The road of rehabilitation can be a bumpy one!
We have already hit problem number 1 on the rehab journey roller-coaster! Athos was due to come home at the end of March, then I got a message that he had been ?Kicked and had another Haematoma, this time on the right hind. I therefore decided to get him home a week earlier than planned so I could at least start treating it.
Cue a week of stress and all things pointing to Athos deciding not to load on pick up day, just to top it off! So, we prepped with snacks and coffee for the long haul ……… and he walked straight on, the best he’s ever loaded in his life! Haha, that’s horses for you!
He has had a full MOT from the vet, his teeth rasped and his vaccinations brought forward a couple of months (due to the Equine flu outbreak and moving yards). The vet’s thoughts – his main issue is his weight! The haematoma, although a mess, will reduce, but hopefully I can speed that up a little.
During this first week of him being home I have started his rehabilitation gently, as I have also had some surgery in the last week(!), with:
He has also been clipped and bathed and is starting to look a little smarter than the swamp monster I picked up!
So, already, the plan has changed with this new Haematoma to contend with – and this is ok (although very disappointing), and is often the case with any rehabilitation plan! It may be a little longer before we are in a position where we can start ridden work, but the groundwork is all “money in the bank” and will help him prepare for taking a saddle and rider after a lengthy period off!
The plan for the next couple of weeks:
The Journey continues!
Becky & Athos
As a Chartered physiotherapist and veterinary physiotherapist, I spend a large portion of my time talking to patients about exercise, rehabilitation, progressive loading, doing your stretches/home exercise programme, maintenance techniques etc. Well, it’s time for me to practice what I preach!!
My horse, Athos, has had over 12 months off due to lack of time and losing my mojo. He’s spent this time just being a horse at Cheshire Retirement Livery. I’ve missed him terribly – and his ridiculous quirks! So with a change in my working circumstances I’ve decided to bring him home and start bringing him back into work (fingers crossed!). I will also need to get fitter and strengthen up myself!
He is a rising 14, Lusitano gelding, who I have owned from him being 6 months old…. and he has had his fair share of orthopaedic / musculoskeletal issues! At 5 he was diagnosed with Osteoarthritis of the left fore fetlock, at 7 Proximal Suspensory Desmitis (PSD) of his bilateral hind limbs which he had a fasciotomy & neurectomy, at 8 he was treated for spavin of the hocks. Following intensive rehabilitation and some great training of us both (mostly me!!) with my incredible trainer, Nikki Ellis-Hughan, he was finally sound and going well. Then work, children and life got me down and I lost my mojo – plus a loooong, hard winter – I needed a break!!
Whilst he’s been away, he’s had a lovely time getting chubby and had a rather large haematoma from a suspected kick (he is always in the wrong place, at the wrong time!!!), so it is going to be interesting to see how he is moving!
I’d like to share our journey, as even physio’s can struggle with the rehabilitation journey! I’ll show what we get up to, any problems we encounter, what equipment and exercises I decide to use to help him, and hopefully, getting him back to being a ridden horse! My ambition is not too high, just to be able to get back to schooling, lessons and some hacking!
He’s coming home at the end of March…wish us luck!!!
Becky & Athos
Recently there has been a few clients who have done so well in their own or with their animal's rehabilitation that the importance of persistence and the amount of dedication required to the rehab process has really been highlighted!
There have been horses who were on the verge of being turned away, retired or looking at a different job altogether, dogs who had not responded to pain medication or some other conservative inerventions and physiotherapy was almost the last chance saloon!
One client in particular springs to mind who's horse had had surgery for kissing spines and a neurectomy for proximal suspensory desmitis of both hind legs. The rehabilitation process has lasted over several months with regular check ups from both myself, as the treating physiotherapist, and the veterinary surgeon, plus some real hard work from the owner in following advice and putting in some excellent rehabilitation and schooling exercise. The horse is now looking and moving great! The road has not always been smooth, with relapses and some additional diagnoses to content with, but the power of persistence has definitely paid dividends.
