Hi Group 3,
Welcome to Equine SEL sign off 2, 556AVN - Biomechanical assessment and exercise prescription.
In your group, using your allocated scenario, discuss a remedial exercise programme appropriate to your case and stage of repair, which would improve locomotion and proprioception. You are required to discuss the pros, cons of the chosen exercises and recommendations when performing these exercises. You all have from now until 5pm on Thursday 7th May to contribute to this blog. You must contribute to this blog to get your SEL signed off. Ensure that your entries are based on evidence and that you are reactive to one another to allow a good discussion of the topic. I will be keeping an eye on the blog, but if you have any issues, you should email me. Please ensure that you register your name with your comments so that I know who has written what.
Rosa
With upward fixation of the patella cases, work on circles or bends is not recommend whilst building up musculature to support the stifle (Kitchener, 2013). Continuing on from the hacking on flat ground, some gradients may be able to be introduced in weeks 1/2 to increase hip and stifle flexion (Crook et al., 2010) and help to improve proprioception (McGowan and Goff, 2016). May maintain 30 min hacks whilst progressing through gradients?
ReplyDeleteYes the hacking on different gradients will help proprioception, but care should be taken not to use too steeper declined surface as horses do lose ability to support their weight and stay stable (Self et al., 2012). I think one of the key aims here would be to strenghthen the muscle groups that affect patellofemoral control as this will help strengthen the stifle as a whole (McGowan and Goff, 2016).
DeleteGeorgie Burrin
Working the horse on a gradient makes use of the effects of gravity to selectively load the hind limbs on an incline. The Resistance of a horse’s body weight and rider’s weight develops hind leg, forearm,and shoulder muscles and braking on a decline strengthens the quadriceps muscle (Castejon-Riber et al., 2017). This can be incorporated at week 2 or 3 during the 30 minute hacks. Possibly making up 8-10 mins of the hack?
DeleteAmy
sorry i accidentally put this below too!
To further increase proprioception, a variety of surfaces can be used in the daily exercise regime. Altering from soft, hard, long grass will stimulate the proprioceptors in the skin and enhance the neural connections, increasing the spatial awareness (Mendez-Angulo et al., 2014)
Delete^ Lucy Finan
ReplyDeleteTo start with I would consider starting to strengthen the hind end, specifically the quadriceps. Starting with isometric contractions, allowing the muscle to be worked without causing effect to the muscle. Lateral tail pulls held for 10 seconds with 4 reps to start with, increasing reps over the week when the horse becomes stronger.
ReplyDeleteBacking up would be another good exercise- encourages movement of the hind end, and good stride quality. Encourages correct limb placement.
Including slight inclines and declines in hand to start with for 5 minutes a day increasing to 10 for week 2. Increasing to using long lines at week 3 starting with 5 minutes increasing to 10 for week 4. This enables further strengthening within the hind limb muscles
Include changes in surface within the in hand walking or long reining would help improve proprioception and ROM of the limbs.
Brooks, J (2011) Physical Therapy approaches for strengthening stifle and pelvic limb, Intergrative Medicine (complementary and alternative medicine), 57 (1) pp. 158-130.
Anderson, C. and Tnibar, A. (2015) Medial patellar ligament splitting in horses with upward fixation of the patella: A long‐term follow‐up, Equine Veterinary Journal, 48 (3) pp. 312-314.
^ Alex-Paige Salmon
DeleteThe tail pulls are a really good idea, I think caudal weight shifting (also at 4 reps to start with) would help with the subtle muscle contractions needed to strengthen the hind end without the horse having to exert much effort.
