Hi Group A,
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 15-year-old, 15.2hh long
distance riding gelding has sustained an injury from a blackthorn to the
plantar aspect of his hind right hoof, 5 months ago. This resulted in infection
within the distal interphalangeal joint which was treated by the veterinary
surgeon. As a result, from this, there is scarring within the DDFT at pedal
bone attachment. This horse was initially box rested, due to infection and
lameness. He has gradually been re-introduced to in hand walking, with short
bursts of trotting on a flat surface.
He has now returned to turnout in
an individual paddock and is now sound. He is also walked in hand 30 minutes
twice daily and trotted 10 minutes in short bursts. He has restricted ROM of
the right hind distal limb and muscular atrophy of the musculature of the right
hind limb and has reduced fitness level due to the period off work.
The aim for this horse is to
return to his previous level of activity.
He has now been referred, by the
veterinarian, to the physiotherapist for REP.
Georgia-
ReplyDeleteGoals/ Aims for the case:
Improve ROM
Improve muscle atrophy- strengthening exercises to improve weaker limb
Improve overall fitness
Improve locomotion and proprioception
Core stability refers to the strength of the muscles surrounding the horses back and abdomen. A strong core helps to support the horses back, giving them the correct balance and movement. As the case has experienced an injury and so has had a long period of time off work, they will have a loss of core stability and strength and so it’s important to improve this before riding the horse begins as lack of core stability and strength means there is no muscle and so the horse will be unable to support the rider.
Core stability can be achieved through the use of different exercise techniques as part of an appropriate exercise program. These exercise techniques can be both groundwork and ridden work (EquineMechanics, 2021).
Groundwork exercises for the case could include lunging, long reining, training aids, pole work and in hand work.
Using lunging as part of the REP for the case will help to improve the case’s fitness and balance but it’s important to take into consideration the case's injury as tight circles when lunging should be avoided after injury. As this case is now sound, lunging could be introduced before ridden work starts to avoid the case being fresh as this could lead to re-injury or rider injury. However, lunging causes more weight to be put onto the inside limbs and so would not be useful for the case who is experiencing atrophy to their hindlimb.
Long reining the case will help to engage their hind quarters, increase strength and balance, helping with core stability and strength. Long lining is not as forceful as a training aid, useful for the case who has restricted ROM and muscle atrophy. Long lining will be useful for improving the case’s overall fitness, helping them to get back to their original fitness.
Training aids can include a Pessoa, Equiami and Kincade de Gogue. Training aids can help the case with core engagement by encouraging them to step through with their hindlimbs (Equiami), engaging their topline and helping to build muscle (Kincade de Gogue). The pessoa encourages the case to use the correct muscles (Cottriall et al., 2009). Training aids can sometimes be difficult to fit correctly especially for those who have not used a certain training aid before, making it difficult to use as part of the cases REP. Training aids can also include bracelets/ boots which can be used to help improve proprioception of the case study.
In hand work- As the case has been out of work for a while, there will be a lack of core strength and stability and so it’s important to improve their core strength before their tack and a rider is put onto the horse. In hand work exercises can help to improve core stability whilst also improving flexibility. Useful exercises would be the back lift for core strength and lateral bending for flexibility.
Georgia-
ReplyDeleteIn relation to the cases aims/ goals, the following groundwork and ridden work exercise techniques will be used as part of their REP.
Ground work:
Training aid- Using bracelets/ boots on the atrophied right hindlimb will help to improve the case’s proprioception of this limb by giving them more awareness of this limb and so helping to strengthen it, reducing muscle atrophy.
Long reining- Help the case to engage their hind quarters, increasing strength and balance, helping with core stability and strength. Long lining will help to improve the case’s overall fitness, helping them to get back to their original fitness. Long reining can be carried out on different surfaces. This being soft and hard surfaces, sand surfaces, grass and road surfaces, helping to improve the case’s proprioception and ROM. (Trumble et al., 2014)
Polework- As the case has one weaker limb, this being muscle atrophy to the right hindlimb improving their balance and proprioception/ awareness of this limb through the use of polework will help to encourage them to strengthen it due to the increased flexion during polework. Polework will improve core strength and help to improve the ROM of the right hind distal limb. Polework can be progressed by raising the poles, putting them closer together, adding more poles in or increasing the duration.
