This slide show is from a presentation given by holistic veterinarian, Dr. Chris King, at the 3rd International Symposium on Rehabilitation and Physical Therapy in Veterinary Medicine, which was held in Raleigh NC in 2004. It presents an integrative view of musculoskeletal anatomy in the horse. Please enjoy, and move through the slide show at your own pace.

1. Equine Anatomy in Perspective
an integrative view of musculoskeletal anatomy
Christine King BVSc, MACVSc, MVetClinStud
3rd International Symposium on Rehabilitation
and Physical Therapy in Veterinary Medicine
Raleigh, NC 2004

2. Equine Anatomy in Perspective
the way we’re taught anatomy limits our understanding
of how the body functions as an integrated whole

3. Equine Anatomy in Perspective
the way we’re taught anatomy limits our understanding
of how the body functions as an integrated whole
teaches us to view the body as a collection of separate parts

4. Equine Anatomy in Perspective
the way we’re taught anatomy limits our understanding
of how the body functions as an integrated whole
teaches us to view the body as a collection of separate parts
we approach illness, injury, and other dysfunction as a failure
of the offending part…

5. Equine Anatomy in Perspective
the way we’re taught anatomy limits our understanding
of how the body functions as an integrated whole
teaches us to view the body as a collection of separate parts
we approach illness, injury, and other dysfunction as a failure
of the offending part…
rather than the system failure that it so often is

6. Equine Anatomy in Perspective
it’s useful to start out by learning anatomy in readily
‘digestible’ pieces…

7. Equine Anatomy in Perspective
it’s useful to start out by learning anatomy in readily
‘digestible’ pieces…
but we must then assimilate it - put it all together
in a way that serves us…

8. Equine Anatomy in Perspective
it’s useful to start out by learning anatomy in readily
‘digestible’ pieces…
but we must then assimilate it - put it all together
in a way that serves us…
otherwise, we miss the big picture!

9. Equine Anatomy in Perspective
an integrative or wholistic view of anatomy better
describes how the living horse functions

10. Equine Anatomy in Perspective
an integrative or wholistic view of anatomy better
describes how the living horse functions
it better explains and helps us to predict the scope of illness,
injury, and other dysfunction…

11. Equine Anatomy in Perspective
an integrative or wholistic view of anatomy better
describes how the living horse functions
it better explains and helps us to predict the scope of illness,
injury, and other dysfunction…
because it emphasizes relationships

12. Equine Anatomy in Perspective
an integrative or wholistic view of anatomy better
describes how the living horse functions
this relational approach has more clinical value
diagnosis
treatment
rehabilitation
prevention

13. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:

14. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
bones as passive struts and support columns

15. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
bones as passive struts and support columns
muscles as activators

16. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
bones as passive struts and support columns
muscles as activators
tendons & ligaments as cables & guy wires

17. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
this mechanistic paradigm has the system functioning
like a crane

18. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
this mechanistic paradigm has the system functioning
like a crane
(fascia as an inert outer covering or binding material)

19. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
a muscle exerts its effect on a bone (or bones) either directly
or via its immediate extension (a tendon)

20. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
a muscle exerts its effect on a bone (or bones) either directly
or via its immediate extension (a tendon)
this effect is essentially limited to the bones and joint(s)
with which the muscle (+ tendon) is directly associated

21. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
a muscle exerts its effect on a bone (or bones) either directly
or via its immediate extension (a tendon)
this effect is essentially limited to the bones and joint(s)
with which the muscle (+ tendon) is directly associated
i.e. the effect is LOCAL

22. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
the foundation for most forms of therapy in sports medicine

23. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
the foundation for most forms of therapy in sports medicine
if a part is injured, it is because localised forces have overcome
local tissue strength

24. Equine Anatomy in Perspective
conventional view of musculoskeletal anatomy:
the foundation for most forms of therapy in sports medicine
if a part is injured, it is because localised forces have overcome
local tissue strength
thus, local remedies are needed

25. Equine Anatomy in Perspective
integrative view of musculoskeletal anatomy:

26. Equine Anatomy in Perspective
integrative view of musculoskeletal anatomy:
still uses elements of the mechanistic model

27. Equine Anatomy in Perspective
integrative view of musculoskeletal anatomy:
still uses elements of the mechanistic model
also recognises that everything in the body is interconnected

