For the aged horse, massage can be both good AND bad. Well, to start with, you're probably wondering why a massage therapist would say that massage might be bad, especially when it is how he makes his living. I will try to explain this technically yet simply enough for the layperson to understand. It is a topic that I have had to explain to many of my clients over the past 14 years. Some can grasp the explanation and concept while others have difficulty.

As we are all aware, probably the most common downfall of the horse is arthritis. Just as in humans, it can be a debilitating disease. We have definitely seen tremendous results in recent times with the introduction of Glucosamine and Chondroitin products but when the dreaded disease wreaks havoc in the joints, there are cases that do not enjoy the desired relief. The careful use of injectibles such as Legend, Adequan and corticosteroids may provide relief, and some may aid in the regeneration of cartilaginous material as well as synovial fluid in certain cases, but they should be used with caution.

Arthritis is usually caused by trauma to the joint or tears to the joint sac. Ligaments supporting the joints that have been traumatized can also be predisposed to arthritic conditions, particularly without proper rest and rehabilitation after the sustained injury. The changes in the bony areas are directly related to erosion of the articular joint and surrounding cartilage and bone as well as the 'drying up' of the joint's synovial fluid.

Once a treatment plan that works is discovered and the horse is for the most part out of discomfort, the best prescription is to keep them moving. Work involving mobility in the joints has long been recognized as beneficial rehabilitation. Take, for example, a frozen shoulder in the human. If there were a soft tissue injury to the rotator cuff muscles and the patient were to keep the arm immobile for an extended period of time, the joint would eventually seize and the surrounding tissues would start to atrophy.

Atrophy is another common condition found in injury or 'geriatric' cases. Atrophy is muscle loss. This can be commonly found due to lack of use of the muscle, destruction of tissue, or nerve degeneration.

What does all of this have to do with the original question? Everything. In the geriatric horse, you can put your money on the fact that they have arthritis. Think about your old grandfather or the old woman you used to see hunched over walking down the street doing her daily errands. You'd wonder how they could do it day after day when they had to hurt so badly. The fact is, if they stopped moving they would probably seize up, whereas if they kept mobile, they would be more comfortable.

As humans we have a distinct advantage in that we can contort ourselves out of certain degrees of pain. We can also communicate with our medical professionals for appropriate medications to ease pain as necessary. The horse has to depend on its owner or caretaker for many of its therapies, supplements, and medications as well as its maintenance, exercise and daily turnout. So hopefully the owner is in tune with the horse.

In this day and age, most equestrians are familiar with all the alternative or adjunctive therapies that are available to the horse. I have been a very fortunate therapist to be located in the Northeast United States where we have some of the finest equine practitioners available. While chiropractic and acupuncture play an important role in the overall well being of the horse, massage therapy is undeniably the one modality that can work well in conjunction with all of the other applications.

Finally, I will attempt to explain my statement. The geriatric horse has used his innate ability to compensate for his arthritic conditions or lameness. This will give him the appearance of being very stiff and careful of how he moves. Maybe he has been out of work for a while and has just started back. The owner decides that massage would be very beneficial.

The therapist arrives to massage the horse and should first ask the owner to walk and trot the horse for him so he can make his initial movement evaluation. This is a very important part of the treatment procedure. At the walk, the therapist will be able to tell if there is any muscle tightness or restriction. At the trot there is a little more impulsion and this will be the best gait to determine if the horse is lame and should perhaps be looked at by the veterinarian.

Symmetry

The initial portion of the evaluation will tell the practitioner a lot. While the horse is standing square either in the cross ties or in hand, the therapist should look to see if both sides of the horse are even. As you know, horses are right- or left-side dominant just as we are. Many times, just by walking around the horse and looking at key areas, you will be able to determine which limb might be causing the problem.

I like to start by looking between the horse's front legs and make sure the pectoral region gives a nice even appearance of a bell curve. Next I look up at the horse's neck. If one side is larger than the other, you can usually assume that the shoulder on that side will be too. Scanning the horse's body as you walk around him, look and see if the back is up or starting to develop a dip. Look at the quadriceps (stifle area); do they appear tight, hollow or have a nice strong appearance? When standing behind the horse and looking at the hips, are the gluteals even or is one side lower than the other?

And now, very important, move the horse's tail to the side and examine the gracilis. This is the big bulky muscle that is on the inside of the leg in the stifle area. If one side is much more developed than the other, the horse is using that leg more and overloading on it, compensating for the injured or affected limb. If you determine that one hind limb is stronger than the other, many times the front limb on the opposing side will be stronger as well due to the fact that horses will compensate on the diagonal. If for example, the right hind were the affected limb, you would see the gaskin and gracilis more developed on the left hind. Consequently, the left fore would be more developed because the horse would be loading on that limb, particularly at the trot.

Another common question that people have is "If the horse rests his hind limb by 'knuckling' it does it hurt him or does he have a problem there?" Usually, a safe answer is that if the horse switches sides, don't be too concerned. However, if that is the limb they ALWAYS rest, it could very well be indicative of a problem or potential problem.

Movement Evaluation

An important aspect is to quickly realize if the horse that you are evaluating is true and clean in the 4-beat walk, 2-beat trot or 3-beat canter. If there is a restriction in movement or a structural problem, these footfalls can become impaired and potentially result in injury.

I like to start my evaluation watching the horse coming out of his stall or coming in from turn out. Look to see if they are stiff in everyday movements or if they take corners comfortably and walk relaxed. Next I will ask the handler to walk the horse out in a straight line for me and then walk the horse back. In the walk, I try to concentrate on a few things such as, are his hips even? Is he tracking evenly on both sides? Or does his barrel look even on both sides?

