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JUNE 2019 THE RIDER /35 Injury Rehabilitation of the Equine Athlete


Dr. Bri Henderson of REVS


We have come a long


way from Bute and stall rest. The field of sports medicine and injury reha- bilitation is one of the fastest growing areas of equine veterinary medi- cine – and I think that’s wonderful. Through regen- erative medicine, laser and shockwave, aqua-tread- mills and a greater under- standing


of muscle


recruitment our ability to successfully rehabilitate horses back to full athletic function is greater than ever.


In the last 10 years we


have seen the development of a college of sports med- icine and injury rehabilita- tion to set


the gold


standard for specialists in the field. The American College of Veterinary Sports Medicine and In- jury


Rehabilitation Image 1


post-injury. A sobering thought as we are well un- derway into the 2019 com- petitive season. Did you know that


cardio fitness takes 4-6 weeks to decline in a rest- ing horse but only 6 weeks to re-train? In comparison, musculoskeletal


fitness


takes 12-16 weeks on av- erage to re-strengthen to peak form! Regenerative medi-


cine has been gaining no- toriety both clinically and with scientific research. We have several options for treating injuries which include platelet


rich


plasma (PRP), IRAP, Pro- Stride or stem cells. PRP/ IRAP/Pro-St r ide work similarly where we take the horses’ own blood and process it to concen- trate the natural anti-in- f lammatory/ ’heal ing’ factors in a smaller volume that we can inject into a soft


tissue Image 2 injury


which they are injected. For example, we always worry about the initial in- flammation doing more damage to a torn ligament but the injection of stem cells within the first weeks to a ligament can control and reduce the inflamma- tion.


See imges 1 and 2. Laser and shockwave


are commonly used in gen- eral practice for treating soft tissue injuries. Both modalities have a similar effect of reducing pain, stimulating blood flow and activating cells to encour- age healing with minimal scar tissue. Shockwave uses sound waves while laser therapy uses light waves. So why would we choose one over the other? In my experience, shock- wave is best used for soft tissue that lies close to bone


(suspensory pain/injury and the


strengthen healing soft tis- sue injuries. By controlling the height of the water we can control how different structures are affected. For example, maintaining the water height at knee/hock height offers the range of motion/core work out for a horse with- out placing to much stress on the spine. Older athletes benefit from the cold com- pression of the water as well as the increased range of motion through their joints. The “whole horse”


Image 1: Sterile blood collection for PRP treatment. Image 2: Bone marrow aspiration to grow stem cells


(ACVSMR) is a college similar to the American College of Veterinary Sur- gery and Internal Medi- cine. Specialists in training must complete a residency and pass their board exam- ination. This encourages us to focus on proven sci- ence so that we do the best possible medicine for our horses. Controlled exercise


will always form the foun- dation on which all reha- bilitation programs are built. For example, we know that standing a horse with a tendon tear in a stall encourages the formation of scar tissue and a poor quality repair. We need to get these horses walking! But how much is enough and how much is too much? This depends on the structure injured (a ten- don tear versus a meniscus injury) and the severity of the


injury. Frequent


rechecks are important to monitor healing and adjust the rehab protocol as the horse heals. Depending on the tissue injured, healing and strengthening can go on for months to years


(tendon/ligament) or a joint. Stem cells have been shown to work ex- tremely well in ligament tears and stifle meniscus injuries. In order to use stem cells, we need to col- lect bone marrow (most commonly from the horses’ sternum) and then grow the stem cells in a lab. These baby cells are able to ‘grow up’ to be- come any cell in the body and they have also demon- strated the ability to influ- ence the environment into


branches, pastern liga- ments, high suspensory in- juries). The sound waves bounce off the bone and ‘focus’ their energy into the injured soft tissue. In comparison, laser therapy has found its niche in ten- don injuries, osteoarthri- tis/joint capsule thickening and potentially stifle meniscus injuries. The use of aqua-


treadmills is rapidly being recognized as a superb way to rehabilitate horses with significant back


approach is dear to my heart. Asking a young or fit horse to stand in a stall is never an easy endeav- our. We need to address their minds, nutrition and foot balance throughout the rehab process. Whether maintaining good hoof balance or employing a therapeutic shoe to support an injured structure – your farrier should be kept in the loop about injuries and rehab plans. In addition, maintaining their top line strength is a key concept to success in bringing an ath- lete back. Some incredi- ble research in human patients identified the role of a small muscle in the back called the multifidus muscle in chronic back pain. This small muscle lies along our spinal col- umn and in cases of back injury, atrophies rapidly allowing ‘micro move- ment’ in the spine to create osteoarthritis and chronic back pain. The same ap- pears to be true in horses. Dr. Hilary Clayton and her lab at Michigan State Uni- versity were able to show how carrot stretches and dynamic back exercises were critical in strengthen- ing the horses’ core and improving the strength of the muscles on either side of the spine (epaxial mus- cles including the multi- fidus). In addition to incorporating back mobi- lization exercises into our rehab plans we also often encourage hand walking horses in a bridle/surcin- gle/side reins (once they are cleared to be ready). Once the horse is given the “OK” at a recheck to take on more advanced ex- ercises, we can include pole exercises, gentle lat- eral work in hand, backing up in hand and so much more!


We often integrate


additional supportive ther- apies like K-tape, Game Ready, massage


and


acupuncture into a rehab plans. Our goal is to pre- vent secondary weakness or stiffness that may occur if the horse is protecting a


severe injury or if the in- jury is chronic when it comes to us. It’s easy for our physiotherapist to say “I know this exercise is going to hurt, but you need to do it like this anyway if you are going to get bet- ter”. We don’t have that luxury with horses so we need to make them pain free to the best of our abil- ity.


Diagnosis of an injury


is only the first step on a long road to recovery. Having a close relation- ship with your veterinar- ian, farrier, body worker and barn manager will


make it easier so that we can all work together for the best outcome. Whether we are rehabilitating an in- jured tendon, a neurologi- cal horse recovering from EPM or a fracture, a deep understanding of the in- jured tissue but also of the biomechanics of the whole horse is crucial. Injury re- habilitation is an incredi- bly


challenging and


rewarding career. There are few more rewarding days then watching a pre- viously injured horse re- turn to glory in the competition ring!


Dr. Bri Henderson BVMS MRCVS ACVSMR-resi- dent


(final year) and


Kendra Holman RVT are your core team at REVS (Rivendell Equine Veteri- nary Services). Located where the hills of headwa- ters meets the blue moun- tains,


team REVS is


focused on the investiga- tion of poor performance, rehabilitation injuries and successful maintenance of equine athletes. Visit us on facebook or at www.riven- dellequine.com


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