Case Studies

Muscular injury

Minty is used for cross country and dressage. During a ridding lesson she started to buck violently and occurred to be lame thereafter. The horse was assessed by the vet. Muscular injury due to the bucking was diagnosed. Minty was rested for 3 weeks. Once sound, Minty was brought back into work. She appeared to be moving stiffly with the hind legs and not to engage properly. The horse was also reluctant to work in an outline. Physiotherapy treatment was recommended by the vet.

Examination

Standing square: Level, poor top line, weak abdominals
Gait - Walk: Left hind shorter cranial phase, drags left hind toe
Gait - Trot: Moves very stiff with both hind legs
Gait - Lunge - Left: 1/10 left hind, hollow top line, head up, falling onto shoulder, not engaging behind, not tracking up.
Gait - Lunge - Right: hollow top line, not tracking up.
5 m circle - Left: not crossing under with left hind.
Rein back: Stiff small steps with hind legs, head up, hollow back.
Palpation: Tight right brachiocephalic muscle. Sensitive longissimus dorsi, slight fasciculation under the saddle area, trigger points in L gluteus muscle > Right, reduced range of movement in lumbar spine.

PROBLEM LIST

Stiff gait pattern with hind legs
Sensitive epaxial muscles.
Working stiff through lumbo-sacral junction, not engaging

TREATMENT

Soft tissue mobilisation techniques
Reflex inhibition technique
Reflex stretches
Trans Cutaneous Electrical Stimulation
Exercise program on the long reins to stretch the epaxial musculature

RE-ASSESSMENT

Gait pattern: Moving better through the back using the hind quarters to engage. Tracking up. Sound
Palpation: Reduced sensitivity in longissimus dorsi, no fasciculation.

OUTCOME

Minty has recovered totally from her injury. She is now back in full work and competing successfully.

Post trauma: pelvic stress fracture

Foxy is used for eventing. The horse jumped badly over a fence and slipped, causing her to fall. She appeared a bit stiff during the following days but returned to full work the following week. For the next few months Foxy competed successfully but occurred to be very stiff after the season and suffered regularly from secondary back pain. There was a gradual onset of napping and rearing. The horse remained in training as the trainer at that time thought that the horse was being naughty. Symptoms worsened to the point that Foxy changed temperament and resented being ridden, refusing to jump or perform in the school. Back pain increased and gait pattern deteriorated. The horse was assessed by the vet and referred for diagnostic investigations. Foxy was diagnosed with a stress fracture of the right ilium shaft and treated with box rest and 3 months of field rest. Physiotherapy treatment was initiated after the box rest.

EXAMINATION

Standing square: Level, slightly atrophied gluteal musculature right hind
Gait - Walk: 1/10 lame right hind, stiff and weak(wobbly) gait pattern. Stiff to turn to the right. Swings right hind out.
Gait - Trot: 1/10 lame right hind
Gait - Lunge: Not assessed as not appropriated at this time of rehab.
5 m circle - Left: swings out with right hind, pelvis drops (no stability)
5 m circle - Right: stiff to adduct with right hind, not crossing under
Rein back: Stiff small steps with hind legs, stiff lumbo-sacral junction
Palpation: High toned epaxial musculature all along the near side, trigger points in gluteus muscle bilaterally.

PROBLEM LIST

Lame right hind
Sensitive epaxial muscles.
Weak musculature and asymmetry in hind quarters

TREATMENT

Soft tissue mobilisation techniques
Reflex inhibition technique
Trans Cutaneous Electrical Stimulation
Rehabilitation programme

RE-ASSESSMENT

Foxy has recovered successfully from her injury last year and is has now returned to full work. She has been competing successfully in dressage and show jumping.

On assessment Foxy is moving better than she has even prior to her injury.

Saddle fit

Promise is a 12 year old mare used for dressage. She has been working well until recently. There is no particular medical history. During a competition Promise was not moving well through her shoulders. She was sound in hand but appeared to be `hopping` with the right front leg when ridden. Promise was assessed by the vet and no obvious lameness was detected to investigate further. Physiotherapy input was requested to determine whether there could be muscular pain in the back or shoulder.

EXAMINATION

Standing square: Level, right shoulder less developed as left.
Gait - Walk: Level
Gait - Trot: Level
Gait - Lunge - Left rein: resents trotting, short protraction phase right fore
Gait - Lunge - Right rein: Better rein, very stiff through the back, no engagement
Short turn in hand - Left: stiff, doesn’t bend through spine, flexes through the hocks instead
Short turn in hand - Right: slightly better.
Rein back: Resents going backwards, hollow top line, no lumbar flexion, shuffles with hind limbs.
Ridden assessment: Hopping gait on right fore, breaks into canter, poor engagement behind, stiff through the spine, no lumber flexion
Palpation: Sensitive and high toned : right brachiocephalic muscle, right rhomboid and trapezius muscle. Localised pain on the right side of the thoracic spine, approximately 2 inches below the summit of the dorsal spinous processes T6-T18, localised spasm on the right lumbar area L1-L4. High toned epaxial musculature. Reduced range of motion (flexion) in lumbo-sacral area. Reduced lateral flexion to left compared to right.
Saddle: Poor fit, too narrow, panels unlevel and twisted to one side, narrow gullet.

TREATMENT

Reciprocal reflex inhibition technique, myofascial release, trigger point release, TENS (trans cutaneus electricalnerve stimulation), exercise regime : no ridden work until re-assessment, engaging exercises and stretching exercises on the long reins. Saddle fit.

Follow up assessment.

The owner did all the exercises as advised and did not ride the horse since treatment. Promise appears to be sound on trot up. On the lunge she is moving much freer. She is moving well whilst performing a short turn in hand and is better in rein back, flexing her spine. On palpation the sensitivity has decreased markedly. There remained still one sore point on the right side of the spine right under the back end of the saddle area. Treatment was repeated and sensitivity reduced. I have advised another two days rest in field prior to start ridden work. A new saddle has been fitted.

OUTCOME

The saddle was a bad fit with pressure points causing the soreness in Promise’s back, affecting her gait pattern. There was enough pain and muscle spasm to cause the disturbance in the gait pattern of this horse. Promise responded well to treatment and is now competing successfully.

Haematoma

Bluebell is a 7 year old Arab mare used for showing. She was kicked in the field by another horse.

As a result of the kick Bluebell had a large swelling, the size of a football, on her chest. The vet has drained the swelling which has reduced the injury slightly. Physiotherapy input was requested.

Ultrasound, ice treatment and deep friction massage was used to treat the injury. The swelling reduced fast over the next two weeks. Bluebell recovered totally. There is not a single mark left on her chest and she is now showing again.

Wound

Fred Fred is an 8 year old hunter. Whilst out hunting he injured himself by getting caught in barb wire. He sustained a large gaping wound over his left hind quarter. The wound was stitched and treated by the vet, but a lot of skin was lost. Fred Fred received daily physiotherapy treatments. Laser was used to promote the healing of the wound. The wound healed well with very little scar tissue. Fred Fred returned back to hunting within 8 weeks.