This was our best result so far! You can see how even the graphs look, which is what we are aiming for.
We know from the literature that a difference of greater than 5mm measured at the poll and wither and 8mm at the sacrum (pelvis) is clinically significant as a lameness.
At this assessment Mr P measured within “normal” limits for all measurements except for the propulsion phase at the wither (10R MaxD). MinD is the height of the sensors when the foot is in contact with the ground. MaxD is the height of the sensors when the foot is in mid-swing. UpD is the difference between these two measures.
(To keep it simple just focus for now on the MinD and MaxD in relation to “normal” limits).
We’re pretty happy with this progress! This was measured on a hard surface, we’ll do on a soft surface next to compare the difference
Our transition to ridden work has been a little longer than we hoped, but we are well on our way and will be sharing that part of Mr P’s journey very soon!
We recently had a bit fitting consultation with Amanda Arnold from Bit Bank Australia
Most of us now consider the importance of saddle fit, but bit fit is something that typically doesn’t get the same attention. In our opinion it really should!
Amanda was a wealth of information and the difference we noticed between the different bits we tried was quite remarkable.
Here’s part 1 of our consultation with Amanda, where we discuss why you should your bit fitted to your horse and how to measure bit size.
To learn more about Amanda and the other bit fitters, head over to the their website - https://www.bitbankaustralia.com.au/new-south-wales/
Managing weight, considering energy requirements and building muscle mass can be challenging in the rehab process.
In Mr P’s case we are aiming to ensure that he doesn’t put on too much weight so not to place excess load on the tendon, and keep his energy intake low so that he remains sensible in the paddock and in his work. His work has consisted largely of in hand work at walk, with only recently the introduction of short bursts of trot. We’ve been (not so!) patiently awaiting a new saddle for him, so we can start some work under saddle.
Because of all of this Mr P has dropped muscle through his back and hindquarters, and while it will start to come back again as we increase the intensity of his work as his rehab program allows, we wanted to try and add a little extra boost into his diet.
It’s well known that protein is important for muscle development. It’s important that it’s not just any old protein, but one that has an array of essential amino acids. We’ve recently started Mr P on Prydes Easifeed ProteinPak, feeding it after his training sessions to hopefully help boost the muscle building process.
ProteinPak is extruded full fat soybean and is high-quality quality protein and omega fatty acids.
We look forward to seeing how he goes! It clearly tastes good as he licks the feed bucket every time!
Disclaimer - Mr P was sponsored his EasiKeeper pellets, but not this ProteinPak. We’re trying it as we’ve seen the positive effects on other horses previously.
Learn more about Prydes and ProteinPak here - https://www.prydes.com.au/proteinpak
Mr P’s most recent gait analysis has been his best so far!
While his loading phase on the right front was really good (only a 6mm difference), he was not pushing off as well on the right forelimb (14mm difference) when we tested him last month (graph on the left).
**The research has shown a difference of 5mm in the forelimbs and 8mm in the hindlimbs is considered to be clinically significant.
This month his loading phase was 8mm less on the right compared to the left (we’re still pretty happy with that), with his propulsion phase showing only a difference of 3mm less on the right, a significant improvement from last month and what would be considered to be within “normal” limits. We’re particularly happy with this improvement as we’ve focused on improving this with specific exercises over the past few weeks.
His hindlimbs were looking really good last month (anything within 8mm is considered normal in the hindlimbs), and have gotten even better this month. You can’t get much more symmetrical than those numbers on the right! This has coincided with a visual improvement in the muscle bulk of his hindquarters.
While there is still a very slight right forelimb asymmetry, we see numbers like this (and occasionally worse!) in horses that are in full work and that are considered sound by their owners and vets. These results give us confidence to continue to progress on with his rehab program and start to increase the load on the tendon.
Stay tuned to see what we’re doing next....
Managing Mr P’s hoof balance and alignment has been an integral part of his rehabilitation.
Erin has been such an important member of our team. Check out his latest appointment with Mr P to see how his feet are currently going and what Erin has changed this shoeing in order to address his left forelimb, which hasn’t progressed quite as well as we would have liked.
