Shropshire Veterinary Physiotherapy

16/06/2023

21/04/2023

EQUINE HYOID
So good to get a hands on CPD again! Amazing to see the response from the horses by releasing tension in the hyoid and cervical connections.

07/04/2023

Good to see posts about PSSM 2 and MFM in order to raise awareness.
I have mentioned these conditions before in my posts, and have definitely seen improvement through modifications in diet and exercise.
Looking forward to more research and validated tests in the future.

TESTING FOR TYPE 1 (PSSM1) AND TYPE 2 (PSSM2) POLYSACCHARIDE STORAGE MYOPATHY IN HORSES

PSSM1 horses usually present with symptoms of “tying-up”, i.e. reluctant to move, muscle stiffness, pain, discoloured (dark) urine and high CK and AST (muscle enzymes) in plasma. The condition is caused by defective muscle glycogen storage due to a genetic defect (mutation) in the glycogen synthase enzyme gene (GYS1). PSSM1 can be suspected based on clinical signs and a muscle biopsy but definitive diagnosis requires genetic testing.

PSSM2 is similar to PSSM1 in that horses may present with tying-up, although this can be severe, moderate or mild. Moderate and mild cases of PSSM2 may be challenging to diagnose. Currently, in contrast to PSSM1, there is no validated genetic test for PSSM2. There are companies offering these tests based on hair or blood samples but they have not been shown to be accurate. In fact they have been shown to be inaccurate. The mutations involved in the genes that cause PSSM1 are not found in horses with PSSM2.

Dr Stephanie Valberg has committed her life’s work to equine myopathies and is a leader in this field. Unfortunately, despite her peer-reviewed and published research there are those that refuse to accept the current position based on evidence, even to the extent of attacking her and condemning her research.

➡ If you suspect your horse has PSSM1 or PSSM2 then you are advised to contact your vet.
➡ If you want to learn more there are many good resources.
➡ If you suspect your horse may have PSSM2 then there is no harm in managing them as if they have to see if the symptoms improve, including avoiding rest days, gradual increase in workload, extended warm-up time, low sugar/starch diet, etc.
➡ At this stage there is little to be gained from undertaking unvalidated genetic tests for PSSM2

If you are interested in learning more about equine myopathies, we have a webinar by Dr Stephanie Valberg which clearly explains PSSM1, PSSM 2 and Myofibrillar Myopathy (MFM) https://drdavidmarlin.com/muscle-disease-pssm-1-2-and-mfm-by-dr-stephanie-valberg/ and a webinar by Internal Equine Medicine Specialist Dr Kirstie Pickles on “tying-up” https://drdavidmarlin.com/managing-horses-that-tie-up/

N.B. I am aware this is a contentious issue and many people hold strong views. If you interact innapproriately then this will not be tolerated. Please afford everyone RESPECT!

References
Clinical characteristics and muscle glycogen concentrations in warmblood horses with polysaccharide storage myopathy (2017) Lewis et al.
https://pubmed.ncbi.nlm.nih.gov/29076373/
Muscle glycogen concentrations and response to diet and exercise regimes in Warmblood horses with type 2 Polysaccharide Storage Myopathy (2018) Williams et al.
https://pubmed.ncbi.nlm.nih.gov/30183782/
Commercial genetic testing for type 2 polysaccharide storage myopathy and myofibrillar myopathy does not correspond to a histopathological diagnosis (2021) Valberg et al.
https://pubmed.ncbi.nlm.nih.gov/32896939/
Type 2 polysaccharide storage myopathy in Quarter Horses is a novel glycogen storage disease causing exertional rhabdomyolysis (2022) Valberg et al. https://pubmed.ncbi.nlm.nih.gov/36102343/
Absence of myofibrillar myopathy in Quarter Horses with a histopathological diagnosis of type 2 polysaccharide storage myopathy and lack of association with commercial genetic tests (2023) Valberg et al.
https://pubmed.ncbi.nlm.nih.gov/35288976/

19/02/2023

One relaxed customer after his physio and myofascial release session on Friday.

28/01/2023

PSSM 2
A Case of Myofibrillar Myopathy.

An interesting case that may hopefully raise awareness as more research comes out on this progressive disease.

POLYSACCHARIDE STORAGE MYOPATHY OR PSSM A CASE STUDY What is PSSM? Polysaccharide Storage Myopathy or PSSM is a progressive disease that affects skeletal muscle. There are two types: Type 1 is caused by a genetic mutation, and is commonly known to affect quarter horses in particular. It causes

23/12/2022

Thank you to everyone for your continued support throughout the year, and I look forward to working with you all in 2023.
Wishing you all a Merry Christmas, and Happy New Year.
I have limited availability on Friday 30th Dec, and Saturday 31st Dec Appointments as normal from Tuesday 3rd Jan 2023

15/12/2022

THE PAIN CYCLE

This video is brilliant at explaining the pain cycle in humans.... but it is also relevant for animals.
Importantly, it explains how chronic pain can lead to even more heightened pain sensation over time.
This emphasises the importance of early intervention following trauma of tissues in order to break the pain cycle.

Explore the biological and psychological factors that influence how we experience pain and how our nervous system reactions to harmful stimuli.--In 1995, the...

14/12/2022

Intervertebral Disc Disease IVDD
Meet Penny who recently underwent a hemilaminectomy to remove disc material which was causing spinal compression.
Post operatively, Penny was non ambulatory with hindlimb weakness and ataxia.
Her recovery is going well, and she is learning to walk again with the support of a harness. She has received weekly Laser Therapy and Physiotherapy to help her paw placement, reduce stiffness, and help weight bearing.
She also has wonderful owners that do her home exercises three times per day.
She will continue to improve over the coming weeks.

