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 (04.02.22) 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
Case study:
You have been referred a 15.2 hh, 8
year old Welsh Cob gelding who is used for RDA, Pony club and hacking. He
sustained a grade 2, superficial digital flexor tendon injury.
He was initially box rested for 14
days, received NSAIDs, cryotherapy and bandaging treatments.
He has been on an in-hand walking
program for the last 12 weeks, gradually increasing. He is now walking 40
minutes per day split in 2, 20 minutes in hand walks daily. During which time
you have attended him and completed 4 veterinary physiotherapy sessions with no
change in his REP program. He has gradually
been re-introduced to a small individual paddock.
The veterinary surgeon has re-scanned him and is satisfied with the healing progress. He has now recommended that REP can begin in order to improve stability, muscle mass and strength for the left forelimb and core, to start getting him back into ridden work.
A strong core supports the back which allows for correct balance and movement this is often described as the ‘string and bow theory’ which allows for weight of the rider to be carried, without core stability the horse will not be able to work efficiently and correctly.
ReplyDeleteLonglining:
Longlining is beneficial for building top-line muscles, rhythm, balance and straightness. This has a therapeutic benefit, as influencing both sides equally develops symmetry. Allows for engagement and thus development of epaxial muscles and abdominal muscles. Incorporating serpentines and figures of eights will help with suppleness, straightness and balance. This exercise could be performed for 30 minutes including short bursts of trot as the horse is already far into rehab and walking in hand previously. A weight band on the left forelimb could be used to increase strength for the left forelimb. The disadvantages of longlining include owner unable to do a lot of walking.
Poles:
4 altered raised linear poles spaced by the horses natural stride length, which is usually set out three steps for walking poles (0.8m-1m). This exercise is beneficial for improving core strength which will develop the back muscles, body awareness, balance, joint flexion, core engagement, stride length and overall movement. This will help build strength for a rider to get back on and restore the horse's normal function. The horse should walk over 1 pole to start with to ensure the horse can safely walk over a pole before starting with 4 poles. The handler should not walk over the poles to avoid injury.
- emily
Equiband training aid can be used if lunging as it allows engagement of the core muscles and hindquarter muscle to assist in correct symmetrical movement which will allow development of muscles. Pfau et al. (2017) found the equiband improves dynamic stability of the vertebral column on the lunge allowing muscle development in the back muscles and core muscles and flexibility to bend.
ReplyDeleteCarrot stretches:
Could be done in all weeks of the REP plan.
Carrot stretches enhance vertebral joint range of motion, develop core strength and improve flexibility. As the horse is encouraged to move to the end of its range of movement, the horse has to recruit its abdominal muscles and has to stabilise itself against the increased axial rotation of the spine and against the altered weight distribution. This increases activity of multifidus and longissimus, and therefore, the muscle’s strength and increased muscle development will happen over time with repeated sessions, along with increased spinal stability, and core stability regular performance of dynamic mobilization exercises will result in improvements in the horse’s posture and help the ability to carry the rider once they are re-introduced. The owner should perform the stretches when the muscles are warm, so this exercise can be performed after exercise.
Chin between fetlocks: flexes thoracic region beneath the saddle area and strengthens neck, abdominal and back muscles
Chin to flank: improves flexibility for the neck and base of the neck, including outside shoulder and strengthens neck, abdominal and back muscles. Both sides should be done for symmetry.
Chin to rear fetlock: Creates improved lateral flexibility extending to the barrel of the horse and strengthens neck, oblique abdominal, back and pelvic stabilizer muscles. Both sides should be done for symmetry.
Each stretch should be held for 7-10 seconds with 3 repetitions of each stretch for it to be beneficial (Shakeshaft and Tabor, 2020). If the horse is able to stretch better on one side, the stretches should not be done further until the other side can equally stretch the same. For the group of exercises that flex or round the horse’s neck and back, it is important for the chin to stay aligned with the middle of the horse’s body and not to allow the horse to tilt his head which is shown by having one ear higher than the other (Shakeshaft and Tabor, 2020). These exercises can be performed between 3-5 days a week, depending on owner compliance, to avoid muscle soreness. Oliveira et al. (2015) found that performing DME 5 times per week does not provide additional benefit over performing DME three times per week. Therefore if the owner is only able to perform the exercise 3 days a week then it still benefits the horse the same if it was done 5 days a week.