Similarly, a lovely canine patient with hind limb osteoarthritis and associated lameness, has improved greatly from the start of her physiotherapy and the owner has now seen her jumping obstacles in the garden, jumping into the car and changes in her behaviour at home, following regular physiotherapy sessions and a structured home exercise programme.
It is important to understand that the musculoskeletal system requires several components in order to physiologically adapt and there are certain principles that should be considered with any rehabilitation programme. Tissues need to be progressively loaded in order to develop. For example, if you only ever to 10 repetitions of an exercise at the same intensity, with the same weight, that will limit adaptation above this level. We have to progressively overload tissues to facilitate change. This should be done in a controlled manner and I always advocate quality of movement during any exercise!
It is also important to understand the importance of cross training, be that flatwork, ground work, hacking and pole/jumping sessions in the equine athlete, to fast runs, slow runs, swimming, gym, cycling, etc in the human athlete to train the body for different demands and prevent injury from repetitive overloading. As important as work days are REST days, particularly following intensive exercise to allow recovery and prevent a detrimental amount of tissue overload which could lead to failure. So, sessions of a low intensity or rest days should also be factored into any training programme.
If there are issues throughout the training/rehabilitation programme it is important to address any concerns or niggles to prevent them from escalating and to adjust the plan accordingly, so if something isn't working it is important to communicate this and tweak the plan to make it achievable, so don't be afraid to talk to your physiotherapist if something isn't working,
Most importantly, don't give up! With regular compliance and dedication to your rehabilitation programme you would usually be looking at between 6 and 12 weeks to experience progression in strength, muscle bulk and fitness, and in some cases longer depending on the pathology and individual plan. Of course these are very broad guidelines and there are occasions where physiotherapy is not successful, but sometimes this is a bumpy road which can take tenacity to see through... so please... don't underestimate the power of persistence!
As well as being a Chartered physiotherapist and qualified to treat humans and animals, I am also a qualified Clinical Pilates class instructor with the Australian Physiotherapy & Pilates Institute (APPI). As part of my human clinic work I regularly prescribe physio modified pilates exercises in the rehabilitation of a wide variety of problems, from back pain, to shoulder pain to enhancing athletic performance.
Pilates was originally designed with the athlete in mind by Joseph Pilates. Joseph Pilates was a sickly child and which was frequently highlighted to him. He decided to train hard to overcome his physical limitations and in doing so designed a set of exercises which was later applied to athletes and dancers. He and his wife (a ballerina) also worked closely with the New York Ballet applying their exercises. Although the original pilates exercises have many benefits they were also not designed for people with clinical conditions as Joseph Pilates was not a physiotherapist/ biologist/ physiologist/ exercise scientist etc. The founders of the APPI took the core pilates exercises and modified them using physiotherapy knowledge for clinical populations, and reduced the potential risks from some of the high velocity and long lever exercises from Joseph Pilates’ original exercises – which you certainly wouldn’t advocate for people with a hint of back or neck pain!
What I find particularly exciting about the APPI pilates method is that they go beyond matwork and have diversified into specific populations of people and sports disciplines, delivering highly tailored pilates training. I myself have experienced the benefits of applying the APPI pilates principles to my riding. Control of your core is important in everyday life, from walking down the street, to mucking out, running, riding, if you’re pregnant or have had children, training your core and providing a stable base of control for your peripheral limbs can reduce pain, rehabilitate movement dysfunction and enhance athletic performance. Control of the pelvis and the spine is key in healthy movement! Chartered physiotherapists frequently start with pelvic control in the rehabilitation of neurological conditions for example stroke – yes, this is the extreme end of the spectrum – but great lessons on the importance of pelvic control can be learnt for dynamic stability and function in healthy populations. We must be able to sit, in order to rise and then walk.
QUESTION (for the over 18’s!) Have you ever given a drunk person a piggy back?! Or a wriggly toddler/friend?