Once the vet has stated ridden work can begin the following ridden exercises will be introduced to the REP.
Ridden work-
Pole work- Ridden polework can be introduced, encouraging the improvement of ROM through increased flexion.
Hill work- Hill work will help to strengthen the atrophied right hindlimb, improve locomotion and also improve the fitness level of the case needed for them to return to previous level of activity.
Chloe -
ReplyDeleteAs Georgia has noted core engagement is key to help support the horses back, we want the abdominal muscles to be engaged and the horse can then work up into their epaxial muscles. It will be key to work on the stabilising muscles in the back such as the multifus fibres, originally it may be best to target these with DMEs as they are lower impact but can encourage the horse to engage themselves. This horse is 15 and therefore reaching the end of his prime so it must be considered that he may not return to his pre injury state however that there can be improvements to make him more comfortable. He has been walked in hand which is helping to build his fitness slowly as he will not yet have the muscle to support a rider correctly. With the damage to the DDFT it is important to be careful about the use of poles as any trips or issues may cause further damage, so although they are beneficial for core engagement it may be best to avoid these until a much later stage in the recovery.
As Georgia noted the main short term aims would be to maintain and improve ROM alongside building atrophied muscle to support the limb in it recovery.
Alongside hand walking the addition of long reining may be beneficial to encourage the horse to work through from behind while remaining work on a straight line to limit any further damage. With soft tissue damage it can take months to heal so will require work little and often to prevent further scaring. To improve ROM stretches can be used after the walking, holding a stretch for a minimum of 15 seconds. A good way to encourage flexion of the joint would be to use the bracelets and the added proprioception can encourage the horse to exaggerate normal movements for a few strides. Lunging is a great aid to improve fitness for a horse however being on such small circles can often be detrimental and therefore should be avoided with this case as it may cause unusual loading on his limbs. Once a topline has been developed a saddle check will be necessary and then they can begin with small amounts of ridden work, hacking instead of in hand this can be done while ridden, it will be important to do cross training however in the earlier stages firm flat ground will be better.
Forgot to add my sources for that info, sorry> the links i used for that are (Liñeiro et al 2017 - Structural and functional characteristics of the thoracolumbar multifidus muscle in horses)
ReplyDelete( Tabor 2015 - The effect of dynamic mobilisation exercises on the equine multifidus muscle and thoracic profile)
Fenner 2019 - Cutting to the chase: How round-pen, lunging, and high-speed liberty work may compromise horse welfare)
Phoebe
ReplyDeleteThe goal of this case is for the horse to return to his normal level of work and stay sound. For the short term our goals are to increase range of motion, improve muscle atrophy to the right hind, and also slowly improve his fitness. Due to the restriction in the leg it is important to increase the proprioception to decrease risk of injury when back in work. We also want to try and decrease the scar tissue around the pedal bone attachment to also prevent further injury and reduce any inflammation around this joint by using laser therapy.
When rehabilitating a horse is important for a horse to work correctly and engaging their core. When working from the core the abdominal muscles are engaged this therefore supports the back allowing for a freer movement and balance. As this horse has been out for work for a long period of time is it important to start engaging the core in a correct and controlled way for example the use of dynamic mobilization exercises is important in the early rehab to increase core strength but also improve the horses flexibility before asking him to do anything strenuous (Stubbs and Clayton 2008). The use of rhythmic stabilisation exercises could also be used to improve the atrophic muscles as these exercises cause proprioceptive neuromuscular function which increases muscle size and strength (Paulekas, 2009). When undertaking ground work with this horse backing up would be beneficial due to the core engagement and proprioceptive benefits of lifting the limbs, it will also help with ROM as encouraging flexion of the limb (Oliveira et al., 2015)
Lunging has many benefits when rehabbing as this improves the horses fitness but also engages core muscles for stabilisation and balance but this should only be undertaken when the horse is sound, for this case this should not be used as of yet due to atrophy in the right hind and the additional weight that is put on the outside limb (Tabor 2015).
