Rehabilitation

REHABILITATION

In humans, the goal of rehabilitating muscle injuries is based on 3 goals: (1) Improving flexibility and muscle condition, (2) Strengthening, and (3) Return to full activity.

Improving flexibility and muscle condition can be performed using a number of different techniques. Stretching exercises may be done from day 1 as long as they can be done without pain. If pain is felt then stop and wait. Stretching should be done regularly, at least three times a day in the early stages of rehabilitation. Horses stretch best by walking in a long and low frame. Stretching can be performed before exercise, in order to help the muscles warm up, loosen up, and relax; movements should not be forced and methods limited to what is tolerated.

Carrot stretches are an excellent method. Work is limited to what the horse can do without pain. Likewise, intensity is limited to the gaits the horse can perform without pain. But if the horse is capable, ground poles or cavalettis can stretch the horse as can bending exercises. After exercise, one can take advantage of warmed up muscle and force the stretch more.

Sports massage techniques are exceptionally useful after the initial acute stage (usually 48 hours). This will relax the muscle, loosen and help prevent scar tissue formation and encourage blood flow and healing of the muscle. Massage has many techniques, generally, massage movements should go with the lay of the hair (following the direction of the muscle fibers), sometimes transversely but never counter. Counter movements may induce muscle spasms.

The return to full activity should be a gradual process. Do not go straight back into regular work but build up gradually from slow trotting. When the horse can slow trot for 20 minutes without problems then gradually build up speed. Extended trot should lead to canter and canter to gallop gradually increasing to what is needed for competition.

Only when the horse can comfortably manage specific training should they be returned to full training or competition. As training is commenced massage therapy, acupuncture, and in some cases chiropractic adjustments can help the horse recover. But for long-term the author has found that altering the exercise program can be most beneficial and conditioning is of utmost importance. The work schedule should be a progressive schedule that will take 60 to 90 days, ideal work schedule is 6 days per week. Initially, most exercise should be warm up (stretching). This will consist of walking in a long and low frame until the rider can feel the hips moving equally and a normal over-stride behind. Once achieved the horse should be worked over ground poles for 15 to 20 minutes. When ground poles become easy, change to cavellettis. Exercise for at least 1 hour. As work becomes easier then slow trot can be added. Work in a long and low frame (extended frame). This will help stretch the horse’s top line and any tight muscles there. Once the horse can slow trot consistently for 15 minutes, then the intensity (speed) can increase. When 15 minutes of extended trot is achieved, the canter can be added. Work the horse for at least an hour each day. Lateral work should not be added until the horse can consistently canter for 15 minutes without problems.

In one study areas of hindlimb muscle injuries in horses were identified. One, the croup myopathy, involved inflammation over the areas of the longissimus lumborum, gluteus medius, gluteus profundus, the sacroiliac joint, and the gluteal insertions on the greater trochanter and associated fascia. The analogous regions in man would constitute the lower back and hip. The second, the caudal thigh myopathy, involved the areas over the biceps femoris, the semitendinosus, the semimembranosus, and their origins and their upper limb insertions and musculotendinous attachments. This would be analogic to hamstring injury. The third, the cranial thigh injury, constitutes damage to the quadriceps and tensor fascia latae. A gluteal tendon lameness has been described in the horse; the major clinical sign was pain around the greater trochanter.