Contents

Foreword

Preface

Acknowledgements

1 The Musculoskeletal System Explained

Introduction

Members of the team

Interdependence of the body systems

Cells

Bones

Joints

Ligaments

Muscle

Tendons

The respiratory system

The heart

Circulation

The lymphatic system

The nervous system

The skeleton

The hind limbs

The forelimbs

Skeletal muscle

Reflex movement patterns

2 Injury – Effects, Repair and Causes

Common musculoskeletal injuries

Injury and repair

Possible causes of injury

Stable injuries

All-weather surfaces and gallops

Tooth problems as a cause of injury

The foot and shoe as a possible cause of injury

Saddles as a cause of injury

3 Problem Assessment

Soft tissue examination

Imaging as an aid to diagnosis

Ultrasonic scanning

Heart rate computers

4 Common Sites of Injury in the Horse

5 Therapy

First aid

Treatment

Massage

Hand massage

Mechanical massagers

Cold and heat

Cold and its uses

Methods of employing ice/water therapy

Heat

Cellular effects in response to varied stimulation

Magnetic field therapy PMF (pulsed magnetic flow) and static magnet fields

Ultrasound

Light therapy

Laser therapy

Light emitting diodes

Electrical stimulation of muscle

Transcutaneous electrical nerve stimulators (TENS)

Manipulation

6 Rehabilitation

Reflex action

Muscle re-education

Passive movements

Rehabilitation aidsy

Hydrotherapy

Thalassotherapy

Long reining

Ridden work

Summary

7 The Back – Horse and Human

The horse

The human back

8 Common Rider Injuries

Rider injuries

Types of injury

General rehabilitation

Appendix I The Veterinary Act

Veterinary surgeons, guide to professional conduct

Treatment of animals by non veterinary surgeons

Appendix II Bandaging

Types of bandage

Appendix III Cupping

Appendix IV Points for Those Treating Horses

Machines

General points

The owner

Appendix V Use of Anti-Concussion Pads

Appendix VI Suppliers of Machines Suitable for Animal Physiotherapy

General suppliers UK

Bibliography

Glossary

Index

© Blackwell Publishing Ltd 2007

© Mary Bromiley 1987, 1993

Blackwell Publishing editorial offices:

Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK

Tel: +44 (0)1865 776868

Blackwell Publishing Professional, 2121 State Avenue, Ames, Iowa 50014-8300, USA

Tel: +1 515 292 0140

Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia

Tel: +61 (0)3 8359 1011

The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act

1988, without the prior permission of the publisher.

First edition published 1987 by Collins Professional Books

Reprinted by BSP Professional Books

Second edition published 1993 by Blackwell Science

This edition published 2007 by Blackwell Publishing Ltd

ISBN: 978-1-4051-5061-3

Library of Congress Cataloging-in-Publication Data

Bromiley, Mary W.

Equine injury, therapy and rehabilitation / Mary W. Bromiley; drawings by Penelope

Slattery; photographs by Penelope Slattery and the author. – 3rd ed.

p. ; cm.

Includes bibliographical references and index.

ISBN: 978-1-4051-5061-3 (pbk.: alk. paper)

1. Horses–Wounds and injuries. 2. Horsemen and horsewomen–Wounds

and injuries. I. Title.

[DNLM: 1. Horses–injuries. 2. Wounds and Injuries–rehabilitation. 3. Wounds

and Injuries–therapy. 4. Wounds and Injuries–veterinary. SF 951 B868e 2007]

SF951.B86 2007

636.1′08971–dc22

2006031999

A catalogue record for this title is available from the British Library

Set in 10.5/12.5pt Palatino

by Graphicraft Limited, Hong Kong

The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards.

For further information on Blackwell Publishing, visit our website:

www.blackwellpublishing.com

Disclaimer

There are no restrictions for the administration of human therapy, but in the UK a Parliamentary Act, The Veterinary Act (1966), restricts the examination, for the making of a diagnosis and subsequent treatment, by any person other than a veterinary surgeon.