Rider could be reintroduced in week 3 as in week 1 and 2 the horse had different exercises to build muscle strength, core development and build strength in the left forelimb. The ridden exercise can be on an even surface so no injury can occur through a slippery surface.
- emily
Short Term Goals
ReplyDelete- Increase stability
- Restore Coordination
Long Term Goals
- Strengthen and Condition for rider return.
Tactile stimulators applied to pasterns to encourage weight bearing and increased arc of flight which will enable the demands of higher muscular activation - apply to Uninjured limb initially to gauge temperament response as wouldn’t want to exacerbate issues in injured limb. Then apply to the injured limb when confident there will be no further risk for reinjury
Long reining:
Long reining can be completed to replace the hand walking, the use of a roller will start allow the horse to gain sensation for saddle, along with the lines to replicate sensations of rider aids. Long reining can be completed on straight lines to maintain even forces through the forelimbs, which can progress to work on a circle and faster pace and increase forces going through the inside legs. Can include a variety of ‘sub’ exercises eg- backing up, the use of hills and poles which will increase core engagement and proprioception. (Lilley, 2012)
Polework:
The effects depend on the arrangement of poles and the arrangement must be made to target muscle groups (Bromiley, 2015)
Scatter poles can be used under long lines in week 1 to help increase proprioception and encourage increased arc of flight and additional weight baring on the grounded limb (important to note the handler should not walk over the pole)
Trotting over poles is effective for activating the flexor musculature (Brown Et Al,. 2014)
Using a fan layout will activate the muscles on the inside limb, allowing them to work in their middle range - the strengthening phase. The fan needs stability and enables the inside limb to weight bare for a fractionally longer period of time while the outside limb produces a longer stride. (Bromiley, 2015)
DME’s:
DME’s carried out, repeated 5 times and held for 5seconds, required activation of the epaxial and hypaxial muscles, creating flexion through the thoracolumbar spine creating the change in thoracolumbar posture thus increasing the ability for core engagement, repeating these exercises will improve musculature and posture over a longer period of time. In previous research, it has been suggested that DME should be carried out between 3 to 5times per week, In this study, the change in musculature was evident after one hour but not at 24 h, suggesting a daily exercise frequency is required, if change in musculature is a targeted outcome (Shakeshaft and Tabor,. 2020)
Week 1: 20 mins long reining, in straight lines (twice daily)
ReplyDeleteScatter poles (under long reins, starting at 5 mins with 4-6 poles)
Dmes- wither rocks (3 reps on the affected limb, twice a day)
Thoracic Lifts (3 reps, held for 3 seconds, twice a day)
Week 2: 20 mins long reining, starting to include serpentines and small incline/ declines)
4-6 Linear walk poles set out at 3 feet (every other day).
DMES- Wither Rocks (3 reps, held for 5 seconds, twice a day)
Thoracic lifts “ “
Week 3: 30 mins long reining, with 5-10 mins on as large circle as possible, core resistance bands can be applied to encourage core engagement. Start to include small bursts of trot 30 - 40 seconds (ensure soundness)
Raise linear poles on alternative sides or, set out large fan with one side raised to complete on the circle (raise one pole first to ensure horse is aware of the change) alternate reins to allow even load through the forelimbs. Every other day
(Include inclines and declines when long reining on days pole work is not completed)
DMES: WRs 5 reps/ 5 secs
TL 5reps/ 5 secs
Week 4: 40 mins long reining over inclines and declines, and on a circles. Increase short bursts of trot to 40 - 60 seconds (only if horse remains sound)
5-7 poles in fan formation with raised ends (can include up to 3 reps of trot over poles on the ground) walk over raised ends.
REP plan
ReplyDeleteweek 1:
longlining over 4 linear ground poles (handler should not walk over poles), allowing the horse to walk over one single one first to make sure it is suitable (5-10 minutes)
Carrot stretches, ((3 reps , 7-10 seconds) when doing these make sure to avoid head tilts, and make sure to do both sides of the horse so that both sides are being built up and treated equally
Thoracic lifts (3 reps 3-5 seconds, daily)
week 2:
linear ground poles, scatter ground poles
longlining, normal/straight with added serpentines (20-30 minutes twice a day)
Carrot stretches (3 reps, 7-10 seconds)
Thoracic lifts (3 reps 3-5 seconds, daily)
week 3:
4 alternate raised poles, make sure the horse has made progression and is not tripping
longlining, normal/straight with added serpentines and added inclines and declines (20-30 minutes twice a day, depending on progression rider might be able to be introduced in this week)
Thoracic lifts (3 reps 3-5 seconds, daily)
Carrot stretches (3 reps, 7-10 seconds)
week 4:
trot poles can be set up if the horse has made progression (O'Sullivan, 2007)
longlining, normal/straight with added serpentines and added inclines and declines (20-30 minutes twice a day)
Thoracic lifts (3 reps 3-5 seconds, daily)
Carrot stretches (3 reps, 7-10 seconds)
Clinical reasoning ;
Goals...
