10 Veterinary Times

PACK mules play an essential

role in mountain tourism and

agriculture in the High Atlas

of Morocco and contrib-

ute significantly to the local

rural economy.

Harness sores and injuries

are a common health problem

with significant welfare implica-

tions in these remote areas

(Sells et al, 2010; Cousquer,

2011). Tethering injuries are

commonly seen in expedition

pack mules and arise where

the tether causes damage to the

underlying tissues. This article

reviews the aetiology of these

injuries and key points that must

be considered in developing

solutions to sustainably reduce

their incidence.

Three different potential

solutions were presented to

muleteers working for the Cen-

tre de Formation aux Métiers de

la Montagne (CFAMM) during a

300km, 12-day crossing of the

High Atlas in 2010 and in 2011.

Drawing on these experiences

and feedback from the mule-

teers, the three alternatives are

compared and evaluated.

Owners of expedition pack

animals feel the need to tether

their animals to prevent them

wandering off (Brager, 2005;

Cousquer, 2011; US Army,

2004). Plastic or nylon rope

is readily available in Morocco

and many other countries in the

developing world. It is cheap,

strong and durable and, when

knotted around the lower

limb of a mule, will prevent its

escape if secured to an immov-

able object, such as a tree,

fence post or stake (Figure 1).

Unfortunately, tethering sys-

tems made from wire, chain,

nylon or plastic rope, and other

synthetic materials, can easily

Developing solutions to expedition pack mule tethering injuries in the High Atlas

GLEN COUSQUERBSc(Hons), BVM&S, CertZooMed, PGDOE, MSc, MRCVS

HASSAN ALYAKINEDVM, PhD

continue an article begun in VT42.09 by looking

at the damage some methods of mule tethering

can cause and highlighting three alternatives

WELFARE EQUINE

cause damage to the underlying

tissues (Hadrill, 2002; Pearson

et al, 2003; Garrett, 2010;

SPANA, 2002). This occurs in

a number of ways. The tether

can move across the affected

area, rubbing the underlying

skin and produce a friction burn

(Thomsett, 1991) – with clinical

signs sometimes taking days or

weeks to appear (Knottenbelt

and McGarry, 2009; Figure 2).

Direct pressure applied to

a small surface area can also

cause damage where the nar-

row diameter of the material

used allows it to cut through

the skin and into the underlying

soft tissues (Figures 3 and 4).

Where the skin is damaged

the creation of a wound may

continued on page 12

Figure 1. This pack mule has been short-tethered using a length of thin plastic rope. The rope is tied around the mule’s right pastern and wrapped around a convenient tree stump. The muleteer is pulling on the head collar in an attempt to stop the mule pulling back on the tether. An old injury is visible over the mule’s left pastern.

these agents also differs between

individuals. The use of N-methyl-

D-aspartate (NMDA) inhibitor

amantadine, in combination with an

NSAID has been reported to have

SAMANTHA WOODS graduated with a pharmacology

degree from the University of Aberdeen in 1998 and

qualified from the University of Cambridge in 2003. After

four years in mixed practice, followed by a small animal

internship at Dick White Referrals, she completed a surgery

residency at the Royal (Dick) School of Veterinary Studies,

University of Edinburgh where she is now employed. In

2010 Sam gained the RCVS certificate in small

animal surgery and is now studying towards the DipECVS.

efficacy in the treatment of OA pain

(Lascelles et al, 2008).

Corticosteroid therapy and intra-

articular corticosteroids are not rec-

ommended for the treatment of

canine OA. Intra-articular therapy

may provide a temporary remission

of clinical signs, however, steroids

accelerate the catabolic processes

occurring in OA patients, leading

to an eventual worsening of the

disease process.

Other treatmentsOther documented treatments for

use in OA cases include pentosan

polysulphate, doxycyline, extracor-

poreal shockwave therapy, therapeutic

ultrasound and acupuncture. For all

these treatments there is little, or no,

scientific evidence to support their use.

In one clinical study hyaluronic

acid administered intra-articularly was

shown to effect an improvement in

dogs with OA, but this has not been

reproduced in further studies and the

analgesia provided was only tempo-

rary (Hellstrom et al, 2003).

