Hi Group B,


Welcome to Equine SEL sign off blog, 556AVN - Biomechanical assessment and exercise prescription.  
In your group, using your allocated scenario, discuss a remedial exercise program appropriate to your case and stage of repair, which would improve locomotion and proprioception. You need to include groundwork and ridden work, explain the concept of "core stability and how this is achieved. Give the pros and cons of the use of lunging, long reining, and the use of training aids, in relation to your case. You all have from now until our next taught session (22.01.21) to contribute to this blog. You must contribute to this blog to get your SEL signed off. Ensure that your entries are based on evidence and that you are reactive to one another to allow a good discussion of the topic. I will be keeping an eye on the blog, but if you have any issues, you should email me. Please ensure that you register your name with your comments so that I know who has written what. 

Rosa 

Your case study:

A 22-year-old, 14.1hh leisure gelding used for hacking and schooling by a novice rider has sustained an injury to his front right forelimb. After tripping in the school, he knuckled over and fell which resulted in a grade 1 strain of the common extensor tendon and a hairline fracture of the 3rd Metacarpal. He was initially box rested and treated with NSAIDs.

After 6 weeks of box rest, he started in-hand walking at 5 minutes twice daily. This was increased by 5 minutes, twice daily, every 2 weeks. It has now been 5 months since the injury, and he is walking 40 minutes in hand on a flat surface twice daily. He has returned to an individual turnout paddock and is now sound. As a result of the time off work, he has muscular atrophy of his topline and reduced fitness. As a result of the injury, he has reduced ROM within the distal right forelimb and still has tripping episodes with that limb.

The aim for this horse is to return to gentle hacking and schooling.

He has now been referred, by the veterinarian, to the physiotherapist for REP.


Comments

  1. Unknown15 January 2021 at 02:20

    Tom - Using pole work would be beneficial to this horse. Pole work will help by improving ROM as the extra height of the pole will mean the shoulder will be lifted higher, and the leg will extend further, increasing the ROM of the joints of the distal limb. Pole work will also help with the tripping as it can be used to improve proprioception. Pole work requires the horse to elevate the limb to ensure clearance of the poles and place the feet accurately between poles. This type of exercise needs coordination which is important within rehabilitation (Brown et al, 2014). https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/evj.12253

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  2. Anonymous15 January 2021 at 07:31

    Massage could also be used on the compensatory areas to relieve pain and compression could also be used on the atrophied muscle to help regain this but not over bony areas and if the muscles still have some tone (Davies, 2013). Equine rehabilitation. Pain Management in Veterinary Practice.

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  3. Anonymous15 January 2021 at 07:31

    Also Tom would poles be a bit risky at first if it is prone to tripping?

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  4. Anonymous15 January 2021 at 07:41

    Leah - On the lines of pole work, once the poles flat and raised are successfully being clear, a rider would then as their influence may change the horses movement (Guire, 2015)

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    1. Anonymous15 January 2021 at 07:50

      Leah - On the lines of pole work, once the poles flat and raised are successfully being clear, a rider could then be added as their influence may change the horses movement. A trainer could also then come in at this stage to perfect the riders influence or the horse so tripping is further prevented (Guire, 2015)

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    2. Anonymous15 January 2021 at 07:56

      Rachel - Yes absolutely, a rider could be introduced but it should be a well-balanced and more advanced rider rather than a novice as this would encourage weight bearing on all four limbs and prevent the horse shifting the weight off the right forelimb.

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    3. Unknown15 January 2021 at 08:15

      Holly- yes agreed Rachel and Leah; a more experienced rider would be ideal as they should be more balanced, and able to encourage the horse to work correctly. Meaning driving from the hind end, engaging the core and working over the back. However this should be further along in the plan, as the horse still has a very low fitness level?

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    4. Unknown15 January 2021 at 08:17

      Holly- perhaps make use of lunging and long reining first to build a better base line level of fitness and work on improving balance as one limb was injured, before the weight of a rider is added?

