IN-DEPTH: ULTRASONOGRAPHY IN LAMENESS DIAGNOSIS Table 1. Physical Agent Modality Options


Ice, laser, US, TENS for pain control, relative rest, PEMF, iontophoresis


Elevation, compression, ice, relative rest, laser, PEMF, high-volt stimulation


Joint mobs, active and passive ROM, control inflammation


Soft tissue mobilization, high frequency vibration, dry needling, joint mobs to release fascial restrictions, stretching


Muscle electrical stimulation, therapeutic exercise, physical training, correct biomechanics


Dry needling, soft tissue release, joint mobs, laser, US, PEMF, acupuncture electrical stimulation


Neuro reeducation, therapeutic exercise, physical training


Balance and coordination exercise, physical training


Strengthening, muscle electric stimulation, therapeutic exercise physical training


Soft tissue mobs, joint mobs, stretching, therapeutic exercise


Joint mobilization, manipulation, stretching, active exercise


Correct joint and soft tissue restrictions, physical training, biofeedback, correct biomechanics


Acute Inflammatory, 24–72 hrs


Pain Swelling Decreased Joint ROM Myofascial Restrictions Muscle Weakness


Trigger Points Proprioception


Balance/Coordination Muscle Atrophy


Soft Tissue Restrictions


Joint Hypomobility Biomechanics PEMF, pulsed electromagnetic field; ROM, range of motion; TENS, transcutaneous electrical nerve stimulation; US, ultrasound.


and animal rehabilitation and sport performance. It should be noted, however, that modalities in gen- eral have varied levels of scientific evidence in sup- port of purported claims.


10. Managing Suspensory Branch Injuries in Horses


Acute Phase (Equine) In acute stages with severe injuries, cold therapy, compression, leg wraps, topical anti-inflammatories, systemic NSAIDS, laser therapy, and stall confine- ment are recommended. Most interventional thera- pies are performed during the acute or sub-acute phase. It is impossible to eliminate loading of the suspensory apparatus. Although, recently, a me- chanical boot has been invented that restricts fetlock drop (HorsePower). Leg wraps should be changed twice daily and the affected leg inspected. Cold therapy consisting of 20 minutes, four times a day is initially recommended. Compression cryo-boots can effectively deliver cold therapy while providing compression (i.e., Ice horse). During this time, pas- sive range of motion exercises of the fetlock may be beneficial. The acute phase generally lasts 2–10 days. A clinical examination and ultrasound study at the conclusion of the acute phase will help deter- mine whether the horse is ready to enter the next phase of rehabilitation.


16 2018  Vol. 64  AAEP PROCEEDINGS Subacute Phase (Equine)


Once the horse can walk comfortably and the major- ity of tissue edema has resolved, treatment of sub- acute injury may proceed. Loading exercises such as prolonged walks on even footing, manual thera- pies such as cross-fiber massage, and tools that en- hance lymphatic circulation (cross fiber massage, laser) may be beneficial. Cold therapy may be de- creased to twice daily. The subacute phase gener- ally lasts 2–6 weeks. A critical component of rehabilitation involves the retention of elasticity. In some cases where scar tissue exists with a new SB injury, the clinician must meet the contradictory needs of rest (acute lesion) and loading (maintain elasticity of scar tissue). Some horses benefit from swimming or underwater treadmill during this time. During this phase, the horse should be reevalu-


ated monthly with careful attention to monitoring clinical status (soundness, flexion test, palpation re- sponse), as well as monitoring ultrasonographic improvements.


Remodeling Stage (Equine)


As the ligament and surrounding tissues are heal- ing, the clinician will recommend specific strategies to incrementally challenge the tissue. In the sub- acute stages, the horse gradually increases walk


Subacute Regenerative, Days to 6 Weeks


Chronic Remodeling, 6–12 Weeks


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