21/09/2017
Finally!
Out.
Misaligned.
Subluxation.
Popped.
What do these terms have in common?
They are all incorrectly used to describe Musculoskeletal issues with horses.
But wait you say, my therapist has been doing this for ages/is actually trained and qualified so they must be right, right?
If they say my horse is out at the poll, out at the hip, misaligned in the neck, popped a rib.. I should believe them shouldn't I?
No.
Skeletal joints very rarely go out. They are strong, well designed connections designed to support a 500kg horse moving at speed over all kinds of terrain, if something goes out, it's a trauma and will probably need a vet, and a shovel.
So why do people talk about things being out?
Several reasons: they don't understand anatomy and genuinely think that's what has happened, they are lazy and don't want to educate and explain to the client what has happened, they learnt from someone who they trusted and genuinely think they are on the right track so unintentionally continue to spread misinformation.
Ok.. if it's not out, what are they feeling/finding?
Imagine 4 spinal vertebra in a row, so there's 3 joints. These vertebra connect at 3 points, the round vertebral head and the 2 facet joints. That's 3 points of movement and connection surrounded by ligaments and muscles designed to allow movement but not past a certain point... for each joint.
Now, imagine pushing on each vertebra, push it away from you. The vertebra will give, or translate, and the joint moves to allow it. It's a small range of motion, but it's there. (You can practice the feeling by asking a friend if you can gently push on their spine.. gently!)
Push along the imaginary vertebra, until you come to the 3rd one. It doesn't move, it feels stiff or restricted, the joint doesn't open.
This is what people say is out.
"It's out of line, its misaligned" they think because it's not following the normal range and line of motion it's out of line.
It's not! I can assure you, all 3 points of connection are still very much attached and in the correct place.
They just aren't moving.
The correct or more accurate term would be restricted, because that's all it is.
Some also call it an osteopathic lesion or somatic dysfunction, depending of their schooling.
What has happened is that the muscles and tendons have become looped in a neuromuscular contraction some call a Gamma Loop.
How did that happen? Stress, trauma, incorrect biomechanics, pain - some of the obvious triggers.
The joint perhaps tried to over extend, or was held in an unusual position for a time. Then the neuromuscular spindle and Golgi tendon spindle engaged to prevent overextending and joint trauma but the signal to contract the muscles and tendons to protect from injury became stuck on, causing the brace and immobility you feel when you pushed on the vertebra.
So, now is when you would be told they are going to 'put it back in'.
This can take many forms, and we have all seen various techniques.
Jerking legs really high and hard, cranking necks around to the side, forcing heads to chests, thumping on ribs from 2 foot away, thrusting down on the spine, the use of rubber mallets, chiropractic activators, tennis balls.
You get the idea.
But they are not putting anything back in place... it wasn't out to start with.
What they should ( or by luck might be) doing is delivering a shock to the restricted joint and associated soft tissue to switch off the gamma loop that's happily but misguidedly saying don't move, danger!
Sometimes this is a small movement, sometimes it may be a larger movement.
Sometimes side of ease side of barrier passive stretching is enough.
They are not, can not and will not move the vertebrae. Physical impossibility.
(True subluxations and luxations are very rare, and require X-rays, anaesthesia and several very experienced people to correct, depending on the area affected)
Edited to add: chiropractics uses the term subluxation to refer to the gamma loop dysfunction.. however this is generally not explained well to clients if at all in many cases and the image in people minds is of a partial or full dislocation. I have also heard the terms subluxation and out used in the same conversation referring to the same issue on several occasions, hence my reason for including it in my incorrectly used words.
If you are a therapist who uses the word correctly and explains it to your clients then understand I am not tarring you with the same brush.
Once the neurological restrictions are released, the joint will very quickly return to normal range of motion.
Experienced therapists will check the joint before and after a mobilisation.
If they are not, how do you know it's "fixed"?
Knowledge of anatomy and neurology is essential for correct effective assessment and mobilisation.
Next time someone says your horse is out, you can take the comment with a grain of salt, and smile knowing you now know what is actually happening.
I think we should start a protest movement...
Edited 10.7.2017 to add...
I wrote this post 4 days ago fairly quickly after seeing yet another therapist post using some of these terms. It's a very frustrating point for me, and I tell people all the time the terminology is misleading and wrong.
I was not expecting 1.2k shares, over 300 comments (I thought I would get the usual 40 likes and a couple of shares from my clients), if I had I would have tidied up some points...
▪️I don't hate chiropractic or osteopaths, I am in my 4th year of Equine Osteopathy myself.. I think they are great modalities.
▪️I am well aware other factors can cause a joint to become immobile, arthritis, fusing etc.. but again, this was to address terminology not encompass all that could be going on.
▪️yes, there is a visceral link as well, but again, this was about terminology. I will go into the visceral aspect soon.
▪️some joints have large ranges of movement, and parts seem quite mobile, but they are still "in" the joint, I will follow this one up too.
▪️some therapies are interpreting this post as a we (soft tissue) are better than chiro/Osteo.... actually it's not like that, my current education says to me that you can't have one and not the other.. learn to love each other peoples.
▪️in the end, I don't mind what terms you use, as long as no one thinks their horses spine looks like a stair, or that the shoulder is like a lego piece that just "popped out".
