Association of Chartered Physiotherapists in Animal Therapy

Four FrontSeptember 2011

The Magazine of the Professionals in Animal Therapy

What Qualifications does your animal therapist have?

Get on the Research Treadmill

©

Book reviews

www.acpat.org

www.acpat.org

�

CONTENTS

Front cover: CC from Hertfordshire Fire and Rescue Service.

Designed by Three Hats Design . www.threehatsdesign.com

4 Editorial

5 A review of the physical components associated with rider performance and how this may effect the horseLouise Broom BSc(Hons) MCSP

9 Musculoskeletal profiling of ridersAnna Risius MCSP BSc(Hons) PGDip VetPhysio ACPAT Cat A

11 Foot lameness in the horse: A Veterinary Surgeons perspectiveAlice Sheldon BVM&S BSc MSc CertEP MRCVS

17 Get on the research treadmillHelen Blamires*, Nicolas Granger*, Nick D Jeffery#, Robin J M Franklin** Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, UK

# Department of Veterinary Clinical Sciences, College of Veterinary Medicine, 1600 South 16th Street,

Ames, IA 50011, USA

20 ‘Can the results of research underpinning human musculoskeletal physiotherapy practice be extrapolated to support the rehabilitation of animal musculoskeletal problems?’Canine hamstring injuries (partial rupture), with particular reference to the greyhoundAnna Victoria Woods HPC MCSP BSc MSc ACPAT Cat A

24 What qualifications does your animal therapist have?

28 Diary of events

28 Course reviews

29 Book reviews

29 Product review

30 Journal of Interest

32 Recent news

37 Writing for Four Front

�

EDITORIAL

Welcome to the second edition of Four Front. As ever we would like to thank all the author’s who have contributed to this edition as without you there would be no magazine.

We hope you find the magazine thought provoking and stimulating and of course it counts towards your CPD. We hope that the content of this magazine will inspire you to write something for your next journal or newsletter. We would also like to encourage you to write ‘a letter to the editor’ to share your thoughts and ideas with the whole membership.

The magazine has been peer reviewed to maintain and help raise the profile of our ever growing profession. We would like to thank the peer reviewers for their support, time and energy

We are always trying to improve the magazine so if you have any comments negative or positive please contact us via email to journal@acpat.org.

It has been another busy year for ACPAT, raising our professional profile and increasing public awareness at events including BEVA, Your Horse Live, The London Vet Show and Crufts. We would like to take this opportunity to thank all those members who have contributed their time to these events. On the PR front, 2011/2012 is another exciting year and your continued support is needed. With the Olympic Games fast approaching and our presence at the games, we hope that ACPAT will continue to thrive.

Di Messum and Polly Hutson

Di Messum and Polly Hutson

CC from Hertfordshire Fire and Rescue Service is a very special highly trained dog used to investigate the causes and origin of fires in hundreds of fire scenes throughout Hertfordshire and East Anglia.

There are only a handful of dogs in the UK who have been trained to detect traces of flammable liquids, especially in investigating fires of a suspected deliberate nature.

As seen here, CC wears protective boots to protect his paws from cuts and scratches in the debris he is working within. Ongoing training is part of CC’s daily routine and it is vital that CC remains competent in his work and he is fully prepared to perform a search in any environment.

FIRE INVESTIGATION DOG TEAM

�

A REVIEW OF THE PHYSICAL COMPONENTS ASSOCIATED WITH RIDER PERFORMANCE AND HOW THIS MAY EFFECT THE HORSELouise Broom BSc(Hons) MCSP

The aim of this article is to discuss the concept and physical components of rider performance and to consider why this may be relevant to equine physiotherapists. Performance is made up of physical, mental and skill elements. Riders have traditionally focused solely on the skill element until a recent shift in attitude, which has also led the Federation Equestre Internationale (FEI) to refer to the rider as the ‘athlete’. In order to evaluate the essential components of rider performance, it is necessary to consider the forces involved in the horse/rider relationship. What does the rider need to be able to do with their body? What kind of forces do they need to generate? What kind of forces do they need to absorb?

According to Newton’s third law, when the horse exerts a force on the ground an equal and opposite reaction is exerted upon the horse. These are known as ground reaction forces (Richards 2008) and can be divided into horizontal forces, which accelerate and decelerate, and vertical forces which propel the horse upwards. These forces are experienced by the rider through the saddle. As the back rises and falls, the effect of inertia causes the rider to be momentarily be ‘left behind’ as the back drops from underneath her. At the bottom of the stride, she contacts the saddle more heavily as she ‘catches it back up’. Pressure studies demonstrate these peaks. Fruehwirth et al. (2004) state that two peaks occur per motion cycle in the trot and that these correspond with the end of the stance phase in one diagonal pair. It is a widely held belief by coaches that experienced riders sit more softly to the trot and this appears to be supported by the literature. Studies show that advanced riders’

movement was more consistent with the horse (Terada 2000, Peham et al. 2001, Lagarde et al. 2005).

What would happen if these forces were asymmetrical?

Asymmetrical distribution of pressure under the rider’s seat measured by the Pliance system (Novel, Germany).

A fundamental requirement of dressage is that the horse moves symmetrically, therefore, it is essential that the rider sits symmetrically (Licka et al. 2004). In the frontal plane there should be parallel alignment of the shoulders and pelvis (von Dietze, 1999) and as a consequence the weight distribution through the seat should be even (The German National Equestrian Federation 1990). The Pliance system (Novel, Germany) can be used to measure the pressure and force both beneath and on top of the saddle. This dynamic measurement shows how the rider’s seat responds to the movement of the horse’s back, giving an indication of symmetry and stability. It is often difficult to predict by eye, the effect of rider asymmetry on the weight distribution through their seat. It is therefore, necessary to consider dismounted screening tests which highlight the movement patterns observed when mounted.

A case can be made for assessing and correcting functional movement patterns before sports specific skills (Cook, 2003 and Giles, 2008). In our sedentary society many hours are spent at a desk or in the car and children no longer play freely. This leads to fewer stimuli to the nervous and musculoskeletal system to develop sound patterns of movement (Cook, 2003). Faults such as poor lumbo-pelvic stability, lateral flexion and trunk rotation can be observed during an overhead squat, split squat and single leg squat (National Academy of Sports Medicine, 2006). These suboptimal recruitment patterns are believed to be the result of weakness or restriction somewhere in the kinetic chain. Although there is little conclusive evidence to support the claim that poor execution of the screening tests can predispose the athlete to injury or hinder performance, it can be hypothesised that poor fundamental movement patterns are reflected in our riding.

The overhead squat and split squat can be assessed in riders and correlation to riding performance is an area for future research.

Figure 1

Figure 2

�

The next part of the article will focus on each of the physical components necessary for rider performance. The first aim for any athlete is to establish movement symmetry around a central longitudinal axis (Elphinston, 2008). Faults can be observed in riders in the sagittal plane i.e. Lumbar flexion with associated loss of the lower leg position forwards or lumbar extension with loss of the lower leg backwards. Faults in the frontal plane are often referred to as ‘collapsing’ a hip or a shoulder. Faults can also occur in the transverse plane i.e. Pelvic or trunk rotation.

In popular equitation literature an ‘ideal’ rider alignment is described as a straight line between ear, shoulder, hip and heel (von Dietze, 1999) in the sagittal plane. It has been demonstrated that it is possible to maintain this alignment dynamically during motion. A study into rider kinematics by Schils et al. (1993) states that an advanced rider sits closer to the vertical in all three gaits with the thigh and lower leg positioned underneath the body. However, Lovett and Hodson-Tole (2005) argue that position is influenced by the velocity of the horse’s gait, ground reaction forces, flexion/extension of the horse’s back and propulsive forces of the hind limb.

The physiological advantage of maintaining ‘correct’ alignment is that it allows the rider to remain near to neutral spine position. In neutral spine, muscles have an optimal length tension relationship. Therefore, they can effectively assist with stability and also provide optimal proprioceptive feedback (Comerford et al. 2008).

Dynamic stability is the result of a balance between mobility and stability. The rider must be supple enough to absorb the movement but stable enough to resist the forces acting upon them (The German National Equestrian Federation, 1990). Riders do not have to move through a huge range at multiple joints. However, they do have to be able to dissociate pelvic

and trunk movement with precision. Bystrom et al. (2009) describe a biphasic pattern of pelvic rotation which corresponds to the rise and fall of the horse’s back. The pelvis also moves laterally and rotates in relation to the horse’s pelvis. MacPhail et al. (1998) state that automatic postural righting reactions occur as movement of the horse’s back alters the rider’s centre of gravity. The rider’s postural reaction to the horse’s gait was found to be very consistent.

In order to better understand the notion of dissociation, it is necessary to consider the anatomy of stability. Bergmark (1989) described a classification system, defining muscles as local or global. He proposed the role of local muscles was to control inter-segmental motion of the spine, due to their attachments to the lumbar vertebrae. Whereas, global muscles, which attach from the pelvis to the thorax, were more equipped to control spinal orientation by resisting the external forces acting upon them (Hodges 1999). Subsequent research supports Bergmark’s claims that the local muscular system remains tonically active, where the global muscles work phasically to accelerate and decelerate the trunk (Cresswell et al. 1992, Creswell 1993, Aruin and Latash 1995, Hodges and Richardson 1997, Hodges et al. 1998 and Hodges 1999).

It can be hypothesised that riders require tonic activation of the local muscle system to control intersegmental motion and the global muscle system to accelerate and decelerate the trunk as the horse’s back rises and falls. Research by Terada (2000 and 2004) supports this hypothesis. Muscle activation in the trunk flexors and extensors was shown to be phasic and the timing was found to be relative to the horse’s gait. Consistent patterns of activation were observed between riders. Novice riders, when compared to advanced riders, were shown to lack this co-ordination between activation of the trunk flexors and extensors and used the adductors to compensate. It could

be argued that the inability to grade the recruitment of the global system appropriately leads to a bracing pattern or ‘functional rigidity’, which prevents dissociation and the ability to swing through the seat.

An essential component of stability is the neural control unit which evaluates the stability requirement and determines the necessary muscular response (Panjabi, 2003). Gandevia et al. (1992) state that proprioceptors provide information regarding movement and position of the joints and perception of effort, force and timing of muscle contraction. This information is essential for postural control and balance (Batson, 2009). In order to remain in balance it is necessary to respond to constantly changing internal and external perturbations (Batson, 2009). An example of an internal perturbation in dressage would be moving the leg back to give an aid. Batson (2009) states that external perturbations are associated with gravity and inertia. Therefore, the rise and fall of the horse’s back is a predictable example, whereas a sudden spook is an unpredictable example. Riders need to be able to organise their body in preparation for movement (feedforward) and also correct errors in movement such as timing and force (feedback) (Batson, 2009). A high level of self awareness is essential for the co-ordination and reactivity necessary in effective dressage riding.

Proprioception is also essential for joint stability as it provides necessary information for neuromuscular control (Blackburn et al. 2000). Blackburn et al. (2000) argue the strength of the muscles must also play an important role. They found that resistance training had a similar effect to proprioception training. They hypothesised that this may be to do with an increase in muscle stiffness, which increases the sensitivity to stretch, thus improving neuromuscular control.

Resistance training is often overlooked in riders but a lack of strength and endurance may limit

performance by negatively affecting stability, reactivity and motor control. Symmetry of strength is also an important factor to consider. Any unilateral strength deficit may be observed in tests such as a single leg squat or a split squat. The lateral line, consisting of the peroneii, iliotibial band (ITB), Tensor Fascia Lata, gluteals, obliques, intercostals and sternocleidomastoid (Myers, 2001) creates and controls movement in the frontal plane. Weakness in one part of the line may cause the rider to side flex the spine and appear to drop the contralateral hip and shoulder. Releasing the ‘tight’ muscles will be ineffective if the strength deficit causing the compensatory over activity is not dealt with. The posterior oblique chain consisting of Latissimus Dorsi, Thorocolumbar fascia, Gluteus Maximus and ITB and the anterior oblique chain consisting of the Obliques, Transversus abdominis (Pool-Goudzward et al. 1998), adductors and pectorals (NASM, 2006) are instrumental in controlling rotation. All isolated strength gains must be re-integrated into a functional pattern in order for riders to access optimal motor programmes and movement patterns.

So why is rider performance an important consideration for equine physiotherapists? It is widely accepted that the forces exerted by a rider have a direct influence on the movement patterns of the horse. But what effect does the rider have? Does asymmetrical weight bearing have a deleterious effect on the horse’s musculoskeletal system? Does it lead to a sub clinical decrease in performance or even an overt lameness? Peham et al. (2001 and 2004) demonstrated that the rider can have a stabilising effect on the horse’s gait but an unskilled rider disturbs the motion pattern consistency. Licka et al. (2004) stated “the presence of a rider can alter the degree of lameness, however, its influence cannot be predicted for an individual horse.” In the study, some of the horses that were lame in hand appeared sound when ridden and vice versa. This occurred equally with the novice

rider and the dressage rider. The authors suggested the distribution of mass may be more important in predicting the effect on gait as it may affect the horse’s ability “to relocate the centre of mass away from the lame limb”.

In conclusion, more research is needed to ascertain how

fundamental movement patterns caused by deficits in range of motion, strength and proprioception, may be reflected in riding. In turn, more investigation into the affect of rider symmetry, balance and strength on the horse’s gait is warranted.

�

�

References

Aruin, A.S., Latash, M.L. (1995) Directional

specificity of postural muscles in feed-forward

postural reactions during fast voluntary arm

movements. Experimental Brain Research.

103: 323-332

Batson, G. (2009) Update on Proprioception.

Journal of Dance Medicine and Science. Vol 13.

(2) 35- 41

Bergmark, A. (1989) Stability of the lumbar

spine. A study in mechanical engineering. Acta

Orthopedica Scandanavica Suppl. 230: 1-54

Blackburn, T., Guskiewicz, K.M., Petschauer,

M.A., Prentice, W.E. (2000). Balance and

joint stability: the relative contributions of

proprioception and muscular strength. Journal

of Sport Rehabilitation. 9: 315-328

Byström, A., Rhodin, M., von Peinen, K.,

Weishaupt, M.A., L. Roepstorff, L.(2009) Basic

kinematics of the saddle and rider in high-level

dressage horses trotting on a treadmill. Equine

Veterinary Journal, 41: 280-284.

Comerford, M.J., Mottram, S.L., Gibbons,

S.G.T. (2008) Understanding Movement and

Function. Theory and Concepts Module

Handbook. Kinetic Control

Cook, G. (2003) Athletic Body in Balance.

Optimal movement skills and conditioning for

performance. Human Kinetics.

