In this episode of the Disease Du Jour podcast, Melanie Perrier, DrMedVet, DACVS, DECVS, CERP, discussed some of the equine rehabilitation modalities she commonly uses in practice, including mesotherapy, laser therapy, and kinesiotape.
Incorporating Equine Rehabilitation Modalities Into a Treatment Plan
Perrier said the basis of establishing a good equine rehabilitation plan is to determine the primary source of the patient’s problem, as well as any secondary functional and structural problems associated with the primary problem.
It’s also important to consider what you hope to achieve with your rehabilitation plan. “A lot of the time with rehabilitation modalities, we want to make the horse more comfortable,” said Perrier. “So we address stiffness, muscle fatigue, hypertonicity, weakness. You need to make sure you know exactly what you’re targeting.”
A third consideration is the phase of tissue healing, because different modalities have different modes of action and will be more efficient at addressing certain physiological problems. “It’s very important to know whether you’re in the acute, subacute, or chronic phase and whether you want to address the inflammatory process or if you want to act on the proliferative or remodeling phase of healing.”
Once you have put these three factors into perspective, Perrier said the next step is to have a discussion with the owner, trainer, and/or rider about goals for the rehabilitation program. She recommended giving them specific objectives and timelines to help measure the horse’s progress.
Perrier said it’s important to reevaluate the patient at regular intervals and to assess the horse both clinically and with more objective modalities, such as diagnostic imaging or objective gait analysis.
Mesotherapy
One modality Perrier uses frequently is mesotherapy, a technique that involves using a linear injector with five very small needles to deliver medication to the dermis part of the horse’s skin so it slowly releases over an extended period. “It’s a great modality because it’s quite easy to perform,” she said.
Veterinarians can use mesotherapy to deliver various medications, but Perrier said it’s important to use some local anesthetic to relax the muscles. She most often uses mesotherapy to treat primary and secondary neck and back pain. “You can treat the primary problem and use the mesotherapy to relax the muscles as an additional component to your treatment,” she said.
Laser Therapy
Another modality that’s growing in popularity is laser (light amplification by stimulated emission of radiation) therapy, which uses penetrating photonic energy to achieve physiological and biochemical changes within the targeted tissues.
“The main indication for using laser is to reduce pain,” said Perrier. “It increases serotonin levels. It increases beta-endorphins. It increases the nitric oxide, which will have an effect on vasodilation and will also enhance oxygen delivery. It decreases bradykinins, and it also normalizes some of the ion channels.”
Laser also reduces inflammation by acting on ATP production, increasing Interleukin-1 production, decreasing prostaglandin centesis, and promoting endogenesis. Perrier especially appreciates this modality’s anti-inflammatory effects in her post-op patients.
“This is maybe a modality that’s a bit less understood, especially on the equine side of things, but we use it to promote healing,” Perrier said.
Kinesiotape
Kinesiotape involves applying an elastic tape to the horse’s skin, which lifts the skin to increase space in the soft tissue and open the vascular pathways and lymphatics, facilitating circulation and reducing pain. Kinesiotape also facilitates proprioceptive stimulation during the remodeling phase of healing.
“It acts by what we call the gate control theory, which is pretty much the fact that when you have a nociceptive, so a painful stimulus, it’s usually the smaller nerve fibers that are recruited,” said Perrier. “When you apply the tape, you’re creating a distractive stimulus that’s going to actually activate those larger nerve fibers, the A-alpha and A-beta.” This mechanism of action helps reduce pain.
Perrier has had success using kinesiotape to decrease edema and pain around surgical incisions. She’s also seen this modality reduce swelling in extensive lymphangitis cases that were not responsive to medical treatment.
Perrier discussed all three modalities in more detail in the episode.
About Dr. Melanie Perrier
After graduating from the Ecole Nationale Veterinaire de Lyon, France, Melanie Perrier, DrMedVet, DACVS, DECVS, CERP, completed an equine surgical internship in California, followed by a large animal surgery residency at The University of Wisconsin, Madison. Perrier was then a clinical assistant professor of large animal surgery and critical care at the University of Tennessee, Knoxville, before returning to private practice in the Middle East and France. Perrier is now a senior lecturer in equine surgery at the Royal Veterinary College, United Kingdom. Her main interests are soft tissue surgery, equine rehabilitation and management of the equine athlete.
Related Reading
- Conservative Management and Rehabilitation Strategies for Equine Back Pain
- Disease Du Jour: Cervical Nerve Root Compression in Horses
- Rehabbing Equine Hind Proximal Suspensory Ligaments
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