Name: Marley
TB/Warmblood / Gelding
Height: 16hands / Age 6
Use: Showjumper and Eventer
Presenting Case: Intermittent nearside forelimb lameness 2/10th. tendency to launch into jumps,always landing on right foreleg from jump and unable to lift left frontleg fully when jumping. Refusing drops on cross country fences .
Previous History: Owner suspects reared and fell onto withers with previous owner. Bought one year ago and presented with nearside intermittent forelimb lameness .Reviewed by Veterinary Surgeon. Thoracic Spinal X rays showed old fractures of T4-T6 which have fused. Lameness narrowed to nearside foot following nerve blocks. Concussion diagnosed and treated with steroid injection which together with corrective shoeing was effective for 3 months. Further steroid injection given and again sound for 3 months.
Examination: Following update on present condition from Veterinary Surgeon referred for Physiotherapy initial assessment.
On Palpation: Marked muscle atrophy over left shoulder particularly thoracic trapezius, dorsoscapular region ,supraspinatus/infraspinatus, deltoid, and biceps brachii with a marked overdeveloped brachiiocephalicus muscle and associated muscle spasm. Reactive to soft tissue palpation over dorsoscapular region. Hypertonia through epaxial long back muscles. Needs to strengthen through postural core muscles. Muscle wastage and muscle spasm++ over gluteals and hamstring muscles and carrying tail to the left. No reaction to Dorsal Spinous Processes to digital palpation. (Saddle good fit at present time and using half sheepskin)
On movement: Just brought in from field following turnout for 1 hour. On leaving stable noticeable lameness left fore. On straight lines on firm surface in walk and trot leaning onto the forehand, fussy through mouth and tossing head and neck frequently. Tight and reactive to palpation through left shoulder, unbalanced and asymmetry to the left side 2/10th lame and on two tracks.
On softer arena surface in arena, on left rein, loosing balance and flexibility to the left onto the forehand, stiff through neck, mouth open, back inflexible loss of engagement, elasticity, rhythm and balance on a circle. Snatching with off hind particularly in canter on left rein and unable to step through fully although correct strike off. On the right rein showing incorrect bend, again lameness left fore, loosing balance, elasticity with stiffness through the back and increased postural sway.
Treatment: Given Red laser, full body massage and myofascial release followed with Theraputic Ultrasound over neck, shoulders and thoracolumbar, lumbosacral and gluteal/hamstrings soft tissue. After 48hours recovery commenced slow rehabilitation programme to build core stability and muscle strength. Further massage and ultrasound at 2 weeks and then loaned Pulse Electromagnetic Flow machine for use over the shoulder and thoracic soft tissue to be used twice daily for 6 weeks, together with massage and myofacial release as needed. Over 2 months initiated plan of in hand work using long lines, weight shifting exercises onto left fore and forehand rocking exercises. Pilates dynamic neck stretches, whole spine tail pulls and dynamic lateral tail pulls, all designed to help strengthen, improve endurance, and help the horse to work symmetrically again. Performed each day following work and then field turnout during the remainder of the day. When time allowed exercises were performed twice daily. When in stable fed hay on the ground. After one month incorporated ground poles progressing to cavaletti work in walk and trot in straight lines and at 6 weeks once showing level steps commenced lateral pole work and short ridden sessions of work large around the arena as difficulty taking out hacking due to business of traffic on road leaving premises. Commenced backup sessions to encourage backward shift of weight to activate the muscles that elevate the forehand. No circle work ridden or lunging for 2 months. Owner aware that it may take several weeks for normal neural pathways to switch on to signal muscles to offer correct movement for foot placement and long back muscles. After this time evidence of muscle mass over left shoulder improvement so commenced lateral work to strengthen abductor/adductor muscles, thoracic sling muscles.. Reviewed by farrier every 5 weeks for balance work with forefeet.
By month 3 able to walk, trot and canter showing level steps on both reins with increased impulsion from quarters and showing signs of improving core stability, flexibility, balance and symmetry. No head tossing or opening the mouth or signs of pain anxiety during work.
At 4 months Marley has gained in strength and is level in 3 paces.. There is a considerable difference in muscle mass over the left shoulder and epaxial long back muscles, and is able to step through well with the off hind with crossovers after work. Further physiotherapy exercises offered to improve the tone and strength in the thoracic sling muscles and core muscles and most importantly the ability to perform symmetrically and comfortably. Further physiotherapy includes incorporating hill work, gymnastic exercises and hacking out each week, and allowing 1 day off per week , always ensuring that the work does not induce muscles fatigue by gently increasing the intensity of work continuing to strengthen and improve endurance of muscle. To continue with dynamic neck stretches long term and 5 weekly shoeing as per farrier advice
At 8 months Marley is back competing in novice dressage and has been placed 1st in his last two tests, and is booked for a show jumping clinic in 1 month.
Photograph showing muscle wastage to left shoulder
Photograph showing improvement in left shoulder following physiotherapy rehabilitation plan
Marley back in full work and remains sound
