A few things not to do with your FES equipment

Don’t wad up your cable when you are finished
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Recoil the cable into its original shape
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Don’t wad up your charger when you are finished
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Recoil the charger wires into their original shapes IMG_0428

Don’t let your dog use your cable as a chew toy  IMG_2122

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I’m having problems holding the pad down behind the withers when treating the thorax

When a horse is hollow behind the withers and you are treating the thorax it can be difficult to keep the electrodes behind the withers in contact with the horse.

There are several options you can try.

First, make sure you have taken the “wrinkle” out of the pad, where the hollow is located, by using the velcro tabs on the pad.

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You can also fill the depression behind the withers with:

Towel under the surcingle  IMG_1778

Leg wrap under the surcingle  IMG_0633

Holding the neck, shoulder and hindquarter electrodes in place

To hold the sticky electrodes onto the neck, shoulders and hindquarters the best option is the electrode tape we now have. If an oil-based coat or fly spray is used, then wipe the area first with alcohol to remove the oil film, let the hair dry and the tape will then stick to the hair coat.
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Sometimes you need to use a second piece of tape to hold the lead of the electrode in place. Especially on the electrodes that are not placed on horizontally with the lead hanging straight down.
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You can also use the tape to hold gauze in place over wounds in difficult to bandage areas.
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Duct tape can be used to hold on the electrodes similar to the pictures below. However, it will not stick as well as the electrode tape, especially if the electrodes are not new.
1.  The tape can be crossed over the electrodes.  DSC02905

2.  The tape can be placed in strips parallel to each other, with the edges not touching. If the horse moves the neck a lot, this placement will work better than crossing the tape over the electrodes.

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If you are having problems with the horse shaking the electrodes off when you are using the sticky electrodes to treat the shoulder and neck you can use a stretchy slinky. Contact us if you would like to order one.

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Another option is to use polo wraps to hold the electrodes in place

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Freezing and hot weather and your FES system

If you leave your FES system out in the cold weather and it gets
BELOW 35 DEGREES Fahrenheit then you must let the system warm up at room temperature for 3 hours before you use it. If you turn the system on when the internal components are frozen, you could either damage the display panel or damage the battery.

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When it is so HOT you can fry an egg on your truck keep your FES system where it is cool. Don’t leave the systemin direct sunlight or unprotected in a hot truck where the temperature will get ABOVE 110 DEGREES Fahrenheit.

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Why does the horse seem to be a little hypersensitive when I wipe off the gel after FES treatments?

There can be several reasons the horse shows more reactivity to touch after FES treatments. These may include:

  1. This sensitivity after the first few FES treatments can be due to the sensory nerve responses that are being activated with the FES stimulus. This superficial sensation may not have been felt by the horse for a period of time due to the chronic muscle spasms or atrophy. After the FES treatment, some horses will be sensitive to even wiping off the gel when normally they are not reactive to touch in that area.  This reactivity can be a sign that the treatments are making a difference and the sensory nerves are starting to function again.  This over-reaction will typically be reduced as time goes on, but some horses are always a little reactive when the gel is being wiped off.
  1. This sensitivity after the FES can happen only after a few FES treatments have been completed. Perhaps this periodic sensitivity is due to the fact that sensory feeling has returned to the area of chronic spasm or atrophy and the muscle tissue is now close to normal in its response to pain. The noticeable hypersensitivity could be due to the fact that the training and/or conditioning is resulting in some discomfort as the horse is asked to increase the workload. Pain is a good indicator of the progress of the training of the horse and is a useful tool in determining the level of success of a treatment protocol. If the sensitivity increases this could be a good indicator that this region is the area where a FES treatment will be helpful. When the pain sensation is reduced, hopefully this is an indicator that the spasm is starting to resolve as well.
  1. This sensitivity may not be noticeable during the early series of FES treatments, but may show up later as you continue to treat in areas that were at first not sensitive. As time goes on and the chronic spasms are reduced, the horses may show us when they are experiencing the acute stages of muscle injury (if we pay attention). This sensitivity could happen frequently and occur in multiple regions when the horses are in training and are performing. The spasms may even switch from side to side during training. However, the spasms will not be as intense and will resolve quickly with the use of the FES.
  1. Sometimes when I see a horse that is very non-reactive to palpation, but is performing poorly so we know there is a problem, I wonder if the pain sensations are dulled due to the chronic pain. This “dullnees” to touch protects the horse from the chronic discomfort.   Perhaps this is one reason horses “allow” themselves to get so bad before they actually “show” us their pain.

 

What if a have a horse that is a “Non-Responder” or “Very Slow Responder” to FES Treatments?