28. Equine Anatomy in Perspective
integrative view of musculoskeletal anatomy:
still uses elements of the mechanistic model
also recognises that everything in the body is interconnected
so, any action (whether positive or negative in outcome)…

29. Equine Anatomy in Perspective
integrative view of musculoskeletal anatomy:
still uses elements of the mechanistic model
also recognises that everything in the body is interconnected
so, any action (whether positive or negative in outcome)…
has LOCAL, REGIONAL, and GLOBAL effects

30. Equine Anatomy in Perspective
the concept of interconnectedness is central to
understanding how injury occurs

31. Equine Anatomy in Perspective
the concept of interconnectedness is central to
understanding how injury occurs
and how seemingly unrelated dysfunction…

32. Equine Anatomy in Perspective
the concept of interconnectedness is central to
understanding how injury occurs
and how seemingly unrelated dysfunction…
at often distant and apparently separate locations…

33. Equine Anatomy in Perspective
the concept of interconnectedness is central to
understanding how injury occurs
and how seemingly unrelated dysfunction…
at often distant and apparently separate locations…
can be either a cause or a consequence of that injury

34. Equine Anatomy in Perspective
No injury occurs in isolation!

35. Equine Anatomy in Perspective
the concept of interconnectedness:
expands our diagnostic abilities

36. Equine Anatomy in Perspective
the concept of interconnectedness:
expands our diagnostic abilities
allows us to customise and thus optimise Tx and rehab

37. Equine Anatomy in Perspective
the concept of interconnectedness:
expands our diagnostic abilities
allows us to customise and thus optimise Tx and rehab
enhances our ability to prevent injury/reinjury

38. Equine Anatomy in Perspective
the concept of interconnectedness:
expands our diagnostic abilities
allows us to customise and thus optimise Tx and rehab
enhances our ability to prevent injury/reinjury
may even help us to optimise performance

40. The Connective Tissue Link
all structures in the body are connected to one another

41. The Connective Tissue Link
all structures in the body are connected to one another
no matter how distinct or distant the parts may seem

42. The Connective Tissue Link
there are three bodywide connecting systems…
(physical systems that, if illustrated in isolation, would accurately depict
the structure of the entire body)

43. Human circulatory system
(Vesalius, circa 1548)

44. The Connective Tissue Link
three bodywide connecting systems…
circulatory (vascular and lymphatic systems)

45. Human nervous system
(Vesalius, circa 1548)

46. The Connective Tissue Link
three bodywide connecting systems…
circulatory (vascular and lymphatic systems)
neural (central and peripheral nervous systems)

47. The Connective Tissue Link
three bodywide connecting systems…
circulatory (vascular and lymphatic systems)
neural (central and peripheral nervous system)
fascial (connective tissue network)

48. The Connective Tissue Link
connective tissue literally forms (and informs) the body

49. The Connective Tissue Link
connective tissue literally forms (and informs) the body
one can follow the connective tissue trail from subcellular
organelle to whole organism…

50. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments

51. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments
links the nucleus, cytoplasmic organelles, and cell membrane

52. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments
cell membrane: network of filaments (integrins)

53. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments
cell membrane: network of filaments (integrins)
links the intracellular structures with the extracellular matrix

54. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments
cell membrane: network of filaments (integrins)
extracellular matrix: network of structural molecules

55. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
cell infrastructure: highly organised, 3-D cytoskeleton
of microtubules & microfilaments
cell membrane: network of filaments (integrins)
extracellular matrix: network of structural molecules
(collagens, laminins, fibronectins, proteoglycans)

56. Conventional view of the cell and the extracellular matrix

57. More accurate view of the cell and the extracellular matrix

58. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
fibrils of one sort or another mechanically link cells
and extracellular matrix to form tissues…

59. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
fibrils of one sort or another mechanically link cells
and extracellular matrix to form tissues…
tissues to form body parts…

60. The Connective Tissue Link
one can follow the connective tissue trail from subcellular
organelle to whole organism…
fibrils of one sort or another mechanically link cells
and extracellular matrix to form tissues…
tissues to form body parts…
and body parts to form…

61. a whole body

62. The Connective Tissue Link
information sent along these mechanical connections…

63. The Connective Tissue Link
information sent along these mechanical connections…
influences cell structure and function!