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  5. Unknown15 January 2021 at 07:53

    Holly- Leah and Tom; I agree poles would be beneficial, however starting with scattered poles? This will work to improve proprioception (perhaps part of the issue in initially tripping) as well as ROM like Tom said. Also perhaps using a TheraBand/band under both the hind quarters and the trunk (looks weird). This encourages coordination and improves proprioception (Paulekas et al, 2009).

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  6. Unknown15 January 2021 at 07:57

    Holly - Paulekas, R. and Haussler, K. (2009) Principles and Practice of Therapeutic Exercises for Horses, Journal of Equine Veterinary Science, 29 (12) pp.870-893 (online) Available from

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  7. Anonymous15 January 2021 at 08:02

    Leah - Agreed Holly, improve the ROM before introducing more technical patterns especially after box rest.

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  8. Unknown15 January 2021 at 08:09

    Holly- The core works to support posture, spinal movement and acts as a generator for locomotion. Without any core stability the horse is unable to provide a 'stable platform' for limb movement (Clayton 2016). Clayton, H. (2016) Core Training and Rehabilitation in Horses, Veterinary Clinics of North America: Equine Practice (online) 32 (1) pp49-71. Available from https://www.sciencedirect.com/science/article/abs/pii/S0749073915000942

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  9. Ellie15 January 2021 at 08:14

    Ellie- As the horse has muscular atrophy it may be beneficial to lunge initially as this can build core strength and stamina without the extra weight or influence of a rider. Another benefit of lunging is that the owner can see how the horse moves from the ground which will highlight what is good and what needs focusing on. Lunging aids such as side reins, de gouges and chambons are good for providing the horse with a consistent contact to work into which may encourage him to engage his core and work correctly however often the horse is resistant to use the correct muscles as they find it easier to hold the neck in an outline without engagement from the hind quarters. Pessoas are more likely to encourage hind end engagement which will make the horse use their core muscles and consequently build their top line.

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    1. Ellie15 January 2021 at 08:16

      It may not be suitable to introduce a rider or pole work until the horse can work without tripping

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    2. Anonymous15 January 2021 at 08:43

      Rachel - I think perhaps long lining could be more beneficial initially as it also helps to build core strength and stamina but also controls the posture of the horse effectively. Cottriall et al. (2008) found that when lunging, the activity of the longissimus dorsi is 2-3 times greater on inside than outside. So lunging could cause asymmetry in muscle mass along the longissimus, it is important that when the top-line is atrophied that there is even muscle mass and long lining could be a potential alternative as it doesn't have constant lateral flexion of the spine. I think that after the horse has built up this longissimus dorsi and has a good controlled posture that lunging could be introduced to the exercise programme.

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  10. Anonymous15 January 2021 at 08:51

    Rachel - I definitely agree with Ellie in that the horse should not be introduced to poles without tripping as this increases the risk of the horse injuring himself. Poles could be introduced after working with the horse over different surfaces and hill work as these can improve proprioception as well as range of motion (especially over surfaces like longer grass where they have to pick their feet up more to step over the grass). As the horse is aiming to be hacking, it is important that the horse is able and comfortable to work on lots of different surfaces so this is key to the programme. Pole work would be incredibly useful slightly later in the exercise programme to improve the ROM and core engagement as it requires development of coordination first.
    Also Holly is quite right, introducing an experienced rider to the horse should be later in the programme due to the horse's lack of general fitness, therefore long lining may be helpful in building this.

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  11. Rosa Carton27 January 2021 at 02:38

    Well done to all of you, a good discussion with points raised and challenged. As some of you have mentioned, poles would improve ROM and proprioception, however this horse is still tripping, if he was to trip over the ground pole this could cause re-injury, therefore waiting until tripping has ceased would be better for this particular case. Also on safety aspects for the rider, this should not be re-introduced until tripping has ceased. Different terrain would be beneficial but ensuring that this terrain is even (without holes) to ensure the risk of re-injury is reduced. For proprioception maybe a proprioceptive bracelet or overreach boot could be used? Well done with this anyway and good use of evidence base. I will sign the 1st equine SEL discussion for: Ellie, Rachel, Leah, Tom and Holly when we return to face to face teaching.

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