ConclusionThe treatment of OA is complex and

requires a multimodal approach (Panel

1). Each dog has very different needs

and a good clinician should adapt his

or her approach to the individual case.

It is vitally important to ensure clients

are aware of the necessity to review

and alter therapies regularly, and that

treatment is in no way a “quick fix”.

Although a number of therapies are

available, scientifically proven clinical

trials are few and far between and the

evidence for a large number of sug-

gested therapies is lacking.

AcknowledgementsThank you to Dylan Clements and

Marge Chandler for their input and

images. All images remain the property

of The University of Edinburgh.

References and further reading

Abercromby R A, Innes J and May C (2006).

Arthritis. In BSAVA Manual of Canine and

Feline Musculoskeletal Disorders (1st edn),

BSAVA, Gloucester.

Fox S M and Millis D (2010). Multimodal Man-

agement of Canine Osteoarthritis (1st edn), Man-

son Publishing/The Veterinary Press, London.

Hellstrom L E, Carlsson C, Boucher J F and

Michanek P (2003). Intra-articular injec-

tions with high molecular weight sodium

hyaluronate as a therapy for canine arthritis,

Veterinary Record 153: 89-90.

Lascelles B D, Gaynor J S, Smith E S et al

(2008). Amantadine in a multimodal anal-

gesic regimen for alleviation of refractory

osteoarthritis pain in dogs, Journal of Veteri-

nary Internal Medicine 22: 53-59.

Marshall W G, Hazewinkel H A, Mullen D et

al (2010). The effect of weight loss on lame-

ness in obese dogs with osteoarthritis, Veteri-

nary Research Communications 34: 241-253.

Millis D L (2006) Nonsteroidal anti-inflam-

matory drugs, disease-modifying drugs, and

osteoarthritis, Veterinary Medicine supple-

ment: 9-19.

Roush J K, Cross A R, Renberg W C et al

n MANAGING THE OA-AFFLICTED DOG – from page nine

PANEL 1. MULTIMODAL

APPROACH OVERVIEW TO

MANAGING THE CANINE

OSTEOARTHRITIC PATIENT

1. Assess patient, stage the disease and ensure the client is on board.2. Adopt a weight loss plan for overweight animals.3. Consider the exercise regime.4. Provide analgesia (NSAID).5. Consider nutraceutical supple-mentation or prescription diet.6. Monitor clinical response – change regime if necessary.7. Consider further analgesia if “breakthrough” periods occurring.8. Consider salvage surgical pro-cedures if conservative therapy fails.

(2010). Evaluation of the effects of dietary

supplementation with fish oil omega 3 fatty

acids on weight bearing in dogs with osteo-

arthritis, Journal of The American Veterinary

Medical Association 236: 67-73.

Salter R B, Hamilton H W, Wedge J H et al

(1984). Clinical application of basic research

on continuous passive motion for disorders

and injuries of synovial joints: a preliminary

report of a feasibility study, Journal of Ortho-

paedic Research 1: 325-342.

Sparkes A H, Heiene R and Lascelles B D

X (2010). ISFM and AAFP consensus guide-

lines: long-term use of NSAIDs in cats, Jour-

nal of Feline Medicine and Surgery 12: 521.

Tobias K M and Johnston S A (2012). Veteri-

nary Surgery Small Animal (1st edn), Elsevier

Saunders, Missouri.

Veterinary Medicines Directorate (www.

vmd.defra.gov.uk/). n

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n DEVELOPING SOLUTIONS TO EXPEDITION PACK MULE TETHERING INJURIES IN THE HIGH ATLAS – from page 10

induce the owner to swap

the tethering to the other leg,

thus temporarily eliminating

the cause of any wound and

affording it an opportunity to

heal. Therefore, in time, inju-

ries appear on both forelimbs.

The presence of broken-off

pieces of nylon rope and other

foreign bodies or contamination

within a wound can, however,

delay healing (Knottenbelt,

2003; Cousquer, 2011). The

repeated and sustained nature

of these injuries results in con-

siderable remodelling of the

local tissues with many older

mules demonstrating scarring

around the entire circumfer-

ence of the pastern. Such indi-

viduals demonstrate varying

degrees of leukotrichia, where

the melanocytes associated

with the hair follicles have been

destroyed (Thomsett, 1991).

