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Application of Principles and Techniques to Equine Practice

Kevin K. Haussler, DVM, DC, PhD

Anecdotal evidence and clinical experience suggest that chiropractic is an effective adjunctive modality for the diagnosis and conservative treatment of select musculoskeletal-related disorders in horses. Because of its potential misuse, chiropractic evaluation and treatment should be provided only by specially trained individuals. Formal research has to be conducted to further evaluate the use of chiropractic techniques in horses. Author’s address: Veterinary Orthopedic Research Labora- tory, Dept. of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California—Davis, Davis, CA 95616. ௠ 1997 AAEP.

1. Introduction and often without his or her knowledge. In addi- Practitioners have seen a recent proliferation in the tion, some so-called equine chiropractors are not use of chiropractic on horses. However, because professionally trained nor licensed in either chiro- veterinarians have not been formally educated in practic or veterinary medicine. The purpose of this chiropractic principles or techniques in their tradi- article is to describe the principles, indications, and tional education, many practitioners do not under- contraindications for equine chiropractic evaluation stand the basic premise behind chiropractic or its and treatment. indications or contraindications. Also, limited re- search has been done to evaluate the clinical use of 2. What Chiropractic Has to Offer to Veterinary chiropractic techniques on quadrupeds. Veteri- Medicine nary medicine, for the most part, has been forced to Veterinary medicine is faced with some limitations acknowledge the use of animal chiropractic and when dealing with animals that have no obvious other nontraditional modalities by owners that have localized pain or have vague, unspecified lameness. sought practitioners that utilize these techniques Lameness is usually characterized as affecting three and have experienced their perceived therapeutic different body regions: front legs, hindlegs, or the effects.1 If veterinarians have not taken the time back, which may involve any structure from the head or effort to learn about these nontraditional tech- to the tail. However, neck or back problems and leg niques, then it is difficult for them to evaluate their injuries are often interrelated. An example of this use objectively or discuss the indications for a spe- relationship is an acute or chronic lower limb injury cific treatment modality. Therefore, owners often that causes the horse to carry the affected leg seek advice about alternative therapies or treatment abnormally. The abnormal weight bearing and al- from someone that is not their regular veterinarian tered gait can subsequently overwork or injure proxi-

NOTES

312 1997 ΋ Vol. 43 ΋ AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 1997 Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS THERAPEUTIC OPTIONS mal limb musculature and neck or back muscles. and potential prevention of select musculoskeletal Similarly, spinal injuries can in turn cause increased disorders in horses. concussive forces, lower limb lameness, or gait abnor- malities as the horse tries to protect its sore neck or back. Horses may also appear to have back pain 3. Who Practices Equine Chiropractic? with a primary neurologic disorder, colic, or even Chiropractic evaluation and treatment of horses dental problems.2,3 The diagnostic dilemma facing requires a thorough knowledge of the musculoskel- veterinarians is to decide whether the leg injury, or etal system, specifically spinal anatomy, neurophysi- the spinal injury, is the primary or initial cause of ology, biomechanics, and musculoskeletal pathology. the horse’s clinical problem. Unless the primary Licensed professionals that have pursued additional cause of the neck or back pain is identified and formal training in equine chiropractic principles and treated, most horses will have recurrent back pain techniques are best qualified to treat horses chiro- when returned to work after a period of rest or a trial practically. The primary organization involved in of anti-inflammatory medications. training veterinarians and chiropractors in animal The prevalence of back problems in horses varies chiropractic is the American Veterinary Chiropractic greatly (from 0.9% to 94%), depending on the special- Association. However, many untrained individuals ization or type of practice surveyed, i.e., general claiming to be equine chiropractors do not have any practice, 0.9%; Thoroughbred racehorse practice, formal schooling or training in the basic principles 2%; veterinary school referrals, 5%; mixed equine and techniques of chiropractic. Untrained individu- practice (dressage, show-jumpers, eventing), 13%; als also often have a limited knowledge of equine spinal research clinic, 47%; or equine chiropractic musculoskeletal anatomy, physiology, biomechanics, 4 clinic, 94%. Chiropractic provides expertise in the or potential