Gelding Age 7

History:  Brought over from Ireland, age 4. ? old injury  over left temporal mandibular region with loss of hair and boney lump, non tender to palpation. Used for preliminary/novice dressage and as pleasure horse. Severe twisting and  snaking  of neck and shaking head, increasing in severity over the past few months. Now not safe to ride and referred back to vet.  Treated with veterinary acupuncture {Phil Richards Veterinary Surgeon} with good relief for 2 - 3 weeks but then symptoms reoccurred.  Possible headshaker.  CT head performed, no abnormality detected. 

On assessment: thickening over occipitomandibular muscle left, guarded through complex/splenius muscles bilaterally but left worse, hypertonia left brachiocephalic muscles. Hypertonia epaxial long back muscles. Reactive Sacroiliac right side.  Spasm to gluteals worse right side.  On movement 1/10th lame bilaterally forelimbs in walk and trot on straight line and on two tracks for 2/3 steps then straight, with frequent shaking of head.  In obvious discomfort 10 meter circles snaking of head and neck, worse on the left rein, 1/10th lame bilaterally forelimbs and snatching with right hind. No tripping/stumbling noted. Teeth checked by dentist recently and satisfactory and saddle checked in past couple of months.

Red laser to relax and release natural endorphins. Attempted light massage but too sore.  Ultrasound administered severe reaction throwing head in the air, after 2/3 seconds, relaxed stretching head and neck long and low and yawned 20 times ++. Allowed to complete ultrasound from occipitomandibular region and  full neck bilaterally. Further massage and ultrasound through thoracic lumbar and gluteal muscle mass bilaterally.

Rehabilitation plan. 24 hours field rest and keep warm including neck region. Commence walking out for 15 mins in hand on straight line increasing by 5 mins weekly. Do not pull with the headcollar. Recommence rounding dynamic neck stretches, whole spine stretches gently increasing the stretch. Increase repetitions to x 5 as tolerated over 2 weeks.  Massage over occipitomandibular region daily and full neck/shoulders massage twice weekly then review.  Red laser to occipitomandibular region left side daily.  Feed hay on the ground.

2 weeks physiotherapy review  comfortable over head and neck with palpation, noticeable reduction in headshaking with in hand work, increase in hand marching walk and include trot work. Add forelimb weight shifting and thoracic sling rocking exercises daily.  Commence ground polework sessions 15 mins twice weekly.  Continue  red laser before work over occipitomandibular region and continue with weekly massage over neck/shoulders. Include lateral dynamic neck stretches to rounding exercises. 

4 weeks marching out in hand for 30 mins and starting to work well with elevated alternate poles with good co-ordination and proprioception.  Minimal headshaking.  Once saddle checked and can commence ridden work  starting with 15 mins twice weekly hacking out and gradually increase duration as strengthens/conditions core muscles. Encourage some long and low stretching work during ridden work.

Regular physiotherapy every 2 weeks over 3 month period and Wotsit continued to go from strength to strength commencing some gentle schooling at around 6 - 8 weeks with frequent changes of direction and bend to ensure able to maintain balance/flexibility and not fatigue. Has taken part in preliminary dressage test at 4 months, with judge commenting on relaxed test.  Icing on the cake placed 5th.