Non-steroidal anti-inflammatory drugs, corticosteroids, bronchodilators, and antibiotics are all traditional treatments currently utilized for exercise related ailments in equine. While they been determined to be efficient treatments, they possess proven side effects such as ulcers, susceptibility to secondary infections, as well as inefficiency or problems from long-term administration. These consequences have led to an increased demand for alternative methods and therapies to treat exercise related ailments, and increase performance in equine.
Acupuncture
Acupuncture techniques are used in horses to detect sensitivity, aid in the diagnosis of lameness, as well as treatment of conditions such as musculoskeletal pain (Le Jeune & Jones, 2014). One of the primary effects of acupuncture techniques is stimulation of the nervous system, which can increase blood flow and improve physiological function (White & Medicine, 2009). Stimulation of acupuncture points has also been observed to aid in inflammation and pain management through triggering of the pituitary gland to release the adrenocorticotropic hormone which further stimulates the release of the cortisol, a naturally produced steroidal anti-inflammatory (Huisheng, Asquith, & Kivipelto, 1996). Acupuncture scanning can be accomplished via palpation of acupuncture points located along specific pathways and meridians; there are over 100 known acupoints in equine (Le Jeune & Jones, 2014; Shmalberg & Huisheng, 2009).
A common cause of equine lameness is chronic musculoskeletal back pain and acupuncture techniques are a highly recommended treatment (Tangjitjaroen, Shmalberg, Colahan, & Huisheng, 2009). In a study observing the correlation of positive acupuncture scans and lameness, 102 performance horses underwent a two-minute scan of acupuncture points to determine sensitivity and were further evaluated as either lame (51 horses) or sound (51 horses). Acupuncture scanning detected sensitivity in 82.4% of lame horses. It was concluded that acupuncture scans can be a beneficial component of an overall exam, but should be accompanied by other diagnostic lameness techniques (Le Jeune & Jones, 2014).
Chiropractic Therapy
Chiropractic therapy is defined as the application of high-velocity, low-amplitude thrusts to induce therapeutic effects in articular structures, muscle function, and neurological reflexes. It is common during joint manipulation to hear a cracking or popping sounds due to the applied force overcoming the elastic barrier of resistance. This treatment can result in significant and beneficial alterations to the kinematics of the spine, increasing overall spinal mobility and flexibility (Haussler, 2009). The overall goal of chiropractic therapy is to restore normal joint function, stimulate neurological reflexes, reduce pain, and reduce muscle hypertonicity (Snow, 2013). Horse owners will seek out chiropractic therapy as a means to treat clinical signs of lameness including back pain, abnormal movement, stiffness, and loss of performance (Schultz, Haffner, Wooten, Hoffman, & Spooner, 2015). Articular neurophysiology, biochemical alterations, pathologic changes within the joint capsule, and articular degeneration are all basic elements of dysfunction in the joint and/or spine (Haussler, 2009).
Chiropractic treatment has been observed to increase stride length and improve collection in lesson horses, possibly as a result of increased flexibility and decreased pain in the spinal joints (Schultz et al., 2015). Improvement of symmetric pelvic rotation can also result from chiropractic joint manipulation, leading to improved gait and performance. While chiropractic therapy has been concluded to have a beneficial effect on performance in horses, the effects are generally temporary. Studies have shown that range of motion increases directly after chiropractic treatment, but decreases within the duration of one month. This form of therapy can be used alone or accompanied by other methods; either way as a valid treatment for joint related musculoskeletal related lameness (Gomez Alvarez, L'Ami, Moffatt, Back, & Van Were, 2008).
Massage Therapy
Massage therapy is the manipulation of the skin and underlying soft tissues either manually, with an instrument, or with a machine for therapeutic purposes; this includes rubbing, kneading, tapping, and introduction of mechanical vibrations (Haussler, 2009). Equine massage therapy focuses mainly on stress point therapy, trigger point therapy, and myofascial release techniques. Trigger point therapy involves applying direct pressure to a hyperirritable area, and is most commonly recognized in sport’s massages in humans. It is common to combine massage therapy techniques with exercise and other physiotherapies to improve musculoskeletal function (Buchner & Schildboeck, 2006).
Therapeutic massage can relieve muscle tightness, increase muscle compliance, increase joint mobility, and decrease stiffness within both muscle and joints. Equine studies focusing on the effects of massage on range of motion observed increased range of motion, increased stride length, and decreased stride frequency implying a positive effect on the athletic performance horse (Scott & Swenson, 2009). Additionally, mechanical pressure from massage increases muscle temperature and arteriolar pressure, fundamentally increasing blood flow. Alterations in heart rate, blood pressure, and physiological hormones as a result of massage therapy can also induce a relaxation response during times of stress and anxiety (Scott & Swenson, 2009). Consistent massage therapy has been observed to have positive effects on attempts to reduce stress levels in race horses, concluding that it is a beneficial technique for equine welfare and performance (Kedzierski, Janczarek, Stachurska, & Wilk, 2017). In general, more research should be conducted to prove the effects of this technique on equine physiology (Haussler, 2009).
Physical Therapy
Mobilization of joints and soft tissue by physical therapists is utilized in assessing quality and quantity of range of motion in joints for the treatment of musculoskeletal disorders. These techniques overall aid in rehabilitation of neuromotor control and help to activate spinal reflexes, increase flexibility, strengthen the musculoskeletal system, and stimulate proprioception. Physical therapy is primarily used in equine as a means to increase joint mobilization after removal of a cast or fixture that has caused immobilization (Haussler, 2009), and is the primary form of therapy for horses competing in competitions that prohibit the use of medications (Andris, 2016). Some common forms of physical therapy in equine rehabilitation include thermal therapy, shockwave therapy, laser therapy, manipulative therapy, and rehabilitative exercise. Thermal therapy consists of both hot and cold techniques. Cold thermal therapy is utilized in reducing pain during acute injury through techniques such as ice water immersion, ice surface application, and cold packs. Cold therapy reduces local blood flow, pain, and inflammation. Heat thermal therapy is applied during chronic injury to enhance tissue stretching and the healing response primarily in the forms of warm water, hot packs, and therapeutic ultrasound. Heat therapy increases local blood flow, relaxes muscles, reduces pain, and can increase joint and tendon mobility (Andris, 2016). Manipulative therapy such as range of motion exercises and stretching are utilized to strengthen muscles, increase flexibility, and reduce pain and muscle discomfort. All of these techniques can be accompanied with controlled exercise, such as hand-walking, and retraining to assist the horse in regaining musculoskeletal tissue strength and returning to normal performance abilities (Andris, 2016).
Nutraceuticals
Nutraceuticals are considered any natural dietary supplement, typically plant based, that provide beneficial precursors and catalysts aiding in the prevention and treatment of diseases; primarily lameness in the horse (Montgomery, 2011). One of the largest issues with nutraceuticals is that they are not FDA approved and have very little research to prove their efficacy. While they are being tested more and more, equine research is still very minimal; proper dosage, side effects, and health benefits for horses is still unknown (Bland, 2015; Brown, 2009). One of the most well-known nutraceutical supplements is Glucosamine, which is favorably absorbed across the epithelium of the small intestine (Wright, 2001). Glucosamine and chondroitin sulfate in combination have been studied for their effects in treating equine musculoskeletal related lameness (Montgomery, 2011). There are many claims that glucosamine can actually improve motor function in older horses, but a study analyzing the effects of three-month oral supplementation of glucosamine and chondroitin sulfate concluded there was no sufficient evidence that oral supplementation results in substantial improvement of locomotor performance in horses (Higler et al., 2014). Another study, however, concluded that oral supplementation of glucosamine and chondroitin sulfate did aid in reducing pain associated with lameness, and was not accompanied by any adverse side effects (Montgomery, 2011). The quality of some glucosamine products available has been tested and observed to be substantially different from the claims on their product labels; a consequence due to the lack of FDA regulations (Oke, Aghazadeh-Habashi, Weese, & Jamali, 2006).
While the alternative treatments are still relatively new to the field of equine medicine, they have shown very promising results when used in conjunction and sometimes in place of the traditional treatments. These alternative treatments focus to enhance the horse’s natural physiological processes, and so far, minimal side effects have been observed. Further research on the efficacy of some of these therapies and supplements would be extremely beneficial in the education of the equine industry.