It should be clearly understood by anyone practising the techniques or giving therapy, as described in this book, that to do so without veterinary permission from the vet normally in charge of the animal, constitutes a legal offence.

It is very important to be aware that there are risks attached to the giving of all forms of therapy and also to personnel, when working with horses or ponies. Neither the author nor publisher can be held responsible in any way for injury sustained to any person or animal if they administer therapy or rehabilitation in the manner described, after reading this book. Neither can the author or publisher be held responsible for any adverse effects or injury resulting from the inappropriate use of massage, therapy machines/apparatus, aids and exercises for therapy and rehabilitation.

Foreword

I have suffered many injuries through car accidents and falling off horses: a pin through my right ankle, a broken femur with a pin in my knee etc. They say I limp, but I believe God has made me suffer so that I can understand the way horses can feel, even with the most minor injury. Any one who lands on stones, uneven, or hard ground with an injury, however minor, experiences the jarring effect.

However minor an injury, a horse cannot perform to its best. Mary advises us on suitable therapies, whether the horse has had a fall or a specific injury, in order to keep the horse in good shape.

I was sent a horse towards the end of its career that had major problems. Mary looked, pointed out all the many defects and I was upset, but she said ‘don’t worry, we will have to rebuild him’. I thought she was being rather optimistic, but she said to go back to basics and start at the beginning, long rein over poles, get him to use himself, build his back up on the weak side with weights, lots of long, slow work. The horse in question was Carvills Hill and his history – he went on to win the Rehearsal Chase at Chepstow followed by the Welsh Grand National, a weight carrying performance not equalled and in record time, ridden by Peter Scudamore, whom Mary advised on the best way to make Carvills Hill use himself. He then achieved a phenomenal third consecutive win, the Hennessy Gold Cup at Leopardstown when he was ten years old. It was all down to Mary, her technique, her patience and eye for detail of every muscle on the horse. The latest high profile winner is Celestial Gold; Mary helped him win the big race at Aintree 2006.

I am extremely fortunate to have Mary work for me, sharing her wealth of knowledge and unparalleled expertise which is hugely beneficial when preparing the equine athlete and has helped me to train, to date, over 4000 winners.

Martin Pipe CBE
Fifteen times champion National Hunt Trainer

Preface

An ongoing relationship has existed between man and horse since domestication of the latter began, as conclusively demonstrated by archaeological excavation, some 6000 years ago.

For domestication, dictionary definition, ‘trained to live with and be kept by man’, substitute ‘source of multiple usage’; food, transport, and later, following the invention of the wheel, the engine for vehicle/chariot. Archaeologists suggest the relationship may have actually been mutually beneficial, a two-way adaptation, rather than man dominance. A type of compatible evolution, the horse possibly recognising stewardship by man, reduced the ever-present danger of attacks by predators, man realising a source of semi-tame meat was advantageous.

When tamed and ridden, the speed of the horse was also advantageous, at full gallop, times of up to 70 k per hour have been recorded. Another plus was the fact that unlike the domesticated, cloven-footed species, camel, ox, sheep, and goat, the horse was able to survive, due to an unique digestive ability, on poor-quality forage; the equine caecum able to break down the cellulose contained in stalks, stems, leaves, and coarse grasses indigestible in other species. The horse can also digest even when on the move, unlike the cloven-footed species, who not only require a better type of fodder, but even if this is available, require long periods of recumbency to ‘chew the cud’, a process of regurgitation required to achieve fermentation. This factor reduced their usefulness as a means of transport.

Mechanisation has changed the role of the horse; no longer required, except in a few remote areas, as a means for transport and survival, the animal has become, not just a source of pleasure, but a competition adjunct, enabling man to extend his prowess through equestrian sports; polo and racing both brought back from the Mongolian steppes; dressage, originating from movements taught for combat survival; chariot racing has been replaced by competitive driving. Show jumping, eventing, endurance riding, the list continues to expand, the most recent being horse-drawn surfing.