In extreme cases, all layers

of the epidermis, including the

basal tissues, are destroyed,

as occurs with second-degree

burns (Hanson, 2005) and

freeze branding (Farrell et al,

1966; Thomsett, 1991). The

destruction of hair follicles

results in the formation of a

hairless scar.

During a weekend veteri-

nary clinic in the Aït Bouguemez

Valley, where CFAMM, the

national mountain guide school,

is based, it was estimated that

less than 20 of the 324 mules

treated had no obvious sign of

tethering injuries (Elmouhaine,

pers comm). This is consistent

with the author’s estimate that

90 per cent or more of mules

working in the High Atlas have

such injuries.

Ropes tied above the fetlock

can also cause damage to the

epidermal and dermal tissues

– even the underlying tendons

(Hadrill, 2002). Fortunately,

tendon damage appears to be

relatively rare as the pastern

area is more commonly used

for tethering. However, the inci-

dence of injuries to the tendons,

arising through blunt trauma and

compression, where no skin

damage is visible, may be under-

reported, given the absence of

an external wound.

Tethering injuries are, at best,

WELFARE EQUINE

Figure 5. An owner is shown how a cotton hobble can be attached to the forelimbs

(usually over the pastern, which has been left free here to show the granulating tethering injury provoked by a plastic

rope). The cotton hobble is wider and softer than nylon rope and less likely to cause damage to underlying tissues.

TABLE 1. Key factors in developing a sustainable tethering system for expedition pack mules

Factor Explanation

Secure The tether must prevent mules from escaping

Strength and durability

The tether must withstand prolonged use and weathering

Cost The tether must be affordable

Simplicity The tether must not be overly complicated to use and should be easy to apply and undo

Locally produced

The tether should be produced locally and easily made from materials not requiring importation

Maintenance The tether should be easy to clean and maintain

Technical factors

Natural materials

The tether should not irritate the underlying tissues and should not be made from artifi cial materials such as rubber, nylon or plastic

Atraumatic The tether should be free from sharp edges and as wide as possible to maximise the surface area over which force is applied

Non-constrictive

The tether should not constrict tissues. Slip knots should be avoided as should systems that allow owners to over tighten the attachment

Figure 2. A strip of canvas has been used to form a bracelet as part of a hobbling system on this young mule. The material has been placed above the hocks and been allowed to rub, producing extensive friction burns.

Figure 4. The remote nature of the High Atlas can mean skills, knowledge, understanding and access to good equipment are very limited. This mule has been reshod by a local farrier, who did not have the skills or knowledge to deal adequately with this overgrown hoof. This refl ects the general lack of equine husbandry skills and knowledge in remote mountainous areas. The mule is hobbled with a worn piece of plastic rope that has been over-tightened over the mule’s pasterns.

Figure 3 left). This mule is tethered using a fi ne-gauge nylon rope secured with a self-tightening slip knot above the pastern. The dorsal aspect of the canon shows evidence of hair loss and depigmentation. Bands of depigmentation are also evident over the pastern refl ecting chronic trauma to this area.

abcd Metacam contains meloxicam. Prescription only medicine. Further information available from Boehringer Ingelheim Vetmedica, Bracknell, Berkshire,RG12 8YS, UK. Tel: +44 (0)1344 746959. Email: vetmedica.uk@boehringer-ingelheim.com. Date of preparation: Apr 2010. AHD 6304. Use MedicinesResponsibly (www.noah.co.uk/responsible)

13July 30, 2012 WELFARE EQUINE

uncomfortable and even pain-

ful. At worst, they can provide

a breach in the skin’s defences

through which infection can

enter. However, the incidence

of wound infections is difficult to

quantify, for mules appear to be

resistant to infection. Bacterial

contamination of the wound is

to be expected, but it is difficult

to predict how often it will over-

whelm the animal’s ability to

deal with it (Cousquer, 2011).

