In a previous blog, we spoke about the different causes of back pain in our patients. These causes can be primary or secondary to another injury, but regardless of the cause, the horse’s back is an area that is predisposed to pain and to dysfunction for an endless number of reasons.

For any horse that is ridden, it is essential that we maintain the best possible health and function of the back, and for an athlete, a strong, healthy and supple back is a non-negotiable. It is imperative to their functionality and performance over the long term.

 

Multifidus muscle

According to Clayton, 2012, ‘Although there are many inciting causes of back pain, these often lead to a common pathway involving changes in neuromotor control and neurogenic atrophy of m. multifidi.’

This means that whatever the cause of the back pain, there is a common response – the muscular recruitment pattern of the stabilising muscles of the back will change, and the multifidus muscle will atrophy.

Why is this muscle so central to the horse’s response to injury? According to Clayton, 2012:

‘The multi-layered and multi-directional fibres of this muscle stabilise the intervertebral joints in the face of bending and torsional moments. Inactivation and atrophy result in spinal instability and micromotion of the joints that predispose to further injury and degenerative changes, thus setting the scene for recurrent episodes of back pain.’

In other words, we need the multifidus to stabilise and control the individual joints of the spine as they move during the horse’s natural gait, to prevent injury, degeneration and recurrent cycles of back pain from occurring. 

From research already available, we have a good idea of how the multifidus responds to pain, and we also know how this muscle responds to our interventions, so it is easy to focus on and explain the ways in which we target this specific muscle. That said, this is not the only muscle in the horse’s back that is important to us as we think about core strength, protecting the spine, strengthening and building the topline, and protecting the horse from injury or optimising their performance. Many muscles above and below the spine, within the neck, the abdominals, and the hindquarter play a role in achieving these long-term goals.

And so while it is good to be specific, we also need to remember the big picture. We need to think about moving and strengthening the horse through its full range of motion in all gaits, starting from the foundational muscles and movements, and progressing to the larger muscle groups and movement patterns with a strong foundation in good muscle recruitment patterns and posture.

Which horses should be on a strengthening programme?

If you have a horse, it very likely needs to be on a core strengthening and back strengthening programme. Horses are predisposed to back pain when they:

  • are recovering from an injury
  • are on prolonged box rest
  • are on prolonged periods of rest from exercise
  • have a chronic lameness (Marks, 1999)
  • have a condition affecting their spine, pelvis or neck (Jeffcott, 1999)
  • after surgery, especially colic or spinal surgery 

We should act in a protective and proactive capacity when it comes to horses who:

  • are young and preparing for backing
  • are competitive athletes in any sport (Tabor, 2015).

The foundational exercises to improve the function of the multifidus muscle and hopefully the associated musculature are simple and easily adopted into your horse’s management and grooming routine.

Small adjustments and additions to the warm-up and cool-down routine can allow these simple exercises to be progressed and incorporated into exercises that will improve your horse’s functional ability and performance over time.

 

Start in standing

Dynamic mobilisation exercises have been shown to effectively increase the cross-sectional area of the multifidus muscle in horses that are resting from work (Stubbs et al, 2011), as well as in horses that are in full race training (Tabor, 2015).

Many of us know these exercises as ‘carrot stretches’, but the effects we are achieving, and the way we want to perform these exercises for back strengthening,  don't align well with that name. It is better to think of them as dynamic mobilisation exercises or targeted core strengthening, or, if you prefer, the first steps in pilates for horses.

The goal is to activate the core stabilisers throughout the full range of motion available to the spine, allowing the horse to actively participate in achieving this range of motion and holding the position for a few seconds at a time. 

 

Spinal mobilisation exercises

These exercises have been shown to be effective over a period of three months, performed as 5 reps each, once daily for five days a week.

1. Cervical flexion exercises
There are three positions you want to achieve. The first is chin-to-chest, then chin-to-carpi, and lastly chin-to-fetlocks.
2. Cervical extension exercise
For this exercise you want to bring the horse’s nose and chin as far forward and away from their bodies as possible. It helps to have a barrier in front of their chest to prevent them walking forward.
3. Lateral bending exercise
Again there are three positions you want to aim for when going into lateral bending: bringing the chin to the girth area, bringing the chin to the flank area, and lastly bringing the chin towards the hock. The lateral exercises need to be repeated on both sides.

Using a carrot to bait or draw the horse’s head into the desired position and to encourage them to hold it there for up to five seconds at a time is the easiest way to perform the exercises.

