IN-DEPTH: COMPLEMENTARY MEDICINE 10. Adjunct Recommendations and Prognosis


Chiropractic care often is supplemented with mas- sage, physiotherapy modalities, and stretching or strengthening exercises to help soft tissue rehabili- tation and to help restore normal vertebral joint motion. These concurrent therapies also help to encourage owner participation in the healing pro- cess and provide close monitoring of the patient’s progress. Other recommendations may include changes in training schedules or activities, correc- tive shoeing, or tack changes. Horses with ill- fitting saddles often have localized pain and muscle hypertonicity in the caudal withers region. Saddle refitting, coupled with chiropractic treatment of the painful withers region, leads to rapid recovery and management of a common problem for many horse owners. A horse with a 6-month history of consis- tently resenting saddle placement and bucking the owner off was treated chiropractically and in the next week won 11 ribbons at the local country fair. Many horses with repetitive-use disorders may ben- efit from cross-training activities. Clinicians also have reported synergistic therapeutic effects with the combined use of chiropractic, acupuncture, and other holistic modalities in equine patients. In general, horses with conditions with an acute onset respond rapidly and have a good prognosis for re- turn to function. Horses with chronic injuries may gain only short-term improvement of restricted mo- tion, pain, or muscle hypertonicity. This corre- sponds to current research on joint immobilization and spinal learning.17 Horses with chronic condi- tions usually require a series of treatments to affect a more lasting improvement. Musculoskeletal health depends on movement and use. Scientific evidence suggests that long-term rest or inactivity is contraindicated for back problems in people.


11. Equine Chiropractic Research


The focus of recent equine manual therapy research has been on assessing the clinical effects of chiroprac- tic techniques on pain relief, improving flexibility, and restoring spinal motion symmetry. Obvious criticism has been directed at the physical ability to even induce movement in the horses’ back. Pilot work in three horses that were instrumented with spinal transduc- ers attached to Steinman pins implanted into dorsal spinous processes at adjacent vertebrae demonstrated that manually applied forces associated with chiro- practic techniques were able to produce substantial segmental spinal motion.26 The induced spinal mo- tions were usually beyond the normal range of seg- mental motion that was measured during treadmill locomotion (up to 227% larger segmental spinal range of motion induced by high-velocity, low-amplitude thrusts than measured at the walk). The next logical research question would be what, if any, are the ther- apeutic effects of these induced spinal movements. Two randomized, control clinical trials have used pres- sure algometry to assess mechanical nociceptive thresholds (MNTs) in the thoracolumbar region of


312 2018  Vol. 64  AAEP PROCEEDINGS


Table 1. Summary of the Overall Percent Change in Mechanical Noci- ceptive Thresholds (MNTs) from Baseline (Day 0) within Treatment Groups across Days


Treatment Group


Inactive control Active control Phenylbutazone Massage therapy


Chiropractic (Activator)


Day 1 Day 3 Day 7 1


0


9 8


11 0


0


68 9


111


12 27


horses and to evaluate if chiropractic treatment can reduce back pain (or increase MNTs), compared with a control group.29,30 The first study evaluated 24 horses in active exercise, with the treatment group receiving high-velocity, low-amplitude thrusts applied to the T13 to L6 region.29 At the 2-week comparison, 72% (21 of 29) of sites had increased MNTs, 21% (n6) of sites had decreased MNTs, and 7% (n2) of sites had no change in the treatment group MNTs, com- pared with the control horses that had no applied treatment. The second study used 38 horses without clinical signs of back pain randomized into 5 treatment groups, with MNTs measured at 7 bilateral sites within the T9 to S2 vertebral levels.30 Single appli- cations of instrument-assisted (Activator), high- velocity, low-amplitude thrusts and massage therapy were given at day 0 in two groups at sites of pain, muscle hypertonicity, or stiffness. Phenylbutazone was given orally at a dose of 2 grams, twice a day for 7 days in the third group, and active and inactive horses were assigned to two control groups. MNTs were measured at days 0, 1, 3, and 7. The day 7 median MNTs had increased by 27% in chiropractic group, 12% in the massage therapy group, and 8% in the phenylbutazone group, with less than 1% changes in both control groups (Table 1). Future research is rec- ommended to evaluate longer-term effects and the po- tential synergistic effects of combined therapies (i.e., chiropractic and massage therapy) for treating back pain.


Additional studies have assessed the effects of


equine chiropractic techniques on passive spinal mo- bility (i.e., flexibility) and longissimus muscle tone.31,32 The first study used 10 horses to objec- tively measure vertical displacement, applied force, and stiffness at 5 thoracolumbar intervertebral sites in an experimentally-induced back pain model by using a randomized, crossover study design.31 The chiropractic treatment induced a 15% increase in vertical displacement and a 20% increase in applied force, compared with control measurements, indica- tive of increased spinal flexibility and increased tolerance to applied pressure. The second study measured changes in muscle tone and electromyo- graphic (EMG) activity within the longissimus mus- cle immediately after spinal manipulation or reflex inhibition therapy, compared with a control group.32 Significant decreases in muscle tone and EMG ac- tivity were measured in both treatment groups, com-


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