The first step of a consultation is the assessment. This comprises of a few key steps:
1) Taking the history
2) Clinical examination
3) Forming a hypothesis through clinical reasoning
4) Treatment plan
Every assessment starts with taking an in-depth history. This means your therapist will ask you about the history of your horse, how long you have had him and how this has evolved. Next to that, his living situation will be documented: how often does he go outside, in the field or in a paddock, what does he eat, and how often does he work? After we have obtained a clear picture of your horse and what you expect of him, it is time to talk about the reason of the consultation. This can be because you have a clear complaint and a vet referred you, because you don’t exactly know why your horse is behaving the way it is, or on the contrary, just to have a general check-up as a preventative measure.
The next step in a thorough assessment of the movement of the horse. This starts with observing the conformation of your horse and forming an idea of how it is supposed to move. After this, the horse is looked at in walk and trot on a straight line. Following this, the horse is observed on the lunge through the various gaits and transitions. Lastly, the horse is put through a series of specific movements: walking a small figure 8 and reining back. If any neurological signs are present, these will be investigated more through adapted tests.
After we heard and what we saw, it is now time to add the last part of information: what we feel. Feeling how tense or supple the muscles are, and how each joint moves is the last step in our thorough assessment. Using specific manual techniques, we can test the range of motion in the joints and if that movement is obtained fluently or if there is a lot of resistance.
Forming a hypothesis through clinical reasoning
By combining what we hear, see and feel, we can make a problem list of treatable parameters, and form a hypothesis of what caused the malfunction of the system. We aim at solving the cause, instead of just treating the symptoms, and our goal at the end of the treatment plan is to have obtained an altered, and improved movement pattern, that prevents the injury from returning.
Restoring movement and recovering muscle suppleness is key to establish a well-moving, pain-free horse. To maintain this state, specific exercises and training is required.
Physiotherapists have toolbox full of techniques to achieve this goal:
- Myofascial techniques: various massage techniques to relieve muscle tension and increase the movability of the layer between the muscles and the skin: the fascia.
- Mobilisation: increasing joint mobility and decreasing pain through gentle movements of specific joints
- Taping: taping is a technique used to decrease pain, decrease swelling or alter movement patterns.
- Exercise therapy: this might be the most important part of the treatment plan. After a body’s mobility is restored, it is crucial that the correct muscles are trained to maintain this mobility and to stabilise it at the same time. This will happen through specific exercises taught to the rider or groom, and through riding and lunging.
At the end of each session, the assessment findings are summarised, the treatment is explained, and the owner/rider/groom is talked through the plan of action for the next few weeks. Together they will decide in what time frame the horse will need to be treated again, and what has to be done in the meantime.