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Contents

        Preface: Integrative Medicine: What Is it Good for? xi

        Kevin K. Haussler

        Integrative Medicine in Equine Practice 445

        Kevin K. Haussler
        Integrative medicine is based on a model of being proactive and promoting health and wellness, rather than being reactive and solely focusing on episodic disease processes. Integrative medicine incorporates a holistic approach to clinical practice that encourages owner involvement with a focus on individualized care, maintained wellness, optimized performance, and disease prevention. Health promotion and preventative care require a different set of clinical skills and perspectives than is typically provided by a traditional veterinary education. Productive interprofessional collaborations are an essential component to the effective delivery of integrative medicine services.

        Integrative Philosophy: Case Management 455

        Steve Adair
        This article serves as an introduction into integrative case management as it applies to the horse’s mental health, pain management, and tissue healing. The integrative philosophy pertains to the combination of conventional Western medicine and complementary and alternative therapies to provide the best patient care possible using currently available evidence. The goal is to improve the health of the patient in a more holistic manner.

        Optimizing Health – Integrative Medicine & Poor Performance 463

        Kimberly Henneman
        Addressing poor performance issues in horses is a common yet challenging request to veterinarians. Often, there are limited field diagnostic or therapy choices. Growing lay popularity in integrative therapies, as well as increasing clinical incorporation, is creating more awareness of their clinical applications. Many modalities are showing increasing evidence of positive outcomes with minimal harm, but additional safety and efficacy evaluation is needed. Integrative modalities have unique ways of perceiving disease patterns that are different from more modern approaches, and these different perspectives can be used diagnostically and therapeutically either combined with more conventional approaches, or when those approaches fall short.

        Preventative Care: Managing the Geriatric Horse with Integrative Therapies 475

        Edward Boldt Jr.
        Horses 15 years of age and older now account for a significant portion of the equine population. Integrative therapies can provide important diagnostic and treatment tools for managing and maintaining the health of geriatric horses. Aged horses are often afflicted with chronic disease processes that are difficult to effectively manage with conventional medicinal approaches, such as laminitis and osteoarthritis. Diagnostic and therapeutic approaches using integrative therapies, such as acupuncture and spinal manipulation, are presented in this article for managing aged horses with metabolic disorders and musculoskeletal pain, stiffness, or muscle hypertonicity.

        Integrative Approach to Neck Pain and Dysfunction 485

        Melinda R. Story
        Equine cervical pain and dysfunction may be difficult to diagnose and effectively manage. Understanding techniques in integrative medicine often allows the practitioner to observe and palpate areas of pain and dysfunction in the horse being evaluated in ways often not taught or used in conventional medicine. There are many integrative therapies that also may be utilized to more effectively manage these horses, resulting in a more comfortable and functional horse.

        Clinical Application of Myofascial Therapy in Horses 493

        Tuulia Luomala
        Video content accompanies this article at http://www.vetequine.theclinics.com.
        Fascia is a complex and intriguing tissue, which can take on structural properties of being loose or dense, irregular or regular. Fascia functions by connecting, separating, and uniting different structures of the body. Myofascial dysfunction can be a significant source of pain and can be categorized as densification, adhesion, and fibrosis. Digital palpation and treatment of myofascial disorders can be provided via superficial or deep techniques. Different myofascial treatment techniques include slow and fast techniques, which can be applied at different depths, angles, and rhythms.

        Spinal Mobilization and Manipulation in Horses 509

        Kevin K. Haussler and Tim N. Holt
        Video content accompanies this article at http://www.vetequine.theclinics.com.
        There is a growing body of evidence to support the use of spinal mobilization and manipulation techniques in equine practice. Outcome parameters reported across studies include measures of joint motion, nociception, muscle tone, and performance. Spinal examination procedures include static and dynamic assessments of the quantity and the quality of both active and passive movements. Tiered treatment approaches are recommended to stage the application of various therapies based on ease, cost, and efficacy.

        Clinical Application of Acupuncture in Equine Practice 525

        Jennifer Repac, Emily Mangan, and Huisheng Xie
        Acupuncture is an inexpensive nonpharmacological modality that has a variety of musculoskeletal, neurologic, and internal medicine applications for the equine practitioner. Common uses include back pain colic, laminitis, laryngeal hemiplegia, and suprascapular neuropathy. Although there is a growing body of literature supporting the use of acupuncture in equids, there remains a need for further robust, double-blinded, placebo-controlled clinical efficacy trials.

        Clinical Application of Chinese Herbal Medicine in Equine Practice 541

        Emily Mangan and Huisheng Xie
        Traditional Chinese herbal medicine has been used for the treatment of equine diseases for thousands of years. Clinical studies have found Chinese herbal medicine to be an effective treatment for a variety of equine conditions, and extensive toxicology studies performed on more than 12,000 Chinese herbs provide guidance for safe administration in the horse. Chinese herbal medicine may be used for preventive medicine as well as an integrative or complementary modality for common equine diseases and injuries.

        Rehabilitation: Proprioception, Incoordination, and Paresis 557

        Melissa R. King
        Physiotherapeutic exercises aimed at stimulating motor control, flexibility, and stability are regularly employed in human physical therapy programs. Specifically, the use of such exercises has been shown to reduce both pain and reinjury. Pursuant to the equine patient, several core strengthening exercises and their role in activating deep epaxial musculature to subsequently improve postural motor control and alter thoracolumbar kinematics have been investigated. Both baited and passive exercises offer opportunities to facilitate stretching during dynamic phases and strengthening during static phases of exercise. Blanket recommendations regarding prescription of exercises is not advised, individual patient prescription should be considered in context of handler safety, specific rehabilitation goals, and patient ability to effectively complete the exercise.

        Therapeutic Exercises for Equine Sacroiliac Joint Pain and Dysfunction 569

        Lesley Goff
        Video content accompanies this article at http://www.vetequine.theclinics.com.
        This article provides the equine practitioner with a review of sacroiliac joint pain and dysfunction and outlines the importance of providing a specific prescription for a safe and effective therapeutic exercise program. The continuum of clinical dysfunction associated with the sacroiliac region is presented with prescribed interventions. The intent is to encourage the practitioner to perform a thorough assessment of the sacroiliac joint and the adjacent soft tissues and to use sound clinical reasoning to formulate a therapeutic exercise plan.

        Tack Fit and Use 585

        Hilary M. Clayton and Russell MacKechnie-Guire
        Not too long ago, tack often fell into the “one size fits all” category but, fortunately, times have changed. In recent years, tack has become not only more functional but also a fashion statement. This article describes scientific concepts of the saddle, bridle, and bit with emphasis on clinical signs associated with ill-fit or incorrect use.

        Managing the Rider 603

        Lesley Goff
        Video content accompanies this article at http://www.vetequine.theclinics.com.
        The rider’s personal injuries, impairments, or biomechanical dysfunction may be detrimental to their horse’s performance. Assessment of the rider on and off the horse is important to identify structural and functional issues that may impact performance. An ongoing program to enhance rider flexibility and motor training may be useful. The purpose of this article is to provide strategies that may be used to determine if the rider needs to be assessed formally by an appropriately qualified practitioner.