64. The Connective Tissue Link
connective tissue truly connects everything in the body

65. The Connective Tissue Link
connective tissue truly connects everything in the body
it doesn’t begin or end anywhere

66. The Connective Tissue Link
connective tissue truly connects everything in the body
it doesn’t begin or end anywhere
there are no real origins and insertions

67. The Connective Tissue Link
connective tissue doesn’t just arise from or cover
muscle…

68. The Connective Tissue Link
connective tissue doesn’t just arise from or cover
muscle…
it arises within and comprises muscle

69. The Connective Tissue Link
it arises within and comprises muscle
connective tissue is not confined to the tendonous extension
or the fascial covering of muscle

70. The Connective Tissue Link
it arises within and comprises muscle
connective tissue is not confined to the tendonous extension
or the fascial covering of muscle
it originates at the subcellular level and forms muscle…

71. The Connective Tissue Link
it arises within and comprises muscle
connective tissue is not confined to the tendonous extension
or the fascial covering of muscle
it originates at the subcellular level and forms muscle…
and then keeps on going!

72. The Connective Tissue Link
connective tissue doesn’t just run to bone…

73. The Connective Tissue Link
connective tissue doesn’t just run to bone…
it runs through bone

74. The Connective Tissue Link
it runs through bone
connective tissue is an integral part of bone’s structure

75. The Connective Tissue Link
it runs through bone
connective tissue is an integral part of bone’s structure
not only does collagen form a major component of the bone’s
outer covering (the periosteum)…

76. The Connective Tissue Link
it runs through bone
connective tissue is an integral part of bone’s structure
not only does collagen form a major component of the bone’s
outer covering (the periosteum)…
collagen and other structural molecules create a matrix
on which mineral is laid down to form bone throughout life

77. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…

78. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…
makes it easier to understand how the body functions
as an integrated whole

79. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…
makes it easier to understand how the body functions
as an integrated whole
switches us on to whole-body patterns of strain distribution
and compensation

80. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…
helps us appreciate how a painful problem in one part…

81. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…
helps us appreciate how a painful problem in one part…
can be linked to a ‘silent’ problem in some distant part

82. The Connective Tissue Link
seeing the body as a continuous, 3-D network
of connective tissue…
helps us appreciate how a painful problem in one part…
can be linked to a ‘silent’ problem in some distant part
reminds us to think GLOBALLY

84. A Living Tensegrity Model
Tensegrity = tension + integrity

85. A Living Tensegrity Model
Tensegrity = tension + integrity
refers to structures that maintain their integrity…

86. A Living Tensegrity Model
Tensegrity = tension + integrity
refers to structures that maintain their integrity…
primarily via a balance of continuous tensile forces
throughout the structure

87. A Living Tensegrity Model
Tensegrity = tension + integrity
refers to structures that maintain their integrity…
primarily via a balance of continuous tensile forces
throughout the structure
e.g. suspension bridge (tensegrity) vs. stacked-stone bridge
(compression)

88. A Living Tensegrity Model
tensegrity structures comprise:

89. A Living Tensegrity Model
tensegrity structures comprise:
individual compression-resistant members (rigid struts)…

90. A Living Tensegrity Model
tensegrity structures comprise:
individual compression-resistant members (rigid struts)…
balanced and ‘poised’, separate from one another, in a…

91. A Living Tensegrity Model
tensegrity structures comprise:
individual compression-resistant members (rigid struts)…
balanced and ‘poised’, separate from one another, in a…
continuous network of tension members (flexible cables)

92. A Living Tensegrity Model
tensegrity structures:
the struts resist the inward pull of the tension members

93. A Living Tensegrity Model
tensegrity structures:
the struts resist the inward pull of the tension members
the tension members restrain & support the struts

94. A Living Tensegrity Model
tensegrity structures:
the struts resist the inward pull of the tension members
the tension members restrain & support the struts
as long as these forces are balanced, the structure
remains in dynamic balance

95. A Living Tensegrity Model
this balance and synergy of compression and tension
makes the structure maximally efficient

96. A Living Tensegrity Model
tensegrity structures are:

97. A Living Tensegrity Model
tensegrity structures are:
very strong
stronger than predicted by the sum of their parts

98. A Living Tensegrity Model
tensegrity structures are:
very strong
very stable
despite initial appearances (insubstantial and unsteady)

