Making a start in testing times...

I am perhaps what could be described as being a little behind the times in terms of using social media, blogging etc. to keep connected with the world. The main part of my focus has, and always will be, those actual face-to-face appointments with my clients. However, staying at home during the COVID-19 outbreak has provided me with an unexpected bit of 'down time' that has meant I could finally get cracking on some of those little jobs I've always wanted to do but just never seem to have found the time to start. Therefore - drum roll please because it's only been 17 years in the making - here we go now with my very first blog post! I am aiming to make these posts a nice mix of news, light entertainment at times, but primarily hopefully a source of education and help with all things equine physio-y.

The obvious topic to be discussing of course currently is indeed the coronavirus outbreak (sorry!) and how it is affecting all of us in the horse world in lots of different ways. Some are unable to continue working at all, whereas others in the industry such as vets, grooms, and farriers are trying to negotiate that tricky balance between needing to care for our horses adequately whilst trying to do everything possible to minimise risks to themselves and their clients. All competitions have of course been cancelled for the foreseeable future. Some owners on full or part livery are unable to even visit their horses at all currently during the lockdown, whilst others with horses either at home or on DIY might have been left wondering how they would cope and what contingency plans to put in place should they need to self-isolate for a time. There have been lots of rapid changes to normal life and working protocols, and the situation is continually fluid and evolving. 

At the time of writing when it comes to animal treatment, the government and our governing bodies have advised that during this lockdown period, we can only be treating where it is absolutely essential to do so. Therefore with regard to physiotherapy appointments, a vet would need to have first decided that the case did warrant 'emergency' physiotherapy care and then the animal physiotherapist must risk assess the situation and determine how best to proceed with caution for all involved.

Unfortunately though for the vast majority of our clients, that has meant the cancellation of upcoming appointments. This is a difficult thing to be doing because obviously all animal physiotherapists feel an ethical obligation to our patients to provide them with the very best of care at all times....I truly love my clients though for having been so supportive and completely understanding of this new situation and why we are all needing to reduce any work down to the very bare minimum now, even despite all the social distancing and extra hygiene precautions that have already been in place over recent weeks. We know many of our patients might have been right in the middle of rehabilitation programmes, and of course, many older horses and those with underlying conditions for example really benefit from the extra help that more routine physiotherapy can provide on a regular basis. However, none of that truly comes under the realm of 'essential emergency care' in the face of this pandemic. It might perhaps be far from ideal for our animals currently, but it is a small sacrifice to make if by doing so we can be helping save more lives and ensuring that our wonderful NHS system can cope. Most things can usually safely wait a little bit longer and of course, if they really genuinely can't and there is simply no other way of resolving the problem without having a visit from a professional, then there are still the mechanisms in place for you to be able to access the emergency care your animals require.

Whilst many other businesses are trying to move towards teleconferencing and operating from home, unfortunately when it comes to equine physiotherapy assessment and treatment, an online consultation cannot effectively replace our normal service. Aside from any logistical issues of owners rarely having internet access or a decent enough phone signal when at the yard for video calling(!), we have to assess the whole animal from head to toe at each visit in order to properly tailor (and of course deliver) the most appropriate plan of treatment or be deciding how best to implement incremental changes to remedial exercise programmes.

Proper effective ‘gold standard’ rehabilitation should never just be prescriptive or based solely on examination of the injury site alone, but instead requires a thorough physical assessment of the whole animal in order to truly tailor the programme to that particular individual at that moment in time, with continuous re-assessment at every stage along the way. Each physical assessment allows us to take into account current muscular development, any restrictions to movement, areas of discomfort, and/or compensatory mechanisms that might be occurring. We then add that into all of the other information already gathered, such as their underlying conformation, any concurrent issues or underlying health concerns, the skill set of the owner/rider, the horse's temperament, management and environmental factors, and so on to come up with the best 'next step' for that individual. (Yes - we really do think about so many different factors whilst we are with you normally! However, please don't worry of course when I'm talking about factoring your own skill set into that... There is absolutely never any 'judgement' there are at all - simply that I would not recommend using long reining for example if you had never done it before.)

Any ethical practitioner should therefore not currently really be advising any incremental increases in a horse's rehabilitation plan or sending out new exercise programmes for you to follow during this time without that ability to properly (re-)assess the horse fully at each stage to know how they are doing and therefore how they might cope with any such changes. Whereas your vet might very feasibly be able to keep up-to-date with the progress of at least some patients still online, equine physiotherapists cannot similarly rely only on a gait assessment with perhaps one or two simple checks we could ask the owner to perform whilst videoing their horse's responses as an adequate substitution for their usual full body assessment. To be progressing any rehabilitation plan, we need to be able to properly determine if, and where, any compensatory mechanisms or new issues might be starting to arise. Whilst being a fundamental physiotherapy skill, unfortunately the ability to accurately palpate the current state of tissues is of course in fact something that takes many years of training to develop. Much as we might perhaps wish to be able to at the moment, it is therefore not something we could simply teach owners how to do for us with just a simple bit of instruction over the phone! 

What we CAN do safely though is continue to help to advise our clients remotely with any problems or concerns they may be having. Reviewing videos and photos for existing clients is very much a part of my normal practice in any case and so it has just been ‘business as usual’ with that support mechanism. I spent the entire first week of so of lockdown with my ear glued to my phone checking in with each and every client whose appointment has had to be postponed (and a few more besides!) to ensure they all had the support and strategies they needed in place to cope with the necessary changes.

In general terms most advice will likely currently be going along the lines of either simply holding a rehab programme at the same level (effectively just pressing pause for a short while so that hopefully we can pick right up where we left off when we can safely resume more routine visits again), or decreasing any work load appropriately (and/or implementing other simple strategies from afar) if any issues appear to have arisen until the horse can be properly re-assessed by either their practitioner or their vet as appropriate. There may of course also be situations where all work on a rehab programme has needed to stop (if a client is ill or shielding, is not allowed onto their yard, or maybe where a rider simply wants to reduce the risk of themselves potentially having an accident during this time). This raises a whole other set of challenges possibly and therefore if you have not already spoken to your physiotherapist about your horse’s progress and what you will be doing with them during this period, then please do contact them. We might be more restricted in what we can physically do for you right now but we still have the same desire to want to help you do the best thing for your horse, and to minimise any new problems or regression as far as we are able to until more routine work can resume.

On a lighter note, there have certainly been plenty of amusing posts on social media at the moment about everything from loo roll challenges to hairdressing nightmares. Emily Cole produced a particularly amusing cartoon on her Facebook page that resonated with me this week (if you haven't seen her work before then you really need to give her a like!). 

​This definitely represents how I could be looking emerging from lockdown if I don't keep up with Joe Wicks and step away from the chocolate cupboard! It is also a timely reminder to clients to monitor your horse's weight if making any changes to exercise levels or their management during this period - that spring grass is definitely starting to make itself known in all the sunshine we are currently enjoying. Take care, and remember of course to keep one large horse length (or two small ponies) apart from anyone else whilst out braving your shopping!