Creswell, A.G. (1993) Responses of intra-

abdominal pressure and abdominal muscle

activity during dynamic trunk loading in man.

European Journal of Applied Physiology.

66: 315-320

Creswell, A.G., Grundstrom, H., Thorstensson,

A. (1992) Observations on intra-abdominal

pressure and patterns of abdominal intra

muscular activity in man. Acta Physiologica

Scandanavica. 144: 409-418

Elphinston, J. (2008) Stability, Sport and

Performance Movement. Great technique

without injury. Lotus Publishing.

Fruehwirth, B., Peham, C., Scheidl M,.

Schobesberger, H. (2004) Evaluation of

pressure distribution under an English saddle

at walk, trot and canter. Equine Veterinary

Journal, 36: 754-757.

Gandevia, S.C., Burke, D. (1992) Does the

nervous system depend on kinesthetic

information to control natural limb movement?

Behavioural Brain Science. 15: 614-32

Giles, K., Fox, M., Elcock, P. (2008) Movement

Dynamics. Physical Competence Assessment

Manual for Schools and Clubs. Movement

Dynamics.

Hodges, P.W. (1999) Is there a role for

transversus abdominis in lumbo-pelvic stability.

Manual Therapy. 4 (2) 74-86

Hodges, P.W., Richardson, C.A. (1997) Feed-

forward contraction of transversus abdominis

is not influenced by the direction of arm

movement. Experimental Brain Research.

114: 362-370

Hodges. P.W., Cresswell, A.G., Thorstensson,

A. (1998) Preparatory trunk motion precedes

upper limb movement. Experimental Brain

Research. 124: 69-79

Lagarde, J., Kelso, J., Peham, C., Licka T. (2005)

Coordination dynamics of the horse-rider

system. Journal of Motor Behaviour,

37: 418-24.

Licka, T., Kapaun M., Peham C. (2004) Influence

of rider on lameness in trotting horses. Equine

Veterinary Journal, 36: 734-6.

Lovett, T. E., Hodson-Tole, K. (2005) A

preliminary investigation of rider position

during walk, trot and canter. Equine and

Comparative Exercise Physiology, 2: 71-76.

MacPhail, H.E.A., Edwards, J., Golding, J., Miller,

K., Mosier, C. (1998) Trunk postural reactions

in childern with and without cerebral palsy

during therapeutic horseback riding. Paediatric

Physical Therapy. 10: 143-147

Myers, T. W. (2001). Anatomy trains. Myofascial

meridians for manual and movement therapists.

Sydney: Churchill Livingstone.

National Academy of Sports Medicine (2006)

Movement Assessments: Corrective Exercise

Specialist. Calabasas, CA; National Academy of

Sports Medicine

Panjabi, M.M. (2003) Clinical spinal instability

and low back pain. Journal of Electromyography

and Kinesiology. 13: 371-379

Peham, C., Licka, T., Kapaun, M., Sheidl, M.

(2001) A new method to quantify the horse-

rider system in dressage. Sports Engineering,

4, 95.

Peham, C., Licka, T., Schobesberger, H.,

Meschan, E. (2004) Influence of the rider

on the variability of the equine gait. Human

Movement Science. 23. 663-671

Pool-Goudzwaard, A.L., Vleeming, A., Stoeckart,

R., Snijders, C.J., Mens, J.M.A. (1998) Insufficient

lumbopelvic stability: a clinical, anatomical and

biomechanical approach to ‘a-specific’ low

back pain. Manual Therapy. 3(1) 12-20.

Richards, J. (2008). Biomechanics in Clinic and

Research. Elsevier.

Schils, S. J., Greer, N. L., Stoner, C.N. (1993)

Kinematic analysis of the equestrian - walk,

posting trot and sitting trot. Human Movement

Science, 12: 693-712.

Terada, K. (2000) Comparison of head

movement and EMG activity of muscles

between advanced and novice horseback

riders at different gaits. Journal of Equine

Science, 11: 83-90.

Terada, K., Mullineaux, D.R., Lanovaz, J., Kato,

K., Clayton, H.M. (2004) Electromyographic

analysis of the rider’s muscles at trot. Equine

and Comparative Exercise Physiology.

1(3) 193-198.

The German National Equestrian Federation.

1990. The Principles of Riding. The Official

Handbook of the German National Equestrian

Federation. (The Complete Riding and Driving

System. Book1). Half Halt Press.

von Dietze, S. (1999). Balance in Movement.

The Seat of the Rider. London: J.A. Allen.

15: 614-32

�

In recent years, the awareness and value of veterinary physiotherapy has increased and the equine physiotherapist is a key member of the team around most equine athletes.

Proactive physiotherapy for performance of both horse and rider, not just reactive physiotherapy post injury, is also catching on. With London 2012 approaching, our world class team are not taking any chances and are working very hard on rider performance too, although it is not just the elite riders who benefit on working on themselves as well as their horses.

As Chartered physiotherapists we are all fully qualified and well equipped to treat riders, and in the sports setting, assessment skills have been used to develop a profiling system to look at maximising rider performance and prevent injury.

I work part time for a busy vet physio practice, treating horses of all levels and disciplines, including elite athletes, particularly in eventing. I also work part time for the Abbey Clinic, Bisham Abbey National Sports Centre, a sports injuries practice that offers musculo-skeletal

profiling of athletes, particularly tennis players and riders.

A profiling session takes around an hour and a half. I ask the rider to come suitably dressed for examination (shorts and a vest top for girls) and bringing along video footage of them riding can be helpful if I have not seen them ride already.

I would begin by taking a history including discipline and level, number of horses ridden a day, and any other work activities done regularly as these can cause conflicts with postural adaptation. I would then look at overall posture and test range of movement and muscle lengths of all major joints. It is important to remain objective and create and overall assessment, rather than getting too focused on pain/injuries.

The gym ball is useful in simulating balance and control, so tests seated on the ball will often show which compensatory ‘cheat’ mechanisms a rider uses to maintain stability. Squats, lunges and single leg balance tests are also useful in checking alignment, spinal and pelvis control. These can then become exercises later on, once the basics have been improved.

Building up an overall picture of a riders posture and muscle balance allows me to formulate a treatment plan, i.e. what tissues need to be more flexible, which muscles are overactive and which are inhibited and whether there are any underlying causes like poor biomechanics or posture at work.

I am lucky in the setting I work within as I have access to podiatrists, sports masseurs, psychologists and nutritionists who I can refer riders to when necessary, however it is important to set goals with the rider so the profiling remains relevant. If a full time desk job funds the horses, I cannot advise that rider to stop sitting over a computer. However strategies and equipment can make the day job contribute positively to riding rather than negatively.

Rehabilitation exercises are nearly always part of treatment for performance and there is some research to suggest supplemented exercise is necessary to improve fitness and reduce the risk of injury (Lofqvist et al. 2009, Meyers 2006). There is also a place for hands on treatment of tissue adaptations from ingrained postural habits. Even though results may be temporary, pain relief and increased freedom

MUSCULOSKELETAL PROFILING OF RIDERSAnna Risius MCSP BSc(Hons) PGDip VetPhysio ACPAT Cat A

Jeffery, R, Cronin, J and Bressel, E

(2005). Eccentric strengthening: Clinical

applications to Achilles tendinopathy. New

Zealand Journal of Sports Medicine. 33:

22-30

10

of movement is a great motivator to doing the exercises and making the changes permanent. Physiotherapists have an advantage because we know the principles, we can try our hand at many different manual techniques and exercise therapies and find what works best. I favour muscle energy techniques, fascial release and kinesiotaping as these are gentle ways of affecting movement and motor control. Our advisory role is also important and I try and recommend things that can be done on a recreational basis as maintenance, such as Pilates and Tai Chi, as long as the rider knows what they are specifically working on.

Ultimately I would progress to assessing the rider on their horse(s). It is great if I have had involvement with the horses too and assessing what they do when ridden is vital. For example I would not want a rider to get despondent when they cannot sit as perfectly to a movement where the horse is throwing his quarters in to protect his own weaknesses and this would have to be addressed separately.

As veterinary physiotherapists, I believe we have the advantage of seeing the situation from all angles – the horse’s condition and soundness, the tack used, the rider’s fitness and ability and any environmental or emotional factors. We are able to liaise with all members of the team – instructors, vets, saddlers and farriers to help sort the problem out and maximise that horse and riders performance, whether to make it comfortably round a hack, or win a gold medal!

References

L. Lofqvist, S. Pinzke, M. Stal, P. Lundqvist, (2009)

Riding Instructors, Their Musculoskeletal

Health and Working Conditions, Am Society

of Agricultural and Biological Engineers, St

Joseph, Michigan

M.Meyers (2006) Effect of Equitation

training on health and physical fitness of

college females, European Journal of Applied

Physiology Vol. 98;2 pp.177-184

11

Introduction

Foot pain is an extremely common cause of lameness in the horse and a thorough examination of the hoof is essential in all lameness investigations. While problems such as a bruised sole or foot abscess may be relatively easy to identify, damage to soft tissue structures within the hoof capsule, such as the distal aspect of the deep digital flexor tendon (DDFT), may require advanced diagnostic imaging.

Clinical anatomy

An appreciation of the relevant anatomy is paramount to understanding and correctly interpreting the findings of a clinical examination and any diagnostic analgesia techniques performed. Detailed descriptions of the anatomy of the equine digit can be found elsewhere (Denoix 2000) but figures 1 and 2 summarise the principle structures of clinical importance.

History

The acquisition of a detailed history is an essential starting point for all lameness investigations. While most information is relevant to all cases, some questions are particularly pertinent when foot lameness is suspected, for example those relating to shoeing. Table 1 summarises the principle details obtained.

Age, breed, use and management must not be omitted as certain predispositions should be considered. For example, with respect to foot lameness, an older horse, maintained in heavy work may be more likely to develop osteoarthritis of the distal interphalangeal (DIP) joint, a Thoroughbred with a low heel, long toe conformation may be vulnerable

FOOT LAMENESS IN THE HORSE: A VETERINARY SURGEONS PERSPECTIVEAlice Sheldon BVM&S BSc MSc CertEP MRCVSTowcester Veterinary Centre Equine Clinic, Plum Park Farm, Paulerspury, Northamptonshire NN12 6LQ Mobile: 07525 667 096 Email: alsheldon@hotmail.co.uk

Fig 2 Sagittal dissection specimen demonstrating the relevant osseous and soft tissue structures of the foot (Denoix 2000).(1)proximal phalanx (2)middle phalanx (3)distal phalanx (4)navicular bone (5)proximal interphalangeal joint (6)distal interphalangeal joint (7)common digital extensor tendon (8)straight sesamoidean ligament (9)deep digital flexor tendon (10)collateral sesamoidean ligament (11)distal impar ligament (12)digital cushion (13)frog (14)sole.

Fig 1 Dissection specimen demonstrating the arrangement of the sensitive tissue between the hoof wall and distal phalanx (Denoix 2000). (1)periople (2)hoof wall (3)coronary band (4)dermal lamellae (5) corium parietis (6)ungular cartilage (7)distal phalanx

12

Signalment

Age

Breed/Type

Sex

Management

Exercise regime

Diet

Farriery including shoeing interval and date when last shod

Physiotherapy

Tack

Previous History

Previous lameness

Diagnosis

Limb(s) affected

Duration

Treatment

Outcome

Current Problem

Complaint; lame at walk/trot/only when ridden/poor performance

Duration

Limb(s) affected

Treatment(s) already attempted and outcome

Improves or worsens with exercise

Effect of different surfaces

to palmar heel pain, while a pony in light work kept on plentiful grass may be at increased risk from laminitis. It is also important to establish as much information as possible about any previous lameness problems, before focusing on the presenting complaint.

An appreciation of what the owner/rider perceives as the problem is important. Foot pain is often implicated in cases of poor performance and should be considered, along with otherorthopaedic and non-orthopaedicaetiologies as a potential explanation. Although this may appear a lengthy procedure in reality much of this information can be obtained during the initial stages of the clinical examination outlined below.

Clinical examination

A thorough and systematic

approach maximises the information that can be obtained from this stage of the investigation. The horse is examined at rest, moving in a straight line and on the lunge as well as under saddle in some instances.

At rest

If possible the horse is first observed unrestrained in the stable or paddock to allow identification of behavioural and postural signs such as weight shifting, persistent resting of one limb or pointing of a foot. An assessment of conformation is then made before closer observation and palpation is carried out. Hoof conformation is traditionally described in terms of mediolateral and dorsopalmar foot balance. Figure 3 demonstrates the arrangement of schematic lines in ideal mediolateral foot balance. Obvious deviations from the ideal can be picked up during clinical

examination, but more subtle changes may require radiographic identification (Parks 2011).

Dorsopalmar foot balance is described in terms of the hoof pastern axis (HPA). Figure 4 demonstrates an ideal alignment of the hoof and pastern angles (A). Deviations with either the pastern angle being more upright than the foot (B) or vice versa (C) are described as a broken forward or broken back HPA, respectively (Ross and McIlwraith 2011).

While good hoof conformation is desirable, many horses have poor foot balance without overt lameness. Furthermore, there are differences in hoof shape and balance between breeds, for example the long toe, low heel, broken back HPA of the Thoroughbred and the boxy, upright hoof of the Warmblood. Conclusions made about hoof conformation and foot balance should, therefore, be made in context.

Closer inspection of the hoof is made to identify the presence of potential problems such as hoof wall cracks which may destabilise the hoof wall capsule or become infected and divergent growth rings at the medial and lateral quarters which may indicate a previous laminitic episode. The coronary band is assessed for defects which may have arisen due to trauma or rupture of an ascending a subsolar

Table 1. Summary of history details to be obtained at the start of a lameness investigation.

Fig 3 Schematic diagram showing assessment of mediolateral foot balance. Viewed from the front, an imaginary line (1) is dropped down the middle of the third metacarpal/metatarsal bone to bissect lines along the DIP joint (2) and weight bearing surface (3) (Parks 2011).

1�

abscess. With the limb lifted observations are then made of the heel bulbs, sole, frog, shoe type and fit and white line if visible. Additional assessments of ML balance are also made at this stage.

Following these observations further information is gained from palpation. In relation to potential foot lameness assessment of the strength of the digital pulses is a useful starting point (fig 5).

In breeds where there is heavy feathering it can be difficult to feel a pulse but in most horses a slight pulse can be palpated and this should be considered normal. Bounding pulses on one or more limbs indicate increased blood flow to the region and are commonly palpated in cases of subsolar bruising or abscessation and laminitis. The absence of an elevated digital pulse, however, does

not preclude the presence of a foot problem.

