Behind the Scenes: How a Physical Therapist Can Work with Horses

This is an individualized approach to this equine’s rehabilitation. Please consult your horse’s DVM to discuss if a program like this is suitable for your horse before starting any rehabilitation program.

*Names changed to protect anonymity* 

What’s it like to Rehab a Horse:
A Physical Therapist’s Perspective

Dr. Shields has a new patient in her client rotation– an 8 year old gelding who competes as a high level Grand Prix Jumper. The horse, we’ll call him Secretariat, was referred to Dr. Shields for equine physical therapy by his usual veterinarian after incurring an injury during training. He was diagnosed with suspensory desmitis on the left front, a nightmare for his owners. 

The first sign of trouble presented as having difficulty picking up or holding the canter. He then developed lameness with lunging to the right. It’s common to have lameness only in one direction on a circle. This is due to the placement of the affected limb on the inside or outside track. For Secretariat, he was lame only when his left front was pushing his body forward from the outside of the circle. 

The initial ultrasound revealed an increase in size of the left front suspensory as compared to the same ligament on the right front. There was also some mild fiber disruption in the same area.  

Early Treatment

Secretariat came to Dr. Shields’ Farm after the injury occurred. Some early treatment had already taken place in the form of PRP injections by the referring vet, stall rest, hand walking, and laser therapy performed by Dr. Shields. At this point, it was time for added equine exercise prescription.

In cases like this one, controlled exercise can start as soon as 21 days after the injury occurs. At this point in time, the ligament is entering the remodeling and maturation phase, which continues into the first year of recovery. During this time period, the fibers that make up the ligament begin to fully develop and realign when stress is applied. If the ligament is not carefully stretched and strengthened, the fibers will remain randomly aligned and will decrease in tensile strength. 

If there is scar tissue present in the ligament, the site of the injury will be unorganized, lack mobility and extensibility, lack resistance to tensile forces, and will have abnormal proprioceptive input. In other words, it will have decreased strength, flexibility, and a noted lack of ability to provide spatial awareness input to the brain. Injuries that heal with excessive amounts of weak, unorganized scar tissue are prone to reinjury and degeneration. 

Secretariat’s PRP injections allow injured tissues to regenerate in normal non-scarred collagen fiber. The hope is that this, combined with equine physical therapy, will allow injured tissues to restore to normal structure and function with minimal scar tissue. 

The Return to Work

The riskiest part of healing any ligament injury is the slow return to work. The fibers of the suspensory ligament need to be stressed just enough to increase strength, flexibility, and promote proper alignment. However, if too much work is added too fast, you risk a prolonged healing period and the possibility of an incomplete recovery. 

One of the most important parts of bringing Secretariat back to work included a long warm up. The warm up helps to slowly increase circulation in the ligament for added strength and flexibility, while also decreasing the risk of re-injury. Also essential, was the addition of compression ice wraps applied for 20 minutes after each workout. 

Secretariat’s warm up began with 10-15 reps of PROM work of the shoulder, carpus, and fetlock to decrease pain, as well as encourage circulation and movement of fluids throughout the affected limb. PROM stands for Passive Range of Motion. These movements are completed without activation of the patient’s muscles. Instead, a Doctor of Physical Therapy will move the affected limb for the horse. 

Carrot stretches, pelvic lifts, and tummy tucks completed the warm up. Early treatment also included 20 minutes of hand walking daily, changing speed every minute. It’s crucial when rehabbing ligaments to avoid soft or slippery surfaces at all costs!

If the ligament is healing normally, noted by reduced pain and a normal healing diagnostic ultrasound by the referring DVM every 30 days, then work can be increased by 10 percent each week. This strengthens the ligament, while avoiding turning up the heat too fast and actually moving backwards in the recovery process. 

How to Measure Progress at Appropriate Intervals

Just as important as a slow return to work is the accurate measurement of healing in the left front suspensory. For Secretariat, Dr. Shields evaluated the affected limb each week to assess for pain. This assessment included evaluating behavioral changes, palpation/observation of the left front, and an assessment of the joint’s range of motion. 

On top of this evaluation, Dr. Shields performed the Equine Physical Therapy Assessment weekly to assess symmetry of the gait, fluidity of the limb, and overall coordination and balance. 

This includes:

  • Straight line walk and trot
  • Walk, trot (medium to working), canter circles both directions.
  • Difference between how the horse goes over hard and soft surfaces. Softer surfaces will demonstrate lameness.
  • Under saddle with rider at the trot, the lameness will be more visible with the rider in the air at the posting trot. 

If any lameness is detected, the patient should return to rest immediately and the referring DVM is contacted.

On top of these equine physical therapy assessments of Secretariat’s healing, Dr. Shields worked closely with his veterinarian. The DVM would perform an ultrasound every 30 days, if the lameness persisted, to assess internal healing. 

Looking to the Future

Unfortunately, Secretariat will always have a higher risk of injury in his left front suspensory ligament, even after the injury has healed. However, his future’s still bright. With appropriate care including the proper warm up, cool down, and progressive training, he should be able to return to competitive Grand Prix jumping successfully. 

Takeaways for the Everyday Rider

Secretariat’s story has a lot of good takeaways for the everyday rider. His story could have ended very differently if his owner and trainer hadn’t taken his pain symptoms seriously and acted proactively by using equine physio and adding a Doctor of Physical Therapy to their team, as well as their usual veterinarian. 

There are many things you can do everyday to evaluate your horse for possible injuries. Always examine all four legs before and after exercise for abnormalities. Watch for pain symptoms that could be misconstrued as behavior/training problems, such as a reluctance to hold or pick up the canter. If his rider and trainer had treated this as a behavioral problem, Secretariat could have had much more damage to his ligament and been unable to return to Grand Prix level jumping. 

Look out for symptoms of acute injury, such as heat, swelling, and pain on palpation. Be vigilant when it comes to symptoms of chronic injuries as well. These symptoms include persistent thickening of the ligament and intermittent or persistent lameness. 

If your horse does injure himself, remember: an active working relationship between your veterinarian and a Doctor of Physical Therapy offers you the best chance of a full recovery. 

Contact Physio Equine Solutions to discuss physical therapy solutions that are right for your horse.

Call or Text 443-883-0724