What can we learn about horseshoeing principles from a veterinarian who's practice is 70-75% hands-on acupuncture and chiropractic for horses' back pain? According to Dr. Joyce Harman, holistic and alternative medicine veterinarian from Virginia, we can learn an armful!
Dr. Harman has one of those minds that never sleeps. For the past 11 years, she has specialized in back problems and saddle fit, searching out how to correct pain in the horse's body and discovering its effect on performance. When her freind and associate, Centered Riding instructor and clinician Wendy Murdock, stumbled upon a new form of farriery that made a marked difference in how horses move, Dr. Harman made a point of studying the method for herself. She had to discover why.
"My friend Wendy has taken Centered Riding far beyond just the basics-into the biomechanics of the horse and rider working together. She observed that horses she had previously worked with, when shod traditionally, changing dramatically after the feet were changed using Natural Balance principles and when she told me, I became very interested and started to explore changing my own horse's feet."
"From this I was able to see and feel the influence [of Natural Balance] on the horse's upperbody. My own horse's rib cage, which I hadn't been able to get straightened out, is now level, and that was in the span of just a single shoeing!"
Dr. Harman had to know why. So she went back to her anatomy books, and, in her words, "This is what happens to me every time I go to an exciting clinic-I open up every anatomy book I have and try to find out what muscles are involved, which tendons and ligaments, and how the whole thing ties together. I have observed that as we change the feet according to the principles of Natural Balance, w end up with the upper body significantly improved."
Dr. Harman feels the Natural Balance approach restores biomechanical correctness to the feet. "As we properly support the coffin bone by leaving the sole callous, bars, and frog intact and by bringing support to the rearmost part of the foot by aligning breakover under the tip of PIII rather than just shoeing the perimeter of the hoof wall, I have observed what happens to the rest of the horse's body. The freedom of movemement that occurs throughout the rest of the body tells me that the horse wants the coffin bone supported more than just having the wall suppported.
In her lecture at SoundFest 2001 at UC Davis this spring, Dr. Harman addresssed one of the problems plaguing horses today: negative-plane coffin bones, often with subluxated coffin joints. This condition on the hind end migrates tension and pain up into the hock, stifle, back and spine. On the front end, negative plane subluxation of the coffin joint and lack of heel support affects the muscles that tie into the rib cage and neck, causing muscle tension and imbalance in the rib cage, shoulders and neck musculature. Symptoms of negative plane include a bull-nosed appearance to the anterior hoof wall, sore stifle, hip and back, large frogs and hind legs that are often held tucked underneath the horse's body.
The more the sole plane is dropped below normal the more strain there is going to be, particularly in the hind legs, stressing the lower back.
In fact, Dr. Harman discovered in her anatomy books a fascinating direct relationship between the coffin bone and the rib cage. The foot, through the muscles and tendons, connect into upper body musculature and tie directly into the rib cage and back of the horse!
"By restoring biomechanical soundness to the hind feet," Dr. Harman explains, "and correcting the negative plane of the coffin bone, tension is released in the tendons, ligaments, and muscles that travel from the coffin bone to the rib cage."
"The psoas muscle flexes the hip joint; you cannot reach this muscle to treat it or massage it, because it is too deep within the body. You can stretch it out a bit by stretching the hind leg gently out behind the horse, but you can't directly get your hands on it, thus making it difficult to cause to release."
Many of the horses that don't want to stretch the hind leg out for the farrier to shoe can't do it because of the amount of pull they have on the psoas muscle, which pulls on the lumbar area and lower ribs, similar to our lower back. The horse then fights and becomes uncomforable because of the pain, not because they are bad horses. The rider may also be having some issues, but the farriers, quite honestly, feel the problem even more than the riders.
In the front legs the connection is from the DDFT at the back of the coffin bone up to the caudal and medial side of the radius and humerus. The superficial flexor tendon goes from the middle pastern bone (PII) to the medial side of the humerus. The triceps continue the line upward, attaching to the humerus and scapula, and connect to the rib cage with the serratus ventralis and pectoral muscles.
"As we change the biomechanics of the feet, improving the function of these muscles, the rib cage releases. This is why the horse's body evens out when we start to corect the function of the feet."
Once the feet are correct and we remove restrictions in the muscles and spine [through chiropractic or acupuncture], then the horse experiences springy, fluid movement, up through the legs and body. This affects the entire muscular-skeletal system by restoring the horse's 'spring' and freedom of movement similar to that of a ballet dancer. The joints move more freely and the entire system has fresh, springy flexibility and energy.
The psoas muscle in the hind end is a particularly important muscle in dealing with back pain. A downward pullon this muscle by having a negative plane in the coffin bone creates pain in the back directly under the rearmost area of the saddle.
"When you remove the restrictions in motion, when you remove the pain in the muscles, and when you correct saddle fit and shoeing, the horse's performance is better than it was previously. This is true even if the horse is 17 or 18 years old. In fact many of the older horses perform better after treatment than when they were ten years old, because they move better and they feel better."
