Multifidus Part 2!

Hello and welcome back to this research rewind and this is part two of my multifidus story. Um it carries on a decade later. So I left the last uh podcast where I was telling you about my reliability study and whether you could um measure the cross sectional area of multifidus. in a uh live horse because I used uh segments of a horse post-mortem to actually suggest that it was a valid approach to measuring the size of this deep stabiliser muscle.

Now, I originally started doing that because I wanted to measure the effect of a core stability program in horses but um because the measurement tools weren't available yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n But that was in the early two thousands and I completed my masters at the Royal Vet College.

I went away, I continued part-time working for the NHS in Hampshire and then I started my own business in Hampshire and then I got the opportunity to move to Devon and when I did that I went Claire MacDonald and we worked together for quite a while. Um what then happened, uh which happens to actually a lot of my graduates when they finish Hartbury University is they start a family. So I had my son

And uh left the NHS and went into full time equine and uh private human practice. At that time I was treating a lot of riders, I got my Pilates, uh, instructors qualification, so I ran Pilates for Riders courses locally. And um I'd sort of dabbled a little bit with doing online and putting videos on YouTube and it was all sort of good fun at the time. Um I wasn't sort of thinking about research or teaching.

One of my clients, uh locally to me here in Devon was Hailey Randall, and she is now Professor Hailey Randall. And she works at Charles Sturt University in Australia now. But I was treating her horses. She did endurance with her Arabs, and we were talking about research and And uh she told me that she worked for Dutchy College, which was uh in Callington, so still is in Cornwall. And she ran the equine degree programmes there.

She invited me to teach on the applied rider performance module to start with, so I went down, did a few guest lectures, and then I took over the running of the module. and it was my first experience of working in higher education. I really, really enjoyed it. I was able to sort of interact with uh students on the Equine programmes, look at the rider as part of their

There's a relationship with the horse and the influence on the horse. And um I still know a couple of my students and even one has gone on into lecturing, the other one um turned out to be a fantastic equestrian coach. And so that's, you know, a really nice sort of uh closing the loop to education into applied practice.

But um W as well as running the undergrad equine programmes, Haley also ran the Equitation Science Masters and they had a research master's at Dutchy Uni that was validated by uh Plymouth University. And she convinced me that um I ought to carry on with my studies. And the reason for that was whilst I was teaching and working in practice

Uh Norr Stubbs published her papers. The the first one that I read was about the presence of osseous pathology in the horse's back and the fact that there was a relationship Between the size and the symmetry of the multifitous muscle are actually at the levels where there was osseos pathology at in the vertebral um thoroughcolumbar region.

So, um, you know, I was like, Oh, oh that that's my method and her supervisor was Doctor Kathy McGowan, who is my supervisor at the Royal Vet College. And I was like, Oh, oh that looks familiar. And then a little while later, she released her infamous study on what everybody calls carrot stretches, um, should be better termed um exercises because they are active on the part of the horse. So that's why we call them dynamic mobilization.

And with that research, she used the ultrasound imaging of the size of multifidus to demonstrate that with 12 weeks of the exercises, the actual size of them and the symmetry of them improved. And again I thought, Oh, that's really familiar, that that's my research.

And so I studied I so looked into it a little bit more and realised that actually um my original reliability study had sort of paved the way for her PhD. Now at the time I I was like, oh, but you know, I wanted to do that, but I wasn't in the situation because I didn't go to Australia and um by that stage I'd had my second child. Um so, you know, research hadn't been an option until Haley mentioned this research masters.

And I was like, right, I was fueled up. I wanted to uh do something similar. So I signed up for the research masters. Um Chloe, my uh baby at the time was quite baby, quite young, as a bit of a mad thing to do, but Haley convinced me that I was capable and I was gonna be able to do it.

