In our latest equine webinar series, Dr Elizabeth Uhl and Dr Michelle Osborn deeply challenge our perceptions, perspectives and beliefs when it comes to how we evaluate our patients, develop treatment programmes, and understand pathology. I would like to share a few of my biggest learning points from this webinar series with you.
1. Rethinking Functional Anatomy: What we have failed to notice
Our primary understanding of the body is based on a mechanical model. We learn about and understand the shape and function of the components of the body mechanically – each muscle has an origin and an insertion point, which indicates its action. We see the spine as blocks stacked on top of one another in people, and in animals we compare the spine to some form of suspension bridge. This model of understanding is compression-based – we build ‘something’ by stacking its parts on top of one another, in a way that provides stability.
This is not how the body functions, however, and when we try to recreate the body from a compression-based standpoint, we lose the mobility, adaptability and grace of the structure.
Drs Uhl and Osborn posit that the body is rather a tension-based structure. This simple shift in perspective changes everything about how we understand anatomy, pathology and treatment.
In a compression-based model, joints need to be in contact with one another and would experience friction with movement – the more the joint moves, the faster it would wear. We see the opposite effect in a tensegrity-based model, where there is no contact between joint surfaces and they do not wear with movement. Rather, we see wear and tear when movement is no longer in tensegrity and the joint surfaces therefore come into contact with one another.
When force is applied to a compression-based model, it is localised and concentrated. When applied to a tensegrity model, it is dispersed through tensioned structures. A body in tensegrity can remodel in response to mechanical force; as a result, changes in one area will be dispersed throughout the body. This model far better describes the living body and allows us to understand pathology, and why so many of our treatment approaches fail to bring long-term healing and function.
In their lecture, Drs Uhl and Osborn go on to explore what causes lameness, a case study where there was hyperextension of the hind fetlocks and why this occurred, and, very importantly, they explain degenerative joint disease from the tensegrity perspective, changing everything…
Why does it matter how we think the body works?
Our understanding of how the body works will fully determine how we treat it and what we expect the outcomes of that treatment to be.
When we see the body through the lens of a compression-based model, we focus on the static management of mechanical force. We cannot explain the relationship between structure and function, and we ignore the fascia, to a large degree. We emphasise isolated areas of pathology instead of what damaged them. Most importantly, we often see that outcomes are poor, conditions recur, and pathology progresses.
When we shift to a tensegrity-based understanding of the body, we focus more on the dynamic management of mechanical forces. We place an emphasis on the fascia and the interconnected nature of the body, which leads us to look for the causes of pathology within the whole body function of the horse. This results in a highly individualised therapeutic approach that is based on the functional movement, pathology and presentation of the individual.
With this shift in perspective, many individuals have experienced therapeutic outcomes that completely break the rules in terms of their prognosis and ability to return to function.
2. Functional Whole-Body Modeling of Horse and Rider
In this fascinating webinar, Drs Uhl and Osborn describe the process of the creation of a 3D model of horse and rider, and the many applications of this kind of technology. An essential aspect of the model that they point out is the inverted rotation of the thoracolumbar spine that occurs in an incorrect bend, and the impact this can have on the functional movement of the horse.
Lateral flexion of the thoracolumbar spine is coupled with rotation. This rotation can occur in the same direction as the bend of the horse, which is ideal, or it can occur in the opposite direction to the bend, with an inverted rotation of the ribcage. In strong lateral flexion of the head and neck, rotation of the ribcage will be inverted.
Their lecture highlights a concept that they build on in subsequent lectures – the same exercise or movement can either cripple or rehabilitate a horse. For movements such as walking, collection, shoulder-in or haunches-in to be beneficial, they must be formed correctly.
3. Practical Applications: Navicular Syndrome
In this eye-opening webinar, Drs Uhl and Osborn discuss the presentation, causes and treatment of navicular syndrome. They highlight that just because we don’t have the tools to implement an effective treatment does not mean that no effective treatment exists!
They go into great depth in their discussion of the anatomy of the navicular as an enthesis organ. They highlight the whole-body biomechanics that lead to strain of the navicular area, and the early signs of dysfunction.
To effectively rehabilitate or treat navicular disease, we need to recognise that it is caused by the way in which the horse is working and moving: The mechanical overload of the navicular enthesis organ results from an overload of the forelimbs, coupled with significant transverse rotation of the thoracolumbar spine. This results in hyperextension of the forelimb at the end of the stance phase of the stride.
In the discussion of a case, they share how the retraining of healthy movement in spinal integrity allowed a horse with navicular disease to remain sound and in work.
4. Practical Applications: Cervical DJD and Other Case Studies
Equine chronic cervical osteoarthritis, or degenerative joint disease, occurs in older horses and develops over time. Cervical vertebral malformation is quite different. If you would like to learn more about cervical vertebral malformation, watch the webinar on this condition with Dr Martina Neidhart.
Over the last 20 years, there has been a highly significant increase in the presentation of horses with chronic cervical DJD, with lesions most commonly occurring between C5 and T1. Evaluation of the vertebral bodies post-mortem reveals remodeling in the facet joints of the neck, supporting a chronically bent or curved neck, as well as facet joints that sit incredibly deeply on one another. This indicates chronic compression, which results in a dynamic compression of the spinal cord as well as nerve outlets in this lower cervical region.
Drs Uhl and Osborn do a phenomenal job of discussing the most commonly hypothesized causes of this condition, which include:
- overperforming, or an excessively high workload and performance expectation;
- anatomical variation in the caudal cervical vertebrae;
- changes in type and breed, with horses being bred to be larger and more powerful than before; and
- changes in riding and training techniques.
When we evaluate any potential cause for this presentation, we must take into account the dramatic increase in its occurrence over the last 20 to 30 years. The presenters go into great detail discussing each of these suggested causes, what it would mean, and why it may or may not be accurate in explaining the presentation.
What We Need to Notice
In the conclusion of this webinar series, Dr Uhl highlights the following points:
- We must consider the whole horse from a functional perspective. This means we need to look at the horse’s dynamic posture, and how it performs specific movements and exercises.
- Tying down the neck with any gadget is simply dangerous and does not serve our goals.
- We should notice when joints are working in extreme ranges of motion. These days, this is so common that it has become normalised.
- The same movement can cripple or rehabilitate a horse. It is our job to learn to recognise when movements are performed correctly, and when they are performed in a way that will be harmful in the long run.
- We need to develop exceptional training skills. Only then can we rehabilitate the movement of our patients.
This webinar series has been a great confirmation and encouragement to me, personally. For some time now, I have realised that to truly rehabilitate horses, we need to do more than the static bodywork that we are trained to do. The majority of our therapeutic exercise toolbox can likewise be applied in a harmful way. It is only by sharpening our training skills and developing training methods that focus on spinal integrity that we can really take the next step in serving the patients that traditional approaches have failed for so long.
0 Comments