Would you recognise if your horse had laminitis?

By Sue Palmer

A recent study (https://onlinelibrary.wiley.com/doi/pdf/10.1111/evj.12963) found that out of 38 horses with Cushings disease, 76% of them had (either currently or in the past) laminitis, but that this was only recognised by owners in 37% of cases.  They looked at the level of insulin dysregulation (hyperinsulinaemia), and found that the greater the level of insulin dysregulation, the more severe the laminitis, and the greater the level of insulin dysregulation, the more likely it was that the owner recognised laminitis.


Looking into insulin dysregulation and metabolic syndrome (which is linked with insulin dysregulation), the main advice in relation to treatment or management is good diet and exercise.  I’m not a nutritionist so I can’t advise on diet, but there are plenty of excellent resources available.  With regards to exercise, I cannot of course advise on an individual basis through a blog, but I can say that the evidence base for regular exercise improving or maintaining your health is overwhelmingly strong.  I cannot, of course, help you figure out how to fit that regular exercise into your already jam packed life, although if you’re mucking out and turning out every day then you’re taking steps in the right direction!


I think the main take away from the study (https://onlinelibrary.wiley.com/doi/pdf/10.1111/evj.12963) for me is that low levels of laminitis, whilst presumably still fairly painful, are not always easy to spot.  The Royal Veterinary College has a fact sheet on Cushings disease (https://www.rvc.ac.uk/equine-vet/information-and-advice/fact-files/cushings-disease), and many clients have told me that the information on the laminitis trust page has been really helpful (http://www.laminitis.org).


Do you have experience of managing a horse with Cushings and / or metabolic syndrome?  I’d love to hear your experiences, what’s worked for you and what hasn’t, and in particular, which sources of information you found most useful

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“What we didn’t understand was the complexity of the referrals coming in…”

A new initiative on managing chronic pain at a Cumbria Partnership NHS Foundation Trust was reported on recently in Frontline, the magazine for Chartered Physiotherapists, and I felt there was some relevance to horses that I’d share with you. The focus was on managing chronic pain using a team approach rather than heading straight for investigation and medication, based on NICE (National Institute of Clinical Excellence) guidelines.


Chronic pain, as opposed to acute pain, is pain that has lasted for a long time.  It is described in various ways, but is pain that has lasted beyond normal healing time, and it’s usually classified as chronic if it lasts or recurs for longer than 3-6 months.  I know plenty of horses whose back, neck or quarters has been sore for at least that long. The article says “‘We’re looking at the whole person rather than just their pain”, which fits perfectly with the way I feel about physiotherapy for horses.  If you’re interested, there’s a scholarly article on the classification of chronic pain here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/


Owners commonly ask me whether their horse is in any pain, and it’s reasonable to assume that on palpation (when I feel through the muscles), many ridden horses will have a level of discomfort, as would most humans, especially athletes. This soreness on palpation is not necessarily bothering the horse though on a day to day basis, in a similar way that many athletes would not complain about their various points of discomfort, because they willingly accept it as ‘part of the deal’. With horses especially, it’s important to take into account the ‘whole’, in particular to listen to the owners’ report of the horse’s performance and behaviour. Does your horse appear to willingly accept any discomfort that he has going on, or does it bother him?


Just because a horse has ‘always been that way’ doesn’t mean he isn’t in chronic pain.  I highly recommend watching the Equitopia video with Sue Taylor, ‘Recognising Subtle Lameness’ (https://www.youtube.com/watch?v=0lPvyxzSER0), as well as the other videos in the series, for more thoughts on this. Anyone who has watched a foal play can imagine how he might damage himself in a lasting way. Side reins left on for a prolonged period of time, as commonly happens during the ‘breaking in’ process, may lead to long term pain.  Pulling back when learning to lead or tie up can put an immense pressure through the poll which does not always resolve by itself. And that’s not counting the various limb injuries and pathologies that may occur, including in the young unbacked horse, without the horse being noticeably ‘lame’, and which may also lead to secondary pain in the neck, back and quarters. The Frontline article states “You’re … living with pain, fatigue, and the secondary suffering around anxiety and depression, and all the other things that spiral out of control. It’s the same for back pain…” Might this explain some of your horse’s spookiness, grumpiness, or lack of willingness to work?