pathology. evaluation of joint and spinal-related disorders and Most state chiropractic and veterinary medical can provide an additional means of diagnosis and boards do not allow chiropractors to treat animals early treatment options in certain types of gait unless they are working under the direct supervision abnormalities or performance problems, especially of a veterinarian. This means that both the veteri- conservative treatment of mechanically related mus- narian and the chiropractor must work together in culoskeletal disorders. Prepurchase examinations the evaluation and treatment of the horse. How- using chiropractic examination techniques can also ever, this does not happen very often in reality, help identify horses that have chronic underlying 5 especially if the person is not a licensed professional. neck or back problems. Chiropractic addresses It is strongly recommended that owners and refer- subclinical conditions or abnormal biomechanics that ring veterinarians seek out licensed professionals may progress to future debilitating musculoskeletal that have had specialized training and experience in injuries (Fig. 1). Chiropractors are also trained in the chiropractic evaluation and treatment of horses. the use of physiotherapy techniques, such as heating and cooling modalities, muscle stimulation, transcu- taneous electrical nerve stimulation (TENS, a form 4. and Chiropractic: A Few of electrically induced pain relief), and therapeutic Definitions ultrasound. Strength training exercises, massage, stretching techniques, and other forms of musculo- A. Chiropractic skeletal and nerve rehabilitation are also taught in The word chiropractic is derived from the Greek chiropractic school and used clinically in most hu- words cher, meaning hand, and praktike, meaning man chiropractic practices. Equine chiropractic is business or to practice. Therefore, chiropractic lit- a complementary modality that can be used in erally means to use the hands to diagnose, treat, and veterinary medicine for the diagnosis, treatment, help prevent disease. The purpose of chiropractic is to optimize health through the body’s inherent heal- ing ability as affected by and integrated through the nervous system.6 The practice of chiropractic fo- cuses on the relationship between structure (primar- ily the spinal column) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. Chiropractors use specific, controlled forces or thrusts applied by their hands or specialized instruments. Forces are applied to a specified articulation or anatomic region to induce a therapeutic response by means of induced changes in joint structures, muscle Fig. 1. Diagram representing the spectrum of health, diagnostic function, or nerve reflexes. The principle common continuum, and the effectiveness of therapeutic intervention. The to all chiropractic theories is that joint dysfunction outlined regions enclose the perceived realms of chiropractic and affects the normal neurological balance found in traditional medicine. healthy individuals.

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B. Manual Therapy Joint motion can be categorized into three zones of Manual therapy is the application of the hands movement: physiologic, paraphysiologic, and patho- directly to the body with the goal of treating articula- logic (Fig. 2). The physiological zone of movement tions or soft tissues. Chiropractic is a form of includes both active and passive ranges of motion manual therapy. and is the site where mobilization and low-force or nonforce adjustments are applied. The paraphysi- C. Mobilization ological zone of movement occurs outside the joint’s Mobilization is movement applied singularly or re- normal elastic barrier and is the site of joint cavita- petitively within or near the physiological range of tion. The normal elastic barrier of the joint is a joint motion, without imparting a thrust or impulse. semirestrictive anatomical barrier between the physi- Mobilization is used to restore joint mobility, but ologic and paraphysiologic ranges of motion. The it does not elicit the same mechanical or bio- pathological zone of movement lies outside the limits logical sequelae as manipulation or chiropractic of normal anatomic joint integrity and is character- adjustments.7,8 ized by joint injury (e.g., sprain, subluxation, or luxation). D. Manipulation The purpose of chiropractic adjustments is to restore normal joint motion, stimulate neurologic Manipulation is a manual procedure that involves a reflexes, and to reduce pain and muscle hypertonic- directed thrust to move a joint past the physiological ity. Successful manipulation requires the proper range of motion, without exceeding the anatomical technique and heightened psychomotor skills.7 The limit (Fig. 2). Manipulation involves both long- and proper chiropractic technique includes precise pa- short-lever contacts. Chiropractic is a form of ma- tient and doctor positioning and joint manipulation. nipulation that uses short lever, high velocity, low The specific requirements of adjusting include