condition well so the horse is comfortable that is important and oen we can help with that. Here at the Centre we believe all horses deserve a pain free working life and that it is our responsibility to achieve that - especially if we have decided to ride them for our enjoyment.With Sue Dyson joining your team what are the rst projects you’d like to get started with? We do not rely on guesswork so all that we do is centred around rstly obtaining a correct diagnosis, followed by proven treatments. For that reason we are delighted that Dr Sue Dyson is happy to take on the role of being our Chief Veterinary Adviser. Dr Dyson has a wealth of experience in so many veterinary areas and we are blessed to be able to draw upon all that knowledge and experience. e horses at the centre will, undoubtedly, benet enormously. Dr Dyson has particular expertise in equine lameness and poor performance, with extensive experience working with sports horses, leisure horses and racehorses. She has also ridden to upper national level in Eventing and Show-jumping, and holds the Instructor and Stable Management certicates of the British Horse Society (BHSI). Her extensive background knowledge relevant to rehabilitation of horses will provide us with an excellent source of support and guidance.in September on Equine Lameness – another key area of focus for her and the Centre. We are also planning further talks for Physiotherapists and/or vets throughout 2021. Dr Dyson is - of course - open to considering any topics oered by the professions she helps, and working with Moorcro enables her access to the horses and the facilities needed. We are also currently trying to organise a monthly Dr Dyson M.O.T. Clinic for Horses. Many physiotherapists we are in touch with have fed back that they would love somewhere to send their client’s horses in order to receive a better diagnosis of the underlying conditions that they are treating. is is Dr Dyson’s area of expertise and could help many; more information coming soon! www.moorcroftracehorse.org.uk

28Animal Therapy Magazine | ISSUE 20TRAUMATIC avulsion of the brachial plexus nerve roots is the most common cause of acute thoracic limb monoparesis/plegia in small animals. Patients suering from this type of injury will have decreased voluntary motor and sensory function (Añor, 2017). What is a brachial plexus avulsion?A brachial plexus avulsion is a common cause of peripheral nerve injury. ese are commonly caused through fractures, poor surgical technique, traumatic avulsion of the nerve root (such as from a fall from a great height or a road trac accident (RTA)), and intramuscular injection (omas et al., 2014). ere are dierent degrees of injury associated with peripheral nerve injuries: • Neurapraxia is the interruption of nerve conduction without physical disruption of the axon. It can be caused by a loss of blood supply, compression or blunt trauma. Patients will usually completely recovery in 1-2 weeks, however, if demyelination has occurred (without axonal discontinuity) this can take up to 6 weeks.• Axonotmesis is the physical interruption of an axon, with separation from the neuronal cell body. This results in loss of conduction distal to the injury. Recovery is more guarded in these cases but, if possible, may take as long as the axon takes to regrow (between 1-4 mm/day) (Uchida et al., 1993).• Neurotmesis is the complete severance of the nerve trunk, including the axon, Schwann cells, and any supportive connective tissue. This is the most severe type of nerve injury, regeneration to the nerve tissue is unlikely, and the formation of a neuroma is possible (Añor, 2017). ere are three types of avulsions which are classied depending on which nerve roots are aected. Cranial avulsions (C6-C8) are rare and have very few clinical signs. e animal is able to bear weight on the limb as the elbow extensors are not aected. However, there is loss of elbow exion, shoulder movement, as well as muscle atrophy of infraspinatus and supraspinatus occurs (Añor, 2017). Caudal (C8-T2) and complete (C6-T2) avulsions are more common and have more noticeable and severe clinical signs. e C8-T2 section of the brachial plexus includes the nerve roots that form the radial, median, ulnar, and lateral thoracic nerves, as well as sympathetic innervation of the head (Añor, 2017). is means that paralysis of triceps brachii and limb extensor muscles occur (radial nerve) and so the animal cannot extend the elbow or carpus and cannot weight bear on the aected limb. If the injury is a complete avulsion, the animal will drag the limb, however, if it is a caudal avulsion, function of the musculocutaneous nerve is spared and so the animal may hold the limb in exion. Severe neurogenic atrophy begins aer around 1-week post injury (Añor, 2017). Rehabilitation of brachial plexus avulsionsby Matthew Scott BSc (Hons) MNAVPCANINE PHYSIOFigure 128 Animal Therapy Magazine | ISSUE 20