DeleteGeorgie Burrin
Holly -
Deleteto conflict with the argument that circles and bending is not good for this case, reinhold (2017) suggests that
as a step up from long reining would be to begin lunging with flat poles first to ensure the horse is capable of stepping over them. after the first week of lunging with flat they could be raised to cavalettis and then hogsback and sway back exercises can be introduced as the weeks go on and increasing in repetitions depending on the horse progression. reinhold also suggests that therabands are useful to aid hindlimb gait re-education as well as engaging hindlimb musculature such as the quadriceps, gluteals and hamstrings which when muscle tone increases it will support the patella and prevent luxation. it would no be advisable to use the theraband whilst going over poles as it could limit the retraction of the hindlimb which could cause injury to the horse so it should only be used when lunging without poles.
dyson, 2013 suggests a step up on hacking would be to to introduce surfaces and inclines gradually as weeks go on in the plan. the inclines will engage hind limb muscles causing contraction which will in turn help to improve tone and balance. the surfaces such as sand, gravel or long grass wil improve proprioception and limb awareness which will help improve gait re-education. boswell (2017) emphasises how isometric weight shifting exercises can be beneficial as mentioned above. exercises such as lateral tail pulls starting at 4 reps and ending at 10 holding each one for around 5 to 10 seconds as well as leg lifts which can advance in anterior to prosterior or lateral weight shifting as the weeks go on which all engage hind limb muscles which support the patella. west (2012) suggests that pole work cal be beneficial to encourage protraction and retraction on the hindlimbs but because this horse is tripping a lot then it would not be wise to use this exercises until the tripping stops in the arena and the hindlimb muscle have built up some tone from the flat work exercises first.
In reference to the point made by Holly - Straight line work is recommended by Rhodin et al. (2016) to develop muscular symmetry as the left hindlimb of the presented case is more affected by the condition, thus resulting in greater weakness of the left hind quarter musculature compared to the right. Once symmetry of musculature is achieved, further progression into work on a circle and bending exercises may be introduced (Nankervis et al., 2017) such as the pole work exercises you suggested above. - Lucy
DeleteThe tail pulls is a great exercise but I would decrease the holding time as the animal may find this uncomfortable to start with. 3-5 secs would be adequate as a starting point with 10 secs being a goal to work towards
DeleteIn reference to Lucy's point. Straight line work at walk is also beneficial for stimulating a sequenced gait pattern and encourages WB on all four limbs (Millis and Levine, 2014)
DeleteDue to the case i would keep the rider off initially due to tripping as this can make it dangerous for the rider. As well as this during the early stages I would avoid small circles and tight turns until there is more hindlimb stability as well as this i would only use smooth surfaces initially to prevent creating unnecessary torsion or uneven loading forces on the joint and the surrounding tissue structures.
DeleteExercises to consider :
DMES : lateral weight shifting (tail pulls), sternal lifts and pelvic tilts
Pros - increases loading gradually, develops muscular tone, engages core and increases flexibility of spine and pelvic region.
Cons - some horse can be sensitive to sternal lifts and pelvic tilts so may not be compliant
Reps - 4 reps 1x day 4 days a week hold for 3 - 5 secs
Gradual contractions little and often will help to strengthen the muscle whilst avoiding overexertion of the tissue
Clayton (2016) explains how dynamic mobilisation exercises incorporate both mobilising and stabilizing muscles to help develop muscular strength, balance, stability and gradual increased loading.
Ground Poles (could be added after more hacking on flat surfaces, at first these could be scattered with no tight turns and a further progression in the later stages to develop groin muscles and stability of the hindlimb further you could use adduction and abduction over straight poles)
Pros - increase engagement of hindlimb adductor and pelvic muscles and increase range of motion, proprioception and balance
Cons - poles could be a potential trip, so this must be considered before adding this into their exercise
Paulkas and Haussler (2009) states that pole work engages the hind end of the horse and can aid in strengthening the pelvic muscles, this will help to reduce impact and aid in shock absorption.
Brown et al., (2014) found that ground poles can be used to increase a joints range of motion and increase and strengthen hind limb musculature.
Inclines at walk (2 / 3 times a week initially again depends on progression etc)
Pro - engages hindlimb musculature and increase proprioceptive awareness, alters limb placement and joint loading
Cons - too steep of an incline can have the opposite effect and over strain the muscles and overload the joints, initially this should only be done in a controlled pace such as walk to help develop and strengthen the correct musculature with minimal concussive force
Van weeran (2014) says that hilly terrain is beneficial as it alters the joints loading and can aid in building different muscle groups that help to aid in the stability of the hindlimb.