99. A Living Tensegrity Model
tensegrity structures are:
very strong
very stable
very resilient

100. A Living Tensegrity Model
tensegrity structures are very resilient:
continuous network of flexible tension members…

101. A Living Tensegrity Model
tensegrity structures are very resilient:
continuous network of flexible tension members…
allows the structure to be very accommodating

102. A Living Tensegrity Model
tensegrity structures are very resilient:
continuous network of flexible tension members…
allows the structure to be very accommodating
in response to local stress, all of the interconnected elements
rearrange themselves a little

103. A Living Tensegrity Model
tensegrity structures are very resilient:
continuous network of flexible tension members…
allows the structure to be very accommodating
in response to local stress, all of the interconnected elements
rearrange themselves a little
the whole system accommodates to attenuate local stress

104. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
load one part and the whole structure will ‘give’ a little

105. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
load one part and the whole structure will ‘give’ a little
load it too much, however, and ultimately the structure
will ‘give way’…

106. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
load one part and the whole structure will ‘give’ a little
load it too much, however, and ultimately the structure
will ‘give way’…
but not necessarily anywhere near where the excessive load
was placed

107. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
because it distributes strain throughout, along the lines
of tension…

108. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
because it distributes strain throughout, along the lines
of tension…
the structure is most likely to break at some weak point…

109. A Living Tensegrity Model
whole system accommodates to attenuate local stress:
because it distributes strain throughout, along the lines
of tension…
the structure is most likely to break at some weak point…
which may be some distance from the area of applied strain

110. A Living Tensegrity Model
by virtue of its continuous network of connective tissue…

111. A Living Tensegrity Model
by virtue of its continuous network of connective tissue…
the horse’s body acts like a living tensegrity structure

112. a living tensegrity structure

113. conventional view

114. tensegrity view

115. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
conformation, tone, balance, and resilience (or vulnerability)
of the entire system are determined by…

116. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
conformation, tone, balance, and resilience (or vulnerability)
of the entire system are determined by…
myofascial tension

117. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
it then becomes clear how an injury can result from abnormal
load or tension in another part…

118. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
it then becomes clear how an injury can result from abnormal
load or tension in another part…
that may be some distance away

119. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
it then becomes clear how an injury can result from abnormal
load or tension in another part…
that may be some distance away
e.g. flexor tendonitis in a forelimb, arising from a problem
in the contralateral hindlimb

120. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
injury may occur where it does because of…

121. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
injury may occur where it does because of…
inherent weakness or previous damage at that site…

122. A Living Tensegrity Model
the horse’s body as a living tensegrity model:
injury may occur where it does because of…
inherent weakness or previous damage at that site…
not necessarily because of excessive local strain

123. A Living Tensegrity Model
seeing the body as a living tensegrity model:

124. A Living Tensegrity Model
seeing the body as a living tensegrity model:
enables us to get a more complete picture of the problem

125. A Living Tensegrity Model
seeing the body as a living tensegrity model:
enables us to get a more complete picture of the problem
provides a basis for which structural interventions
can improve movement and facilitate tissue repair

126. A Living Tensegrity Model
seeing the body as a living tensegrity model:
enables us to get a more complete picture of the problem
provides a basis for which structural interventions
can improve movement and facilitate tissue repair
e.g. various manual and movement therapies

127. A Living Tensegrity Model
seeing the body as a living tensegrity model:
enables us to get a more complete picture of the problem
provides a basis for which structural interventions
can improve movement and facilitate tissue repair
e.g. various manual and movement therapies
or simply restoring balance and comfort to the feet!

128. A Living Tensegrity Model
seeing the body as a living tensegrity model:
and, by identifying areas of local strain or lines of chronic
tension/strain before they lead to structural damage…

129. A Living Tensegrity Model
seeing the body as a living tensegrity model:
and, by identifying areas of local strain or lines of chronic
tension/strain before they lead to structural damage…
and restoring the balance of myofascial tone in the system, …

130. A Living Tensegrity Model
seeing the body as a living tensegrity model:
and, by identifying areas of local strain or lines of chronic
tension/strain before they lead to structural damage…
and restoring the balance of myofascial tone in the system, …
many athletic injuries may be prevented

132. ‘Anatomy Trains’
a metaphorical approach to functional anatomy

133. ‘Anatomy Trains’
a metaphorical approach to functional anatomy
takes the concept of interconnection and lines of strain
a step further…

