Veterinary Medical Manipulation Case Study
When the “chiropractor” visits the barn to adjust your horse, what’s really being done is called veterinary medical manipulation, which Dr. Ryan Lukens, DVM, CVMMP, of Palm Beach Equine Clinic 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 normal range of motion.
The way Dr. 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 helps the horse to maintain their natural balance and 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.
One notable case Dr. Lukens recalls involved a nine-year-old Dutch Warmblood gelding was 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, it presented with right front limb lameness and stiffness on the left while traveling left. Balance is essential for dressage, and this horse struggled with its natural balance.
The horse showed severe cavitation of the muscling in its 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, Dr. 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.
The horse tolerated the adjustments and was more welcoming to hands on the neck, face, and ears after the manipulations Dr. 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. Dr. 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.
“The diagonal lameness that this horse presented could have been the result of lower cervical pain,” said Dr. Lukens. “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 continued.
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. Dr. 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.”Dr. Lukens
To learn more about veterinary medical manipulation or to schedule an evaluation for your horse, contact Palm Beach Equine Clinic by calling 561-793-1599.
Horse owners often joke that they take better care of their horses than they do themselves. While there are maintenance treatments and products that could be considered a luxury, veterinary chiropractic adjustments do not fall into that category. Palm Beach Equine Clinic veterinarian Dr. Ryan Lukens is a certified Veterinary Medical Manipulation Practitioner from the Chi Institute in Ocala, FL, and recommends every horse reap the benefits of regular chiropractic adjustments.
From minis to draft horses and pasture pets to top sport mounts, the parasympathetic stimulation triggered by chiropractic adjustments improves multiple facets of health for any horse. Therefore, equine chiropractic adjustments improve more than just athletic performance, and for sport horses, Dr. Lukens considers them a necessity.
“One of the most beneficial outcomes of regular veterinary chiropractic adjustments is an increase in range of motion,” said Dr. Lukens. “Ensuring the horse has proper range of motion can greatly reduce the chances of them having to physically compensate for an area that may not be functioning up to par. By reducing the chances of compensation, we reduce the chances of many common sport hose injuries. Most athletic injuries occur when a horse is slightly off balance due to compensating. Regular chiropractic adjustments help horses to maintain their natural balance.”
According to Dr. Lukens, further benefits of veterinary chiropractic adjustments include:
- Relief of pain and soreness
- Reversal of muscle atrophy by increasing the frequency of nerve activation
- Increasing the speed and accuracy of athletic movement
- Adjustments help calm the “fight or flight” response. This has a domino effect of improving various bodily functions, such as neutralizing stomach acids, improving hind gut digestion, lowering blood pressure, lowering cortisol levels, and strengthening the immune system.
Dr. Lukens outlines the “must know” details of an equine chiropractic adjustment for any sport horse owner. Here’s what he would like you to understand about your horse’s chiropractic adjustment:
1. The major adjustment points.
I take a full body approach to every session. There are 205 bones that comprise the skeleton of a horse, however, I am not just adjusting the skeleton––I work to improve motion at segmented levels that involve bones and the supporting soft tissue structures and nerves. I was taught to use “motion palpation” to test moving segments. If a segment is not moving freely in the appropriate directional planes, I can perform an adjustment to correct the restriction of this movement.
Major adjustment points include the:
- Mandible and tongue
- Temporomandibular joint (TMJ)
- Poll and cervical vertebrae
- Withers and sternum
- Front and hind limbs
- Thoracic and lumbar vertebrae
2. Every horse is different, and their discipline of riding places different demands on their bodies.
The most common adjustments for various performance horses include:
|Dressage||Balance is essential for dressage. The major points of balance affected by veterinary chiropractic work are the TMJ, hyoid, sternum, and cervical facets. Other common adjustments affected by lateral work include the shoulders, elbows, and pelvis.|
|Hunter/Jumper||Hunters and jumpers typically benefit from vertebral adjustments of the lumbar and upper cervical regions, ribs, sternum, front distal limbs, and the shoulders.|
|Eventing||Most eventing horses benefit from adjustments to the pelvis, all cervical vertebrae, TMJ, ribs, and the shoulders.|
|Western Disciplines||Reiners benefit from adjustments to their right shoulder, lower cervical facets, withers and pelvis, and barrel racers benefit from shoulder, sacroiliac and hip joint adjustments.|
3. Things to keep in mind before and after an adjustment.
It is important that dental and farrier work is not overdue before veterinary chiropractic adjustments. Sharp dental points can cause adjustments to hold for shorter periods of time, especially in the poll, TMJ, and cervical vertebrae. In addition, if a horse is currently not shod well or has recently pulled a shoe, the adjustments of their limbs, back, pelvis and sacrum may not provide long lasting benefits.
