Flexion test during physio

[Bernster]

This is one where I know I should wait and get more info, chat to the vet etc etc., but I’m kind of unpleasantly surprised, so wanted to gauge the great mass of HHO knowledge and experience!

A new vet physio treated F yesterday. I wasn’t there but I left some notes with the yard. She picked up on the usual issues that he gets treated for by my previous physio, nothing major there, but she said he needs the vet as he was lame on the right hind after a 60 second flexion test. So, ofc I will get the vet as you don’t get a specialist out and then ignore what they say.

But, here’s the ‘but‘ - no signs prior to this (although the saddle doesn’t fit, which also got checked yesterday), he’s working lovely in the school and feels good. I’m not a fan of flexion tests unless done by an equine vet. I didn’t realise that physios even do them and 60 secs seems like a long time. Also I got the news in an email which is a bit of a shock to be told your horse is lame and needs the vet through an email, but maybe I’m being overly sensitive.

He’s 10, he‘s not going anywhere and obv I want him to be comfortable, able to work and not build up issues for the future, so i will get a work up done. So, I suppose I’m feeling a bit meh ganerally, but also a bit concerned about the flexion. AIBU? PS Usually when someone asks that, I tend to think the answer is - yes!

ETA Googled and seems like 60 secs is ok but the max time that vets tends to apply.

 

[ihatework]

When you say vet physio, do you mean a qualified vet who also happens to be a physio - or do you mean a ‘veterinary physio’ which seems to just be a terminology and not a qualified vet.

If the former then I would be seriously angry that a non qualified person was performing flexions and would be on the phone to the governing body.

But I wouldn’t dismiss what they say out of hand either.

 

[Bernster]

It‘s the term for animal physio, so not a qualified vet. Agree I’ll act on it as this is an experienced equine physio, but i have very mixed feelings about non vets identifying lameness and about flexion tests generally.

 

[ihatework]

It‘s the term for animal physio, so not a qualified vet. Agree I’ll act on it as this is an experienced equine physio, but i have very mixed feelings about non vets identifying lameness and about flexion tests generally.

I actually don’t know whether under their governing body this is considered acceptable, but I would be damn well finding out. I have never had a qualified physio do flexions and I’m pretty appalled one has done this without your permission

 

[milliepops]

it's an odd one. I haven't ever had a physio do a flexion test on my horses, but I have had one spot lameness and we went through a bit of trotting up and down, lunging etc to get a proper look at it and then I picked up the phone to the vet. She did not treat the horse that day as we had identified a problem that needed sorting out first.

I had had my doubts about the horse at the time but being on my own all the time I didn't have anyone to look from the side/front etc so it was a valuable input (eta and in that context I would have gone along with it if she'd thought a flexion test would be worthwhile - trusted person). I think flexions can be useful where they show differences between legs rather than necessarily just picking up a positive result in both hinds, for instance. but what led her to do them.. is that standard practice for her or was it done because something looked iffy during initial assessment?

 

[Bernster]

Waiting to hear but I understand it was after the initial trot up assessment. I‘m a mix of - I chuck everything at a horse to make sure it’s as comfortable and healthy as possible, but equally I’m also quite pragmatic about adult working horses. Many wouldn’t pass a 5 stage vetting and they have their niggles, stiffness etc. Never had any major concerns about F but wouldn’t be surprised if he gets a bit of arthritis, and maybe this could be the start of something like that.

I use the RVC and I rate them, although i sometimes think vets are very good at finding something wrong if they look hard enough !

 

[be positive]

I am not impressed, a 60 sec test is going to find a niggle in most and should in my opinion only be performed by a vet, or maybe the owner, a physio will often pick up the leg and hold it to feel for the reaction but I have never seen one hold it for anywhere near 60 secs or ask for trot afterwards, like ihw I am shocked this was done without you being there and would be taking it further.

You do need him checked obviously as this has been brought to your attention but that does not justify her actions.

 

[SEL]

I spent quite a lot of time trotting mine up and turning her in circles for the ACPAT physio last Friday. I thought the Appy was a bit off in front, but with a third party taking a better look we easily went from 'off' to 'lame'. Mine does do hind leg stretches but not flexion tests. I wonder if your physio spotted a bit of 'offness' and decided to see if it would turn into lameness after a flexion test. Still not convinced that is something a physio should do though - if they've got concerns they should just refer back to the vet like mine has done.

 

[milliepops]

if they've got concerns they should just refer back to the vet like mine has done.

this is the thing I find a bit more surprising tbh, my physio wouldn't treat my lame horse until she had been seen and signed off by the vet.

 

[ForeverBroke_]

Any chiro/phsyio/massage etc etc etc person I have ever had out for my horse has refused point blank to treat my horse in the past if they have identified any kind of lameness.

I think I too would be interested to hear what the governing body had to say for itself..

 

[Pippity]

this is the thing I find a bit more surprising tbh, my physio wouldn't treat my lame horse until she had been seen and signed off by the vet.

That's interesting. My ACPAT physio identified bilateral hind lameness from watching the horse move, and said she needed to see the vet. However, she was happy to continue with general massage there and then, and continued to come out while the horse was being treated by the vet.

I wouldn't be happy about a physio doing a flexion test, and especially not for 60 seconds.

 

[milliepops]

That's interesting. My ACPAT physio identified bilateral hind lameness from watching the horse move, and said she needed to see the vet. However, she was happy to continue with general massage there and then, and continued to come out while the horse was being treated by the vet.

i think this comes under the requirement that the vet should authorise the physio to give the treatment to the horse. general assumption is that the horse is basically fit and well and it's just routine maintenance, since the owner hasn't been in touch to tell them there's an issue.
If the vet knew the horse was lame they might not have authorised the physio to go before assessing the horse themselves.

