By Kyle Jones
As the new University of London, Royal Veterinary College MSc and post-graduate diploma in veterinary physiotherapy opens its doors at Potter's Bar to new students, it's important to reflect on the growth of this specialised field and what it can teach us. Anna Johnson, a Chartered Physiotherapist who trained thirteen years ago, now specialises in sports injuries for animals and humans. She not only travels with British equestrian teams around the world, but also treats two-legged patients at Bisham Abbey and at home in Ibstone, Buckinghamshire.
Human Physiotherapy Benefits Horse Clients
Anna's practice on humans and maintenance of human physiotherapy skills hugely benefits her horse clients also. "Although people want a physiotherapy course that is just veterinary, I personally feel that the technique on humans is more advanced than veterinary. There is more human research and they can talk. Equine practices have just got MRI scanners but humans have had them for years. I maintain human skills because they are far more technically advanced and I can then transfer them across. If people become just veterinary physiotherapists they will be missing out on some of the basic principles," stresses Anna.
As human medicine devotes much larger resources to research than the veterinary world, it is for the most part human ideas and technology that are transferred across to animal physiotherapy and not the other way round. The market for veterinary medicine could not have supported the development of lasers and ultrasound used in human field. Transcutanious Electrical Nerve Stimulation (T.E.N.S.) machines are used as a basic muscle stimulator on horses after they were developed for pain relief of women in labour. Rugs and boots for pulsed electro-magnetic energy also evolved from human technology.
Differences between Humans and Horses
There are many differences and similarities between horse and human physiotherapy. "Animals respond quicker to electrotherapy with lower doses than humans," says Anna, although she wishes there was more research in electrotherapy on animals. The anatomy also differs between four and two-legged creatures, but "body part names are very similar and there are similar muscle groups and areas. The equine stifle, towards the hindquarters of the horse, is identical to the structure of the human knee. They have a femur and tibia. The patella is the kneecap on us. Horses and humans have similar problems with meniscus and cartilage tear. The stay apparatus of the horse's stifle can be locked, however, and he can rest standing up. Soft tissue and joint mobilisation are the same as is sinovial fluid for all animals".
Unraveling the complexities of treating horses can get quite complicated. "A sharp tooth can also cause problems or badly fitting tack might be the cause of a back problem," says Anna "so we often have to consult an equine dentist or saddler to rule these aspects out. We also have to obtain veterinary permission to treat an animal and often the vet has input on each case". In equine physiotherapy she treats all sorts of tendon, ligament, muscle tear, soft tissue injuries with her hands plus laser, ultrasound, and muscle stimulation devices. A lot of work is on top performance problems as opposed to injury and there may be restriction through larger muscle groups. She helps mobilise, build strength in, and treats spinally.
The difference in treating animals versus humans also transpires in pain detection. A horse's eyes, reflexes, and change in temperament all indicate presence of pain. "A normally friendly horse might become easily agitated and suddenly bite or kick. If a horse is really ill it won't eat, drink, defecate, or stale and may roll on the ground," says Anna. "Working with horses has its advantages as on the whole a horse doesn't elaborate its pain. In the human world the patient might not look too bad, but often if you question a human they state they aren't any better, when in fact there has been much improvement. Human perception of pain is greater than a horse. The horse wouldn't limp on purpose. I'm sure there are some horse owners who think their horse is hypochondriac, but I don't believe it. Horses are more tolerant of pain and humans are more sensitive".
Horse whisperers and faddish treatments are quite vogue in today's horse world and Anna is quite emphatic there is nothing magic about what she does. "It is all clinical and proven. Any clinician must have the skills to palpate or have a feel with joints, watch an animal move, and perform gait analysis. With experience you spot lameness or stiffness far quicker than the average person does. However, quite a few dressage riders and trainers have knowledge from watching horses over the years to recognise an abnormality or asymmetry. I have great empathy with horses and known horses from age two. It does help to have an inbuilt knowledge of horses and I feel or listen with my hands. However, this is a learned skill that comes with experience," Anna explains.
Animal and human physiotherapy work toward similar objectives of mobilising restrictions and improving muscular symmetry, but the techniques, skills, and equipment can vary considerably. However, the combination of treating both horses and humans is hugely beneficial according to Anna Johnson. "Working with horses has improved both my palpation and observation skills," she notes, as verbal communication is simply not an option with the horse.
Her observation of gait in both human and horses is finely tuned as she relies heavily on a sharp eye to detect the slightest problem of each horse's limb, foot, back, or neck. "You don't tend to ask humans to walk up and down, but working on horses has taught me otherwise". Her sense of touch has also become extremely sensitive through working on horses.
Besides relying more on her own faculties to compensate for limited communication with her horse patients, Anna also confronts a much different environment than her peers working in heated hospitals and clinics. Although she's travelled to some exotic places accompanying Britain's top riders; such as Sydney 2000 Olympics, two World Championships, European Dressage championships, and many eventing team venues, her average day involves travel, often hostile weather conditions, and temperamental large animals. "In winter it is windy and often James Herriot like. I have to see them move outside and then do treatment inside where it is dry. I'm an outdoor person so the spring months are pleasurable. Winter can be freezing and pouring with rain. My hands get numb. When it is raining I look forward to the luxury of days when I treat humans inside".
Successful Case Studies
There are a few cases that Anna recollects with great satisfaction. A horse referred from Cambridge University frequently tripped. Electro-miacardialgram and nerve conduction tests confirmed there was an impingement of a cervical (neck) nerve. Anna treated the horse under sedation with a technique devised for humans in America, known as "SNAGS" (sustained neuro-apophyseal glides). "It involved taking neck into range of movement by lifting up the vertebra to lift impingement on the nerve". "It was a heavy horse, but we had amazing results with an objective measurement of the EMG test afterwards. The horse returned to full function," Anna beamed.
Another case involved a horse from Newbury that hit a tree galloping. It had a nerve injury at the brachioplexus, where nerves meet to form spaghetti junction for the forearm. The impaired nerve caused reduced muscle tone and atrophy, commonly known as a "sweeney". It was a very difficult rehabilitation, but it was decided not to euthanise the horse. She used a neruo-muscular stimulator while the horse rested in his box. Luckily the owner persevered with daily treatments and the horse returned to full function after six months. Now it is back jumping.
The daily observation and treatment of horses gives Anna enormous feedback. "I often wish I was a horse trainer. I love watching people ride horses. I am a great observer of movement and I like to watch horses being ridden to see what happens under saddle as well as how the rider performs. The rider can be one-sided and it is no wonder the horse is then presented with one-sided problem. Sometimes I encourage or educate the rider to seek training or schooling advice," she adds.
Working with both horses and humans often involves treating all the family members and at some point horse and rider form one. According to Anna, "My practice is helped by treating both humans and animals. A woman rang yesterday in a panic wanting treatment and it was through her horse that I gained her respect. Another client I treat had a terrible car accident and recently I've done all her horses". Despite the interlocked relationship between horse and human, however, bear in mind "who but a horse would choose to roll in the muddiest part of a field, except possibly a rugby player".
Text by Kyle Jones