Following on from my article on the principles of rehabilitation in Equestrian Life’s June issue, we will now examine in more depth the types of exercises that can be done both for rehabilitation and improving core strength and balance.
“Work with a qualified
therapist or veterinarian
initially.”
Exercise can be both passive and active. “Passive exercise” is one which involves either a piece of equipment or a person orchestrating the movement, as opposed to an “Active exercise” where the horse is bringing about the movement.
A good example of a passive exercise is one where the limb would be lifted, and the fetlock flexed and extended by the handler as the horse stands there. This may be required in the early days following a surgery, whilst the horse is bandaged and box rested. It allows for movement in the joint without weight-bearing and discourages the formation of surgical adhesions and fibrosis, as well as improves blood flow and reduces swelling to the area.
The other form of exercise when it comes to rehabilitating the horse is the active form. Here the horse is encouraged to use its own joints and soft-tissue structures to bring about an action. A good example of this, which we are all familiar with, is the “baited stretches”, also known as carrot stretches, which get the horse to flex its own neck while seeking to eat a carrot or some feed from a particular point.
Exercises can be performed any time, but for horses that are rehabbing and working, they are perhaps more beneficial if undertaken prior to the horse going out doing a regular form of exercise (akin to warm-up exercises in people). In the early stages after an injury, the degree of stretching and joint movement should be limited to accommodate the horse’s pain tolerance.
Over-stretching or extending the range of joint movement can be detrimental if the forces applied outweigh the strength of newly laid down tissue and cause further tearing. Start off slow and gradually increase the intensity as the horse improves and can tolerate the advances. Work with a qualified therapist or veterinarian initially, so an appropriate exercise regime can be formulated and a timetable can be followed. Exercises do not need to be done every day as this can lead to muscle fatigue, and often 3-4 times a week is more beneficial than 6-7 times a week.
The hamstring stretch, where the hind leg is lifted and brought forward toward the fetlock of the front leg, is another passive exercise.
PASSIVE EXERCISES
HIP EXTENSION: This is a passive exercise designed to strengthen the sub lumbar (lower back) muscles in horses that need to do a lot of collection work. The hind limb is stretched out behind the horse, so the hip is extended, and the limb is held in this position for 30 seconds, and this is repeated 4-5 times on each side. As the horse’s muscles relax, the person stretching the leg can feel the relaxation and they can stretch the leg further out. This is repeated 4-5 times on both legs and can be done 2-3 times a week.
HAMSTRING STRETCH: This is probably more of a warm-up exercise than a rehabilitation exercise, however, it is still useful in strengthen the core. The hind leg is lifted and brought forward toward the fetlock of the front leg. As with the hip extension, the rehabilitator or therapist waits until the muscles relax and then stretches the leg further forward, holding the limb in position for 30 seconds and then repeats the procedure 4-5 times on both sides.
FORELIMB STRETCH: The front limb is lifted and brought out front of the horse, and held for 30 seconds, repeating the procedure 4-5 times. The height to which the front limbs are lifted can be increased with time until the limb can be held out to a horizontal level.
DYNAMIC MOBILISATION EXERCISES
These are active exercises aimed at rounding and laterally bending the neck and back to improve stability and balance of the horse and build up strength in the multifidus muscles of the spine.
BAITED STRETCHES:
A) Rounding the neck to encourage the horse to flex the joints in the neck and spine. By changing the position of the nose of the horse, different parts of the cervical spine (neck) are flexed to different extremes. The bait (carrot) is placed on or close to the chest (in the midline), and then progressively moved down so the horse is encouraged to place its mouth near the knees and then in between the knees and up toward the girth area.
B) Lateral bending of the neck to a position in line with the shoulder, the girth and the hip will encourage the muscles attached to the vertebrae in the neck and thoracic spine to strengthen. As the horse continues doing these exercises, the amount of flexion in the mid neck and back should improve, allowing for more flexion to occur. It is important that the horse does these exercises correctly and keeps its head and neck relatively straight (ears level), as twisting the neck and head to get the reward will not produce the same result.
C) Neck extension exercises are done by making the horse stand and extend the neck down and as far forward as it can. It is easier to have a barrier in front of the horse, for example a low door, to discourage the horse from walking forward, only allowing the prize to be accessed by extending the neck. As the horse improves, the reward (carrot, sugar cube or feed) can be gradually moved further away to increase the degree of extension achievable.
A – Rounding the neck to encourage the horse to flex the joints in the neck and spine. B – Progressively moving the bait, so the horse is encouraged to place its mouth in between the knees and up toward the girth area. C – Rounding the neck, with a limb off the ground.
Lateral bending of the neck. Note, it is better to stretch with the head not twisted and pole straighter; ideally the horse would stand with legs more balanced.
Thoracic lifts are aimed at strengthening the large postural muscles of the back to improve the horse’s topline.
“Working on different
surfaces can help
improve proprioception.”