 

[AFB]

I'm a bit torn on this tbh, my horse was 'off' on his right hind when the physio came, turned out to be 100% muscular (well overdue, bad mum) and had she referred back to the vet I'd be £100's down and it wouldn't be resolved - so I would be happy for a qualified & trusted physio to look at a horse with slight lameness.

 

[milliepops]

I'm a bit torn on this tbh, my horse was 'off' on his right hind when the physio came, turned out to be 100% muscular (well overdue, bad mum) and had she referred back to the vet I'd be £100's down and it wouldn't be resolved - so I would be happy for a qualified & trusted physio to look at a horse with slight lameness.

while I agree that lots of unsoundness can be muscular in origin I think there's potential for a physio to overstep their professional boundary/expertise with this kind of scenario. Obviously it's great that it has worked out in your case but it's not uncommon to get tightness or asymmetry of musculature that has developed in response to an issue elsewhere such as an arthritic joint or poor foot balance. you can loosen off the soft tissue all you like but it wouldn't fix the root cause, hence, IMO, a physio should refer the horse back to the vet first.

 

[Tiddlypom]

No, I would not be happy any body worker other than a vet doing a flexion test on my horse.

My ACPAT physio came out one day for a routine treatment for my wonky mare. Mare, who had been looking grand before the physio’s arrival, hobbled out of the stable on 3 legs. Physio, although she’s a ‘by the book’ person and will not normally diagnose, agreed with me that it looked like an abscess (which it proved to be) and rather than refuse to treat her at all, treated my mare’s usual expected muscular twinges.

 

[Bernster]

I contacted the vet and gave them clearance to release his notes, so they were fine with it, and obv no known issues. I feel like I’m about to go down a rabbit hole as he’s in the middle of his post lock down MOT checks and needs a new saddle, so he will have 2 weeks off, some ground work, and then a new saddle in a few week’s time. Chuck a vet check in the middle of that and it all gets a bit messy, but off down the rabbit hole I go...

 

[TPO]

Under the 1966 (? Brain fog) veterinary act therapists must only work under vets permission and must not work on an undiagnosed lameness.

Therefore if she suspected he was lame, good therapists should do static and dynamic observations before starting, she should not have worked on him.

 

[Pippity]

Under the 1966 (? Brain fog) veterinary act therapists must only work under vets permission and must not work on an undiagnosed lameness.

Therefore if she suspected he was lame, good therapists should do static and dynamic observations before starting, she should not have worked on him.

I think the wobbly area there is work ON an undiagnosed lameness or work WITH an undiagnosed lameness. My physio was making no attempt to treat the lameness - just to treat various aches and tensions on a horse who'd never had physio in her life (and wasn't entirely sure she wanted it now, thank you very much).

 

[Auslander]

I would have a fit if a physio carried out flexions on a horse. Flexions are a diagnostic tool which should only be used by a vet. Physios aren't permitted to diagnose, and if they have any concerns about a horse's soundness, they should be referring back to the vet, not investigating it themselves.
As an aside, my vet (and your second vet!) said she could, if she wanted to, make pretty much any horse trot up lame after flexion, even if it's never taken an off step in it's life, so try not to worry about the boy too much!

 

[Bernster]

Thanks Aus. Appreciate that. I’m really not a fan of flexion outside of a vetting and I’m very surprised given how well he’s going but, having been given this info, I’ve obv got to investigate. Then I’ll eat my words if there is something ofc. Hopefully not, or just something minor.

 

[TPO]

I think the wobbly area there is work ON an undiagnosed lameness or work WITH an undiagnosed lameness. My physio was making no attempt to treat the lameness - just to treat various aches and tensions on a horse who'd never had physio in her life (and wasn't entirely sure she wanted it now, thank you very much).

One of the contraindications to treating a horse as a therapist is working on an undiagnosed lameness. Whether you turn up to a lame horse where the owner has been unaware or it becomes apparent after starting treating you must not (continue to) treat and a vet should be involved.

You are correct that therapists are allowed to treat lameness WITH vet's explicit permission, even if its undiagnosed, BUT the vet had to be aware of it and preferably have examined the horse themselves.

 

[SEL]

I'm a bit torn on this tbh, my horse was 'off' on his right hind when the physio came, turned out to be 100% muscular (well overdue, bad mum) and had she referred back to the vet I'd be £100's down and it wouldn't be resolved - so I would be happy for a qualified & trusted physio to look at a horse with slight lameness.

My PSSM mare is often 'off' when the physio turns up but there is that 'offness' that comes with them twisting with tight muscles and the 'offness' that comes from moving oddly with [yet] another issue. I think an experienced physio can usually make a good assessment as to whether or not they can help or it is a vet callout, especially if they know the history of the horse.

When mine was trotted up on Friday we then went back to the barn, tied her up and the physio had a good feel over her usual tight spots and put the ultrasound machine on the worst bit to see if that would help. We both had a good poke around the dodgy leg to see if there was any obvious soreness (the horse likes to self harm) and I'm sure if she'd spotted tension in the shoulder for instance then she may have felt comfortable working on it to see if that was the issue.

Flexion tests irritate me no end! I've walked this particular horse up and down for numerous vets with obvious lameness and every single one - apart from the one I now use - tried to flexion test. No idea what they were trying to prove, but it got to the stage where it was getting dangerous to handle her hind legs because she was fed up of people hurting her! Gel injections have been game changing so if there is an issue OP then I highly recommend them.

 

[SusieT]

It is appropriate for physio to examine the horse to identify any issues- this might include flexion imo
60 sec is perfectly normal for flexion - flexion does not do any harm contrary to common myth of horse world
and she identified a problem she wasnt happy treating and referred to vet - which is what they are supposed to do
I don't see th eissue?