This transition from necessity to pleasure has tended to distort the true nature of the horse, due to the incorrect assumption that human thought processes and concepts, particularly when preparing for athletic prowess, also apply to the horse. Man and horse are two very differing species and an appreciation of this fact is essential for those working with horses, particularly those who work as trainers and therapists for with every type of physical activity there is the possibility of injury. This book attempts to increase the understanding of those involved with horses, by explaining, in relatively simple terms, the interaction and reliance of the body systems one to another, the construction of the musculoskeletal system, the general effects of injury, and the repair processes of tissues following damage in a species differing from man.

Added to this information, the text contains, as far as they are currently understood, the facts about therapy machines along with a description of the varied methods of aiding repair, this in order to enable the reader to make an informed choice from the available options; it may entail simple applications of heat, cold, massage, or possibly the use of sophisticated machines. Also described is the advisability of, and reasons for, controlled activity.

Acknowledgements

My grateful thanks go to the members of the veterinary profession who have trusted me with their patients, and to all the owners, trainers and head lads who, over the years, have given me support and help by allowing me to work with them and their horses. Thanks also go to my two daughters Pelly and Rabbit who work with me and without whose help the rehabilitation would be impossible.

Dedicated to my late Father

Robert Hamilton Miller,

Veterinary Surgeon and Medical Practitioner

1

The Musculoskeletal System Explained

Introduction

The goals following tissue breakdown are similar in both man and horse; to restore the pre-injury state of the whole by persuading the affected tissue to repair as rapidly and efficiently as possible. The first consideration, when something goes wrong is, ‘Why did it happen’? Sometimes the answer is obvious, but in most cases a broad-based investigative route is required to source the primary cause of the problem.

A quick illustration to demonstrate that treatment of the obvious may not constitute a cure. A patient presented with a tennis elbow, appropriate treatment resolved the problem, three weeks later she was back needing further treatment. In-depth discussion unfortunately failed to identify the cause. Shortly after her fifth treatment she was spotted wrestling with an up-and-over garage door. It was suggested that the garage door mechanism be oiled and she did not reappear for treatment. When the account was paid an enclosure stated, ‘Quite an expensive oil can!’

To ensure successful treatment outcome the many different characteristics of man and horse need consideration. The ‘tree’ of evolution has many divisions but species follow two main routes: those which kill in order to eat (predator) and those that are eaten (prey).

Man is a predator (killer), the horse a prey (food source). Domestication has required that the predator, man, sits on his prey the horse, small wonder that things can go wrong particularly when it is appreciated that the prey, despite domestication, retains all its endowed survival instincts, these include the flight reaction in response to fear and the requirement to survive a presumed attack by fighting.

All predators are born helpless, all prey species are fully functional within minutes of birth and this is not the only difference between the two types of species (Figs 1.1 and 1.2; Table 1.1).

Figs 1.1 and 1.2 Human baby and foal the same age.

Symbiosis between human and veterinary medicine does exist despite there being specific differences between species. In order to be successful when working with injury these variations should be understood and appreciated.

It is also essential to remember the limitations of the basic horse, particularly with regard to learning ability, rather than rely on man’s imposed interpretation of its thought processes and behaviour.

Table 1.1 Man versus horse.

The concept of treatment and rehabilitation following athletic injury is now an acceptable part of veterinary medicine and is the task of suitably qualified physiotherapists. The physiotherapist is part of a team headed by the veterinary surgeon in charge of the case.

By law the vet must make the initial diagnosis and write giving permission to the physiotherapist in order for her/him to administer appropriate therapy. This requirement applies to any person offering or practising any form of therapy (Veterinary Act, see Appendix I).