cor- amplitude, controlled thrusts. rect direction, force, amplitude, and velocity of the applied thrust. A thorough knowledge of vertebral E. Adjustment anatomy and joint biomechanics is required for An adjustment is any chiropractic procedure that proper chiropractic evaluation and treatment. Dur- uses specific and controlled force, leverage, direction, ing a successful adjustment, a release or movement amplitude, and velocity, which are applied to a of the restricted articulation is palpable. An au- specified anatomical region, bone, or joint to produce dible cracking or popping sound may also be heard a desired therapeutic response (i.e., restore joint during adjustment, as the applied force overcomes motion and reduce pain). Adjustments influence the elastic barrier of joint resistance. The rapid both mechanoreceptor and nociceptor function by articular separation produces a cavitation of the means of mechanical and biological mechanisms.8 synovial fluid. Radiographic studies postadjust- The therapeutic dosage of chiropractic adjusting is ment have shown a radiolucent cavity within the controlled by the number of vertebral levels ad- joint space (i.e., vacuum phenomenon) that contains justed, the amplitude of the applied force, and the 80% carbon dioxide and lasts for 15–20 min.9 A frequency of adjustments. second attempt to recavitate the joint will be unsuc- cessful and potentially painful until the intra- 5. Physiology of Joint Manipulation articular gas has been reabsorbed (i.e., refractory A spinal motion segment is a functional unit of the period). spine and includes two adjacent vertebrae and the associated soft tissues that bind them together. 6. Pathophysiology of Spinal Segmental Dysfunction Injury or alteration of a spinal motion segment may Spinal segmental dysfunction (i.e., chiropractically cause altered proprioception, muscle hypertonicity defined as subluxation) is a spinal lesion character- (i.e., protective muscle guarding), altered meningeal ized by (1) asymmetric or loss of normal joint motion tension, altered intervertebral disk and joint biome- in one or more planes; (2) altered point tenderness or chanics, or increased tension and stress in the joint 7,8 diminished pain threshold to pressure in the adja- capsules and adjacent ligaments. cent paraspinal tissues or osseous structures; (3) abnormal paraspinal muscle tension; and (4) visual or palpatory signs of active inflammatory processes or chronic tissue texture abnormalities (i.e., edema, fibrosis, hyperemia, or altered temperature).8 Segmental dysfunction is the primary dynamic spinal lesion that chiropractic addresses. The complex is a theoretical model of spinal segmental dysfunction that incorpo- rates the complex interaction of pathological changes in nervous, muscular, articular, ligamentous, vascu- Fig. 2. Diagram of the three zones of joint motion. lar, and connective tissues. These altered physi-

314 1997 ΋ Vol. 43 ΋ AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 1997 Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS THERAPEUTIC OPTIONS ologic and biochemical processes influence the bility (i.e., listhesis) or evidence of intervertebral neuromusculoskeletal system in the following ways: disk protrusion. The spinal degenerative phase is altered joint mobility (hypomobility, hypermobility), characterized by attempted stabilization of the degen- altered neurologic reflexes and pain sensation (inhi- erative tissues. Radiographic signs of advanced bition, facilitation), altered muscle function (hyperto- osteoarthritis and osteophyte formation, spinal liga- nicity, atrophy), connective tissue changes (fibrosis), ment ossification, and spinal ankylosis can be visual- and vascular alterations (ischemia, hyperemia). ized at this stage. Additionally, the inflammatory process influences The basic elements of spinal dysfunction include all these components to produce biochemical and altered articular neurophysiology, biochemical alter- cellular changes that result in distinct spinal ations, joint capsule pathology, and articular degen- histopathology. eration.7,8 Alterations in articular neurophysiology Hypomobility of a spinal motion segment is charac- from mechanical or chemical injuries can affect both terized by abnormally reduced joint mobility caused mechanoreceptor and nociceptor function by means by altered joint biomechanics (Fig. 3). Hypomobil- of increased joint capsule tension and nerve-ending ity may be caused by altered intervertebral disks, hypersensitivity. Mechanoreceptor stimulation in- local edema or inflammation of tissues, muscular duces reflex paraspinal musculature hypertonicity contractions, or capsular or periarticular adhesions. and altered local and systemic neurologic reflexes. Reduced or asymmetric motion in one spinal motion Nociceptor stimulation results in a lowered pain segment may induce compensatory hypermobility in threshold, sustained afferent stimulation (i.e., facili- adjacent spinal segments. tation), reflex paraspinal musculature hypertonicity, Hypermobility of a