29 Animal Therapy Magazine | ISSUE 20Clinical exame clinical exam allows a veterinary surgeon to discern between an injury to the brachial plexus or orthopaedic disease, this involves static and dynamic assessments of the patient as well as a thorough neurological assessment.e patient will likely present with a severe lameness of a thoracic limb, either dragging the limb, minimal weight bearing, or completely non-weight bearing. Additionally, as there has been disruption of the lower motor neuron, there may be severe muscle atrophy and accid muscle tone seen over the aected limb.A full neurological examination should be performed including testing conscious proprioception as well as reexes including limb withdrawal and myotatic (extensor carpi radialis, biceps brachii, and triceps brachii in the thoracic limb).ere will be a lack of cutaneous sensation to certain areas of the limb, depending on the type of avulsion and therefore should be checked throughout the entire limb. Additionally, nociception is considered the best predictor for recovery, particular attention should be paid to the nociception in the medial digit (radial and musculocutaneous nerves) and lateral digit (radial and ulnar nerves) (Faissler et al., 2002). If nociception is present in the medial and lateral digits, prognosis is good provided the patient is prescribed intensive physiotherapy as soon as possible (Añor, 2017). If nociception is absent, the prognosis depends on the severity of axonal injury. For neuropraxic injuries, the prognosis is good, whereas this becomes guarded for axonometric injuries and poor for neurotmetic injuries. If no improvement is seen within the rst 2 months, full recovery is unlikely to occur (Van Soens et al., 2009). Peripheral nerve injuries can also cause paraesthesia and hyperaesthesia. ese abnormal sensations can result in an animal self-mutilating through licking and biting at the aected limb (omas et al., 2014).ere can also be a loss of the cutaneous trunci reex if the lesion aects the C8-T1 spinal cord segment due to the nerve root for the lateral thoracic nerve. If the lesion also aects the T1-T3 spinal cord segments there will be presence of partial Horner’s syndrome (a miotic or constricted pupil) on the ipsilateral side as the sympathetic nerve bres of the eye leave the spinal cord at this point (Wheeler et al., 1986).If the injury is severe enough, it can cause traction on the spinal cord and aect the ipsilateral pelvic limb (Añor, 2017).DiagnosisIn order to diagnose an avulsion of the brachial plexus and to rule out other possible causes of the symptoms such as neoplasia, the patient requires a referral to a specialist neurology service for assessment and investigations can include: • X-ray to observe for any bone fractures or orthopaedic disease. • MRI to view the degree of damage to the nerves and associated soft tissues.• Electromyograph (EMG) to assess which muscles have become denervated (Añor, 2017).Veterinary treatmentIf the injury occurred as a result of an RTA, bone fractures or open wounds could also be a concern and will require intervention and management rst. Treatment of the neurological condition depends on the severity of nerve damage and which nerve roots have been aected. If the muscles responsible for exing and extending the elbow (therefore also responsible for weight bearing) are still innervated, some surgical options are available. A carpal arthrodesis can be performed if there is sucient triceps function to prevent constant knuckling over, or muscle tendon transplantations can be performed in cases of partial avulsions (Añor, 2017). If sucient function and sensation does not return and the patient is constantly re-opening wounds due to self-mutilation or scung, amputation of the limb may have to be considered (Añor, 2017). Either way, intensive rehabilitation should start as soon as possible aer the injury or before and aer any of the possible surgical options. Carpal splints, braces, or orthotics can be used to help keep the carpus in extension, preventing contractures forming and, if