If you have, it is not the nicest feeling and its surprising how quickly you tire and get sore (and irritable)! Just imagine being a horse and carrying an unbalanced rider for a moment; confused aids, uneven weight distribution, feeling unbalanced yourself, pain… But it is not just about balance when in the saddle. Do you have an asymmetrical posture on land? Do you have an injury or a weakness? Land based asymmetries and injuries can inevitably have an impact on your effectiveness in the saddle. Having control of our own bodies and maintaining a symmetrical position is much more comfortable, kinder, and clearer for your horse, as well as more energy efficient for you in the long term.
The influence of the horse and the rider on EACH OTHER cannot be underestimated. The rider can cause musculoskeletal problems in the horse, just like the reverse could be true. Where APPI pilates can help, with a qualified instructor, is with individual exercises programmes or group classes designed to align, strengthen and gain control of the core.
Engage Physiotherapy are trained in APPI pilates for horse riders, with specific modifications to the exercises designed to enhance the riding position and rider effectiveness, be you a dressage enthusiast, showjumper, eventer, jockey or a happy hacker just wanting to do the best for your horse. If you would like a personal, horse or joint horse and rider assessment and individual treatment and training programme get in touch.
Carrot stretches, baited stretches, neck stretches – whatever you may call them they amount to the same thing – getting your horse (or dog) to follow a tasty treat in directions to bend, flex or extend their neck. They are frequently given as homework for owners between therapy sessions. But what are they actually doing? How can they help in the rehabilitation of other areas other than the neck?
Well…. I will digress into the realm of human physiotherapy research and some key principles regarding back pain (don’t worry, all will become clear!).
Humans, canines, and Equines and all have a spinal stabilising muscle called Multifidus. Rather than one single muscle, multifidus is a group of smaller muscles which run all the way from the pelvis to the top of the neck and attach one vertebra to another vertebra two/three levels above it, interlocking the sections.
Human research into back pain has highlighted this small, multi-level spinal stabiliser as being critical in a) spinal stability and healthy function, and b) being frequently dysfunctional or atrophied (wasted) in patients with back pain. Evidence shows that multifidus is so key in spinal and whole body stability that, say for example you want to reach your arm up to grab something or throw a ball, the multifidus switches on (to stabilise the spine) before any of your upper limb muscles do. Our limbs have to work from a stable base and the multifidus is at the very core – literally.
Further evidence from human practice has shown that in patients with low back pain the multifidus muscle becomes atrophied (wasted) at the spinal level where the pathology/issue originates – and even once the pain has resolved, the muscle atrophy does not just spontaneously recover – meaning there is a continued weakness in the spinal stabilisers at that level with the continued risk of recurrence of the pain and further problems.
How do we fix this? ……….. Exercise! The correct type of exercise.
Back to baited stretches……
So, following on from the human research the same issues have been found in horses; muscle atrophy of multifidus – and therefore weakness and continued pain/dysfunction. Using diagnostic ultrasound (like used during pregnancy) to assess the cross sectional area (thickness) of multifidus researchers found that multifidus atrophy corresponded to spinal levels where there was pathology and this did not spontaneously recover once the pain was gone. Just like humans.
So, how do we fix this in horses?
Exercise! Just the same as human patients …… and the exercise they used in the study …… baited stretches! Hurrah!
So baited stretches of the neck can help in the rehabilitation of back pain in horses – but why is this? Why would moving the neck help increase muscle bulk of a muscle deep in the back (and it is VERY deep)?
A horse is a quadruped (walks on all 4 legs – obviously!), when it moves the neck, it has to stabilise through the rest of the body – the length and weight of the horse’s head and neck is pretty heavy! As you encourage the horse to move to the end of its range of movement you will see that it has to recruit its abdominal muscles and the horse has to stabilise itself against the increased “axial rotation” of the spine and against the altered weight distribution. This increases recruitment/activity of multifidus, and therefore, rehabilitation of the muscle’s strength and increased thickness happen over time with repeated sessions, along with increased spinal stability – which is great considering we then sit on horses and ask them to perform extremely athletic tasks!