Having no impulsion at the walk is to the observers benefit, because we can pick out muscle stiffness more easily. As the horse approaches you at the walk, take note of his head and neck. Are they carried straight or off to the side? Does he "roll through" in both shoulders? Is there a swing of relaxation through his shoulders, back and hind? And does he use his neck properly for balance?

Once you have determined where the obvious muscle stiffness is, you would want the handler to trot the horse for you, preferably on even, solid footing. On hard footing with the concussion of the trot, gross lameness, if there is any, becomes more evident.

This would be done only for evaluation purposes by the therapist, as it is not our job to diagnose. It is, however, beneficial to the owner and the attending veterinarian to work in conjunction with a therapist who can at least determine if soundness is an issue. At the trot, we would look for many of the same things as at the walk but more will be evident especially if there may be a problem that would show up with the increased concussion of the foot strike. Look for the swing through the horse's hind end, make sure the hips are even, check if tracking is even and make sure the hocks flex evenly. This is also perhaps the best way to evaluate if the horse's stifles may be an issue, such as being weak.

I prefer to watch the horse walk and trot away from me in a straight line. I will then observe them from the side to check for flight arc discrepancy or symmetry. When the horse comes toward you, does he hold his head evenly and have a nice rhythmic swing to it, or is he uneven with a "head bob"? By this I mean does he lift his head sharply when landing on the affected forelimb or does he have a subtle lurch forward when he lands on the suspected sore hind limb? Again, these are just some simple basic tips to look for in your movement evaluation that will help you decide whether a massage therapist should treat the horse or if he may need to be examined by a veterinarian first.

Treatment

After evaluating the horse, the therapist should have a mental picture of what the treatment protocol might be. As you know, horses are very individual and what works for one will many times not work on the next. Hopefully the therapist will have enough experience to tailor the session to that particular horse.

For purposes of this article, a horse was, say, a 22-year-old ex-Dressage horse - a schoolmaster, teaching the new owner many things as well as being a wonderful trail horse. The horse was taken out of his stall, walked out and seemingly very protective of putting his full weight on his front feet. He didn't look totally lame but was very stiff and tentative. At the trot, there was just the slightest head bob but it was very intermittent. A veterinarian had examined the horse a couple months prior and there was nothing too conclusive. The horse received 3 weeks off and was then started back in light work. He seemed willing enough to try but still had this nagging stiffness.

After hearing the full history of the horse and from my observations, I shared with the owner that I thought that the horse would benefit from the massage immensely BUT, he may appear very lame after. The owner asked why, because he's 'not really lame right now'. In fact, he was lame but he had been able to compensate the manifested problems into other parts of his body. When the horse was walked and trotted, I noticed that there was the slight head nod compensating for the right fore, however I also noticed the slightest lurch forward. This made me think that it might be a more serious problem than just stiffness.

Although not terribly obvious, he appeared to be compensating for the right hind as well. He was definitely landing a bit heavier on his left fore and this was also obvious by listening to his footfall on the pavement. I would explain to the owner that when all the muscles that have been splinting or compensating by tensing all this time are loosened up that he will show his now obvious discomfort or lameness. This is when massage therapy can be a valuable diagnostic tool and I would suggest that they ask the veterinarian if they feel massage would benefit this horse. They assured me that the veterinarian had definitely approved of the massage.

When massaging the horse, there were a lot of areas that were restricted in range of motion as well as adhesed throughout the fascia. I like to employ a number of techniques and I determined rather quickly that this particular horse responded well to direct pressure techniques and a myofascial technique called skin rolling.

Although I didn't use heavy or deep pressure on the horse and he appeared to enjoy the entire session, sure enough he trotted out lame after the session. At this point, I suggested that they call the veterinarian out again.

Diagnostics

This particular owner was very understanding of all that was explained to her and she coordinated a visit with the veterinarian and me. The veterinarian had a few other calls in the barn so he made his evaluation before I massaged the horse. The horse once again was very stiff. We discussed what we both saw and agreed that the horse appeared to be compensating for a couple of problems.

When he returned, I was just finishing up my session. We had the horse trotted out and he was noticeably lame. The veterinarian did a barrage of field tests and determined that the right hind had some arthritis flaring up as well as an old abscess that was just about healed in the right front.

Conclusion

This older horse, as with many horses regardless of age, had his proprioception (coordination) temporarily impaired by injury and/or compensatory issues. The massage in this case made the lameness more evident, not by hurting the horse but by helping restore normal function to the muscles. The massage did not aggravate the arthritic condition directly but did make the horse appear more lame than he was before the session.

The massage helped this older horse to move more freely but helped to show the problems that were underlying. This in many cases is good because the conditions may be treated and soundness restored. It is also a great way to help the owner become aware of any asymmetry (muscle imbalance) in the horse by pointing out the compensatory factors. This affords the owner to work with the horse in a rehabilitative manner when sound in such a way to which they can balance their musculature and prevent further injury.

This particular horse now receives regular massage without sore or lame results. Massage might have been viewed as a bad choice if an owner felt that the therapist hurt the horse and would continue to do so if they ever received a massage again, so communication is important. We as owners make the decisions for our special friends; it is up to us to decide when to employ a therapist or practitioner to work with our horses and which practitioner to call. Always ask questions, particularly when dealing with the older horse. You deserve to know what the outcome might be before the session. Though it is difficult or impossible to predict the outcome, it is helpful to know what the possibilities are before the session begins.

Equine massage does not intend to diagnose a problem on its own. As pointed out, when working as a team, many benefits can be discovered. If your horse appears lame, please call the veterinarian first.

About the author:

Mike Scott, LMT, NSMT, NCTMB of Bolton, Massachusetts, is the author of The Basic Principles of Equine Massage/Muscle Therapy. Mike is also the director of the Equine Massage/Muscle Therapy Certification Program.