short term- improving core strength and increasing stability,
long term- improving muscle mass, getting the horse back to a stage where it can take the rider back on.
carrot stretches - are active stretches of the neck and trunk which help to increase flexion, extension and also help with back muscles (Haussler, 2018; Sayers, E. and Tabor, G., 2020)
Thoracic lifts - help with back strengthening and core engagement (Quiney et al, 2020)
Longlining allows you to maintain some control whilst also building up core engagement and encourage use of forelimbs (Haussler, 2020)
Serpentines will help with building up muscle as well as increasing balance and stability
Poles - help with flexibility and coordination, as well as help to build up muscle and engage core abdominal activation and engagement (Haussler, 2020; Shaw et al., 2021)
Scatter poles will also help improve proprioception
Disadvantages could include, the owner tripping over poles, the horse causing more injury to itself it it trips over the poles badly, long lining will mean that owners will have to be walking a lot which they might not be in a position to do, if the rider is put back on tooo quickly more damage could be done
- micailla
Week 1- carrot stretches, long reining, scatter poles
ReplyDeleteWeek 2- carrot stretches, long reining, linear poles
Week 3- carrot stretches,rider back on (hacking), linear poles
Week 4- carrot stretches, rider back on (hacking), linear poles
Carrot stretches-
This could be done approximately 5 days per week once the horse is warmed up (ideally after exercise) and repeated 3 times per stretch initially, holding for a minimum of 7 seconds. The horse’s head should be stretched laterally towards the flank on both sides and down between their forelimbs to their chest; ensuring they are not twisting their neck, if they begin to do this they should be taken back to a comfortable range and this can be slowly increased. Progression throughout the weeks will include increasing the distance stretched. Carrot stretches will activate epaxial and core musculature building strength while also increasing axial flexibility (Haussler, 2016). Development of core stability and topline will allow the horse to move in a better posture, preventing the likelihood of further muscle imbalances or trigger points as well as helping to prevent diseases such as kissing spines (Zeiger, 2018).
Long reining and hacking-
Long reining will replace in hand walking for weeks 1 and 2 and should be carried out daily for 30-40 minutes (could begin at 30 and increase in week 2) as the horse has previously been doing, aiming to move in straight lines where possible. This provides contact on the bit allowing an owner to promote collection and therefore better posture than is possible through hand walking. This will strengthen the horse’s core musculature while also putting tensile force on the affected ligament allowing strengthening. Small bursts of trot could be introduced in week 2 if the owner is able to do this. A limitation of long reining as opposed to exercises such as lunging is that it is difficult to work in trot or canter, or for long periods of time due to the owner walking along with the horse. A drawback of lunging in this case is that movement in circles will put uneven strain through the sides of the body which would have the potential to overload the affected limb or build uneven musculature.
Progression to riding could then begin in weeks 3 and 4 at which point the horse should have built enough stability and strength to carry a rider. 40 minutes of hacking daily will build on the same factors as long reining while allowing the owner to see progress and have more control over the horse’s posture. A training aid such as the equiband could be used in both the long reining and hacking exercises in order to provide a proprioceptive tool which will encourage hind-quarter engagement. This should however only be used for a few minutes at a time to prevent habituation, this could make it difficult to use effectively while riding.
Poles-
Scatter poles will be used in week one 3-5 days a week for 5-10 minutes in order to increase proprioception initially, turning between poles could also be beneficial in increasing factors such as spinal flexibility. Progression to linear poles will then take place in weeks 2-4 provided the horse isn’t tripping over the scatter poles and proprioception has improved enough to do this safely. 4 linear poles should be utilised with the same reps as with scatter poles, this will help to increase limb stability, proprioception, core strength and posture (Quiney and Dyson, 2017). Activation of the rectus abdominis and longissimus dorsi muscles through pole work will be particularly beneficial in building core strength, therefore promoting good posture ready for the rider to get back on (Shaw et al., 2021). Clayton et al., (2014) discussed that ground reaction forces on the limbs aren’t increased when carrying out pole work, this suggests that the exercise will not put excessive strain on the injured SDFT.
