Year 1 Complete, Now to Work…

Can’t believe I’ve already finished year 1 of my degree. It has been such a fantastic year of learning and exploring the subject of equine therapy.

I’m off to Sweden and Poland for the next month or so. In Sweden I’ll be living and working on a small private farm owned by a vet who promises to let me join her at work when she’s not too busy, which will be exciting. I’ve also got 3 other work experience placements, with small animal vet practices, organised over the summer back in the UK.

At the end of July I’m attending an equine MyoFascial Release course which will be fantastic, giving me a great new technique to apply to the horses I treat. I’ve had such wonderful feedback from all the clients whose horses I’m working with to complete my sports massage externship. It’s unbelievably rewarding to see the sessions making a difference to the horses.

My main aim for this summer however is to get cracking with retaking my chemistry and biology a-levels, and I’m now even considering topping up my maths a level too. Not only will it enhance my core understanding of the biological concepts covered at degree level, but it will also broaden the spectrum of future career and studying possibilities available to me post graduation. I have been seriously considering applying to study BVetMed once I finish my degree. But to do this I’ll have to get these a-levels solid.

Seems like there’s no hope of a relaxing summer! Time to get to work…

Fascia

I was upset there wasn’t a question on fascia in my exam today, since it’s such an interesting topic and I’ve been revising so much about it. So I’ve decided to impart some of my knowledge on the subject via this post:

Fascia is an amazing and vital structure of mammalian bodies. It is a critical part of the horse and an important structure to recognise and understand as a physiotherapist. Despite its importance, little is known about fascia and limited research has been conducted on the matter.

Fascia is a connective tissue which surrounds and separates pretty much everything in the body. Fascia is found around bones (periosteum), surrounding the CNS (dural fascia, eg. arachnoid mater), blood vessels, hypodermis (superficial fascia), surrounding muscles (epimysium), surrounding every cell etc. and is continuous throughout the entire body.

Fascia itself is an 3D elasto-collagenous web, suspended in an extracellular matrix (ECM) containing proteoglycans, lubricin and hyaluronan amongst other metabolites. Interestingly, fascia is piezolelectric in that it is able to conduct ion changes similarly and comparatively to the nervous system (Langevin et al., 2006). It is also rich in nerve endings, allowing it to serve as a sensory organ.

The fascial web, suspended in ECM, is constructed of collagen and elastin fibres which form dynamic links with eachother. Collagen is critical in the tensile strength of the fascia, and has microtubules filled with crystalline saline solution to allow its capacity to withstand multidirectional forces and maintain structure. Elastin is important in the tensegrity model of maintaining structures in place, allowing structures to be deformed with load and elastically recoil to original position. Proteoglycans are made up of a core protein with numerous sulphated glycosaminoglycans (GAGs) attached. GAGs are highly negatively charged, thereby being highly hydrophilic and attracting water molecules. This means that fascia serves as an important water reservoir in the body, providing hydration for surrounding tissues. It also means that fascia has great compressional strength, enabling it to withstand and dissipate concussion forces.

Injury to fascia is often associated with acute inflammatory phase of injury in nearby tissues. Tissue injury is often dealt with by the body by recruiting proteoglycans from fascia to allow nearby tissue repair. This results in reduced proteoglycan content of fascia and subsequent dehydration and loss of compressional strength. Dehydration extends through the elasto-collagenous web, causing it to become dense and fibrotic as the crystalline saline solution of collagen solidifies. There is also increased cross-linking between elastin and collagen fibres, causing adhesions, increasing friction  between structures.

This ‘clamp down’ in fascia creates focal and eventually global restrictions, pulling on bony attachments and eventually causing postural misalignement and eventual atrophy. The clamp down also causes nerve ending irritation, which causes hypersensitivity and pain.

Treatment of fascial injury is varied, and includes:

  • Myofascial release
  • Anti-inflammatory treatment
  • Crystalline saline injection

Functional Anatomy Exam

Back in my dorm room literally just finished my Functional Anatomy exam. While my adrenaline is still running I’m taking advantage of it to finally write a post! I’ve been living with my nose in textbooks for the last month, furiously revising for my exams which are all this week. Functional Anatomy was the exam I just came out of, which was basically 2 hours of frantic essay writing on Horse anatomy.

There were 5 questions in the exam, of which you choose 3 to answer. I chose questions which were roughly:

  1. Describe the bony and soft tissue structures of the equine spine and how these relate to movement.
  2. Describe the functions and structure of hyaline cartilage and how its structure allows its function.
  3. Describe the pathology, clinical signs and treatment of Tetanus.

