Rehabilitation for horses with soft tissue injuries Flashcards
What are the aims of rehabilittaion of horse with soft tissue injuries?
- Hasten return to function following injury
- Improve function of the structure involved
- Reduce pain and inflammation
- Reduce re-injury rates
- Improve quality of life
- Improve range of motion or flexibility
- Improve proprioception and balance
- Adopt a whole animal approach
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What rehab techniques have consistently improved outcomes?
what factors impact this technique
Controlled exercise programs
LOTS of variation in programs prescribed based on:
* Structure involved
* Severity of injury
* Practitioner preference
* Past experiences
* Discipline of horse
* Time of year
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What is used to benchmark and monitor progress of rehab?
- monitor levels of Lameness
- Palpation
- Ultrasound
when should exercise be commenced with soft tissue rehab?
The historic approach to rehabilitation of tendon injuries involved protracted periods of box rest and VERY gradual incremental exercise plans
More modern approach gets horses moving faster and tends towards goal-directed decision making - end of inflammatory phase (2-4 weeks after injury), during the proliferative phase, input to the soft tissue will cause beneficial changes in structure which will influence the structure in the end stage
describe an example increase in exercise intensity for a soft tissue rehab program
- Walking in hand or under saddle
- Trotting under saddle in straight lines
- Trotting under saddle on circles and bends
- Canter work in straight lines
- Canter work on circles and bends
what are the thought and considerations about uncontrolled exercise after a soft tissue injury?
what can be done to assist with uncrontrolled exercise
Turnout, lunging and loose schooling are all uncontrolled exercise and come with an increased risk of re-injury
This decision making will depend on temperament,
* a calm horse with access to small individual paddock can be turned out sooner
* An anxious horse living in a herd will be kept indoors for longer
Anything we can do to help?
* Anxiolysis – acepromazine, can be safely used medium-long term
* Enrichemnt – access to stimuli and food
What are some of the methods that can be used to directly influence the injury site during soft tissue rehab?
Order in terms of evidence:
- Extracorporeal shockwave therapy (ESWT)
- Laser (class 4)
- Cold/heat treatment
- Therapeutic ultrasound
- Pulsed magnetic field therapy
What is shock wave therapy?
in what soft tissues injuries is it most effective for?
what are the outcomes and drawbacks of this therapy?
what are the future direction of this?
Delivery of high-pressure waves to tissues – probably most focused at the junction between soft tissue and bone:
* Practical application to proximal suspensory ligament, suspensory branches, thoracolumbar spine - junction between soft tissue and bone
Shockwave seems to temporarily improve lameness, but has limited effects on structure and function:
* Commonly applied to chronic injuries as part of a management plan
* not helpful for acute injury management
Future directions: Investigations underway to looking at combination of shockwave with biologic treatments.
What is the patient preperation and protocol for shockwave therapy for soft tissue injuries?
Variables
* Number of “shocks” – often in the region of 1000-2000 per site
* Energy of impulses – measured in mJ/mm2\
* No evidence basis for selecting these variables!
Patient preparation
* Restraint – sedation
* Clipping long haired horses
* Application of acoustic gel
* Delivered when non-weightbearing
Protocol
* Often delivered weekly/fortnightly
* Treatment period of 4-6 weeks
* Not within 5d of FEI competition!
what is the evidence behind high power laser therapy for soft tissue injuries?
what is the contraindication and clinical application of lasers?
Good evidence that high power laser can:
Reduce lesion size, increase doppler signal, change collagen deposition, improve US fibre pattern
No evidence (yet!) that this leads to reduced re-injury rates!
Contraindications for the use of high powered (class 4) lasers: Eye exposure, neoplasia, haemorrhage, pregnancy? sex glands?
Probably more logically applied to more superficial structures: Suspensory branches, flexor tendons
Multiple treatments as for ESWT
Prohibited for use at FEI events
How should you manage and rehab a horse with a soft tissue leg injury, with regards to the rest of the body?
how is this done?
Want to increase core stability - Core stability aims to improve neuromuscular control, reduce force/stride variability, negate compensatory mechanisms, reduce frequency and severity of abnormal loading events.
Methods include:
Water treadmill exercise
Swimming
Ridden or in-hand exercises
Whole body vibration (lacking evidence!)
What are the principle of water treadmill exercise?
what is it recomended for improving?
what is the clinical use?
Huge topic of research currently:
* Adds resistance to cranial phase of stride
* Increases limb retraction (stride height)
* Increases ROM of the axial skeleton
* Buoyancy (if deep enough…) (reduces stress and strain on joints)
Recommended for improving:
* Strength
* Coordination
* Stability
* Postural control
Clinical use: Can be prescribed as an intensive course or incorporated into ongoing training
What is swimming recomended for in horses?
what are the clinical uses?
Recommended for improving:
* Aerobic fitness
* Brachiocephalicus tone
* Reducing stress on joints and soft tissues
Clinical use:
* Largely used in the training and rehabilitation of thoroughbred racehorses (improved fitness and reduced repetitive strain)
* Less useful for sports horses as it encourages an extended neck and thoracolumbar spine – the opposite of what we hope to achieve!!
* Consider implications for a fit horse with reduced bone stimulation…
What exercises can be used to rehab horses with soft tissue injuries? (esp if no access to water treadmills)
- Hill work (trot up and walk down)
- Pole exercises (raised)
- Working on a range of surface types
- “cross training”