Dr. Harman continues, "When you straighten out the tension in the muscles through chiropractic, acupuncture and stretching, along with proper shoeing, suddenly the farrier can get underneath the horse and stretch the leg, putting it whereever he wants it."
Dr. Harman began her saddle fit research when she first started looking at back problems. "It made a lot of sense to me that if the saddle wasn't right the horse's back was going to be chronically sore. In fact, if the saddle fit problems were not corrected, you'd have to continually work on the horse's back. However, if you can correct saddle fit, a lot of your problems could go away and stay away. The rider is able to ride better and the horse is able to perform better."
Saddle fit issues include, but are not limited to: the horse is difficult to shoe, resistance to saddling, doesn't move or travel well, lack of concentration, excessive shying, rushing jumps, rushing downhill, bucking, rearing or rolling excessively, poor performance, unable to use back/hindquarters well, pinning ears, swishing tail, grinding teeth, tossing head, bad attitude, and resistance to work.
Dr. Harman has found that a staggering 90% of the new horses she sees have saddle fit issues. Even if the saddle fits well, manufacturing defects such as crooked saddles, twisted or broken trees, uneven panels, bars and flaps, and unevenly attached stirrups contribute to the saddle being responsible for causing pain. As a result of her findings, she is now writing a book addressing the topic in depth.
"Certainly from the farrier's standpoint, the more the horses hurt through their backs and hips, the harder they are to shoe," she says. "Furthermore, if the feet aren't addressed properly with preservation of the callous, bars and frog,and if the breakover isn't set back under the tip PIII, chiropractic and acupuncture treatments won't hold nearly as well. Yet when the feet are addressed properly, its amazing how much tension is relieved, even with the first few minutes. The horses change their stance and the tension in their back releases almost immediately."
"Once you line everything up into a biomechanically sound platform, which is the basis of holistic medicine, you look at the whole horse so that you're treating al lthe parts-nutritional, feet, muscles,-the whole thing."
"Another problem with horses is subtle lameness in the hind end that transfers to the front end, or vice versa, along the topline. Most of the time you see, for example, in the front leg; the left front heel starts to crush down, showing that there is some kind of stress in the body. Yet often the main probem is actually located on the opposite hind leg. The front legs are connected with the hind legs, as I've mentioned, through the ligaments and tendons and muscles, all the way up through the rib cage. We have tendency, however to look for the problem to the leg where the foot is changing. If you have pain anywhere in the body, the horse is going to generally compensate on the diagonal leg."
"So if you have a problem that shows up in the left front foot,it may very well be starting on the right hind leg; even the right hind foot. Tension may be traveling up through the back end to the front. Or it may be starting in the right glueteal muscle or even the sacroiliac joint, and traveling up into the diagonal front. You can treat that front foot forever, but you are never going to fix the problem until you address what is going on behind. And as far as what's going on behind, if you don't address the feet as well as the back, then you will never quite get there."
Another issue Dr. Harman addressed at the SoundFest Conference as chronic Cushing's-related laminitic horses. (See anvil Magazine article Baby's Battle: A Case Study in Laminitis in the April 2001 issue for further disucssion of Cushing's syndrome.) "I thnk that Cushing's itself is a widespred syndrome rather than a specific disease. It is being diagnosed with increased frequency and the condition is being seen in younger horses."
Dr. Harman described the many symptoms for Cushing's including hirsutism, or long hair that does not shed out in the summer, refractory laminitis, winter laminitis, weight problems-over or under weight-slugglish thyroid gland and /or thyroid dysfunction, insulin resistance, diabetes, muscle sorness, stocking -up of legs (especially hinds), polyuria/polydipsia (drinking and urinating excessively), collagen breakdown, poor hair coat, frequent infections of the skin and other organs, (including chronic hoof abscesses), colic, poor teeth, multiple dental abnormalities, lowered immunity to intestinal parasites, decresed intestinal wall integrity, infertility, and muscle wasting.
"Laboratory diagnosis of Cushing's syndrome can be unrewarding, as it is difficult to test for accurately. If a horse has even just a few of these symptoms and at the same time has chronic laminitis, it is probably related to Cushing's syndrome."
"Cushing's syndrome is very closely related to what is called in people 'insulin resitance', or Syndrome X, which is where the cells basically become too stiff to allow the insulin to carry the glucose into the cells. Glucose is needed by each cell for fuel to burn for energy. Glucose comes out of all foods, but is very concentrated in sweet feeds and rich, green grass. Many of our horses are basically easy keepers and are very sensitive to the effects of too much glucose."
"As the body gets bombarded with excessive amounts of glucose and the cells become too stiff to allow the insulin to carry the glucose into the cells, the insulin system esentially becomes worn out. Consequently, then the insulin is not utilized correctly by the body, you end up with the glucose being stored as fat rather than beng used as fuel."
"This sets up numerous metabolic disorders, of which one of the complications is the chronic laminitis. Another thing that happens in a lot these horses is that they have high levels of steroids internally, or endogenous steroids, and those seem to weaken the elastic tissue of the hoof wall."
