Dr. Lance Cleveland

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Report of Findings Summary: What They Mean and How They Can Help You and Your Horse.

Report of Findings Summary
Phase I and Introduction
(Click here to download the newsletter to print.)
Following each equine evaluation and treatment, we create detailed documentation for my records. From the detailed documentation, we then create an Evaluation & Treatment Report of Findings Summary for you. The Summary is exactly that, the highlights of the evaluation and treatment that I performed that day. It is a brief communication expressing my findings, the treatment performed, and the assigned recommendations (homework) that I am asking you to performed to enhance your horse’s rehabilitation, longevity, and optimal performance. An outline of the complete equine consult protocol used on each visit is located on the back of your summary.
Creating detailed documentation for every treatment that I have performed over the years has allowed me to observe that horses present with patterns of fixations or subluxations. With the exception of trauma, it is my observation that these patterns are present in an extremely high percentage of sport horses. Trauma will alter and sometimes present a reversed pattern of fixation from that which I find in chronic failed biomechanics, with compensatory adaptive physiology.
I have divided these patterns into three phases to assist you in making sense of your horse’s Evaluation and Treatment Summary. Comparing your horse’s summary with the example summaries should help to increase your awareness of its current biomechanical and functional ability.
This newsletter will discuss and illustrate Phase I. The next newsletters will discuss and illustrate Phase II, then Phase III. The intent of this information is to share my observations with you for the enhanced health and well-being of our equine friends. Clarity is an essential portion of these newsletters, so please direct your questions to me so that I can continue to improve this service. I realize that I condense a large amount of information into these newsletters, so we will archive them on my website for your future reference. I will also revise them from time to time to enhance communication.
Phase I ~ Scenario In a Nut Shell
Phase I is usually the initial phase of care for a horse that has not previously been under any type of effective chiropractic care, and is suffering from biomechanical malfunction, with compensatory adaptive physiology. The following is a very common scenario regarding the presentation of a horse referred to me for evaluation and treatment.
I think that it would be helpful for your understanding of failed quadrupedal biomechanics for me to first set the stage of the scene that has typically occurred prior to my being called into a case.
The initial causation factors that I find are more frequently related to the absence of an event than to the occurrence of an actual traumatic event. In other words, inactivity or greatly reduced activity can bring one of these athletes out of condition quickly, similar to decubitus ulcers or “bedsores” found in humans that are inactive in hospital beds. We are we designed for motion and mobility. Life is motion, without it we begin to atrophy and our tissue wastes no time before it begins to break down. Our muscles now adapt to the new level of reduced work or inactivity. In horses, this reduced activity can be due to; stall rest during the rehabilitation of an infirmity, turnout to a new life of grazing after a previous lifestyle of consistently heavy work. In short, stalls can be job security for animal chiropractors.
Following this period of reduced activity and muscle shortening, one day just being a horse, a bucking episode occurs which causes the pelvis to rotate toward extension. If the hind muscles have shortened, it may allow the pelvis to “stick” or become fixated in this extended position. A pelvis locked in extension can be very painful for our equine friends, so they now attempt to correct themselves by bucking even more. This can cause the pelvis to go further into extension or hyperextension, causing even greater pain for the horse. Bucking can eventually release endorphins, which can give the horse some relief and may even cause the horses to think that they are correcting or helping themselves, but in reality, they may only driving the pelvis into further trouble.
When the pelvis is fixated or subluxated in extension or worse yet, hyperextension, not only can the horse tend to experience back and pelvic pain, but it can also begin to suffer from a lack of weight bearing abilities. A pelvis fixated in extension is like an unloaded spring that cannot load. It causes weight-bearing difficulties for the horse to support its own weight, not withstanding, the weight of a rider. In an effort to ease its discomfort, the horse will apparently begin to shift its weight forward to the front legs to overcome the level of weakness that has developed, or is developing in the hind. This can be compared to one of us walking around in a handstand, or what riders often describe to me as their horse being “heavy on the forehand.”
If the horse shifts another 10 to 15% of its weight forward to get it off the hind, then before long, symptoms begin to arise in the front end, because it is only designed to carry 55-65% of the horse’s weight. Eventually something has to give. It may cause front-end lameness or soreness in the shoulders and eventually the horse may use its head and neck as a counter-balance to get even more weights off the hind, eventually causing fixations in the neck and poll.
At this point, the veterinarian is called in to perform a lameness evaluation. Unless there has been direct trauma, or over-utilization injuries due to the forward weight shift, the lameness evaluation may prove to flex within normal limits. This is when I typically receive a referral from the veterinarian. It could be Phase I.
Phase I ~ Report of Findings Summary
The Report of Findings Summary for a “Phase I” horse can only be described as appearing bloody! There is so much red ink on the report that it looks like the horse is bleeding profusely. It would be difficult to confuse a Phase I horse with any other phase. It is not the kind of report card that you would want to post on your refrigerator!
Usually the horse has experienced a trauma, a period of inactivity, stall rest, or has been in chronic pain due to prolonged failed biomechanics. Frequently, by the time I am called to evaluate a horse, it is experiencing a form of compensatory adaptive physiology. The horse has had back and pelvic pain, shifted weight forward, pulled its knees into fixation, twisted its rib cage, and used it head and neck to pull weight off of the hind until the neck and poll is lodged or fixated in the counter-balanced position. A “bloody” mess!
This is not a happy camper. This horse is not likely to be glad to see you or your saddle coming toward it. When the pelvis is locked or fixated in extension, it is difficult for the horse to canter since that requires pelvic flexion on the opposite side from the lead. To make matters worse, if the sacrum, the bone between the pelvic bones, like the horses “rudder,” is stuck to the left, it would be difficult to get your horse to bend to the right. In my experience, one-sided issues tend to be more of a physical problem than mental or “training issues.”
Eventually the counter-balancing poll will remain fixated. In the human world, when our “poll” is subluxated or fixated it can cause migraine headache-like or even “hangover” symptoms. You remember…”Turn down the stereo, don’t you know I have a headache.”  You just want to pull the covers over your head because the lights are so bright.  “Just leave me alone; don’t you know I feel terrible?”  Well in horses, we just like to call them “spooky”! In humans, it is an uncomfortable inconvenience; in horses, a prey animal, their instincts may tell them that it could be a death sentence. If their poll locks or subluxates in the wild to the point that and they cannot see what is coming up behind them, they can become dinner. As a result, their priorities may be different than yours when under saddle.
The arrows over the top and side view of the pelvic region demonstrate the direction of pelvic fixation or subluxation. The small triangle between the pelvic bones will point in the direction that the “rudder” (sacrum) subluxated. The columns depict areas of subluxation, muscle spasms, pain, and restriction on each side as viewed from above.
Prolonged front loading will eventually subluxate knees, fetlocks, shoulders, etc. The scale at the bottom rates your horse’s hind flexibility and hamstring length by the amount of cross-under ability in “hoof widths” across the midline. Optimal is (2) hoof widths across the midline. The “Findings” will speak of the progress in Phase I.
The “Notes” will provide recommendations or homework to help your horse advance to Phase II. The back of the Report of Findings Summary outlines the consult episode, and contains a reminder of the online location, username, and password for the assigned homework stretching video for your reference.  Focusing on muscle lengthening stretches and exercises are the key ingredients needed for me to help your horse advance to Phase II.
If a date has been set for my return visit, it will be written on the bottom of your Summary.