Although the injury is on the right forelimb, it’s so important to not just focus on the area of the horse that is injured. As we keep saying, “treat the horse, not the tendon”.
There have been several studies looking at the benefits of using hindlimb weights in horses, and we’ve posted about this previously.
At our most recent gait analysis with Mr P, we found that while he was loading all the limbs pretty well symmetrically, he wasn’t pushing off as well with the right forelimb compared to the left. We needed to improve strength of the muscles involved in propulsion of the forelimb while still keeping our speed really slow. If you watched our recent physio assessment you may have seen he struggled a bit more on a stability exercise of the right forelimb.
Coming back to our process of utilising slow heavy resistance while still in the stage of tendon healing, we figured that if weighting the hindlimb increases the muscular effort of the muscles around the hip, perhaps we may get a similar effect in the shoulder/thoracic sling region if we weighted the forelimbs? To our knowledge there hasn’t been any studies investigating the forelimbs, so we weren’t too sure of how it would effect kinematics. If anyone knows of any research please share it with us!
We started initially with 500g weights then progressed up to 750g. We’ve kept the sessions short, starting with just a couple of minutes, progressing up to 5 min max and only staying in walk.
At first we could see that it required a large muscular effort for him, particularly on the right side. We only used them twice a week, mixing it up with other exercises in his program. It didn’t take long for him to start to find it easier, naturally stretching his head forward and low as he walked.
We’ll look forward to measuring the results with our next gait analysis soon.
⚠️ Please note that we do not recommend that you do this on your own horse unless advised by your vet or qualified (and insured!) rehab practitioner.
Mr P recently had another scan of his tendon to check how it was healing.
While you can see there is still an area in the SDFT of disrupted fibre pattern, the vet was really happy on how it was looking compared to the previous scan. She was happy for us to continue to progress his workload, focusing on slow heavy resistance.
We’ll scan him again in 6-8 weeks.
Mr P’s proprioception (awareness of where his limbs are in space) hasn’t been great in his pole work sessions. He has a tendency to knock the poles with his back feet particularly.
So we decided to experiment a little and see if the addition of tactile stimulation bracelets, or jangles, made any difference.
These were the subject of a few published papers by Hilary Clayton and her research group. One published in 2010 “Hindlimb response to tactile stimulation of the pastern and coronet” found that the flight arc of the hindlimbs was increased due to increased flexion of all the joints of the limb from the stifle down. They also found it stimulated concentric activity of the tarsal musculature (muscles that move the hock), which they concluded may have therapeutic applications in conditions such as toe dragging.
Initially we had a much greater response to him picking up his hindlimbs over the poles. You can see though that by the third rep he goes back to knocking the poles again. This fits with another paper by Clayton et al in 2008, “Short-term habituation of equine limb kinematics to tactile simulation of the coronet”.
“The first trial with stimulators showed the greatest elevation, followed by a rapid decrease over the next three trials and then a more gradual decrease. If the goal is to facilitate a generalized muscular response, a short burst of tactile stimulation is likely to be most effective”.
A couple of other things to consider in this case. This is more 2 poles in a row than Mr P is used to. They are also on a curve, so he had to adjust his stride depending on the curve position. We may need to take him back to poles on a straight line/less poles, give him a bit more time to think about where he is placing his feet, and then introduce more poles and/or difference distances.
It’s ok in your rehab to modify your exercises. It’s a balancing act between making the exercise challenging enough to get a positive effect and also not making it so challenging that your horse is unable to do the exercise well. Some days Mr P is super at poles and other days it can be, well... watch the video to see!
To progress Mr P’s work intensity we have recently started to add in hill work. We thought this video of him walking downhill was really interesting in light of our last post discussing thoracic sling function.
Look at how much movement is occurring at the scapula (shoulder blade). This can be a really simple way to help improve strength in the shoulder and thoracic sling.
We often talk about working our horses uphills to promote hindquarter strength, but we don’t often talk so much about the benefits of working on a decline.
We’ve talked before about how slow heavy resistance or loads should be a focus in tendon rehab. Walking both up and downhills can be great way to do this in your rehab plan
We're nearly 5 months post-injury now. How is Mr P tracking from a physiotherapist's point of view?