It is known that ponies

mount a more effective acute

inflammation during second-

intention wound healing than

horses (Wilmink et al, 1999a;

Wilmink et al, 1999b). It is

likely this is also true of mules,

given their reputed resistance

to disease. The ability to rap-

idly mobilise large numbers of

polymorphonuclear leucocytes

may allow wound infection to

be controlled and the wound to

pass swiftly from the inflamma-

tory to the granulation phase.

Tetanus is often cited as a

serious consequence of teth-

ering injuries (Kay, 2007), but

there has been little work con-

ducted to quantify this risk, rela-

tive to the thousands of mules

with pastern wounds. During

an 18-month period between

2003 and 2004, the Society

for the Protection of Animals

Abroad (SPANA) hospitalised

56 cases of equine tetanus

in Morocco (Kay, 2007). It is

unclear whether this figure

reflects a widespread resistance

to the disease among working

equines in Morocco and, with-

out further research, it is impos-

sible to draw any conclusions.

However, it is probably fair

to say these injuries should be

preventable, and that owners

and employers of pack mules

on expedition have a duty to

ensure the packing equipment

used does not cause injury to

the mules (Cousquer, 2011).

It should be noted that many

of these tethering injuries occur

when equines are first trained to

accept tethering (Brager, 2005).

However, mules are said to

learn more quickly and may be

less susceptible to such injuries

of such injuries in older animals

reflects the fact these injuries are

sustained repeatedly through-

out a mule’s working life.

Developing a viable alternative

M Cotton hobble

Historically, SPANA teams have

distributed cotton hobbles to

owners in an attempt to pro-

mote an atraumatic means of

preventing equines from wan-

dering. However, despite the

distribution of many hundreds

of hobbles, the authors have

yet to see a cotton hobble used

by muleteers in the mountains.

In seeking to develop a pre-

ventive response to tethering

injuries, a number of factors

must be taken into consid-

eration (Table 1). Any solu-

tion proposed must not only

provide an atraumatic means

of ensuring the mule does not

wander off, but must meet the

owner’s criteria for use.

Interviews with muleteers

during the 2009 and 2010

trekking seasons in Morocco

identified a number of key

issues. Muleteers were found

to be unwilling to resort to hob-

bles (Figure 5) on expedition,

as their priority was to prevent

the mule from wandering off.

Cotton hobbles, even when

attached to one foot as part

of a tethering system, were

rejected as insecure and unreli-

able. When trialled, they were

also found to be of inadequate

strength and durability.

In view of the difficulties

experienced trying to persuade

owners to change their long-

held tethering practices, alter-

native systems (Brager, 2005)

were reviewed and a number

of prototypes developed with

local artisans in Marrakech.

The final two models chosen

for trialling had to respect the

key factors detailed in Table 1.

They had to be secure, strong

and durable, and simple to use

and maintain. They also had to

be easy and cheap to manufac-

ture using local materials and

equipment. To avoid potential

over-tightening of the tether, a

system was needed for it to sit

snugly and comfortably in the

space between the coronary

band and fetlock.

Measurements were taken

of the pastern circumference of

13 adult mules (both forelimbs

were measured – yielding 26

measurements) to establish

the range of fetlock dimen-

sions encountered in practice.

These ranged between 16cm

and 20.5cm, with a mean of

17.8cm. The narrowest meas-

urements were recorded in

young mules (aged between

four and five), the largest in

older mules with remodelling

of the underlying first phalanx.

This work resulted in the

production of two models,

which are compared to the

cotton hobble in Table 2.

M Leather bracelet

The first model consisted of

a leather bracelet made from

thick (2mm to 4mm) cow’s

leather. Strips of leather meas-

uring 23cm by 2.5cm were cut

and either end equipped with

a metal eyelet. When closed

around the pastern the eyelets

meet up – allowing the tether-

ing rope to be passed through

and secured with an overhand

knot either side (Figure 6).

This prototype has been

manufactured at a cost of

20MAD (Moroccan Dirham),

approximately £1.42 per unit.

than horses (Guenon, 1999).

The lack of well-designed

atraumatic equipment, together

with inadequate knowledge of

horsemanship (Figure 4) and

animal training, contribute to the

incidence of these injuries, both

in young mules and in older

animals (Cousquer, 2011).