The temperature of the hoof wall should be checked and compared with the contralateral hoof. Temperature will vary according to time of day and recent activity and should, therefore, be assessed in context. Unilateral heat is most commonly associated with subsolar abscessation. Importantly, many foot pathologies may exist without appreciable changes in hoof wall temperature, including fractures of the distal phalanx (P3).

Hoof testers are used to aid further examination of the foot. Focal pressure is applied in a systematic manner over the entire solar surface of the hoof and across the heel bulbs (fig 6). Response to hoof tester application varies between individuals and will be affected by sole thickness as well as the presence of underlying pathology. Withdrawal in response to pressure applied over a small area leads to the suspicion of localised bruising or abscessation. In cases of laminitis where there is rotation of P3 there may be increased sensitivity to pressure at the point of the frog. Increased sensitivity over the entire sole may be found with P3 fractures but similar responses may be elicited in thin soled horses so comparison with the other hooves is important. Hoof testers can also be used to percuss the hoof wall and nail heads in a further attempt to localise pain to the foot.

Straight line movement

Straight line movement is carried out on a hard surface which is flat and level (fig 7). The horse is seen first at walk as the slower gait allows more time for a detailed examination. Observations are made from in front, behind and the side as well as during left and right turns. Turning is sometimes poorly tolerated in cases of foot lameness and may be the only point at which signs of discomfort are exhibited. Particular attention is paid to the placement of the foot to the ground to assess dynamic foot balance. Common dynamic asymmetries include landing with the lateral hoof wall or palmar region of the hoof wall fractionally before the rest of the weight bearing surface.

Repeat observations are made at trot where signs of lameness such as a head nod, uneven movement of the tuber coxae and reduced stride length are noted. The severity of the lameness is graded on a subjective scale, usually out of 10 with 1/10 referring to mild lameness noticed intermittently during the trot up and 10/10 referring to a non-weight bearing lameness.

Fig 5 The method of assessment of digital pulse strength. Light finger pressure is applied to the palmar/plantar digital arteries over the abaxial surface of the proximal sesamoid bones. Fig 6 Hoof tester application.

Fig 4 Schematic diagram demonstrating assessment of dorsopalmar foot balance.

1�

Flexion tests are routinely performed in lameness investigations, including those where foot lameness is suspected (fig 8). Stress is applied for 45 seconds followed by an immediate trot up. The test is deemed positive if an increase in lameness grade is sustained for more than a few strides. A full limb flexion test applies stress to multiple joints, tendons and ligaments simultaneously and consequently is relatively nonspecific in terms of localising the lameness. Despite these limitations, flexion tests provide a useful aid in the identification of subtle lameness and in cases where multiple limbs may be affected.

Lunging exercise

Observation of lunging exercise is of particular value in cases of foot lameness since the stresses applied to the hoof capsule are magnified

during circling. Lunging is performed on soft and hard surfaces, on both reins at trot. Care must be taken to ensure the latter surface is suitable and does not put the horse at risk of further injury (fig 9).

Ridden exercise

In some cases the lameness may manifest more as an unlevel feeling experienced by the rider or a reduction in athletic performance. Careful history taking may reveal, for example, a sudden reluctance to jump drop fences or perform certain dressage movements. Clinical signs

of foot lameness are often seen before this stage and ridden exercise may not be required. It should, however, be considered as a useful adjunct if earlier findings are equivocal or inconsistent. As with all assessments of the ridden horse, observations must be made in light of the horse and rider’s discipline and ability.

The findings of the clinical examination may lead to a strong suspicion of foot lameness. In some circumstances an obvious explanation may be identified without further diagnostics. For instance, in a case where there is marked lameness at walk, asymmetric elevation in hoof wall temperature and digital pulse strength and localised sensitivity to hoof tester application the next logical step may be to remove the shoe, if present and explore the sole region with a hoof knife. Identification of a tract or nail hole with draining purulent pus confirms a foot abscess. However, examination may reveal less obvious findings and diagnostic analgesia is

required to ascertain their clinical significance.

Diagnostic analgesia

In cases where there are no localising signs on clinical examination diagnostic analgesia is commenced with a perineural injection that will desensitise the entire foot. If a positive response to this is found further investigation of the anatomical region(s) involved is carried out using intra-articular and intra-bursal injections. In other circumstances a more targeted approach may be possible from

the onset. For example, if there is palpable effusion of the DIP joint the intra-articular analgesia of this joint would be the logical starting point. The perineural, intra-articular and intra-bursal injections of local anaesthetic relevant to foot lameness are summarised in table 2 (Bassage and Ross 2011). Safe and accurate technique must be employed during all diagnostic anaesthesia procedures. For perineural injection the skin must be clean and the precise location of the nerve must be palpated prior to injection. In some cases it may be necessary to clip the hair to facilitate this. Strict asceptic preparation and technique must be adhered to during intra-articular injection. Following clipping and preparation of the skin, the solution is drawn into the syringe in a sterile manner and sterile gloves are worn for injection (fig 10).

Several studies have demonstrated a need for cautious interpretation of the results of diagnostic analgesia in the foot (Schumacher and Steiger 2000; Gough Mayhew and Munroe 2002; Schumacher, Livesey and De

Fig 7 A horse being assessed at walk..

Fig 8 A full limb flexion test being performed on the left fore limb.

Fig 9 A horse being lunged on the right rein at trot on an appropriate gravel surface.

1�

Graves 2004). Demonstrations of diffusion of local anaesthetic solution away from the original site of injection, in conjunction with the close proximity of clinically relevant structures in the foot have lead to the understanding that these blocks are less anatomically specific than previously thought. Despite this, diagnostic analgesia performed and interpreted correctly still provides useful information regarding the presence or absence of foot pain and is a routinely performed lameness investigation. Consistent, accurate technique in terms of site of injection as well as total volume of solution used helps to minimise confusion.

Once the approximate anatomical region giving rise to the lameness has been identified appropriate diagnostic imaging can be performed.

Diagnostic imaging

Radiography is the usual first line imaging modality in foot lameness investigations. A variety of projections and exposures are used to detect osseous pathology, for example P3 fracture (fig 11), osteoarthritis of the DIP joint and remodelling of the navicular bone. Gas shadowing within the hoof capsule may also be identified in cases of subsolar abscessation or acute laminitis.

Ultrasonography has limited use in the diagnosis of foot problems due to the inability of ultrasound waves to penetrate the hoof wall. Imaging of the proximal third of the collateral ligaments of the DIPjoint is possible above the coronary band (fig 12) and some distal soft tissue structures, such as the DDFT and digital cushion, can be imaged through the frog if prior foot preparation is meticulous.

Nuclear scintigraphic images, or bone scans, may be useful in some

instances, for example identification of increased bone turnover in navicular bones that show no radiographic abnormalities. However, careful interpretation is required as increased turnover is not synonymous with lameness and may merely reflect the foot’s physiological adaptation to biomechanical forces (Dyson 2002). This imaging modality has high sensitivity and will readily demonstrate the presence of active bone remodelling but with low specificity. It provides a physiological rather than anatomical insight into potential underlying pathology. Figure 13 shows a scan image with increased radiopharmaceutical uptake (IRU) in P3.

MRI allows simultaneous assessment of bone, cartilage and soft tissue pathology in multiple sections across three planes; sagittal, frontal and transverse (fig 14). This imaging modality has substantially enhanced the understanding of distal limb pathologies and in particular the clinical relevance of the soft tissue structures of the foot. (Dyson et al 2011) (Table 3). This is especially relevant to our understanding of navicular disease where the traditional radiographic diagnosis of a single navicular bone pathology has been superseded by

Fig 10 Local anaesthetic solution being injected into the DIP joint.

Table 2. Summary of the site of local anaesthetic solution injection and corresponding anatomical region desensitised by the procedure (Bassage and Ross 2011).

Site of local anaesthetic injection Anatomical region desensitised

Medial & lateral palmar/plantar digital nerves(PD block) Most structures within the foot, variably

pastern structures.

Medial & lateral palmar/plantar nerves at level of

proximal sesamoid bones (abaxial sesamoid (AS) block)

All structures within the foot and

pastern, variably fetlock joint.

Distal interphalangeal joint (DIP block) DIP joint, variably additional foot

structures.

Navicular bursa block (NB block) Navicular bursa & navicular bone,

variably additional palmar/plantar foot

structures.

Fig 11 Dorsoproximal-palmarodistal 600 oblique radiograph of sagittal P3 fractured (Towcester Equine Clinic).

Fig 12 Ultrasound image of the lateral collateral ligament of the DIP joint in transverse (left) and longitudinal section (right). (Courtesy of E Cauvin Azur Vets, Cote D’Azur, France).

Fig 13 Lateral (above) and solar (below) scintigraphic images of the distal limbs. (Courtesy of A Font MRCVS Bearl Equine Clinic, Northumberland, UK)

1�

the recognition of multiple bone and surrounding soft tissue changes and the concept of a multifactorial navicular syndrome (Dyson et al 2011).

Computed tomography can provide useful information regarding pedal bone fracture configuration but is not commonly used in cases of foot lameness.

Differential Diagnosis

To reflect the range of potential causes of foot lameness that may be identified in the horse, a non-exhaustive list of differential diagnoses is shown in table 3.

Summary

Foot lameness is a common problem in the horse. A thorough, methodical approach to the assessment of a lame horse must, therefore, include clinical examination of the foot. While not all horses with poor hoof conformation or foot balance are lame, a wider appreciation of these other clinical examination findings, helps promote a multifaceted approach to lameness investigations between veterinarians, physiotherapists and farriers. Diagnostic analgesia is a useful veterinary aid but must be interpreted with caution, particularly in cases of foot lameness. While radiography remains the most common imaging modality in first opinion practice, MRI provides more detailed information. Ongoing research will hopefully allow a greater understanding of the clinical significance of this information and further enhance

diagnostic and prognostic accuracy of foot lameness investigations. and prognostic accuracy of foot lameness investigations.

Fig 14 MR image of distal DDFT lesion in sagittal (left), frontal (right) and transverse(bottom) planes. (Courtesy of A Font MRCVS Bearl Equine Clinic, Northumberland, UK)

Table 3 Summary of differential diagnoses of foot lameness.

Hoof wall

Cracks

Coronary band defects

Sole and laminae

Solar bruising, corns

Subsolar abscess

Inflammation of laminae secondary to nail prick

Laminitis

Keratoma

P3

Fracture

Rotation secondary to laminitis

Infective osteitis

DIP joint

Osteoarthritis

Sepsis

Collateral ligament desmitis

Navicular bone

Remodelling

Cystic lesions

Fracture

Navicular bursa

Inflammatory bursitis

Septic bursitis

Distal soft tissue structures

Collateral sesamoidean desmitis

Distal impar desmitis

Distal DDF tendonitis

References

Bassage, L.H. and Ross, M.W. (2011) Diagnostic Analgesia. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Elsevier Saunders, Missouri, USA. Chapter 10.

Denoix, J. (2000) The Equine Foot. In: J. Denoix (2000) The Equine Distal Limb: An Atlas of Clinical Anatomy and Comparative Imaging. Manson Publishing Ltd, London, UK. Chapter 1, pp. 2, 38-39.

Dyson, S. (2002) Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain. Equine Veterinary Journal, 34, pp. 164-170

Dyson, S., Murray, R., Schramme, M. and Blunden, T. (2011) Current concepts of navicular disease. Equine Veterinary Education, 23, pp. 27-39

Gough, M.R., Mayhew, I.G. and Munro, G.A. (2002) Diffusion of mepivicaine between adjacent synovial structures in the horse. Part 1. The foot and carpus. Equine Veterinary Journal, 34, pp. 80-87Parks, A.H. (2011) The Foot and Shoeing. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Elsevier Saunders, Missouri, USA. Chapter 27, pp. 290

Ross, M.W. and McIlwraith, C.W. (2011) Conformation and Lameness. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Eds. Elsevier Saunders, Missouri, USA. Chapter 4 pp. 31

Schumacher, J. and Steiger, R. (2000) Effect of anaesthesia of the distal phalangeal joint or palmar digital nerves on lameness caused by solar pain in horses. Veterinary Surgery, 29, pp. 54-61

Schumacher, J., Livesey, L. and DeGraves, F.J. (2004) Effect of anaesthesia of the palmar digital nerves on proximal interphalangeal joint pain in the horse. Equine Veterinary Journal, 36, pp. 409-413

Williams, G. and Deacon, M. (2002) No Foot, No Horse. Poor feet and bad backs. In: G. Williams and M. Deacon. (2002) Foot balance: The Key to Soundness and Performance. Stamford Press, Singapore, Chapter 5 pp. 58 -64

1�

Helen Blamires*, Nicolas Granger*, Nick D Jeffery#, Robin J M Franklin** Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, UK# Department of Veterinary Clinical Sciences, College of Veterinary Medicine, 1600 South 16th Street, Ames, IA 50011, USA

GET ON THE RESEARCH TREADMILL

As part of a randomised and blinded clinical trial investigating the efficacy of intra-spinal transplantation of olfactory ensheathing cells (OECs) for spinal cord injury (SCI) repair in dogs, gait analysis is being used to obtain the mean diagonal coupling interval (MDCI) when the dogs walk on a treadmill. As the primary outcome measure of the trial, the MDCI is used to analyse the coordination between the normal thoracic limbs and the paraparetic pelvic limbs in dogs with SCI located at the thoraco-lumbar junction. This method exploits the quadrupedal locomotion of dogs and provides an indirect means to examine the restoration of connection across the injury site.

Spinal cord injury occurs in people (mostly due to trauma) and dogs (as a result of disc herniation, typically in chondrodystrophic breeds such as Dachshunds). In both species, the most severe cases fail to recover, even when current treatments (surgery for compressive lesions and supportive care with rehabilitation) are carried out promptly (Furlan et al. 2010). Many animals still have to be euthanized due to cost factors or management issues related to the remaining neurological deficits.

Having said this, even in cases of SCI that appear to be clinically complete, there are axons which still have measureable continuity through the

lesion. This phenomenon has been recorded, generally by detecting action potentials travelling across the lesion (i.e. nerve conduction

tests called magnetic motor and somatosensory evoked potentials). These axons, usually described as physiologically dysfunctional but anatomically intact, have for example lost their myelin sheath and thus form the target of cell therapies such as with the olfactory bulb-ensheathing cell line (Franklin et al. 1996). Other axons are severed at the lesion site but it is possible to enhance their sprouting abilities. Some of the placebo-controlled clinical trials that have been or are currently being performed in dogs include the use of pharmaceuticals such as methylprednisolone sodium succinate, polyethylene glycol, N-acetylcysteine, 4-aminopyridine or implants like oscillating field stimulators (for a review see Olby, 2010). Olfactory ensheathing cell (OEC) therapy is a cell therapy approach for SCI repair (Ito et al. 2006).