Luckily I was well prepared with my revision so all seemed to go ok… phalanges crossed

Close up on Strongyles spp.

Currently revising endoparasites of the horse, these fantastic images give you a good graphic picture of the microscopic activity of worms in the horse. These tiny creatures can cause terrible damage if allowed to proliferate, so make sure you are following an effective worming programme properly coordinated by the vet. And don’t forget: faecal egg counts won’t indicate an infestation in some cases. There are some species which enter hypobiosis, ie. they encyst in the gut wall, and so won’t show up in an egg count.

The pictures I’m sharing with you here are of Strongyle worms which have a characteristically large mouth with sharp teeth (buccal capsule). They are plug feeders, which  means they suck a plug of intestinal tissue into their mouths, and lacerate it with their teeth, mixing this with digestive enzymes and anticoagulants, the results of which they digest. Once finished, the intestinal area is left ulcerated.

endoparasites 6endoparasites 7

Sweet Itch Mite

Currently revising parasitology, came across these great pictures showing what the Sweet Itch mite looks like.

It comes from a species, Acariasis spp., which have mouthparts similar to ticks. Much of the problem with mite infestation is the horse’s possible hypersensitivity to the secretory/ excretory products of the mite interacting with the horse’s skin. Some horse’s are more susceptible to infestation than others, and some have a higher sensitivity.

Revising

April already upon us! Time has absolutely flown by, and only 4 teaching weeks left at university. Have spent my Easter break revising for exams, which are next month, getting nervous already. I’ve also managed to fit in lots of great Bodywork sessions, really great to see progress and improvements session to session.

Next month’s exams are in Functional Anatomy and Equine Nutrition. In my revision I’ve found it hard to get to grips with the Passive stay apparatus and Suspensory apparatus in the horse. Both are immensely complex and involve so many structures! I also forgot how complicated equine nutrition can be. Since the horse isn’t naturally evolved to be eating the concentrate feeds we give it, it is important we are feeding the correct ingredients in correct amounts.

It’s easy to forget how important it is to know exactly what’s in your horse’s feed and consider whether it’s getting the right nutrition. Horses, like dogs, have a good capacity to cope with deficiencies and excesses in vitamins and minerals and this is often overlooked by owners who are keen to give their horses supplements, which are often unnecessary and expensive. Remember that supplements supposedly improving joint mobility have no substantial scientific evidence to prove their supposed benefits, there is no scientific evidence that backs their use. They simply contain ingredients which are found within the joint structure, but ingesting them through the diet is unlikely to have any real effect on the joints once digested.

For Functional Anatomy I have made pages and pages of notes, and am now focusing on understanding that tricky Passive stay apparatus!

The Passive Stay Apparatus
This apparatus is found in both front and hind limbs, and is an important evolutionary adaptation which allows the horse to rest and sleep standing up, and cope with stance phase of locomotion up, whilst using minimal muscle exertion to do so. In the forelimb it involves:

  • The Synsarcosis
  • Proximal interphalangeal joint
  • Distal interphalangeal joint
  • Coffin joint
  • Suspensory apparatus
  • SDFT
  • DDFT

At the synsarcosis the largely tendinous serratus ventralis is the main weight-bearing connection. The biceps tendon has a stabilising role for the glenohumeral joint (shoulder). This joint is further stabilised by the biceps tendon anchoring the muscle to the radius via lacertus fibrosus and extensor carpi radialis (ECR) to Mc3. The weight of the trunk at the scapula tenses the biceps-lacertus-ECR, causing relative extension at the elbow and carpus.
The elbow is in turn further prevented from flexing by the carpal and digital flexors arising from the humerus.
The carpus is stabilised by the ECR tendon. The attachment of flexor carpi ulnaris and ulnaris lateralis to he accessory carpal bone tends to keep the carpus extended.
The fetlock is prevented from further extending by the suspensory apparatus (a whole other story!!) that is associated with the interosseous tendon and SDFT and DDFT.
🙈 Help

Friday Update

Lectures are back in full swing, this afternoon I have a hind limb dissection and this morning we discussed Parturition and Dystocia in equine foaling. There seemed to be an endless list of dystocia presentation possibilities in parturition of the foal. One particularly harrowing one was Rectovaginal Fistula, where the foal’s hoof tears through the vagina, destroying the separation between the vagina and rectum. Thankfully this can be surgically corrected although there will always be scar tissue and the tissue will never be the same. All talk of dystocia just made me thankful I am not following the path of Equine Stud work, although I fully expect further along in my career to be doing therapy with brood mares and, in particular, stallions since covering a mare is strenuous work!