The article reports that the emphasis of the new Cumbrian initiative includes cognitive behaviour therapy, acceptance and commitment therapy as well as appropriate physiotherapy, as opposed to heading straight for investigation (i.e. scans, X-rays and other tests) and medication.  You might think that the ‘acceptance and commitment’ side of things is not relevant in horses, but how about the owner accepting the horse’s physicality and potential shortcomings, and committing to the best course of treatment for him? Whether or not it’s best to go straight for veterinary investigation is also more difficult in the equine field.  If your horse is visibly lame, then the vet is most definitely your first port of call.  If the issue is a change in performance or behaviour, or equally importantly, long term concerns over your horse’s performance or behaviour, then a whole team approach may well be needed, including vet, physical therapist, saddler, farrier, dentist, trainer, behaviourist and nutritionist. In these cases, as in the findings of the Cumbrian initiative, heading straight to investigation and medication is not always the best answer, and your horse may be better supported by care from the team. A Chartered Physiotherapist or other well qualified physical therapist is ideally situated to be a key member of this team, with their approach to the ‘whole horse’ at the forefront. At all times though, you are the ‘key worker’ of your horse’s team, and your horse is relying on you to listen to him and take action.


To find your local Chartered Physiotherapist visit www.acpat.org, and to find your local Registered Animal Musculoskeletal Practitioner, visit www.rampregister.org. For links to other recognised organisations (e.g. saddlers, farriers, etc), visit www.thehorsephysio.co.uk and click on ‘BPT’ then ‘Links’.

Are you flapping?

By Sue Palmer

A recent study (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196960) looked into rider stability on saddles with flaps (i.e. what we think of as ‘normal’ English saddles) versus saddles without flaps (EQ saddles https://eqsaddlescience.com).  It was a small study size (5 riders), but the research was headed by the well respected Dr Hilary Clayton.  The study was funded by EQ Saddles, but it’s stated on the study that they had no say in study design, data collection or data analysis, and that none of the researchers received salary support for the study.

Don’t get me wrong, I’m not saying that I recommend these saddles – I haven’t personally come across them, so I wouldn’t be able to.  I’m also not saying that I disagree with them – but if they are supporting ongoing research, then I’m certainly interested in knowing more.  Evidence comes not only in the form of published, peer reviewed studies, but also through experience and knowledge.  Peer reviewed, published studies are certainly a good starting point though!

I’m also not saying that I support or don’t support treeless saddles – I think it’s very dependent on the saddle and the horse, and personally I’d recommend working with a saddler you trust and respect and taking their advice.  I’m a Chartered Physiotherapist, not a saddler.  So I can tell you if your horse is sore through his back, and if this might possibly be caused by poor saddle fit, but I certainly don’t feel qualified to tell you which saddle will fit your horse, or how to adjust your saddle fit.

I’m also unsure of any evidence as to whether or not a more secure seat is beneficial, but on the whole, I’d think yes, it is.  Certainly it feels better as a rider if you are able to sit more still.  From a behavioural / training point of view, I think it’s really important to be still in the saddle in order to be able to give subtle signals that the horse can distinguish from the ‘white noise’ of the general movement of your body as you balance.  I do, however, believe that there needs to be a degree of movement of the saddle on the horse, because if exactly the same amount of pressure is put through exactly the same area for a prolonged period of time (as would happen if the saddle didn’t move at all), this would lead to muscle atrophy beneath that entire area.  The movement need only be small, but capillaries must have the pressure removed intermittently in order to refill, and therefore to maintain healthy functioning of the muscle.

As I mentioned earlier, I’m not a saddle fitter or a Master Saddler, I’m a Chartered Physiotherapist.  This study interests me, saddle design interests me, the treed / treeless debate interests me.  I don’t feel qualified to advise as saddle fit is not my area of expertise. But I do want to remain open minded and to share new ideas and information, and this study fits squarely into that field for me.  I hope it’s of interest to you as well, and I wish EQ saddles the best with their ongoing research.