134. ‘Anatomy Trains’
a metaphorical approach to functional anatomy
takes the concept of interconnection and lines of strain
a step further…
by identifying clinically important myofascial pathways

136. ‘Anatomy Trains’
The premise:

137. ‘Anatomy Trains’
The premise:
“whatever else they may be doing individually…

138. ‘Anatomy Trains’
The premise:
“whatever else they may be doing individually…
muscles also operate across functionally integrated
body-wide continuities within the fascial webbing

139. ‘Anatomy Trains’
“these sheets and lines follow the warp and weft
of the body’s connective tissue fabric…

140. ‘Anatomy Trains’
“these sheets and lines follow the warp and weft
of the body’s connective tissue fabric…
forming traceable ‘meridians’ of myofascia

141. ‘Anatomy Trains’
“these sheets and lines follow the warp and weft
of the body’s connective tissue fabric…
forming traceable ‘meridians’ of myofascia
strain, tension, fixation, and compensations are all
distributed along these lines”

142. ‘Anatomy Trains’
11 “myofascial continuities commonly employed around
the human frame”

143. ‘Anatomy Trains’
11 “myofascial continuities commonly employed around
the human frame”
individuals may develop other functional lines that
are unique to them

144. ‘Anatomy Trains’
11 “myofascial continuities commonly employed around
the human frame”
individuals may develop other functional lines that
are unique to them
set up by patterns of use or injury

145. Superficial Back Line

146. Superficial Front Line

147. The two lines work together
for postural support
Superficial Back Line (SBL) Superficial Front Line (SFL)

148. Back Functional Line

149. Back Functional Line
in the horse?

150. ‘Anatomy Trains’
underlying principle:

151. ‘Anatomy Trains’
underlying principle:
continuity of fascial fibres from one piece of track to the next

152. ‘Anatomy Trains’
underlying principle:
continuity of fascial fibres from one piece of track to the next
either direct or indirect (via intervening bony connection)

153. Superficial Front Line

154. ‘Anatomy Trains’
underlying principle:
continuity of fascial fibres from one piece of track to the next
thus, continuity of tensile transmission along the entire track

155. ‘Anatomy Trains’
underlying principle:
continuity of fascial fibres from one piece of track to the next
thus, continuity of tensile transmission along the entire track
functional integration of the structurally integrated elements

156. ‘Anatomy Trains’
Anatomy Trains and the horse:

157. ‘Anatomy Trains’
Anatomy Trains and the horse:
provides much food for thought in reinterpreting equine
functional anatomy, but…

158. ‘Anatomy Trains’
Anatomy Trains and the horse:
provides much food for thought in reinterpreting equine
functional anatomy, but…
it is an exercise in frustration to attempt to transfer myofascial
lines directly from human to equine frame

159. ‘Anatomy Trains’
Anatomy Trains and the horse:
horses have much more substantial fascial connections
and interconnections…

160. ‘Anatomy Trains’
Anatomy Trains and the horse:
horses have much more substantial fascial connections
and interconnections…
which reflects the functional priorities of this species

161. The Horse
speed & economy of locomotion are priorities for horses

162. The Horse
speed & economy of locomotion are priorities for horses
flexibility & dexterity may be higher priorities in humans

163. The Horse
speed & economy of locomotion are priorities for horses
several structural and functional features reflect
these priorities…

164. The Horse
long, slender limbs

165. The Horse
long, slender limbs
strong enough to support the body, yet…

166. The Horse
long, slender limbs
strong enough to support the body, yet…
lightweight enough to move with minimal effort at speed

167. The Horse
the bulk of the muscle mass is located on the upper limb
and attachment of the limb to the trunk…

169. The Horse
the power for gross limb movements (i.e. locomotion)
is generated at the top of the limb

170. The Horse
the power for gross limb movements (i.e. locomotion)
is generated at the top of the limb
forelimb kinematics - jointed pendulum

171. The Horse
the power for gross limb movements (i.e. locomotion)
is generated at the top of the limb
forelimb kinematics - jointed pendulum
hindlimb kinematics - jointed lever

173. The Horse
joint conformation below shoulder and hip limits gross
movement to flexion-extension in the sagittal plane

174. Left forelimb, lateral view Left hindlimb, lateral view

175. The Horse
joint conformation below shoulder and hip limits gross
movement to flexion-extension in the sagittal plane
shape of the articular surfaces

