Common modalities in equine rehabilitation

Equine rehabilitation is a large, focused field of specialized equine medicine. Its main indications are to reduce pain, facilitate tissue healing, and restore muscle strength, endurance, and proprioception to return the patient to its prior level of activity while also trying to prevent further injury.¹ Several modalities are available to the equine practitioner, and they can be divided into manual therapies, physical therapies, therapeutics, and biological.²

Once an accurate and complete diagnosis is reached, a rehabilitation protocol can be put in place taking into consideration the phase of the tissue healing (acute, subacute, chronic) and the primary functional rehabilitation issues (pain, incoordination, muscle weakness).³ An adequate protocol should outline specific goals and a rehabilitation timeline after discussion with the owner/rider/trainer to ensure compliance.

Once a rehabilitation program has been chosen, regular reevaluation and adjustment of the modalities used may be necessary based on the clinical response obtained.⁴ A brief overview of 3 modalities the author uses commonly in equine rehabilitation and that could be incorporated into various rehabilitation programs follows.

Mesotherapy

Figure 1. Equipment needed to perform mesotherapy: a blue linear adaptor connected to 5 intradermal needles and a small extension for ease of injection.

Mesotherapy consists of intradermal injection of small amounts of highly diluted drugs. By injecting small volumes of drugs, it reduces the risk of adverse effects and increases the drug duration activity. This procedure can be performed in a hospital or on the road, is relatively easy and economical to perform, and has the advantage of being synergetic with other therapies. Mesotherapy is often indicated in cases of back pain (kissing spine, lumbar pain, sacroiliac pathology) and cervical pain or stiffness. As with any other modalities, owner consent should be obtained prior to treatment, and risks of complications should be discussed including local reaction, infection, and hair growing back white at the injection sites. Mesotherapy necessitates the use of a linear injector, a small extension set, and intradermal needles with a depth of no greater than 4 mm (Figure 1). Drugs commonly used for mesotherapy include mepivacaine local anaesthetic, corticosteroids, Traumeel homeopathic injectable solution (Heel Veterinary Medicines), vitamin E complex, and sarapin. With the use of corticosteroids, withdrawal time should be taken into careful consideration as the drug may stay longer within the dermis. The linear applicator is inserted perpendicular to the skin in lines parallel to the midline for the back, about 1 cm apart. Medication is injected until a small lump is seen on the skin (Figure 2). Horses are usually given 24 hours of rest during which they should neither be washed nor rugged, and they can then progressively resume regular exercise.^5-8

Figure 2. Mesotherapy is applied to a horse’s thoracolumbar region. Note the raised injection site in lines parallel to the midline and about 1 cm apart on each side of the back.

Kinesiotape

Kinesiotape consists of an elastic tape made of 100% cotton elastic fibers that can stretch along its longitudinal axis up to 130% to 140% of its resting length. Once applied it can stay on up to 5 days, 24 hours per day. Kinesiotape affects all layers of tissue and organs. Applied to the skin surface, it results in a lifting effect with the creation of space between superficial layers. It also directly acts on the fascia through an unwinding effect and redirection of movement. Finally, it optimizes muscle function and helps provide decongestion and fluid redirection by acting on the lymphatic system. The main indications for using kinesiotape are tendon and ligament injuries, muscle imbalances, postural adjustments, lymphatic and circulatory conditions such as lymphangitis (Figures 3 and 4), pathologic movement patterns, fascial adhesions, and acute and chronic pain.^9-10

Figures 3 and 4. Kinesiotape is applied in a lymphatic drainage pattern to treat lymphangitis over the hock region. Most of the lymphatic drainage occurs on the medial aspect of the limb; therefore, that is where the tape should be applied predominantly.

Laser

Laser, or light amplification by simulation of emitted radiation, is commonly used in equine practice. Class III and IV lasers are most commonly used in equine rehabilitation. They have a range of less than 500 mW, and their wavelengths vary from 540 nm to 1060 nm. Laser stimulates cell growth and metabolism, improves cell regeneration, increases fibroblastic activity, and modulates inflammation by acting on prostaglandin E2, tumor necrosis factor-α, interleukin-1β, plasminogen activator, and cyclooxygenase-1 and -2. Laser increases serotonin, which is an excitatory neurotransmitter peripherally, and it also works in the dorsal horn to modulate pain response, providing a general feeling of well-being. It also increases the release of β-endorphin, which results in increased production of endogenous opioids. Finally, it increases acetylcholine, which is an inhibitory neurotransmitter, resulting in the decreased discharge frequency of excitatory neurons and increases the frequency of inhibitory neurons; this results in a significant increase of the pain threshold required for the transmission of sensory nerve input. The main indications for laser use in equine practice are performance maintenance, prevention of injury recurrence, tendon and ligament injury, chronic joint disease, synovitis, osteoarthritis (Figures 5 and 6), back pain or injury, wound healing, and pain relief.^11-13

Figures 5 and 6. Application of a class IV laser to a horse’s tarsal region to relieve pain caused by chronic osteoarthritis.

Conclusion

There are several modalities available for the practitioner to integrate into the rehabilitation of the equine patient. Each modality should be chosen carefully and the function of their mode of action and the pathology diagnosed. Given that the scientific evidence is limited in this area of veterinary medicine, frequent assessment and reevaluation of patients is recommended to make adjustments when needed and obtain the best outcome from each rehabilitation protocol.

REFERENCES

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11. 1Luna SPL, Schoen A, Trindade PHE, Rocha PBD. Penetration profiles of a class IV therapeutic laser and a photobiomodulation therapy device in equine skin. J Equine Vet Sci. 2020;85:102846. doi:10.1016/j.jevs.2019.102846
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