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 wastage over left shoulder particuarly thoracic trapezius, dorsoscapular region,supraspinatus/infraspinatus, deltoid,  and biceps brachii with a marked overdeveloped brachiiocephalicus muscle and associated muscle spasm left side. Muscle wastage over gluteal and hamstring muscles and carrying tail to the left. Muscle spasm gluteal and hamstring muscle mass. Very sore  over T4 - T16  nearside only spinalis musculature and bilateral lumbar sacral soft tissue discomfort to palpation.  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 solid through left shoulder, leaning to the left side 2/10th lame and not quite straight

On softer arena surface in arena, on left rein, leaning left onto the forehand, stiff through neck, mouth open, back stiff with reduced 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, stiff through the back with reduced energy and thrust and suppleness.

Treatment:  Given full body massage and Theraputic Ultrasound  over neck,  shoulders and thoracolumbar, gluteal/hamstrings region. After 48hours recovery commenced slow reconditioning 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 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.  Pilates type neck stretches,  whole spine tail pulls and dynamic lateral tail pulls,  all designed to help  strengthen core muscles 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 cavaletti work in walk and trot in straight lines and at  6 weeks once showing level steps commenced 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.  After this time evidence of muscle mass over left shoulder improvement so commenced lateral work to strengthen abductor/adductor muscles. Reviewed by farrier every 5 weeks for balance work 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 and balance(. It is important to take into account that it may take several weeks for normal neural pathways governing foot placement to be restored following relief of pain).

 At  4 months Marley is sound.  There is a considerable difference in muscle bulk over the left shoulder and the horse can step through well with the offhind. Further physiotherapy exercises will help to improve the tone and strength in the thoracic sling muscles which will continue to help change the shape of the withers and shoulder and most importantly the ability to perform comfortably. Further physiotherapy includes incorporating hill work, gymnastic exercises and hacking out each week, and allowing 1 day off per week.  To continue with 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 cross country clinic in 2 months.

 


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