-Tasha
Aims: Restoration of affected structures to allow for rider return following SDFT injury and compensatory reduction in forelimb and core musculature as a result of a reduced workload.
ReplyDeleteShort term goals: Improve tensile strength of the superficial digital flexor tendons Improve stability and proprioception. Strengthen core and left forelimb musculature
Long term goals:Encourage the horse to work in a correct outline to maintain the development of the core musculature Begin rehab porgram to return to ridden work
Week one Wither rocks to encourage weight bearing in the left forelimb - REPS X 5 (pulling weight over to the left side) hold for 5 seconds- this can be done every day
Incorporate 5 minutes of soft surface in hand walking and 5 minutes of scatter poles on a hard surface into the usual 20 minute in hand walking routine - this should be done every day Week two Leg lifts- lift ipsilateral limb to the right fore to further encourage weight bearing and as a progression from wither rocks
Incorperate 5 minutes of soft surface and 5 minutes of scatter poles on a soft surface in hand walking into the usual 20 minute in hand walking routine- this should be done every other day- (in hand walking without poles can be done every day)
Week threeThoracic lifts to stimulate core musculature prior to activity.
15 minutes long reining on a soft surface: 5 minute warm up 5 minutes using an equiband to encourage core enaggement. 5 minutes trot, 5 minutes of linear poles on a hard surface- 4-6 poles.
Leg lifts- lift ipsilateral limb to the right fore to further encourage weight bearing and as a progression from wither rocks
Week four Thoracic lifts to stimulate core musculature prior to activity.
5 minutes of linear poles on a soft surface 4-6 poles in walk and 5 minutes of trot, 5 minutes of trot using equiband. This should be carried out every other day.
Caileigh
Strengthening the superficial digital flexor tendon:Horse has sustained an injury to the superficial digital flexor tendon, a soft tissue structure. Referring to young's modulus, Soft tissue structures are viscoelastic, and follow a typical load-deformation pattern (Legg et al., 2019) . Softer surfaces tend to ‘bed in’ compared to harder surfaces, meaning the tendons and ligaments are being stretched more to compensate for the terrain.
ReplyDeleteThe horse is already being walked for 40 minutes a day, in 20 minute sessions. As a progression from this exercise, for every 20 minute walking session, ensure that 5 minutes of this is on softer terrain such as a sand surface or a soft grass verge. The time spent walking on the soft can then be increased by 5 minutes each week. Clinical reasoning is based on the foundations of Wolf’s law; wolf’s law refers to the fact that musculoskeletal structures respond to mechanical loading by remodelling and therefore need to be exposed to forces to be able to remodel and thus strengthen. Referring to the case study the SDFT will be exposed to forces the most when eccentrically and concentrically contracting on the softer surface, allowing for remodelling and strengthening of the SDFT.
Proprioception and stability: Poor postural stability is likely to exacerbate pain in the axial and appendicular skeleton. A study evaluating postural sway in horses found that horses with experiemntally induced carpal ostearthrtis had more symmetrical limb loading following a hydrotherapy session focusing on improving postural stability. This suggests that horses with improved postural stability had enhanced propricetibe and neuromuscular control which is critical for protecting the axial and appendicular skeleton (King et al, 2013., King et al., 2017; Ellis and King, 2020). - Although the findings of these studies highlight the correlation between postural stability and propricoeption, the methodological approach can be heavily crticised. Surveys conducted in America have found that 60% lameness is related to osteoarthritis (Caron and Gonevese, 2003) and it has been found to be an important cause of pain and disability in humans and is similarly important in horses (Mcllwraithe et al., 2012). Why could the researchers not have selected a sample of horses already diagnosed with osearthtis opposed to inducing it for the sake of the research?
Scatter poles - improve propriocetion and begin to stengthen core musculature (Shaw et al.., 2021
Strengthening core musculature: Bow and string theory: The back muscles (bow) are activated when core muscles are engaged (when tension is applied to the string). Shaw et al., 2021 found that linear ground poles at trot significantly increase sEMG data within the rectus abdominis.Furthermore, application of an elastic abdominal resistance band was also found to increase abodinal activation by 27% whilst carrying out the same exercise. Need to be cautious when exercising these findings considering sEMG adhesive markers are prone to moving and slipping during exercise. This movement could potentially cause residual heat generation leading to a skewed result.
Caileigh