Frequent use of baited stretches consisting of a programme of: 5 to each direction, 5 times a week has been shown to have a profound effect on the rehabilitation of multifidus – and therefore spinal stability in the horse.
So, carrot stretches really DO have a point. Along with the obvious benefits of baited stretches in horses with pain, tightness, weakness or decreased range of movement in the neck, these very simple exercises are great for horses with back pain or as part of maintaining a healthy spine in your horse!
N.B: If you are unsure of whether these exercises are suitable or if your horse has specific issues (diagnosed or not), it is advisable to discuss any programme of exercise rehabilitation with your veterinary surgeon and/or ACPAT Chartered veterinary physiotherapist prior to commencement.
Baited stretches should be used with caution in animals which may be food aggressive or have an increased risk of adverse behaviours. Baited stretches form a part of wider comprehensive physiotherapeutic assessment, treatment and management of pain and dysfunction.
First blog, I thought the best place to start was a full introduction to myself and my journey to becoming an ACPAT Chartered Physiotherapist.
My journey to becoming a Chartered physiotherapist probably started when I was a young girl! Allergic to horses (very badly) but determined to learn to ride, I vividly remember my dad giving me an old book on keeping horses and ponies (before I was allowed to have lessons due to the allergy). I learnt all the parts of the bridle, saddle, all the colours of horses, all the names of the brushes – eventually my mum caved in and I started lessons …. Followed by a very naughty, grey, Welsh section B called Peter. I now have two naughty greys, a Lusitano called Athos and a Section A called Tilly and two equally naughty dogs; Shreddie (Border Terrier x Westie) and Weeto (Soft Coated Wheaten Terrier).
We were always surrounded by a menagerie of animals growing up – dogs, cats, rabbits, hamsters, gerbils, chinchilla's, fish… and ponies. A house simply isn’t a home without (several) pets! And so, I dabbled in equine behaviour, taking the stage 1 of the NAC Equine Behaviour Qualification and teaching riding – but they weren’t for me career wise. And so, I started a successful “proper” job in Human Resources! Circumstances then lead me to re-train to become a human physiotherapist, completing my BSc (Hons) Physiotherapy at the University of Salford, gaining a 1st class degree. From here I entered the NHS on junior rotation, followed by a Senior Physiotherapist position working with adults with learning disabilities, alongside private practice outpatient musculoskeletal clinic work. I then gained a place on the PG Dip/MSc Veterinary Physiotherapy course at the University of Liverpool, based out of their Leahurst campus on the Wirral, one of the most prestigious specialist veterinary referral hospitals in the country and completed the PG Dip with Distinction.
This long and arduous study route enables a Chartered physiotherapist to upgrade to become a Category A member of the Association of Chartered Physiotherapists in Animal Therapy (ACPAT Cat. A), and practice as a Chartered Physiotherapist specialising in Veterinary Physiotherapy.
In addition to my core university education I have also undertaken numerous additional Continuous Professional Development courses and qualifications to fully equip my treatment toolkit, these include: fully qualified in medical acupuncture, sports massage therapy, Kinesio-taping, myofascial release, specialist runners gait analysis and rehabilitation and clinical pilates.
I myself pride myself on aiming for excellent standards of care, be it an animal or human patient. I truly believe in educating and empowering clients during their rehabilitation journey and that clients must understand what is happening anatomically and biomechanically in theirs or their animal’s body to fully understand their treatment plan!
So this is me………. Animal fanatic, who despite swollen eyes and face, continued to ride and own horses for over three decades. This journey has threatened to break me at times; sustaining the demands of work, family and study for such a long time has been no easy task …. But here we are, ready to help you and/or your animal on the way to the best possible health, fitness and performance.