In which Horse Osteopath introduces Lord Henry.
Horse Osteopath loves Henry, or Lord H, as his owner insists on calling him.
Lord H is a large Irish Draft horse. He competes internationally in Horse Osteopath’s dreams, and in Cloud Cuckoo Land will be show jumping at the Olympics.
On planet Earth he schools regularly with his owner, Mrs S, and has lessons with classical dressage trainer Marcia Wakeman. He also hacks several times a week.
Horse Osteopath was first called out to see Henry because he felt ‘wrong behind’. The words ‘wrong behind’ are often heard by equine physical therapists. Naturally, the first thing we all do is look at the back legs and the pelvic area. This makes sense as the top priority is to ascertain whether the horse is sound or not.
On finding the horse sound, several things might whizz through the brain, including:
Pastern joint restrictions
Irritation/weakness/tightness of the buttock muscles
Pain/dysfunction of the lumbar-sacral joint.
The osteopathic brain will also consider possible issues further afield:
Through Latissimus Dorsi the shoulder might be implicated.
Restricted joint mobility in the spine, with associated muscular tightness.
Problems in the transitional areas of the curves in the spine.
Poll restrictions (well they always come up, don’t they!)
The fact that I’m making the effort to write about Henry probably is enough to tell you that Henry did not have any of these issues, however I will be honest and admit that for several months I thought I was doing the right thing by treating all of the above areas. I pummeled, pushed, poked, wobbled, manipulated, unwound, massaged and stretched. Yes, we have technical terms for all of the above, but this is a blog, not an exam essay.
And Henry improved. He improved on a regular basis.
Improving on a regular basis means deteriorating between improvements. To me this is simply not good enough.
Then one day, Mrs S asked whether the jaw might be involved. Of course Horse Osteopath, like all osteopaths, is open minded and unbiased, and is always happy to consider any owner’s input. In theory, that is. In reality, horse owners are not supposed to know more than Horse Osteopath. Nor are they supposed to come up with theories more osteopathic than Horse Osteopath’s diagnosis. Nor are they supposed to be right.
On this occasion Horse Osteopath looks blank, tries to work out anatomical connections between a horse’s arse and gob, and hopes Mrs S will give some indication as to why, and how, she’s come up with this bizarre diagnosis.
Mrs S explains that Henry hangs on the left rein. And that’s it.
Horse Osteopath pokes the joint of the jaw (the temporo-mandibular joint, or TMJ) and Henry throws head up, before hiding in corner of stable.
“Oh,” says Horse Osteopath.
“Hmm, thought so,” says Mrs S.
Horse Osteopath ponders, briefly, which one of the humans in the stable has the certificate in osteopathy. Then wonders, nervously, whether she is good enough to warrant it.
So TMJ treatment commenced (as always the serious technical stuff is below). Basically Horse Osteopath worked on the muscles around the TMJ and the joint itself. Due to the strong connections to the poll and shoulder, these areas were also given a good seeing to.
And lo! Lord H was astoundingly better. Seriously, he moved better, held himself more easily, and stopped hanging on the left rein.
Mrs S was delighted, and is now working with Marcia Wakeman to perfect canter half pass.
I had intended to write a detailed account of the unusual anatomy of the TMJ, but a variety of other people have produced such nice articles about it I don’t see the point.
Instead I offer you a list of things I think are fascinating about the TMJ and surrounding area. I have listed some useful references and website links at the end, though I’m sure you’ll find many more without too much searching. At the bottom of the page I’ve described Henry’s treatment programme.
Things Horse Osteopath Finds Interesting About the TMJ
The hyoid is attached to the petrous portion of the temporal bones.
An injury, or poor dentition, will cause wasting of the muscles in the area.
A horse usually favours one side when chewing, so do not expect the jaw to move evenly from one side to the other.
Ear problems can be associated with TMJ restrictions.
The mandible drops forward and when the head is down (eg when grazing) . When the head is up (eg eating from a high haynet) the mandible drops backwards. This can affect wear and tear of the teeth.
A biconcave fibrocartilaginous disc divides the TMJ into two parts. This allows the joint to perform more complicated movements.
Ankylosis of the TMJ is possible.
The TMJ is part of the stomatognathic system. Stomatognathic is such a fabulous word! It means the structures involved in speech and in the reception, mastication, and deglutition of food, so comprises skeletal components (maxilla and mandible and TMJ), dental arches, soft tissues (salivary glands, nervous and vascular supplies), and the muscles of mastication.
Ultra sound assessment of the joint gives good images for the lateral aspect of the joint.
There appears to be a connection between the structures of, and around, the TMJ and balance/postural control. This basically means that a problem with the TMJ can have an effect pretty much anywhere in the body! From what I have read it seems this is due to the structure, function and position of the trigeminal nerve nucleii. The nucleus of the spinal part of the trigeminal nerve is elongaged. It starts in the brainstem but and finishes around C1. On its journey it becomes intwined with other nuclei that supply the upper neck.
There appears to be an unexplained link between the hip joint (the actual joint, not the point of hip) and the opposite TMJ, however, Henry did not have any pain in the hip area, so I do not think this strange link was part of his problem.
So, with all that fascinating, but complicated information, what did I do to Henry? Well, to be honest, nothing you wouldn’t think of yourself. Sternocephalicus and brachiocephalicus were both hypertonic, and the temporalis muscle was tight on the left. The TMJ itself was more restricted and painful on the left, and movement of the left scapular was slightly restricted in comparison with the right.
Soft tissue work involved the above muscles, and also the rest of the cervical musculature, and periscapular muscles. I also treated Latissimus Dorsi, and the Erector Spinae muscles to reduce any muscular tightness between the afore mentioned arse and gob. I articulated the same areas, including the TMJ itself, and used cranial techniques to release the fascial restrictions around the hyoid and the whole stomatognathic system (I’m so pleased I managed to get that word into a sentence!) Articulation of the TMJ was done both holding the mandible, and with my hand inside the mouth, over the top of the lower jaw. I did not notice a difference in efficacy when comparing these techniques, but it was interesting to try the two approaches.
The frustrating thing about Lord H was that after treatment it did not take much for the TMJ to become restricted again. This was disappointing, but the difference in his gait after treatment made me certain we were treating the right thing. Initially I had to treat him every few weeks, and gradually we stretched it out to a number of months. Sometimes the treatments were quite short, to tweak whatever part of the system had broken down, but I felt it was important to stay on top of the improvements and not let him deteriorate. He is now treated far less often, and continues to perform well.
The links below take you to some of the articles and books I read in the process of improving my knowledge of the TMJ. The first one has wonderful photos & I really recommend you have a look at it.
Osteopathy and the Treatment of Horses, Anthony Pusey et al.
Anatomy of the Horse, K Budras et al.