176. The Horse
joint conformation below shoulder and hip limits gross
movement to flexion-extension in the sagittal plane
shape of the articular surfaces
e.g. sagittal ridges and corresponding grooves in facing surfaces

177. Left forelimb,
cranial view
Left hindlimb,
cranial view

178. The Horse
joint conformation below shoulder and hip limits gross
movement to flexion-extension in the sagittal plane
shape of the articular surfaces
position and orientation of supporting soft tissues

179. The Horse
joint conformation below shoulder and hip limits gross
movement to flexion-extension in the sagittal plane
shape of the articular surfaces
position and orientation of supporting soft tissues
collateral ligaments, palmar ligaments, flexors, extensors, etc.

180. Left carpus, lateral view

181. The Horse
and tying it all together (literally):

182. The Horse
and tying it all together (literally):
the long, polyarticular flexors/extensors and the many
shorter but functionally inseparable fascial structures…

183. The Horse
and tying it all together (literally):
the long, polyarticular flexors/extensors and the many
shorter but functionally inseparable fascial structures…
“tie” the bones together such that…

184. The Horse
and tying it all together (literally):
the long, polyarticular flexors/extensors and the many
shorter but functionally inseparable fascial structures…
“tie” the bones together such that…
flexion/extension of the limb during locomotion is a single,
fluid, coordinated action, in which…

185. The Horse
and tying it all together (literally):
the long, polyarticular flexors/extensors and the many
shorter but functionally inseparable fascial structures…
“tie” the bones together such that…
flexion/extension of the limb during locomotion is a single,
fluid, coordinated action, in which…
the entire limb folds up or straightens as a unit

186. during locomotion, flexion/extension of the limb is a single, coordinated action

187. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…

188. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…
individually, they primarily act as shock absorbers or energy
stores

189. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…
individually, they primarily act as shock absorbers or energy
stores
another important contributor to economy of locomotion

190. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…
individually, they primarily act as shock absorbers or energy
stores
they flex/extend in concert with, and under the influence of,
the more proximal muscles

191. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…
individually, they primarily act as shock absorbers or energy
stores
they flex/extend in concert with, and under the influence of,
the more proximal muscles
in other words, they flex/extend both actively and passively…

192. The Horse
flexors/extensors below the elbow or stifle don’t really
do what we were taught they do…
individually, they primarily act as shock absorbers or energy
stores
they flex/extend in concert with, and under the influence of,
the more proximal muscles
they serve an equally important role in supporting and stabilising
the joints they cross

193. The Horse
example: deep digital flexor (DDF) in the forelimb

194. The Horse
example: deep digital flexor (DDF) in the forelimb
connects distal humerus and proximal radius & ulna…

195. The Horse
example: deep digital flexor (DDF) in the forelimb
connects distal humerus and proximal radius & ulna…
to third phalanx along the caudal/palmar aspect of the limb

196. The Horse
example: deep digital flexor (DDF) in the forelimb
connects distal humerus and proximal radius & ulna…
to third phalanx along the caudal/palmar aspect of the limb
when considered in its entirety, it is mostly connective tissue

197. Deep digital flexor tendon

198. The Horse
example: deep digital flexor (DDF) in the forelimb
when considered in its entirety, it is mostly connective tissue
there are three fleshy muscle bellies in the forearm

199. The Horse
example: deep digital flexor (DDF) in the forelimb
when considered in its entirety, it is mostly connective tissue
there are three fleshy muscle bellies in the forearm
but these muscle bellies have extensive fascial connections
both within and without

200. deep digital flexor
(humeral head)
Left forelimb,
medial view
(deep dissection)

201. Left antebrachium, cross-section

202. The Horse
example: deep digital flexor (DDF) in the forelimb
its primary action can be replicated in a dead horse…

203. The Horse
example: deep digital flexor (DDF) in the forelimb
its primary action can be replicated in a dead horse…
simply by reproducing the action of the long head
of m. triceps brachii

204. The Horse
example: deep digital flexor (DDF) in the forelimb
its primary action can be replicated in a dead horse…
simply by reproducing the action of the long head
of m. triceps brachii
i.e. drawing up on the olecranon

205. The Horse
example: deep digital flexor (DDF) in the forelimb
thus, an important component of its primary role as a digital
flexor is accomplished passively

