A properly managed rehabilitation program can restore the health and ability of a horse so that it can perform at a level equal to, if not better, than it was before it was injured.

“The whole horse
needs to be considered,
not just the injury.”

There is a lot of evidence, both scientific and anecdotal, that implementing a rehabilitation program on a horse that has had an injury improves the quality of the healing and reduces the risk of a recurrence of the injury when the horse returns to performance. Added to these is the benefit that many horses that have undergone a suitable rehab program return to a level of performance equal to that reached prior to their injury/accident compared to those horses which are not rehabilitated (only spelled in a paddock) and perform at a lower level when returned to work.

The aim of rehabilitation is to restore the health and physical ability of the horse to enable it to perform at a level equal to, if not better, than it was before it was injured. Whilst most owners would be happy to have a horse return to the same level of competition, there are times when an injury or accident has occurred before the horse has achieved its maximum potential, and in these horses the aim is to have the horse improve and perform beyond what it had previously achieved.

For many horses that incur exercise related injuries, simply resting these animals and returning them to work several months or years later results in performances below their former capabilities. It should be noted that there are also horses that have incurred injuries that will permanently prevent them from returning to a highly intensive athletic career, but with rehabilitation they may be suitable for a career involving a reduced level of athletic intensity.

The injuries we are most familiar with that limit performance on return to work are the musculoskeletal injuries associated with joints and ligaments/tendons. A horse relies on a full range of motion from its joints, including those in the spine, and support from the surrounding soft tissues to be able to perform at its best and to minimise the chance of injury to other structures in the body. If a horse cannot use one area of its body equally to that of another area, it risks offloading one structure and overloading another, causing damage and further loss of use.

There are several areas to address when looking at rehabilitating a horse:

• Resolving pain and reducing inflammation in structures that have been injured.

• Improving core stability and balance.

• Returning good proprioception.

• Maximising the range of movement and flexibility of joints.

• Ensuring tendons and ligaments repair so they can maintain strength and elasticity.

• Strengthening muscles and other body structures to ensure the horse can perform and maintain its performance, including cardiovascular fitness.

• Remembering that there is a horse attached to an injury and that the whole horse needs to be considered, not just the injury.

People have the distinct advantage of being able to control the amount of exercise and physiotherapy they do because they can communicate when things start to hurt. Unfortunately, a horse cannot say during a training exercise, “hey, I think that’s enough for today” and relies on the handler or rider to assess how a session is progressing. This means anyone undertaking a rehabilitation program with their horse needs to have a good grasp of assessing pain and inflammation and be able to monitor subtle changes so that the exercises can be refined if necessary.

Working closely with an experienced veterinarian or physiotherapist is important to enable an objective assessment of pain levels and establish guidelines that can be followed to monitor these levels. Types of assessments can include clinical parameters such as heart and respiratory rates, lameness assessments, and functional examinations including flexion tests. There are some more technical methods available to assess pain, however, most of these are unavailable for general use and not included here.

Core strength is vital for good posture, balance, and stability of the limbs so that movement can occur in an effective and efficient manner. Therefore, maintaining good core strength is one of the key issues we need to address when trying to restore health and function to a horse that has injured part of its musculoskeletal structure.

The “core” for a horse consists of the its axial skeleton, ribs and sternum, the abdominal muscles, sub-lumbar muscles, epaxial muscles, and the musculature (thoracic sling muscles and pelvic stabiliser muscles) that help attach the limbs to the spine. By providing strength and stability, the core structures allow the limbs to propel the body forward. If the core is weakened or becomes imbalanced, then movement quality is compromised. Postural stability is important and research has shown that exercises that work on the small muscles that stabilise the vertebrae along the spine (multifidis muscles) and help to increase the size and strength of these muscles, greatly increase the body’s ability to maintain this stability.

Proprioception is the sense of knowing where your body is positioned when standing and throughout movement. It relies on an interaction between nerves and muscles to tell the brain where limbs are placed and what needs to be activated to maintain that position or move to another. When areas are injured, some of these neuromuscular inputs are affected because of pain and loss of movement, and it becomes important to get these areas back functioning properly to restore normal movement. For example, with an injury that causes the horse to feel pain on joint flexion of a particular joint, the brain learns to exercise without flexing that area fully and relies on flexing another area more to attain similar movement, which can lead to imbalances in body motion.  By retraining the body and establishing good proprioception, the body’s movements become more rhythmic and able to perform more efficiently whilst reducing the risks of future injury.

