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’.