International Association of Animal Therapists
Case Study

05/08/2021

TB racehorse with poor performance

Summary

Supa Wonder a 5yo thoroughbred racehorse presented with asymmetry of gait on dynamic assessment and poor performance in racing.  Previous treatments highlighted chronic back pain believed to be causing the intermittent bilateral forelimb unsoundness and poor engagement of hindquarters in trot-up.  Complaints included poor race performance, unsoundness with no conclusive veterinary diagnosis, signs of respiratory distress following all work, and racing in spite of high-level fitness. No evidence of upper respiratory tract pathology.

Referral to veterinary physiotherapy following sustained poor performance and impending retirement from racing should no improvements be made in his next race.

After a full physiotherapy assessment and knowledge from prior treatments, a weeklong intensive physiotherapy programme was drawn up in preparation for the next race meeting, which included the use of manual soft tissue therapy, kinesiology taping, and stretching.

This program is presented as an example of how progressive and intensive physiotherapy can be applied in the management of chronic back pain related to poor performance.

 

Introduction

The spine is central to function.  Chronic pain has been found to have a variety of deleterious effects on the body including pathobiomechanics, compensatory changes in muscle function, lowered pain threshold, and altered proprioceptive function.  Lameness has been found to be dependent at times on back pain. Landman et al., (2004) evaluated 805 horses and discovered, of the horses that had back pathology, 74% were also lame, suggesting that the compensation mechanism disseminates pain to other areas resulting in changes in muscle tone and posture as well as proprioceptive loss.

 

Current Management

Weekly physiotherapy sessions had been prescribed for 8 weeks, however did not provide substantial enough relief or sustained relief from pain and unsoundness. General manual therapy and stretching were found to result in some immediate relief but no improvement in race performance was noticed.

 

Case History

History of poor performance and unsoundness without overt lameness.  Increased muscle tonicity in the epaxials and altered proprioception during trotting as well as poor kinematics (very restricted) of the spine in walk and trot with reduced protraction of hindlimbs and occasional toe drag on one or both hind hooves.  No conclusive diagnosis by Vet surgeon and no reaction on palpation and flexion of distal limb structures.

 

Assessment Finding

Difficulty in managing pain relief and spasm of the epaxials. Reduced lateral and dorso-ventral movement of the spine. No obvious reaction following the application of dorsoventral force over spinous processes but the pain in the epaxials did change from treatment to treatment (i.e. switching between left and right epaxial pain) although there was usually the presence of pain in the lumbar area. Poor separation and restricted movement of hindlimbs on dynamic assessment. The horse appeared uncomfortable in trot up (body appeared rigid and engagement was poor) though not overtly lame on a single limb.  Left hindlimb adducts during swing phase and lands medially with quarters (at times) travelling to the left side, resists right hindlimb stretch. Right forelimb at times shows a very slight head nod in trot and right tuber coxa lower than left.

Clear signs of pain/ discomfort were observed as suggested in the Dyson et al., (2018) study; that is: head tilted, tail clamped tightly, rushed gait with an irregular rhythm, gait too slow, spontaneous changes of gait, reluctance to move forward, ears rotated behind vertical, etc.

 

Postural observation

The horse stood camped under in the forelimbs.  Epaxials showed increased tone as well as some extension of the spine being prevalent in standing. Generally appeared depressed with clear signs of pain as described by Dyson et al., (2017) in that the eyes were often partially closed and there was usually tension around the eye (image 1) and ears were usually behind the vertical.

 

 

Image 1 – Supa Memories parading to the start (Andrew Philip Photography)

 

Palpation

Palpation highlighted hypertonicity of epaxials and hamstrings. Significant tightness in muscles of the forelimb particularly lateral digital extensor and all the flexors. No obvious reaction was found on palpation of distal limb structures despite clear unsoundness, although caudal muscles of the hindlimbs exhibited tightness particularly the gluteals and gastrocnemius.

 

Pain provocation

Pain responses were monitored through assessment and it was found palpation of gluteals and epaxials rendered the biggest pain response.

 

Goals

To provide an intensive physiotherapy programme for the week leading into the race meeting to ascertain whether or not substantial changes in chronic pain relief could be made.

Ensure that pain relief and reduced tone could be sustained for a period of at least 24 hours.

Notice an improvement in the soundness.

Have a substantially improved run in the next race.

 

Discussion

Monday: Full physiotherapeutic treatment of the horse focusing on relieving back pain through targeted treatment of the superficial back line using trigger point, joint mobilisations, massage, and engagement of ventral line through baited “stretches”.

The initial focus was based on improving the mobility of the spine through joint mobilisations particularly at lumbar vertebrae believing that to have a knock-on effect to releasing hip flexors via their attachment sites. Extensive trigger point therapy applied through the thoracolumbar fascia, gluteals, and along-shelf of ribs followed by myofascia release.

Tuesday: Full body myofascial release strategies, specifically along the superficial back line beginning at the head and working to the palmar distal hindlimb.

Complex stretches targeting whole kinetic chains of the body (i.e protract and adduct right hindlimb while laterally flexing the neck to the right side and then baiting the horse to lower the neck to the ground on the right side).

Wednesday: Gentle effleurage treatment combined with low-grade joint mobilisations along the spine followed by Kinesio Taping along the epaxials and then a basic stretch.

Thursday: Comprehensive stretch session, including baited stretches of the neck as well as extensive limb stretches held for 30s per stretch.

***Noticeable improvement in back pain and tension following kinesio taping.

Friday:  Full body treatment, as on Monday, with taping of epaxials included.  

Saturday: Stretch and myofascial release session.

Sunday: Gentle stretch in the morning before lunchtime racing.

 

Aftercare

The Groom was instructed to remove Kinesio tape immediately prior to the horse entering the parade ring on Sunday’s race day. Jockey instructed to allow for adequate warmup before the race.

 

Conclusion

Supa Wonder managed to win convincingly that Sunday. The transformation of the back on the Thursday following Kinesio taping 24hours before was remarkable.  Having treated the horse for months prior to this week, there was a noticeable (drastic) improvement on the Thursday.

Following up on the Monday, after the race meeting, some tightness was prevalent again, so Kinesio tape was administered following a stretch to aid recovery.  Super Wonder went on to race for another year winning one more race though required regular physiotherapy. He retired to showjumping where he improved in soundness. Anecdotal evidence from my practice suggests the use of Kinesio Tape is indicated in cases of chronic back pain, though mechanisms of action are not totally understood, it is thought to relieve sensory receptors and provide proprioceptive feedback to aid pain relief.

Image 2 – Winner’s circle with Supa Wonder Andrew Philip Photography

 

A case study conducted by IAAT Member Kylie Bonthrone (member number 1371)

 

References

Dyson S., Berger J., Ellis A.D., Mullard J. (2018) Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J. Vet. Behav. 23, pp 47–57. doi: 10.1016/j.jveb.2017.10.008.

Dyson, S., Berger, J.M.,  Ellis, A.D. and Mullard J. (2017) Can the presence of musculoskeletal pain be determined from the facial expressions of ridden horses Journal of Veterinary Behavior, 19, pp. 78-89

Landman, M.A., de Blaauw, J.A., van Weeren, P.R. and Hofland, L.J. (2004) Field study of the prevalence of lameness in horses with back problems. Veterinary  Record 155, 165–168

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