Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part Two: Road to Recovery

Willow Road to Recovery

In part two we discussed Willows history and issues that were causing her complex lameness, which you can find more detail in Case study Part One: Complex lameness. In this part we are going to discuss what treatments were used and Willows progress.

Treatment

Willow’s treatment was started very gently. In this case less is more. Willow is also a very receptive and expressive horse, which as a therapists is brilliant as she leads her own treatments. It is so important to listen and respond to a horses reaction. In this case Willow directs me on duration and areas she needs working on. Willow is also very responsive to acupressure points.

Her treatment began with Bladder 25 to help strengthen her lower back, address any stiffness or pain in this area. Willow responded by lowering her head almost to the ground and softening her eye to the point that she almost went to sleep. This allowed me to massage through her hind quarters to release further tension and relieve pain. Willows neck and poll muscles were also released through a number of soft tissue techniques. As well as her adductors on her inner thigh. This caused increase tone and activation through the TFL and quadriceps.

To finish of the session 5 gentle dock pulls were included on both sides to help strengthen and activate the TFL and quadriceps. A number of belly lifts were also performed to help activate the core muscles and stretch through the back.

Initial Outcome

Just from the above treatment and exercise Willow showed immediate improvement. Firstly her TFL (tensor latae fascia) and quadriceps started to activate. Had increased tone and secondly she was far less sensitive through her back and hindquarters. Her movement seemed eased but was still showing signs that were present on initial assessment. However the goal of making Willow more comfortable was achieved.

Continued Treatment

The original plan was to come and treat Willow little but often to allow her body to make small adjustments and to not overload her system with change. So visits were made twice a week for about two weeks. During this time I was fully aware that the country might go into lockdown and that I wouldn’t be able to come up to physically treat Willow. So Willow’s owner was taught how to do some of the key techniques that were helping Willow the most and given equipment to allow progress if I couldn’t be there. Willows owner was also doing some of acupressure points on a daily basis in between my treatments.

So in the second treatment acupressure point Bl 25 continued to be used along with the introduction of Bl 21 which helps with atrophy, gastrointestinal issues, edema , back pain and general weakness. Each session I added a new point Bl 11 (helps strengthen bones and joints, nourishes and facilitates blood flow, benefits joint problems and also helps neck and spinal pain), Bl 19 (helps with hip pain and gastrointestinal issues) and lastly Bl 23 (helps with general weakness, lower back pain and estrous cycle). The owner was also taught these points as treatment progressed. Willow responded well to all these points

Massage through Willows back, hindquarters, neck and poll were also carried out to help activate muscles and release tension that has developed due to compensatory mechanisms. Again Willow responded well over the two weeks

Exercises

Initially dock pulls and belly lifts were introduced. Gradually the number of repetitions were increased and this was something Willows owner performed between sessions. In the second treatment weight shift directed through the shoulder was introduced this along with dock pulls were to encourage Willow to use her stabilising muscles. To start the main aim was to develop Willows core to give her a stronger foundation to develop more global muscle strength.

Willow was introduced to some foot pads. Just one placed under a fore foot to start and then moved to a hind foot. The foot pad was placed under for as long as Willow would stay. This was often a couple of minutes. This was again to encourage Willow to use the finer muscles to stabilise herself.

Before I got to progress Willow further lockdown occurred. However with guidance Willows owner was able to progress her exercises gradually. Walking over a pole in straight lines was introduced then progressed over a week to a figure of out over a pole. These progressions occurred over a 3 week period from initial treatment.

Willows owner continued with all the above acupressure points, exercises and pole work by week 4 she was walking over 2 poles in a row with several repetitions. By week 5 Willow was introduced to slightly raised poles done in hand exercises. Willow is also on a track for the summer months so poles and obstacles to step over were introduced to encourage her to use her hind quarters more throughout her daily life. By week 6 straight line trotting in hand was introduced. By week 7 3 poles on a circle at walk was performed with no ill effect.

Progress

Walk up 3 months after initial assessment

Willow showed great improvements in her walk and confidence by week 2 of initial treatment. She was also getting increased turnout time. By week 3 she was back out on full turnout and her Bute had been gradually decreased as well. Within a month Willow was out 24/7. Willows feed was also changed to help increase weight and muscle mass by phasing in Copra and Speedi beet into her seaweed, brewers yeast, lucerne and chaff. Gradually the lucerne was phased out and replaced with Agrobs Leichengrass. There were two aims with these changes one was to reduce any feed stuffs that might cause increase in inflammation (hoof friendly) and to help increase condition.

The above photographs show a vast improvement in muscle mass and posture. The video further up also shows huge improvement in movement patterns. Willow will always have some sacroiliac issues but with careful management she should be able to lead a happy and comfortable life.

If you have any concerns about your own horse and lameness then do consult a vet or contact Pollyanna with any queries and she will try and help the best she can.

Chat to Pollyanna

Human, Injury Management

Lower Back Pain

At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement