The art of veterinary medical manipulation explained

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Dr Ryan Lukens working on the cervical vertebrae.
Dr Ryan Lukens working on the cervical vertebrae. © Palm Beach Equine Clinic

When the “chiropractor” visits the barn to adjust your horse, what’s really being done is called veterinary medical manipulation, which US veterinarian Dr Ryan Lukens defines as the art of improving motion at segmental levels, including bones, the supporting soft tissue structure, and nerves.

The ultimate goal of veterinary medical manipulation is to allow free movement throughout the horse’s body by restoring a normal range of motion.

The way Lukens determines what specific segments to manipulate is by motion palpation, or by examining for a decrease in motion. Not only does this have the ability to relieve pain and soreness, but it also reduces the chance of horses having to physically compensate for an area of their body that may not be functioning properly. This act of compensating for being off-balance is a frequent cause of sport horse injuries. Regular adjustments by a certified veterinary medical manipulation practitioner help the horse to maintain their natural balance and a full range of motion to perform at the best of their ability.

Medical manipulation can benefit every horse, from miniature pasture pets to grand prix equine athletes. In addition to improving their range of motion, adjustments can help calm nerves associated with the “fight or flight” instinct. This can lead to calming effects across various bodily systems such as neutralizing stomach acids, lowering blood pressure and cortisol, and strengthening the immune system.

Case study

One notable case Lukens recalls from his work at Palm Beach Equine Clinic in Florida involved a nine-year-old Dutch Warmblood gelding training at third-level dressage. The horse was roughly 300 pounds overweight and was too head shy to even have a fly mask put on. Under work, he presented with right front limb lameness and stiffness on the left while traveling left. Balance is essential for dressage, and this horse struggled with his natural balance.

Aerial view showing the spines of both scapula bones clearly visible because of the lack of musculature.
Aerial view showing the spines of both scapula bones clearly visible because of the lack of musculature.

The horse showed severe cavitation of the muscling in his neck at the first evaluation. The divots seen in the neck indicate the atrophy of the paracervical muscles which is not normal. Though circumstances like this are seen often, it can be a sign that the horse’s nerves are not functioning properly, and that the muscles are suffering. When adjusting the horse, Lukens found that the horse had restricted movement at the poll and cervical vertebrae 5, 6, and 7 to the left, which essentially covers the whole lower neck on that side, and the sixth cervical vertebrae on the right side.

Atrophied paracervical muscles, shown as divots in the neck, improved after just two sessions and four weeks of training.
Atrophied paracervical muscles, shown as divots in the neck, improved after just two sessions and four weeks of training.

The horse tolerated the adjustments and was more welcoming to hands on the neck, face, and ears after the manipulations Lukens performed. Four weeks later, after just two sessions, the muscles appeared more filled out in the neck, signaling improvement. On the left side of the neck, the muscle mass became very convex, signifying proper muscle tone. Lukens adjusted only the head and neck while treating the horse to see what changed and how the horse performed before making further adjustments. The horse lost about 100 pounds of fat with training, and the right front lameness improved without any other treatment or medical manipulation.

Convex musculature of the neck showing a significant improvement after manipulation sessions.
Convex musculature of the neck showing a significant improvement after manipulation sessions.

“The diagonal lameness that this horse presented could have been the result of lower cervical pain,” Lukens said. “The underdevelopment of the muscles of the cervical region that support the scapula was a large clue to the primary problem of this horse’s lameness.

“Restrictions in the cervical region can cause the horse to keep its head in an extended position and decrease the range of motion within the facet joints of the vertebrae. This decrease, along with local inflammation and the overall restricted range of motion, causes a decrease in the frequency of nerve firings. Nerves that are not firing properly can lead to cartilage degeneration, adhesions, and decreased circulation,” he said.

Often issues a horse presents physically can be tied back to its inability to access its full range of motion. It is important to have horses routinely examined by a certified veterinary medical manipulation practitioner to ensure proper range of motion, especially if they have demanding jobs that could exacerbate minor injuries with continued work. Lukens believes that a veterinarian trained in medical manipulation is the safest choice for the horse.

“A veterinarian’s extensive knowledge of anatomy and understanding of when not to adjust a horse is key. Medical manipulation is a safe treatment if performed by the correct practitioner under the correct circumstances. A veterinarian can use a whole-body approach to treating lameness or enhancing performance while ensuring the horse’s safety and well-being.”

Palm Beach Equine Clinic

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