Originally, the physiotherapist had only his/her hands to work with, but with the arrival of the machine era, physiotherapists were taught the effects the varied devices had on tissue. An in-depth knowledge of anatomy and physiology allows for the choice of machine most appropriate for the condition diagnosed, and furthermore, an understanding of healing gives the knowledge needed to change machines as the recovery pattern dictates.

Therapy machines have, in the main, been developed for use in the human field, with no adaptations for use in veterinary medicine other than the reshaping of pads or the changing of machine names – for example, a therapeutic ultrasound machine has been renamed a Vet Sonic.

Although recently a few trials have been instigated it should be understood that the exact effects on the tissues, be they those of man or horse, resulting from the stimuli delivered from many of these human-oriented machines are still unknown. However, fractures, sprains, strains, arthritis, muscle tears, bruising and painful backs, are all common to humans and horses, and electrotherapy is being widely used to treat athletic injuries in both species, despite the fact that benefits remain largely speculative. Unfortunately, if technology is available it will be used even if the end result is not known.

Therapy machines are available for purchase by the layman, but little has been written describing the best time during the healing process to use the machines, the contra-indications to usage, or the dangers of over dosage and usually the only available literature are the manufacturers’ pamphlets.

Reliable information can be found in science-based textbooks, but these are written solely for professionals, qualified members of the medical or veterinary profession. Understanding the text requires indepth, specialist knowledge. In an ideal world, only professionals should use the machines but many have been sold to the layman and unfortunately, they are often used to the detriment rather than to the advantage of the patient.

It is very important to realise that there can be no exact criteria as to treatment times or dosage – each case should be judged on the individual circumstances.

It is also important to recognise that no one machine can be expected to fulfil all requirements, each has a specific effect. The purpose of all therapies, including the use of machines, is to enhance the natural, inbuilt, healing abilities of the body, with the aim of restoring full function to the injured area and thus minimising secondary trauma.

Nearly all tissues, other than central nervous tissue, have the ability to reconstruct to their original state. The programme for healing follows a set pattern which is instigated, in the main, as a result of specific chemical signals. For example, blood leaking from a damaged vessel is considered free blood. Free blood within or adjacent to bone changes the normal chemical balance of the area, messages flash to appropriate recovery units, cells migrate to the area of damage and construct, to a pre-set pattern, which includes very precise timing, the new bone. Over time, and in response to exercise stress, the damaged bone remodels, eventually resembling its pre-damage configuration. Research has demonstrated that the use of therapeutic ultrasound given for, or during, the first ten days post injury will enhance the mobilisation of the first set of bone repair cells, the osteoclasts. Given after ten days, therapeutic ultrasound reverses the repair programme because signals from the machine have interfered with the natural, body induced, sequence of events. This reverse effect might be useful for treating a splint when the object is to dissuade the body from creating an unsightly bone mass but is of little use in, for example, a knee injury when a slab fracture of a carpal bone has been diagnosed and is healing.

There are many unscientifically based claims that machines accelerate healing and these have yet to be proven. Some of the machines may induce an earlier start to the natural repair processes of the body thus enhancing the natural succession of tissue response. However, health and performance go hand in hand, no type of therapy can cure a problem or enhance performance if the original cause of the problem or poor performance is not sought. This requires team work involving a large number of people and an understanding of the inter-relationship which exists between all the body systems

Members of the team

The horse

Horses are amazingly adaptable but conformation cannot be changed and consideration must always be given to this fact since conformation may limit performance. Conformation is determined by genetic make up and attempts to change or correct a naturally adopted gait can lead to inappropriate strain within associated structures, often resulting in lameness.

Muscles take time to model in response to demand as does bone. Horses are often asked to progress too rapidly, before their musculoskeletal system is adequately prepared. There is a big difference between being conditioned and being fit.

The hypothesis, now described as Wolff’s Law, of Julius Wolff (1836–1902) has never been disproved. He stated ‘adaptive changes in the structure and biomechanical properties of bone occur in accordance with functional demands’. The skeleton and the soft tissues need adequate preparation time to ensure that at cellular level their structures have remodelled and adapted to fulfil requirement.