So um off I went and I had to do some talk modules. So I had to do a module on contemporary research practice and I did it on the uh the addiction to Diet Coke that I um seem to have and I looked into the sweeteners and all the research into rats and I can remember um presenting to my cohort uh it in uh Plymouth

And it was a cohort of mixed scientists, so not just the equine ones, and I stood at the front of the lecture theatre and said, Hi, my name's Julian, I'm addicted to Diet Coke but that's good'cause I'm not a rat and I'm not gonna die of cancer. Uh that stuck in my mind quite strongly. But anyway, that was um it was all about just understanding research and being able to take uh, you know, a a story, uh a body, uh a whole group of research and be able to present

So what did I do for my research masters project? Well this was the one where I took racehorses. So I took 12 racehorses and uh fortunately they were accessible to me because I was working at a racing yard as a physio on a weekly basis at that time. So my twelve race horses were they're all the same breed, they're all thoroughbred, they were all within a very sort of narrow age range, they were between the age of three and I think

Uh six and a half. They were all undertaking a very, very similar exercise pattern, which I logged, and they were all stabled, they were all. the same feed uh and the same day to day management. So uh if anybody is out there that understands the challenges when it comes to trying to limit the variables with your sample in research, you'll see that I had quite good homogeneity, so they were all as similar as, you know, possibly you can get when it comes to horses.

So out of my twelve horses we randomly select uh randomly allocated them to two groups and one group didn't have any change to their management. And the other group had our dynamic mobilisations five times a week. So we followed the protocols set out by Norell and her study. But we actually measured the size of multifetes, not just at day one and at twelve weeks, we measured it at six weeks as well.

And in this study we're able to show that the size of multifidus had increased by six weeks and then it sort of plateaued off and there wasn't a significant change between the six and the twelve weeks. But that was in the exercise group and there was no change to the size of multifitis between zero and six uh zero and twelve and between six and twelve weeks in the control group.

And this was really interesting because as I said they were fairly matched in their exercise levels and they all started out at the same stage. So The group that just did their race training, um, and this this is all they did. So they uh went and they warmed up round uh a a 250 metre track and then they uh galloped some days, they cantered some days and they didn't do anything else on the other days or they went on the walker. Um those horses didn't have a change in their size of motivity.

So this is really interesting because this was suggesting that actually these dynamic mobilisations in addition to a usual training programme are what was influencing multiplicity.

And if we sort of make a a huge assumption that there is a relationship between training and uh the sort of effect on the spine And also another assumption that if we could develop multifitus, perhaps we could reduce that effect, then this showed that you needed to do the dynamic mobilisations in addition to the normal training. Now I'm taking a couple of big leaps there and um you know that's something that I advise my students and myself not to do when you're writing conclusions.

But if we sort of extrapolate from the human research and and um you know if we had the benefit of a crystal ball, we might want to do a study where we look at the size of multifidus and the incidence of spinal pathology over a period of years with groups of horses. Now unfortunately that study hasn't been done, but that's really sort of what we want to know because at the moment it's it is guessing.

But I can say that in addition to normal exercise, doing your dynamic mobilisations did help in these race.

So that was sort of fairly useful and it it was wonderful. I I really enjoyed being back in research. Um as an aside, what I did is a a couple of other projects. So we knew the size of the multifidus in these horses at three stages, so at week naught, at week six, and week twelve. And I also used a flexicurve ruler to take a template of the thoracic profile at those levels at the same time that we did the ultrasound imaging of the multitude.

Now the reason I wanted to do that was I wanted to see whether there was an easy way of evaluating what was happening in those deeper stability muscles. Uh compared with actually having to have a uh you know, usually a vet with their imaging equipment to be able to measure the size of multiple. And um when you looked at the relationship between the changes in the size of multifidus and the changes in the size of the thoracic profile, unfortunately uh there wasn't any correlation.

So what that tells us is you can't actually evaluate the size of multifidus by measuring anything externally. Now some of you out there might go, well duh, that's obvious. The thoracic profile takes into account not just the multifitous size but it takes into account the longissimus dorsi dimensions and also iliocostalis. It also takes into account the thickness of the hair, the skin and the underlying fat layers, the adipose tissue, under the skin and also between the muscles.

