What is Equine Veterinary Medical Manipulation?
We are excited to announce that Dr. Katy White is now offering equine veterinary medical manipulation
(EVMM)!
This manual therapy, similar to chiropractic work or spinal manipulation therapy, includes a full-body assessment of the horse and incorporates spinal manipulation, fascial work, trigger-point therapy, acupressure, and massage.
Dr. White completed a certification program with over 150 hours of training from the Chi University in Ocala, Florida that is specifically for veterinarians with a focus on performance horse medicine and rehabilitation.
EVMM falls under the umbrella of integrative veterinary medicine, a practice that blends western medicine with holistic techniques such as manual therapies, acupuncture, and nutrition in a personalized “whole-horse” approach. See below for some frequently asked questions about EVMM and reach out to our clinic today if you’d like to explore this option as a part of your horse’s general preventative health care plan or treatment for a specific condition today!
FAQ:
Are EVMM and chiropractic the same thing?
Chiropractic, defined by law, applies specifically to humans. A chiropractor has completed human chiropractic training and obtained a Doctor of Chiropractic degree (DC). When similar techniques are applied to animals, it is most correctly called spinal manipulation (axial skeleton) or medical manipulation (whole body treatment) though there are many practitioners (DC and DVM) who will use animal chiropractic or spinal manipulation therapy techniques.
The designation of “Certified Veterinary Medical Manipulation Practitioner” (CVMMP) is only available to veterinarians to have completed the Chi University’s VMM programs. For equine veterinarians, this includes a performance horse medicine pre-requisite course, extensive anatomical studies and class work, in-person hands-on clinical labs, and a comprehensive final exam including a written exam, osteology and anatomy exam, and a practical exam.
What is EVMM?
Equine veterinary medical manipulation (EVMM) is a combination of manual therapies including spinal manipulation centered around restrictions in joint motion (sometimes referred to as subluxation). A normal joint’s range of motion can be restricted due to changes in the bones, soft tissues, nerves, or joint fluid. This misalignment creates abnormal pressure and inflammation that affects the surrounding nerves and soft tissues. For example, a restriction in the neck may have associated mechanical effects pinching spinal nerves or inflammation of associated spinal nerves resulting in forelimb lameness. By applying fast, high velocity, low-amplitude thrusts to the affected joints, adjustment can help restore normal range of motion, release muscle spasm, and improve nerve function without forcing a joint outside of the safe range of motion. When combined with massage, acupressure, regenerative laser therapy, and/or trigger point therapy (as is typical of your average EVMM appointment) it can help to provide long-lasting comfort for the horse and act as an adjunct to traditional western veterinary techniques (e.g. joint injections etc.).
What can EVMM be used for?
EVMM can help to address problems in the head, poll, neck, back, pelvis (including sacro-iliac pain), and limbs. These problems may lead to lameness or more subtle signs such as poor performance, uneven gait, lack of impulsion, or poor attitude. It is proven to improve range of motion and comfort for horses with back and neck pain. It is helpful to address cases of mild acute injury or pain as well as to slow the progress of degenerative conditions. As such, it is an excellent, non-invasive treatment option for performance horses in their overall athlete management program. That being said, these benefits are not limited to performances horses. Regular adjustments can dramatically increase mobility, comfort, and quality of life for pleasure horses, geriatrics, and horses recovering from injury or illness (especially those on stall rest).
Are there any limitations to EVMM?
While EVMM has many benefits, there are certain times when it is contraindicated or not helpful. We do not recommend EVMM in cases of neurologic disease, when there is hypermobility of a joint, or when there has been a significant acute trauma and we have concern for potential fracture or other serious underlying disease. EVMM should also be used carefully when extensive arthritis is present. This is because when extra bone development (osteophytes) or fusion has occurred, then adjustments may need to be limited and alternative manual therapies, laser therapy, or joint injections relied upon. Being a manual therapy, EVMM is considered a relatively gentle manipulation technique compared to those who utilize tools (e.g. hammers or percussion tools) that may increase the risk of adverse event by pushing the range of motion beyond the normal anatomic limits. The benefit of seeing a veterinarian who is EVMM certified for these cases is that they can identify underlying disease which may require further diagnostics or alternative therapies beyond which the average lay person can offer.
