By Chris Bates, DO and Animal Therapist
Quite often in equine therapy, we can find ourselves looking way beyond the biological limits of the horse (i.e., the horse’s physical body) and seeking answers to our questions in the external impacts upon them. It is par for the course to assess the horse’s living situation, feeding regime and exercise, but what if the horse is ridden?
While some horses that we visit will be retired, too young to ride or maybe even carriage driving horses, a large number of clientele are likely to be regularly ridden horses.
Clearly it is important to only work within your scope of practice and the LCAO Diplomas do not cover the treatment of humans; however, it can pay dividends to investigate the rider’s disciplines, style, training level and effectiveness in the saddle.
My advice to LCAO students and graduates would be to work closely with their trainer/coach and perhaps ask if you can watch during one of their lessons. You could even ask to observe them riding as part of your assessment but be sure not to offer riding advice or tuition unless you are qualified and insured to do so and only with consent and understanding from the rider.
Knowing a little more about the rider’s impact upon the horse can really help to inform your Osteopathic hypothesis with regards to the horse. The following is an account of my work with one particular horse and rider with whom I discovered that treatment can start with a well-placed referral.
The case of the recurring neck issues
It was a hot summer that year. I had been extremely busy with various horses trying to keep them fit and well during a full-on competition season. I don’t think my phone stopped ringing from early in the morning until the evening but I was glad to be helping so many lovely horses.
One horse however would play on my mind even after my work week was done. This particular horse was continually exhibiting the same issues returning time and time again. He was an 11-year-old TB X gelding with a great temperament, I had a real soft spot for him as he was always very obvious in his appreciation of my work.
In the beginning of my work with him, I had asked for the vet to visit prior to my assessment as was the requirement in the UK at the time. The vet couldn’t find anything that he could address and suggested speaking with me and her trainer.
When I first visited, the owner told me that he was very “upside down” under saddle and that when asking for right lateral bend, he would stutter suddenly to a halt and threaten to rear up.
Now I am lucky in that I am also a qualified Osteopath for humans and a riding instructor so I do often ask to see clients riding if the complaint is riding related. However, on this occasion, the owner was also injured so asked her friend to ride for me to observe.
I did indeed notice that the horse was underdeveloped in his topline and under saddle he would hollow very easily. Right bend was an obvious issue for him but not showing much pain behaviors.
I have noticed both in humans and horses that pain is not always the thing that the patient notices most, sometimes its lack of ability or lack of strength.
It wouldn’t be uncommon for a human patient who runs a lot to come in and mention in their presenting complaint that they just can’t manage the same distances and times they used to when running.
So, let us transfer this to the horse in this case. Perhaps the lack of pain behaviors and signs could indicate that his “way of going” and tendency to stop and rear was actually based in frustration at lack of ability.
Imagine going to the gym and having a personal training session; now, the trainer starts you off with a great warm up and everything is going well. You are enjoying your session and feel positive with the trainer’s encouragement.
Suddenly, the trainer asks you to move to the bench press and sets up huge weight on the bar! You think “surely not!? I can’t possibly do that…”. But low and behold your trainer asks you to bench press 2 sets of 8.
You manage a few good presses but then your body just won’t cooperate and your stamina is clearly not sufficient for this level of intensity yet…. “YET” (very important word – health and fitness are dynamic).
What would you do? Your trainer is continuing to suggest you lift it. Do you keep going until you get an injury? That would be foolish and let’s remember horses are NOT foolish.
You protest and stop! Now, how might a horse protest? They can’t speak as such, so they use non-verbal communication in as clear a way as possible.
The horse I was seeing was showing non-verbal communication to indicate that he was simply incapable of holding the frame the rider was asking for and he was also unable to sustain bend.
It is certainly not likely for a horse to bend laterally in a comfortable and sustainable way if they cannot work over their topline and engage their trunk, thoracic sling and hindquarters. At LCAO, our courses cover behavior and certainly teach how pain is displayed.
So, if we don’t see obvious pain but the disruptive behaviors persist, we must consider if the horse is actually physically and mentally fit to undertake the activity. I found this a very interesting opportunity to start a referral.
Of course, I continued to assess and indeed treat the horse. I had found that the horse was presenting with cervical spine restriction and pain sensitivity with reduced range of motion in right side bend.
This issue was focused to the C3-4 and C4-5 motion segments. If you want to learn about lesion types and how they present then LCAO Diplomas have great detail on this and Professor McGregor has a great lecture on this Osteopathic principle.
This lesion was certainly exacerbated if not caused by a repeated hyper extension but I also considered that the type of lesion was impacted by rotation (the horse’s way of trying to negotiate movement and sustain posture under the demand), this is informed by Fryette’s principles of spinal motion (also taught at LCAO).
Two other therapists (one Physiotherapist and one Chiropractor) had also found this lesion in their assessments, or at least they identified a neck complaint.
The issue had continued to occur and the poor owner had spent a considerable sum of money for practitioners to come back time and time again to treat this it.
The problem was that these other practitioners had seen the behaviors as symptoms of the neck issue; I needed to see it the other way around.
The behaviors were causing the neck issue, or put it more Osteopathically “The behaviors WERE the neck issue”. This is where Osteopaths try to see the whole, the bigger picture and how form is a result of forces, structure and function are reciprocally interrelated.
Now, I would certainly not say to an owner to stop using a certain trainer but I did suggest consulting a different trainer with whom I had worked before on a similar case.
This trainer was very good at seeing weaknesses in locomotion and had excellent understanding of equine psychology and behaviors. The owner agreed and the new trainer helped her to instill a regime of strengthening and stamina work incorporating mobility and stretching.
Within only a month, the horse had completely stopped the worrying behaviors and the owner was over the moon. I returned for a follow up treatment and all that remained of the previous issue was minor fibrous tissue that had developed to maintain the lesions integrity.
I used soft tissue techniques to assist in the remodeling of this region and educated the owner in some self-management. Horse = Happy, Rider = Happy… Me? = Very Happy.
So, everything turned out great right? Well… I wouldn’t be very holistic if I didn’t ask myself “why was the horse not developing the strength and correct locomotion under saddle?” would I?
The horse’s nutrition was certainly adequate and well monitored, he had a good manner and temperament. There was no veterinary diagnosis of systemic condition that would explain weakness or myopathy.
So, what was the onset and the causative factors? Then I remembered when I watched the horse being ridden, I saw the owner’s friend ride and not the owner. It struck me! “It’s so obvious now! It’s the rider!”.
In the next part of this series “It’s the Rider”, we will explore how this particular rider had been the reason for the horse’s ridden frame, locomotion and subsequent weaknesses. Look out for part two coming soon.
For more information on how you can become an Equine Osteopath, click here