Dr Gillian Tabor, a Chartered Physiotherapist who specialises in the treatment and rehabilitation of horses, discusses how she sees horses who are underperforming and are referred by vets to her. Some signs owners and trainers describe to Gillian are conflict behaviours: for example, bucking, refusing at jumps and napping. More subtle signs may be that the rider has noticed the horse is stiffer when performing a dressage movement, or maybe the horse used to come downhill on the cross-country confidently and now it isn’t keen to move forward downhill or is crooked. Another sign can be the horse turns away in the stable when it sees the saddle or has started becoming difficult to girth. Gillian will look for musculoskeletal issues and work with owners when investigating these signs and sometimes she discovered the horse actually needs to be scoped for ULCERS – which is why this podcast was produced to link with Dr David Marlin’s Webinar on GUT HEALTH and links with Dr Kirstie Pickles’ webinar on GASTRIC ULCERS.
More about Gillian:
Gillian is the Programme Manager and lectures on the MSc Veterinary Physiotherapy course at Hartpury University, and is undertaking research, both her own equine projects and supervising students.
Gillian Tabor is a Chartered Physiotherapist who has been working as an ACPAT Veterinary Physiotherapist for over 15 years, in her own practice in Devon. She specialises in physio for horses and riders, with the focus on treatment and rehabilitation of competition horses.
Scroll down to learn how to download and listen on the go and to watch the related webinars after you have listened to Gillian’s podcast.
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Further Resources:
Gut Health Webinar by Dr David Marlin, click here
Gastric Ulcer Webinar by Dr Kirstie Pickles, click here
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TRANSCRIPTION:
Here is a transcription of the podcast. (Please note this is an automated transcription, so we apologise for any errors from the original podcast.)
Hello,
my name is dr Gillian table and I’m a chartered physiotherapist and I specialize in the treatment and rehabilitation of horses in this podcast.
I’d like to talk to you about my thoughts of equine gastric ulcer syndrome and back pain in horses.
And this links to David’s webinar on gut health.
So on a day to day basis, I go and see horses that might have been referred to me with specifically diagnosed orthopedic issues and those that would come from a veterinary surgeon looking for my assistance in pain management and rehabilitation.
But also I have referrals for those horses that have been considered to have a poor performance issue and it could be the owner and the rider is noticing this performance or the owner and rider has asked the vet to have a look and the vet hasn’t found anything specific in terms of lameness or other other pathology.
So in this instance, I would go in and perform firstly a an examination which is preceded by a thorough history taking from the owner or the caregiver or the rider of the horse.
And the reason that I’d like to take a full history is that this in itself can give me some clues.
So I take all the information such as the horse’s age and breed and size and current workload.
But also I ask for specifics such as what is the reason that they consider the horse has a reduction in performance and they might tell me specific signs.
So there can be blatant clinical signs, such as conflict behaviors.
So the horses started bucking or the horses started refusing it jumps or there may be more subtle signs saying the horse has perhaps got a little bit stiffer when we’re asking for half past, perhaps in a sort of medium level dressage horse.
Or maybe a horse has issues coming downhill.
That used to come down confidently and not alter its sort of speed and stride length, but now it’s coming a little bit short and shuffling or maybe, you know, it’s going crooked downhill.
The other things that I might get suggested as an issue is the horse is turning away from them, then they’re approaching it in the stable with their saddle or maybe it’s becoming increasingly grumpy or reactive to ger thing.
So there’s a sort of a wide variety of science reported that may be a factor of this reduced performance.
So, my job as a physiotherapist is mainly looking for musculoskeletal issues.
So after the history taking, I’ll do a gait assessment.
I’ll look at the horse moving in hand and if facilities allow, I’d really like to see horses on the lunch so that I can assess cantor.
We know the cantor is very useful for looking at hind limb issues and and back problems.
And then my clinical exam carries on with some hands on assessments, looking for motion restrictions,
looking for pain reactions, looking for change in muscle tone and stiffness is, and reduced range of motion.
So all the things that, you know, musculoskeletal practitioners should assess.
So, in my mind, I am looking for something that has this musculoskeletal origin.
I’m looking for a soft tissue pathology or maybe, excuse me, I’m looking for a joint pathology or it could be that there’s some fashion restriction or there’s some inflammation or swelling and there’s there’s there’s a huge range of findings obviously from my clinical exam.
But basically I’m looking for physical signs on the structures that I can see and I can feel and I can assess.
