Equine Physiotherapy

by Kate Sagar B. App. Sci. (Physic) M. Anim. St. (Physic)

THE REHABILITATION OF RADISH:

A TENDON INJURY

THE FLEXOR TENDONS

The horse has two flexor tendons, which run down the back of the cannon bone, they are the continuation of the forearm flexor muscles, attaching onto the bones in the hoof. The tendons are made up of collagen fibres which form a rope like structure. When the hoof lands on the ground, the horse’s weight causes the pastern and fetlock to drop, thereby stretching the tendons. When the weight is unloaded off the leg, the tendons act a bit like a ‘rubber band’, having been stretched they then recoil, helping the leg to float through the air.

HOW ARE THE FLEXOR TENDONS INJURED? The rope like tendons are injured if they are continually over loaded or over strained. The strain on the tendon is a direct result of the weight of the horse and the speed it travels at. Further strain is added to the tendon if the horse has a conformational fault, i.e. very straight or very sloping pasterns or a broken hoof pastern axis due to poor shoeing. It is however normal for some degree of strain to be placed on the tendon, with an ongoing process of micro-damage and repair happening in the tendon all the time.

When the micro-damage out weighs the repair process, the tendon is in trouble and will eventually tear. The main point to note, is that tendon injuries normally occur over a period of time (with some event simply being the straw that broke the camel’s back), rather than being a one off injury.

HOW DO WE REHABILITATE A TENDON INJURY? When a tendon is injured the entire back section of the lower leg becomes swollen, hot and painful to touch. The horse may or may not be lame. The first thing is to ice the leg, for fifteen minutes two to four times a day. Icing should continue whilst there is heat in the leg. This will help to reduce the swelling which will aid the healing process and reduce pain in the area.

The horse should be kept in a small yard and have total rest for three weeks to let everything settle down.

At three weeks a structured rehabilitation process begins with the GRADUAL LOADING of the leg. As the tendon heals it requires a small amount of load or strain in order for the new collagen to line up in a linear pattern, which increases the strength of the end result. (The tendon however will never be as strong as prior to the injury. The new collagen which forms to heal the tendon is a different type and never matures to the same strength as before).

The best results will be achieved if we can very slowly increase the amount of load placed through the tendon. During this time the horse needs to be kept in a small yard and will not be returned to the paddock until he is up to the trotting phase of his rehabilitation.

To illustrate the process of rehabbing a tendon we will look at the program used by Jenny Bowker and her horse ‘Radish’. Radish sustained a major tendon injury, with a 10 cm tear which damaged 40% of the cross sectional area of the tendon.

WEEK 1–3 Yard rest with ice 2–3 times a day and a support bandage to help reduce swelling.

WEEK 4 Begin exercise program of WALKING in HAND for 2 minutes ONLY on a FIRM SURFACE. Stay on 2 minutes for 3 days then increase by 1 minute every 3rd day. Continue this until walking for 1 hour. After each session ice the tendon for 15 minutes. SIGNS to watch for are swelling, heat and pain on feeling the tendon. If any of these occur, call the physio and the program will be slowed down.

4 MONTHS Add weights to further increase the loading of the tendon. Begin with adding a 5 kg weight to the saddle and walking for 20 minutes for 3 days, then 30 minutes for 3 days, increasing by 10 minutes every 3 days up to 1 hour. Then increase the weight by 5 kgs and continue until reaching 30 kgs. At this stage Radish can now be ridden WOW!

7 MONTHS (approx) Begin trot work. 30 minute walk, with 30 second trot for 3 days, then 1 minute trot adding 30 seconds up to 5 minutes. Then increase by 1 minute up to 15 minutes trotting.

9 MONTHS Begin arena work. Begin by doing 25% of the walk work in the arena for 1 week, then 50% for I week, then 75% then 100°.

10 MONTHS Add trot work in the arena, starting with 1 minute for 2 days, the 2 minutes for 2 days up to 20 minutes.

12 MONTHS (approx) Begin canter and jumping. Start JUMPING. Begin with 1–2 jumps, for a week, and add 1–2 jumps every week until jumping a course. Add canter work in small intervals.

14–15 MONTHS Radish has now completed his full rehabilitation and Jenny can think about training towards a competition! Start adding faster canter work and building towards a slow gallop. Start with a couple of minutes 1–2 times a week and slowly increase. Once the final goal is achieved, keep the fast work and jumping to a minimum, as this is where the risk of re injury is greatest. Remember to feel the tendon daily for heat, swelling or pain. Always work the horse on a good surface, no boggy or rock hard competition tracks allowed! ICE ICE ICE after all jumping work, and good luck.

Radish received regular physiotherapy treatments during his rehabilitation in order to monitor his tendon and address any secondary muscle tightness that arose. His chest area would often become tight and needed to be stretched in order for him to use the leg normally.

His program was extremely conservative and slow due to the size of the tear and the fact that Jenny wanted to return to eventing, meaning we had to bias the exercise program towards endurance work. In cases where the tear is small, or show jumping/dressage disciplines are involved the rehabilitation process can be reduced considerably.