De oliveira et al., (2015) suggests that because walk has no suspension phase it could be used for rehabilitation as it places little strain and torsion on the joints in comparison to other gaits.
Long lining could definitely be carried on as it is a good form of controlled exercise (short regular sessions would be more beneficial than long intermittent ones)
Pro - encourages self carriage, correct engagement of the hindlimbs and increases balance, coordination and proprioceptive awareness
Con - tight turns should be avoided as this can create to much torsion on the joint
Jones (2014) found that long lining can help to improve balance and coordination whilst gradually increasing stride length and joint flexion.
Varied surfaces could also be incorporated later on
Pros - improves proprioceptive awareness and loading (Dyson, 2017)
Cons - too boggy or uneven of a surface can create too much strain and torsion to the surrounding soft tissue structures, as well as this ground that is wet or grass, wood chip and chalk can sometimes be very slippery, with a horse that is tripping already you would want to avoid surfaces such as these to prevent overexertion of the muscles, slipping and further damage/ injury
Any surfaces incorporated should be introduced gradually so that the horse can adapt where necessary (Dyson, 2017)
(Emily Austin)
Working the horse on a gradient makes use of the effects of gravity to selectively load the hind limbs on an incline. The Resistance of a horse’s body weight and rider’s weight develops hind leg, forearm,and shoulder muscles and braking on a decline strengthens the quadriceps muscle (Castejon-Riber et al., 2017). This can be incorporated at week 2 or 3 during the 30 minute hacks. Possibly making up 8-10 mins of the hack?
ReplyDeleteAmy
DeleteI concur with Amy, however not should be taken to integrate this in slowly and not too steep of gradients as you would not want to cause any further injury or fatigue.
DeleteIt will also have the added benefit of helping improve stride length (Crook et al., 2010)
The introduction of gradients should be introduced progressively :To progressively recruit musculature, there is evidence supporting use of inclines and increased speed. On the incline, peak forces are greater in the hindlimb compared with on the level, and a shift of weight distribution is seen from a forelimb/hindlimb ratio of 57%/43%–52%/48%. (Tabor and Williams, 2018).
DeleteAmy
DeleteOn an incline hindlimb muscles are contributing to the increased hind limb power Crook et al, (2010),this supports Tabor and Williams, (2018) study as they propose, gradients should be introduced progressively.If too much power is excerted onto the hind limbs, injury is likely to occur due to the weakness aparent.
DeleteAmy
Regarding the stage of repair, there is no structure damage but there is the potential for the development of OA or a meniscal tear. So it vital the structures surrounding the joint are strengthened in order to prevent this.
ReplyDeleteAims:
- Strengthen the lateral and medial thigh musculature (Quadriceps femoris, vastus lateralis, medialis, intermedialis and rectus femoris}, TFL, sartorius, supf. gluteal)
- Strengthen protractors (TFL, supf gluteal, Quads)
- Enhance proprioception and visuomotor control
- Maintain ROM of stifles
- Increase the cardiovascualr fitness so he can be returned to his normal level of work
Exercises that would be recommended to the owner:
- SME's: Tail pulls and caudal weight shifting.
These can be done several times a week (5-6, allowing a day for tissue recuperation). Tail pulls will specifically target the quadriceps mm., these muscles are vital for the strength and stability of the tibio-femoral joint. Having a sufficent strength of this muscle will enable the patellar ligament to release from the patella (McGowan and Goff, 2016). Targeted caudal weight shifts, will target all of the musculature in the pelvic limb helping with the conditioning process and encouraging normal weight distribution, altering the compensatory pattern (Millis and Levine, 2014).
The owner should be advised, the horse may react badly to the tail pulls as they may experience discomfort when activating the lateral thigh musculature. If this is the case, continue with caudal weight shifting for a week and when the horse is finding this easier, then implement the tail pulls.
Regarding the caudal weight shifting, th horse should be stood square and it is easier to have them positioned against a wall so they cannot step back.