What does a typical EVMM appointment look like?
At your visit you can expect a static musculoskeletal exam and dynamic exam of your horse at a walk with a “find-and-treat” pattern as your horse is assessed from nose to tail. Adjustments may be performed on joints as they are identified, as well as manual therapies including massage, acupressure, or fascial work that tend to improve the quality and length of the treatment result with adjustment. At additional cost, regenerative laser therapy can be added.
An initial visit is typically 45 minutes in length with follow-up visits lasting about 30 minutes. In acute situations, a series of 3 treatments spaced 1-3 weeks apart is generally recommended. For more routine health and performance maintenance, most horses do well when adjusted every 4-6 weeks while accounting for their condition and competition schedule. Ideally, they should have no forced exercise (regular turnout is OK) on the day after their adjustment. Stretching and return to work programs will be personalized to your horse. (Note: the walk is an excellent gait to tell us about restrictions in joint movement due to its 4-beat nature and increased axial skeleton motion compared to trot or canter; examination of other gaits can be performed as part of a more comprehensive soundness/lameness examination).
What is the cost of an EVMM visit?
For 2025, Burwash Equine is excited to be offering a special introductory EVMM rate with costs comparable to a basic soundness exam. All initial visits come at a slightly higher rate to account for the additional time associated with getting to know your horse with discounted rates for regular follow-up visits. You can save money on clinic visit fees by attending our monthly “EVMM Days” with Dr. White at the clinic or on farm calls by coordinating visits with people in your area.
Is acupuncture offered?
At this time, we do not have any acupuncture certified practitioners at our clinic but acupressure and other manual techniques will frequently be incorporated into your horse’s EVMM treatment.
Is there any science behind EVMM?
Yes! There are blinded, peer-reviewed clinical trials in all species, but specifically in horses we have research that shows improved range of motion, pelvic tilt, lameness scores, pain scores, and nervous system regulation after manipulation. See below for a short (but not comprehensive list) of some of the more recent and impressive research in this area.
ALVAREZ, C.B.G., L'AMI, J.J., MOFFATT, D., BACK, W. and van WEEREN, P.R. (2008), Effect of chiropractic
manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems.
Equine Veterinary Journal, 40: 153-159. https://doi.org/10.2746/042516408X250292
HAUSSLER, K.K., MARTIN, C.E. and HILL, A.E. (2010), Efficacy of spinal manipulation and mobilisation on
trunk flexibility and stiffness in horses: a randomised clinical trial. Equine Veterinary Journal, 42: 695-
702. https://doi.org/10.1111/j.2042-3306.2010.00241.x
Haussler, K. K., Hesbach, A. L., Romano, L., Goff, L., & Bergh, A. (2021). A Systematic Review of
Musculoskeletal Mobilization and Manipulation Techniques Used in Veterinary
Medicine. Animals, 11(10), 2787. https://doi.org/10.3390/ani11102787
Kevin K. Haussler, Philippe T. Manchon, Josh R. Donnell, David D. Frisbie. Effects of Low-Level Laser
Therapy and Chiropractic Care on Back Pain in Quarter Horses, Journal of Equine Veterinary Science,
Volume 86, 2020, 102891, ISSN 0737-0806, https://doi.org/10.1016/j.jevs.2019.102891
Lorello O, Rule E, Haughan J, Wang K, Niu M, Brown K, et al. Chiropractic effects on stride parameters
and heart rate during exercise in sport horses. Equine Vet
J. 2025; 57(1): 69–75. https://doi.org/10.1111/evj.14043
Maldonado, M. D., Parkinson, S. D., Story, M. R., & Haussler, K. K. (2022). The Effect of Chiropractic
Treatment on Limb Lameness and Concurrent Axial Skeleton Pain and Dysfunction in
Horses. Animals, 12(20), 2845. https://doi.org/10.3390/ani12202845
Erin K. McQueen, Sarah E. Urban, Mike T. McQueen. Equine Performance and Autonomic Nervous
System Improvement After Joint Manipulation: A Case Study, Journal of Equine Veterinary Science,
Volume 56, 2017, Pages 80-87, ISSN 0737-0806, https://doi.org/10.1016/j.jevs.2017.04.012