Saddle fitter or physiotherapist?
How about both, says Faith Fisher–Atack. Saddle fitters who read the feature and submit correct answers to the quiz will receive CPD recognition from the Society of Master Saddlers (SMS).
Never has there been a more appropriate time to discuss the interaction of the horse, rider and saddle.
At the 2017 National Equine Forum, Dr Sue Dyson presented several studies addressing the impact that saddle fit plays on both the horse and rider and not least the negative implications and welfare issues that may arise in the presence of poorly fitted tack. In a recent article in Horse and Hound, Hazel Morley of the Society of Master Saddlers (SMS) suggested that “getting the whole industry working together” would improve standards and education on the subject.
As saddle fitters and physiotherapists, we are two groups of industry professionals that serve to improve this interaction, with the common interest being the welfare of horse and rider and placing them at the centre of all decisions and interventions. As professionals in our respective fields, we are aware of the importance of multidisciplinary team working. It may seem like a simple principle that we all believe we are employing. However, do we really understand why we need to work together?
Defining our roles
Defining the roles of both key parties is important. Physiotherapy is an established health care profession with protection of title issued by Royal Charter. The Chartered Society of Physiotherapy (CSP) governs physiotherapy provision within the UK to service users in both the NHS and private sector.
The application of physiotherapy to animals is recognised by the CSP as a specialist interest group titled The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) which requires formal education routes following the acquisition of chartered status in human practice. Chartered physiotherapists that specialise in animal practice are therefore uniquely placed to work with both riders and horses.
Application of clinical practice serves across all levels of performance, with the British Equestrian Federation (BEF) employing chartered physiotherapists to serve at Olympic and international competition across the equestrian disciplines.
Members of the SMS are trained to deliver high quality workmanship to deliver a professional and quantified service with the first saddle fitting qualification launched in 1995. The society continues its work to carry these standards through build, repair and fit, and to work towards the complete comfort and safety of horse and rider, ensuring that its members meet continual professional development standards. Recently, the SMS joined a cross-industry steering group to improve industry led education and training.
The two groups of professionals are therefore perfectly placed and armed with the knowledge, tools and qualification to deliver both quantifiable and clinically reasoned approaches to improving the interaction of the horse, rider and saddle.
A review of the literature
There is growing evidence that justifies the need for increased frequency of saddle fit and in doing so also highlights the need for chartered and veterinary physiotherapy intervention. Within the literature, variables associated with saddle fit include the effect of and on rider position, equine performance, lameness and equine back pain.
At an international workshop hosted by the Animal Health Trust in Newmarket in 2012, the effect of the rider was addressed by Dr Narelle Stubbs, a human and equine physiotherapist from the McPhail Equine Performance Centre at Michigan State University, USA. Dr Stubbs highlighted common biomechanical patterns that riders adopt often as a result of over activity and dominance of one side of the body. Also that rider asymmetries are common and can be a causative or contributory factor in the horse, saddle and rider interrelationship.
Adding to this conundrum, Guire et al (2015) objectively evaluated riders’ hip position with both a correctly fitted saddle and a saddle that rolled. A significant asymmetrical increase of rider hip flexion was measured with the poorly fitted saddle, showing that saddle position and therefore fit affected rider biomechanics and capabilities to maintain balance.
Conversely, a saddle that may fit the horse may not fit the rider. In a recent review, Dr Sue Dyson noted the presence of equine back pain was prevalent in cases where the saddle did not fit the rider. In this instance, a physiotherapist would be uniquely placed to address both equine and rider abnormalities. Methods such as taping and balance exercises that target the riders’ weaknesses and promote a more balanced seat could be utilised as well as employing treatment for the equine patient.
There is additional evidence to suggest that even correctly fitted saddles can still lead to equine movement and performance adaptation. In one recent study, fore limb and hind limb range of movement and thoracolumbar widths were compared in horses ridden in correctly fitted saddles that met industry standards against a saddle designed to reduce peak pressure on the mid-section of the spine.
The study highlighted a 13% and 22% increase in fore and hind limb protraction respectively as well as increased size of spinal muscles following a prolonged time of exercise associated with a saddle that reduced peak pressure (Guire et al, 2016).
This study not only highlights the potential performance limitations associated with pressure upon the spine but also the fact that peak pressure can be present under what would otherwise be identified as a correctly fitted saddle. The need for both improvement in fit and saddle design is raised. Additionally, regular physiotherapy assessment would identify pain associated with peak pressure, identify changes to muscle size and symmetry and, if necessary, use treatment modalities to reduce pain and inflammation.
The importance of using both a qualified saddle fitter and physiotherapist in the management of ridden horses is highlighted in one study that found that horses who received regular physiotherapy management of back pain increased the likelihood of also having regular saddle fittings (Dyson et al, 2015).
These findings were reversed for horses that didn’t receive a combined professional approach. 51% of these horses were significantly more likely to have both a poor saddle fit and abnormal findings at the thoracic spine. In addition, 62% of riders interviewed noted that they had suffered back pain themselves and horses ridden by these individuals presented with thoracic abnormalities and muscular asymmetries when assessed.
Dr Dyson’s research distinctly shows that a combined management approach and increased frequency of skills delivery in view of fit and pain management improves not only the welfare of the horse but also the comfort for the rider. Interestingly, 48% of riders interviewed for the study noted that they would only consult a professional if they felt there was a problem albeit with the saddle and/ or their horse. This shows there is a need for both saddle fitters and physiotherapists to encourage a proactive, preventative approach to management as opposed to waiting for a problem to develop.
Understanding the literature is key to understanding why both professions should work together and promote one another. As research continues to deepen our understanding of biomechanics, anatomy, physiology and clinical application, there is a distinct interrelationship evolving between our respective areas of expertise, most notably the correlation between equine back pain, lameness, rider position and saddle fit.
This not only justifies the importance and relevance of our roles individually but also highlights the need for multidisciplinary interaction between us. The rotation of both physiotherapy assessment and saddle assessment should be promoted along with other services acquired on rotation such as farriery and dentistry. This can be achieved through both industry led initiatives and individual education to our clients.
What will a physiotherapist do?
Calling up on a physiotherapist to assess your horse or client’s horse will include a thorough assessment and treatment regimen.
• Observe the horse’s natural posture
• Assess the horse’s movement at different gaits
• Palpate muscle tissue for irregular tone and pain
• Mobilise joints to assess range of movement and quality of movement
• Perform special tests for pain reaction
• Soft tissue mobilisation techniques that reduce spasm and increase circulation
• Electrotherapy modalities will often be used to mobilise tissue or to reduce pain
• Joint mobilisation will increase range at specified joints
• Dynamic taping
• Exercise prescriptions to strengthen and/ or mobilise target areas.
A saddle fitter’s view…
Kim Gordon-Holt of Krugar Saddlery, West Yorkshire agrees there must be interaction between the physiotherapist and saddle fitter to truly benefit the horse.
“Horse owners require continued education from professionals to realise the importance of correctly fitted tack and how to identify underlying reasons why a horse may not perform as it should. Saddle fitters and physiotherapists are key to this education.
“In most cases, I would recommend the saddle fitter visits the horse prior to the physiotherapist. It makes more sense to get the saddle correctly fitted first and then have the physiotherapist treat the horse for secondary muscle spasm. That way, the work of the physiotherapist is not undone when an ill-fitting saddle is placed back on following treatment.
“I can’t stress enough how important it is that the saddle fitters and physios work together. A horse cannot verbalise pain, it is our job to identify a problem and resolve it professionally and further educate to minimise the risk of further problems.”