Do as I say, or else... Clinical practice versus research

'Evidence based medicine' is a phrase these days. The concept began in the 90's, and was originally defined as the best available option combining evidence from clinical practice with evidence from research. It seems to have morphed into a debate between those who believe clinical expertise is more important, and those who believe research is more important.

How can we apply this to our practice with horses, either in behavioural work or in physio assessment and treatment? Like everything with horses, I believe the judgement should be made on an individual basis. 

I remember studying veterinary physio at the Royal Veterinary College and having to study a section on horse behaviour. It was taught by, in my opinion, very research based scientists as opposed to clinical practitioners (ie by university lecturers as opposed to by those working with horses and their owners on a daily basis). I had worked in and studied horse behaviour for nearly 10 years, and been an instructor / groom / horse problem solver for another 10 years before that. I found myself wondering whether these lecturers had ever actually tried applying the techniques they were teaching in the real world (ie with horses and their owners, rather than with horses and students in scientific trials). When it came to exam time I struggled to answer the behavioural questions because none of the multiple choice answers fitted my experiences!

I do believe that research is of huge value, and should underpin the majority of our practices. I say 'majority of' rather than 'all of' because the fact is that there will never be enough funding for equine / equestrian research, except in conditions that affect racehorses. So it is impossible to base all of what we do on what the science recommends. But what science there is available to us should not be ignored.

Nerves that fire together wire together

"Nerves that fire together wire together"

This is a comment from a physio podcast I was recently listening to, and it's a phrase that really got me thinking. There is plenty of science available now demonstrating the plasticity of the brain, it's ability to adapt over time. Monty Roberts has often mentioned what he calls 'muscle memory', in particular in relation to loading - where the more times the horse goes up the ramp successfully the more his muscles will remember that pattern. 

In the podcast they were discussing chronic pain, and how in some cases the brain still signals pain even though the original injury is long healed. The interviewee explained that if you spent a couple of years intensely learning to speak French, for example, you couldn't just 'unlearn' it. I felt that was a great way of explaining how some people continue to suffer long after it seems they should have recovered.

How does this apply to horses though? I'm not sure. I think that in far too many cases, a horses attempts to communicate pain or discomfort are dismissed as being 'remembered pain'. The classic is the horse whose saddle didn't fit, and once the saddle has been adjusted he continues to grump about the saddle being put on. Is that because the pain from the old saddle hasn't resolved, does the new saddle not fit as well as it should, is he displaying 'remembered pain', or was the original problem actually not about the saddle?

It's a really tough one, because we can only pick practitioners we trust and respect and go by what they say. Personally I believe that in the huge majority of cases, the horse is genuinely trying to communicate. Sadly this doesn't necessarily make it any easier to decipher what he's trying to say! 

"Expectation is the root of all heartache"

"Expectation is the root of all heartache"is a quote that has been attributed to William Shakespeare (but this is not confirmed as no one has been able to find a reference in Shakespeare's works to these words).  As I listened to the quote on a recent Physio Matters podcast however, it struck me how strongly it relates to our relationship with our horses, both in behavioural work, performance / competition work, and in health matters (including physio assessment and treatment).

Monty Roberts talks about having plan A, plan B, plan C, etc.  To me this indicates that I shouldn't have fixed ideas about how I'm going to achieve a certain goal with my horse.  My work, schooling, or treatment, should be 'horse led', i.e. it should follow a route that is appropriate for my horse as well as for me.

He also mentions that I should break my goals down into bite size pieces.  It's all too easy to see the end goal but not know how to get there, leading to frustration for both me and my horse.  If I can look at my end goal and break this down into 3 or 4 smaller goals, then break each of these down into 3 or 4 smaller goals, and so on, then in no time at all I will have a goal that I can work towards right now that I know puts me in good stead of eventually reaching my end goal.  Of course, taking note of the aforementioned and being willing to adjust my plan if necessary means that my end goal might change as time goes on!

Expecting my horse to behave in a certain way, or to perform to a certain level, or to reach a certain level of rehabilitation, can lead to disappointment.  Asking my horse to give me his best is reasonable, but no one can give their best all of the time.  Being realistic with what we can achieve together will help me to set appropriate, achievable goals, leading to contentment for both myself and my horse.

The Million Dollar Question

If you were given a million pounds to finish today something that you are meant to finish, could you do it? If not, any reason you give for not finishing it is just an excuse. Which is fine of course, as long as you realise that.

I think the same could apply to working with horses. If you were given a million pounds to find a way of teaching your horse to stand still without using violence, could you do it? I bet most of us could. So often in behavioural work, the solution is for the owner to spend more time with their horse which in turn leads to better understanding and communication (which includes listening to him). And I don't mean a few more minutes each day, or visit him 6 times a week rather than 4 times. I mean spend hours with him every day. Spend time hanging out in the field, do some groundwork in the school, lead him out on a 'hack', groom or massage him, ride him in the school or out hacking or both, ride him bareback, bath him, check his feet, take a good look at his saddle fit, do some stretches with him, ride him again, and so on... all in one day, then again the next day and the next. I don't mean gallop or jump him until he's tired, but slow and steady just be with him. My initial learning was through conventional pony club and riding club - we were lucky enough to keep our horses at home so I got lots of time with them. Then a huge proportion of my learning came from my time living for 5 years with a gipsy horse dealer. We lived on a small holding in a caravan amongst the horses, and I was with them every daylight hour. The horses were my teachers, and if you could spare the time, your horse would be your teacher.