Why use Olfactory Ensheathing Cells?

As the neurons that allow us to smell are under constant insult from environmental factors, such as smoke, and die throughout life, progenitor cells give rise to new neurons that have the ability to regenerate new processes with the

support of OECs and thus maintain connections with the brain and facilitate our sense of smell. OECs thus play a key role in this ‘natural’ regenerative process. When OECs are transplanted into an injured environment they can assist in the regeneration of severed axons and remyelination of demyelianted axons.

OEC Transplants

Injection of OECs in the injured spinal cord has been associated with significantly improved functional outcome in rats (Ying et al. 2003) but there is a massive step from treating experimental SCI in laboratory rodents to treating clinical SCI in a hospital. In an earlier study it was established that OEC transplantation in dogs is both practical and safe (Jeffery et al. 2005). A blinded and randomised trial investigating the efficacy of autologous OEC transplantation for the treatment of naturally occurring SCI in pet dogs has been running for 2 years.

A brief description of the clinical trial

To qualify for inclusion on the trial the dogs need to have a lesion located between T3 and L2 which was caused by an acute traumatic episode (fracture/luxation/IVD extrusion), and had a three month period of static and unacceptable neurological recovery.

Once accepted onto the trial, a frontal sinus biopsy is carried out to harvest the frontal sinus mucosa (Fig 1). The mucosal biopsy (Fig 2) is dissected under an optical microscope to remove unwanted tissue and treated with enzymes to prepare it for culture (Fig 3). It takes between three and five weeks to culture and purify the growth of

Fig 1 The mucosal tissue is collected from the frontal sinus via a rhinotomy.

Fig 2 Olfactory mucosa biopsy photographed through a dissecting microscope.

References

Bassage, L.H. and Ross, M.W. (2011) Diagnostic Analgesia. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Elsevier Saunders, Missouri, USA. Chapter 10.

Denoix, J. (2000) The Equine Foot. In: J. Denoix (2000) The Equine Distal Limb: An Atlas of Clinical Anatomy and Comparative Imaging. Manson Publishing Ltd, London, UK. Chapter 1, pp. 2, 38-39.

Dyson, S. (2002) Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain. Equine Veterinary Journal, 34, pp. 164-170

Dyson, S., Murray, R., Schramme, M. and Blunden, T. (2011) Current concepts of navicular disease. Equine Veterinary Education, 23, pp. 27-39

Gough, M.R., Mayhew, I.G. and Munro, G.A. (2002) Diffusion of mepivicaine between adjacent synovial structures in the horse. Part 1. The foot and carpus. Equine Veterinary Journal, 34, pp. 80-87Parks, A.H. (2011) The Foot and Shoeing. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Elsevier Saunders, Missouri, USA. Chapter 27, pp. 290

Ross, M.W. and McIlwraith, C.W. (2011) Conformation and Lameness. In: M.W. Ross and S.J. Dyson (2011) Diagnosis and Management of Lameness in the Horse. 2nd Edition. Eds. Elsevier Saunders, Missouri, USA. Chapter 4 pp. 31

Schumacher, J. and Steiger, R. (2000) Effect of anaesthesia of the distal phalangeal joint or palmar digital nerves on lameness caused by solar pain in horses. Veterinary Surgery, 29, pp. 54-61

Schumacher, J., Livesey, L. and DeGraves, F.J. (2004) Effect of anaesthesia of the palmar digital nerves on proximal interphalangeal joint pain in the horse. Equine Veterinary Journal, 36, pp. 409-413

Williams, G. and Deacon, M. (2002) No Foot, No Horse. Poor feet and bad backs. In: G. Williams and M. Deacon. (2002) Foot balance: The Key to Soundness and Performance. Stamford Press, Singapore, Chapter 5 pp. 58 -64

1�

OECs (Fig 4) to the point where there are at least 5-8 million cells ready for the autologous transplantation.

A MRI is carried out to confirm the localisation of the lesion treated in the acute phase (Fig 5). Spinal needles are placed in to the spinal canal with the aid of fluoroscopic guidance. The needles are placed cranially, centrally and caudally in the lesion so that the transplant is spread throughout the dysfunctional tissue (Fig 6).

Functional evaluation of the dogs consists of:

Gait analysis – treadmill recordings of locomotion using reflective markers and infra-red cameras.

Urodynamic recordings – bladder cystometry to assess the autonomic function, i.e. micturition.

Nerve conduction – evoked potentials are recorded below the lesion after stimulation of the cortex (magnetic motor evoked potentials/MMEP) or above the lesion after stimulation of the tibial nerve (somatosensory evoked potentials/SSEP) to help assess the spinal cord conductivity.

These functional evaluations are carried out before the transplantation to establish a base-line, and then on a monthly basis for six months after the transplant.

Gait analysis

Treadmill equipment can be used to assess locomotion or be part of a rehabilitation protocol for SCI patients. The mean diagonal coupling interval (MDCI), developed by Hamilton et al (2007), describes the coordination between forelimb and hindlimb movement. It is derived using mathematical analysis of the data recorded during digital motioncapture equipment, whilst the dog walks on the treadmill (Fig 7). Reflective markers are placed on the legs of the dog and the movement of the markers is recorded by the infrared cameras. The motion capture software provides a digital 3D image of the dog on the treadmill (Fig 8) and the stride patterns can then be visualised and compared. In normal dogs the MDCI parameter is very constant (Fig 9), and has been shown to be highly sensitive to alterations in forelimb-hindlimb coordination in dogs that have suffered SCI (Hamilton et al. 2007) (Fig 10). MDCI therefore provides a useful method to compare the functional effect of therapeutic interventions after SCI in quadrupeds, which is why the MDCI has been selected as the primary outcome measure for the OEC trial.

Recruitment for the trial has recently been put on hold so that the first wave of data (34 transplanted dogs) can be analysed. We are taking it just one step at a time.

Fig 3 Cell culture flasks used to grow the cells.

Fig 4 Immunocytochemistry is conducted on the cultured cells for identification and count of OECs. The OECs are stained red and the green cells are fibroblasts.

Fig 5 Sagittal MR image of the spine and spinal cord taken to localise the centre of the lesion (yellow arrows) before transplantation takes place.

Fig 6 Sagittal X-ray of the spine of a transplanted dog. The placement of the three spinal needles is guided by fluoroscopy.

Fig 7 Treadmill equipment showing infra-red cameras placed around the treadmill to record the movement of the reflective markers that have been placed on the dog’s limbs.

1�

Fig 8 3D digital dog, produced after treatment of the acquired data by the software and observer.

Fig 9 3D normal dog with stride pattern. The stepping movement can be seen when the reflective marker’s movements are plotted on the screen (forelimbs = blue & purple markers, hindlimbs = yellow and green) markers. Note the regularity in the strides in this normal dog.

Fig 10 3D paraplegic dog with stride pattern. The stepping movements made by the forelimbs (blue and purple markers) are regular (white arrow, red double headed arrow). The stepping movements made by the hindlimbs (yellow and green markers) are more irregular in both stride length (blue arrow) and lateral stability (white double headed arrow).

References

Franklin, R.J. Gilson, J.M. Franceschini, I.A. Barnett, S.C. (1996) Schwann cell-like myelination following transplantation of an olfactory bulb-ensheathing cell line into areas of demyelination in the adult CNS. Glia 1996.1(3):217-24).

Furlan, J.C. Noonan, V. Cadotte, D.W. (2010) Timing of decompressive surgery after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma. [Epub ahead of print].

Hamilton, L. Franklin, R.J.M. Jeffery, N.D. (2007) Development of a universal measure of quadrupedal forelimb-hindlimb coordination using digital motion capture and computerized analysis. BMC Neuroscience 8:77

Ito, D. Ibanez, C. Ogawa, H. Franklin, R.J. Jeffery, N.D. (2006) Comparison of cell populations derived from canine olfactory bulb and olfactory mucosal cultures. American Journal of Veterinary Research. 67(6):1050-6.

Jeffery, N.D. Lakatos, A. Franklin, J.M.D. (2005) Autologus Olfactory Glial Cell Transplantation is Reliable and Safe in Naturally Occurring Canine Spinal Cord Injury. J Neurotrauma. 22(11):1282-1293.

Olby, N. (2010) The Pathogenesis and Treatment of Acute Spinal Cord Injuries in Dogs. Veterinary Clinics of North America: Small Animal Practice, Spinal Diseases. 40 (5):791-807.

Ying, L. Decherchi, P. Raisman, G. (2003) Transplantation of Olfactory Ensheathing Cells into Spinal Cord Lesions Restores Breathing and Climbing. J Neuroscience. 23(3):727-731.

20

‘CAN THE RESULTS OF RESEARCH UNDERPINNING HUMAN MUSCULOSKELETAL PHYSIOTHERAPY PRACTICE BE EXTRAPOLATED TO SUPPORT THE REHABILITATION OF ANIMAL MUSCULOSKELETAL PROBLEMS?’ Canine hamstring injuries (partial rupture), with particular reference to the greyhound Anna Victoria Woods HPC MCSP BSc MSc ACPAT Cat A submitted as part of the veterinary physiotherapy rehabilitation module of the UWE hartpury MSc in veterinary physiotherapy

Introduction

Physiotherapy is widely used in human medicine and the prevalence of physiotherapy in veterinary medicine is increasing. Considering the Association of Chartered Physiotherapists in Animal Therapy (ACPAT) upgrading route to animal physiotherapist requires the applicant to firstly complete a human degree, it is suggestive that it is deemed the skills acquired for human practice are necessary and applicable to animals. Additionally a lack of animal literature regarding physiotherapy interventions means extrapolation of research from other areas is necessary to achieve the evidence based practice strived for by physiotherapists and as dictated by the Chartered Society of Physiotherapy (CSP). However it remains unclear whether these decisions based on human practice are justified when treating animals. The following report strives to discuss the limitations and benefits of this approach in the context of partial hamstring rupture in the greyhound.

Report

Hamstring injuries in humans comprise a substantial percentage of acute musculoskeletal injuries acquired during sporting pursuits (Heiderscheit et al. 2010). Carlson (2008) further identified that those

competing in sprinting activities were particularly susceptible to partial ruptures of the hamstring muscle complex, defined as biceps femoris, semimembranosis and semitendinosis (Woodley and Mercer, 2005).

In the animal kingdom the greyhound is recognised as an elite sprinting athlete, who has undergone artificial selection for high- speed running and aerobic stamina (Usherwood and Wilson, 2005). A prerequisite of effective sprinting is rapid acceleration, requiring a large mechanical force to be produced to increase kinetic energy of the body, capable of high power production (Payne et al. 2005)and this is achieved in the greyhound by a large hip extensor muscle bulk (Schoning and Cowan, 1993) yet it is noted that the literature within the greyhound racing fraternity consistently identifies the pelvic limb as an area of injury and the hamstring muscle as a common site for soft tissue injury such as partial rupture (Sicard et al. 1999).

Despite comparable hamstring partial rupture pathology between man and greyhound it remains unclear whether human intervention underpinned by current literature may be substantiated when applied in a veterinary scenario for the greyhound. Many authors express the limitations of evidence - based

practice without extrapolation to other species (Di Fabio, 1999). As each clinical presentation is unique, influenced by numerous factors, the literature can rarely be representative of one individual yet the practitioner is still required to apply the scientific research to practice. The interpretation of the literature is reflected in the philosophical position of the clinician, as what is perceived when read, is directly dependent on the perceived current knowledge of that individual (Di Fabio, 1999). This may suggest that reviewing journal articles will only be a subjective interpretation of disparate results.

Evans (2002) proposes that to decrease the probability of trial results being misrepresented the hierarchy of evidence may be employed to identify journals articles defined as higher quality; ensuring practice is based on valid trial outcomes (Appendix I). However in cases where it is necessary to further extrapolate these findings to varying presentations; or other species, a sound knowledge of research methodologies and professional experience can aid inference and build a scholarly argument to present an appropriate treatment for a patient. Acknowledging the theory proposed by Evans (2002) the following report identified ‘excellent’ and ‘good’ journal articles by applying strict

21

search criterion (Appendix II) to access research concerned with the management of partial hamstring ruptures in humans, to assess its possible efficacy and justification in the treatment of greyhounds.

Malliaropoulos et al (2004) conducted a randomised controlled trial in athletes to assess the effects of static stretching in rehabilitating a partial rupture of the hamstring muscles. The participants were split into two groups and one underwent an intensive stretching programme and the other applied the same stretches less frequently. The outcomes suggested that applying a hamstring stretch as recommended (four repetitions held for thirty seconds each) (Appendix III) four times per day, when compared to once daily, accelerated the time required to achieve normal knee range of movement (ROM) (when compared to the uninjured limb) and reduced the time taken to return to a full training programme.

From a practical perspective it could be deemed that this treatment technique could be replicable in the Greyhound, as equivalent exercises are advocated in canine texts by veterinary physiotherapists (McGowan et al. 2007). This would however depend on the stretch stressing the comparable hamstring complex noting the anatomical differences. Van Emmerik et al (1998) note the differences in the hamstring complex between the biped and quadruped; the lateralised position of the biceps femoris and the slip of biceps femoris and semitendinosis to the calcaneus.

If these biomechanical deviations could be surmounted it could be concluded that the outcomes could be applied to the greyhound as recent studies dictate the foundation of human and greyhound hamstring muscle have similar characteristics with regard to the construct of mammalian striated muscle at cellular level (Grosberg et al, 2011). Matthews (2001) discusses how these cells are anatomically organised with regard to fascicles arranged of myofibrils

composed of repeating sections of sarcomeres, noted for their role in strength (Grosberg et al, 2011), with longitudinally oriented filaments arrayed in parallel groups.

However as in the study the individual subject determined the stretch applied, it would be impractical to replicate the treatment procedure as described, due to limited cognition in the greyhound (Broom and Fraser, 2007). Many authors indicate that restricted feedback is a common problem when applying human medical practice to animals, yet it has been suggested that superior palpation skills, for which physiotherapists are renowned may be able to replicate a similar stretch by assessing tissue response (McGowan et al, 2007).

Furthermore the trial utilised a thirty second hold per stretch repeated four times, which is the widely accepted stretch protocol for healthy human tissue, whereas recent findings advocate stretching injured muscles for longer intervals, due to histological changes occurring after partial rupture (Askling et al, 2006). This is supported by Aquino et al (2010), who illustrated that torn tissue, scar tissue and tissue reorganisation were responsible for altering the biomechanical properties of the tissue. Although this has not been substantiated, if correct this may alter the practicalities of applying the stretches to the greyhound. Wilcoxon (2001) suggests that greyhounds are sensitive in nature and those from a racing environment may not experience frequent human handling. These factors may in turn reduce greyhound compliance to treatment over extended time frames (Broom and Fraser, 2007).