  1. Muscle issues are probably not the main or secondary problem for the uneven movement issues seen with these horses. Therefore, the FES will not make large changes in movement patterns.  You won’t do anything bad by using the FES, but you really won’t get the large degree of change you see is some horses.  In addition, the riders will not feel big changes in the movement of these horses, but the riders will usually note that the horses do feel a little easier to ride and the horse’s attitude is better after FES treatments.  These horses are very slow but steady with their improvements, they will not show big improvements in movement that some horses give you in response to the treatments.  Typically over time the riders will be able to feel the difference the FES is making and will really note the change in the horse if FES is discontinued for a long period of time. 
  1. These horses are super stiff in the deep musculature, and they are not allowing you to access the deep tissue that is the “problem“.  Therefore, you are treating more the superficial muscles and not getting to the “core” of the problem.  These horses will improve gradually over time but never really show big improvements after the FES.  Horses should typically show functional movement to get improvements and it will be difficult to get the functional movement out of these horses.  Local contractions under the electrodes will not get the changes you want in the movement patterns of the muscles.  These horses are tough because they can fight a bit with the treatment if it gets too deep, but that is what you may need to do to get to the site of the problem. 
  1. Treatment could be focused on a compensatory area rather than a primary area. You may need to explore a bit with your treatments so that you can find the specific muscle groups which are limiting the movement.  You may need to treat associated areas, not just the area that shows the primary discomfort.
  1. Multiple treatments during one session may be necessary.  For example, thorax, si and neck treatments may all need to be done on the same day.  Then repeat this group of 2 or 3 treatments the next day.  Watch to see if you get functional movement consistently in one area vs no movement in another area.  Then revisit your diagnosis and your palpations to see if everything agrees.  If not, you may be incorrectly evaluating what the primary problem is.  This technique of multiple treatments over time can make the horse feel a little “unsteady” to the rider because you are loosening up so many muscles at one time.  Make sure that especially after serial treatments, the owners do not let the horse go out and tear around the field and slide to stops at the gate.  The horses are very loose and need to have time to rest after the treatments.  Typically, with nervous horses, the horses should have a minimum of 2 hours after the FES treatments before they are turned out and only turned out if they will be relaxed.  If the horses tend to be nervous then do your treatments later in the day after they have been turned out.  With calm horses, they can be turned out immediately after the FES treatments as long as they can stay relaxed.

 

After the FES treatment, rider says horse feels stiffer than normal to the right

Practitioner:

The horse was reportedly stiffer to the right and just not comfortable during riding after two treatments with the FES on the si region.  This is interesting because the right side was the quicker side to provide contractions and felt looser upon palpation.  I am of the opinion that I would like to do a third treatment and see how he does. I’m surprised because I felt like the horse was responding well to the FES.  If the horse is still not feeling right after the third treatment, then I’ll back up and recommend some diagnostics – such as back x-rays – as he may be one that needs some shockwave etc. to address the pain prior to working on the muscles again.

 Dr. Schils:

It is interesting that you received contractions first on the right side and also palpated that side as looser.  I would trust the FES at this point and assume that the stiffness they are feeling is really related to the left side of the horse. They may feel that the horse is a bit more out of balance because the right side responded to the treatment well and the left side didn’t.  This asymmetry of reaction to the FES put the horse a little more out of balance until we can get the left side to loosen up and make the horse more symmetrical.  If they could send a video of the horse going both directions in large and small circles that would be helpful to see exactly what is happening.  The shockwave sandwiched in with the FES on each side of it is a perfect idea if you feel you need to reduce pain.

FES Treatment Discussion – Case Study Long Term Spasms

Background
Horse has no skeletal problems and has been thoroughly examined for lameness. The horse has had chronic sore back problems.

Case Study Part A:
Horse was making some improvement with just the FES. The horse then received back and sacroiliac injections and has not felt right since. The horse received another FES treatment a week after those injections. The horse’s response was to show resistance when asked to move forward in the canter. The gait was “hoppy” especially in the upward transitions. During the downward transitions the horse wanted to die out and stop. A discussion about the warm-up routine included starting with a walk and then moving to an easy canter to loosen up. Another FES treatment is planned to get the horse back on track. Is it possible that the horse has been tense for so long that when he receives treatment and starts moving his muscles he doesn’t know how to use his body under saddle?

Dr. Schils:
Yes, it is possible the horse has been tense for so long that after the FES treatments he feels that the improvement in symmetry is not his “normal” movement and he may start out feeling a bit awkward or unsteady until he feels comfortable with his “new” movement.

The change in the warm-up routine is a great idea with the emphasis on the canter. The work load should be precise, but maybe shorter than a normal ride. The rider must try and support the changes in the muscle memory that we are attempting to make with the FES and injections.  

Case Study Part B:
After the injections the horse responded slow and remained stiff during the FES treatments. The reaction to the FES was so much better before the injections. The horse’s attitude was good, but we received little muscle movement during the FES treatment. The second day we received even less movement during the FES treatment when compared to the first treatment.

Dr. Schils:
This shows the spasms are probably very long term and will come and go, unfortunately. I would give the rider the confidence that the FES and injections are setting up the situation for the horse to be able to move more correctly. The rider must then train the changes in the movement patterns of the horse that she wants to see, rather than just letting the horse determine the best way to move. Clients can be a bit apprehensive about pushing the horses during riding after the FES treatments, and this firm encouragement to move correctly is exactly what the rider needs to do if there is going to be a change made in the quality of the horse’s movement. However, this firm but correct requirement of the horse to move properly should be expected for only for a short period of time and then build up to a longer ride time.  Perhaps the colder weather is also not helping with the smooth progress. It is complex to make out what the rider is telling you with all the other external influences. The rider must be willing to take the time to help the horse understand how to learn new this muscle memory, especially in the beginning.