A Rehabilitation Case Study
I thought I would do something slightly different for my blog on this occasion and write up a case study of a horse I have recently been seeing.
The horse was referred to me after being treated at Newmarket equine hospital and being investigated after a history of bucking, despite having a great season previously. They found some mild irritation around the sacroiliac joint, which was injected with steroids, but other than that not a lot. Further examination revealed that unfortunately the saddle being used was affecting her way of going and causing discomfort throughout the back. The vets suggested resting, changing the saddle and a course of physiotherapy to rehabilitate back into work.
When I first saw the horse there was moderate muscle atrophy through the epaxial muscles, these are the muscles that run along the top of the horses back, also known as the ‘top line’ muscles. It was noted that the development of these muscles appeared to be restricted. She also struggled to complete a tight circle in either direction, so some restricted movement in the thoracic spine. Furthermore she struggled to tilt her pelvis downwards, this means she was not able tuck her pelvis under, which is likely to cause problems when completing transitions, canter work and jumping.
She was quite tender on palpation, so as a first treatment we mostly focused on myofascial release, a technique used to gently stretch the fascia. Fascia is a connective tissue that lies superficial to the muscle. It is highly innovated and a common source of tenderness in both horse and human (see left)
We discussed her home exercise program, this is often the most important, and sadly commonly over looked part of a physiotherapy treatment. However the owners here were dedicated and already completing regular baited stretches. They were also encouraged to gradually start walk work in hand and in a pessoa in a long and low position. This encourages the horse to work through their hind limbs and back muscles, ensuring they are strong enough for when the rider comes to sit back on top.
We followed her up two weeks later and reviewed how she was working on the pessoa, I was pleased to see she was working in a lovely long low outline, much like in the photo above, but in walk. It is important to remember that not all horses will tolerate the pessoa, there are many different aids out there, and many ways to ensure you get the best from your horse, sometimes it takes a little trial and error to find which is the most suitable for your horse.
I was pleased to find that the horse here was feeling much better. There was far less muscle spasm and improving muscle bulk through the epaxials. However there was one point where we found a particularly stubborn trigger point (see facebook post from a few months again to learn more about trigger points https://www.jhhphysiotherapy.com.au/blog/2017/1/7/myofascial-trigger-points )
To help with this we utilised the use of K-tape or kinesio taping. There are many uses for K-tape, but in this instance we used it to help ease the palpable trigger point in a star (see below right). We also completed some gentle spinal mobilisations to help loosen her off through the thoracic spine, this not only eases joint stiffness, but also muscle tightness as well.
She was advised to continue with her home exercises, slowly progressing the amount of time spent walking and on the pessoa, and incorporating some pole work in walk on a circle.
Two weeks later the stubborn trigger point had eased, there was minimal muscle spasm and she was continuing to improve in her epaxials. She was treated with soft tissue massage, myofascial release, and reflex inhibition. A technique used to target deeper tissues to help release any further spasm. But I was really impressed with her progress.
She was then reviewed by the vets and given the all clear to start ridden work. A new saddle was fitted and ridden work began. I reviewed approximately 3 weeks after this. I was pleased to see that muscle had continued to develop, but unfortunately she was getting some significant muscle spasm across her epaxial muscles again. I discussed in a previous blog about gradual return to work and how easy it can be to overdo things when things are feeling so good. I suspect that in this instance, despite mostly walking when ridden, she was ridden every day, which may have just been a little too much too soon. Instead I suggested that they mix the exercise program to ensure a well-rounded fitness regime is developed. We came up with a plan of ridden work one day, followed by in hand walking or gentle hack, day off then pessoa training.
Following this advice I was incredibly pleased to see one month later, significantly improved muscle spasm, gradually increasing ridden work and even managing a walk, trot dressage test. The difference in how the muscles felt was amazing and shows how well horses can progress given the right guidance. I was so pleased with how the owners had followed all my advice and how well the horse was doing and I hope they continue to do so well.
If you have had any problems with your own horse, either through injury or you feel that their performance has dropped off, feel free to get in contact. A small change can make a big difference and there are many different techniques we can use to ensure the horse benefits the most from their therapy.