Clearly, the greater severity

TABLE 2. Comparative evaluation of the merits of three different types of hobbling system

Tethering system

Materials Production Local cost Strength and durability

Popularity with muleteers

Strengths (+) and weaknesses (-)

Cotton

hobble

Cotton Local. Requires training

12MAD (Khémisset) 16MAD (Marrakech)

- - Atraumatic (+). Easy to apply (+). Easily undone (-). Insecure (-). Deteriorates rapidly (-). Muleteers reluctant to trial (-).

Leather

bracelet

Cow’s leather and brass eyelets

Local. Requires some equipment for closing eyelets

20MAD + + Atraumatic (+). Muleteers willing to trial (+). Harder to apply as it requires rope to be threaded through eyelet (-). Loose if size does not correspond to fetlock (-). Leather may deform (-). Eyelet may cut through leather (-).

Leather

sheath

Goat’s leather and nylon rope.

Local. Requires needle and thread. Easily made by muleteers.

5-10 MAD +++ +++ Atraumatic (+). Sheath can be supplied at 16cm and rope then cut to fit fetlock (+). Nylon rope takes the load rather than the leather (+). Long lasting (+). Muleteers willing to trial (+).

Figure 6. This prototype leather bracelet is secured around the mule’s pastern. The tethering rope is threaded through the two apposed metal eyelets and secured with an overhand knot on either side. The last overhand knot must be undone to release the mule from the tethering system – this may be difficult if the knot tightens.

continued overleaf

etmedica, Bracknell, Berkshire, -ingelheim.com. Date of preparation: Apr 2010. AHD 6304. Use Medicines www.metacam.co.uk

14 Veterinary Times

trials of the leather sheath are

proposed to evaluate this teth-

ering system further. These

will focus on the will-

ingness of mule-

teers to change

t h e i r h a b i t s

and practices

in favour of a

more humane

tethering system.

AcknowledgementsThe author would like to thank

The Donkey Sanctuary and

Stephen Blakeway for their

invaluable support, mentoring

and encouragement. This col-

laborative project would not

have been possible without

their foresight and funding. The

author would also like to thank

Michael Crane and the staff at

SPANA Maroc for their hard

work and support throughout

the past few years. Additional

thanks are due to Above and

Beyond, Cotswold Outdoor

and Brasher for their support

and contributions.

References

Brager E (2005). Techniques du voy-

age à cheval, Nathan, Paris.

Cousquer G O (2011). Manage-

ment of saddle and harness sores in

a pack mule on expedition – a case

study, www.worldwidewounds.com

Farrell R K, Kroger, L M and Win-

ward L D (1966). Freeze branding

for identification, J Am Vet Med Ass

149: 745.

Garrett C (2010). The Good Har-

ness Guide, The Donkey Sanctuary

Sidmouth, Devon.

Guenon A (1999). La grande histoire

du mulet (le mulet intime), Editions

du vieux Crayon, Le Poiré sur Vie,

France, (original work published

1899).

Hadrill D (2002). Horse Healthcare,

A Manual for Animal Health Work-

ers and Owners, ITDG Publishing,

London.

Hanson R R (2005). Management

of burn injuries in the horse, Vet

Clin North Am Equine Pract 21(1):

105-123.

Kay G (2007). How useful is tetanus

antitoxin in the treatment of equidae

with tetanus? A comparison of three

treatment protocols used in the

WELFARE EQUINE

management of 56 cases of equine

tetanus presented to the SPANA

clinics in Morocco in 2003/2004. In

R A Pearson (ed), The Fifth Interna-

tional Colloquium on Working Equines:

The Future for Working Equines, The

Donkey Sanctuary, Sidmouth: 197.

Knottenbelt D C (2003). Handbook

of Equine Wound Management,

Saunders, London.

Knottenbelt D C and McGarry, J W

(2009). Pascoe’s Principles and Prac-

tice of Equine Dermatology, Elsevier

Saunders, Edinburgh.

Pearson R A, Simalenga E and

Krecek R (2003). Harnessing and

Hitching Donkeys, Horses and Mules

for Work, University of Edinburgh.

