SPORT SPECIFIC REHABILITATION OF THE DRESSAGE HORSE – STRAIGHTNESS: A CASE STUDY Hannah Nash ACPAT Cat A History Frisbee is an 8 yr old warmblood gelding who was purchased from Holland following a full 5 stage pre purchase veterinary examination for low level dressage in his 7th year. Conformationally, he is long in the body with high set neck typical of Dutch carriage horses. His full history is unknown. At the time of purchase he was working at basic preliminary dressage level and despite his conformation, showed no significant difficulty with progressive schooling towards elementary level over the next eight months. He was always reluctant to lower his head and neck and relax the topline when ridden or lunged and showed less suppleness on the left rein. Eight months following purchase, he developed a sudden onset shortened stance phase on the left hind leg when ridden which was graded 1/10. Full lameness work up with nerve blocks revealed a resolution of the lameness with a tarsometatarsal (TMT) block to the left hock. Radiographs indicated possible minor degenerative changes to both distal TMT joints which was felt to be borderline significant. Veterinary treatment consisted of bilateral Depo Medrone injections to the TMT joint space and a Tildren infusion. After ten days, a progressive walking programme was started in hand and under saddle. Six weeks post medication; there remained an intermittent uneven stride on the left hind on a left circle. Secondary referral to a specialist referral centre for Gamma Scintigraphy to the hind quarters showed no abnormality and a gradable lameness was not able to be reproduced on trot up, lunge or under saddle. A return to full work was advised. In this case study, the horse was shod with a standard shoe on all four feet
and remedial alterations to support the veterinary treatment were not added. Physiotherapy Assessment The main issue we noted with Frisbee’s movement was an intermittent irregular stride pattern. On close assessment we noted poor muscular development of the hind quarters relative to the shoulder and he carried his head in an elevated outline but was unwilling to stretch his neck down and forward when lunged or ridden.
that would require rehabilitation. On palpatory assessment, there was a moderate range of cervical side flexion and flexion equal bilaterally and spinal range of movement was within normal expectations. Left sided caudal longissimus spasm was elicited with pressure into resistance and mild increased tone in the lumbar insertion of the left middle gluteal. The middle gluteal and biceps femoris bulk was reduced on the left. Treatment 0-4 weeks
On a right 10 m lunge circle, the right hind limb had a shortened cranial swing phase – possibly due to the extended stance phase and increased weight bearing on the right fore limb. The left hind had a shortened stance phase with marked medial rotation through to the end of the caudal phase. The hind limbs travelled laterally left to the forelimbs with the right hind crossing under the body therefore travelling on four tracks. There was a lack of lower cervical side flexion and over activity of splenius during gait (not evident in stance).
The secondary lumbar and gluteal muscle spasm was addressed with reflex inhibition techniques and myofascial release. Reflex Inhibition Techniques have been demonstrated to temporarily reduce spasm in longissumus (Wakeling et al., 2006) which may be utilised to restore normal movement patters. In cases of long standing back pain it is suggested that the multifidus in the horse is inhibited (Clayton, Stubbs, 2010). Baited stretches have been proposed to help in the recruitment and hypertrophy of the multifidus in the horse (Clayton, 2010).
We hypothesised that the sudden onset of left hind limb lameness was due to the repetitive shearing and rotational forces through the tarsal and stifle joints as a result of the asymmetrical movement pattern. We proposed that the shearing forces would have been increased as ridden work progressed at increased paces and more complex schooling patterns, a possible factor in the sudden onset of lameness. The author proposes that the initial sudden onset of gradable lameness and a positive block suggested that hock pain was the initial problem. The symptoms remaining post medication were suggestive of an underlying mechanical dysfunction
In this case we used daily lateral spinal flexion exercises biased to the lower cervical, thoracic and lumbar spines. We added a combination of weight transfer and pelvic stability exercises to increase recruitment of the biceps femoris, particularly on the left. It is proposed that Biceps femoris is active throughout the stance phase of gait (Robert et al., 1999) and the deep fibres contain a higher percentage of type 1 fibres (Karlstrom et al 1994). It has an important stabilising role in controlling the forces transmitted through the hock and stifle (Clayton, 2010). The stability exercises were started immediately and continued daily for 4 weeks along side a walking programme. The stability exercises
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