Equine Chiropractic Evaluation and Treatment
My chiropractic evaluation and treatment consultation typically includes:
For New Patients: Stationment: A description of the patient including: name, age, gender, breed, color, and unique markings
History and chief complaints including: Location, date of onset, duration, exacerbations, remissions, previous medical, and chiropractic history. Handedness of the rider, and the side of the body on which the patient most frequently sleeps.
For New and Established Patients: A brief updated history of the patient’s activities, your observations, and the level of training and any changes in performance since the previous consultation.
Observation of the patient’s postural adaptation to the environment. Static and motion palpation of the spine and primary musculoskeletal system to help locate areas of restricted range of motion, as well as areas of pain.
Spinal testing with the Activator - a chiropractic adjusting instrument which in quadrupeds can also be used for testing and sometimes treating areas of the spine that are subluxated. Subluxations are fixated vertebrae that can cause abnormal function, and frequently also cause nerve root irritation and pain.
Gait analysis: Observation of movement at various gaits as needed to demonstrate the degree of spinal soundness.
Formulate an assessment of my impressions as a result of the evaluation regarding the patient’s current biomechanical state.
Manual Adjustments of the spine, pelvis, and extremities to reduce fixations or subluxations.
Determine Assignments for the client to perform between chiropractic visits to enhance the patient’s rehabilitation, optimize performance, or to maintain soundness.
Create a detailed written Report of Findings for the patient’s chiropractic records.
Create a Summary of my Findings which is provided for you, the client to have a general overview of the findings, treatment, and recommendations formulated during each visit. If you would like a copy of the more detailed data recorded for my records, please give us a call.
Follow-up appointment scheduled as needed.
A stretching video is provided as a training reminder for you on my website. Go to: http://www.theanimalcracker.com scroll to the client’s page. Click on the stretching video. When a window pops up asking for: Username enter: equine Password enter: stretches
Be sure to sign up for my newsletter while you are there for additional helpful information about Phases I, II, and III.
Please direct your questions to me at lance@theanimalcracker.com
Thank you for your continued interest in animal chiropractic.
Dr. Lance E. Cleveland
Animal Chiropractor

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Phase I

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