Manual therapies involve the application of the hands to the body, with a diagnostic or therapeutic intent. In horses, a diverse array of manual techniques, such as touch therapies, massage, joint mobilization, and manipulation (i.e., chiropractic), have been used to improve flexibility and reduce pain and muscle hypertonicity. However, all these therapies also provide important diagnostic cues to assess musculoskeletal pain and dysfunction that is not possible with other more traditional physical examination approaches or imaging modalities.
Each technique has unique origins and different proposed biomechanical or physiological effects; however, all forms of manual therapy are characterized by applying variable gradations of manual force and degrees of soft-tissue or articular displacement. The goal of all manual therapies is to influence reparative or healing processes within the neuromusculoskeletal system. Therapeutic effects may be generalized to the entire body by inducing relaxation or altering behavior, regional effects may include alterations in pain perception or neuromuscular control, or effects may be localized to specific tissues and cellular responses.
The challenge is in selecting the most appropriate and effective form of manual therapy to produce the desired physiological effect within an individual patient, such as increasing joint range of motion, reducing pain, or promoting general body relaxation. Anecdotally, all forms of manual therapy have reported levels of effectiveness in humans and horses. However, most claims are not supported by high levels of evidence such as randomized, controlled trials or systematic reviews of the published data.
Haussler, K.K. Equine manual therapies in sport horse practice. Vet Clin North Amer Equine Pract 2018, 34, 375-389, doi:10.1016/j.cveq.2018.04.005.
The goal of all manual therapies is to influence reparative or healing processes within the neuromusculoskeletal system. Therapeutic effects may be generalized to the entire body by inducing relaxation or altering behavior, regional effects may include alterations in pain perception or neuromuscular control, or effects may be localized to specific tissues and cellular responses. The challenge is in selecting the most appropriate and effective form of manual therapy to produce the desired physiological effect within an individual patient, such as increasing joint range of motion, reducing pain or muscle tightness, or promoting overall relaxation.
The physical act of touching someone can induce physiologic responses and is often considered therapeutic. In humans, therapeutic touch is used by nurses for nurturing premature infants, for supportive care in cancer or terminally-ill patients, and for support of the bereaved. Some well-known touch therapies in human beings include Healing Touch, Therapeutic Touch, and Reiki techniques. These techniques are considered a form of energy-based therapy in which practitioners move their hands over the body but do not touch the patient or use a gentle touch over certain areas of the body with the goal of facilitating physical, emotional, mental, and spiritual health.
In horses, touch therapies have been primarily developed and promoted by Linda Tellington-Jones in a collection of techniques named the Tellington Touch Equine Awareness Method (TTEAM) or Tellington TTouch. Anecdotally, therapeutic touch is considered to improve behavior, performance, and well-being of horses and enhance the relationship between horse and rider, but no controlled studies exist to support these claims.
Similar touch therapy techniques have been used in foals at birth to assess the effects of touch or imprint-training on behavioral reactions during selected handling procedures. Conditioned foals were significantly less resistant to touching the front and hind limbs and picking up the hind feet at 3 months of age. More controlled studies are needed to determine the effectiveness of touch theories in managing behavioral or musculoskeletal issues in horses.
Haussler, K.K. Review of manual therapy techniques in equine practice. J Equine Vet Sci 2009, 29, 849-869, doi:10.1016/j.jevs.2009.10.018
Massage therapy is defined as the manipulation of the skin and underlying soft tissues either manually (e.g., rubbing, kneading, or tapping) or with an instrument or machine (e.g., mechanical vibration) for therapeutic purposes. In humans, massage techniques include many well-known methods such as Swedish massage, sports massage, trigger point therapy, cross-fiber friction massage, myofascial release, lymphatic drainage, and acupressure. Clinically, massage and soft-tissue mobilization are believed to increase blood flow, promote relaxation, relax muscles, increase tissue extensibility, reduce pain, and speed return to normal function; however, few controlled studies exist to support these claims.
In horses, massage therapy has been shown to be effective for reducing stress-related behavior and pain thresholds within the thoracolumbar region. A noncontrolled, clinical trial using eight horses measured increased stride lengths at the walk and trot compared pre and post-massage, but changes were not significant because of a small sample size. Manual lymph drainage has been described for use in the management of lymphedema in horses; however, no controlled studies exist evaluating its effectiveness. More high-quality, scientific-based evidence is needed to support the use of massage therapy in horses.