There is no point in trying to teach the horse a new task until it is physically capable of performing the task. This is particularly important, given the fact that if muscles are inadequately prepared, they become fatigued and fatigue leads to discomfort. Because the horse is endowed with survival instincts, when discomfort is felt, the animal will alter the way it recruits muscle, imperceptibly changing from an economic movement pattern to a painless movement pattern, thus creating secondary areas of stress. The new pattern will also be logged in the movement centre of the brain as normal and therefore remaining even when the discomfort resolves. Should this happen in man voice direction and visual example are employed to re-establish normal movement.

The veterinary surgeon

The veterinary surgeon is the most important person in the health team. It is sensible to have a horse examined pre purchase by your own vet. Should anything go wrong the vet will have the advantage of already knowing the horse. Unfortunately, there is often a reluctance to consult a vet, rather as man tends to avoid the doctor lest something unpleasant may be heard. Vets and doctors are bound to tell the truth, be that pleasant or unpleasant. However, leaving a problem may, and unfortunately often does, result in irreversible changes.

The veterinary profession is generally very amenable to enlisting help from team members with expertise in complementary professions, farriers, dentists and trainers. To be asked to help when all else has failed is not so much irritating as frustrating.

The rider

Riders damage horses rather more often than a horse damages its rider, usually because muscle fatigue is overlooked during training and a horse is asked to repeat a task again and again. Try press ups and see how long you can repeat the exercise before you tire, relate this to the hour of concentrated flat work demanded from your horse.

Beginners, new to horses, often think two novices can develop together. Sadly, this usually leads to confusion in the horse and disappointment in the rider.

Experienced riders will often ‘feel’ all is not well when on a horse; over time their body instincts have become so tuned that these have become, without conscious thought, a source of information. These experienced riders are easy to help because the information they provide should help the appropriate team member both to identify and deal with the primary cause of the problem.

The groom

A good groom is the horse’s nanny. Their input is essential to all other members of the team provided they have been taught to observe. Small observations make for improved help from other team members. The dentist needs to know if the horse is quidding its food, the nutritionist the state and smell of the urine and droppings, the masseur if the horse is cold backed and the physiotherapist if lameness wears off after warming the horse up.

The dentist

Comfort in the mouth is essential, any evasion caused by discomfort will affect the head position. There is important inter linkage between head, neck and back. The position of the head, and consequent break over in the neck affects through tension created in the nuchal ligament the supraspinous ligament which supports the back. Thus the position of the head determines the ability of the horse to lift the back. This lift, in association with muscle groups taking origin from the nuchal ligament, enables the horse to carry the rider without being hollow.

Teeth should be checked at least twice a year, and preferably every three months in young stock.

The blacksmith

No foot no horse.

The foot is designed to absorb, in part, the compaction forces generated by foot fall during movement. These can reach unbelievable peaks when body weight is momentarily born on a single limb, following the airborne phase. The absorption capacity of the foot is helped by the unique arrangement of its own internal structures including the laminae and ligaments.

The supporting tendons with their ability to create and store elastic energy each time the foot bears weight, also create a type of spring, but if the foot is out of balance appropriate to the individual, i.e. unhealthy, under run or untrimmed, then the tendons are subjected to abnormal stress.

The frog, sited between the heel bulbs, acts as a pump creating the force required to drive venous blood up the distal limb against gravity in a part of the body where, other than tendons and fascia, no soft tissues exist. The health of the foot is an essential element for general health and performance.

Vital neural messages from the feet enable the horse to coordinate the movement of the four limbs, often at high speeds and over varied terrain, to use a variety of gaits, to jump obstacles, swerve to avoid collision, change leads and remain in balance in spite of rider weight.