Outside of lectures I’m thoroughly enjoying doing bodywork sessions with my case studies. I’m seeing lots of improvement in them, which is very encouraging. Each horse reacts and tolerates different parts of the Bodywork session differently, so I am learning how to tailor each session to suit their tolerances and problematic areas.

This weekend I finally have a free schedule so am spending time with my beloved dogs and starting work on our latest assignment which is an Equine Business Report.

Dissecting my Week

Have been ridiculously busy since finishing my Equinology® course. Not only have I had to catch up on all the university work I missed whilst I was on the course, but I have had to continue with all the work towards my Equinology® externship. The first half of the week I spent meeting lots of interesting people and their horses after I advertised that I was looking for case studies of my Externship. I had a fantastic response and was inundated with replies from a huge range of people and their many different horses. I had to shortlist those which were going to work best for the externship, and the huge response I got allowed me to choose a good variety of case studies.

So far I’ve taken on 4 wonderful case studies that I’m so excited to work with:

  • A  17hh 5yo ID x Dutch Warmblood mare
  • A 16yo Warmblood mare
  • A 15hh Haflinger gelding
  • & a 15.3hh 12yo Arab mare

I still have space to take on one more case study but am being very picky about who I choose. I have a meeting with a potential case study tomorrow so hopefully all goes well!

Very exciting week, and to top it all off out dissection at university today was fantastic! We had a thoracic limb dissection where we explored all the muscles layer by layer that are involved in the forelimb. What was absolutely clear was that no diagram or textbook could explain the arrangement of the muscles in a way that is faithful to the actual limb. It is such a complicated structure of ligaments, tendons, fascia, vessels, muscles, nerves, bone, cartilage, etc., all wrapped and entwined around each other. But having studied anatomy ferociously for my Equinology® course I was able to work out what each of the muscles were, so it’s nice how much the Equinology® course feeds back into my degree.

First Bodywork Session

This evening I carried out my first Bodywork session with one of my case studies. I was thrilled to be able to get started on one of my case studies and the session went wonderfully. The mare I was working on was really responsive and showed me some interesting areas of sensitivity which I will have to assess and consider whether they are related. The mare isn’t used to sports massage sessions and was quite perplexed when it came to stretching out the hind limbs! So I will have to teach her how to stretch with me in our future sessions. It was so rewarding to see how much she enjoyed the session and how relaxed and well behaved she was, especially considering her age and lack of familiarity with massage sessions. I was in such deep concentration throughout that the session took me not my predicted 2 hours, but 3 hours! I had a well deserved flask of tea once our session was finished.

My next sessions are all booked in for Tuesday where I have 3 of them back to back. One flask of tea will probably not suffice for the day! It is wonderful to be able to spend so much time on one horse and really be able to read them through there muscles and behaviour. It’s very rewarding to see the horse reacting to you being able to relieve pain or simply soothe them through massage.

Tomorrow I look forward to doing my first write up of the session using the Cavanti software which has been developed for use by animal practitioners for managing appointments.

Note: Please do not attempt hind limb stretches without the proper guidance of an equine practitioner

Day 8 EEBW® Course

Today we ran over the whole routine, we are now almost finished learning the routine, just a last few hindlimb stretches to learn.

Lectures today focused on our professional development: initial assessments of horse prior to first session, static and dynamic observations, repeat sessions documentation,documents to allow the bodyworker to carry out a session, how often a bodywork session is required for the horse, professional practice etc.

Really excited to arrange my first session with a client and fill out all that paperwork! Will be really exciting to document the horse as I do sessions of bodywork with it over time and recognise any effects of my work on the horse. The session documentation is quite detailed, you would mark on anatomical diagrams any locations of concern. A copy of these session observations are given to the owner which is a nice way for them to track the horse’s progress along with the bodyworker.

Very exciting also, today I became a member of IEBWA (International Equine Body Worker Association) which is a fantastic organisation which is the first of its kind to create a network of qualified and recognised Equine Body Workers. Members of IEBWA must fulfil the membership criteria:

  • To have completed a recognised training in Equine Sports Massage
  • Hold professional indemnity insurance
  • Complete a minimum number of hours of CPE (Continued Professional Development) each year
  • Adhere to IEBWA code of ethics