sucient triceps function is present, allow the patient to weight bear (Marcellin-Little and Levine, 2014). is can be useful during “pre-hab” before arthrodesis, or in some cases even as an alternative to surgery. However, the brace/orthotic should be tted correctly to the individual. If it is too loose it will not be eective and may slip or rotate causing skin abrasions due to friction. If it is too tight, it will not be comfortable for prolonged periods of wear and could even interfere with blood ow (Marcellin-Little and Levine, 2014). Additionally, a lot of patients will require rehabilitation with the brace on in order for the patient to learn how to move comfortably with it in place.Rehabilitation It is important that the therapist involved with the care of such a case should also be able to perform a thorough neurological examination in conjunction with a standard physical examination, in order to monitor the neurological status of the patient, observing for improvements or deteriorations in the limb’s function.For patients suering from this type of injury the main goals for rehabilitation include:• Improving the neuromuscular function of the aected limb (this may be limited depending on the extent of the nerve damage sustained). • Preventing secondary complications within the injured leg including soft tissue and joint contractures. • Prevention/management of any wounds that may occur due to repeated scung/dragging of the limb or self-mutilation. • Management of any potential compensatory musculoskeletal issues residing in other areas of the body or a reduction of their development and/or severity.Improving the function of the leg requires eective exercise prescription centred around re-establishing normal neural pathways (omas et al., 2014). e exercises chosen should be targeted around improving the coordination of the animal’s gait, as well as neuromuscular function and balance, muscular strength, and proprioception of the injured limb. Hydrotherapy would be a benecial addition to the exercise plan as a form of low impact resistance-based exercise and in the author’s experience, if the patient is unable to weight bear and/continued overleaf29 Animal Therapy Magazine | ISSUE 20

30Animal Therapy Magazine | ISSUE 20or has severe muscle atrophy, they should be started in the pool (gure 1) (see case studies). As brachial plexus avulsions cause delayed or even absent sensation throughout the aected limb, thermal therapies such as cryotherapy and heat therapy should be avoided as the patient will not be able to give any indication that the temperature used is too extreme. However, sensory or tactile stimulation should still be considered as it has the potential to assist with improving nerve function in peripheral neuropathies (Khalil et al., 2007). is can be done in numerous ways, including gently running grooming brushes or electric toothbrushes over the aected limb, foot slides over a sensory wobble cushion, as well as electrical stimulation. Electrotherapies such as neuromuscular electrical nerve stimulation (NMES) can be used to help stimulate a contraction of the atrophied muscles in an attempt to strengthen those that are still innervated and stimulate those that have become denervated (Baxter and McDonough, 2007). e application of NMES can also provide sensory stimulation to the damaged limb (Khalil et al., 2007). Laser therapy and photobiomodulation therapy in general has the potential to help heal and manage any wound that may occur on this limb, as well as assisting with healing of the damaged nerves (Gigo-Benato et al., 2005; Mendez et al., 2004). When it comes to wound management, the therapist should also guide the owner through eective and hygienic wound care.Manual therapy in the form of massage, stretching and passive range of motion (PROM) is key to preventing secondary complications occurring in the injured limb e.g. joint or so tissue contractures and throughout the rest of the body e.g. muscle or joint pain due to overuse. Patients that suer with lower motor neuron decits and low muscle tone of antagonistic muscles are more susceptible to joint contractures and therefore massage and stretching should be applied to both the low toned muscle and its antagonist (omas et al., 2014). Additionally, there will be a degree of sensory input to the injured limb when applying dierent forms of manual therapy which will assist with nerve rehabilitation. (Sutton and Whitlock, 2014).DiscussionAn injury to the brachial plexus can