Long lining will be a good start for this case and this allows the horse to work long and low encouraging correct work of the hind limbs and the core, but also help with their balance and proprioception due to the owner being behind therefore the horse had to think for itself and is a great way to start the rehab plan. The horse is still able to move through the body without restriction like some training aids cause, and will slowly increase their fitness. In the later stage of this case training aids like an Equiami. This can be used as this allows the horse to engage their core which allows the horse to push of the hindlimbs encouraging suppleness and building up their muscle. The use of weighted boot would be an advantage to this horse as this encourage proprioceptive input and tactile stimulus which increases peak hoof height during the swing phase and may even help in building up muscle (Clayton et al., 2008). Long lining can be done over different surfaces as this help improve ROM but also proprioception of placing the limb, you can also use gradients to improve muscle and to encourage further core engagement (Paulekas and Huassler, 2009)
phoebe
ReplyDeletePole work – the use of ground poles will assist in proprioception but also ROM due to the activation of the whole limb, therefore this will strengthen the limb flexor muscle, the back but also the abdominal muscles, depending of the height of the poles this will also develop strength and neuromuscular control but this should be thought about when there is a rider on. Advise not to do raised trotting pole in case the horse misplaces a foot and cause further injury.
Before sitting on the horse it is important that the vet has seen this horse and is happy for this to continue but it also important to have the saddle check as the loss of muscle will affect the fit. Starting out with ridden work hacking is a great start as this is similar to long lining only with a rider on, gradually increasing the work overtime and different gradients will improve fitness, ROM, core stability and muscle. Pole work when ridden will also be beneficial to this horse to improve ROM but this would be thought about further down the line.
Lorna:
ReplyDeleteGoals for case study: improve range of motion in right hind distal limb, reduce atrophy in right hind limb, increase and maintain fitness levels (improving overall fitness) all to assist in recovery and to reduce the chance of reinjury.
Core stability is considered the ability to create movement without compensatory movements of the spine or pelvis. Core engagement is important because a strong core supports the horses back and gives them a foundation for correct balance and movement. Our case study may have a lack of core engagement due to being on box rest, which can be difficult when a rider can get back on the horse (Davies, 2013; Tabor and Williams, 2018).
Ground work: For our case study, ground work (including lunging, long reining, using training aids and doing pole work) will be beneficial. Ground work can be done on softer surfaces initially, to reduce the forces going through the limbs, and go onto harder surfaces as the strength of the hind quarters improve (Wilson et al., 2018).
Lunging will help this horses fitness levels increase, without the weight of the rider on its back, but this does require the horse to move in one direction around the circle, which would put a lot of stress on the injured right hindlimb, so alternative methods are more beneficial to this case study (Wilson et al., 2018).
Long lining: This is beneficial for increasing the horses fitness levels, balance, and can allow the physiotherapist and owners to monitor how the horse is moving and it its gait is abnormal. It engages the hind quarters, including the affected right hindlimb, and therefore improves the strength of it. Core stability is also increased from long lining, beneficial for preparing the horse to be ridden.
Training aids: weighted boots can be used to increase the proprioception and to reduce the muscle atrophy as the horse has to flex a heavier limb, requiring more muscle strength. Pessoas can also be used, as these have significant impacts on the activity of the longissimus dorsi, meaning if these are strengthen, the overall core engagement of the horse will increase (Cottriall et al., 2008)
Pole work: pole work will benefit this case study as its range of motion is restricted, so through the use of poles placed on the ground, the horse can slowly increase its range of motion by flexing its limbs, and the poles can get higher as the surrounding musculature strengthens and as ROM increases. Pole work also improves proprioception, especially when using randomly places poles (Mills and Nankervis, 2013).
Ridden work: Once the vet has approved that a rider can go back onto the horse, hacking would be beneficial as this calm exercise will strengthen core musculature and improve fitness, without being too strenuous (Wilson et al., 2018). Pole work exercise can also be carried out with a rider on, once the core engagement has improved. This was strength the core further as well as strengthening the muscles, improving proprioception and balance (Tabor and Williams, 2018).