spinal motion segment is char- and abnormal neurologic reflexes. acterized by abnormally excessive joint mobility Mechanical or chemical irritations also induce caused by intra-articular damage, injuries to the local biochemical alterations and the release of in- joint capsule, or ligamentous laxity. The increased flammatory products. The inflammatory process joint mobility results in altered joint stability, joint can alter the intra-articular environment and contrib- derangement, and secondary muscle hypertonicity. ute to joint capsule pathology and periarticular Hypermobility is generally considered a contraindi- fibrosis. Concurrent paraspinal musculature hyper- cation for chiropractic adjustments but can be man- tonicity further restricts joint motion and may also aged with other forms of therapeutic intervention. contribute to intra-articular and extra-articular ad- Multiple theories have been proposed and tested hesion formation. Progressive joint immobilization over the years to explain the pathophysiology of can lead to continued articular degeneration, fibrocar- spinal segmental dysfunction and its interactions tilaginous replacement of the joint cavity, degenera- and influences on the neuromusculoskeletal system tive joint disease, and eventual ankylosis. Joint 7,8 and the other body systems. Joint degeneration degeneration continues as the dysfunctional joint is usually progresses through three phases of pathol- unable to distribute normal biomechanical stresses. 10 ogy: dysfunction, instability, and degeneration. Abnormal joint and paraspinal tissue biomechanics Spinal segmental dysfunction is not usually visible induce additional articular degeneration, subchon- on plain films, but it can be seen with flexion– dral bone changes, and joint derangement. extension (i.e., stressed views) or videofluoroscopy. Joint dysfunction is characterized by altered joint motion (i.e., hypomobility or hypermobility), local- 7. Why Do Horses Need Chiropractic Care? ized pain and inflammation, and abnormal paraspi- Chiropractic conditions in performance horses usu- nal muscle hypertonicity. The instability phase is ally have a history of a traumatic event or injury characterized by cartilaginous, meniscal, capsular, related to overexertion.11 The trauma may have and ligamentous deformation and degeneration. occurred in a single event such as a trailer accident Potential radiographic findings may include osteo- or fall (i.e., macrotrauma). The injury may also phyte formation (i.e., traction spurs), vertebral insta- occur over a long period as a result of cumulative, repetitive injuries (i.e., microtrauma) associated with poor saddle fit, improper riding techniques, or faulty conformation. Long periods of confinement, incon- sistent training programs, overuse syndromes, or stresses and strains related to athletic activities may also predispose horses to musculoskeletal injuries and reduced performance. Older horses, just like elderly humans, are susceptible to loss of spinal flexibility, joint degeneration, and loss of muscle strength. Aged horses also have increased healing times and increased chances of having chronic condi- Fig. 3. Diagram of symmetrical and asymmetrical loss of normal tions or abnormal musculoskeletal compensations joint motion. from prior injuries.

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8. What Types of Conditions Respond to Chiropractic horses with back pain.12 The most commonly re- Care? ported injuries included longissimus muscle strain Many injuries start as mild or seemingly harmless and supraspinous and sacroiliac ligament sprains. conditions that after time develop into more serious Jeffcott reported a complete recovery rate of 73% and problems. Poor saddle fit, inadequate shoeing, or recurrence of 25% in horses with soft-tissue spinal poor conformation are factors that contribute to injuries.2 Chiropractic care is usually contraindi- these types of slowly developing injuries. Other cated in the acute stages of soft-tissue injury. How- injuries are severe or life threatening and gradually ever, as the soft-tissue injury heals, chiropractic has improve but may never totally resolve; or they the potential to help restore normal joint motion, improve for a short time but later develop into thus limiting the risk for future reinjury. Special- debilitating arthritis or soft-tissue fibrosis. Trailer ized soft-tissue techniques can also help to treat accidents, falling over backward, or dramatic falls myofascial trigger points and muscle hypertonicity over jumps are examples of some of these types of characterized as noninflammatory muscular disor- injuries. Chiropractic care can help manage the ders that may produce ischemic, tender points or muscular, articular, and osseous components of some hypertonic bands within muscles. Myofascial trig- of these injuries in performance horses. ger points are usually associated with sites of muscle Chiropractic treatment addresses mechanically belly innervation. Various physiotherapy tech- related disorders of the nervous or