oen be a dicult condition to rehabilitate as the outcome is predominantly based upon the degree of injury that was sustained before rehabilitation was started. erefore, the expectation of the owner should be managed throughout the process as the likelihood of the patient requiring maintenance therapy is quite high whether the patient has to be managed with/without a splint, post-arthrodesis, or post-amputation. However, through a thorough neurological examination, the most eective therapeutic interventions can be selected and some improvements can certainly be seen, making these cases very rewarding as well.CANINE PHYSIOCASE STUDY 17-year 1-month old, male neutered Labrador RetrieverHistory: Presented to the referring vet with a left thoracic limb lameness of unknown origin. After orthopaedic and neurological assessments including CT and MRI scans revealing post-traumatic contusion and early brosis in the thoracic portion of iliocostalis at the level of T1-T2. Diagnosed with neuritis of the left brachial plexus secondary to trauma or immune mediated cause.Presentation: Holding left thoracic limb up when stationary. Around 9/10 lame when moving but knuckled over when the limb was placed on the ground. Severe muscle atrophy was present throughout the left thoracic limb, particularly over the scapula, triceps, and antebrachium with accid muscle tone. Myofascial trigger points were present along the spinal musculature, and left latissimus dorsi. Proprioception of left thoracic limb was absent, withdrawal reexes were present but weakened, and nociception and the cutaneous trunci reex were also present. There was a mild miosis of the left pupil and absent cutaneous sensation over dorsal antebrachium. Treatment: Initial treatments consisted of NMES over the left scapula musculature, laser therapy along the track of the left radial nerve, massage and PROM of the left thoracic limb, slow lead walking, and gentle rocking weight shifting in standing position with manual placement of the left thoracic limb. Other thoracic limb strengthening exercises were introduced over the following month including low gradient incline and decline walking, weaving, and wheelbarrow walking, as well as manual therapy to maintain comfort and mobility throughout the rest of the body. After this period, the dog started using the limb more consistently and moved with a lameness of around 6-7/10 but there was no signicant change in muscle mass or tone. Therefore, hydrotherapy was started, initially in the underwater treadmill (UWTM) but this case was too weak to bring the limb through the resistance of the water and place it and so the modality was switched to the pool. This completely non-weight bearing form of therapy allowed the muscles of the left thoracic limb that were still innervated to strengthen and eventually he was strong enough to walk correctly in the treadmill. From this point, the dog moved onto maintenance therapy in order to prevent deterioration and to maintain the condition of the rest of the body but had gotten to the point of walking with a 5-6/10 lameness and the load on the other limbs was signicantly less.

31 Animal Therapy Magazine | ISSUE 20CASE STUDY 211-month old, male entire Miniature PinscherHistory: Ran out into the road after escaping and was hit by a car. Referred to a specialist neurology service, no diagnostic imaging was performed in this case, however, after thorough neurological assessment the most likely diagnosis was a traumatic avulsion of the right brachial plexus. No other injuries were sustained aside from a wound on the inside of the right pelvic limb.Presentation: Non-weight bearing on the right thoracic limb when standing but had started to compensate when walking by landing on the dorsal aspect of the carpus. Muscle atrophy of the right triceps and muscles of the antebrachium, as well as multiple sites of myofascial trigger points throughout the body. Cutaneous trunci was present up to just distal to the right elbow, proprioception, nociception, withdrawal and cutaneous trunci reexes were all absent on the right side. Additionally, a mild miosis of the right pupil was present. The wound on the right pelvic limb had healed but there were some wounds on the right thoracic limb on the dorsal carpus and digit II due to scung of the limb.Treatment: Initial treatments consisted of laser therapy of the wounds, cervicothoracic spine, and track of the radial nerve, massage and PROM right thoracic limb, and gentle rocking weighting