Dr. Harman refered to the work of laminitis researcher Dr. Chris Pollitt of Australia and the Streptococcis bovis bacteria he discovered that stems from the hindgut, which multiplies and triggers enzymes which cause the lamina to separate. (See Anvil Magazine article Baby's Battle: A case Study in Laminitis in the April 2001 Issue of for a complete description of Dr. Pollitt's theory.) Her concern, from a holistic standpoint, is that many of our standard stable management practices increase intestinal permeability and cause 'leaky gut'.
"When the gut wall becomes inflamed, it leaks undigested food particles through to the liver. The liver detects the foreign material and goes into overdrive trying to solve the problem. Many of the wormers, vaccines and drugs we use on a regular basis over-tax the liver, and it has a difficult time coping with the overload. This in turn stresses teh immune system, and can cntribute to arthritis and other symptoms (well documented in human literature), which we treat with drugs, particularly anti-inflammatories, that can further tax the system, resulting in a vicious cycle."
"Leaky gut can be caused by overuse of anitbiotics, which kill off both the good bacteria and the bad. Yeast (candida) over-load also inflames the gut wall, as well as Phenylbutazone (bute). Throw in a little stress and you a recipe for potential laminitic disaster."
"One of the problems we see is that we feed an awful lot of bute to laminitic horses," Dr. Harman laments. "Also, a lot of horses live on bute long before they become laminitic, and bute itself causes inflammation of the gut wall and actually makes the gut wall leaky. If we are indeed helping to make this gut wall leaky, my big, question is: are we then allowing this [Streptococcis bovis] bacterial toxin to migrate more easily? I think that we are. So when we remove the bute and treat these horses holistically, we get a much better response to the treatment. The hores might be uncomfortable for few days as they are getting accustomed to not having the bute, but in the end they start to heal, usually in about three to four days.".
And how does Dr. Harman treat these horses holistically? To treat these horses naturally requires more than just throwing a few natural substances at them. It really takes a concerted effort to figure out what each individual needs.
"Cushing's disease is one of those perfect examples of what alternative or holistic medicine is about. We have to really look at the individual horse. Some horses need one minimal treatment with one or two ingredients. Some horses need multiple ingedients because their systems have already started breaking down so much they cannot repair themselves without a lot of support."
Dr. Harman views nutritional supplementation as critical to helping these horses, particularly mineral supplementation. She recommends beginning with probiotic treatment to repair the gut, and cheap isn't better: buy the best you can. Fermented probiotics balance the ph level of the gut and help repair the gut wall. Keep non-fermented probiotics refrigerated and feed as directed. Glutamine, an amino acid, helps the gut wall and can be fed, as well as the herbs slippery elm and aloe vera. Digestive enzymes are also helpful, and a candida-type herbal cleanser may be necessary.
Basic nutrition includes unprocessed feeds low in sugar. Free choice minerals are very important, especially trace minerals, and should be availabe, separate from the salt. Cushing's horses require extra minerals, especially magnesium, chromium, and vanadium. MSM, a sulfur, is helpful, as it relieves sore muscles, adds flexibility to the cells, and repairs scar tissue. Glandular supplements, available from veterinarians, work well for stimulating hair to shed and they also enhance the function of the hormonal system. Vitamin C also aids the immune system. Coenzyme Q10 (500-600 mg/day) is an important antioxidant, and OMEGA 3 essential fatty acids (found in hemp oil, flax oil or meal) make the cells more permeable. A high quality multivitamin and whole foods, such as carrot ad rice bran are recommended.
Dr. Harman thinks the horse also needs stress reduction, and help for the rest of the body, therfore chiropractic, acupuncture, Chinese herbs and homeopathics may be called for.
She says "Homeopathy is one of the branches of natural medicine where you really need to be working with a professional homeopath who is accustomed to dealing with laminitis cases. But that's part of the key in taking most of these horses off bute- you don't just walk up and say, 'Okay, I'm going to take him off the bute,' and leave him hanging. You have to use the rest of the tools available."
As far as the feet of these horses are concerned, Dr. Harman suggests beginning with support such as Styrofoam until the horse stablilizes, then trimming and shoeing in such a way as to support the coffin bone.
"I think that part of the key is finding out what is going to make each foot on each horse comfortable," she says. "That requires fiddling around to find out what is needed-adding wedges, taking away wedges, adding pad suppoort on the bottom of the foot, putting on a hospital plate-it just depends on what each and every horse needs. But the principals of Natural Balance have supported these horse better than anything else that I've seen."
There is much to learn from the holistic apporach Dr. Harman has adopted in treating and viewing horses. With a better understanding of how the horse's feet contribute to the function of the whole horse, farriers can become more knowledgeable to what might be contributing to some of the problems we come across in our practice.
Dr. Joyce Harman graduated from Virginia Tech in 1984. She started Harmony Equine Clinic, Ltd., a holistic veterinary practice, 11 years ago in Northern Virginia. She can be reached at 540-675-1855. Email her at: firstname.lastname@example.org