musculoskeletal niques can also be used with traditional veterinary systems. Chiropractic care can provide a conserva- care to optimize ligamentous healing. tive means of treatment for horses with back prob- Osseous pathology is usually localized to the mid- lems and may also help in the prevention of some section of the back that lies under the saddle. Jeff- mechanically related disorders. Research suggests cott reported a 39% prevalence of osseous vertebral that may also affect certain lesions in horses with back pain.2 A thorough neurologic and visceral disorders (e.g., cardiovascu- knowledge of the osseous anatomy and potential lar, respiratory, gastrointestinal, etc.) by means of developmental or congenital anomalies of the axial somatovisceral reflexes in both animals and hu- skeleton is required for the proper evaluation and mans.7,8 Trained animal chiropractors should be treatment of spinal disorders. Abnormal spinal cur- able to evaluate spinal disorders and determine if the neck or back problem will be potentially respon- vatures are due to either structural or functional sive to chiropractic care or if a medical or surgical defects. Structural defects include articular facet condition exists that can be better managed with hypoplasia, hemivertebrae, or other osseous malfor- traditional veterinary care. Unfortunately, chiro- mations. Chiropractic is usually not indicated in practors are often asked to treat animals as a last these types of defects because they are usually quite resort, when all else has failed or when the disease severe if noted clinically, and affected horses are has progressed to an irreversible condition. Chiro- often euthanized. However, functional defects, such practic care has helped some of these chronic condi- as unilateral paraspinal muscle contraction, may be tions when other types of treatment have failed. amenable to chiropractic care. Severe osseous However, chiropractic care is usually much more changes such as joint subluxation, luxation, or frac- effective when utilized earlier in the course of a tures are often contraindications for chiropractic. disease (Fig. 1). Impinged spinous processes are thought to be due to conformational defects in the spinous processes.12 9. Spinal Pathology in Horses Abdominal strengthening or spinal flexibility that Injuries or disorders anywhere along the spinal promotes a reduction in spinous process impinge- column can have serious effects on the horse’s ability ment may be helpful in the healing process. Chiro- to perform. Diagnosis of the underlying spinal pa- practic care may provide symptomatic relief in early thology in horses with back pain is very important in degenerative joint disease if related to joint hypomo- the appropriate treatment and chiropractic manage- bility and subsequent joint degeneration. ment of spinal disorders. Primary spinal injuries Cervical myelopathy is due to both structural and usually affect the paraspinal musculature or spinal functional disorders in the cervical vertebrae. Static articulations. Back or neck injuries may occur as a compression caused by malformation and dynamic result of trauma, poor conformation, improper tack, lesions caused by segmental hypermobility are both or use and fitness level of the horse. Spinal prob- contraindications for cervical adjustments. How- lems can be classified into three basic types of ever, regional hypomobile vertebrae may require injuries involving either the muscles, tendons, and chiropractic adjustments to help restore adjacent ligaments (soft-tissue injuries), bones and joints joint motion and potentially reduce joint hypermobil- (osseous injuries), or nervous system (neurologic ity in the affected vertebrae. All infectious or toxic disorders). However, multiple concurrent injuries neurologic disorders are not primary chiropractic have been reported in 17% of horses with back conditions because they are not mechanically related pain.12 spinal disorders. However, chiropractic care or cer- Soft-tissue injuries have been noted in 39% of tain physiotherapy modalities may be indicated af-

316 1997 ΋ Vol. 43 ΋ AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 1997 Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS THERAPEUTIC OPTIONS ter initial medical treatment to help limit residual 11. Equine Chiropractic Techniques spinal pathology. Horses are usually held by a trained handler on a loose lead during the chiropractic adjustments. The cervical spine, sacrum, and extremities are evalu- 10. How Does Chiropractic Work in Horses? ated and adjusted as needed from ground level. Most of what we know about animal chiropractic has However, the thoracolumbar spine and pelvis often been borrowed from human chiropractic techniques, require an elevated surface for the horse to stand on theories, and research and adapted to our animal for effective adjustments and proper doctor position- patients. Therapeutic trials of chiropractic adjust- ing to limit potential injury to the doctor. Equine ments are often used since we currently have limited chiropractic