Doing these exercises will improve ROM, muscle strength and locomotion, returning the horse to previous levels of fitness (Baxter, 2020). Exercises should only be made progressively harder if the horse is making improvements and is not showing signs of pain.
ReplyDeleteGoals for the study have already been mentioned as well as types of ground and ridden exercises that can be used for rehabilitation. Frequencies and repetitions should be carefully considered as to not re-injure. The horse is already doing 30 mins of in-hand walking twice a day, so a suggestion should be to start of only including one new exercise/training aid in the current exercise he is doing (in the 30 mins twice a day). This way they aren't introducing too many of these exercises too quickly. Different exercises and training aids can be incorporated later and length can be increased.
Core stability is the ability of epaxial and core muscles to maintain balance and posture, especially during movement. To achieve core stability, exercises to increase core and epaxial muscle strength and engagement can be done. Pole work, tummy lifts and carrot neck stretches can be used to improve this.
Lunging
Pros- Helps to build epaxial muscles, as well improve the horses balance. Allows the horse to get used to work before having a rider on him. Incorporate training aids and poles can assist in hind end muscle strengthening and improved ROM.
Cons- The horse could trip and re-injure himself. He could get away from the handler and they could have less control of him leading to possible further injury. It also loads on the inside limbs more, so both reins need to be utilised in order to have even weight-bearing and not over work that effected limb.
Long reining
Pros- Can work the horse in a straight line not just on a circle. It is a gentle technique, that also enables the horse to get used to work before being ridden. Contact from both sides enable symmetry, long reining can help with the horses balance and fitness. Using training aids and poles as well can help encourage further muscle strengthening, improve ROM in the right hind.
Cons- Incorrect length of reins can effect the way the horse moves. The horse could be reluctant to go forward (Start to suck back). It can be difficult to get a good lateral bend from the horse.
Training aids
Pros- The pessoa will help the horse to engage the hind end. This will help with hind end muscle strengthening, as well as developing their top line, balance and improve back muscles. Its meant to be used during lunging.
Cons- If fitted incorrectly, too tight or too loose it will effect the way the horse can move and become ineffective.
Forgot to add some of my references
ReplyDelete(Wilson, et al., 2018; Davies, 2013) for my first paragraph
(Okada et al., 2011; Tabor and Williams, 2018) core stability
Hannah
ReplyDeleteThe Goals of this case is to improve proprioception and locomotion, ROM, Muscle atrophy (using Strengthening exercises to improve) and return to previous fitness and Previous Work as a long distance riding horse. Exercise therapy is a key component in rehabilitation (Tabor and Williams, 2017)
Groundwork Exercises before ridden work can include circular locomotion scu as lungeing is suggested to be beneficial which can be used with and without training aids, with the use of training aids being used to add/improve type of exercises and outcome from this particular exercise (lunging)( along with the use of treadmills which can beneficial during rehabilitation due to the fact t can be controlled such as variables of speed, duration, and incline Tabour and william 2018)
Long reining is also a exercise that can use training aids or as a (or different exercises) exercise of its own with the benefits of long reining being that there is no rider weight or interference and the added benefit of being an exercise that can be done on straight lines on different surfaces, which can make up for the lack of rider by allowing the horse to continue with work that still simulates the type of work they previously were in without the rider weight or interference and risk of injury. Long reining helps to engage their hind quarters, increasing strength and balance, helping with core stability and strength. Long lining will help to improve this case’s overall fitness, and to get back to their original fitness and work load. Longreing also benefits with that it exercises and strengthens muscles equally on both sides meaning they influence both sides equally and develops symmetry along with
Long reining is also beneficial as it allows for an insight into how the horse moves and behaves without the weight of a rider. Additionally, the visual perspective of long-lining allows for the analysis of specific attributes of movement. For example, the amount of over-track, individual joint range of motion, pelvic movement and rotation, weaker rein… (a good way to assess proprioception while the horse performs exercises it may normally perform in its everyday ridden work)(Charles, et al 2018).