The efficacy of this treatment approach may also be judged on its outcome measures. Assessment of ROM compared to the uninjured limb offers a straightforward objective measure of muscle length, which can be reproduced in the greyhound. However Brady et al (1997) found that stretching in their study increased participants

tolerance to the discomfort of stretching. It therefore remains unclear whether the increased joint ROM is produced by a true increase of muscle length or a greater tolerance to increased muscle tension. Despite this Askling et al (2006) describe such improvements as increased flexibility, which is vital in avoiding re-occurrence in partial ruptures and Aquino et al (2010) suggest this as a sound approach to rehabilitation. However further definitions describe rehabilitation, as restoring normal function and athletic capacity, which could be proposed is then not achieved as Ben and Harvey (2010) demonstrated that hamstring extensibility was not affected by static stretching. This refers to the increased number of sarcomeres in series and the rearrangement of collagen, resulting in restoration of pre-injury muscle strength of contraction (Huet de la Tour et al, 1979), indicating that the canine may not regain the same sprinting ability, which is vital for racing greyhounds (Schoning and Cowan, 1993).

Sherry and Best (2004) produced a randomised controlled trial to compare the effects of two rehabilitation programmes utilised in humans with partial rupture of the hamstring complex, but it is unclear whether these outcomes found in humans, with less sporting ability, could be applied to the elite sporting greyhound due to possible muscle adaptations occuring through extensive athletic training. Grosberg et al (2011) noted that muscle organisation is the product of functional adaptation. This is reinforced by Williams et al (2008), who established that the greyhound pelvic limb muscle bulk makes up 18.5% of the total body mass, with semitendinosis and biceps femoris double the size of a ‘normal’ canine and a longer fascicle length of hamstrings. It is hypothesised that this aids a higher power output and results have been mirrored in human sprinters (Kumagai et al, 2000). This may suggest that extrapolating outcomes from this more athletic cohort may provide a more reliable comparison and therefore

22

conclusions drawn from Sherry and Best (2004) should be viewed with caution, as there could be large variation and inconsistency between species as the aforementioned theory is suggestive of outcome discrepancies.

The stretching and strengthening programme is compared to a progressive agility and trunk stabilisation programme. Both Sherry and Best (2004) and Malliaropoulos et al (2004) suggest that because of the origin of the hamstring muscle, neuromuscular control of the pelvis and lumbopelvic region, including anterior and posterior tilt, is needed to create optimal function of the hamstring during sprinting and where control is poor the risk of hamstring partial rupture is increased. Many authors illustrate that pelvic position influences length tension relationships and force velocity relationships (Sole et al, 2010), endorsing the use of progressive agility exercises and trunk stabilisation exercises in a hamstring rehabilitation programme.

Sherry and Best (2004) describe the exercises as promoting activation of the trunk and pelvic musculature in a desired or neutral postural alignment, which is reflective of McGowan et al (2007) aims when recruiting and building core stability. This is commonplace in veterinary physiotherapy and many authors document equivalent exercises to target these muscles in the quadruped, which could be applied to the greyhound to perhaps achieve similar results. However by implementing such techniques in the greyhound it is suggestive that neuromuscular control is lacking, which has not been substantiated by any veterinary literature. Gilette and Angle (2008) condemn broadly comparing muscle function between species, due to varying contraction velocities, but this view is opposed by Nicholson et al (2007) who detected similar patterns between human and greyhound hip and stifle biomechanics and their response to external stimuli, indicating that humans and greyhounds may therefore suffer from similar

biomechanical mechanisms of injury and benefit from similar treatment. Therefore it could be justified that these exercises may be implemented in the rehabilitation of a partial rupture in the greyhound. Yet it would be prudent to use caution with this approach and such unfamiliar situations highlight the importance of sound clinical reasoning skills and clear outcome measures, to allow the practitioner to validate the treatment choice. Albeit Deutscher et al (2009) reinforce that it is through means of trial and error that practice is developed.

The authors found that this programme was more effective than the stretching and strengthening programme in shortening the time frame required for the subjects to return to normal activities and achieving a lower rate of re-injury over one year. As the programme used active dynamic and isometric strength exercises, it may be implied that these forces would be problematical to recreate in the greyhound, with regard to animal compliance (Broom and Fraser, 2007). Despite this, components of the programme may be applicable in the greyhound and the efficacy of these should not be ignored, as there was no control group used, which therefore did not allow a relative comparison of the effectiveness of this programme (Greenhalgh, 2001). Furthermore the mean age of the stretching and strengthening group was higher and Hoskins and Pollard (2005) and Worrell and Perrin (1992) suggest that this could have a detrimental effect on the healing rate of hamstring muscle tissue.

Sherry and Best (2004) also implement the use of cold therapy in their rehabilitation approach. This was applied equally in all the programmes at the end of each phase and therefore the groups remained standardised (Greenhalgh, 2001). However such an approach does not allow the clinician to identify the respective outcome of single interventions, but this may be more representative of clinical practice and allows the reader to

adapt elements of the literature to their case, accepting that the accuracy of the research outcomes is challenged. Due to the similar vascular properties of the hamstring tissue between man and greyhound (Williams et al, 2005) it may be proposed that the greyhound could benefit from the widely reported benefits of icing hamstring partial ruptures; reduction in pain, decreased inflammatory response (Swenson et al, 1996; Kerschan- Schindl et al. 1998). However Wilcoxon (2001) discusses the hypersensitivity of the greyhound to cold, which is noted by Lane and Latham (2009) as a contraindication to cryotherapy.

To justify using human literature regarding hamstring partial rupture rehabilitation in the application of treatment in the greyhound, the practitioner must recognise the limitations of applying any research to practice. Furthermore despite the requirement for evidence based practice increasing, sound research knowledge and a perspective based on clinical experience must not be disregarded, as they are vital in translating the literature to practice (Dawes et al, 2005). Philosophical principles reveal that this translation is largely subjective and is based on a perceived truth, dependent on current levels of knowledge, suggesting that the translation will vary as understanding and knowledge of the subject is deepened.

Acknowledging this perception it may be suggested that evidence based practice can allow the clinician to apply one interpretation of the literature to practice, yet relies on clinical reasoning skills and objective measures to assess the outcomes of the treatment modalities implemented. Finally by utilising an evidence based approach to treatment the practitioner may be challenged and a dialogue opened, which could serve to improve the efficacy of veterinary physiotherapy practice and aid in the development of the profession.

2�

References

Aquino, C. F., Fonseca, S. T., Goncalves, G. G. P., Silva, P. L. P., Ocarino, J. M. & Mancini, M. C. (2010) Stretching versus strength training in lengthened position in subjects with tight hamstring muscles; a randomised controlled trial. Manual Therapy. 15, pp 26 – 31.

Askling, C., Saartok, T. & Thorstensson, A. (2006) Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Bristish Journal of Sports Medicine. 40, pp 40 – 44.

Ben, M. & Harvey, L. A. (2010) Regular stretch does not increase muscle extensibility; a randomised controlled trial. Scandinavian Journal of Medicine and Science in Sports. 20, pp 136 – 144.

Broom, D. M. & Fraser, A. F. (2007) Domestic Animal Behaviour and Welfare. 4th ed. Cambridge: Cambridge University Press.

Carlson, C. (2008) The natural history and management of hamstring injuries. Current Reviews in Musculoskeletal Medicine. 1, pp 120 – 123.

Dawes, M., Summerskill, W., Glasziou, P. Cartabellotta, A., Martin, J., Hopayian, K., Porzsolt, F., Burls, A. & Osborne, J. (2005) Sicily statement on evidence based practice. BioMed Central Medical Education. 5 (1), pp 1 – 7.

Deutscher, D., Horn, D. S., Dickstein, R., Hart, D. L., Smout, R. J., Gurtirtz, M. & Ariel, I. (2009) Assoiciations between treatment processes, patient characteristics and outcomes in an outpatient physical therapy practice. Archives of Physical Medicine and Rehabilitation. 90 (8), pp 1349-1363

Di Fabio, R. P. (1999) Myth of evidence based practice. Journal of Orthopaedic and Sports Physical Therapy. 29 (11), pp 132 – 134.

Evans, D. Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing. 12, pp 77 – 84.

Gillette, R. L. & Angle, T. C. (2008) Recent developments in canine locomotor analysis: A review. The Veterinary Journal. 178, pp 165 – 176.

Greenhalgh, T. (2001) How to read a paper. 3rd ed. Oxford: Blackwell Publishing.Grosberg, A., Kuo, C. L., Geisse, N. A., Bray, M. A., Adams, W. J., Sheehy, S. P. & Parker, K. K. (2011) Self organisation of muscle cell

structure and function. PLoS Computational Biology. 7 (2), e1001088.

Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S. & Thelen, D. G. (2010) Hamstring strain injuries: Recommendations for diagnosis, rehabilitation and injury prevention. Journal of Orthopaedic and Sports Physical Therapy. 40 (2), pp 67 – 81.

Huet de la Tour, E., Tabary, J. C., Tabary, C. & Tardieu. (1979) The respective roles of muscle length and muscle tension in sarcomeres number adaptation of guinea pig soleus muscle. Journal of Physiology. 75, pp 589 – 592.

Hoskins, W. & Pollard, H. (2005) Hamstring injury management: treatment. Manual Therapy. 10, pp 180 – 190.

Kerschan- Schnidl, K. Uher, E. M., Zauner- Dungl, A. & Fialka- Moser, V. (1998) Cold and cryotherapy: a review of the literatire on general principles and practical applications. Acta Med Austriaca. 25 (3), pp 73 – 78.

Kumagai, K., Abe, T., Brechue, W. F., Ryushe, T., Takano, S. & Mizuni, M. (2000) Sprint performance in related to muscle fascicle length in male 100m sprinters. Journal of Applied Physiology. 88, pp 811 – 816.

Lane, E. & Latham, T. (2009) Managing pain using heat and cold. Paediatric Nursing. 21 (6), pp 14 – 18.

Malliaropoulos, N., Papalexandris, S., Papalada, A. & Papacostas, E. (2004) The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up. Medicine and Science in Sports and Exercise. 36 (5), pp 756 – 759.

Matthews, G. G. (2001) Neurobiology: molecules, cells and systems. 2nd ed. Oxford: Blackwell Science Ltd.

McGowan, C., Goff, L. & Stubbs, N. (2007) Animal Physiotherapy. Oxford: Blackwell Publishing.

Nicholson, H. L., Osmotherly, P. G., Smith, B. A. & McGowan, C. M. (2007) Determinants of passive hip range of momvement in adult Greyhounds. Austrailian Veterinary Journal. 85 (6), pp 217 – 221.

Payne, R. C., Hutchinson, J. R., Robilliard, J. J., Smith, N. C. & Wilson, A. M. (2005) Functional specialisation of pelvic limb anatomy. Journal of Anatomy. 206, pp 557 – 574.

Schoning, P. & Cowan, L. A. (1993) Gross and microspocpic lesions of 230 Kansas

greyhounds. Journal of Veterinary Diagnostic Investigation. 5, pp 392 – 397.

Sherry, M. A. & Best, T. M. (2004) A comparison of two rehabilitation programmes in the treatment of acute hamstring strains. Journal of Orthopaedic and Sport Physical Therapy. 34, pp 116 – 125.

Sicard, G. K., Short, K. & Manley, P. A. (1999) A survey of injuries at five greyhound racing tracks. Journal of Small Animal Practice. 40, pp 428 - 432.

Sole, G., Milosavljevic, S., Nicholson, H. & Sullivan, S. J. (2011) Altered muscle activation following hamstring injuries. British Journal of Sports Medicine.Available from: http://bjsm.bmj.com/content/early/2011/03/09/bjsm.2010.079343.full.html[Accessed: 2nd April 2011].

Swenson, C., Sward, L. & Karlsson, J. (1996) Cryotherapy in sports medicine. Scandinavian Journal of Medicine and Science in Sports. 6 (4), pp 193 – 200.

Usherwood, J. R. & Wilson, A. M. (2005) Biomechanics; no force limited on greyhound sprint speed. Nature. 438, pp 753 – 754.

Van Emmerik, R. E. A., Wagenaar, R. C. & Van Wegen, E. E. H. (1998) Interlimb coupling patterns in human locomotion: Are we bipeds or quadrupeds? Annals of the New York Academy of Sciences. 16, pp 539 – 542.

Wilcox, C. (2001) The Greyhound. Minnesota: Capstone Press.

Williams, S. B., Wilson, A. M., Rhodes, L., Andrews, J. & Payne, R. C. (2008) Functional anatomy and muscle moment arms of the pelvic limb of an elite sprinting athlete: the racing greyhound. Journal of Anatomy. 213, pp 316 – 372.

Woodley, S. J. & Mercer, S. R. (2005) Hamstring muscle; architecture and innervation. Cells, Tissues, Organs. 179 (3), pp 257 – 271.

Worrell, T. W. & Perrin, D. H. (1992) Hamstring muscle injury: the influence of strength, flexibility, warm up and fatigue. Clinical Commentary. 16, pp 12 – 18.

2�

WHAT QUALIFICATIONS DOES YOUR ANIMAL THERAPIST HAVE?

If like me, you are confused by the different routes available to qualify as an animal physiotherapist, animal chiropractor or animal osteopath, read on! The views expressed in this article are given to the best of our knowledge, following thorough research and the use of information from websites of the relevant organisations. This article does not cover massage or any therapies other than physiotherapy, chiropractic and osteopathy.

Animal Physiotherapy

Most Veterinary Physiotherapists are aware of both the benefits and limitations of the title ‘Veterinary Physiotherapist’, and the law relating to this title. Animal Physiotherapy is covered in Section 19 of the Veterinary Surgeons Act 1966, from where the Veterinary Surgery (Exemptions) Order 1962 “allows for the treatment of animals by ‘physiotherapy’, provided that the animal has first been seen by a veterinary surgeon who has diagnosed the condition and decided that it should be treated by physiotherapy under his/her direction. ‘Physiotherapy’ is interpreted as including all kinds of manipulative therapy. It therefore includes osteopathy and chiropractic but would not, for example, include acupuncture or aromatherapy.”

The title ‘Animal Physiotherapist’ or ‘Veterinary Physiotherapist’ is not protected by law, which means that anyone can in theory call themselves an animal or veterinary physiotherapist regardless of their qualifications. However, the title ‘Chartered Physiotherapist’ is protected by law and can only be used by physiotherapists who have achieved a high level of academic and practical training in all aspects of physiotherapy (in the human field). An animal physiotherapist should work alongside your

veterinary surgeon to provide the best possible treatment for your animal. It is, as you will see from the above, illegal for anyone other than the owner to treat a horse without the veterinary surgeon’s consent.

