The use and importance of rehabilitation through schooling and therapeutic exercise.
By Karina Hawkridge
Schooling and thertherapeutic ridden exercise is important not only in the rehabilitation of the horse after injury, but also in maintaining general health and fitness. Progressive schooling and ‘conditioning’ of a healthy horse prevents injury by promoting connective tissue strength and elasticity, developing cardio vascular and respiratory fitness as well as preparing the horse to support a rider by developing core strength and postural stability whilst promoting, compliance, balance, lightness, ease of movement and ‘self carriage’.
Schooling and therapeutic exercise aims to return a horse to pre injury levels of fitness which will vary depending on age, breed, temperament, conformation and purpose. All rehabilitative exercise must start with slow, regular, carefully structured work incrementally increasing stress, velocity, duration and mental stimulation depending on the patient’s response. ‘Hardening’ the horse takes weeks of progressive exercise to minimise stress, stretch, compression and concussion which could lead to re injury, muscle soreness, galls or blisters. Signs of pain, heat, swelling or non compliance means regressing to less demanding work or cessation of work until the vet advises otherwise.
The vet, owner and physiotherapist must act as a team. The client’s riding ability and compliance must be assessed. Benefits could be negated by an unskilled rider therefore prescribing in hand/lunge exercises, allowing the client to work the horse without exerting manual restrictions, imbalances and asymmetries or interfering with the freedom of the gait, may be more productive. A horse returning to work after surgery for kissing spine for example, will benefit from a progressive programme starting with in hand straight line work progressing to work on the lunge using a chambon or pessoa to dorsally extend the spinous processes; the required ‘outline’, rhythm, balance, energy, engagement can be achieved without restrictions. Encouraging a less capable client to employ an experienced rider to implement ridden exercise may be judicious.
Before implementing exercises goals need to be set and assessments made; the nature of the injury, the stage and rate of healing, the horse’s current level of mobility, the general health of muscles, tendons and ligaments, the horse’s level of coordination and whether he is pain free should be considered. Exercises must be structured to individual cases; work that is too demanding, either for the horse or the owner or vestiges of pain, may result in compensatory recruitment of alternative muscles, negating any benefit. Facilities should be considered; prescribing school based exercises on an unsuitable surface could retard progress or result in re injury.
Controlled therapeutic stress needed to optimise collagen matrix formation or bone deposition, for example after tendon or ligament injury, or when encouraging fusion in bone spavin cases should be introduced progressively. Too much stress can damage new structures and retard the healing process, too little stress will have little or no benefit. Exercise should start with slow work in straight lines on a suitable supportive surface, incrementally progressing to straight line ridden work increasing velocity and duration accordingly. A horse with any tendon or ligament injury will take at least 6 months of restricted activity to allow sufficient time for the majority of healing to occur (Gillis.1997). By working closely with the vet and utilising diagnostic ultrasound scans, the therapist will be able to advise when to increase or reduce the work.
Narelle C. Stubbs et al, (1), cite studies that have found similarities in equine multifidus structure and function to that of humans. Core stability development is generally considered key to aiding postural strength as well as developing effective propulsion therefore limiting injury. In health and after injury it is important to recruit the flexors of the back such as, the internal and external abdominal obliques, the transverse abdominals and rectus abdominus as conditioning these muscles will assist posture by developing stability to the back. Exercises to recruit the flexor chain include slow work over raised poles, direct transitions and where appropriate encouraging collection within the pace (maybe with the use of ground poles).
Schooling plays an important role in developing flexibility and suppleness; shortened or tight muscles will exert tension on tendons, ligaments and joints causing overstretch injuries. Gently flexing the neck and back away from the site of soreness will help stretch the muscles of the back, thorax and neck releasing any tight spots. Combining flexion/ counter flexion with ‘long and low’ work will stretch and soften the horse both laterally and longitudinally helping release tight areas and aiding symmetry and alignment.
Back mobilising exercises can be used to dorsally extend the spinous processes particularly useful when there is impingement of the spinous processes and especially after surgery for kissing spine. Research has been conducted into the effect of head and neck positioning and its effect on back mobility and engagement. (2) Exercises that lower the head exert tension on the nuchal and supraspinous ligament providing traction on the spinous processes of the withers rotating them forwards resulting in ventral flexion of the back. Positioning the head higher will ventrally extend the back. Working the horse with the face behind the vertical and an elevated head position can lead to stride length restrictions and tightness through the poll and back whereas encouraging the horse to work with his face on or a little in front of the vertical with the head lowered but still with the poll remaining the highest point will allow greater freedom to the stride length with greater mobility through the back whilst permitting good engagement of the hind quarters. It is important to explain to the client how the horse should be worked when prescribing therapeutic schooling exercises that require specific positioning of the head to instigate back mobility and engagement.
Pole and grid work, progressively introduced in duration, velocity, distances between the poles and increases in height, is an important exercise for re developing atrophied muscles as well as encouraging flexion and extension of the joints and developing proprioceptive awareness. Work through poles regularly spaced in relation to the horse’s natural stride length is a useful tool in developing synergy to the gait after injury where ligaments, muscles or tendons have become shortened. Mechano receptors within muscles, ligaments, tendons and joints can be stimulated to sense stretch and compression by the use of pole work; poles set at different heights and distances and using poles of differing weights, colours and thicknesses all provide sensory stimulation helping develop proprioceptive awareness, as will working on varying types of surface such as gravel, sand, water, tarmac and long or short grass.
Schooling and athletic exercise aims to;
• Condition and strengthen muscles, tendons and ligaments.
• Promote bone density.
• Improve circulation and lymphatic drainage.
• Promote cardiovascular and respiratory efficiency.
• Improve gaseous exchange.
• Promote proprioceptive skills.
• Promote straightness and alignment.
• Promote healing by aligning collagen fibres and encouraging correct bone deposition.
• Promote joint flexibility and improve ROM including engagement of the quarters.
• Promote longitudinal and lateral flexibility and responsiveness.
• Provide mental stimulation.
• Promote balance.
• Develop gait synergy.
• Build confidence.
• Burn off fat.
Schooling and athletic exercise is vital in returning the horse to pre injury fitness levels and is limited only by the imagination of the therapist and the skill, compliance, time, facilities and finances of the owner.
(1) Stubbs, N. C., Rombach, N. (2012). Epaxial musculature and its relationship with back pain- muscle asymmetries a neuromotor control approach. Winning Ways conference, Aintree. UK. pp33-38.
(2) Wishaupt, M.A.,Wiestner,T.,von Peinen,K., Waldern, N., Rosepstorff, L.van Weeren,R., Meyer,H, and Johnston, C (2006) Effect of head and neck position on vertical ground reaction forces and interlimb coordination in the dressage horse ridden at walk and trot on a treadmill. Equine vet. J. Suppl. 36, 387-392
Gillis, Carol L. DVM, PhD. (1997). Rehabilitation of Tendon and Ligament Injuries. AAEP research. School of Veterinary Medicine,University of California. USA.
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Paul, J. MSCP, ACPAT. (2012). Equine Health, issue. no. 6. Where are my feet? pp 32-36
Robartes, H. (2012). Equine abdominal muscles in locomotion. Four Front. August 2012. pp8-10.
Baechle, T., Earle, R.W. (2008). The essentials of strength training and conditioning. http://www.humankinetics.com/excerpts/excerpts/understand-rehabilitation-to-facilitate-a-return-to-competition, November 2012.