206. The Horse
example: deep digital flexor (DDF) in the forelimb
thus, an important component of its primary role as a digital
flexor is accomplished passively
when the olecranon is raised by another muscle (or muscles)

207. The Horse
this structural & functional relationship between
P3 and triceps is part of an ‘Anatomy Trains’ line…

208. deep digital flexor
triceps (long head)
rhomboid
(nuchal ligament)

209. The Horse
this integrative approach to anatomy suggests a new
way of interpreting musculoskeletal disorders

210. The Horse
this integrative approach to anatomy suggests a new
way of interpreting musculoskeletal disorders
consider the implications of the DDF-triceps-rhomboid
connection in relation to the club-footed horse…

211. The Horse
DDF-triceps-rhomboid & the club-footed horse…
flexor contracture of the coffin joint is assumed to be caused
by excessive tension in the DDF

212. The Horse
DDF-triceps-rhomboid & the club-footed horse…
flexor contracture of the coffin joint is assumed to be caused
by excessive tension in the DDF
WHY excessive tension develops and persists in this structure
is never addressed

213. The Horse
DDF-triceps-rhomboid & the club-footed horse…
flexor contracture of the coffin joint is assumed to be caused
by excessive tension in the DDF
WHY excessive tension develops and persists in this structure
is never addressed
what if the DDF is merely a passive participant in an event
that originates further up the line?

214. The Horse
DDF-triceps-rhomboid & the club-footed horse…
what if the DDF is merely a passive participant in an event
that originates further up the line?
if so, then it suggests some less invasive alternatives to
inferior check desmotomy and other surgical solutions

215. a living tensegrity structure

217. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact

218. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact
introducing tension into the system at one location…

219. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact
introducing tension into the system at one location…
e.g. uncomfortable saddle, rider hauling on the reins

220. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact
introducing tension into the system at one location…
e.g. uncomfortable saddle, rider hauling on the reins
e.g. postural adjustments made to avoid further foot pain

221. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact
introducing tension into the system at one location…
inevitably results in bodywide compensations that limit
optimal function…

222. Putting it all Together
every part of the musculoskeletal system is inter-
connected, so any action has system-wide impact
introducing tension into the system at one location…
inevitably results in bodywide compensations that limit
optimal function…
and may ultimately overload a vulnerable structure

223. Putting it all Together
fortunately, the converse is also true:

224. Putting it all Together
fortunately, the converse is also true:
a sensitive and skilled therapist or rider can positively impact
the situation…

225. Putting it all Together
fortunately, the converse is also true:
a sensitive and skilled therapist or rider can positively impact
the situation…
by relieving or redistributing abnormal myofascial tone…

226. Putting it all Together
fortunately, the converse is also true:
a sensitive and skilled therapist or rider can positively impact
the situation…
by relieving or redistributing abnormal myofascial tone…
thus shifting the system back towards balance, resilience…

227. Putting it all Together
fortunately, the converse is also true:
a sensitive and skilled therapist or rider can positively impact
the situation…
by relieving or redistributing abnormal myofascial tone…
thus shifting the system back towards balance, resilience…
and optimal function

228. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best

229. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
no injury occurs in isolation!

230. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
no injury occurs in isolation!
there will always be other areas of disorder elsewhere

231. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
no injury occurs in isolation!
there will always be other areas of disorder elsewhere
secondary/compensatory…

232. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
no injury occurs in isolation!
there will always be other areas of disorder elsewhere
secondary/compensatory…
or actually the ‘silent’ instigator of the clinical problem

233. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
if not identified and addressed, these other problem areas
can delay or limit full recovery…

234. Putting it all Together
diagnosis and treatment that is confined to just the
injured part is incomplete, at best
if not identified and addressed, these other problem areas
can delay or limit full recovery…
and increase the potential for reinjury to occur

235. Putting it all Together
when evaluating a horse with a structural or functional
abnormality:

236. Putting it all Together
when evaluating a horse with a structural or functional
abnormality:
ask “WHERE and WHAT?”

237. Putting it all Together
when evaluating a horse with a structural or functional
abnormality:
ask “WHERE and WHAT?”
ask “HOW and WHY?”

238. Putting it all Together
when evaluating a horse with a structural or functional
abnormality:
ask “WHERE and WHAT?”
ask “HOW and WHY?”
and then ask “WHERE ELSE?”

239. Tailor treatment & rehab accordingly.