The nutritionist

In evolutionary terms the horse is designed to eat herbage and when allowed a natural diet does very well. However, herbage is not just grass, it is a mix of plants which includes herbs in season, twigs from hedgerows and varied grasses, enabling the horse to ingest all required nutrients, carbohydrates, proteins, minerals and vitamins.

Many horses are inappropriately over fed through kindness or necessity, for example the show hunter is required to be well topped, often to the detriment of feet and joints.

Horses which eat earth when in a paddock, are generally looking for missing minerals.

Most feed merchants employ or can recommend a nutritionist who will advise on a diet appropriate for breed, life style and work requirements.

The trainer

The trainer can observe from the ground, seeing movement patterns, unlike the rider who has to feel them.

A trainer should be able to assess the muscle condition of the horse with which they are working as well as recognise any conformation limitations. They should also be able to advise on specific exercises in order to improve the functional ability of individual muscles.

Pole work is, for example, discussed in many training manuals, and the virtues extolled as being useful for balance, suppling and rhythm, but the muscle groups which are being targeted are not stated. It is no good promoting rhythm, achieving this on a straight line and then losing it on a corner because the stabilising muscles of abduction and adduction were not considered.

The masseur

The task of the equine masseur is to enhance muscle function and prevent injury as opposed to treating injury. Because of their underpinning knowledge, equine masseurs recognise through touch fatigue, hydration, tension, filling and subtle temperature variations. The feel of the coat is an excellent indicator of general health and the rider can be alerted to changes in muscle.

Physiotherapist

The physiotherapist is required in cases involving injury to the musculoskeletal system. Their job is to enhance tissue recovery by using electrotherapy appropriate to the state of the recovering tissue.

Many physiotherapists are also masseurs and some become involved in retraining either by suggesting or implementing training programmes.

If a system is in equilibrium, and an external action tends to alter the equilibrium, the system will adapt to oppose the external action (Le Chatelier’s Principle).

Therapy machines deliver a variety of electrical and/or compressive signals to tissue, upsetting/changing the behaviour of the cells lying in the path of the current. It is for this reason that it is essential to consider if this type of therapy is pertinent, and ask ‘Will changing cell behaviour be of benefit or could it be detrimental’?

Interdependence of the body systems

Trying to visualise the complexity of a living being is as daunting as trying to comprehend space. A grasp of the essentials is, however, necessary in order to understand the problems associated with injury (Table 1.2).

Cells

The basic unit of life is the cell, it is cells bonded together which form the different tissues of the body, these tissues in turn create the varied body systems. All cells contain fluid, intra-cellular fluid, and are suspended in fluid, extra-cellular fluid.

Table 1.2 The body’s systems and their functions.

Efficient function requires the intra- and extra-cellular fluid to be in an appropriate state of balance, electrolytes play an important part in this balance. The cell membrane, or outer wall, ensures the cell contents and the all-important nucleus remain within the boundaries enforced by the membrane. Just as the brain retains overall control of the body so the nucleus controls its cell. Contained within the nucleus is the genetic code appropriate to the cell, as well as function commands which determine growth, repair and reproduction.

The cell membrane is porous allowing the movement of liquid and substances both into and out of the cell. Internally, the jelly-like cytoplasm, consisting of approximately 70% water, suspends substances such as salts, sugars, fats and amino acids. A precise chemical and electrical balance, appropriate for each cell type, is necessary to ensure efficient cellular function.

Some cells are described as ‘free’, these cells are not clumped together to form tissues. Free cells are transported around the body in the blood, for example the oxygen-carrying red cells erythrocytes, others, lymphocytes, can migrate via the extra-cellular fluid.

Despite the fact that the equine body contains approximately 400 trillion cells there is constant intercommunication, essential for the exchange of information, between them all, at all times, from the animal’s first breath to its last.

