The Horse

OCT 2017

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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42 TheHorse.com THE HORSE October 2017 mobilize and stabilize the horse's back. "Static ground activation exercises are something clients can do for abdominal muscles, back muscles, and multifidus muscles (which stabilize the spinal column)," he says. "I recommend Activat- ing Your Horse's Core and the Equiband resistance band system to my clients." Conditioning programs can address both prehabilitation—the preventive strength training described—and reha- bilitation. "Taking proactive steps to build core muscles helps to prevent injuries, just like in human sports medicine," he adds. Horses with kissing spines, for instance, might benefit from rounding exercises, which "can help by taking some of the pressure off the (impinged) dorsal spinous processes," says Denton. Treatment Modalities A spectrum of rehabilitation therapies is currently available to address upper- body issues. Because many of these can be expensive and have little peer-reviewed research behind their efficacy, work with your veterinarian when deciding whether your horse might benefit from one or more of the following: ■ Underwater treadmill Schlachter uses this tool for a variety of rehabilita- tion scenarios, including back and sacroiliac injuries, weight reduction in an injured horse, and straightening a crooked horse. A submerged treadmill creates a partially buoyant environ- ment, allowing for full range of motion without concussion; this provides safe, low-impact conditioning. She says that in her experience, "it takes six to eight weeks of treatment to see true improvement in the upper body. This really improves straightness and rideability under saddle; we get a lot of horses that come in once or twice a year for a 'touch-up.' " ■ Laser "The most common thing we use in my practice for upper body is a high-power class IV cold laser," which is purported to have anti-inflammatory effects, says Schlachter. "However, laser's limitation is depth, in my opinion," she adds. "For example, if I'm trying to treat L4 or L5 (fourth and fifth lumbar verte- brae) arthritis, laser is not going to be my first choice, because that's 6 to 8 inches deep. If I want to decrease inflammation in the first few centime- ters, it's great." ■ Shock wave Veterinarians generally use extracorporeal shock wave therapy (ESWT), which involves applying high- energy sound waves that travel through tissue, to address pain associated with ligament and muscle injuries, arthritis, and fascia (connective tissue that sur- rounds muscles and muscle groups), says Schlachter. For optimal success, Denton usually recommends administering ESWT in a series of three to five treatments, spaced about two weeks apart. "One of the keys with shock wave is you have to know the exact area you're working with and try to localize it to the best of your abil- ity," he says. "I think it breaks the pain cycle with a slight analgesic effect, help- ing the muscles relax, reducing spasm. It's horse-dependent; some horses seem to respond quite well to it, and others you don't seem to get that effect." ■ Functional electrical stimulation (FES) Schlachter says she uses this therapy to stimulate motor nerves and improve muscle contraction and range of mo- tion. She says she's had success using FES to reduce scarring, in particular, and that it might also be useful for addressing other injuries in horses re- turning to work, as well as maintaining those in work. "Each treatment takes longer than shock wave, but you don't have to sedate for FES," she says. ■ Acupuncture By placing needles to stimulate nerve fibers, skin, and mus- cle, Schlachter seeks to decrease pain and restore range of motion. "I'll use acupuncture for back pain daily while introducing the underwater treadmill and other modalities," she says. "Often it takes up to seven days to see a re- sponse." She cautions owners and their veterinarians to avoid this modality in cases of skin infection or active tumor growth. ■ Mesotherapy Denton says injecting fluid into the skin's mesodermal layer stimulates nerve fibers, blocking pain, and thereby breaking the muscle spasm cycle, allowing an injured back to rest and heal. "Once you have chronic ir- ritation, whether from kissing spines or impingement on a nerve, the muscles will spasm," says Denton, explaining that he administers mesotherapy in a series of treatments, in conjunction with other therapies. Schlachter adds that with this therapy she might also inject steroids, vitamin B12, or beta-carotene into the skin's superficial layer, to target the nerves to decrease pain. ■ Intra-articular injections For target- ing localized pain, such as arthritis in a specific joint, Schlachter and Class IV laser offers anti-inflammatory and pain-relieving properties that might be beneficial for muscle or ligament injuries or arthritis. LISA DIJK/ARND.NL SPORTS MEDICINE One of the keys with shock wave is you have to know the exact area you're working with and try to localize it to the best of your ability." DR. STEPHEN DENTON

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