is physically demanding and requires knowledge about the effects of chiropractic care in significant mental concentration. The horse must animals. Chiropractic adjustments are applied to be relaxed and focused on what the practitioner is areas of spinal segmental dysfunction and the horse’s doing. The practitioners must also be relaxed and condition is closely monitored as the neuromusculo- focused on the horse to adjust a specific vertebra skeletal system responds to the applied treatment. without causing injury to the surrounding tissues or In general, conditions with an acute onset respond to the doctors themselves. Environmental distrac- rapidly to adjustments, whereas chronic conditions tions are counterproductive to effective chiropractic usually take long-term treatment or rehabilitation. care. Muscle relaxation allows the specified joints Chiropractic is a conservative modality that may be to be brought to tension before adjusting and to applied repetitively over a set time period as the evaluate the elastic barrier of the joint. Motion patient’s own recuperative abilities are used in the palpation is utilized to evaluate joint motion restric- healing process to restore normal joint motion and tions so that the adjustive thrust can be applied neurologic function. This is often a confusing con- correctly. Stabilization of adjacent joints or spinal cept for most traditional practitioners accustomed to segments is required for the application of a proper a one-time fix by utilizing potent medications or adjustive thrust. Chiropractic adjustments involve surgical procedures. rapid, small amplitude forces applied to specific musculoskeletal structures with the intent of evok- Question: How can a 1200 lb ( 544 kg) horse be ϳ ing a therapeutic response. adjusted? Answer: one spinal segment at a time. Postadjustive recommendations for actively train- The following equation helps us to understand what ing horses usually include stall rest or pasture is happening when a force is applied to a horse’s back turnout for one day. This provides an opportunity during adjusting: for the horse’s body to respond to the applied treat- force ϭ mass ϫ acceleration. ment without being exposed to potential inciting factors of the spinal segmental dysfunction. The Because the mass (i.e., spinal segment) is constant, a horse is asked to return to normal work the next day rapidly applied adjustive thrust will produce a pro- unless other musculoskeletal injuries are present; portionately larger force within the spinal column then appropriate supportive care is recommended. than a slowly applied adjustive thrust can produce. If stiffness or soreness is noted after adjusting, then Small, rapidly applied adjustments are also easier to an additional day of rest is suggested. If severe or control and have less risk of soft-tissue injury than continued discomfort is noted for 2 days then re- more forceful types of manipulation. Additionally, examination and appropriate referral, medications, if the horse does not relax the paraspinal muscula- or physiotherapy should be prescribed. ture, then the mass that is affected increases dramati- cally from the weight of one spinal segment to the 12. Adjunctive Recommendations or Treatment weight of the entire spinal region or potentially the Chiropractic care is often supplemented with mas- entire horse. An effective adjustment cannot be sage, physiotherapy modalities, and stretching or applied to a nervous, tense horse without risk of strengthening exercises to assist soft-tissue rehabili- injury to the horse or the practitioners themselves. tation. These concurrent therapies also help to Chiropractic adjustments are usually done with- encourage owner participation in the healing process out any sedation or other medications, but they may and provide close monitoring of the patient’s progress. occasionally be done under anesthesia if this is Other recommendations may include changes in indicated. Chiropractic is not done with sledge training schedules or activities, corrective shoeing, hammers and two-by-fours, ropes and pulleys, pickup or tack changes. Many practitioners have also re- trucks, or tractors. These types of techniques are ported synergistic therapeutic effects with the com- often applied without a thorough understanding of bined use of chiropractic, , and other joint physiology, spinal anatomy or biomechanics, or holistic modalities in equine patients. chiropractic principles. A good rule of thumb is, if it does not look like something that you would be 13. What Conditions Are Not Treated by Chiropractic? willing to have done to yourself, then maybe you Chiropractic is not a cure-all for all neck or back should not have it done to a horse. problems and is not suggested for the treatment of