shifting on a sensory stimulation wobble cushion. The client had already purchased an orthotic splint to keep the carpal in extension and so an additional exercise of slow walking over low poles was added into the exercise plan. Additional treatments added over the next few months included stretches of the left carpal exor muscles as they were beginning to shorten, and additional sensory stimulation in the form of proprioceptive foot slides on the wobble cushion and stimulation using an electric toothbrush. After this period, the cutaneous sensation was moving further distally but there was no improvement in the function of the limb and so the owner went for a recheck with the neurologist. Eventually, the supercial cutaneous sensation moved to the level of the carpus (unfortunately no further) and nociception became present in both medial and lateral digits. Overall function of the limb did not change signicantly but action and strength of the muscles that remained innervated (which included the lateral head of the triceps) did increase, especially with inclusion of hydrotherapy swimming (UWTM was unsuccessful even with the carpal brace in place). This allowed this dog to be a potential candidate for a carpal arthrodesis surgery as the brace and toe slings were not successful enough to be used long term due to how thin the dog’s legs were. The client is currently considering the surgery whilst continuing the rehabilitation.REFERENCESAñor, S. 2017. Monoparesis. In: Platt, S. and Olby, N. ed. BSAVA Manual of Canine and Feline Neurology. 4th ed. Gloucester: British Small Animal Veterinary Association. pp. 328-341.Baxter, G.D. and McDonough, S.M. 2007. Principles of electrotherapy in veterinary physiotherapy. In: McGowan, C., Go, L. and Stubbs, N. ed. Animal Physiotherapy: Assessment, Treatment and Rehabilitation. Oxford: Blackwell. pp. 177-186. Faissler, D., Cizinauskas, S. and Jaggy, A. 2002. Prognostic factors for functional recovery in dogs with suspected brachial plexus avulsion. Journal of Veterinary Internal Medicine, 16, pp. 370.Gigo-Benato, D., Geuna, S. and Rochkind, S. 2005. Phototherapy for enhancing peripheral nerve repair: A review of the literature. Muscle & Nerve, 31 (6), pp. 694-701. Khalil, Z., Ogrin, R. and Darzins, P.J. 2007. The eect of sensory nerve stimulation on sensory nerve function in people with peripheral neuropathy associated with diabetes. Neurological Research, 29 (7), pp. 743-748.Marcellin-Little, D.J. and Levine, D. 2014. Devices for Ambulation Assistance in Companion Animals. In: Millis, D.L. and Levine, D. ed. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia: Elsevier Inc. pp. 305-311.Mendez, T.M., Pinheiro, A.L., Pacheco, M.T., Nascimento, P.M. and Ramalho, L.M. 2004. Dose and wavelength of laser light have inuence on the repair of cutaneous wounds. Journal of Clinical Laser Medicine and Surgery, 22 (1), pp. 19-25.Sutton, A. and Whitlock, D. 2014. Massage. In: Millis, D.L. and Levine, D. ed. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia: Elsevier Inc. pp. 464-483.Thomas, W.B., Olby, N. and Sharon, L. 2014. Physical Rehabilitation of the Neurologic Patient. In: Millis, D.L. and Levine, D. ed. Canine Rehabilitation and Physical Therapy. 2nd ed. Philadelphia: Elsevier Inc. pp. 609-627.Uchida, Y., Sugimara, M., Onaga, T. et al. 1993. Regeneration of crushed and transected sciatic nerves in young dogs. Journal of the Japanese Veterinary Medical Association, 46, pp. 775.Van Soens, I., Struys, M.M., Polis, I.E., Bhatti, S.F., Van Meervenne, S.A., Martle, V.A., Nollet, H., Tshamala, M., Vanhaesebrouck, E. and Van Ham, L.M. 2009. Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: a report of 53 cases. Veterinary Journal, 182, pp. 108-113.Wheeler, S., Jones, C. and Wright, J. 1986. The diagnosis of brachial plexus disorders in dogs: a review of twenty-two cases. Journal of Small Animal Practice, 27 (3), pp. 147–157.Matthew Scott BSc (Hons) MNAVP Matthew graduated from Harper Adams University in 2017 as part of the rst cohort undergoing undergraduate training for veterinary physiotherapy. Since graduation he has been working as the in house physiotherapist at the Animal Health Trust’s small animal referral centre, assisting services throughout the hospital including neurology and hydrotherapy. Matthew is also currently involved in research into canine rehabilitation and is undertaking additional training to become a Certied Canine Rehabilitation Practitioner through the University of Tennessee.

