Your therapy session can only be as effective as your assessment is thorough.
If you have ever been for therapy yourself you will likely remember that your therapist took you through a thorough assessment prior to treatment. Typically included are history taking, observation, palpation, movement screens, range of motion testing, and lastly special examinations to rule out certain pathologies (neuro, systemic, etc).
Without assessment, it is close to impossible to provide an effective treatment and the same applies to your horse's therapy sessions.
Assessment is the pillar from which treatment is determined. Assessment provides the therapist a clear overview of which areas and structures are affected, the levels of pain that may be present, the state of the tissues and where there are functional limitations. Assessment also provides both therapist and client a baseline from which to measure changes. If we do not establish a baseline reference we are not able to evaluate efficacy.
Assessment is a fundamental component of therapy for humans, yet often overlooked when it comes to horses.
In human licensing for manual therapy, assessment is one of the most focused areas of study. Going through hundreds of hours of education and evaluation on the ability to carry out an effective assessment. Precisely examined during board licensing on all the mandatory procedures and protocols. Then repeating this process with each patient from that day forward. There is, however, not this same level of consistency when it comes to our horses' therapy sessions. In part, due to lack of regulation in the industry but also absence of self initiated education by therapist and horse owner. Regulating bodies provide ethical and competency standards as well as scope of practice requirements by province and country but unfortunately are not yet established in our equine industry (BC, Canada).
Assessment is a skill but with practice it becomes automatic and extremely intuitive. The more it's practiced the easier it becomes to execute the process and interpret information. You will begin to recognize hierarchies in the body with ease and treatment planning becomes uncomplicated.
Why Is Assessment The Most Important Skill?
Because the assessment is what directs the treatment, the short and long term plan, and the the specific techniques that will be applied. Assessment is the determining factor in which direction the therapist will treat, the answer to which modalities will be most suitable, the framework from which to build a treatment plan. If we do not examine the body as a whole then how do we know where we must focus our treatment? Insufficient evidence or rationale for what is imposed on the body lacks specificity and may even be considered harmful.
Would you accept treatment to your own body if the therapist said, "lets just do a bunch of techniques and see what happens?" Probably not. You will likely wish for some sort of rationale and explanation of findings, a list of possible outcomes, and the proposition for treatment before allowing a series of physical techniques to your body. This is what we call informed consent in human therapy.
Now unfortunately, since horses cannot provide verbal consent we must do our best to communicate the assessment findings and obtain informed consent from the owner. And how do we demonstrate what we have found if we have not evaluated the horse and provided some tangible evidence for our proposed treatment? The answer is through assessment. It is not only the ethical choice but it provides the therapist and horse owner with objective evidence to monitor over the course of the sessions.
Now that we have discussed the importance of assessment, let's examine the specific areas that should be included in your horse's initial session in order to formulate an effective treatment plan.
1. History Taking
Taking a horses history is the first crucial step to recognizing pain patterns and functional limitations. History provides many of the answers needed to carry out the assessment. Included in your horses basic health history should be a summary of the chief concern (what is the reason for the therapy session), a list of prior injuries, medications being taken, type of living environment (paddock vs pasture, herd vs solo), occupation (what does the horse do), dental records, worming protocols, feeding practices, activity levels, and any other relevant considerations.
Next the history questions must be specific to the horse's current state, what we call the 'chief concern' which indicates what is going on right now for the horse. Which movements are difficult and what "behaviours" are presenting.
Then specific follow up questions such as:
"Does this happen on the ground or only ridden?"
"Does it get better or worse with rest?"
"Is there any swelling or heat following exercise?"
"Is movement easier in the morning or night?"
"Is this intermittent or regular"
"How long has the movement or behaviour been presenting?"
These are all valuable questions that give specific information of what tissues are impacted, the stage of healing, and what is causing the dysfunction in the first place. These are just a few of the basic questions to ask in the health history interview portion of your session which will provide a clear picture of what is going on for the horse right now.
2. Observation
The goal of observation is to provide a visible blueprint of the horses current state. Great observation is what makes a great therapist. Here is where we can see postural compensations, lines of pull, force distributions, loading patterns, pain stances, bony alignment, symmetry and much more the better you train your eye.
Observing the horse from four views is mandatory in order to get a full picture of the presentation. Front, left side, right side, back, and even a closer look at the spine as well and cranium (face) for more information.
3. Movement: Active (gait assessment)
Next we must watch how the horse moves. Looking at static positions only tells us so much, we must observe what happens when the nervous system is activated. This is where understanding how to carry out a basic gait assessment will be necessary. Watching the horse walk (and trot if possible) from four views provides a multitude of valuable indicators and must never be overlooked. Other simple movement tests such as backing up and yielding also expose pain patterns and reveal so called "behavioural" issues which are nothing more than painful indicators and valuable feedback.
4. Movement: Passive (specific range of motion testing)
Checking individual joints based on what was observed during gait allows for greater understanding of the specific health of the associated structures. This is where the assessment process may focus in on very specific joints to determine if there is a restriction within the joint itself and/or which associated soft tissues are impacted. Without passive range of motion testing we lose specificity.
5. Palpation
Feeling the tissues. Palpation provides the next level of understanding to what is happening in the body. The answers to most queries lies in the ability to feel the anatomy. Through careful palpation and understanding of the various structures beneath the skin, you will be begin to see that information is abundant if only you can learn to feel it.
Palpation is generally applied after movement assessment as a confirmation of what was seen in gait and and to gather more information regarding pain, dysfunction, and restriction. Different tissues provide different information. From skin to muscles to fascia there is something to be examined at each level. Palpation will reveal areas of heat (inflammation), swelling, hyper/hypotonicity, pain, discomfort, and overall quality of health and vitality in the tissues.
Most importantly though, palpation gives the horse the opportunity to provide valuable feedback! During palpation it is of utmost importance that any and all feedback form the horse be received. This is their chance to "talk" so please let them. If we correct what we feel is "bad behaviour" (horse not standing still to be touched in certain areas, or lifting legs, nipping, fidgeting, head shakes, etc) we risk losing the chance for critical information to be provided.
Based on palpation, we may then decide we want to do a few 'special' tests to gather further pathological findings.
6. Special Tests
These vary between practitioner but generally speaking, special tests are used to rule things in or out such as neurological or systemic issues. Special tests may also serve as a guideline for when to call your vet or refer to another qualified professional.
In Summary
Now having looked at an overview of what a full assessment should include, you can begin to appreciate the value in the skill. Even you as a horse owner can learn to carry out a basic evaluation too and may come to realize why this is a non-negotiable aspect of care. Understanding these methods of evaluation also provides the ability to communicate more clearly with veterinarians and the therapeutic team and more importantly know when it is time to receive the help of a professional. For me, there is no treatment without assessment.
If you would like to learn how to start evaluating your own horse, we cover this in my online course and live clinics. Check out our Courses for Horse Owners.
If you are an equine or human therapist, we have approved courses in Equine Orthopaedic Assessment available for continuing education credits.