However, as I said, I am talking to you to think about the relationship between perhaps some of these signs of poor performance and equine gastric ulcer syndrome.
Now, I’m not a vet, I am not legally allowed to diagnose, nor would I have the skills to, you know, that is a veterinary surgeon’s job.
However, my knowledge of general health, ill health disease, um and sort of horses well being has expanded so that I have differential diagnoses to consider.
And certainly it’s something that I need to be aware of so that I know where my scope of practice finishes and where I might need to refer the horse.
That I’m seeing back to the vet, some of the clinical signs of gastric ulcers actually overlap quite well with those clinical signs of back pain.
And this is an issue when it comes to trying to establish what is causing what we know that equine gastric ulcer syndrome can cause sort of internal medicine signs.
So colic um weight loss, coat condition, diarrhea, that kind of situation, but also listed in the signs to look out for changes in behavior.
And they might be an increase in stereotypically.
So such as crib biting, but also there’s a big suggestion that gastric ulcers can also cause poor performance.
And in fact, there is a study of horses where gastric ulcers were treated and they found that in half of the group that didn’t have the metropole treatment, there was an effect on stride length and they thought it could be in relation to abdominal pain and obviously that would then have an effect on their performance.
So where we’ve got uh an internal issue causing an external sign.
This is where our overlap and potential confusion can happen.
So as I said, back pain are clinical signs of poor behavior, poor performance rather and changes of behavior and also those conflict behaviors.
And now we’ve got equine gastric ulcers syndrome that is also showing poor performance signs.
So how do I, as a clinician when I approach a horse?
Use that knowledge in practice?
Well, this comes with the discussion part, using the owner to help me with my detective processes, has a change of behavior been linked to any changes in circumstances for the horses.
So have they been traveling more or competing more or has there been a change of diet or a change of environment because that would then maybe make me move away from a musculoskeletal um cause and and think maybe a sort of an internal issue.
However, if there has been recent trauma or for instance saddle fit problems or a change of training program, then that could be muscular skeletal.
So if I have an owner that has any doubt and perhaps we have a mixed picture, what do I do?
Well, in that instance, I don’t have, excuse me, I don’t have either X ray eyes and I also don’t have the ability or the I’m not a vet.
So I can’t look at those sort of internal signs without the vet performing gastric scope.
And that actually is the gold standard diagnosis for equine gastric ulcer syndrome.
There’s a lot of talk about these external clinical signs that might be pointing to it, but in the european consensus documents that came out a few years ago, they said that they recommend the gastric gastric scope so that they can diagnose it and they don’t want people to go on these characteristics or clinical signs.
So it is a bit of a gray area, there is a huge overlap between the clinical science for back pain and ulcers.
And so really, if there isn’t any, if you’re in any doubt and you’re in this situation or you know,
somebody that is, I would really recommend going to the vet for further diagnoses, what we don’t want to have is a situation where we are assuming musculoskeletal pain and we are treating that again and again and again and obviously not having any outcomes, only positive outcomes.
But there are some practitioners out there that do persist in regular treatment without looking for an underlying cause.
And I would say that if I treat um my findings once, maybe twice and I haven’t made a change, then that really is a clear sign for me.
Then I am treating secondary symptoms and then that would be needing to be referred to back to the vet for investigation.
So that, that’s just my opinion.
I think it is complex and I think the more that we learn about internal issues such as ulcers, I think the more we have to open our eyes to potentially different reasons as to why we’re getting these symptoms.
I also think that diagnosis here is really key.
I don’t think we can make assumptions and change treatment plans or management’s unless we really know what’s going on.
So, I think that’s sort of my concluding point really, if in doubt, then definitely get it looked at by your vet and then once, once you have a diagnosis or maybe an absence of presence of ulcers, then that can give you the confidence that you know, that you’re taking the right treatment approach.
But I’d be interested to hear any thoughts, so any of you that listening, you know, maybe you’ve had horses with ulcers and no back pain or maybe you’ve had horses that have got back pain and have got ulcers.
Um, there isn’t actually any research to demonstrate the clinical link between the presence of ulcers and that causing back pain, although certainly in humans, we know that peptic ulcers can throw off all all sorts of signs in terms of muscle spasms and back pain.
So, you know, there is the potential, but that purely would be anecdote at this stage and obviously an area for further research if anybody was interested.
Um, But yeah, if you if you’ve had that experience and you want to share, then please do and yeah, we welcome any further discussion on it.