There are, however, alternatives to using a carrot or a bit of food in your hand to achieve the exercises. Some of the best suggestions I have come across include using a lickit block – this will slow the horse down a great deal, and will encourage them to hold the position for longer. It also gets your fingers out of the way and reduces the risk of an accidental nip from a horse trying to swing their head into position and grab a carrot.

The second way you could get your horse to perform these exercises is through target training. I have recently been using this method with my stabled horses, and it gives me a few advantages. It allows me to accurately assess their mobility and ability, giving me a good idea of how they are feeling through their bodies. It actively involves their minds in the process; they need to think about what it is they need to be doing. And lastly, it forces me to keep each exercise within the comfortable ability of the individual horse in front of me, because they won’t go into a painful position to touch the target, but they absolutely will to grab a carrot. And finally, it enables me to progress the hold more slowly, because they are learning a behaviour and not following a carrot. Which you might see as either an advantage or a disadvantage, depending on your perspective.

 

Reflexive spinal exercises

There are three spinal reflexive exercises that are fantastic at improving the horse’s ability to lift and engage the thoracic sling, tuck and engage the pelvis, and mobilise and activate the lumbar region. These are all areas many horses struggle with, and can make a great addition to your toolkit.

That being said, I don’t feel that they are exercises you can learn by reading a blog, and I recommend you learn them directly from a professional.

 

Balancing exercises

These exercises are used to teach the horse to activate the thoracic sling, the stabilisers of the spine and the hindquarters. They consist of weight shifting in different areas and forms, with a few variations and progressions.

1. Backward weight shift
By applying a gentle backward and upward pressure to the sternum on the horse’s chest, you ask them to shift their center of weight backwards and activate the muscles of the thoracic sling, as well as the hindquarters.

2. Whither rocking
Standing next to the horse with a hand on the whither, you gently rock them from side to side. This is particularly valuable if you need to retrain weight-bearing in a specific forelimb.

3. Tail pulls
Standing next to the horse, you gently take the tail in your hand anywhere along the dock that you feel comfortable, and slowly pull towards you until you see the muscles in the hindlimb and pelvis activate. Slowly release and repeat.

 These exercises can be repeated up to ten times on either side. The positions should be held for three to five seconds each. The trick is to slowly and smoothly come into and out of each of the weight shifts and not to do them abruptly. I use my breathing to help me go slowly – four seconds as I shift, four seconds hold, four seconds as I release. That way each movement is smooth and slow.

Progressions can include combining the exercises, if you have another person available. For example, you can combine a backward weight shift with a reflex exercise, or with a tail pull. You can lift a front or hind limb while doing any of the weight shifting exercises. You can add an unstable surface below one or multiple hooves, such as the Surefoot pads, while doing any of the weight shifting exercises.

 

A good foundation

With some or all of the above exercises, you will be establishing a really solid foundation for your horse to prevent back pain, but of course, all of these exercises are performed in a standing position, and the goal is to have these structures activated during movement, especially when the horse is ridden, as this is when we really need the muscles to be at their most functionally active.

Having a good training structure and routine, focused on good posture and muscle recruitment patterns, along with regular cross training can help you activate the thoracic sling, spinal stabilisers and hindquarter stabilisers as the horse comes into movement and into progressively more complex exercises.

I highly recommend that your horse’s weekly exercise routine includes both ridden and unridden work. In-hand groundwork and longlining are incredibly valuable for strengthening the back and hindquarters and preparing the horse to work correctly, in self-carriage, with a rider.

 

References

  1. Clayton, H.M. Equine back pain reviewed from a motor control perspective, Comparative Exercise Physiology 8(3):145-152.
  2. García Liñeiro, J. A., Graziotti, G.H., Rodríguez Menéndez, J.M., Ríos, C.M., Affricano, N/ O. & Victorica, C.L. 2016.  Structural and functional characteristics of the thoracolumbar multifidus muscle in horses. Journal of Anatomy 230(3):398-406
  3. Jeffcott, B.1999. Back problems: Historical perspective and clinical indications. Vet Clin North Am Equine Pract 15(1):1-12
  4. Marks, D. 1999. Medical management of back pain, Vet Clin North Am Equine 15(1):179-94
  5. Tabor, G. 2015. The effect of dynamic mobilisation exercises on the equine multifidus muscle and thoracic profile. University of Plymouth research thesis. (https://pearl.plymouth.ac.uk/bitstream/handle/10026.1/3320/pdf?sequence=1&isAllowed=y)
  6. Stubbs, N.C., Kaiser, L.J., Hauptman, J., Clayton, H.M. 2011. Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. Equine Vet J. 43(5):522-9

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