13/12/2022

Before and after photos of this lovely chap after just two sessions!
Releases through neck and work to encourage activation of the thoracic sling has helped his posture and jumping technique.

07/12/2022

Assymetry in the pelvic area leads to alteration in loading and transmission of forces. Inflammation and compensation in the tissues may lead to neuropathic pain.
I know some of you will be very interested in this!
I am looking forward to this webinar on Saturday.

Could nerve damage be responsible for Lumbosacral region pain? Loss of distal limb sensation? Poor limb flexion?

Quiney et al. (2021) found that 26% of horses that presented with lumbosacral region pain had damage to the sciatic or obturator nerves, stating that neural pain may play an important role in some horses. The paper described that It is probable that lumbosacral region pain can be caused by osseous or soft tissue pathology, or both. Furthermore, it has been suggested that sacroiliac joint region pain in humans can be neuropathic in origin. Impingement or damage of the sciatic could of course be resultant of regional inflammation.

The study mentioned alteration of load transfer or torque through the sacroiliac joints, which may occur as a result of asymmetry, may contribute to the development of degenerative changes of the sacroiliac joints, however it could be reasonable to suggest altered static biomechanics (posture) due to hoof balance could create the same changes in load transfer and dysfunction in the region. And once again, vice versa.

Damage or impingement to the sciatic nerve can create loss of sensation in distal limb (below stifle), Motor loss and poor limb flexion and pain. Some features of lumbosacral region pain in horses, as suggested by Quiney et al., may be considered consistent with neuropathic pain, such as episodic shooting forwards (sudden increase in anxiety and rapid transient acceleration), as if experiencing paroxysmal pain, and bucking and kicking out and a lack of response to systemic analgesics.

Join myself and Celeste-Leilani Lazaris , an expert on equine nerve impingement and its treatment, for a joint webinar on nerve impingent and its connection to the hoof and posture.

https://equineeducationhub.thinkific.com/courses/nerve-impingement-hoof-balance

I also delve into the findings of my recent research suggesting links between hind hoof balance and sacroiliac region pain and sciatic dysfunction. Which you can read here..

https://www.theequinedocumentalist.com/post/negative-plantar-angles-and-pathology-along-the-dorsal-myofascial-line

01/12/2022

I definitely believe that some undiagnosed subtle forelimb lameness issues may arise from nerve compression of the brachial plexus.
It will be interesting to listen to discussion surrounding this complex area involving the base of neck and surrounding musculature.

Did you know that compression of the brachial plexus can create unexplained forelimb lameness!?

Compression between the scapula and the ribs has been considered as the most common cause of injury to the brachial plexus. This can cause unexplained lameness and stumbling.

There becomes a cause and effect cycle that occurs as these horses present with neurogenic atrophy of the thoracic muscles. The lack of muscle development means a loss of cushioning between the scapula, brachial plexus and rib, predisposing to more compression.

Studies have outlined that this diagnosis is rare, however appreciate this could be due to underdiagnosis as neurological issues are difficult to assess with screening modalities, some may have conservative management, go without further investigation, or be euthanized because of a belief of poor prognosis or a suspicion of other severe conditions such as limb fracture.

So, it is possible that many horses with milder compression of the brachial plexus could be dealing with milder discomforts and sub clinical lameness'.

Join myself and Celeste-Leilani Lazaris, a pioneer of the recognition and treatment of this pathology in an upcoming webinar where we also go into the fluid, interconnected relationship with posture and hoof balance.

Tickets..

https://equineeducationhub.thinkific.com/courses/nerve-impingement-hoof-balance

Facebook event..

https://m.facebook.com/events/495304939243117

06/11/2022

NECK PAIN AND DYSFUNCTION

Following the fascinating three hour webinar with Dr Melinda Story, I thought it useful to summarise some of the main points.
Neck pain in horses has become an increasingly popular topic amongst equestrians.
The anatomy is complex, and may involve both nervous and musculoskeletal systems.
Importantly..... neck pain is very difficult to diagnose with current imaging such as lateral view X Ray or Ultrasound.

So, what are the signs of neck pain?

Affected horses may present with a variety of issues such as:
Poor performance
Gait abnormalities
Subtle forelimb lameness
Alteration in behaviour
Increase in spooking
Muscle assymetry/atrophy through neck
Stiffness in neck
Avoidance of coming on the bit

What are the possible issues?

Cervical vertebral compressive myelopathy (Wobblers)
Disc Disease
Cervical Facet Joint Osteoarthritis
Fracture
Nuchal Ligament Desmopathy
Compression of nerve root or brachial plexus
Bony abnormalities of vertebral body (often C6 or C7)

How do we diagnose?

Neck pain can be difficult to diagnose in human patients, even with advanced imaging techniques.

A thorough history from the owner, along with careful palpation of the tissues is crucial. Careful observations of demeanour, posture, muscle symmetry/ atrophy/hypertonicity as well as joint range of motion is vital.

This is where a multidisciplinary approach is key.... ie Veterinarian/Physio/Farrier/Saddle Fitter etc... all collaborating together.

Provided any pain has been managed,
Veterinary Physiotherapy can help during rehabilitation in the following ways:

Improve Vertebral Joint stability
Maintain/ Improve Range of Motion
Maintain/ Improve Flexibility
Improve muscle tone ie strengthen weak muscles, and deal with compensatory muscle spasm
Re educate neuromuscular pathways.

Finally, and most importantly.... prevention is better than cure. Bring young horses on slowly, with attention to stability before asking too much strengthening.

For further information on this post, or how Veterinary Physiotherapy can help, either send a message or contact me on 07791 423772.