The Association of Chartered Physiotherapists in Animal Therapy

ACPAT is a Clinical Interest Group of the Chartered Society of Physiotherapy (CSP) and represents the interests of Chartered Physiotherapists in Animal Therapy. Members of the Association of Chartered Physiotherapists in Animal Therapy (ACPAT) will always work in co-operation with a Veterinary Surgeon. There are three categories of membership of the ACPAT.

Category A membership is available to Chartered Physiotherapists who have thorough supervised clinical training and/or postgraduate qualification, demonstrated competence in the administration of physiotherapy to animals via a recognised ACPAT upgrading route.

Category B membership is available to:

Chartered Physiotherapists resident in the United Kingdom, Channel Islands or the Isle of Man and do not qualify for classification under Category A.

Chartered Physiotherapists who do not qualify for classification under Category A whilst they are students on an ACPAT approved course.

Chartered Physiotherapists who have been accepted or who are waiting to obtain a position on a training course. NB Chartered Physiotherapists may remain as Category B members for a maximum of 3 years. During this time they should have evidence of trying to obtain a place on a training course.

Category C membership is available to Chartered Physiotherapists who are members of the Chartered Society of Physiotherapy but not practicing in the animal field. Category C membership is also open to Veterinary Surgeons and other para veterinary professionals. It is open to students and other interested persons at the discretion of the ACPAT Executive Committee.

Qualifying as a Veterinary or Animal Physiotherapist

At present, to my knowledge, there are 4 routes to qualifying as a Veterinary Physiotherapist in the UK. Students from the Royal Veterinary College (RVC) and the University of West England (UWE) graduate with an MSc or Postgraduate Diploma (PgD) in Veterinary Physiotherapy and are then eligible to become ACPAT Cat As. Harper Adams University College (HAUC) students graduate with an MSc or Postgraduate Diploma (PgD) in Veterinary Physiotherapy and may then become members of National Association of Veterinary Physiotherapists (NAVP). A slightly different route is via the Advanced Certificate in Veterinary Physiotherapy (AdvCertVPhys), developed by Canine and Equine Physiotherapy Training (CEPT) and using the facilities at Nottingham Veterinary School (note though that the CEPT website states that the course is not academically affiliated with Nottingham Veterinary School nor the University of Nottingham).

Anonymous Author

2�

You can also qualify as an Animal Physiotherapist through the College of Animal Physiotherapy near Aylesbury in Buckinghamshire. Entry requirements and course structure vary for each of these routes.

Royal Veterinary College

RVC students will already be Physiotherapists registered with the Health Professions Council (HPC) and the CSP. The course is internationally recognized, and is run on a part-time basis on one weekend per month for 18 months. The clinical syllabus which students undertake during the two years of the course is a mix of short courses, placements at the RVC hospitals and clinical placements with recognised RVC clinical educators. The placement takes 259 hours or approx 35 days to complete in total in addition to the course weekends. If students choose to continue onto the Masters element, this is undertaken during the final 6 months of the course. Graduates are eligible for Category A membership of the ACPAT. Please note that as of December 2010 no further applications are being taken for this course.

University of West England/Hartpury College

UWE students will already be Physiotherapists registered with the Health Professions Council (HPC), and will need to register with the Chartered Society of Physiotherapy (CSP) and the ACPAT, for insurance purposes. The course is either 2yrs (PgD Veterinary Physiotherapy) or 3yrs (MSc Veterinary Physiotherapy), and students are required to attend 4 day blocks approximately once a month at Hartpury College. Clinical placements are also under taken with recognised clinical educators and also takes about 31 days. The clinical placements include in house days at Hartpury. Graduates are eligible for Category A membership of the ACPAT.

Harper Adams University College

HAUC students are expected to

have obtained the equivalent of a 2:1 in an animal science / health or physiotherapy degree and have animal handling experience. Successful students are eligible for membership of the National Association of Veterinary Physiotherapists (NAVP). At the time of publication no further details were available.

Canine and Equine Physiotherapy Training

CEPT students are required to have some form of higher education or further education qualifications, and a good working knowledge of animal care and handling. The first year consists of nine teaching weekends (one a month), with exams on the tenth week. The second year places a heavy emphasis on practical techniques and experience using placements with experienced veterinary physiotherapists, and includes three teaching weekends and a dissertation / project. Students who achieve a merit on the two-year course may apply to the University of Nottingham for a one-year research masters in a topic related to veterinary physiotherapy. This is run by the University of Nottingham and is separate from the CEPT AdvCertVPhys. Successful students on the CEPT course are eligible for membership of the Institute of Registered Veterinary and Animal Physiotherapists (IRVAP).

The College of Animal Physiotherapy

The College of Animal Physiotherapy grants successful students the title of ‘Animal Physiotherapist’. It does not mention on its website what qualifications are required to enroll on the course. The teaching is covered by distance learning and practical placements. To complete the course students need to complete and pass 10 modules, including a research project, complete 4-5 weeks practical training and attend 3 therapy related lectures. Successful students become members of the International Association of Animal Therapists (IAAT).

Animal Chiropractic

The situation for Chiropractors is different, as in order to use the title ‘chiropractor’, practitioners must be registered with the General Chiropractic Council. Therefore any animal ‘chiropractor’ must have qualified as a chiropractor in the human field initially. The GCC does not recognize any courses in animal chiropractic. This is because ‘Chiropractic is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health’ (World Federation of Chiropractic, 1999). However, the Veterinary Surgeons Act (1966) states that ‘only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery. Veterinary Surgery is defined within the Act as encompassing the ‘art and science of veterinary surgery and medicine’ which includes the diagnosis of diseases and injuries in animals, tests performed on animals for diagnostic purposes, advice based upon a diagnosis and surgical operations which may not necessarily form part of a treatment.’ Since the Act states that only Veterinary Surgeons may offer diagnosis for animals, and chiropractic is defined as being concerned with diagnosis, chiropractic cannot currently be recognized in the animal field. However, there is still confusion around qualifications within the field of animal chiropractic.

The International Veterinary Chiropractic Association

The International Veterinary Chiropractic Association (IVCA) is a non-profit making international organisation dedicated to promoting excellence in the field of Veterinary Chiropractic.

The association endeavours to establish consistently high standards of Veterinary Chiropractic through approved educational courses, certification examinations and the membership code of conduct

2�

and standard of proficiency.

Membership to the IVCA is only granted to qualified veterinarians or chiropractors (or individuals qualified in both professions) upon successful completion of approved veterinary chiropractic postgraduate training, board certification exams and adherence to membership rules and regulations.

The International Academy of Veterinary Chiropractic

The International Academy of Veterinary Chiropractic (IAVC) runs Basic and Advanced courses exclusively for professionals from both the veterinary and human chiropractic fields. The Basic courses are hosted at the Anglo-European College of Chiropractic (AECC) in Bournemouth, and Sittensen, northern Germany (English and German language instruction in Germany). The Basic 210 contact hour course is presented in five modules, each consisting of 4.5 days, at six to eight week intervals. Individual modules can be taken at either location while completing the course. The Basic course is described as clinically oriented and includes examinations and written report requirements. The course is currently in consideration for an M level academic offering at AECC. Successful students are also eligible for membership of the IVCA, which offers an independent Clinical Competency Exam (CCE) in veterinary chiropractic internationally.

The Advanced course certification consists of six two-day modules of detailed specific topics, oral case presentations and an independent research paper. This course is designed for clinically experienced veterinarians and chiropractors who have completed the Basic course.

The McTimoney College of Chiropractic

The McTimoney College of Chiropractic offers a two year MSc in Animal Manipulation, validated by the University of Wales.

Students should be fully qualified and registered in a manipulative therapy (i.e. chiropractor, osteopath, physiotherapist), hold a BSc in Equine or Animal Science, or be a member of the Royal College of Veterinary Surgeons. However, mature students who do not hold formal academic qualifications can apply under the Assessment of Prior Experience system. Successful students are eligible to join the College of Chiropractors Animal Faculty.

The McTimoney College of Chiropractic also offers an MSc in Animal Chiropractic (Small Animals), validated by the University of Wales. This course is open to students who hold a professional qualification in Chiropractic, which would qualify the holder for registration with the GCC or other registering body. It is held over two academic years, each of six month duration. As with the MSc in Animal Manipulation, successful students are eligible to join the College of Chiropractors Animal Faculty.

The Oxford College of Equine Physical Therapy

Oxford College of Equine Physical Therapy (OCEPT) runs a twelve month course (one weekend a month + additional field days) to qualify as an animal manipulator. Applicants under 25yrs old are required to hold a degree (BSc, or possibly BA). Other non-academic entrance criteria can be applied for mature students (over 25), but substantial prior experience and a general competence in handling horses is a necessary prerequisite. Graduates are eligible to join the Association of McTimoney Corley Spinal Therapists.

Animal Osteopathy

The title ‘Osteopath’, like the title ‘Chiropractor’, is protected by law. Anyone calling themselves an osteopath must be registered with the General Osteopathic Council (GOsC), and therefore in order to qualify to treat animals, you must first qualify as a human osteopath.

The Society of Osteopaths in Animal Practice

The Society of Osteopaths in Animal Practice (SOAP) was set up in 2004 following close consultation with the GOsC. The aims of the society are to promote the professional development of osteopathy within the area of animal treatment. SOAP offer a four weekend certificated course covering the main topics needed to get established within a veterinary practice.

The McTimoney College of Chiropractic

SOAP also run a two year MSc in Animal Manipulation (Osteopathic Pathway) validated by the University of Wales, and in conjunction with the McTimoney College of Chiropractic. Students applying for this qualification must hold a professional qualification in Osteopathy, which would qualify the holder for registration with the GOsC. The first year is mainly theory based, and the second year involves clinical placement days, a practical based 20,000 word thesis, and final theory and practical exams. Students are required to attend monthly weekend tutorial sessions, mainly at Warwickshire College.

Summary

Confused?! It is difficult, even as a professional working in the field of animal therapy, to comprehend the different routes to qualification, and the benefits of membership of each of the many organizations within the animal field. However by ensuring that the therapist who treats your animal has undertaken rigorous training and achieved nationally recognized qualifications, you increase the likelihood of receiving a good standard of expertise – an important factor when choosing between therapists.

2�

Qualification University or College Entry Requirements Length of Course Successful students are eligible for membership of:

MSc Veterinary Physiotherapy

Royal Veterinary College Chartered Physiotherapists registered with the HPC and the CSP

2yrs Association of Chartered Physiotherapists in Animal Therapy (eligible for Category A membership

PgD or MSc Veterinary Physiotherapy

University of West England

Chartered Physiotherapists registered with the HPC and the CSP

2 yrs (PgD) or 3yrs (MSc)

Association of Chartered Physiotherapists in Animal Therapy (eligible for Category A membership)

MSc Veterinary Physiotherapy

Harper Adams University College

No details No details National Association of Veterinary Physiotherapists

Advanced Certificate in Veterinary Physiotherapy

Canine and Equine Physiotherapy Training (held at Nottingham Vet School)

Some form or higher education of further education qualifications, and a good working knowledge of animal care and handling

2yrs (can upgrade for a 3rd yr to study for an MRes through University of Nottingham)

Institute of Registered Veterinary and Animal Physiotherapists

Animal Physiotherapy College of Animal Physiotherapy

Unknown No set time limit International Association of Animal Therapists

International Academy of Veterinary Chiropractic course

Anglo-European College of Chiropractic and Sittensen, northern Germany

Professionals from the Veterinary and Human Chiropractic fields

210 hrs (5 modules, each consisting of 4.5days, at 6 to 8 week intervals)

Veterinary Chiropractic Association

MSc Animal Manipulation McTimoney College of Chiropractic (validated by University of Wales)

Fully qualified in a manipulative therapy (i.e. chiropractor, osteopath, physiotherapist, or BSc in Equine or Animal Science, or member of Royal College of Veterinary Surgeons. Mature students who do not hold formal academic qualifications can apply under the Assessment of Prior Experience scheme

2yrs College of Chiropractors Animal Faculty

MSc Animal Chiropractic (Small Animals)

McTimoney College of Chiropractic (validated by University of Wales)

Professional qualification in Chiropractic

2yrs College of Chiropractic Animal Faculty

McTimoney Corley Spinal Therapist

Oxford College of Equine Physical Therapy

Degree if under 25yrs old. Other requirements are applied to mature students (over 25yrs old)

1yr Association of McTimoney Corley Spinal Therapists

Unknown Society of Osteopaths in Animal Practice

Professional qualification in Osteopathy

4 weekends Society of Osteopaths in Animal Practice

MSc Animal Manipulation (Osteopathic Pathway)

McTimoney College of Chiropractic

Professional qualification in Osteopathy

2yrs Society of Osteopaths in Animal Practice

References

Aquino, C. F., Fonseca, S. T., Goncalves, G. G. P., Silva, P. L. P., Ocarino, J. M. & Mancini, M. C. (2010) Stretching versus strength training in lengthened position in subjects with tight hamstring muscles; a randomised controlled trial. Manual Therapy. 15, pp 26 – 31.