32Animal Therapy Magazine | ISSUE 20WHEN Duncan a Welsh section B gelding aged 18 developed severe laminitis in all four feet, including rotation of the pedal bones and frequent foot abscesses, his owner of 15 years, Caroline Hearn (Dip ICAT, MICHT), brought him back from the brink with the help of Photizo Vetcare.Duncan had been in good health all his life, owned by Caroline since he was only three. He had been regularly ridden either hacking out or taking part in pony club activities. e ve months Treating Laminitis with Photizo Vetcareby Anna Webb on behalf of Photizo VetcareBroadcaster, Author, Trainer has studied natural nutrition and therapies with the College of Integrated Veterinary erapies (CIVT)PHOTIZOleading up to his laminitis, he was un-ridden due to lack of a rider but instead, was lightly worked from the ground on long-lines. Duncan always had very good quality hooves and been barefoot for the majority of his life, receiving regular trims from the farrier. Caroline couldn’t work out how this acute Laminitis had started, she explained: “Two weeks leading up to the rst signs of the disease, he unexpectedly had to move yards, which unsettled him. He also experienced a particularly unpleasant reaction to a u vaccine on the 25th June 2019. is le him with a sti, painful neck, which he was unable to move lower than his knees and he was very o colour for approximately ve days”. Duncan presented with the rst signs of laminitis in early July 2019. ey weren’t the classic signs we all look for such as becoming footy in front, extending front limbs forward to transfer more weight onto the heels but instead it was concentrated in the hind feet, which had an increased digital artery pulse. He constantly shied

33 Animal Therapy Magazine | ISSUE 20continued overleaf33 Animal Therapy Magazine | ISSUE 19from foot to foot and was in a lot of discomfort. He started to show signs of colic and refused to eat or drink.e pain didn’t allow him to position himself in order to urinate and the only sample I did manage to collect was very dark brown in colour and of a syrupy consistency. e pulses in all four limbs had now increased and he showed other signs of being in pain, such as sweating and rapid breathing. e vet prescribed pain relief, a sedative paste, rehydration with uids, ice packs on his hooves and a very deep shavings bed to support the soles of his feet. X rays followed, showing a moderate rotation in all four pedal bones. e crest of his neck rapidly became very hard and he developed fat pads around the girth area and the lumbar region. He was very tender in his pectoral muscles and sties, from the constant shiing of weight. It was an extremely worrying situation! Not prepared to give up on her pony, Caroline explained: “ I was prepared to try everything! As Duncan’s heels were growing rapidly, giving them an upright appearance, the farrier trimmed them and tted “Imprint” equine foot care system shoes. ese are thermoplastic shoes, which enable the shoe to be moulded onto the hoof without the trauma of the nailing on process. ese initially provided immediate relief and Duncan walked comfortably back to his stable”. Aer two months of the Imprint shoes being in place, they started to impede the healing and Duncan suered from foot abscesses either erupting through the sole, in the location of the pedal bone or from the coronary bands.e internal damage that had taken place was starting to become apparent and the resulting debris had to come out in order for the healing to take place. e shoes were removed and “Easy Boot Cloud” therapy boots used instead. No stranger to Photizo Vetcare, Caroline was condent in its ability to promote natural healing and that it would help Duncan. She explained: “Initially I could only carry out very short treatments with the Vetcare, usually when Duncan was laying down, as he was very unsettled and constantly shied his weight from each hoof. I would also treat his pectorals, lumbar and stie area, which were very sore through constantly moving back and forth. As the pain medication started to make him more comfortable, I would give him two treatments a day with the Photizo. I treated each hoof for ve minutes, twice a day. is involved concentrating on the bulbs of the heels, the front aspect of the coronary band and on the inner and outer quarters of the coronary band. Aer two weeks I decreased the treatments to once a day. As he became more able to support his weight on three legs, I would pick up each hoof in turn and briey use the Photizo directly on the frog”.By November 2019 Duncan was allowed approximately 1-2 hours of turnout in a small paddock with the protective “Cloud” boots on, which he adapted to wearing very quickly. By March 2020 with consistent care and regular Photizo treatments, Duncan had built up to three hours in the Above: Imprint shoe onBelow: Imprint shoeBottom: Photizo coronary band