Bones

Bones are of differing designs, their shape and size varying with their functional requirements. With the exception of the teeth, bone is the hardest tissue in the body. It provides the framework, the support of the body, and protects certain internal organs. It provides sites of attachment for muscles and tendons as well as constituting the levers which the muscles move. The structure of bone allows great strength: it is subject to compression, tension, twisting and bending strains, and is able to withstand these stresses by virtue of a certain amount of elasticity.

Long bones, or limb bones, have a central cavity, which acts as a factory producing certain cells. At the distal end of a long bone, before maturity, is an epiphyseal plate. This is a cartilage-type plate from which the long or limb bones grow. At maturity this plate has completed its function and turns into exactly the same structure as its parent bone. The bones of the skull, the ribs and the shoulder blades are known as flat bones. Sesamoid bones are small, rounded masses found in certain tendons at points of friction. The largest of these sesamoid bones is the patella located on the front of the knee in man and on the front of the stifle in the horse. All bones are covered by an outer skin or periosteum this giving support to the blood vessels which feed the bone and also allows for the attachment of the fibres of muscles, tendons, ligaments and the capsules of joints.

Joints

Joints are the meeting places between bones. Some meeting places, like those of the bones of the skull, have no movement (articulation) between them. Another example is found in the pelvis at the sacroiliac joints. The majority of joints, however, are synovial joints (Fig. 1.3) and allow for free movement between the bone ends. In this type of joint the ends of the bones are covered with a cartilage, hyaline cartilage. The cartilage is smooth and has a very low coefficient of friction, ensuring a slippery surface which allows for easy movement. Hyaline cartilage acts in part as a shock absorber and assists in the lubrication of the joint by producing synovial fluid, also known as joint oil.

Joints are enveloped by a sleeve or capsular ligament. The cells on the inner surface of this tissue produce synovial fluid or joint oil. Working alone, the capsule would be unable to support and restrain the movement between the ends of the opposing bones, support is therefore assisted by ligaments.

Fig. 1.3 Diagram of a synovial joint.

Ligaments

Ligaments are often confused with tendons but ligaments are concerned only with joints. The capsular ligament surrounds a joint and, as the name suggests, encapsulates it. Specialist cells on the inner surface aid joint lubrication by producing synovial fluid (joint oil). On the outer side of the capsular ligament, and spanning the gap between bone ends, bands of tissue, collateral ligaments, support joints and restrict their movement to the required range ensuring efficient economic function. These ligaments work in partnership with local muscles. Rooney (1980) presented work which demonstrates that as the collateral ligaments are stretched through joint movement they ‘load’ with energy, and this energy can be used to assist muscle action in returning the joint to its normal anatomical position.

When ligaments are subjected to severe overstretch they do not regain their original state. They are also slow to recover after being torn and may need to be stitched. Receptors sited within the dense tissue matrix of ligaments are quick to record any change within the tissue components and register their findings as pain.

The function and presence of proprioceptors (sensory nerve endings) in ligaments is still not fully understood, but recent research (Delforge 2002) has shown that disturbance of their activity is secondary to ligament strain, atrophy also occurring in local muscle groups. This atrophy is probably due to disruption of the normal intercommunication between the ligaments and muscles. An over stretched ligament is said to be sprained. Severe ligament sprain leads to joint instability.

Muscle

The type of muscle which moves one bone upon another and produces the movement required for activity is known as skeletal muscle. It is of a different construction from the muscle which controls the heart, cardiac muscle, and also differs from the type of muscle tissue which forms the hollow internal organs; the bladder, the intestines and the blood vessels. Composed of a series of components or muscle spindles, skeletal muscles are highly elastic. They are controlled by motor nerves and they function as the result of signals transmitted via motor nerves. In any one muscle only a proportion of the total mass is working at any one time.

In books on anatomy, muscles are described as having an origin (a starting point) and an insertion (an ending). The origin may be stated to be proximal to an adjacent structure. This indicates that the origin is nearer to the central body mass. Distal indicates a site further from the central body mass.

periosteumtendon tissue