References

The Association of Chartered Physiotherapists in Animal Therapy (ACPAT): http://www.acpat.co.uk/

Canine and Equine Physiotherapy Training (CEPT): http://www.ceptraining.co.uk/

College of Animal Physiotherapy: http://www.tcap.co.uk/

College of Chiropractors Animal Faculty: http://www.colchiro.org.uk/default.aspx?m=21&mi=139&ms=55&title=Animal+-

Chartered Society of Physiotherapy (CSP): http://www.csp.org.uk/

General Chiropractic Council (GCC): http://www.gcc-uk.org/page.cfm

General Osteopathic Council (GOsC): http://www.osteopathy.org.uk/

Harper Adams University College (HAUC): http://www.harper-adams.ac.uk/

Health Professions Council (HPC): http://www.hpc-uk.org/

International Association of Animal Therapists (IAAT): http://www.iaat.org.uk/

International Academy of Veterinary Chiropractic (IAVC): http://www.i-a-v-c.com/

Institute of Registered Veterinary and Animal Physiotherapists (IRVAP): http://www.irvap.org.uk/

International Veterinary Chiropractic Association (IVCA): http://www.ivca.de/eng/

McTimoney College of Chiropractic: http://www.mctimoney-college.ac.uk/

National Association of Veterinary Physiotherapists (NAVP): http://www.navp.co.uk/

Oxford College of Equine Physical Therapy (OCEPT): http://www.ocept.info/

Royal Veterinary College (RVC): http://www.rvc.ac.uk/

Society of Osteopaths in Animal Practice (SOAP): www.uksoap.org.uk

University of Nottingham: ttp://www.nottingham.ac.uk/

University of West England (UWE):

http://www.uwe.ac.uk/

2�

DIARY OF EVENTS2nd October 2011

TMM as a Mobilising Treatment Modality, Cockburnspath, East Lothian, Scotland, TD13 5XW

16-17 November 2011

Splinting & Bracing Options for Orthopaedic & Neurological Conditions, Northamptonshire

18-19 November 2011

Splinting & Bracing Options for Orthopaedic & Neurological Conditions, Northamptonshire

10 December 2011

Business skills & Veterinary Physiotherapy, Northamptonshire

12th - 13th November 2011

Your Horse Live, Stoneleigh Park, Warwickshire, CV8 2LZ

24th - 25th November 2011

London Vet Show, Olympia Exhibition Centre, Hammersmith

25th - 26th February

ACPAT Seminar – 2012 Olympics and Competition Animals, Rugby

Please see www.acpat.org for further details

This two day workshop was held in Mary’s home town of Wheddon Cross, Somerset and was attended by 12 ACPAT members. The weekend was a success with members enjoying talks regarding our role with the sporting athlete and requirements at competition, as well as aquatherapy and nutrition. The course also consisted of a practical component with new clients travelling to the yard and a review of horses based at Mary’s

yard that had their own evident musculoskeletal problems.

We were also lucky enough to attend the vetting for the famous Golden Horseshoe ride that is a tough endurance event bringing riders from all over the country to ride over the undulating terrain of Exmoor. This year Mary King also participated in the 40km ride whilst some riders completed 160km over 2 consecutive days. We were able to

gain further insight of training needs for endurance riding and of racehorses thanks to Dennis and Angela O’Brien who are based at a training yard in Newmarket.

I think all of us on the course would like to thank Mary for her time and experience. The long journey for many of us was well worth it.

Sarah DaltonACPAT Course Organiser

COURSE REVIEWSMary Bromiley Workshop , May 2011

2�

BOOK REVIEWS

This book starts off with a semi autobiographical tone but its value to the physiotherapist lies in the explanation of the horse’s movements, and the aids required to produce them, in the training method chapters.

The book follows the training requirements of the dressage horse from basic straight line work up to piaffe, passage and pirouettes. It is

written in an easy to comprehend way and follows a logical step by step process. Accompanied by photographs and diagrams to illustrate the exercises it will help owners, riders and physiotherapists alike to really understand exactly what they are asking of an animal and how to ask it. Although no book can substitute for a good trainer this one does allow good background reading around the subject.

The health and safety leaves something to be desired as no one is wearing a hat in the photos, and the fact that it flits a bit from autobiography to training manual is a bit of a distraction, however I still found it one of the best explanations of dressage movements and training that I have come across.

Sonya Nightingale

Dressage with Kyra - The Kyra Kirklund Training Method by Kyra Kirklund and Jytte Lemkow. Published by Kenilworth Press 2009, 179 pages, hardback, ISBN 978905693245

Osteopathy and the Treatment of Horses by Anthony Pusey, Julia Brooks and Annabel Jenks. Published by Wiley Blackwell 2010. 272pages, paperback, ISBN 9781405169523

A clinically orientated text aimed at student osteopaths and other professionals interested in osteopathic treatment of horses this is a very easy book to read and pick up for a quick half hour coffee break.

The initial anatomy and assessment chapters lack depth and so should only be intended as an introduction to these subjects. However the following chapters on specific osteopathic techniques are very comprehensive and offer a good overview of the topic. There is a detailed description of each technique accompanied by a photograph to illustrate and additional notes for specific

follow ups and precautions. After reading these most veterinary physiotherapists will find useful inspiration on slight adjustments to their own techniques and indeed new ideas to try. The later chapters on treatments under sedation and under general anaesthetic are probably less applicable to physiotherapists but valuable in the insight that they give in this area. Chris Colles chapter on differential diagnosis serves as a useful reminder of those conditions that we should always have in the back of our minds.

Finally there is a comprehensive glossary of terms and appendixes detailing safety considerations,

examples of referral and consent forms, information sheets and case and history sheets.

Overall this book would be a useful addition to any veterinary physiotherapist’s book case. With over 350 photographs and writing style that divides subjects down into bite sized pieces it is easy to digest and use and this also aids the referencing of a specific area. Some may feel that some areas haven’t been dealt with in enough detail but I would still recommend it.

Sonya Nightingale

PRODUCT REVIEWVersatile mini jump block from poly jumpsweb link: http://www.polyjumps.com/acatalog/Products_Blocks_��.html

Fantastic, compact and light weight although can be filled with sand or water to increase stability. For the equestrians amongst us it’s styled on the original polyjumps jump block just in miniature! For those

that aren’t it’s a rectangular shaped plastic block for balancing poles on that has 3 height options. It’s brilliant for canine work as it’s easily transportable but equally great for it’s original purpose in the equine

world-loads of my clients are now using these after having problems with the stability of polepods.

Louise Carson

�0

Photizo LLLTweb link: http://www.photizo.co.uk/

Photizo is a low level light therapy device brought to you by Danetre Health Products limited. This modality has been recommended for many conditions including wound healing, infectious conditions, pain, inflammatory conditions and cell regeneration.

I found Photizo to be small, light weight and portable, suitable for the clinic, home and outdoor settings. It is available with a hip pouch and battery pack making it suitable for the stable environment. When fully charged the battery provides up to 6 hours of treatment time. There are three main probes available including a 150mW probe and 600mW and

1200mW (recommended for large animals) cluster probes. There is the facility on this machine to use the single 150mW probe and 600mW cluster probe simultaneously, using the single probe for acupuncture or trigger points and the cluster probe for larger treatment areas. With light emitting diode (LED) technology, no safety equipment is required with the use of this machine.

I found this machine very easy to learn the use of and operate due to its pre-programmed settings, thus reducing treatment time for this modality alone. Due to its easy operation it is a device that may be hired out to clients

following clear instructions from their physiotherapist. For those practitioners who prefer to amend the parameters, Photizo does not allow this. During the time I hired this machine, I found it accelerated rehabilitation in several of my cases which included canine biceps tendinopathy and an equine annular ligament tear. I have not yet had the opportunity to use this modality for wound healing but seeing photographs taken by a colleague of a grade 4 ulcer on a human foot undergoing treatment from Photizo has convinced me of its ability in this field.

Di Messum

The Equine Veterinary Journal

Prange, T., et al (2011) ‘Cervical vertebral canal endoscopy in the horse: Intra- and post operative observations’. Equine Veterinary Journal. 43(4) 404-411

Marr, C.M (2011) ‘Clinical grading systems: Can we resolve the needs of clinical practice and those of clinical research?’ Equine Veterinary Journal. 43(4) 377-378

Vilar, J.M., et al (2011) ‘Cross-sectional area of the tendons of the tarsal region in Standardbred trotter horses’ Equine Veterinary Journal. 43(2) 235-239

Clayton, H.M., et al (2011) ‘Swing phase kinematic and kinetic response to weighting the hind pasterns’ Equine Veterinary Journal. 43(2) 210-215

Parsons, K.J., et al (2011) ‘High speed field kinematics of foot contact in elite galloping horses in training’ Equine Veterinary Journal. 43(2) 216-222

Ireland, J.L., (2011) ‘A cross-sectional study of geriatric horses in the United Kingdom. Part 1: Demographics and management practices’ Equine Veterinary Journal. 43(1) 30-36

Ireland, J.L., (2011) ‘A cross-sectional study of geriatric horses in the United Kingdom. Part 2: Health care and disease’ Equine Veterinary Journal. 43(1) 37-44

Gutierrez-Nibeyro, D., et al (2010) ‘Outcome of medical treatment for horses with foot pain: 56 cases’ Equine Veterinary Journal. 42(8) 680-685

Biggi, M., et al (2010) ‘Comparison between radiological and magnetic resonance imaging lesions in the distal border of the navicular bone with particular reference to distal border fragments and osseous cyst-like lesions’ Equine Veterinary Journal. 42(8) 707-712

Claridge, H.A.H., et al (2010) ‘The 3D anatomy of the cervical articular process joints in the horse and their topographical relationship to the spinal cord’ Equine Veterinary Journal. 42(8) 726-731

Also check

Equine Veterinary Journal (2010) Proceedings of the 8th International Conference on Equine Exercise Physiology. 42(8) 1-702

Journal Small Animal Practice

Adams, P., et al (2011) ‘Influence of signalment on developing cranial cruciate rupture in dogs in the UK’ JSAP 52(7) 347-352

Andersen, A., (2011) ‘Treatment of hip dysplasia’ JSAP 52(4) 182-187

Ridge, P.A., (2011) ‘A retrospective study of the rate of postoperative septic arthritis following 353 elective arthroscopies’ JSAP 52(4) 200-202

Hayes, G.M., (2010) ‘Risk factors for medial meniscal injury in association with cranial cruciate ligament rupture’ JSAP 51(12) 630-634

Guilliard, M.J., (2010) ‘Third tarsal bone fractures in the greyhound’ JSAP 51(12) 635-641

Fischer, A., (2010) ‘Static and dynamic ultrasonography for the early diagnosis of canine hip dysplasia’ JSAP 51(11) 582-588

Millard, R.P., et al (2010) ‘Kinematic analysis of the pelvic limbs of healthy dogs during stair and decline slope walking’ 51(8) 419-422

ARTICLES 2010

�1

Results - stated concisely, and in logical sequence, with tables or figures as appropriate.

Discussion - with emphasis on new and important implications of the results and how these relate to other studies.

Case ReportsFull Case Report

Reports of single or small numbers of cases will be considered for publication if the case(s) are particularly unusual or the report contributes materially to the literature. A case report should not exceed 1500 words and must comprise of:

Summary (maximum 150 words);Keywords - for use as metadata for online searching.

Introduction - brief overview of the subject.

Case Histories - containing clinical detail.

Discussion - describing the importance of the report and its novel findings.

To be considered for publication in a single case report must: - Exemplify best practice.

All papers and case reports are subject to peer review and publishing preference will be given to reports of original or retrospective studies.

Letters to The Editor

Letters describing case reports or original material may be published and will be peer-reviewed prior to publication. Letters commenting on recently published papers will also be considered and the authors of the original paper will be invited to respond.

Style of Manuscripts

Writing should conform to UK English, and acceptable English usage must be presented within the manuscript. Where abbreviations

are used, the word or phrase must be given in full on the first occasion.

All manuscripts must be double-spaced for the purpose of peer reviewing.

All manuscripts must be line numbered throughout for the purpose of peer reviewing.

All units of measurement should be given in the metric system or in SI units. Temperatures should be in °C.

Drugs should be referred to by Recommended International Non-Proprietary Name, followed by proprietary name and manufacturer in brackets when first mentioned, eg, fenbendazole (Panacur; Intervet).

Anatomical terminology should conform to the nomenclature published in the Nomina Anatomica Veterinaria (1983) 3rd edn. Eds R. E. Habel, J. Frewein and W. O. Sack. World Association of Veterinary Anatomists, Ithaca, New York.

A Chartered Physiotherapist utilising poles during a rehabilitation programme

In addition to the discount offer, if we receive orders for 10 or more members by 31st September 2011, there will be an additional £100 discount from the discounted price

(excl VAT) for each unit sold.

Training for all the individual members and students who take advantage of the offer will be make available free

of charge. The usual fee per person for this is £100 per training day. The training will be lead by our Partner from

Pharmalight in Sweden, Kicki Odell.

�2

Mary Bromiley MBE

The ACPAT Committee were delighted to learn that Mary had been awarded the MBE in the Queen’s New Year Honours list for services to equine sport. Her nomination had been put forward by some of the principle people in horse racing, the CSP and by ACPAT. It was well deserved for a life-long –still continuing- career in the treatment and rehabilitation of injured animals. Her work continues to place ACPAT in the public eye and helps to establish ACPAT members as the Professionals in animal physiotherapy. Her award was presented at Windsor Castle on May 6th by H.M. The Queen. She was accompanied by her two sons. Typically modest and self-effacing, Mary attributes her success to working with good owners, who, she feels, have participated in the recovery process and thus ensured the pitfalls that can happen in rehabilitating an animal are avoided. Mary has paved the way for the Veterinary Physiotherapy profession. Her work at the highest level and her enduring quest for improvement are an example to us all.

ACPAT are able to nominate our members for distinguished service awards. If there is someone you feel is worthy of nomination for an award, please contact the committee. All you have to do is to write a short citation on the required form in support. It is a great way to recognise our members for their hard work and innovation, and it helps to keep us in the public eye.the next awards meeting of the CSP is in December. Nominations must be in by the first week in November.

Professional Networks Up-dateTor Henderson – Vice Chair

2011 is seeing the re-structuring of what was previously called the Clinical Interest / Occupational Groups (CI/OGs) into what

is now called the Professional Networks (PNs). Each of these PNs is going to be required to go through a re-recognition process which demands that each PN has to fit certain criteria as set out by the CSP. This is not expected to present any difficulty for ACPAT. Part of the criteria is that each PN’s constitution must fulfil new PN Constitution Guidelines. ACPAT has seen these guidelines and has agreed to accept them. We voiced a couple to concerns but have been re-assured that the constitution can be reviewed at a later stage if any of the new changes present difficulties for ACPAT. ACPAT is therefore in the process of re-writing parts of our constitution. ACPAT members will get the opportunity to vote to accept these constitution changes. It is a credit to ACPAT that our previous constitution was so comprehensive and well written that the number of alterations we’ve had to make to the constitution has been minimal. Our efficiency in this process has been commended by the CSPs PN Implementation Project Developer.

The next step in the re-structure process is the development of Alliance working. From now on instead of 3 yearly meetings where all the CI/OGs get together at the CSP each PN will meet with a small group of other PNs. Each of these clusters of PNs are termed Alliances. ACPAT is sitting within the Occupational Roles Alliance together with other PNs like Physio First, Extended Scope Practioners, Independent Health Care, and Occupational Health and Ergonomics. The model of how these Alliances is going to work together and how communication between the CSP and Alliances is going to be facilitated is currently in development.

The reason for the re-structuring of the CSP and PN (CI/OG) working is as a result of previous poor communication between the two,

and criticism that PNs skills and specialist knowledge has previously not been well utilised by the CSP. Additionally there have been a growing number of PNs, some of which are very small and some still not recognised by the CSP. The changes described above will hopefully stream-line the working between the CSP and PNs and therefore be a benefit for both.