Pole work-can also be used to improve balance/proprioception as this case has one weaker limb along with muscle atrophy to the right hindlimb so improving their balance and proprioception and awareness of this limb through the use of polework will help to encourage them to strengthen it with the flexion required and improve core strength and ROM. this can also be progressed by raising the poles, putting them closer together, adding more poles in or increasing the duration this can be used solely in hand, long reining, lunging and ridden work which can be planned and used progressively throughout the REP.
The use of a horse walker for consistent walking and duration of time compared to inhand walking initially or continued throughout the REP considering this is a long distance riding gelding , which a walker can help build up initial fitness and continue fitness throughout (Murphy J, 2008)
Kirsty
ReplyDeleteMain aims:
Improve ROM in the right hind distal limb
Reduce muscle atrophy within the right hindlimb
Improve fitness level (to same level as pre-injury)
Groundwork
The horse is currently walked in hand 30 minutes daily. It is not stated the terrain/gradient this exercise takes place over, however, the incorporation of uphill work would engage the hindquarters and improve musculature within the injured limb. This should be no more than 5 – 10 minutes of the in hand walking to prevent overworking the right hind limb.
Pole work should also be used to improve the horse’s range of motion, as well as proprioception. This should be done in a variety of forms e.g. straight lines, scattered, boxes to prevent the horse from anticipating the way in which it needs to work.
Ridden work
Light schooling and hacking should be the first step back of ridden work for this horse. 30 minutes of walking, ideally at a moderate/impulse pace, will help to improve their fitness. A next step would then be the incorporation of pole work and hill work, both of which will help to engage the horse’s core and hindquarters, before increasing the pace to trotting, cantering etc.
Lunging
A great way to increase horse fitness without rider weight. Poles can be used to improve proprioception and the horse’s movement can also be observed/monitored. Due to the circular nature of lunging, however, regular/length lunging sessions could potentially be detrimental to the horse’s injury (especially when on the right rein). It must therefore be done in moderation.
Long lining
This is also a great way to increase horse fitness, with the added bonus that it can be done outside of a school. This will allow the horse to work over different surfaces (just as they would when completing endurance) and will also help to reintroduce them to external stimuli they may not have encountered due to their 5 months off. Drawbacks of long lining, however, is the restriction to walking pace only. Regular use of this exercise may therefore lead to boredom in the horse, especially once the horse’s fitness begins to improve.
Training aids
The Equiband system, which works to improve core and hindlimb engagement, could be slowly introduced during lunging and long lining sessions. Pressure is applied to the abdominal muscles, encouraging the horse to lift their core and therefore allow flexion of their spine. Similarly, pressure around the hindlimb musculature encourages the horse to rotate their pelvis and “step under” further. This also allows the spine to be more flexible.
Further benefits of Equiband are that it can used in ridden work, as well. Once the system has taught the horse to engage their core and hindquarters, the system can then be used with a rider to allow them to develop a feel for the ideal frame. Overtime, the rider will then be able to learn how to activate the core musculature themselves, and the Equiband can be used less and less.
Well done to all of you with this blog. It is clear that you have all worked hard with this and given it lots of thought. It is also evident that you have done substantial reading around the topic, so well done. All the activity discussed would be beneficial to this case. I will sign the 1st equine SEL discussion for: Laura, Lorna, Phoebe, Chloe, Hannah, Kirsty and Georgia once we return to face to face teaching.
ReplyDeletejust as a note, I based this case study on my pony, although changed some details (mine is actually 13.2hh, and was 21 years old at the time of the injury), we nearly lost him when this happened as he went into septic shock within hours of walking on the thorn. Anyway he never returned to the previous level of activity but 8 months after the injury he completed his last long ride, we did 100 miles in 4 days to raise money for charity. Unfortunately, 2 months after the ride he tripped over and fell in the school which resulted in a common digital extensor tendon tear and a hairline fracture of the cannon bone. He is now 23 years old and semi-retired (he only hacks and does gentle schooling with my daughter once or twice a week). Before I had him, he was a racing pony doing point to point racing until the age of 17.