Besides those prerequisites, a horse can be ridden before an appointment and have a normal day. The only restriction on riding is that they should not be ridden for the remainder of the day after the adjustment. However, they may be turned out to pasture after an adjustment. The following day, I encourage that the horse be ridden as normal and that the owner or rider follow up with me about how they felt.
I prefer to see new patients two weeks after their initial adjustment appointment. After the second appointment, I sit down with the rider to discuss and compare the chiropractic adjustments performed between the two sessions. If I made multiple of the same adjustments, their appointment intervals will stay at every two weeks. Once there is a decrease in similar adjustments, I can increase the time interval between sessions to three weeks. Some horses can maintain the adjustments for about four to six weeks when under lighter work. The rider can usually feel when a horse is due for another adjustment. As a rule, high-level performance horse can benefit from chiropractic adjustments as often as every week, but the most common interval for my clients at that level is every other week.
4. Chiro to the rescue! Common issues:
I often see some common issues solved by a veterinary chiropractic adjustment. For jumpers, changes in jumping style (i.e. landing away from a front limb, only jumping off of a certain lead) and performance (hitting more rails than normal) could indicate a lack of range of motion, which can be corrected through a proper adjustment or series of adjustments.
For dressage horses, a change in their balance could result in head tilting, not working through their back, lifting the lower cervical curve, or their hind limbs not following the path of the front limbs, and commonly seen in a new inability to perform tempi changes. That balance can be reestablished with an adjustment.
For western horses, a decrease in acceleration and turning can be indicative of needing adjustments.
5. How to choose your equine chiropractor.
The Chi Institute in Ocala, FL, trains only licensed veterinarians in medical manipulations (chiropractic adjustments). I believe that a veterinarian trained in chiropractic adjustments is the safest choice for the horse. A veterinarian’s extensive knowledge of anatomy and understanding of when not to adjust a horse is an important part of ensuring the horse’s safety and well-being. If done improperly, adjustments can have adverse effects. I received my certification (CVMMP, or Certified Veterinary Medical Manipulation Practitioner) in 2017 and have had great success in implementing chiropractic adjustments into my patients’ athletic successes.
Palm Beach Equine Clinic veterinary technician Morgane Qualls was interviewed by the Winter Equestrian Festival staff for their Amateur Athlete of the Week on February 6, 2019. Morgane works closely with Dr. Ryan Lukens and competes with her horse Paddy in the 1.30m jumpers. Learn more about her by reading the article here.
Shipping fever is a respiratory disease complex associated with the transport of horses. A common scenario for shipping fever is when a horse is transported from its barn to another state to attend a show. The horse may be healthy and well-hydrated before entering the trailer, but the stress of travel can weaken the immune system.
Another leading factor is tying a horse’s head up while trailering long distances. The mucociliary apparatus of the trachea, which clears dirt and debris from the lower airway, is interrupted due to dehydration, change in temperature, and the inability of the horse to lower its head. The introduction of foreign material into the lower airway can lead to pneumonia, fluid in the pleural cavity (surrounding the lungs), and associated respiratory distress.
Signs and Symptoms to Watch For
Common symptoms noted are hyperventilation, increased rectal temperature, coughing, and nasal discharge after travel. The horse may seem depressed, not willing to work, and not interested in food or water. It is important to call the vet immediately if any of these symptoms are observed after a horse travels. The faster an infection in the lower airway is treated, the quicker and more likely the horse can recover. Shipping fever, if left untreated, can lead to severe pleuropneumonia, which can be life-threatening.
Treatment of Shipping Fever
Initial treatment includes antibiotics, anti-inflammatories, and hydration. If pneumonia progresses without treatment, surgery may be indicated, which can include removal of a rib and placement of chest drains (to drain fluid around the lungs). The vet should be called, and it is crucial to begin treatment at the earliest sign.
There are several preemptive steps that can be implemented to reduce the risk of a horse developing respiratory disease related to travel:
- Split up long trailer rides over several days. Be sure to take breaks and let horses out of the trailer at least every 6-8 hours, if possible.
- Ensure the horse is properly hydrated before travel. Common preventative practice includes administration of oral or IV fluids by a veterinarian prior to travel.
- Discontinue any immunosuppressant drugs 48 hours prior to travel. This includes steroids such as dexamethasone.
- Ship horses in a box stall or similar enclosure so their heads do not have to be tied during travel.
- Ask a veterinarian about immunostimulant drugs that can be given prior to travel.
Dr. Ryan Lukens joined the Palm Beach Equine Clinic team in June of 2012. He has been a great asset and some of you may not have had the opportunity to meet him.
Palm Beach Equine Clinic currently has 24 veterinarians providing exceptional veterinary care and client services. As we grow, thanks to our clients, we feel it is important that everyone gets to know our veterinarians. Not only professionally, but also personally. Each of our doctors brings exceptional veterinary skills and great personal strengths to our Palm Beach Equine Clinic Family. It is the combination of these strengths that makes our Team a success.