Now I was hoping because these were sort of fairly um lean racehorses that would be less of an effect but obviously that I didn't have anything that could measure the fat volume in my circumference areas. But uh, you know, it was just just, you know, another sort of uh way of seeing whether from a sort of an external simple field-based measure we could evaluate change and multiplication. So uh sadly that's not effective.

And it's something that people that use a flexicurve ruler to evaluate templates do need to take into account because it's not just the muscles you're measuring, there's lots of other tissues that influence um that area. Now, time of year, whether your horse is fit or whether your horse is um leaner, it actually doesn't affect your measurement based on um how you're going to use that for your saddle fit, of course, because that profile is your profile.

But if you are trying to evaluate the effectiveness of an exercise program so that you can evaluate change in muscle dimension, so that hypertrophy, the growth or the atrophy, the uh wastage of those muscles, then unfortunately you can't do that. So um that was a bit of a problem.

And then also because I was interested in posture uh that back then as well as I am now, I wanted to see whether there was any methods that we could use to evaluate posture. So again, going down this route of measurement tools, which um seems to have been my been my journey for the last twenty odd years, I wanted to look to see whether we could measure posture from photographs of horses standing up.

uh standing up square. So the idea being that posture being something that is dynamic and can change compared with confirmation, that is something that is fixed uh when the horse is mature, certainly through the skeletal spine anyway. I thought that, you know, could I measure the posture of the horse's back uh from photographs?

This is this is something that um came to my mind when we were thinking about what causes kissing spines in horses. Now, understandably uh without X-ray you can't diagnose kissing spines and certainly without further interventions looking at whether they are the the source of pain or not, you know, using diagnostic analgesia, uh and perhaps, you know, um very sort of uh more sophisticated diagnostic tools than just looking at the posture.

But I was thinking from um a clinical point of view, there are a lot of horses that I see that have back pain that I look at them and think, Wow, they're really hollowed through their back. They're they're carrying that region that we sit on in an already extended position. We know that there is research to suggest that when we put weight on a horse's back

that then puts them into more of more of an extended position, then that is going to approximate those spinous processes. So it's going to bring those regions that might suffer with kissing spines closer together. So if we can try and measure the amount of hollowing, which is uh technically called laudosis, and we could change that through exercise, through um development of further dynamic mobilization exercises, or perhaps um

through our um manual therapies, then that would be a good thing. But to be able to evaluate this change, we need to be able to measure it with a reliable and a valid tool. it is not enough for us to just to sort of stand there and say, oh look, that looks better. We need to have that objective data to actually evidence our change. So I took photographs of a number of horses. Again, I think we used twelve horses.

and I had them stood up square, took a photograph with a standardized protocol. We then put them back in the stable and brought them back out an hour again later. We then did the same. Um I'm saying we I had some very, very helpful research assistance to be able to do this. I um had a uh an item of known size in the photograph so that I could have a scale.

And I was able to show that there was no change in my measurements of the posture of the horse's thoracolumbar spine when they were measured three times from one photograph. and at each uh interval, so an hour after each photograph.

I was hoping that that hour wasn't going to introduce any change. The horses were stood in their box and they were eating um hay through the same method as they were between each of the photographs, and I showed that my uh posture measurement was reliable with that small number of horses.

Um, it is a very gross measure. It is just a measure of the extension of the spine. Um, but um V interestingly alongside this at um unknown to me at the time, Doctor Hillary Clayton or Professor Hillary Clayton was looking at the changes in the vertebral movement with the dynamic mobilization And subsequent me doing my little pilot study, she actually published a fantastic study that we use a lot in sort of referencing the dynamic mobilization exercise.

to show that with um the exercises that move the horse's head are in a further distance, either lower down between the fetlocks or further around towards the stifle and towards the hop, actually influences the intervertebral movement of the thoracolumbar region. So this has actually led on to further studies that I'll tell you about later that you might have already read when we looked at the change in the posture of horses with dynamic mobilisation exercise.