Range of movement is a term used to describe the full range a joint can move when it goes from full extension to full flexion. When joints are injured, their range of movement is usually reduced by either pain, inflammation, or a physical impediment. If this is not addressed in an appropriate manner or in a timely fashion, the range of movement tends to decrease, which results in loss of quality of movement. In its extreme form this can result in joints that have no perceivable flexion or extension, which in turns leads to other areas further up in the limb becoming injured as they are overloaded (over-stretched) to compensate for the lack of movement in the restricted joint. This loss in range of movement is commonly seen in front fetlocks which, when healthy and uninjured have a huge range of motion, but when continually pounded and chronically inflamed become stiff and resistant to flexion.

Many tendon injuries repair with scar tissue that is formed by collagen fibres laid down in an unorganised manner that reduces the quality of the repair. By instigating a rehabilitation exercise program, these fibres become orientated in a more linear fashion in response to the direction the loads on the tendons are placed under, greatly improving the quality of the repair.

Once the injured tissues are repaired sufficiently to cope with work, they need to be slowly and adequately strengthened so they can sustain the activity without fatiguing and succumbing to the risk of re-injury. This means a graduated return to both the intensity of the work and the duration of time of the work. Not only is this important for the previously injured structures, but also for other areas of the body which, if not addressed, will become overworked and risk being injured. The overall health and fitness of the horse must also be taken into account when rehabilitating the animal, as a reduction in overall performance will occur if the rehabilitation does not integrate well with a normal training program.

There are numerous exercises that have been used to strengthen the core, improve proprioception and return full range of motion:

• DYNAMIC MOBILISATION EXERCISES: These are designed to strengthen the muscles of the spine as well as those abdominal and lower back muscles that help maintain posture. These include exercises such as “carrot stretches” to improve lateral bending and rounding exercises.

• CORE STRENGTHENING EXERCISES: These also work on postural muscles to improve balance and the way a horse carries itself. Examples of these include thoracic and lumbosacral lifting.

• BALANCING EXERCISES: These help the body to strengthen and maintain balance by changing the body’s position whilst doing exercises. It can involve standing on pads or elevating limbs whilst exercises are performed, or gently pulling on the tail to shift the balance when walking.

• PROPRIOCEPTIVE EXERCISES: Working on different surfaces and walking with something such as a weighted band around the lower limb can improve the range of motion and flexibility of joints.

• EXERCISES AT DIFFERENT GAITS, CIRCLING AND USING POLES OR SMALL JUMPS: With changing gaits and speeds, the body recruits muscles differently to coordinate these movements.

• THERABANDS: These are elastic resistance bands that can be used to strengthen core muscles and improve proprioception during rehabilitation training.

The use of kinesiology taping can be included in a rehabilitation program when specific areas need to be addressed. Kinesiology tape is an adhesive tape which is unidirectionally elastic that is applied to target areas to improve circulation and reduce pain. It is thought to work on the principle of lifting the skin and decreasing the pressure on the underlying structures and therefore allowing better muscle function, increased lymphatic drainage and improved proprioceptive awareness. It should be noted that kinesiology tape cannot be applied to compete in at FEI competitions, although it can be used in the stabling area.

The use of treadmills and water walkers in training centres is well established as a form of rehabilitation training. They enable exercise to be performed in a more controlled manner as the surface, gradient and speed of exercise can be regulated. Water can improve the mobility and range of motion in joints as well as reduce pain and inflammation whilst reducing the stress on the weight-bearing structures of the body. Warm or cold water can be used depending on the injury and the aim of the treatment. Warm water is better at relieving muscle spasms as the warmth will increase the blood flow to muscles. Cold therapy is better at reducing pain and inflammation by reducing the blood flow to these areas and increasing the lymphatic drainage from the limbs.

Other adjuncts to consider when implementing a rehabilitation program include other therapeutic modalities such as:

• ACUPUNCTURE

• SHOCKWAVE

• VIBRATION PLATES

• THERAPEUTIC ULTRASOUND

• LASER THERAPY

• ELECTROMAGNETIC FIELD THERAPY

• HYPERBARIC OXYGEN CHAMBERS

By understanding the concepts of a good rehabilitation program and implementing some key aspects into our training regimes, we can help return our horses to a level that not only pleases us from a performance standpoint, but improves the health and wellbeing of our animals. EQ

YOU MIGHT ALSO LIKE TO READ BY DR MAXINE BRAIN:

Core Strengthening & Balance Exercises – Equestrian Life, July 2020