34Animal Therapy Magazine | ISSUE 20PHOTIZOpaddock. His soles have become hard enough to allow him to go out barefoot. As the Summer approaches and the ground becomes harder, this situation will have to be reassessed with the possibility of the supportive boots being used for daily turn out as additional protection. He is sound at walk, trot and canter and is lightly worked every day in the sand school on long lines to keep him active and his weight under control. He continues to receive a short treatment with the Photizo twice a week.Concentrating on the hoof area as before, the Red and NIR red light oered by Vetcare has helped prevent any setbacks. Caroline enthused: “e Photizo Vetcare has proved invaluable to Duncan’s recovery so far. Apart from being so easy to use, and portable, Duncan enjoys our Vetcare sessions. He became increasingly more relaxed with each session and the eects of the Vetcare to reduce pain and inammation made him increasingly more comfortable. I noticed how the Vetcare stimulated the natural healing process as I had hoped”. Vetcare combines LED sourced RED and NIR light that penetrates the mitochondria at a cellular level. Using LEDs (Light Emitting Diodes) it is safe for use without the need for any eyewear making it safe for the eyes in home practice.Creating a cascade of biological eects, including reducing pain and inammation, encouraging lymph ow, and not least ATP production at the point of injury to naturally restore and rejuvenate the damaged area.Caroline added: “ anks to the Vetcare’s pre-programmed ‘evidence based’ dose of 31 seconds, I found it very easy to record the doses and analyse progress”. Ruth Milner, MD of Photizo’s sole UK distributor commented: “We’re so thrilled that Duncan has made an almost full recovery. So many positive results are observed and reported to us from those using Photizo in a multi-disciplinary approach. We’re not saying each individual Photizo treatment session alone would be as optimal as a professional Class 3B low level laser treatment session where the dose is likely to be more specic and optimal. However, there is growing evidence showing that if a high-quality LED device is applied with enough power, using appropriate red & near-infrared wavelengths and applied frequently enough eg. daily, there will be a cumulative eect of all the biostimulation observed from low level laser studies. Cells are stimulated (or inhibited) by the light at the right level of dose, regardless of whether light is delivered by a pinpoint laser beam or incoherent LED light and impressive healing results can be achieved with a quality home-use Photobiomodulation erapy (PBMT) device”.More information on Photizo Vetcare: www.danetrehealthproducts.com/Above: Duncan sole infectionBelow: Photizo front bulbs of heel

35 Animal Therapy Magazine | ISSUE 20

36Animal Therapy Magazine | ISSUE 20VetzPetz UKvetzpetz.co.uk @VPetzukvetzpetzantinoluk@vetzpetzantinolukVetzPetz Ltd.Osteoarthritis (OA) is one of the most common diseases in dogs and cats. In fact 20% of dogs over 1 year old and 80% of dogs over 8 years old are aected by OA.Keeping a pet with OA comfortable and supporting their mobility takes a considerable commitment, often requiring veterinary guidance as well as other interventions as part of a complete management plan. Veterinary clinics are ideally placed to monitor a pet’s progress, when making the right choices as to which product to use.Antinol© is available exclusively from vets via our online portal. If you’re a vet or vet led rehabilitation centre and would like to stock Antinol please visit our partnership program page.Contact: milly@vetzpetz.com Tel: 0800 193 3515