Sells P D, Pinchbeck G, Mezzane H,

Ibourki J and Crane M (2010). Pack

wounds of donkeys and mules in

the northern High Atlas of Morocco,

Equine Vet J 42(3): 219-226.

SPANA (2002). Guide de SPANA des

soins des Animaux, SPANA, London.

United States Army (2004). Special

forces use of pack animals – field

manual 3-05.213, Headquarters,

Department of the Army, Wash-

ington DC.

Thomsett L R (1991). Pigmentation

and pigmentary disorders of the

equine skin, Equine Vet Educ 3(3):

130-135.

Wilmink J M, Stolk P W, Van

Weeren, P R and Barneveld A

(1999a). Differences in second-

intention wound healing between

horses and ponies: macroscopic

aspects, Equine Vet J: 31(1), 53-60.

Wilmink J M, Van Weeren P R,

Stolk P W, Van Mil F N and Barn-

eveld A (1999b). Differences in

second-intention wound healing

between horses and ponies: histo-

logical aspects, Equine Vet J 31(1):

61-67. n

n DEVELOPING SOLUTIONS TO EXPEDITION PACK MULE TETHERING INJURIES IN THE HIGH ATLAS – from page 13

that can be passed over a loop

of nylon rope and is then placed

around the fetlock (Figure 7).

The cost of the latter is esti-

mated at 5MAD to 10MAD

per unit, based on a purchase

price of 80MAD (£5.79) for

one tanned goat hide, which

can be used to produce 20

sleeves, and the cost of nylon

rope, which is 1.0MAD to

2.5MAD per metre. The bulk

price of goat hides is as low as

2,000MAD (£145) for 50 hides.

The 13 muleteers trialling

these prototypes on expedi-

tion were all of the opinion

the leather sheath was worth

trying, as it retained the strength

and security of the rope. The

rope passing through the sheath

could be adjusted to ensure a

snug fit. Most significantly, the

leather is not required to take

the strain and is not, therefore,

subject to any force that might

shorten its working life. Its role

is purely to protect the underly-

ing tissues from the rope. The

use of a double length of rope

within the sheath increases the

surface area over which any

force is applied.

Given these findings, more

Figure 7 (left and right). A loop of nylon rope is passed through the leather sleeve and knotted. The tethering rope is then passed through this loop and tied to secure the mule. This system of tethering was used throughout the expedition without any problems or objections.

Figure 8. A coil of nylon rope

encased in a leather sheath. The tethering rope can be

slipped through either side of the coil without over tightening.

GLEN COUSQUER qualified from the Royal

(Dick) in 1997 and has spent much of his

career in wildlife, avian and exotic practice.

He completed his certificate in zoological

medicine in 2003 and has since worked in

various capacities in exotic and small animal

emergency practice in France and the UK. He

holds an MSc in outdoor education and is an

ESRC scholar at the University of Edinburgh’s

Moray House School of Education, where he

is undertaking research into values education in the mountain

tourism industry and pack animal welfare on expedition.

HASSAN ALYAKINE graduated from the Institut Agronomique et

Vétérinaire Hassan II in Rabat in 1989. After a period of military

service he undertook clinical training and a PhD in anaesthesia at

the University of Hannover, and undertook further training in

surgery and ophthalmology at the University of Vienna, in 1998.

He returned to Rabat in 2002, becoming associate professor in

the Department of Equine and Small Animal Medicine, Surgery

and Reproduction, in 2006, and deputy head of department in

2007. Hassan divides his time between teaching and clinical

duties at the institute as well as at SPANA in

Casablanca. His clinical interests are centred

on equine anaesthesia, medicine and

surgery, while his research interests extend to

the genetics of the

“Chien de l’Atlas”, the sloughi and the barb

horse. In addition to teaching veterinary

students, he actively engages in training

programmes for private practitioners and

animal technicians across Morocco.

M Leather sheath

The second model has the

merit of being even simpler and

preserves the natural strength

of the nylon rope. It consists of a

strip of leather measuring 16cm

by 6cm, folded lengthwise and

stitched to form a leather sleeve

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