Haussler, K.K. Review of manual therapy techniques in equine practice. J Equine Vet Sci 2009, 29, 849-869, doi:10.1016/j.jevs.2009.10.018
Passive stretching consists of applying forces to a limb or body segment in order to lengthen muscles or connective tissues beyond their normal resting lengths, with the intent of increasing joint range of motion and flexibility. The amplitude of motion and length of time that an individual stretch is held are gradually increased over time according to patient tolerance and ability. Stretching exercises are thought to increase joint range of motion, enhance flexibility, improve coordination and motor control, increase blood flow to muscles, and help to prevent injuries.
In horses, passive stretching exercises of the limbs and axial skeleton have anecdotal effects of increasing stride length and joint range of motion and improving overall comfort. However, a randomized controlled trial in riding school horses evaluating the effect of two different 8-week passive stretching programs reported no significant changes in stride length at the trot but reported actual decreases in joint range of motion within the shoulder, stifle, and hock articulations. The authors concluded that daily stretching may be too intensive in normal horses and may cause negative biomechanical effects. Additional studies on the effects of different stretching techniques and frequency for specific disease processes using objective outcome measures need to be completed before any further claims of performance enhancement in horses can be made.
Haussler, K.K. Review of manual therapy techniques in equine practice. J Equine Vet Sci 2009, 29, 849-869, doi:10.1016/j.jevs.2009.10.018
Mobilization is defined as manually-induced movement of articulations or soft tissues for therapeutic purposes. Soft-tissue mobilization focuses on restoring movement to the skin, connective tissue, ligaments, tendons, and muscles with the aim of modulating pain, reducing inflammation,
improving tissue repair, increasing extensibility, and improving function.
Joint mobilization is characterized as nonimpulsive, repetitive joint movements induced within the passive range of joint motion with the purpose of applying a stretch to connective tissues and restoring normal or symmetric joint range of motion. Subjective assessment of the ease of joint motion, joint stability, and joint end-feel provides insights into the biomechanical and neurologic features of an articulation.
Few formal studies exist to support the use of active joint or spinal mobilization techniques in horses. Most mobilization studies in horses involve a period of induced joint immobilization by a fixture or cast, followed by allowing the horse to spontaneously weight bear and locomote on the affected limb, without evaluation of specific soft tissue or joint mobilization techniques.
Haussler, K.K. Review of manual therapy techniques in equine practice. J Equine Vet Sci 2009, 29, 849-869, doi:10.1016/j.jevs.2009.10.018
Manipulation is a manual procedure that involves a directed impulse which moves a joint or vertebral segment beyond its physiological range of motion but does not exceed the anatomical limit of the articulation. Therefore, the primary biomechanical difference between joint mobilization and manipulation is the presence of a high-speed thrust or impulse. Spinal manipulation involves the application of controlled impulses to articular structures within the axial skeleton with the intent of reducing pain and muscle hypertonicity and increasing joint range of motion.
Chiropractic treatment is characterized primarily as the application of high-velocity, low-amplitude (HVLA) thrusts to induce therapeutic effects in articular structures, muscle function, and neurological reflexes. From a chiropractic perspective, the basic elements of joint or spinal dysfunction include altered articular neurophysiology, biochemical alterations, pathologic changes within the joint capsule, and articular degeneration. Human research has demonstrated reductions in pain and muscle hypertonicity and increased joint range of motion after chiropractic treatment.
The focus of recent equine chiropractic research has been on assessing the clinical effects of spinal manipulation on pain relief, improving flexibility, reducing muscle hypertonicity, and restoring spinal motion symmetry. Two randomized, controlled clinical trials using pressure algometry to assess mechanical nociceptive thresholds in the thoracolumbar region of horses have demonstrated that both manual and instrument-assisted spinal manipulation can reduce back pain.
Additional studies have assessed the effects of equine chiropractic techniques on increasing flexibility and reducing back muscle tone. The effect of spinal manipulation on asymmetrical spinal movement patterns in horses with documented back pain suggests that chiropractic treatment elicits slight but significant changes in thoracolumbar and pelvic kinematics, and that some of these changes are likely to be beneficial.
Haussler, K.K. Review of manual therapy techniques in equine practice. J Equine Vet Sci 2009, 29, 849-869, doi:10.1016/j.jevs.2009.10.018