Horses can suffer musculoskeletal pain and injuries anywhere along the axial skeleton that comprises the skull, vertebral column, sternum, and ribs. Bringing these horses back to form post-injury can be difficult and time-consuming, but possible thanks to both time-tested mobilization exercises and cutting-edge physical therapy techniques.

During the American Association of Equine Practitioners' Focus on the Sport Horse program, held July 20-22, in Louisville, Kentucky, Philippe Benoit, DVM, MS, of Clinique Equine des Bréviaires in France and former veterinarian for the French show jumping team, described methods for rehabilitating horses recovering from any number of back problems.

After a thorough clinical exam and movement evaluation, "the first technique of rehabilitation of musculoskeletal disease is to obtain progressive movement and mobilization of the affected areas," Benoit said. The main idea behind rehab, he said, is to restore a horse's normal motion.

Owners can perform various mobilization techniques when the horse is cold (before being exercised), warming up, and warmed up.

Benoit said rehabilitation exercises owners can perform when before the horseis cold include:

  • Stretching exercises such as carrot stretches to engage the cervical (neck) and thoracic (mid-back) areas;
  • Massage from a qualified physical therapist;
  • Walking in-hand forward, backward, and on a figure-eight; and
  • Keeping the horse's back warm with a blanket or hot packs.

When the horse is warming up:

  • Electrical stimulation from a veterinarian; 
  • Applying weighted boots around the hind pasterns to improve proprioception (a horse's awareness of where his feet are) and increase hip, stifle, hock, and ankle flexion; and
  • Working on a longe line with a training device—such as side reins, a Chambon, a Gogue, or a Pessoa rig—to encourage the horse to move and use his body properly.

And once the horse is warmed-up:

  • Working on different footings and slopes: "Uphill work promotes engagement and abdominal wall contraction," Benoit said. "Downhill work increases passive engagement and will be challenging for horses suffering from sacroiliac joint disease. Deep footing will make the horse elevate its hind limbs more. Firm footing increases vibration and is not indicated for horses with joint or bone diseases such as kissing spines and facet joint (between the vertebrae) disease."
  • Trotting over poles to induce conscious proprioception and more hip and gluteal (hind end) muscle function.

Benoit then described types of under saddle exercises riders should or should not do depending on what area of the horse's back they are rehabilitating.

Thoracic pain Allow these horses to move freely on the longe line as part of their warm-up, Benoit said, because they tend to counterbend when cold. But make sure the line is loose and the circle size large (at least 20 meters). He said to avoid using a surcingle, which can increase longissimus muscle (the long back muscle that runs from the neck to the pelvis) tension, supraspinous ligament (which runs along the vertebral column) pain, and kissing spines issues. "The choice and fit of saddle is paramount for this type of back issue," he added.

Thoracolumbar and lumbar (lower back) pain Benoit suggested walking these horses for a long time (approximately 20 minutes) before trotting. "Some horses feel better cantering instead of trotting because there is less axial movement of the spinal column," he said, encouraging owners to canter for a couple minutes in each direction before trotting. In cold regions or seasons Benoit recommended covering the back area with a warm rug while working.

Lumbosacral and pelvic or sacroiliac pain Also walk these horses for a long time before working and canter briefly before trotting. Under tack Benoit suggested performing progressive half passes to engage the pelvis after warming up. He also cautioned against working in tight circles and instead suggested riders work on concentric circles (starting 50 to 60 feet wide and getting progressively smaller) to encourage the horse to bend more and lean in less, ultimately pushing more with his inside hind leg.

But exercises alone aren't always enough to promote back healing. In these cases, Benoit said the following commonly used modalities could be beneficial when properly applied:

  • Massage can increase blood flow and identify muscle spasms. "Many massage techniques are available, but this would be the first modality to offer to owners and grooms working on their own horses," Benoit said.
  • Laser can be used to stimulate specific trigger (myofascial pain) points and aid healing.
  • Therapeutic ultrasound can increase blood flow, relax muscles, and stimulate trigger points. Kinesiotape applied to limit certain joints' movement can "relax or strengthen muscles, support ligaments, stimulate circulation, and decrease inflammation, depending upon how and where it's applied," Benoit explained.
  • Electrotherapy uses various instruments—such as transcutaneous electrical nerve stimulators (or TENS), interferential stimulators, neuromuscular and functional electrical stimulators, galvanic muscle stimulators, and microcurrent electrical stimulators—to stimulate nerves and decrease pain.
  • Shock wave therapy can help treat myofascial pain and muscle spasms.
  • Magnetic therapy might enhance blood vessel formation.
  • Cyrotherapy using anhydrous nitrogen can stimulate and relax sore muscles.
  • Hydrotherapy, including water treadmill use and swimming, helps the horse strengthen his muscles without overloading the limbs if, say, he also had surgery recently.
  • Saddle adjustment to ensure a proper fit can help avoid or eliminate muscle spasms.

"Some of these techniques are being scientifically evaluated, but practitioners have used many of these tools to help horses recover quicker," Benoit said. "The main techniques used today are massage, TENS therapy, and stretching; however, functional electrostimulation and therapeutic ultrasound or kinesiotaping can hopefully be used for other serious issues in the future."

Owners should work with their veterinarians to determine which rehabilitation techniques and exercises are appropriate for their particular horse's injury and discipline. And because back problems are often linked to lower limb issues, Benoit suggested working with your veterinarian to ensure the horse remains sound and monitoring the horse's topline muscle for any asymmetries. "This would be the minimum to keep him comfortable under tack," he said.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.

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