Reps should be introduced at 3 and held for 3-5 seconds and built until the horse can do 5 reps held at 5-10 secs.
Long-lining should still continue if the horse is happy to do so. But the owner should start to implement shallow loops, circles and figure of 8's within the next few weeks. Allowing large turns in order to reduce the torsional forces going throughout the limb. These will activate the medial thigh musculature (pectineus, vastus medialis & intermedialis) further stabilising the stifle (McGowan & Goff, 2016). Loops should be done with caution and at active walk, in order to activate musculature and prevent further harm.
Gradients are a good way to target specific muscles as well. Inclines will increase the GPE and targets the quads, TFL, sartorius + supf. gluteal (Crooke et al., 2010). This will aid the hip flexor strength, creating an easier protraction phase for the horse.
Declines will allow the horse to elongate swing phase, stretching the extensors (BF, ST and SM) and reducing stance phase (Mendez-angulo et al., 2014). Gradients should start off mild and increase in intensity. They should not be used everyday, (4 times a week) as to not cause fatigue and muscle strain.
As, well as this backing up and walk-halt transitions should be used. Long-lining should increase incrementally by 5 mins each week until 30min sessions are performed.
Emily Woodbridge
Lunging should be avoid in the initial stages, to prevent excess strain through the stifle. But once the strength has improved (1 mo.) lunging could be implemented to increase the cardiovascular strength, ultimatley improving fitness (Murray et al., 2010). Using two-lines first and building up to 1 line should be a starting point and implementing the use of an equiami (Walker et al., 2013) later on will improve propulsion and collection, conditioning the hindlimb muscles (Bromiley, 2007). To start this should be done in walk and not for very long, 5-10reps each rein, which can then be increased and trot can be implemented when strength and stability is apparent.
DeleteThe use of tactile stimulation could be beneficial to enhance the neural pathways and propriocetive system. The effect would only be short, so having a session of 10-15mins with the device on would be beneficial, this could be done multiple times a week.
Hacking should continue, straight lines and an active pace. In 1 weeks time, the owner should start implementing transitions (halt-walk-trot-walk etc), to build on strength and condition of the muscles (Clayton and Hobbs, 2017). This can increase incrementally but must allow the horse to have a rest day in order to recuperate.
Finally, pole work.
First should be started in hand with scattered poles and hogs back. For the first two week. Then the owner can progress to ridden poles. All poles should be at walk to start off with and should not be used for anymore than 10 minutes per session for the first 4 weeks. Pole work has many benefits such as increased AoF and ROM of the joints (Kaneps, 2016), targets the extensors and flexors of the hind limb in order to clear the obstacle (Brown et al., 2014), proprioception and visuomotor control (Weerdesteyn et al., 2006; Van Swigchen et al., 2013) and also maintains joint health by producing synovial fluid (Holler et al., 2010).
After heavy exercise sessions such as the ridden work and poles, the following day should be less intense to allow for fatigue and tissue healing (Gibbs et al., 1995). The owner should be made aware, that the upwards fixation should begin to be less apparent as the thigh muscles increase in strength, but the risk of it occurring again is likely if strength is not maintained and if the dysfunction deteriorates, surgery is a viable option.
Emily W
totally agree with transition work and (Reinhold et al,. 2018) supports this and also encourages transitions such as reinback in long reining before attempting in ridden flatwork to practice without the weight of the rider making it easier for the horse to engage back and hindlimb musculature as well as allowing more time in long reining to think about the placement of its limbs which improves proprioception as well as increase muscle tone.
DeleteHolly ^^^
DeleteScatter poles could be introduced in week 2/3 as part of the long reining to improve flexion of the stifle bilaterally and increase muscle mass in the hind. Horses must lift their legs higher, arch their back, and stretch their neck, both loos-ening and strengthening muscles, and improving supple-ness and flexibility. By engaging his hindquarters impulsion is also increased (Castejon-Riber et al., 2017).
ReplyDeleteAmy
This could make up 10 minutes of a long reining session of arounf 20 to 30 minutes
DeleteAmy
Delete