Things change very quickly within ACPAT please keep up to date with further developments on the website www.acpat.org.

New ACPAT Category A Members

Congratulations to the following RVC and UWE MSc/PGDip Veterinary Physiotherapy students who have upgraded to Category A membership in 2011:

Sally HopkinsAmy HuntonLily JacksonKaren FullerNycky EdlestonCeri GrahamFiona HamiltonRachel MeasuresKatharine GladwinEmma StrachanBridget FirthAnia WorthingtonBrid WalshElle GrayEdward BakerAmy Gilbert Rabecca SimpsonAnna WoodsLeanne GeorgeKatherine VardyJosephine WookeyAmanda MorganHolly KerrClare LuttonFelicity RodriguezMelanie Grant

RECENT NEWS

Protection of Title Update

I think all physiotherapists have some core traits that make us who we are, hard working, reliable, keen to make a difference and most of all passionate about our career. As a newly qualified veterinary physiotherapist I have entered the industry truly believing that I can make a difference. So when the email regarding the protection of title sub comity came into my inbox I knew this was the project for me, little did I know the detail and hard work that will be ahead of myself and the team in pursuing this issue and hopefully gaining protection of title.

The protection of title or POT as we like to call it came together following an email of interest that many of you may have had. Initially I thought that it sounded like a great idea and then promptly moved onto the next email which was probably regarding my facebook status. It wasn’t until later when checking again, did I realise that this issue was an area that I felt very strongly about and it was for this reason I became involved. A number of individuals put themselves forward and the first meeting was arranged shortly after.

One Sunday five members of the POT arrived at Barbra Coats rehabilitation centre to discuss the subject armed with an adventurous agenda. The meeting started with a brief introduction of each person followed by a recap of the history of the protection of title. Following this it was important to discuss a process that the team would follow so that all ACPAT members can me involved and kept informed.

The suggestions were as follows:

Run all communication and ideas through the chair of ACPAT

The chair will discuss any issues with the committee

Committee may seek help or support from the CSP

All correspondence to be documented and published in either the minutes, the journal or on the web site

Following this an action plan was formed with the initial action to Re- establish links with CSP, HPC, Defra and local government. Especially as the CSP who are currently investigating and researching the charter this may provide the perfect opportunity for POT. Secondly forums and PR were discussed as a way for all ACPAT members to promote the protection of title issue through the internet, media and teaching.

The next discussion point were the areas that have been previously investigated but it was suggested that both changing the Vet referral act and the HPC were deemed to be areas that may be difficult to peruse at present. The possibilities the HPC may provide was thoroughly investigated by the last committee that worked on protection of title with no success. It was felt that although a letter could be sent out to the HPC to inform them that we are re-initialising the POT agenda.

To conclude the involvement of DEFRA was mentioned although a significant base of research needs to be established before it can be pursued any further. It was thought possible however, that a way to become involved in this level of parliament is to create links with some of the charities that deal with animal welfare, such as ILPH, RSPCA, The Kennel Club and DEFRA.

Five hours later we had not scratched the surface of the enormity of the subject. I think it was at this point I realised that this project may be years in the making, it is going to require hours of reading, and networking, a little negotiating and the complete backing and support of the whole ACPAT membership to push this issue to anywhere near where it needs to be. I look forward to the challenges that the POT team and I will encounter and do truly believe that this will one day end in success. If you too feel passionate about this cause but feel that you can not commit fully to the team but would like to assist in any way we would be really grateful of any assistance. Alternatively if you feel you would like to be a member of the team then please do not hesitate in contacting us though the ACPAT web site.

Fiona Dove

��

Olympic Test Event

The Olympic Test Event took place on the week commencing the 4th July 2011. Sonya Nightingale has kindly given us all a little taster of what we can expect in July 2012.

��

��

Wedding and Baby News

Congratulations to our ACPAT Seminar Organiser Melanie Haines (nee Butler) who married Chris Haines on the 21st April 2011.

Congratulations to Anna Risius on her marriage to John King on the 22nd July 2011.

Congratulations to Maeve Grant who gave birth to a gorgeous baby boy Conor Michael Sheridan on 8th July 2011.

Congratulations to Hannah Nash who gave birth to a beautiful baby girl Emma Nash on the 2nd July 2011.

��

Open to CSP and ACPAT members only

Optional levels of cover to suit members needs

Category A members cover includes training

and supervision

Discounted rates for Category B student members

All previous work covered

3 years’ Run-Off cover automatically included

Managed by CSP’s Insurance Broker

LFC Graybrook Ltd

New Professional LiabilityInsurance Scheme forACPAT MembersThe ACPAT have teamed up with LFC Graybrook to provide professional

liability insurance to all ACPAT and CSP members at competitive rates.

Full details of cover and application forms are available from the ACPAT members

section of the LFC Graybrook website: www.lfcgraybrooks.co.uk

Alternatively, you can contact us on enquiry@lfcgraybrook.co.uk or 01245 321 185

LFC Graybrook Limited is an Appointed Representative of LFC Insurance Brokers Limited who are authorised and regulated by the Financial Services Authority.Registered Number 301666

��

WRITING FOR FOUR FRONT THE OFFICIAL MAGAZINE OF THE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS IN ANIMAL THERAPYGuidelines and Information for Authors

The Editor would like to encourage ACPAT members to get involved in the magazine. If you are doing interesting clinical work, have a philosophical viewpoint that you would like to express, would like to share some research findings, have read a relevant book, article or attended an interesting course; please write something for the ACPAT magazine.

The aims of the magazine are to inform members about clinical, research and business developments that affect physiotherapists working with animals. It also provides a channel of communication between ACPAT members by informing and debating all aspects of animal physiotherapy.

We invite you to present material under the following sections:

Editorial Product ReviewsLiterature Reviews Business Related topicsClinical Articles/Case reports Letters to the EditorResearch Articles Useful addressesConference / Course Reviews Small AdvertsProduct News Book Reviews

How to contact us

If you have an article that you would like to submit for publication or you would like to discuss the outline of an article that you would like to write, please do not hesitate to contact ACPAT secretary who will pass on the information to the Journal Officer.

Post: M. Sharon Morgan Pembroke House Middle Lane Shotteswell OX17 1JQ Email: secretary@acpat.org

Submitting an article

Please send all text in electronic form

(ideally in Microsoft Word) by attaching the file to an e-mail or on a disk, along with any original photographs to the editor.

We can accept articles up to 3,000 words and encourage the use of tables, illustrations and photographs. If an article is longer please discuss with the editor.

There is no need to spend time adjusting fonts, columns etc, as we will adjust these to match the current publishing style.

Where appropriate, articles must be supported by a reference list using the Harvard system. In the text quote the authors surname and year of publication. In your reference list please include the full reference, to include authors name, initials, year of publication, full title of the paper, name of the journal, volume number and the first and last page numbers.

Any identifiable photographs must be accompanied by written permission from the owner of the animal, otherwise the image will be obscured, so that recognition is not possible.

Please supply your full name, address, telephone number and e-mail address that you would like to be published with your article.

Format and structure of manuscripts

Manuscripts should be headed with the full title of up to 15 words, which should describe accurately the subject matter. Authors should avoid including within the text: the name of the institution at which the work was performed, initials of the authors; and must remove institution names from illustrations in order to maintain anonymity for the review process.

Title Page

A title page is needed for all manuscript types, it must contain the title of the

paper, names and qualifications of all authors, affiliations and full mailing address including e-mail addresses, and contact telephone number of corresponding author. No author details are to be submitted in the manuscript. In addition details of any acknowledgements should be given on the title page.

Original Papers/Research Articles

Each paper should comprise the following sections:

Structured Summary - maximum of 200 words, divided, under separate headings, into Objectives, Methods, Results, Clinical Significance.

Keywords - maximum of five, for use as metadata for online searching.

Introduction - brief overview of the subject, statement of objectives and rationale.

Materials and Methods - clear description of experimental and statistical methods and procedures (in sufficient detail to allow others to reproduce the work).

Results - stated concisely, and in logical sequence, with tables or figures as appropriate.

Discussion - with emphasis on new and important implications of the results and how these relate to other studies.

Case Reports

Full Case Report

Reports of single or small numbers of cases will be considered for publication if the case(s) are particularly unusual or the report contributes materially to the literature. A case report should not exceed 1500 words and must comprise of:

Summary (maximum 150 words);

Keywords - for use as metadata for

��

online searching

Introduction - brief overview of the subject

Case Histories - containing clinical detail

Discussion - describing the importance of the report and its novel findings

To be considered for publication in a single case report must:

- Exemplify best practice

All papers and case reports are subject to peer review and publishing preference will be given to reports of original or retrospective studies.

Letters to The Editor

Letters describing case reports or original material may be published and will be peer-reviewed prior to publication. Letters commenting on recently published papers will also be considered and the authors of the original paper will be invited to respond.

Style of manuscripts

Writing should conform to UK English, and acceptable English usage must be presented within the manuscript. Where abbreviations are used, the word or phrase must be given in full on the first occasion.

All Manuscripts must be double-spaced for the purpose of peer reviewing.

All manuscripts must be line numbered throughout for the purpose of peer reviewing. All units of measurement should be given in the metric system or in SI units. Temperatures should be in °C.

Drugs should be referred to by Recommended International Non-Proprietary Name, followed by proprietary name and manufacturer in brackets when first mentioned, eg, fenbendazole (Panacur; Intervet).

Anatomical terminology should conform to the nomenclature published in the Nomina Anatomica Veterinaria (1983) 3rd edn. Eds R. E. Habel, J. Frewein and W. O. Sack. World Association of Veterinary Anatomists, Ithaca, New York.

Length

The maximum length for research papers is 3000 words and for case

reports is 1500 words. Review articles should not exceed 4000 words. All word limits include the summary but exclude the reference list. Authors should indicate the word count at the beginning of the manuscript.

Tables and Figures

The minimum number of tables and figures necessary to clarify the text should be included and should contain only essential data.

Presentation of Book, Product and Course ReviewsBook, Product and course reviews should be between 500 – 700 words long. Book reviews should quote the title, publisher, ISBN number and price of the book.

Some points to consider before and during writing an article

Try to produce a structured abstract and a list of key messages before you begin, this will help the article to be more focused and succinct and therefore more interesting for the reader.

Try to make the article as concise as possible, think hard what needs to be in the article to get the message across. Very few articles are longer than 2,000 words.

Try to ensure that references cited for tables and legends are done in sequence at the point where the table or figure is first mentioned in the text.Finally check the final copy carefully.

Previous publication

We do not have a strict policy on publishing material that has appeared elsewhere, but welcome authors to do so, especially where the subject is important to animal physiotherapists.

We may use material on the APCAT website, if you do not want us to publish information on the website, please explain this when you submit your work.

Terms and Conditions

Material accepted for publication will be edited. All articles will be treated as though all authors have read and approved the manuscript. Each author should give his or her name as well as the address and current e-mail for correspondence. We now aim to publish the corresponding author’s e-mail address in every article.

Copyright and exclusive licence

Many publishers traditionally asked authors to assign their copyright as this allows them to tackle copyright infringement, to republish and reproduce on a website.

We however require all authors for an irrevocable licence so that we can reproduce articles on our website without the need to seek further permission.

All articles submitted to the editor are therefore accepted on the basis that all authors of the material agree to ACPAT acquiring this irrevocable license upon the publication of the article in any medium owned or controlled by ACPAT.

Corrections

We try hard not to make mistakes, but errors, both by authors and editors can creep into the journal. We publish corrections when necessary. If you want to notify us about the need for a specific correction, please contact the editor.

Final note from the Editor

The Editorial Board reserves the right to edit all material submitted.

The views expressed in Four Front are not necessarily those of ACPAT, the Editor or the Editorial Committee.

The inclusion of advertising does not imply any form of endorsement by ACPAT.

No article, drawing or photograph may be reproduced without prior permission of the Editor.

Four Front is an annual publication and aims to be published in the spring of each year.

We are looking forward to receiving articles from any member of ACPAT on any relevant topics that you wish to share with fellow members. The success of the magazine and its benefit to members is ultimately dependent on the collective contributions that we receive, thank you, the Editor.

BROCHURES

LOGO & BRANDING

WEB DESIGN

POSTERS

MAGAZINE ADVERTISING

BUSINESS STATIONERY

NEWSLETTERS

PHOTOGRAPHY

Three Hats Design is a multi disciplined graphic design agency with an emphasis on layout and typography for both print and on-line design solutions. Serving both a national and international client base from our studio in a converted barn just off the M4 between Newbury and Marlborough. We are in easy reach of Bath, Bristol & Swindon and less than an hour from central London.

With work featured in Design Week we have quickly earned a reputation for producing exciting, elegant and effective work in the following disciplines, graphic design, design for print, corporate identity, logo design & brand development, magazine advertisements, brochures, catalogues, leaflets & flyers, posters, business stationery and web design.

We work closely with our clients ensuring concise communication throughout. We do not have account handlers at Three Hats, instead the client deals direct with the designer, this engenders confidence, trust and of course value for money. We work with both large and small companies, established or start-ups.

If you have a question about your next project or are just looking for some advice and direction we’d love to hear from you.

01264 731831

1 Ashley CourtAshley DroveHenleyMarlboroughSN8 3RH

info@threehatsdesign.comwww.threehatsdesign.com

Amy Barton Education Sub Committee ajbarton79@yahoo.co.uk

Alison Bates CIG Sub Committee bates842@btinternet.com

Louise Carson PR

Tracy Crook Research Officer research@acpat.org

Sarah Dalton Course Organiser courses@acpat.org

Fiona Dove Protection of Title Sub Committee

Rachel Greetham PR

Melanie Haines Seminar Organiser melvetphysio@yahoo.co.uk

Victoria Henderson Vice Chairperson/ CIG Liaison Officer

cig@acpat.org

Polly Hutson CPD Officer/ Diversity Officer/ Journal Sub Committee

cpd@acpat.org

Sonya Nightingale Chair chair@acpat.org

Diane Messum Journal Editor/Regional Groups journal@acpat.org regions@acpat.org

Hannah Price (Warne) PR

Samantha Rodwell PR sam@countryphysio.co.uk

Felicity Rodriguez flissspace@hotmail.co.uk

Stephanie Wilson Website/IT Officer webmaster@acpat.org it@acpat.org

SECRETARY/TREASURER

Sharon Morgan Secretary secretary@acpat.org secacpat@btinternet.com

Andrea Walters Treasurer

M. Sharon Morgan Pembroke House Middle Lane Shotteswell OX17 1JQ

secretary@acpat.org

EXECUTIVE COMMITTEE MEMBERS 2010