Sadly, of course, very few of us are lucky enough to have that opportunity. The realities of life get in the way - working to pay the bills mostly, or running around after the children. But if you could find the time, just imagine how much you could learn...

"This old horse"

Instead of sharing news with you this month (September 2014), which is full of WEG (World Equestrian Games) and Burghley, I thought I'd share this poem I came across, which pulled at my heart strings, and I'm sure at the heart strings of many others...

"This old horse"

This old horse, the Rancher said,

she’s seen some better days,
she’s eating up my profits,
and costs a lot for hay.

Another horse would suit me,
a stronger one at that,
shes seen a lot of miles
just like my cowboy hat.

This old horse, the Rancher said,
she helped me herd my steer,
I’m pretty sure shes magic,
I know I hold her dear.

Another horse would suit me,
one that can run fast,
maybe one that’s younger,
or maybe one that lasts.

This old horse, the Rancher said,
she’s long and far in tooth,
my children do remember,
her fondly from their youth.

Another horse would suit me,
a gelding in his prime,
one that needs less fixin’,
that helps me save a dime.

Why, they asked, then keep her?
Why not trade her now?
Bring her to an auction?
Replace her with a cow?

The Rancher's brow grew heavy,
he took a staggered step,
his eyes did show his hardships,
in wrinkles, as they crept.

His breath, he took in deeply,
as he poised to say his words,
it’s as if the earth grew silent,
that his message should be heard.

This old horse, the Rancher said,
has given me her life,
I wouldn’t trade for anything,
nor either, would my wife.

Another horse would suit me,
and perhaps someday will come,
but this old gal, I love her,
she is the chosen one.

This old horse, the Rancher said,
her service she did lend,
her and I, have seen the years,
this old horse, she is my friend.

Another horse would suit me well,
but her home is here to keep,
I owe her sanctuary,
my love for her is deep.

Another horse would suit me well,
and younger days for me,
and I will keep my promise,
until our last breaths, set us free."

Poem by Jess Vee

Sticks and Stones

"Sticks and stones will break my bones, but words can never hurt me." 

If only that were true! As a race we are exceptionally good at interpreting things in a manner different to how they were meant to be interpreted. Communication is all important. A current issue that is close to my heart, as you may well be aware, is the lack of protection of title for animal physiotherapists. For anyone who is not aware of this, although the title 'physiotherapist' is protected (in the uk), as soon as you put an animal related word in front of it (for example, the title 'equine physio' or 'veterinary physio'), the title is no longer protected, meaning that anyone can set up as a veterinary physio without any qualifications, if they were confident enough in themselves! 

Something that every Chartered Veterinary Physio knows is that in the animal field, physios are not allowed to diagnose the cause of a problem, only a vet is legally allowed to do this. It's tricky, because of course as an owner, you want to know what's wrong with your horse. Your physio is not able to tell you. She can tell you where your horse is sore, or tight, or lacking muscle, or uneven, but she can't tell you why. There are always multiple potential causes, and without X-ray vision or the ability to scan, you cannot know for sure which of them is the problem. 

Thankfully, as long as a thorough assessment has uncovered all relevant factors, the treatment is often similar, irrelevant of the underlying cause. In very simple terms, reduce inflammation, reduce soreness, free up tension, build muscle tone - all of which contribute to promoting evenness. In the human field as well as the animal field, it is often more prudent to go for the conservative (non surgical) treatment approach initially, and only consider the surgical approach if the conservative one doesn't work. This doesn't by any stretch mean don't get the vet involved early on - having a diagnosis means you can focus your conservative treatment on the affected area, and medication if necessary can speed recovery. I'm lucky to work with a great veterinary practice, Pool House in Staffordshire, who are very approachable and have excellent diagnostic facilities. It's exciting working as part of a team all doing our best for the horse as well as the owner.

Back to the original thought of how important words can be, I wanted to share with you some recent learning from a book called 'The Chimp Paradox'. The author suggests replacing the word 'should' with 'could', 'must' with 'might' and 'how' with 'why'. Try it - for me it was profound.

Separation anxiety

Separation anxiety in horses is one of the most difficult behavioural problems to overcome. I strongly recommend that if you have 2 horses that are bonding closely, you look now into how to separate them for at least some period each day, if either is to have a ridden career.

D and T are sisters, with D a year older than T, beautiful black cob mares of 3 and 4 years. They have lived together for the past 18 months, and it's time now for some more serious effort to go into the backing process. 

Thankfully, they have the ideal set up to begin the separation process, should it prove difficult. A stable block in a small enclosed yard, with another small enclosed area outside that, a field just the other side of that but still in view, another field part in view of the stable yard and part not, and another field completely out of view of the stable block. 

Of course not every horse will suffer separation anxiety, and these might be lucky. But if they do, using the facilities they have to gradually move the mares further apart from each other, over a period of days, weeks or months as necessary, should result in minimal difficulties in the future.