AAEP PROCEEDINGS ΋ Vol. 43 / 1997 317 Proceedings of the Annual Convention of the AAEP 1997 Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS THERAPEUTIC OPTIONS fractures, infections, neoplasia, metabolic disorders, dysfunction and neuromusculoskeletal disorders or nonmechanically related joint disorders. Serious places chiropractic in the forefront of conservative diseases requiring immediate medical or surgical treatment of spinal-related disorders. However, care have to be ruled out and treated by conventional limited research is currently available on equine veterinary medicine before routine chiropractic treat- chiropractic and other nontraditional modalities in ment is instituted. However, chiropractic care may veterinary medicine. In 1996, the AVMA’s Commit- contribute to the rehabilitation of most postsurgical tee on Alternative and Complementary Therapies cases or severe medical conditions by assisting in the suggested that the research community should be restoration of normal musculoskeletal function. encouraged to prioritize avenues of research and to Chiropractic care cannot reverse severe degenera- allocate research funds to projects that will provide tive processes or the overt pathologic manifestations further scientific evaluation of these modalities.13 of most medical disorders. Chiropractic works opti- The future of equine chiropractic in veterinary medi- mally in the early clinical stages of disease versus cine is dependent on future research into the clinical end-stage disease where reparative processes have effects of chiropractic techniques and the basic patho- been exhausted (Fig. 1). This is why chiropractic physiology of spinal-related disorders in horses. care and other holistic modalities often fail to pro- For more information, contact the American Veteri- duce their fully desired therapeutic effects if used as nary Chiropractic Association (AVCA), 623 Main St., a last resort. Hillsdale, IL 61257. Office: 309-658-2920; fax: 14. Complications or Adverse Effects of Chiropractic 309-658-2622; e-mail: [email protected]. This Adjustments article was reprinted in part from K. Haussler, Potential unwanted side effects from properly ap- Equine chiropractic and spinal examination, in Pro- plied chiropractic treatments include a transient ceedings. Annu Conf Am Holistic Vet Med Assoc increased stiffness or worsening of the condition 1996;115–137. after adjusting (i.e., aggravated complaint, worsening of the pre-existing state, regional soreness, lame- References and Footnotes ness, etc.).7 Adverse reactions from spinal adjust- 1. Wynn SG. Wherefore complementary medicine? JAmVet ments may occur immediately postadjustment or Med Assoc 1996;209:1228–1233. 2. Jeffcott LB. Back problems in the horse—a look at past, insidiously within the next 6–12 h. The undesired present and future progress. Equine Vet J 1979;11:129–136. effects usually last less than 1–2 days. If more 3. Jeffcott LB. Diagnosis of back problems in the horse. Com- serious reactions are noted that last longer than 1– 2 pend Cont Educ Pract Vet 1981;3:S134–S143. days, a thorough re-examination and appropriate 4. Jeffcott LB. Guidelines for the diagnosis and treatment of treatment should be prescribed. If the condition back problems in horses, in Proceedings. 26th Annu Conv does not improve with conservative care, then refer- Am Assoc Equine Practnr 1980;381–387. ral for more aggressive diagnostic or therapeutic 5. Willoughby SL. Equine chiropractic care, in Proceedings. modalities is recommended. 39th Annu Conv Am Assoc Equine Practnr 1993;31–32. Potential harmful side effects from improperly 6. The Association of Chiropractic Colleges. Issues in chiroprac- applied manipulation from untrained individuals tic. July 1996. Pamphlet. 7. Haldeman S. Principles and practice of chiropractic. Nor- may include permanent tissue damage and loss of walk, CT: Appleton & Lange, 1992;73–135, 415–441. function (i.e., torn ligaments, injured muscles, lux- 8. Leach RS. The chiropractic theories: principles and clini- ated joints, fractures, or paralysis if severe underly- cal applications. Baltimore: Williams & Wilkins, 1994. ing pathology is present). 9. Unsworth A, Dowson D, Wright V. Cracking joints: a bioen- gineering study of cavitation in the metacarpophalangeal 15. Summary joint. Ann Rheum Dis 1971;30:348–358. A thorough knowledge of equine spinal anatomy, 10. Kirkaldy-Willis WH. Managing low back pain. New York: biomechanics, and potential pathology is required to Churchill Livingstone, 1988;117–131. understand the principles and theories behind chiro- 11. Willoughby SL. Equine chiropractic care. Port Byron, IL: practic and to apply its techniques properly. Chiro- Options for Animals Foundation, 1991;9–10. 12. Jeffcott LB. Disorders of the thoracolumbar spine of the practic provides additional diagnostic and therapeutic horse—a survey of 443 cases. Equine Vet J 1980;12: means that may assist the equine practitioner to 197–210. identify and treat the primary cause of equine 13. Smith CA, Tessier GJ. AVMA at work: house approves lameness or poor performance. Specialized train- guidelines on alternative, complementary medicine. JAm ing in the evaluation and treatment of spinal joint Vet Med Assoc 1996;209:1026.

318 1997 ΋ Vol. 43 ΋ AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 1997