We sat down to interview Dr. Lukens and asked him to tell his story.
Q: You went to Ohio State and played football, do you feel that your football career helped you with your future in veterinary medicine?
A: Yes, I played football for 5 years at Ohio State, from 2004 to 2008. I was a fullback and a linebacker. My senior season was my freshman year in veterinary school. I remember studying for Cell Biology and Clinical Pathology during my plane rides back from games.
My coaches were very accommodating. I would usually have to skip Sunday film day to study for Monday exams and then make up film review after my exams on Monday, which would usually have been a “day off” from football. Needless to say I was busy during that first quarter of vet school. Football taught me discipline and time management.
My Coach, Jim Tressel, instilled values in his players by group discussion and study of leadership books. These values affect my career today, I am always aware of how my actions and words affect everyone around me. The lessons from Coach Tressel have helped me improve my communication skills with my clients and fellow colleagues.
Q: Your wife is a small animal veterinarian, how did this play a part in your education and career?
A: My grades were above average during my last football season but improved the following quarter. This improvement in grades can be traced back to meeting my future wife in school a month after my football career ended. The day we met we spent most of our time studying together and immersing ourselves in our class work.
Studying became fun and we tackled the challenges together. She was small animal oriented and I was able to teach her equine aspects while she helped me with small animal based courses. From our separate experiences working with different animals our entire pre-vet school lives, we greatly improved each other’s understanding of former less-familiar species.
When we entered clinical rotations our 3rd year, I would always find a way to get out to the barn rather than stay in the small animal clinic. It was fun being able to teach my wife about horses, she had almost no experience with horses when we met.
Q: How do you feel about being a part of the Palm Beach Equine Clinic team of doctors? What kind of experiences have you had since joining PBEC?
A: I am more than happy to be a part of this prestigious clinic and to live in the center of horse country in South Florida. I do not miss lameness exams in the snow! I started working at Palm Beach Equine Clinic for over 6 weeks while I was finishing school. This opportunity led to a great start in my career. I was able to familiarize myself with the operation of this efficient, tertiary medical facility.
My interests in school and to this day are sports medicine and I always envisioned performing competent lameness exams. Over the past year and a half, my lameness exam numbers have increased exponentially. This past winter season I was successful in keeping several horses that had lameness issues early on sound throughout the entire season. I enjoy doing pre-purchase examinations. I am fortunate that this area offers a great amount of sale horses. Pre-purchase exams are also an excellent way to develop relationships with new riders and trainers.
Moving from Ohio, I was quickly introduced to “summer sores”. Habronemiasis (summer sores) are not seen clinically in the north. So becoming more educated on them and providing successful treatment has been an educational experience for me.
A fortunate part about being a team member is the number of doctors and specialized fields that Palm Beach Equine Clinic offers. This is what makes the veterinary care here so proficient. It benefits the patient and client as we are able to share ideas and consolidate treatment options amongst our large team.
Q: What are your goals for the future?
A: I am currently working on becoming ISELP (International Society of Equine Locomotor Pathology) certified. This course and certification will continue to expand my knowledge and treatments of lameness. I look forward to meeting new clients and treating new horses. In the future, I want to join the ranks of the lameness experts known throughout the country. Wellington is one the greatest places in the world for the opportunity to treat the best horses in the world. I wouldn’t want to be anywhere else.
On May 10, 2013, Dr. Janet Greenfield-Davis participated in career day at Elbridge Elementary School. Elbridge Elementary is one of many schools that Dr. Greenfield-Davis has donated her time and knowledge to educate our young students of today on equine veterinary medicine. Dr. Greenfield-Davis is the official veterinarian for Vinceremos Therapeutic Riding Center, which focuses on equine-related programs for special needs children. Dr. Greenfield-Davis enjoys educating the community while raising awareness of equine health.
“Educating our community and public service is a culture that we emphasize at Palm Beach Equine Clinic”, stated Dr. Scott Swerdlin, President of Palm Beach Equine Clinic.
Dr. Ryan Lukens recently completed an internship at Palm Beach Equine Clinic. Dr. Lukens excelled during his internship and was presented a contract toward a long and successful future with Palm Beach Equine Clinic. In the spirit of our mission statement, Dr. Lukens presented a lecture to 200 first graders concerning the anatomy of the horse with the Horse Tales Literacy Program. This event occurred at Good Earth Farm in Loxahatchee on Friday, May 17th.
“Dr Lukens was wonderful. He was knowledgeable and very patient with the first graders”, said Shelley LaConte, South Florida Director of the Horse Tales Literacy Project. “He had a smile on his face the whole day. It was a pleasure working with him. We were very grateful for his time and glad he is a part of Palm Beach Equine Clinic.” If you or any of your organizations would like a lecture or presenter please call Eques Solutions at 561-227- 1537.