But just you know to um track back a l little bit, um this was my research masters and I started it. I did all my data collection, started writing up and then we're now in the early 2000s and tens. I got my interest back into research. I had access to some of the published research at that time. And as an aside, it's interesting to see how long that process from conducting research to actually it sort of hitting the desks or or hitting the clipboards of those that are actually out in practice.

So If we look at the timeline, I did my reliability study of ultrasound imaging in two thousand and one. Norell published her papers in 2010 and 2012, but she must have been data collecting around 2005, 2006. Um I hadn't sort of thought about research. I didn't have access to research. So I worked in practice for uh seven, eight years without really um having my methods influenced hugely.

Uh, and then, you know, it it sort of all hit at the same time. The research came out, I started my research masters and I was able to at that time um start sharing some of the information I knew. I like a lot of my colleagues that do now, I spoke at uh riding club evenings, I spoke vet practice, uh client get togethers, uh just to try and um share some of that knowledge that we have.

But it it seems that from the literature into medical studies and um into some other forms of science that it apparently it takes thirteen years for a research study f to go from Um so data collection to actually that knowledge getting out and about.

So I think all of us that are involved with our clients and perhaps have the opportunities to do these evenings where you're talking to members of public who are really keen to do the best they are for their horses. I think, you know, getting out there and sharing knowledge is absolutely fantastic. So where did that leave me? Uh I actually completed my research masters, I published my thesis.

and going back full circle I had two external examiners. One of them was the director of the faculty at the University of Plymouth, but the other one was an invited external examiner who happened to be Philippa Coles from Cardiff University. and um gosh, that was sort of quite a a a moment I walked into the room with trepidation, I was super nervous. I had to

Uh have a viver. It seemed to last for days. I'm sure it was only about an hour, but I had to sit there and be questioned. She sat opposite the desk. And on hers she had little post-it notes literally look like every single page and she turned to page one and she said Right, I'd like to ask you about this and I'd like to ask you about and went through every single like item that she had a question on. Um some of it were challenging questions, certainly the ones on statistics.

Uh Hayley was sat behind me in the room and I sort of almost feel feel her cheer when I was able to answer the questions on um the Blandon Outman and the um genuine general linear model Annova that I used for uh data analysis.

Um but yeah, I passed that. But um in the meantime I realised that I actually enjoyed the sort of academic side of it. I'd enjoyed module leading at Dutchy and a job at Hartbury University had come up and I had sort of said to my family, Oh, it you know, it's too far away, I'm not going to do that. And then I

Yeah, I I might have had a a a really nice roast dinner with a glass of wine on a Sunday evening and I was um talking to my husband and he said, Well, what's the harm in applying? So I applied literally the day before the closing date and um the next day I actually heard that I'd been offered an interview and the rest is history really when it comes to heartbreak.

So that was 2013 and so I moved my research journey from the Royal Vet College through the University of Plymouth and then on to Hartbury College. uh a faculty of the University of the West of England at that time.

And so yes, in my next podcast I'll go on to talk about the series of studies that I've have done since I've been at Heartbreak University. was part two of my Multifidus story. I'm not over and done with Multifidus but I think I had sort of found out enough and actually it had uh been the stimulus to get back into academia. And um w we all know where the popularity is with the dynamic mobilisation exercises. I still

prescribe them to my clients and um they've been ultimately they've been really, really useful. So a fantastic choice of core stability exercise decided by Norell Stubbs and Dr Kathy McGowan. and have been, yeah, really that sort of impetus to keep going with the research and there's lots of fantastic projects that have come out, um, with that sort of area and the idea of core stability. So I'll leave you there for the sort of first decade of my research and I hope you've enjoyed it.

And I'll go into sort more of my recent studies and how they link to the wider evidence base as we go through the next three po next few podcasts.