SPINAL LIFTS:
a) Thoracic lifts are aimed at strengthening the large postural muscles of the back to improve the horse’s topline. To do this, the handler uses one or two fingers to push on the bottom of the abdomen, usually in a midline position just back from the sternum. The fingers are pushed up into the abdomen, causing the horse to lift its abdomen and contract the muscles along the thoracic spine. The horse needs to hold this position for 5-10 seconds and then can relax before the lift is repeated 4-5 times.
b) Lumbosacral lifting users the sub lumbar muscles to round up the hind quarter when pressure is applied to a groove between two large muscles on the rump, approximately 15-20cm either side of the backbone, halfway between the point of the hips and the tail butt. Both sides can be stimulated at the same time causing the back to lift and pelvis to tilt backwards or one side can be done and then the other, causing a bending to the side stimulated as well as a lifting. The horse holds this position for 5-10 seconds and then relaxes before the pressure is applied again (repeated 4-5 times).
BALANCING AND STRENGTHENING EXERCISES
a) Tail Pulling is an exercise used to strengthen the pelvic muscles and improve balance. The tail is pulled to one side, pulling the horse’s weight onto the leg on the same side, causing the hip and stifle muscles to be activated as the horse resists the pull. The secret to this is to pull just hard enough that the horse shifts weight onto the limb but maintains pressure on the tail as it tries to shift back onto the other leg; it is not designed to pull the horse sideways or off balance.
b) Tail Pulling as the horse walks is an extension of (a) whereby the tail is pulled in a similar manner, but the horse is walking as it is done. If too much pressure is applied, the horse will be pulled off stride, which is not the desired effect. As a point of interest, this exercise can be conducted as a test for hindlimb weakness in “wobblers” as affected horses have no or very little strength to resist the pull and can be pulled almost sideways as they walk.
c) Caudal Tail Pulls: The handler stands behind the horse, pulling backwards on the tail to strengthen the middle gluteal muscles and pelvic muscles. The tail is pulled and held for 5 seconds and then released and repeated 5 times. Care should be taken with this exercise and only attempted on horses that are well handled (not those easily excitable or known kickers).
d) As the horse strengthens and performs these exercises with more ease, additional measures can be put in place to further increase the core benefits. One measure is to have a second person hold up a front leg while the tail is pulled to the side, requiring further stability and balance to maintain the position.
e) When horses are walked or trotted on an uphill incline, the hindlimbs take on more load. When they are walked or trotted downhill, it is the forelimbs, which are selectively loaded. Depending on where a horse is in his rehabilitation program, the use of an incline can be utilised to selectively strengthen or reduce the demand on a limb. Exercising a horse on a treadmill with a graduated incline can reduce the load on the forelimbs in horses that have had forelimb injuries. This means, however, that the hindlimbs are working harder and whilst this is good to build up the hindquarters, care must be taken to ensure any increase in demand on the limbs is done gradually and not excessively, as it can lead to injuries in the hindlimbs.
Lumbosacral lifting users the sub lumbar muscles to round up the hind quarter when pressure is applied to a groove between two large muscles on the rump.
PROPRIOCEPTIVE EXERCISES
These exercises usually entail changes in position or the surrounding environment to improve neuromuscular responses to input.
a) Walking a horse from asphalt to sand, to dirt or to grass will help improve proprioception and the range of movement of many joints. Working on different surfaces can help improve proprioception, however, I would be hesitant to recommend exercising on changing surfaces at any speed much above a walk, as sudden changes can increase the risk of injury.
b) Walking over an unstable surface such as a large mattress or deep sand encourages proprioceptive input, as the body needs to adjust constantly to the changing footing.
c) Balance pads are available which can be placed under one or more feet and provide some instability to which the horse learns to accommodate as it improves its core strength and balance. Once the horse is comfortable on these pads then additional exercises are introduced such as lifting individual limbs, rounding exercises and stretches.
d) Backing a horse up and down an incline for several strides, walking back down and then backing up again. Repeat 4-5 times. When horses are walked or trotted on an uphill incline, the hindlimbs take on more load; when walked or trotted downhill, it is the forelimbs which are selectively loaded.
e) Elastic Resistance Bands can be used around the hindquarters when walking, lungeing, or backing to improve stability, flexibility and proprioception. If using these, start with short stints of 5 minutes once or twice a day and then gradually build up the time over several weeks.
RANGE OF MOTION/FLEXIBILITY EXERCISES
a) The use of ground poles and cavalettis set at varying heights and at different distances apart can work well to get the horse to pick up its limbs and flex its joints, helping improve not only the range of motion of joints but also improving proprioception and core strength. Various configurations can be utilised to add variety and depth to these exercises with circular and figure 8 configurations, as well as poles position at unequal heights from one side to another. Walking a horse along the length of a pole on the ground so it has to place one limb each side of the pole as it walks can help improve flexibility in horses with narrow chests that would otherwise land with their feet close together.
b) Tactile Stimulation exercises encourage the horse to lift their limb(s) higher, improving flexibility and range of motion of joints. By placing a weighted bracelet on a pastern or above the fetlock, the horse instinctively picks the limb up higher and places it further out in front as it walks (many readers would see a similar response when boots or bandages are initially put on and the horse starts walking). A bell boot can be substituted for a weighted bracelet. The limitation with this type of exercise is the horse quickly adapts to the weight on its limb and after a short period of time will return to a normal action.
This is by no means a complete list of exercises, but an idea of the types of exercises that can be used to help your horse. EQ
YOU MIGHT ALSO LIKE TO READ BY DR MAXINE BRAIN:
The Principles of Rehabilitation – Equestrian Life, June 2020