IN-DEPTH: COMPLEMENTARY MEDICINE
cific techniques and psychomotor skills.20 A thor- ough knowledge of vertebral anatomy and joint biomechanics is required for proper chiropractic evaluation and treatment. Joint manipulation of- ten induces a palpable release or movement of the restricted articulations. An audible cracking or popping also may be heard during chiropractic treat- ment as the applied force overcomes the elastic bar- rier of joint resistance.23,24 The rapid articular separation produces a cavitation of the synovial fluid.25 Radiographic studies of synovial articula- tions after manipulation in people have shown a radiolucent cavity within the joint space (i.e., vac- uum phenomenon) that contains 80% carbon dioxide and lasts for 15 to 20 minutes. A second attempt to recavitate the joint will be unsuccessful and poten- tially painful until the intra-articular gas has been reabsorbed (i.e., refractory period).
can improve restricted joint motion and may reduce the associated harmful effects of joint immobiliza- tion.19,20 In response to chronic pain or stiffness, new movement patterns are learned by the nervous system and adopted in an attempt to reduce pain or discomfort. Long after the initial injury has healed, adaptive or secondary movement patterns may continue to persist that predispose additional joints or muscles to injury.17 Chiropractic treat- ment is thought to affect mechanoreceptors (i.e., Golgi tendon organ and muscle spindles) to induce reflex inhibition of pain and reflex muscle relaxation and to correct abnormal movement patterns.15,22 Additional modalities used to address altered move- ment patterns in people and horses include stretch- ing or relaxing hypertonic muscles, strengthening weak muscles, and re-education of movement patterns.17 Successful chiropractic treatment requires spe-
7. Contraindications
Chiropractic is not a cure-all for all back problems and is not suggested for treatment of horses with fractures, infections, neoplasia, metabolic disorders, or nonmechanically related joint disorders. Seri- ous diseases requiring immediate medical or surgi- cal care need to be treated by conventional veterinary medicine before any chiropractic treat- ment is initiated. However, chiropractic care may contribute to the rehabilitation of most horses post- operatively or those with medical conditions by help- ing to restore normal musculoskeletal function. Chiropractic care usually is contraindicated in horses with acute stages of soft tissue injury. How- ever, as the soft tissue injury heals, chiropractic has the potential to help restore normal joint motion, thus limiting the risk for future reinjury.17 Acute episodes of osteoarthritis, impinged dorsal spinous processes, and severe articular changes, such as joint subluxation or luxation, are often contraindi- cations for chiropractic. Unfortunately, many hu- man and veterinary chiropractors continue to use the term “subluxation” as a critical component of
310 2018 Vol. 64 AAEP PROCEEDINGS
chiropractic diagnosis and treatment, which has dis- tinctly different connotations and implications com- pared with the traditional or medical definition of subluxation (i.e., incomplete or partial dislocation of a joint that is clearly demonstrated on radiographs). All horses with neurological diseases should be evalu- ated fully to assess the potential risks or benefits of chiropractic treatment. Cervical myelopathy occurs because of structural and functional disorders in the cervical vertebrae. Static compression caused by ver- tebral canal malformations and dynamic lesions caused by vertebral segment hypermobility are contra- indications for cervical manipulation. However, ad- jacent hypomobile vertebrae may require chiropractic treatment to help restore joint motion and reduce biomechanical stresses in the affected vertebrae. Chiropractic care cannot reverse severe degenerative processes or overt pathological conditions.
8. Chiropractic Techniques
Chiropractic care provides important therapeutic approaches that are not currently available in vet- erinary medicine. Most of the current knowledge about equine chiropractic has been borrowed from human chiropractic techniques, theories, and re- search and adapted to animals. Therapeutic trials of chiropractic manipulations often are used because knowledge is limited about the effects of chiropractic care on animals. Chiropractic addresses mechani- cally related disorders of the musculoskeletal and nervous systems and provides a conservative means of treatment and prevention for horses with back problems. Chiropractic treatment uses an applied, controlled force to a specific anatomical region or osseous structure to produce a desired therapeutic response. Chiropractic manipulations are typically applied to areas of vertebral segment dysfunction (i.e., pain, stiffness, and muscle hypertonicity) but can also be applied to the appendicular skeleton and articulations. The condition of the horse is moni- tored closely as the neuromusculoskeletal system responds to the applied treatment. The applied treatment influences joint, muscle, and nerve func- tion via mechanical and biological mechanisms.19 The therapeutic dosage of the applied chiropractic manipulation is modified by the number of vertebrae treated, the amount of force applied, and the fre- quency of treatment. The goal of chiropractic care is to restore normal joint motion, stimulate neuro- logical reflexes, and reduce pain and muscle hyper- tonicity. Comparisons of sensitivity to palpation, muscle tone, and joint motion are made before and after treatment to evaluate the response to chiro- practic treatment. Clinicians and clients often ask the follow-
ing: How can a 500-kg horse be treated with chi- ropractic techniques? The answer is one vertebral segment at a time. Recent equine chiropractic research has demonstrated that forces applied to instrumented vertebral segments do induce sub- stantial vertebral motion, usually beyond the nor-
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